Article

Sex Differences in Clinical Predictors of Suicidal Acts After Major Depression: A Prospective Study

Department of Neuroscience, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr., New York, NY 10032, USA.
American Journal of Psychiatry (Impact Factor: 12.3). 02/2007; 164(1):134-41. DOI: 10.1176/appi.ajp.164.1.134
Source: PubMed

ABSTRACT

Whether sex differences exist in clinical risk factors associated with suicidal behavior is unknown. The authors postulated that among men with a major depressive episode, aggression, hostility, and history of substance misuse increase risk for future suicidal behavior, while depressive symptoms, childhood history of abuse, fewer reasons for living, and borderline personality disorder do so in depressed women.
Patients with DSM-III-R major depression or bipolar disorder seeking treatment for a major depressive episode (N=314) were followed for 2 years. Putative predictors were tested with Cox proportional hazards regression analysis.
During follow-up, 16.6% of the patients attempted or committed suicide. Family history of suicidal acts, past drug use, cigarette smoking, borderline personality disorder, and early parental separation each more than tripled the risk of future suicidal acts in men. For women, the risk for future suicidal acts was sixfold greater for prior suicide attempters; each past attempt increased future risk threefold. Suicidal ideation, lethality of past attempts, hostility, subjective depressive symptoms, fewer reasons for living, comorbid borderline personality disorder, and cigarette smoking also increased the risk of future suicidal acts for women.
These findings suggest that the importance of risk factors for suicidal acts differs in depressed men and women. This knowledge may improve suicide risk evaluation and guide future research on suicide assessment and prevention.

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Available from: Mary Bongiovi, Jan 05, 2016
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    • "In these studies, cluster B PDs, especially borderline PD, have been established as a risk factor for SAs, whereas cluster A and C PDs have received less attention. The most consistent predictors for a future SA have been borderline PD comorbid with MDD (Bolton et al., 2010; Soloff and Chiappetta, 2012; Soloff and Fabio, 2008; Yen et al., 2003), BD with current MDE (Galfalvy et al., 2006) , and both MDD and BD with current MDE (Oquendo et al., 2007) or dysthymia (Stringer et al., 2013). Also baseline cluster C (Oleski et al., 2012), dependent (Bolton et al., 2010), avoidant (Bolton et al., 2010), paranoid (Bolton et al., 2010), schizoid (Bolton et al., 2010), schizotypal (Bolton et al., 2010), or any (Bolton et al., 2010; Undurraga et al., 2012) PD comorbid with MDD or MDE in BD patients has been associated with higher rates of SAs at follow-up. "
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    ABSTRACT: Background: Comorbid personality disorders may predispose patients with mood disorders to suicide attempts (SAs), but factors mediating this effect are not well known. Methods: Altogether 597 patients from three prospective cohort studies (Vantaa Depression Study, Jorvi Bipolar Study, and Vantaa