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Risk factors for suicide in individuals with depression: A systematic review

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... In recent years, the mental health issues of the older adults have gained widespread attention, with depression being one of the primary psychological health concerns among the older adult population [1,2]. Depression not only has adverse effects on their physical health but also contributes to increased mortality rates [3]. In China, where the family-based elderly care model predominates, intergenerational support plays a crucial role in the psychological well-being of the older adults [4,5]. ...
... Research by Li et al. indicated that providing economic support can significantly alleviate depressive symptoms in male older adults, but it doesn't show significant effects on female older adults [16]. Regarding the impact of caregiving support on older adults' depression, there are mainly three viewpoints: [1] Receiving caregiving support contributes to the enhancement of the psychological well-being of older adults [17]; [2] Receiving excessive caregiving support might lead to an overdependence on adult children, accelerating their physical and mental health decline and increasing depressive levels [18,19]; [3] Caregiving support may not exhibit a significant relationship with the psychological well-being of older adults [20]. ...
... Configurations of intergenerational support across different dimensions are sufficient conditions for depression among the older adults. The study achieved a consistency level of 0.83 and a coverage of 0.61 for all samples [3]. The study identifies four types of configurations contributing to depression among the older adults:"Unidirectional Care Deficit" characterized by the absence of receiving caregiving support as the primary feature. ...
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Background The influence of different dimensions of intergenerational support on depression in older adults has a configuration effect. Existing researches have only used linear analyses to examine the independent effects of each dimension of intergenerational support on depression in older adults, resulting in the nature of the effects of each dimension of intergenerational support on the presence of depression in older adults remaining highly controversial. Objective To explore the synergy and substitution effects (configurational effects) of dimensions of intergenerational support on depression in older adults. Method Based on data from the 2018 China Health and Retirement Longitudinal Study(CHARLS), depression among older adults was used as the outcome variable, and intergenerational support (including three dimensions of emotional, economic, and caregiving support) was used as the antecedent variable. Qualitative comparative analysis (QCA) was used to analyze the configurational effects of intergenerational support on depression in older adults. Result A single dimension of intergenerational support cannot be a necessary condition for depression in older adults.Factor configurations of different dimensions of intergenerational support as a sufficient condition for depression in older adults. The consistency parameter for all solution configurations in this study is 0.83, with a coverage of 0.61. The research identifies four types of configurational patterns associated with older adults’ depression: “Unidirectional Care Deficiency Type” (consistency mean of 0.84, coverage of 0.49), “Bidirectional Care Deficiency Type” (consistency mean of 0.86, coverage of 0.33), “Bidirectional Economic Deficiency Type” (consistency mean of 0.85, coverage of 0.48), and “Mixed Type” (consistency mean of 0.83, coverage of 0.23). Conclusion Depression in older adults is influenced by the configurational effects of intergenerational support. The complex link between intergenerational support and depression in older adults should be examined from a holistic perspective, paying attention to the dynamic balance of intergenerational support reception and provision.
... Тревожные расстройства у 60% пациентов с РД vs. 44% при нДР [10,17] против 20% пациентов ДР без СП [17]. Зависимость от ПАВ, включая алкоголь, у 25 и 18% при РД и нДР [10] повышает риск СП [15,20,36]. Так, зависимость от ПАВ у 21, 25 и 9% пациентов с РД, нДР+СП и нДР без СП соответственно [17]. ...
... Anxiety disorders in 60% of patients with TRD vs. 44% with tDD [10,17] vs. 20% patients with DD without SB [17]. Psychoactive substances addiction, including alcohol, in 25 and 18% of patients with TRD and tDD [10] increases the risk of SB [15,20,36]. Thus, addiction to psychoactive substances in 21, 25 and 9% of patients with TRD, tDD + SB and tDD without SB, respectively [17]. ...
... Факторы, связанные с РД [4,27,44] служат независимыми факторами риска СП при РД [15,72] и в населении в целом [36,73] и/или последствиями РД. Плохая новость: лечение ДР влияет лишь на часть сложного уравнения риска СП. ...
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Treatment-resistant depression (TRD) is associated with a higher risk of suicidal behavior (SB) than in depressive disorder prone to treatment, and SB should be considered as its separate outcome. Risk factors for SB in TRD are similar to those in the general population and serve as risk factors and/or contribute to the socioeconomic burden of TRD. Keywords: treatment-resistant depression, suicidal behavior, prevalence, risk factors, burden
... During the COVID-19 period, the rates of men seeking emergency care due to suicidal thoughts or attempts were statistically higher than those during the pre-pandemic period. In the literature, suicide attempts are reported to be more common in women, whereas completed suicides are more common in men (28). Some studies conducted during the pandemic have also reported a higher risk in men (29,30). ...
... From a sociodemographic perspective, most cases seeking help due to suicidal thoughts or attempts during both the pandemic and pre-pandemic periods were predominantly between the ages of 18-40, single, and most of them lived with their families or friends in our study. Generally, suicide attempts are reported to be more frequent among individuals aged 18-24, single, and living alone (28). During the pandemic, single individuals had a higher tendency tfor suicidal thoughts or attempts (36). ...
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Objective: During the COVID-19 pandemic, several studies have reported increased suicidality. The widespread negative impacts of the pandemic, such as the economic downturn, isolation, and quarantine, have contributed to the complex interaction of factors influencing suicidal behavior. This study aimed to compare the clinical characteristics of individuals with suicidal thoughts/attempts between the pandemic and the pre-pandemic period. Methods: This descriptive study retrospectively evaluated the data of patients between 2018 and 2022. The period from March 2020 to March 2022 was defined as the “pandemic period”, while the period from March 2018 to March 2020 was labeled as the “pre-pandemic period”. While 185 patients applied to the emergency department due to suicidal thoughts/attempts in the pre-pandemic period, the number of cases consulted during the pandemic was 150. Results: During the COVID-19 period, 21% of patients were evaluated due to suicidal thoughts/attempts. In the pre-pandemic period, this rate was approximately 20%. There was no statistical difference between the groups in terms of age, suicide method, or lifetime psychiatric diagnoses. The proportion of males who presented with suicidality during COVID-19 was significantly higher. Conclusion: Pandemics can create social trauma and increase suicide rates. Gender roles, such as men being more inclined to conceal their complaints and feeling more economically responsible, may have increased the rates of suicidality during the pandemic. The mental, physical, and social impacts of the pandemic should be assessed in this context, and necessary precautions and interventions should be planned. Keywords: COVID-19, depression, emergency service, pandemic, suicidal attempt, suicidal ideation
... The binary logistic regression identified that depression and anxiety were significant risk factors increasing suicide risk up to 3.8 and 7.6 times. The findings are in line with previous studies, which revealed that depression and hopelessness can increase the death risk by suicide up to 1.9 to 2.2 times [36,37]. In addition, anxiety is also a proven risk factor, contributing to increased suicide risk in previous studies [29,37]. ...
... The findings are in line with previous studies, which revealed that depression and hopelessness can increase the death risk by suicide up to 1.9 to 2.2 times [36,37]. In addition, anxiety is also a proven risk factor, contributing to increased suicide risk in previous studies [29,37]. ...
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Background Nurses, like other healthcare workers, are prone to poorer mental health, increased burnout, and may have an increased risk of suicide. Purpose This study aimed to evaluate mental health problems among Lithuanian nurses and explore factors associated with them. Method The survey was completed by 533 nurses. Mental health was assessed using the Depression, Anxiety, and Stress Scale—21, and suicidal ideation was measured with the Suicidal Behaviours Questionnaire—Revised (SBQ-R). Findings A large proportion of nurses in the study had high psychological distress, with 18% having high depression, 29.3% - high anxiety, and 17.1% - high stress. 21.2% of the sample had an increased suicide risk. 64.9% of nurses considered changing their careers to a non-medical profession in the last 12 months. Discussion Addressing mental health issues in the national healthcare system is critical to avoiding the loss of valued medical community members and ensuring that patients do not lose their critical caretakers.
... These findings highlight a clear seasonal pattern in suicidal behaviors, which should impact existing public health measures mentioned previously. For instance, it may be beneficial to reinforce connections with patients who have a history of suicide attempts or suicidal thoughts during the summer through brief contact interventions (55,56). In addition, broad public health campaigns for prevention and awareness should be implemented during at-risk periods. ...
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Objective This study investigates the trends of suicide and self-harm in Nanjing, China, through 4 years of data collection, aiming to provide valuable information for developing effective suicide prevention strategies. Methods This descriptive study analyzed Nanjing Emergency Medical Center (NEMC) ambulance records from Nanjing (2018–2022) to investigate suicide and self-harm events. Out of 689,305 records, 4,261 cases were included after exclusions. The study categorized incidents into 4,103 suicide events and 158 self-harm cases. Descriptive statistics and content analysis were conducted to identify characteristics and themes related to these events, with age groups defined according to American Medical Association standards. Results The study highlights drug poisoning as the leading method, accounting for 63.56% of the 4,103 suicide events. It notes significant trends by age, gender, and season, with males showing higher rates of self-harm. The study emphasizes the need for targeted prevention strategies, particularly focusing on drug-related suicides among adults and adolescents, as well as the prevalence of various self-harming behaviors. Conclusion To reduce self-harm and suicide, interventions must be strengthened for women, who experience higher rates. Key strategies include regulating pesticides and psychotropic drugs, increasing access to mental health resources, and launching community awareness campaigns. Additionally, training healthcare providers and promoting family education can enhance support for women facing mental health challenges.
... Among these, depressive disorders are the primary cause of disability in individuals over the age of 14, affecting 279.6 million people worldwide, with a lifetime prevalence of 3.4% to 4.2% [1]. Depressive disorders are associated with unemployment, poor physical health, low quality of life, and impaired social functioning [2]. This condition places a considerable burden not only on individuals but also on society, with an estimated annual economic cost of USD 1 trillion due to lost productivity and increased demand for healthcare services from anxiety and depressive disorders [3]. ...
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Objectives: This study aimed to investigate the effects of different dietary patterns on depressive disorders. Methods: PubMed/MEDLINE, Cochrane CENTRAL, Embase, PsycINFO, Scopus, and ProQuest databases were systematically searched until 30 April 2024 for randomized controlled trials (RCTs) assessing the effects of different dietary patterns on depressive symptoms in adults with depressive disorders. Secondary outcomes included remission rates, quality of life, and safety. Standardized mean difference (SMD) and 95% confidence intervals (CIs) were aggregated using a random-effects model. Study quality was assessed with the Cochrane Risk of Bias (RoB)-2 tool, and certainty of evidence was determined using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results: Five RCTs (n = 952) were included, all investigating the Mediterranean diet (MD) in individuals with major depressive disorder or elevated depression levels. The analysis found no significant effect of short-term MD intervention on depression severity compared to active (SMD = −1.25 [95%CI: −5.11 to 2.61]) or passive (SMD = −0.22 [95%CI: −0.74 to 0.29]) controls. There was no effect on quality of life compared to active controls (SMD = 0.71 [95%CI = −3.38 to 4.79]). Intermediate and long-term results were similar. The overall risk of bias was “some concerns”, and the certainty of evidence was “very low” for most of the results. Conclusions: The MD appears to have no potential influence on major depressive disorder. However, this finding should be interpreted cautiously due to the limited number of RCTs. Further studies on dietary patterns and depressive disorders are needed for more robust conclusions. Systematic Review Registration: PROSPERO registration no. CRD42024541885.
... Notably, 10% of clinical trials assessing SSRIs efficacy include individuals with some degree of suicidality [4][5][6]. In the published studies, encompassing diverse age groups (adults, adolescents, and children), revealed that SSRIs and other antidepressant categories are associated with an increased incidence of treatmentinduced suicidal ideation or suicide-related behaviors compared to placebo [7][8][9][10]. A real-world study, incorporating a cohort exceeding 100,000 individuals, underscored the propensity of SSRIs to heighten suicide risk in depressed patients. ...
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Background A number of pharmaceuticals, including antidepressants and antiepileptics, have a strong correlation with suicide risk. However, it is not entirely clear which of these medications are more strongly associated with suicide-related behaviors. Objective This study aims to elucidate the drugs responsible for drug-associated suicidal ideation or self-injurious, recognizing the severe consequences associated with such outcomes. However, it is not entirely clear which specific medications are associated with higher levels of suicide-related behavior. Real-world data from the FDA adverse event reporting system database were analyzed to identify medications correlated with suicidal ideation or self-injurious. Methods The reporting intensity of the High-Level Term “suicidal ideation or self-injurious behavior” and its Preferred Terms across distinct categories was assessed using the Reporting Odds Ratio (ROR) and Proportional Reporting Ratio (PRR). Results We identified the top 20 drugs with the highest reporting frequencies, spanning sedative-hypnotics, antidepressants, antipsychotics, antiepileptics, antihypertensives, antipyretic/analgesic drugs, and antihyperglycemic drugs. Ranking these medications according to ROR, the top five medications with ROR values related to suicidal ideation or self-injurious were alprazolam, zolpidem, amphetamine, quetiapine, and fluoxetine. Further analysis showed that suicide-related adverse events were more frequently reported in females. Antiepileptics had the highest frequency of reported adverse events in the 51–55 year age group, compared to 16–20 years for antidepressants and 46–50 years for sedative-hypnotics. Conclusion Our study provides valuable information for clinical drug selection by presenting a potential list of medication classes commonly associated with drug-associated suicidal ideation or self-injurious behavior. We observed a large number of adverse event reports of suicidal ideation with duloxetine and relatively few reports of suicide attempts. Acetaminophen and amlodipine had substantial adverse event reports of completed suicides, but may not be associated with drug-induced suicidal behavior. On the other hand, some drugs mentioned in this study, such as quetiapine, aripiprazole, and lamotrigine, are recommended to be used after assessing the risk level of suicide in patients.
... La etiología del fenómeno suicida trasciende, sin duda, la aproximación basada en el diagnóstico clínico. Esto es, la literatura científica nos dice que los cuadros depresivos más graves son precedentes del suicidio (Hawton et al., 2013). Lo cual resulta frecuente. ...
... La etiología del fenómeno suicida trasciende, sin duda, la aproximación basada en el diagnóstico clínico. Esto es, la literatura científica nos dice que los cuadros depresivos más graves son precedentes del suicidio (Hawton et al., 2013). Lo cual resulta frecuente. ...
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La tasa de suicidio en España muestra una evolución de tendencia ascendente en las últimas décadas: en el año 1990 España contabilizaba en su estadística oficial a través del INE 2.939 muertes por suicidio, siendo 3.941 en el año 2020. Ello evidencia la relevancia del fenómeno del suicidio, y enfrenta a la pregunta sobre las causas de esta evolución. Cabe comprender dos aspectos, el primero, que el suicidio no es un fenómeno unitario, sino que sería más propio hablar de suicidios atendiendo a las múltiples formas en las que se desarrolla y manifiesta el fenómeno; en segundo lugar, es preciso estudiar los determinantes sociales del suicidio. Atendiendo a estas premisas, este trabajo se plantea dos objetivos. El primero de ello supone analizar la complejidad conceptual entre el concepto de suicidio consumada, la tentativa suicida y la ideación suicida, y la relación que se establece entre estos tres procesos. El segundo, explorar las causas de suicidio, tentativa e ideación suicida, vinculadas a las trayectorias y condiciones laborales, entendiendo que estos son factores determinantes de carácter psicosocial. Para ello se emplea una metodología de revisión bibliográfica, recogiendo artículos de impacto publicados en los últimos diez años, y pertenecientes al contexto nacional e internacional. Los resultados evidencian que para comprender el fenómeno del suicidio en términos amplios es preciso atender a variables de orden sociolaboral, ya que presentan relevancia en el desarrollo de estas conductas. Frente a ello, se concluye que una política de prevención de suicidio de orden estructural precisa incluir en sus propuestas y medidas aquellas relativas a la calidad del empleo.
... For anxiety or depression, the DSMRs indicate that both men and women suffering from these mental health conditions experienced significantly more deaths in 2020 and significantly fewer deaths in 2021, compared with the reference period. This can be potentially explained by a mortality displacement effect, as previous research has established a direct causal relationship between poor mental health and suicide and substance use-related causes of death [40,41]. Elevated levels of anxiety and depression have been reported for Belgium during the first 15 months of the epidemic, especially during times of increased COVID-19 preventative measures (e.g., lockdown) [10]. ...
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Background This study aims to investigate how pre-existing health status and social background contribute to excess mortality during the COVID-19 crisis in Belgium. Methods The study population consists of almost 1.4 million adult members of Solidaris, the second largest health insurance fund in Belgium. Pre-existing health status was identified using health care reimbursement data, including medication use. Social characteristics included a proxy for low socio-economic status, nationality of origin, and living arrangement. Excess mortality during the COVID-19 crisis was measured by computing the relative difference between all-cause mortality in 2020 or 2021 and the average yearly mortality in 2015–2019. Directly Standardised Mortality Rates (DSMRs) were calculated to investigate absolute mortality inequalities. Mortality Rate Ratios (MRRs) were computed using Poisson regression analyses to investigate relative mortality inequalities. Results DSMRs show that persons with no previous disease experienced significant excess mortality in 2020, like men with one, two or three diseases and women with various numbers of pre-existing diseases. Results by specific disease show heterogenous results. After adjusting for age, sex and social characteristics, persons with cancer experienced a significant mortality deficit of 17% in 2020 and of 9% in 2021. For persons with cancer and asthma or COPD, significant mortality deficits of 10% and 3% were observed in 2020 and 2021, respectively. Conclusion The study provides insights into the complex dynamics of mortality during the COVID-19 crisis, emphasising the need to consider individual-level information on pre-existing health and social background jointly.
... It is well established that health care professionals are disproportionately faced with mental health challenges [24,25], which are influenced by grueling occupational hours and exposure to traumatic workplace events. Echoing previous works in the literature, suicidal thoughts and behaviors were associated with higher depression severity, a history of lifetime suicide attempts, male gender and maladaptive coping behaviors such as misuse of alcohol and drugs and disordered eating behaviors [26][27][28]. In a cohort study evaluating data from the National Violent Death Reporting System in the United States, A review of data from the National Violent Death Reporting System found that health care professionals who died by suicide were more likely to have Asian or Pacific Islander ancestry compared with individuals in the general population who died by suicide [29]. ...
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Background/Objectives: Health care workers are at greater risk for death by suicide compared to the general population and are less likely to seek assistance. More information about correlates of suicidality and treatment-seeking behavior are needed to reduce risk. Methods: The American Foundation for Suicide Prevention developed an Interactive Screening Program to identify and engage at-risk staff and trainees in health care settings. The study reports on the prevalence and demographic and clinical predictors of current suicidal thoughts, behaviors and mental health treatment at a single site (n = 5898) from 2009 to 2024. Results: The study found that 18.2% of respondents reported current suicidal thoughts and behaviors. These were more common among respondents who were younger, male, and who identified as a race/ethnicity other than non-Hispanic White. Suicidal thoughts and behaviors were more likely among those with higher PHQ-8 scores (OR = 1.23, p < 0.01) and those who endorsed maladaptive coping behaviors, hopelessness, loneliness, stress and nervousness (ORs 1.36–3.04, ps < 0.01). Current mental health treatment was more likely among women, non-Hispanic White respondents compared with Asian or Pacific Islander respondents, and nurses relative to physicians. Mental health treatment was also associated with higher PHQ-8 scores, lifetime suicide attempts, difficulty controlling eating and alcohol consumption, and recent feelings of anxiety, stress and nervousness. Conclusions: Findings suggest a continued need to identify and engage health care trainees and staff who are at risk for suicide and to establish new approaches to linking these individuals to resources or interventions aimed at reducing risk. The study identified male and/or Asian/Pacific Islander-identifying health care workers who reported intense loneliness and/or hopelessness, use of non-prescription drugs and recent suicidal thoughts and/or behaviors as high-risk individuals who may require enhanced methods of outreach, identification, acceptance and accessibility of treatment.
... For individuals, it can cause considerable anguish, degrade life quality, and heighten the likelihood of physical illnesses, such as heart disease and chronic pain (Kessler, 2012). Depression also escalates the risk of suicidal behaviors, with up to 60% of suicides occurring in individuals diagnosed with a depressive condition at the time of their death (Hawton et al., 2013). On a societal level, depression leads to significant economic strains, including direct healthcare costs and indirect expenses from decreased productivity and increased absenteeism (Greenberg et al., 2015). ...
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This research examines the dynamics between organizationally prescribed perfectionism (OPP), psychological safety, burnout, depression, and coaching leadership in the context of the South Korean workforce. By applying several theories, we developed a moderated mediation model. This model suggests that psychological safety and burnout act as sequential mediators between OPP and depression, while coaching leadership moderates the relationship between OPP and psychological safety. Our data, collected from 413 employees across four waves using a time-lagged design, support our proposed model. Structural equation modeling revealed that OPP directly and indirectly affects depression via psychological safety and burnout. Furthermore, the impact of OPP on psychological safety is reduced under strong coaching leadership. These findings underscore the need to address perfectionism in the workplaces and highlight the central roles of psychological safety and coaching leadership in enhancing employee resilience and well-being. This study enriches existing literature by bringing together different theoretical frameworks to provide a comprehensive understanding of how perfectionism affects employee outcomes. It also provides practical recommendations for organizations seeking to foster a supportive and thriving work environment amidst increasing demands for perfectionism.
... However, the external examination of the corpse must be thorough, searching for any defensive and/or offensive injuries that may indicate death intentionally inflicted by a third person. Before moving the body, it is important to collect nail samples (through extraction, clipping, and/or swabbing) to test for traces of foreign DNA [14]. Additionally, touch DNA analysis should be conducted on the ligature tool to detect and identify any DNA traces left behind [15]. ...
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Background: Strangulation by ligature, most frequently employed for homicidal purposes, is not a common suicide method. Even more infrequent is the use by the victim of cable ties as a tool of self-strangulation. Methods: We describe a case of a 50-year-old woman who was found dead with a cable tie tight around her neck. In our case, analysis of the circumstantial data and the psychopathological history of the victim—along with an external examination, an autopsy, and toxicological findings—was crucial in the differential diagnosis between death intentionally inflicted by a third person and suicide. Through a narrative review conducted by performing a literature search using online resources (PubMed, Google Scholar, and ScienceDirect). Results: we were only able to identify eight similar cases. Conclusions: These were compared with our case, to trace similarities and differences, useful in guiding the forensic doctor in the diagnosis of death in such circumstances.
... The Diagnostic and Statistical Manual of Mental Disorders 5th edition states that one of the main features of major depression is thoughts about death and suicide [35]. Furthermore, underlying anxiety can additionally increase suicide risk [36,37]. A study by the World Health Organisation by Bertolote concluded that 98% of death by suicide had links with mental disorders and 30.2% with mood disorders [38]. ...
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Background Medical doctors and residents are regularly exposed to multiple stressors that may lead to mental health problems. Work-related stressors contribute to elevated levels of psychological distress, anxiety, and depression among health care workers. This is the first investigation evaluating suicidal behaviour and thoughts among Lithuanian medical doctors and residents exposed to various professional stressors at two years after the start of the COVID-19 pandemic. The aim of the study was to evaluate suicidality and factors associated with high suicide risk in a large sample of Lithuanian medical doctors and residents. Methods The research included 685 participants who completed an online questionnaire over a two-month period in December 2021 and January 2022. Medical doctors and residents from all specialties were invited to participate in the survey. The most common stressors in their work environment were measured. Mental health was assessed using the Depression, Anxiety and Stress Scale-21 (DASS-21) scale, and suicidality was measured with the Suicidal Behaviors Questionnaire-Revised (SBQ-R). Results The lifetime suicide risk was found in 30.4% of the sample. Moreover, 11.4% of medical doctors and residents were identified as having previous or current suicide planning ideation, and 2.5% reported a previous suicide attempt. Univariate analysis showed that younger age, having no long-term relationships, shorter work experience, career change ideation, higher depression and anxiety, poor working conditions, at the direct contact with patients, lack of career perspectives, and exposure to mobbing and exhaustion at work were statistically significant risk factors for higher suicidality. Furthermore, regression analysis supported that having no long-term relationship, high depression, and high anxiety were significant risk factors for suicide risk in the sample. Conclusion We found out that almost one-third of medical doctors and residents had lifetime suicide ideations and behaviours at the high suicide risk level. Main suicide risk factors were poor mental health, work-related stressors, and a lack of long-term relationships. The results of the study can help to develop prevention strategies by identifying populations that may be at high risk for mental health problems and provide evidence in implementing specific interventions to address mental health problems in healthcare workers.
... Currently, neurobiological hallmarks of depression and SI/SB are of immense research interest as no current markers of such origins are of sufficient clinical utility (6)(7)(8)(9)(10)(11)(12). Moreover, a thorough understanding of molecular and cellular pathways of these two conditions can be hindered by their complex behavioral manifestations, interaction with psychosocial, cultural, and environmental factors, diverse patient subpopulations, and the presence of somatic and psychiatric comorbidities (10,(13)(14)(15)(16)(17). ...
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The association between inflammation with depression and suicide has prompted many investigations of the potential contributors to inflammatory pathology in these psychiatric illnesses. However, a distillation of diverse clinical findings into an integrated framework of the possible involvement of major physiological processes in the elicitation of pathological inflammation in depression and suicide has not yet been explored. Therefore, this review aims to provide a concise synthesis of notable clinical correlates of inflammatory pathology in subjects with various depressive and suicidal clinical subtypes into a mechanistic framework, which includes aberrant immune activation, deregulated neuroendocrine signaling, and impaired host-microbe interaction. These issues are of significant research interest as their possible interplays might be involved in the development of distinct subtypes of depression and suicide. We conclude the review with discussion of a pathway-focused therapeutic approach to address inflammatory pathology in these psychiatric illnesses within the realm of personalized care for affected patients.
... Studies indicate that approximately 17.2% of adolescents in non-clinical settings engage in NSSI, with rates as high as 27.4% reported among Chinese adolescents aged 13-18 years [1,2]. The high incidence of NSSI in China highlights the urgent need for effective interventions, as individuals engaging in NSSI have a 66-fold increased risk of suicide [3]. ...
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BACKGROUND Non-suicidal self-injury (NSSI) is common among adolescents and frequently co-occurs with depression. Understanding the distinct patterns of NSSI behaviors, along with their associated risk and protective factors, is crucial for developing effective interventions. AIM To classify NSSI behaviors and examine interactions between risk and resilience factors in Chinese adolescents. METHODS A cross-sectional study involving 3967 Chinese students (51.7% female, mean age 13.58 ± 2.24 years) who completed questionnaires on parenting styles, bullying, childhood maltreatment, depression, resilience, and NSSI. Latent profile analysis (LPA) was used to identify NSSI subtypes, and network analysis explored interactions between risk and resilience factors. RESULTS Three NSSI subtypes were identified: NSSI with depression (18.8%), NSSI without depression (12.3%), and neither (68.9%). Bullying was the central risk factor across subtypes, while emotional control and family support were key protective factors. Statistical analyses showed significant differences between groups (P < 0.001). CONCLUSION This study identified three NSSI subtypes among Chinese adolescents. Bullying emerged as a central risk factor, while emotional control and family support were key protective factors. Targeting these areas may help reduce NSSI behaviors in this population.
... Research on the prediction of suicidal ideation has so far yielded few conclusive results, particularly concerning prospective predictions over the time course of hospital treatment (Beck et al., 1989;Hawton et al., 2013). In this study, we identified, for the first time, a cutpoint on the Trusting subscale of the MAIA-2 that served as a significant predictor of subsequent suicidal ideation. ...
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Background Major depressive disorder (MDD) is associated with maladaptive self-reported interoception, i.e., abnormal bodily self-experience. Although diminished body trusting predicts suicidal ideation, interoceptive measures have not been considered in depressed inpatients, whose suicide risk regularly peaks post-discharge. This study aims to explore interoceptive characteristics at admission that help identify inpatients at risk for suicidal ideation at discharge, thereby preventing fatal outcomes. Methods The observational study included 87 depressed inpatients providing self-ratings at both hospital admission (T0) and discharge (T1) on the following scales: Multidimensional Assessment of Interoceptive Awareness (MAIA-2); Beck Depression Inventory-II (BDI-II). A hierarchical logistic regression analysis estimated the longitudinal association between self-reported interoception (T0) and suicidal ideation (T1). The optimal cutpoints for predicting suicidal ideation were calculated using ROC curve analysis. Results Suicidal ideation was found in 17.24% patients at discharge, who reported lower baseline MAIA-2 Trusting scores than non-ideators ( p =0.01). Diminished body trusting ( OR =0.19), somatic comorbidity ( OR =16.77), and baseline suicidal ideation ( OR =24.01) significantly predicted suicidal ideation (T1). For body trusting, we estimated an optimal classification of subsequent suicidal ideation for the cutpoint≤2.33 (AUC=0.70 [95% CI 0.57, 0.83], sensitivity=0.87, specificity=0.44, positive predictive value=0.25, negative predictive value=0.94). Limitations Due to the exploratory nature of the study, the findings should be replicated in pre-registered trials with larger sample sizes. Conclusions Diminished body trusting is, with acceptable sensitivity, a significant predictor for post-treatment suicidal ideation in depressed inpatients. This finding emphasizes the importance of incorporating body-centered approaches into multimodal treatment strategies especially in inpatients under risk to prevent suicidal incidents.
... Increased risk of suicide attempts was also linked to pre-existing suicidal ideation, insomnia, and low socio-economic background (Eikelenboom et al., 2018). Completed suicide has been associated with male gender, suicidal ideation, history of suicide attempt, helplessness, severity of depression, and comorbidity, that is, co-existence of MDD with personality disorder, anxiety disorder, and/or substance use (Hawton et al., 2013). Although such empirical support may reinforce the field of suicide prevention through the development of stepped-care mental healthcare delivery, the complex framework of suicidality underscores the need to examine the interaction of specific psychological variables that may have an impact on suicidality, taking into account that single factors as well as dealing only with the mental disorder can only partially predict the likelihood of suicidal ideation or behavior (Franklin et al., 2017). ...
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Despite recent studies establishing self-compassion and secure attachment to be vital protective factors against suicidality, the role of attachment as a psychological mechanism that may mediate the relationship between self-compassion and suicidality has not been investigated to date. This study aims to address this gap by investigating whether attachment styles, specifically avoidant attachment, mediate the link between self-compassion and suicidality in patients with major depressive disorder (MDD). 273 adult patients with MDD completed the Suicidal Behaviors Questionnaire-Revised (SBQ-R), the Beck Depression Inventory (BDI-II), the Experiences in Close Relationships Scale (ECRS), and the Self-Compassion Scale (SCS) along with sociodemographic and clinical questions. Statistical analyses included correlation analysis and Mann- Whitney U tests to examine the relationships and possible differences between the non-suicidal group and the suicidal group of patients in terms of attachment style, self-compassion, and self-destructive behaviors. A mediation analysis to assess the role of attachment avoidance in the relationship between selfcompassion and suicidality was also conducted. Both attachment anxiety and avoidance were positively associated with suicidality and depression and negatively with self-compassion. The patients with increased suicidality differed significantly in the levels of depression, self-compassion, and attachment compared to those who were non-suicidal. The protective mechanism of self-compassion against suicidality was mediated by attachment avoidance. Research findings highlight the need for considering attachment-related issues to understand suicidality and tailor interventions in the field of suicide prevention and treatment while they gauge treatment priorities in working with depressed patients with suicidal thoughts and behaviors.
... Globally,~3.8% of the population experiences depression, whereas, in the United States, the age-standardized prevalence of depression among adults is~18.5% [4]. MDD is a strong predictor of suicide [5][6][7], and the prevalence rates of suicidal ideation and suicide attempts in MDD patients are 53 and 31%, respectively [8,9]. Also, patients with MDD have an increased risk of complete suicide after a suicide attempt [10]. ...
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Major depressive disorder (MDD) is a debilitating disorder. Suicide attempts are 5-times higher in MDD patients than in the general population. Interestingly, not all MDD patients develop suicidal thoughts or complete suicide. Thus, it is important to study the risk factors that can distinguish suicidality among MDD patients. The present study examined if DNA methylation changes can distinguish suicidal behavior among depressed subjects. Genome-wide DNA methylation was examined in the dorsolateral prefrontal cortex of depressed suicide (MDD+S; n = 15), depressed non-suicide (MDD−S; n = 17), and nonpsychiatric control (C; n = 16) subjects using 850 K Infinium Methylation EPIC BeadChip. The significantly differentially methylated genes were used to determine the functional enrichment of genes for ontological clustering and pathway analysis. Based on the number of CpG content and their relative distribution from specific landmark regions of genes, 32,958 methylation sites were identified across 12,574 genes in C vs. MDD+/−S subjects, 30,852 methylation sites across 12,019 genes in C vs. MDD−S, 41,648 methylation sites across 13,941 genes in C vs. MDD+S, and 49,848 methylation sites across 15,015 genes in MDD−S vs. MDD+S groups. A comparison of methylation sites showed 33,129 unique methylation sites and 5451 genes in the MDD−S group compared to the MDD+S group. Functional analysis suggested oxytocin, GABA, VGFA, TNFA, and mTOR pathways associated with suicide in the MDD group. Altogether, our data show a distinct pattern of DNA methylation, the genomic distribution of differentially methylated sites, gene enrichment, and pathways in MDD suicide compared to non-suicide MDD subjects.
... In our study, we discovered that among young FEDN MDD patients, factors associated with SAs in women and men including HAMA-14 score and A-TPO were consistent with previous studies. A meta-analysis including 19 studies supported our findings, showing that comorbid anxiety was linked to suicide in MDD patients [21] and that depressive patients with anxiety were more likely to experience SAs [39]. Our previous study also implied the important role of anxiety as a risk factor for SAs in MDD [27]. ...
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Thyroid dysfunction is commonly seen in major depressive disorder (MDD), and is particularly prevalent in female patients. Moreover, gender differences occur in many aspects of MDD, including suicide attempts (SAs). We aimed to explore gender differences in the prevalence and clinical correlates of SAs in young first-episode drug-naïve MDD patients with thyroid dysfunction, which have not yet been reported. We recruited 509 patients in this study. Demographic and clinical characteristics were collected. We used HAMD-17, HAMA-14, the positive subscale of PANSS, and CGI-S to assess every participant. We found no significant difference in the prevalence of SAs between male and female subgroup. Gender differences in factors associated with SAs were found with anxiety, body mass index, serum anti-thyroid antibodies (A-TPO), and free triiodothyronine levels in male patients and anxiety, CGI-S score, and A-TPO in female patients. We found no gender differences in the prevalence of SAs; however, there were gender differences in several clinical correlates of SAs, highlighting specific strategies to avoid SAs in male and female MDD patients.
... Sleep problems, including insufficient and poor-quality sleep, are widespread, costly, and are directly or indirectly linked with all 10 leading causes of death in the US [1][2][3][4][5][6][7][8], many of which are associated with inflammation [9][10][11]. Sleep plays an important role in healthy immune system function, and alterations in sleep result in inflammatory cytokine dysregulation, including interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP) [12][13][14]. ...
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Background/Objectives: Sleep problems are frequently experienced and play an important role in inflammation and disease risk. US Montmorency tart cherries (MTC) improve sleep outcomes in previous studies, but studies in individuals with overweight and obesity are lacking. Methods: A total of 34 individuals with sleep issues and overweight or obesity (BMI: 32.1 ± 7.0 kg/m²) were recruited to this randomized controlled, crossover study. MTC capsules (500 mg) or a placebo were taken one hour before bed for 14 days. Sleep outcomes including total sleep time, deep and REM sleep duration, nap duration, and nocturnal sleep duration were assessed using the Zmachine and/or Fitbit Inspire 3. Subjective sleep information on quality and insomnia symptoms was collected using the Pittsburgh Sleep Quality Index, the Sleep Quality Scale, and the Insomnia Severity Index. Markers of inflammation included C-reactive protein, TNF-α, and IL-6, IL-8, IL-10, and IL-17A. Results: No significant effects of MTC supplementation were observed for any of the measures of interest (p > 0.05 for all). Conclusions: These results suggest studies of individuals with overweight and obesity should test higher doses of MTC than those currently recommended.
... However, nearly all research documenting this association to date is cross-sectional. Two prominent challenges arise when attempting to draw conclusions about SI from cross-sectional research: (1) retrospective accounts about SI are frequently vague or exaggerated [24,25]; (2) causal processes cannot be detected. There are only a few longitudinal studies that have examined how relationships influence suicidality (particularly relationship separation and dissolution [26][27][28]), but only one longitudinal study to date has been conducted that revealed low relationship satisfaction to be predictive of suicide risk six months later [16]. ...
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Romantic relationships serve as one of the most important relationships in adults’ lives, yet the influence of relational dynamics on suicide ideation (SI) is limited and longitudinal associations are unclear. The Interpersonal Theory of Suicide has been applied to romantic relationships broadly and supports motivations of suicide (thwarted belonging and perceived burdensomeness) and relationship satisfaction to be predictors of SI. An online daily diary study (n = 94 adults) was conducted to examine romantic relationship dynamics and mental health indicators in adults over 10 days. Multilevel growth modeling results revealed that higher perceived burdensomeness, but not relational satisfaction or thwarted belonging, was associated with higher initial levels of SI. However, perceived burdensomeness, thwarted belonging, and relationship satisfaction were not associated with rates of change in SI over time. Further, no interaction effects between either relationship satisfaction and thwarted belonging or perceived burdensomeness were found in association with trajectories of SI over the 10-day period. The results of this study indicate that relational satisfaction, through a commonly used global assessment of relational wellbeing, may not have a substantial influence on SI, particularly in individuals with mild SI levels. This may be due to relational satisfaction being relatively consistent, while SI is prone to short-term fluctuations. However, additional research is recommended to address other relational dynamics’ influences on SI.
... Delay in the diagnosis and treatment of depression increases the risk of recurrence and prolongs the duration of symptoms [2,3]. In addition, delayed diagnosis and treatment of depression increases the risk of suicide, which is approximately 20 times higher than the risk in the general population [4]. Depression affects both mental health and physical health [5][6][7]. ...
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Background We were interested in developing a methodology for diagnosing the depression status of a focused population group, such as the Korean university student group, with higher accuracy. To this end, we proposed a method of fusing the data collected from multiple depression self-questionnaires aided by a psychiatrist’s diagnosis. In particular, we found that the standard diagnostic cut-offs and factor analysis prepared for a general population by depression self-questionnaires are inadequate for a focused population with its unique cultural background. In this study, a novel approach to optimizing diagnostic cut-offs and generalizing factor analysis for the Korean university student group is presented in the fusion space of multiple self-questionnaires. Methods We collected the data from 30 randomly selected Korean university students, over 21 weeks, with the psychiatric evaluation as a reference, then established the optimal cut-off regions in the fused CESD − PHQ9 score space based on the statistical correlation between CES − D and PHQ − 9 and the reference diagnostics. We also re-extracted the factors in the fused CESD − PHQ9 space to expose the key factors that are behind the depression characteristics of the group. Results We verified the existence of a clear correlation between CES − D and PHQ − 9 scores. However, the standard cut-offs of CES − D and PHQ − 9 are found inconsistent with the correlation. The new cut-off regions we obtained in the fused CESD − PHQ9 score space are consistent with the correlation and optimal for the psychiatrist’s diagnosis with the sensitivity and specificity of 80.95% and 89.74%, respectively. Also, we identified that “socio-psychological” and “interpersonal relationship” factors are the major factors for the depression characteristics of the group. Limitations Although the new cut-off regions we presented were based on the incorporation of clinical diagnosis into the fused CESD − PHQ9 score space, further verification with a larger scale of clinical data is helpful. Conclusion We identified optimal cut-off regions and generalized factor analysis in the fusion space, which can provide more reliable and trustworthy diagnoses. These can serve as a self-diagnostic tool for reliably identifying the depression characteristics of a focused population as well as effectively linking individuals and psychiatrists as an intermediary.
... Another meta-analysis also have demonstrated that patients with anxiety disorders had more suicidal behaviors, including SI and SAs, and complete suicide more frequently than those without anxiety disorders [45]. Furthermore, Hawton et al. reported that anxiety was a risk factor for SAs in MDD [46]. Therefore, it is essential for the prevention of SAs to evaluate and monitor the severity of depression, anxiety and psychotic symptoms, especially the severity of anxiety, among FEDN patients with comorbid MetS regularly. ...
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Backgrounds Patients with major depressive disorder (MDD) have a high rate of metabolic syndrome (MetS), which could worsen disease progression. One of the most serious progressions in MDD is suicide attempts (SAs). Previous studies have found gender differences in MetS and SAs among MDD patients respectively. Therefore, we aimed to explore gender differences of SAs in first-episode and drug-naïve (FEDN) MDD patients with comorbid MetS. Methods 1718 outpatients with FEDN MDD were recruited. Depression, anxiety and psychotic symptoms were evaluated using the Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA) and Positive and Negative Syndrome Scale (PANSS) positive subscale, respectively. Blood sugar, blood fat, blood pressure and body mass index (BMI) were measured to evaluate MetS. Results 34.4% patients with FEDN MDD were diagnosed as MetS and those subjects with or without MetS differed in the distribution of SAs and gender. In MetS subgroup, 29.5% and 29.7% of male and female subjects had SAs respectively, without significant differences. However, compared with non-suicide attempters, suicide attempters had higher level of blood pressure in female subjects, while there are no differences in any clinical variables in male subjects. Additionally, the influencing factors for SAs differed by gender. The HAMA scores and BMI were variables associated with SAs in male patients while HAMA scores, marital status and systolic blood pressure (SBP) were associated with SAs in female patients. Furthermore, the receiver operating characteristics (ROC) curves, demonstrating the combination all influencing factors by gender, showed good performance and model accuracy. Conclusions In FEDN MDD patients with comorbid MetS, there were no gender differences in SAs. However, clinical characteristics and influencing factors of SAs differed in different gender groups.
... [4][5][6] Major depressive episodes (MDEs) and their severity are associated with an increased risk of suicide attempt. 7 Although clinical evaluations aim to capture a broad range of symptoms and comorbidities, their ability to predict suicide attempt can be limited by the complex interplay of diverse medical, psychological, and social contributive factors. 8 Furthermore, the impact of specific features of MDEs that contribute to suicide attempt is not fully elucidated. ...
... Depression is divided into three severity categories: mild, moderate, and severe. The key clinical symptoms include low mood, anhedonia (the inability to experience pleasure from natural rewards), irritability, difficulty concentrating, abnormal appetite and sleep, lack of energy, inability to enjoy life, and suicidal thoughts, especially in individuals suffering from major depressive disorder (3). Furthermore, depression can increase the risk of heart disease, cerebrovascular disease, type 2 diabetes and other causes of death (4). ...
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Background The pivotal responsibility of GABAergic interneurons is inhibitory neurotransmission; in this way, their significance lies in regulating the maintenance of excitation/inhibition (E/I) balance in cortical circuits. An abundance of glucocorticoids (GCs) exposure results in a disorder of GABAergic interneurons in the prefrontal cortex (PFC); the relationship between this status and an enhanced vulnerability to neuropsychiatric ailments, like depression and anxiety, has been identified, but this connection is still poorly understood because systematic and comprehensive research is lacking. Here, we aim to investigate the impact of dexamethasone (DEX, a GC receptor agonist) on GABAergic interneurons in the PFC of eight-week-old adult male mice. Methods A double-blind study was conducted where thirty-two mice were treated subcutaneously either saline or DEX (0.2 mg/10 ml per kg of body weight) dissolved in saline daily for 21 days. Weight measurements were taken at five-day intervals to assess the emotional changes in mice as well as the response to DEX treatment. Following the 21-day regimen of DEX injections, mice underwent examinations for depression/anxiety-like behaviours and GABAergic marker expression in PFC. Results In a depression/anxiety model generated by chronic DEX treatment, we found that our DEX procedure did trigger depression/anxiety-like behaviors in mice. Furthermore, DEX treatment reduced the expression levels of a GABA-synthesizing enzyme (GAD67), Reelin, calcium-binding proteins (parvalbumin and calretinin) and neuropeptides co-expressed in GABAergic neurons (somatostatin, neuropeptide Y and vasoactive intestinal peptide) in the PFC were reduced after 21 days of DEX treatment; these reductions were accompanied by decreases in brain size and cerebral cortex thickness. Conclusion Our results indicate that a reduction in the number of GABAergic interneurons may result in deficiencies in cortical inhibitory neurotransmission, potentially causing an E/I imbalance in the PFC; this insight suggests a potential breakthrough strategy for the treatment of depression and anxiety.
... Depression affects millions of people worldwide, significantly reduces quality of life, and correlates with disease burden and mortality (1,2). It is the most common psychiatric disorder among those who die by suicide (3). However, current treatments like medication and psychological interventions frequently prove inadequate, with depressive symptoms that may relapse (4). ...
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Background The relationship between vegetarianism and mental well-being remains a debated topic in traditional observational studies. Recent studies have revealed the genetic factors in vegetarianism. We aimed to use genetic variations to explore the potential causal relationships between vegetarianism and mental well-being, offering insights from a new perspective. Methods We conducted the inverse variance weighted approach as the primary analysis to explore the bidirectional genetic associations between vegetarianism (N = 442,589) and depressive symptoms (N = 180,866), neuroticism (N = 170,910), and subjective well-being (N = 298,420). The analysis used the summary data from the largest genome-wide association studies (GWAS). We also performed sensitivity analyses to ensure the robustness of the findings, accounting for potential heterogeneity and pleiotropy. Results Genetically predicted vegetarianism showed positive causal relationships with depressive symptoms (odds ratio [OR], 3.26; 95% confidence interval [CI], 1.03–10.31; p = 0.044) and neuroticism (OR, 6.72; 95% CI, 2.29–19.74; p = 5.31 × 10⁻⁴), as well as a negative causal relationship with subjective well-being (OR, 0.20; 95% CI, 0.05–0.77; p = 0.019). Additionally, depressive symptoms were found to have a causal influence on vegetarianism (OR, 1.01; 95% CI, 1.00–1.02; p = 6.87 × 10⁻³). No significant heterogeneity or pleiotropy was detected. Conclusion Vegetarianism is causally correlated with negative mental well-being, reflected in an increased risk of depressive symptoms and neuroticism, as well as lower subjective well-being. Further research should explore the underlying mechanisms in broader populations.
... The risk of suicide and suicidal thoughts is escalating along with the surge in depression due to COVID-19. Depression is one of the most prevalent mental illnesses among individuals with suicidal ideations [9]. Given that depression is a significant predictor of suicide, the growing cases of depression induced by the COVID-19 pandemic could lead to severe societal consequences, including suicide. ...
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Background The unprecedented pandemic situation of COVID-19 has had a negative impact on the mental health of many people, especially among the "old-old" older adults who are aged 75 or older. Therefore, the aim of this study is to investigate the changes in depression among "old-old" older adults before and after the onset of COVID-19, and the extent to which depression affects suicidal ideations. Method The 12th to 16th Korea Welfare Panel Study(KoWePS) conducted from 2017 to 2021 was used for analysis. For this study, 771 older individuals with complete data to estimate the degree of change of depression were selected as the final analysis subjects. Result A Growth Mixture Modeling(GMM) analysis was conducted, resulting in the classification of two groups: an increasing group and a decreasing group. The study findings showed that "old-old" older individuals with high levels of depression, specifically those in the decreasing group, may be more susceptible to suicidal ideation. Despite this steep change slope, the decreasing group still exhibited a higher level of depression in 2021 compared to the increasing group. As per characteristics, the decreasing group, which showed a higher prevalence of suicidal ideation, had a higher proportion of women and individuals with lower levels of education, those living alone, and a lower household income compared to the increasing group. Conclusion It is important to note that although the study emphasized the need to prioritize intervention for the decreasing group with consistently high levels of depression, the majority of individuals belong to the increasing group, which exhibited a gradual increase in depression levels over time. Therefore, intervention plans should be developed concurrently for both groups. Also, it is crucial to implement proactive efforts targeting groups with understandings of these characteristics when establishing preventative measures for depression and suicidal ideation among "old-old" older adults.
Article
Background Among the available pharmacological treatments for acute major depressive disorder (MDD), vortioxetine, a serotonin transporter inhibitor (SERT), has been widely used for its multimodal action on serotonin neurotransmission, which produces essential changes also on glutamate, gamma amino butyric acid (GABA), norepinephrine, acetylcholine, and dopamine. Aim This systematic review and meta-analysis aimed to evaluate the acute efficacy of vortioxetine across multiple dosing and to evaluate whether there is a dose–response effect and as well there is a dose–response issue with respect to side effects in acute depression. Methods According to PRISMA guidelines, we systematically searched three major electronic databases (PubMed/MEDLINE, PsycINFO, and Cochrane Central Register of Controlled Trials) for Randomized Controlled Trial (RCT) studies published between January 2013 and April 2024. Twenty-four studies were included in the review and two meta-analyses were conducted to determine whether the mean Montgomery–Asberg Depression Rating Scale (MADRS) scale values in the placebo groups differ significantly from the mean MADRS scale values in the group receiving vortioxetine 10 mg or vortioxetine 20 mg. Results Vortioxetine significantly improved acute depression severity, anxiety symptoms, and cognitive function, with high response and remission rates in acute MDD. It was also well tolerated with a relatively low occurrence of severe or serious treatment-emergent adverse events (TEAEs). Observing the results of the meta-analysis, the effect was significant for both vortioxetine 10 and 20 mg, with a greater effect size for vortioxetine 20 mg. Conclusion Vortioxetine should be considered efficacious as a first- and second-line therapy.
Article
Objective Despite lower depression rates in men than in women, men’s suicide rates are significantly higher, suggesting potential gaps in depression screening. Rutz et al. developed the Gotland Male Depression Scale (GMDS), which includes symptoms commonly associated with male depression. This study was conducted to validate the Korean version of the GMDS (K-GMDS).Methods The K-GMDS, Patient Health Questionnaire-9 (PHQ-9), and outpatient records of 233 new patients at the outpatient psychiatry department of Catholic University Hospital in Daegu from February and May 2022 were retrospectively reviewed. Internal consistency was measured using Cronbach’s α, and external validity was tested by analyzing the scale’s correlation with the PHQ-9. The screening capacity of the K-GMDS was tested based on the receiver operating characteristic (ROC) curve, sensitivity, specificity, and overall accuracy.Results Of 233 patients, 42.6% (n=98) were classified to the depression group. Cronbach’s α was 0.92, and external validity was established with a Pearson’s correlation coefficient of 0.83 between the total score of the K-GMDS and the PHQ-9. While there were no significant differences in the area under the ROC curve between the K-GMDS and the PHQ-9, the K-GMDS had better sensitivity, specificity, and overall accuracy in screening depressive symptoms among men compared to the PHQ-9.Conclusion The K-GMDS exhibits satisfactory reliability and validity in psychiatric outpatient settings and outperforms the PHQ-9 in screening for depression among men. This study will be useful in developing male depression scales that are currently unavailable in South Korea.
Chapter
In the years following publication of the DSM-5, the field of psychiatry has seen vigorous debate between the DSM’s more traditional, diagnosis-oriented approach and the NIMH’s more biological, dimension-based RDoC approach. Charney & Nestler’s Neurobiology of Mental Illness is an authoritative foundation for translating information from the laboratory to clinical treatment, and this edition extends beyond its reference function to acknowledge and examine the controversies and thoughts on the future of psychiatric diagnosis. In this wider context, this book provides information from numerous levels of analysis including molecular biology and genetics, cellular physiology, neuroanatomy, neuropharmacology, epidemiology, and behavior. Section I, which reviews the methods used to examine the biological basis of mental illness in animal and cell models and in humans, has been expanded to reflect important technical advances in complex genetics, epigenetics, stem cell biology, optogenetics, neural circuit functioning, cognitive neuroscience, and brain imaging. These established and emerging methodologies offer groundbreaking advances in our ability to study the brain and breakthroughs in our therapeutic toolkit. Sections II through VII cover the neurobiology and genetics of major psychiatric disorders: psychoses, mood disorders, anxiety disorders, substance use disorders, dementias, and disorders of childhood onset. Also covered within these sections is a summary of current therapeutic approaches for these illnesses as well as the ways in which research advances are now guiding the search for new treatments. The last section, Section VIII, focuses on diagnostic schemes for mental illness. This includes an overview of the unique challenges that remain in diagnosing these disorders given our still limited knowledge of disease etiology and pathophysiology. The section then provides reviews of DSM-5 and RDoC. Also included are chapters on future efforts toward precision and computational psychiatry, which promise to someday align diagnosis with underlying biological abnormalities.
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Suicide is a serious complication for patients with major depressive disorder (MDD). However, there has not been a broadly accepted scoring system for the assessment of suicidal risk in these patients. Our paper aims to develop a novel model to estimate the risk of suicide in patients with MDD through clinical and sociodemographic factors. In our study, a total of 288 patients with MDD who made their first visit to our outpatient department were enrolled. Objective variables were thoroughly assessed and evaluated. Suicidal ideation was used as the dependent variable. Univariable logistic regression was used for the selection of variables. Multivariable logistic regression was performed for the selected variables to build our model, and an ROC curve was generated for analysis. Past suicidal attempt (p<0.001), number of failed antidepressant categories (p=0.001), disease onset earlier than 25 years old (p=0.011), high disease severity (p=0.002), previous psychiatric ward admission (p=0.001), and recurrent MDD (p=0.045) were found to lead to higher suicidal ideation. A six-item model including these factors was then derived from the multivariable logistic regression (area under curve = 0.768, p < 0.001). This model can serve as a valuable reference to prompt the modification and invention of alternative rating scales in the future.
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Depressive symptoms ad depression are common mental health issues that frequently manifest in elderly individuals. Prior research has shown a correlation between depression and diminished quality of life as well as suicidal ideation. Nevertheless, there is limited knowledge regarding the prevalence rate of depressive symptoms among elderly individuals in Indonesia. Thus, the objective of this study was to ascertain the frequency of depressed symptoms among the elderly population in Indonesia and identify the factors associated with it. This study employed a cross-sectional descriptive and correlational research approach. A stratified random sample method was utilized to select 1 381 participants who were 60 years old or older from 15 Community Health Centres. These centres cater to both healthy and unwell senior individuals. Data was collected via questionnaires. Univariate logistic regression was employed to identify the connections between demographic and characteristic data, and depressed symptoms. The researchers employed multivariate logistic regression to identify the factors that predict depression symptoms. The findings of this study indicate that 60.03 % of older individuals in Indonesia experience depressive symptoms. The multivariate logistic regression analysis revealed significant associations between depressed symptoms in older persons and variables such as gender, past employment, health condition, and loneliness. Depressive symptoms were highly prevalent among the elderly population in the community of Indonesia. It was a critical health issue that required prompt response from healthcare professionals. The implementation of suitable techniques should be prioritized in the near future. Депрессивные симптомы и депрессия являются распространенными проблемами психического здоровья у пожилых людей. Предыдущие исследования показали связь между депрессией и снижением качества жизни, а также суицидальными мыслями. Тем не менее, имеются ограниченные знания о распространенности симптомов депрессии у пожилых людей в Индонезии. Цель исследования — установить частоту симптомов депрессии у пожилых людей в Индонезии и выявить факторы, связанные с ней. В исследовании использовали метод поперечного описательного и корреляционного исследования. Метод стратифицированной случайной выборки был использован для отбора 1 381 участника 60 лет и старше из 15 общественных медицинских центров. Эти центры обслуживают как здоровых, так и больных пожилых людей. Данные собирали с помощью анкет. Для выявления связи между демографическими и характерными данными и симптомами депрессии использовали одномерную логистическую регрессию. Исследователи использовали многомерную логистическую регрессию для выявления факторов, которые предсказывают симптомы депрессии. Результаты данного исследования показывают, что 60,03 % пожилых людей в Индонезии испытывают симптомы депрессии. Многомерный логистический регрессионный анализ выявил значимые связи между симптомами депрессии у пожилых людей и такими переменными, как пол, предыдущая работа, состояние здоровья и одиночество. Симптомы депрессии были широко распространены у пожилого населения в сообществе Индонезии. Это была критическая проблема со здоровьем, которая требовала немедленного реагирования со стороны медицинских работников. Внедрение подходящих методов должно стать приоритетом в ближайшем будущем.
Article
Introduction: Psychiatric disorders are an important risk factor for suicide. The aim of this study was to compare the characteristics of suicide attempts between patients with schizophrenia and mood disorders in Japan. Methods: From 596 patients treated after a suicide attempt in the Emergency and Critical Care Center (ECCC), during a 15-year period (2006 and 2021), two groups of patients were separated, 196 patients with mood disorders (21% bipolar mood disorder and 79% monopolar depression) and 112 patients with schizophrenia, who were compared according to sex, age, method of suicide attempt, and history of psychiatric treatment. We conducted multivariable logistic regression on the schizophrenia group and the mood disorder group, using those diagnoses as the dependent variable and age, suicide attempt method, sex, and history of psychiatric treatment as explanatory variables. Results: Patients with schizophrenia are significantly younger (39.4 ± 13.3 vs. 47.8 ± 17.9; p < 0.001) and significantly more frequently (89.3% vs. 64.3%; p < 0.001) had a history of psychiatric treatment than patients with mood disorders. Violent suicide methods were significantly more often used in the group of patients with schizophrenia (65.2% vs. 50.5%; p = 0.017) than in the group of patients with mood disorders. Jumping from a height was significantly more frequent in the group of patients with schizophrenia (36.6% vs. 16.8%; p < 0.001) than in the group of patients with mood disorders, while hanging was significantly more frequent in the group of patients with mood disorders (12.8% vs. 2.7%; p = 0.003) than in the group of patients with schizophrenia. As a result of multivariable logistic regression, the history of psychiatric treatment (OR = 0.25; 95%CI: 0.11–0.54; p < 0.001) was associated with high odds of the diagnosis of schizophrenia, while the use of the hanging method (OR = 7.25; 95%CI: 1.48–43.6; p = 0.014) was associated with high odds of the diagnosis of mood disorder. Conclusions: Patients with schizophrenia and mood disorders are groups with a high risk of suicidal behavior. Suicide prevention measures should consist of the urgent need for screening and evaluation of mental disorders by primary health care services, as well as successful treatment, successful follow-up of patients after hospitalization, improvement of adherence to therapy, and monitoring of risk factors.
Article
Objectives This study investigated the association between functional limitations and depressive symptoms among older adults in South Korea, focusing on gender differences in the moderating roles of relationship satisfaction with family, friends, and neighbors. Methods Fixed-effect models were applied to five waves of data from the Korean Retirement and Income Study, encompassing 19,180 observations. Results Increases in functional limitations were associated with higher levels of depressive symptoms, regardless of gender. However, the moderating effects of relationship satisfaction differed by gender: For older women, satisfaction with family moderated the association, whereas for older men, satisfaction with friends played a moderating role. Discussion The findings suggest tailoring interventions to improve family relationships for women and friendships for men in mitigating depressive symptoms among functionally vulnerable older adults in Korea, where rapid population aging poses significant challenges to protect functional and mental health among older adults.
Article
Depressive symptoms can spillover between romantic partners. From an attachment lens, depressive symptoms passing from one partner to another may be more frequent in the context of anxious attachment. Using 1179 German couples who remained together across 4 years (five waves) from the Panel Analysis on Intimate Relationships and Family Dynamics, analyses tested the extent anxious attachment moderated the initial level of depressive symptom spillover between partners' depressive symptom trajectories. Results revealed that men's and women's higher initial depressive symptoms were not significantly associated with changes in their partners' depressive symptom trajectories. However, the current study found that women's anxious attachment was associated with the link between men's initial depressive symptoms and the trajectory of women's depressive symptoms. Specifically, women who were more anxiously attached had a small, but greater risk of experiencing increased depressive symptom spillover across a four‐year period when their male partners had higher initial depressive symptoms. Together, this suggests depressive symptom spillover did occur among a general population of German couples, but primarily in the context of more anxiously attached women. Future research should examine the role attachment plays in the depressive symptom spillover among couples.
Article
Individuals engaging in suicidal ideation or making suicide attempts are a substantial demographic group to investigate preventive mental health due to inherent high risks associated with potential outcomes of suicidal behaviors for public health. Factors increasing the likelihood of suicide might include self-esteem, depression, social support, loneliness, or certain demographic profiles, and the purpose of this study is to synthesize these variables to advocate for effective strategies to intervene in cases of suicide. Specifically, this commentary aims to identify suicidal coping mechanisms and psychological resilience factors among suicidal individuals through the enhancement of self-esteem, intervention of depressive symptoms, and promotion of connectedness. Through discussing the determinants that might play a role in the onset of suicidal thoughts and suicide attempts, this paper has important implications for suicide prevention strategies and the identification of psychological resilience factors that can predict suicidal thoughts and suicide attempts in individuals.
Article
Introduction Individuals who are depressed, have suicide attempts, and a substance use disorder (SUD) may have different patterns of suicidal thoughts and behaviors and respond differently to cues associated with suicide and death. Method Implicit affective reactions to visual cues suggestive of suicide and death (as well as to pleasant, unpleasant, and neutral cues), were compared among three groups of hospitalized adults: (a) depressed patients without the histories of suicidal behavior (depression only), (b) depressed patients with suicide attempts, but no current substance abuse disorder (SA), and (c) depressed patients with both suicide attempts and substance use disorder (SA + SUD). Results The SA group demonstrated higher positive evaluations of visual cues associated with suicide and death when compared to the SA + SUD group. The SA + SUD group demonstrated the lowest positive evaluation of suicide‐related stimuli as well as less positive evaluation of visual cues of generally unpleasant stimuli. Conclusion Differences observed between SA and SA + SUD participants underscore differences in responses to cues related to suicide, which may reflect differences in mechanisms of risk.
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Depression is usually defined in terms of behavioural, emotional, social or thinking alterations, and neuropsychological changes are frequently unexplored. Among them, executive functions have a remarkable impact on remission, recurrence and wellbeing. This article reviews studies on executive functions from a cognitive neuroscience perspective, to better understand the mechanisms of executive processes (i.e., cognitive control, inhibition, mind shifting, decision making and problem solving) in depression, and to promote suitable therapeutical approaches. Serving to this purpose, a comprehensive literature search was conducted using major bibliographic databases in cognitive science and neuroscience. The study focus on experiments using electrophysiological techniques since they are non-invasive tools and present high temporal resolution. Results show a variety of brain components and cognitive domains that are impaired under depression, although further research may clarify controversies resulting from depression heterogeneity, demographic differences, and methodological approaches. In numerous studies, P3 amplitudes are diminished and latencies prolonged, indicating executive attentional dysfunction related to mind setting. Similarly, MMN registers decreased amplitudes and prolonged latency, reflecting difficulties for change detection and voluntary effort linked to mental shift. Contrastingly, depression shows increased N1 latencies related with discrimination, and a tendency for increased LDAEP amplitudes (difference between N1 and P2), that suggests difficulties in inhibitory control. Regarding feedback processing, the connection among ERN, Pe, ACC, and frontal regions, associated with error awareness and cognitive control, seem to be compromised under depression. And the CRN response is enhanced in depressive persons showing increased error monitoring. Lastly, the ability to interpret coherently the information value of the negative feedback, together with a propensity to commit more perseverative and non-perseverative errors, need to be further investigated. Depressive individuals commit both types of errors in more occasions than controls, what could reflects alterations of fronto-striatal networks, producing visual attention deficits and difficulties for inhibiting incoming information. DOI: https://doi.org/10.31219/osf.io/f5dhq License CC-By Attribution 4.0 International
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Objective The aim of this research was to examine the association between alcohol consumption and depressive symptoms in the Wa ethnic minority of China, a population where this relationship has been insufficiently explored. Methods A cross-sectional analysis was conducted on a sample of 317 current drinkers from the Wa ethnic minority, a “direct fast-forward” group in Cangyuan County, between December 1, 2022, and February 28, 2023. Utilizing a multi-stage cluster sampling approach, participants were selected, each of whom exhibited an Alcohol Use Disorder Identification Test (AUDIT) score exceeding 0. Data were collected via face-to-face interviews employing a uniform questionnaire. Quantification of alcohol use was achieved through the application of the AUDIT, while the Patient Health Questionnaire (PHQ)-9 was employed to gauge depressive symptoms. The relationship between the severity of alcohol consumption and depressive symptoms was evaluated using a multivariable logistic regression model. Subsequently, potential non-linear associations were scrutinized through the application of a smoothing plot. Results The study included 317 current drinkers (196 males [61.83%]; mean age 41.78 ± 12.91 years), of which 94 (29.65%) exhibited comorbid depressive symptoms. Multivariable logistic regression analysis, adjusting for confounders, revealed that higher AUDIT scores were significantly associated with an increased probability of depressive symptoms (OR = 1.09, 95% CI: 1.02–1.18, p = 0.008). The risk of depressive symptoms was notably greater in the group with alcohol dependent range in contrast the group at low-risk range (OR = 7.01, 95% CI: 1.66–29.62, p = 0.008). The smoothing plot indicated a J-shaped non-linear relationship with an inflection point at an AUDIT score of 15. To the left of this inflection point, no significant relationship was observed, whereas to the right, a positive correlation emerged (OR = 1.39, 95% CI: 1.11–1.74, p < 0.001). Conclusion The findings reveal a non-linear relationship between alcohol consumption and the probability of depressive symptoms within the Wa ethnic minority in China, with implications for the development of nuanced and effective treatment strategies tailored to this population.
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Those who die by suicide and suffer from depression are known to have made more suicide attempts during their life-span as compared to other people with depression. A behavioural sensitisation or kindling model has been proposed for suicidal behaviour, in accordance with a sensitisation model of depressive episodes. The aim of the present study was to test such a model by investigating the distribution of initial and repeated suicide attempts across the depressive episodes in suicides and controls with a unipolar severe depression. A blind record evaluation was performed of 80 suicide victims and controls admitted to the Department of Psychiatry between 1956 and 1969 and monitored to 2010. The occurrence of initial and repeated suicide attempts by order of the depressive episodes was compared for suicides and controls. The risk of a first suicide attempt decreased throughout the later episodes of depression in both the suicide group (p < .000) and control group (p < .000). The frequencies of repetition early in the course were actually higher in the control group (p < .007). After that, the risk decreased in the control group, while the frequencies remained proportional in the suicide group. At the same time, there was a significantly greater decreased risk of repeated attempts during later episodes in the control group as compared to the suicide group (p < .000). The differences were found despite a similar number of episodes in suicides and controls. Repeated suicide attempts in the later episodes of depression appear to be a risk factor for suicide in severe depression. This finding is compatible with a behavioural sensitisation of attempts across the depressive episodes, which seemed to be independent of a corresponding kindling of depression.
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Although numerous studies have documented the clear link between psychiatric conditions and suicide, few have allowed for the comparison between the strength of association between different psychiatric diagnoses and suicide. To examine the strength of association between different types of psychiatric diagnoses and the risk of suicide in patients receiving health care services from the Department of Veterans Affairs in fiscal year (FY) 1999. This project examined National Death Index data and Veterans Health Administration patient treatment records. Department of Veterans Affairs, Veterans Health Administration. All veterans who used Veterans Health Administration services during FY 1999 (N = 3 291 891) who were alive at the start of FY 2000. Psychiatric diagnoses were obtained from patient treatment records in FY 1998 and 1999 and used to predict subsequent death by suicide during the following 7 years in sex-stratified survival analyses controlling for age. In the 7 years after FY 1999, 7684 veterans died by suicide. In diagnosis-specific analyses, patients with bipolar disorder had the greatest estimated risk of suicide among men (hazard ratio, 2.98; 95% confidence interval, 2.73-3.25), and patients with substance use disorders had the greatest risk among women (6.62; 4.72-9.29). Although all the examined psychiatric diagnoses were associated with elevated risk of suicide in veterans, results indicate that men with bipolar disorder and women with substance use disorders are at particularly elevated risk for suicide.
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Although prior research has identified a number of separate risk factors for suicide among patients with depression, little is known about how these factors may interact to modify suicide risk. Using an empirically based decision tree analysis for a large national sample of Veterans Affairs (VA) health system patients treated for depression, we identified subgroups with particularly high or low rates of suicide. We identified 887,859 VA patients treated for depression between April 1, 1999, and September 30, 2004. Randomly splitting the data into 2 samples (primary and replication samples), we developed a decision tree for the primary sample using recursive partitioning. We then tested whether the groups developed within the primary sample were associated with increased suicide risk in the replication sample. The exploratory data analysis produced a decision tree with subgroups of patients at differing levels of risk for suicide. These were identified by a combination of factors including a co-occurring substance use disorder diagnosis, male sex, African American race, and psychiatric hospitalization in the past year. The groups developed as part of the decision tree accurately discriminated between those with and without suicide in the replication sample. The patients at highest risk for suicide were those with a substance use disorder who were non-African American and had an inpatient psychiatric stay within the past 12 months. Study findings suggest that the identification of depressed patients at increased risk for suicide is improved through the examination of higher order interactions between potential risk factors.
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This paper reports the results of a 27 year prospective study of 186 unipolar depressives and 220 bipolar disorders meeting DSM-III criteria for major depression or mania. Subjects were classified into four diagnostic subgroups, according to polarity and presence or absence of schizophrenic symptoms: unipolar depression, bipolar disorder, unipolar schizoaffective disorder and bipolar schizoaffective disorder. Course parameters were assessed for all samples. As the sequence of subtypes of affective and schizoaffective disorders progresses from unipolar depression, schizodepression, pure affective bipolar disorder to schizobipolar disorder, a systematic decrease in age of onset and length of episode can be observed. When compared to unipolar disorders (unipolar depression and schizodepressive disorder), bipolar (bipolar and schizobipolar) disorders showed more periodicity, characterized by greater number of total episodes, more episodes per year, but with shorter episodes and cycles. Despite the lower age of onset among schizoaffective subjects compared to pure affective disorders, the only difference in course between the two groups was a greater frequency in episodes requiring hospitalization among schizoaffectives.
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The purpose of this study was to investigate the prevalence and comorbidity of current mental disorders defined by DSM-III-R among a random sample of suicide victims from a nationwide suicide population. Using a psychological autopsy method, the authors collected comprehensive data on all suicide victims in Finland during 1 year. Retrospective axis I-III consensus diagnoses were assigned to 229 (172 male, 57 female) victims. One or more diagnoses on axis I were made for 93% of the victims. The most prevalent disorders were depressive disorders (59%) and alcohol dependence or abuse (43%). The prevalence of major depression was higher among females (46%) than among males (26%). Alcohol dependence was more common among the males (39% versus 18% for females). A diagnosis on axis II was made for 31% and at least one diagnosis on axis III for 46% of the cases. Only 12% of the victims received one axis I diagnosis without any comorbidity. The majority of suicide victims suffered from comorbid mental disorders. Comorbidity needs to be taken into account when analyzing the relationship between suicide and mental disorders and in planning treatment strategies for suicide prevention in clinical practice.
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Many countries have set targets for suicide reduction, and suggested that mental health care providers and general practitioners have a key role to play. A systematic review of the literature. Among those in the general population who commit suicide, up to 41% may have contact with psychiatric inpatient care in the year prior to death and up to 9% may commit suicide within one day of discharge. The corresponding figures are 11 and 4% for community-based psychiatric care and 83 and 20% for general practitioners. Among those who die by suicide, contact with health services is common before death. This is a necessary but not sufficient condition for clinicians to intervene. More work is needed to determine whether these people show characteristic patterns of care and/or particular risk factors which would enable a targeted approach to be developed to assist clinicians in detecting and managing high-risk patients.
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There are few firm data to guide the clinician in identifying individual depressed patients who may be at high risk for completing suicide. In particular, there have been few prospective studies of well-characterized depressed patients to determine indicators of such future events. Eight hundred thirteen patients with a major depressive episode (DSM-III, DSM-III-R, or DSM-IV criteria) were assessed in detail in a specialist Mood Disorders Unit (MDU) over a 10-year period. Follow-up at the end of that period (mean = 5.1 years) confirmed that 31 patients (3.8%) had completed suicide. The suicide completers were compared on a broad range of clinical and demographic variables obtained at baseline with (1) the total remaining depressed sample, (2) 31 age- and sex-matched subjects who were confirmed to be alive and had never attempted suicide, and (3) 24 age- and sex-matched living subjects who had made at least 1 suicide attempt. The most consistent finding, across all 3 comparisons, was that the suicide completers were more likely to have been inpatients at the time of the index MDU assessment. Other characteristics of completers were a greater number of prior admissions for depression, being older and in a relationship, and being male and married or female and single. Somewhat paradoxically, suicide completers also evidenced fewer previous suicide attempts and less suicidal ideation compared with living subjects who had attempted suicide at the time of index assessment. Overall, we were able to find few predictors of later suicide in this sample. Those who completed suicide demonstrated evidence of more severe illness over a lifetime (for example, having more admissions). but revealed less suicidal ideation at the time of the index MDU assessment. While these features were statistically significant, they are of limited usefulness in predicting suicide in an individual patient.
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The psychological autopsy method offers the most direct technique currently available for examining the relationship between particular antecedents and suicide. This systematic review aimed to examine the results of studies of suicide that used a psychological autopsy method. A computer aided search of MEDLINE, BIDS ISI and PSYCHLIT, supplemented by reports known to the reviewers and reports identified from the reference lists of other retrieved reports. Two investigators systematically and independently examined all reports. Median proportions were determined and population attributable fractions were calculated, where possible, in cases of suicide and controls. One hundred and fifty-four reports were identified, of which 76 met the criteria for inclusion; 54 were case series and 22 were case-control studies. The median proportion of cases with mental disorder was 91% (95 % CI 81-98%) in the case series. In the case-control studies the figure was 90% (88-95%) in the cases and 27% (14-48%) in the controls. Co-morbid mental disorder and substance abuse also preceded suicide in more cases (38%, 19-57%) than controls (6%, 0-13%). The population attributable fraction for mental disorder ranged from 47-74% in the seven studies in which it could be calculated. The effects of particular disorders and sociological variables have been insufficiently studied to draw clear conclusions. The results indicated that mental disorder was the most strongly associated variable of those that have been studied. Further studies should focus on specific disorders and psychosocial factors. Suicide prevention strategies may be most effective if focused on the treatment of mental disorders.
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Cochrane Reviews have recently started including the quantity I 2 to help readers assess the consistency of the results of studies in meta-analyses. What does this new quantity mean, and why is assessment of heterogeneity so important to clinical practice? Systematic reviews and meta-analyses can provide convincing and reliable evidence relevant to many aspects of medicine and health care.1 Their value is especially clear when the results of the studies they include show clinically important effects of similar magnitude. However, the conclusions are less clear when the included studies have differing results. In an attempt to establish whether studies are consistent, reports of meta-analyses commonly present a statistical test of heterogeneity. The test seeks to determine whether there are genuine differences underlying the results of the studies (heterogeneity), or whether the variation in findings is compatible with chance alone (homogeneity). However, the test is susceptible to the number of trials included in the meta-analysis. We have developed a new quantity, I 2, which we believe gives a better measure of the consistency between trials in a meta-analysis. Assessment of the consistency of effects across studies is an essential part of meta-analysis. Unless we know how consistent the results of studies are, we cannot determine the generalisability of the findings of the meta-analysis. Indeed, several hierarchical systems for grading evidence state that the results of studies must be consistent or homogeneous to obtain the highest grading.2–4 Tests for heterogeneity are commonly used to decide on methods for combining studies and for concluding consistency or inconsistency of findings.5 6 But what does the test achieve in practice, and how should the resulting P values be interpreted? A test for heterogeneity examines the null hypothesis that all studies are evaluating the same effect. The usual test statistic …
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There is no data on the variation in the suicide risk over lifetime and on the suicide-preventive effect of the long-term treatment of mood-disorder patients with antidepressants and neuroleptics. Our research focused on 186 unipolar (D), 60 bipolar II (Dm), 130 nuclear bipolar I (MD), and 30 preponderantly manic patients (M/Md); that were followed-up from 1963 to 2003. By 2003, 45 (11.1%) of the 406 patients had committed suicide. Suicide rates were highest among D patients (Standardized Mortality Ratio, SMR = 26.4), MD (SMR = 13.6), Dm (SMR = 10.6) and lowest among M/Md patients (SMR = 4.7). Prospectively, the suicide rate decreased over the 44 years' follow-up; Lithium, neuroleptics and antidepressants reduced suicides significantly. Long-term treatment also reduced overall mortality, and combined treatments proved more effective than mono-therapy.
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Major depression is a major risk factor for suicide. However, not all individuals with major depression commit suicide. Impulsive and aggressive behaviors have been proposed as risk factors for suicide, but it remains unclear whether their effect on the risk of suicide is at least partly explained by axis I disorders commonly associated with suicide, such as major depression. With a case-control design, a comparison of the level of impulsive and aggressive behaviors and the prevalence of associated psychopathology was carried out with control for the presence of primary psychopathology. One hundred and four male suicide completers who died during an episode of major depression and 74 living depressed male comparison subjects were investigated with proxy-based interviews by using structured diagnostic instruments and personality trait assessments. The authors found that current (6-month prevalence) alcohol abuse/dependence, current drug abuse/dependence, and cluster B personality disorders increased the risk of suicide in individuals with major depression. Also, higher levels of impulsivity and aggression were associated with suicide. An analysis by age showed that these risk factors were more specific to younger suicide victims (ages 18-40). A multivariate analysis indicated that current alcohol abuse/dependence and cluster B personality disorder were two independent predictors of suicide. Impulsive-aggressive personality disorders and alcohol abuse/dependence were two independent predictors of suicide in major depression, and impulsive and aggressive behaviors seem to underlie these risk factors. A developmental hypothesis of suicidal behavior, with impulsive and aggressive behaviors as the starting point, is discussed.
Article
Background: There is considerable debate as to whether suicide is more likely to occur early in the course of major depressive disorder or by cumulative risk, with an increasing risk with each subsequent major depressive episode (MDE). By considering the number of MDEs among representative suicides, we aimed to further investigate the relationship between suicide outcome and the course of major depressive disorder. Method: A psychological autopsy method with best informants was used to investigate 154 consecutive suicides who died in the context of a DSM-IV MDE. Proxy-based interviews were conducted by using the Structured Clinical Interview for DSM-III-R; the Structured Clinical Interview for DSM-IV Axis II; and a series of behavioral and personality-trait assessments. Second, 143 living depressed outpatients of comparable age to the suicide group were assessed for their history of MDEs. The study was conducted between 2000 and 2005. Results: The distribution of MDEs among depressed suicide completers was as follows: first MDE, 74.7%; second MDE, 18.8%; more than 2 MDEs, 6.5%. This distribution is compared to 32.9% of depressed living outpatients with a single MDE. Increased levels of hostility were associated with single MDE suicide completers. The anxious trait of harm avoidance increased among multiple MDE suicide completers. Alcohol abuse increased among first MDE suicide completers. Conclusions: Suicide in major depressive disorder is most likely to occur during the first MDE, and this appears to be related to increased levels of the impulsive-aggressive diathesis.
Article
The Global Burden of Disease, which is a comprehensive assessment of mortality and disability from diseases and injuries in 1990 and projected to 2020, highlights the importance of mood disorders for the world. Using the measure of disability-adjusted life years, it was determined that unipolar major depression was the fourth leading cause of disease burden in the world. It was also projected that, in the year 2020, unipolar major depression would be the second leading cause of disease burden in the world. Disabilityadjusted life years is based on both mortality and disability. If one looks at disability alone, then unipolar major depression was the leading cause of disability in the world in 1990, and bipolar disorder was the sixth leading cause. Across the world, 10.7 per cent of disability can be attributed to unipolar major depression and, in developed countries, unipolar major depression contributes to nearly 20 per cent of disease burden in women aged from 15 to 44 years. This chapter addresses bipolar disorders and depressive disorders, covering diagnostic issues, prevalence, comorbidity, use of health services, and risk factors for both types of disorder.
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IntroductionOverview of Psychotherapeutic ApproachesIssues in the Delivery of PsychotherapyReview of Treatment OutcomesConclusion References
Chapter
Depressive disorders in the general population are common. More than half of clinically depressed persons have suicidal thoughts, and their suicidal ideation is significantly related to the severity of depression. The main cause for the increased mortality in depression is suicide. Suicide risk is elevated in all mental disorders, but particularly so in depressive disorders, with a 20-fold increase for major depression. Findings from psychological autopsy studies conducted over the past 40 years suggest that depression is found in 29-88% of all suicides. Suicide in depression is particularly common among subjects with co-morbid mental and physical disorders. While a large proportion of depressed suicide victims have undergone psychiatric treatment, very few have received adequate therapy for depression. Psychological autopsy studies have shown that 1-5% of all suicides suffered from bipolar disorder. The majority of bipolar suicide victims had a depressive episode just before the suicide, most were co-morbid cases, and compliance problems were reported in almost all cases. It seems evident that lithium treatment in bipolar disorder is associated with a long-sustained reduction of fatal and non-fatal suicidal acts. Attempted suicide is common in the course of depressive disorders. Subjective depressive feelings, hopelessness and suicidal ideation are significantly more marked in suicide attempters than in non-attempters. About two-thirds of attempted suicide patients suffer from a mood disorder. Few depressed suicide attempters receive adequate treatment for depression. Inadequate recognition and treatment of depression and mood disorders has been the focus of professional discussion during the past decade. The best possible treatment for depression is urgently needed for effective suicide prevention.
Article
A total of 219 inpatients with a DSM-III diagnosis of major depression, 150 women and 69 men, were followed prospectively for 3–10 years and mortality was recorded. The patients were previous participants in psychopharmacological multicenter trials, which were carried out for the purpose of comparing the antidepressant effect of newer 5-HT reuptake inhibitors with that of the tricyclic antidepressant drug, clomipramine. The study comprised patients with a total Hamilton Rating Scale for Depression score of ≥ 18 and/or a Hamilton subscale score of ≥ 9. Diagnostic classification according to the Newcastle I Scale in endogenous and nonendogenous depression was performed. The observed mortality was significantly greater than that expected. The increased mortality was essentially due to suicides and mainly found among women. Patients scored as nonendogenously depressed had a significantly higher suicide rate than endogenously depressed patients. The excess number of suicides in the nonendogenous group largely occurred within the first year of observation. No association was found between response to the antidepressant treatment in the trial and the suicide risk in the first 3 years of observation.
Article
The role of response to cognitive therapy as a predictor of suicide was investigated by comparing 17 outpatients with mood disorders who committed suicide with 17 matched patients who did not commit suicide. The suiciders attended significantly fewer sessions of cognitive therapy and dropped out of therapy more frequently: 88% of the suiciders, compared to 53% of the controls, were rated by their therapists as requiring more treatment at termination. They also had higher levels of hopelessness at the termination of therapy. The results suggest that premature termination of therapy and inadequate response to treatment have unfavorable prognostic significance for eventual suicide.
Article
Objective To determine the rates of psychiatric disorder and personality variables in a sample of older people who had committed suicide and to compare the rates in a subgroup of this sample with those in a control group of people who died from natural causes.DesignDescriptive psychological autopsy study, including interviews with informants, of psychiatric and personality factors in 100 suicides in older people. Case-control study using subgroup of 54 cases and matched control group.SettingFour counties and one large urban area in central England, UK.SubjectsIndividuals 60 years old and over at the time of death who had died between 1 January 1995 and 1 May 1998, and whose deaths had received a coroner's verdict of suicide (or an open or accidental verdict, where the circumstances of death indicated probable suicide). The control group was an age-and sex-matched sample of people dying through natural causes in the same time period.Main outcome measuresICD-10 psychiatric disorder, personality disorder and trait accentuation.Main resultsSeventy-seven per cent of the suicide sample had a psychiatric disorder at the time of death, most often depression (63%). Personality disorder or personality trait accentuation was present in 44%, with anankastic or anxious traits the most frequent. Depression, personality disorder, and personality trait accentuation emerged as predictors of suicide in the case-control analysis.Conclusion Personality factors, as well as depression, are important risk factors for suicide in older people. Copyright © 2001 John Wiley & Sons, Ltd.
Article
Eighty-nine inpatients with a primary severe depression and melancholia who had committed suicide were investigated. They were admitted to the Department of Psychiatry, Lund, Sweden between 1956–1969 and died before 1984. Matched controls were selected. Case records were evaluated at index admission to find suicidal risk factors in melancholia. Prospective ratings were compared. Women committing suicide had higher scores than their controls on the items unmarried, non-compliance and suicide attempt but lower ratings on disharmonic childhood and non-severe physical disease. Men committing suicide had higher scores on the items heredity for psychosis and a brittle or sensitive personality. For the latter item suicide was related to life-weariness. Suicide attempt was related to acute onset and lack of psychomotor retardation. Two suicidal processes were proposed for men: one related to aggression and one not. Social factors seem less important in the prediction of suicide in melancholia than in depression in general.
Article
To estimate the strength of the associations between the suicide of psychiatric in-patients and demographic, historical, symptomatic, diagnostic and treatment factors. A systematic review and meta-analysis of controlled studies of the suicide of psychiatric in-patients including suicides while on approved or unapproved leave. Factors that were significantly associated with in-patient suicide included a history of deliberate self-harm, hopelessness, feelings of guilt or inadequacy, depressed mood, suicidal ideas and a family history of suicide. Patients suffering from both schizophrenia and depressed mood appeared to be at particular risk. The association between suicidal ideas and in-patient suicide was weak and did not reach statistical significance after a quantitative correction for publication bias. A high-risk categorization as defined by a combination of retrospectively determined individual risk factors was strongly statistically associated with in-patient suicide (OR=10.9), with a sensitivity of 64% and a specificity of 85%. Despite the apparently strong association between high-risk categorization and subsequent suicide, the low base rate of in-patient suicide means that predictive value of a high-risk categorization is below 2%. The development of safer hospital environments and improved systems of care are more likely to reduce the suicide of psychiatric in-patients than risk assessment.
Article
Suicide receives increasing attention worldwide, with many countries developing national strategies for prevention. Rates of suicide vary greatly between countries, with the greatest burdens in developing countries. Many more men than women die by suicide. Although suicide rates in elderly people have fallen in many countries, those in young people have risen. Rates also vary with ethnic origin, employment status, and occupation. Most people who die by suicide have psychiatric disorders, notably mood, substance-related, anxiety, psychotic, and personality disorders, with comorbidity being common. Previous self-harm is a major risk factor. Suicide is also associated with physical characteristics and disorders and smoking. Family history of suicidal behaviour is important, as are upbringing, exposure to suicidal behaviour by others and in the media, and availability of means. Approaches to suicide prevention include those targeting high-risk groups and population strategies. There are, however, many challenges to large-scale prevention, especially in developing countries.
Article
Health systems with limited resources may have the greatest impact on suicide if their prevention efforts target the highest-risk treatment groups during the highest-risk periods. To date, few health systems have carefully segmented their depression treatment populations by level of risk and prioritized prevention efforts on this basis. We conducted a retrospective cohort study of 887,859 VA patients receiving depression treatment between 4/1/1999 and 9/30/2004. We calculated suicide rates for five sequential 12-week periods following treatment events that health systems could readily identify: psychiatric hospitalizations, new antidepressant starts (>6 months without fills), "other" antidepressant starts, and dose changes. Using piecewise exponential models, we examined whether rates differed across time-periods. We also examined whether suicide rates differed by age-group in these periods. Over all time-periods, the suicide rate was 114/100,000 person-years (95% CI; 108, 120). In the first 12-week periods, suicide rates were: 568/100,000 p-y (95% CI; 493, 651) following psychiatric hospitalizations; 210/100,000 p-y (95% CI; 187, 236) following new antidepressant starts; 193/100,000 p-y (95% CI; 167, 222) following other starts; and 154/100,000 p-y (95% CI; 133, 177) following dose changes. Suicide rates remained above the base rate for 48 weeks following hospital discharge and 12 weeks following antidepressant events. Adults aged 61-80 years were at highest risk in the first 12-week periods. To have the greatest impact on suicide, health systems should prioritize prevention efforts following psychiatric hospitalizations. If resources allow, closer monitoring may also be warranted in the first 12 weeks following antidepressant starts, across all age-groups.
Article
Synopsis The characteristics of 64 suicides with a retrospective diagnosis of depression and 128 depressives referred for psychiatric treatment were compared. The following items differentiated the suicide group: male sex, older age in females, single status, living alone, the symptoms of insomnia, impaired memory and self neglect, and a history of suicide attempts. The value of these items in assessing suicide risk in depressive illness is discussed.
Article
The authors report suicide risk among 1,593 patients with major depression or bipolar disorder, 443 (27.8%) of whom were psychotic (260 bipolar and 183 unipolar). The subjects were followed for 0-14 years, and their suicide experience was compared with that of the state population. Eight (19.5%) of the 41 suicide victims were from the psychotic group. The psychotic and nonpsychotic subjects in each diagnostic group had similar risks for suicide. A higher risk for suicide was not found in the bipolar subjects. The authors conclude that among patients with major affective disorder psychosis per se does not predispose to suicide.
Article
The suicide rate among people under 30 years of age has nearly tripled in the past several decades. We compared 133 suicides under the age of 30 years with 150 aged 30 years and over. After gathering and reviewing extensive clinical information and postmortem toxicologic data, we assigned diagnoses using DSM-III criteria. A major diagnostic finding was the occurrence of more drug abuse than had been previously reported, significantly more often in the young people. Few other differences were found either between our total sample and previous studies or between our younger and older groups. We conclude that a closer look at the young group is necessary to see what other differences might occur between the drug abusers and other young suicides.
Article
Historically, doctors have not always acknowledged that they have an obligation to prevent suicide, partly because they shared the prevalent idea that most suicides were caused by moral crises, no concern of theirs—and indeed suicide was a criminal matter until quite recently; but more, perhaps, because a fatalism has characterized their attitudes to its prevention, even where the suicide was clearly suffering from mental illness. Yet two recent American studies have shown more than 90 per cent of suicides to be mentally ill before their death (17, 8); this finding and the familiar clinical observation that suicidal thoughts disappear when the illness is successfully treated provide a strong case for a medical policy of prevention.
Article
A retrospective analysis of all the suicides at the New York State Psychiatric Institute over a 25-year period was carried out. The authors retrospectively assigned diagnoses according to Research Diagnostic Criteria and DSM-III and found that among the patients who committed suicide there were 14 with unipolar endogenous depression. Of those 14 patients, 10 were considered delusional or probably delusional. In comparison, a control group of similarly diagnosed depressed patients taken from the same institution over the same time period included far fewer delusional depressions. Thus, there was a significant association between delusions and suicide: A delusionally depressed patient was five times more likely to commit suicide than a nondelusional one.
Article
To examine period trends in the rate of suicide in the first 28 days after discharge from psychiatric hospital. Cohort study of patients discharged from psychiatric hospital. Scotland. All patients aged 15-84 who were discharged from Scottish psychiatric hospitals during 1968 to 1992. The rate of suicide (classified as codes E950-9 and E980-9 according to the International Classification of Diseases, Ninth Revision) within 28 days of discharge per 100,000 person years at risk for five year periods during 1968 to 1992. Crude, within cohort rates and externally standardised rates were calculated. Overall, 196 male patients committed suicide in 20,520 person years at risk, and 171 female patients committed suicide in 24,114 person years at risk. A significant linear trend was seen in period effect on externally standardised mortality ratios in both sexes: a decrease in male patients (P = 0.008) and an increase in female patients (P = 0.0001). The adjusted standardised mortality ratio in 1988-92 compared with 1968-72 was 0.62 (95% confidence interval 0.39 to 0.98) in male patients and 2.73 (1.64 to 4.56) in female patients. The increase in the rate of suicide in the 28 days after discharge in female psychiatric patients makes this an increasingly important period to target. The rise has occurred against the background of a reduction of 60% in the number of psychiatric beds for adults.
Article
People with a history of psychiatric disorder are at higher risk of suicide than people without such a history. The policy of reducing inpatient care in psychiatry has probably meant that some of the risk of suicide has shifted from the hospital to the community setting. We have quantified the risk of suicide within a year of psychiatric discharge in a population-based study in the Oxford health region, UK. We calculated suicide rates per 1000 person-years at risk (time from discharge to death, subsequent readmission, or the end of the study) and the standardised mortality ratio (SMR) for suicide, taking the value among the general population as 1. Among male patients the SMR for suicide (defined by coroner's verdict of suicide) in the first 28 days after discharge from inpatient care was 213 (95% CI 137-317); the equivalent SMR for female patients was 134 (67-240). The result was similar when we defined suicide more broadly as a suicide, open, or misadventure verdict. The suicide rate in the first 28 days after discharge was 7.1 (4.1-12) times higher for male patients and 3.0 (1.5-6.0) times higher for female patients than the rate during the remaining 48 weeks of the first year after discharge. Most of the patients studied (both those who committed suicide and those who did not) had been psychiatric inpatients for only a short time. The findings confirm that there is significant clustering of suicide soon after discharge from psychiatric care. Skilled support after discharge for high-risk patients in the community is essential. Audit of suicides that occur soon after discharge may help identify the patients at highest risk and thereby reduce the number of avoidable deaths.
Article
The purpose of this study was to examine a sample representing all suicide victims with current DSM-III-R major depression in Finland within 1 year in aspects relevant to suicide prevention, including comorbidity, clinical history, current treatment, suicide methods, and communication of suicide intent. Using the psychological autopsy method, the authors examined all 71 suicide victims with current unipolar DSM-III-R major depression, taken from a random sample of 229 subjects representing 16.4% of all suicide victims in Finland in 1 year. The majority (85%) were complicated cases with comorbid diagnoses, and comorbidity varied according to the subjects' sex and age. Three-quarters had a history of psychiatric treatment, but only 45% were receiving psychiatric treatment at the time of death. Most suicide victims had received no treatment for depression. Only 3% had received antidepressants in adequate doses, 7% weekly psychotherapy, and 3% ECT. None of the 24 psychotic subjects had received adequate psychopharmacological treatment. Few (8%) had used an antidepressant overdose as a suicide method. Men had received less treatment for depression and had more commonly used violent suicide methods. Although about half of the suicide victims with major depression were receiving psychiatric care at the time of death, few were receiving adequate treatment for depression. There were significant sex differences in current and previous treatment and suicide methods. For suicide prevention in major depression, it would seem crucial to improve treatment and follow-up, for males with major depression, in particular.
Article
A total of 219 inpatients with a DSM-III diagnosis of major depression, 150 women and 69 men, were followed prospectively for 3-10 years and mortality was recorded. The patients were previous participants in psychopharmacological multicenter trials, which were carried out for the purpose of comparing the antidepressant effect of newer 5-HT reuptake inhibitors with that of the tricyclic antidepressant drug, clomipramine. The study comprised patients with a total Hamilton Rating Scale for Depression score of > or = 18 and/or a Hamilton subscale score of > or = 9. Diagnostic classification according to the Newcastle I Scale in endogenous and nonendogenous depression was performed. The observed mortality was significantly greater than that expected. The increased mortality was essentially due to suicides and mainly found among women. Patients scored as nonendogenously depressed had a significantly higher suicide rate than endogenously depressed patients. The excess number of suicides in the nonendogenous group largely occurred within the first year of observation. No association was found between response to the antidepressant treatment in the trial and the suicide risk in the first 3 years of observation.
Article
Eighty-nine inpatients with a primary severe depression and melancholia who had committed suicide were investigated. They were admitted to the Department of Psychiatry, Lund, Sweden between 1956-1969 and died before 1984. Matched controls were selected. Case records were evaluated at index admission to find suicidal risk factors in melancholia. Prospective ratings were compared. Women committing suicide had higher scores than their controls on the items unmarried, non-compliance and suicide attempt but lower ratings on disharmonic childhood and non-severe physical disease. Men committing suicide had higher scores on the items heredity for psychosis and a brittle or sensitive personality. For the latter item suicide was related to life-weariness. Suicide attempt was related to acute onset and lack of psychomotor retardation. Two suicidal processes were proposed for men: one related to aggression and one not. Social factors seem less important in the prediction of suicide in melancholia than in depression in general.
Article
Suicide risk was studied in a sample of 346 mood disorder inpatients, 92 of whom were admitted after a current suicide attempt. The overall suicide mortality after a mean observation period of 6 years was 8%. The potential of attempted suicide to predict suicide risk in hospitalized patients with mood disorders was studied by survival analysis after subgrouping on the basis of whether a current suicide attempt had occurred or not. The suicide risk the first year after attempting suicide was 12% (11/92), compared with 2% (4/254) in the mood disorder subgroup with no current suicide attempt. The long-range suicide risk after a current suicide attempt in depression was 15% (14/92) as compared with 5% (13/254) among those without a current suicide attempt. It is concluded that a current suicide attempt in mood disorder inpatients predicts suicide risk particularly within the first year and should be taken very seriously.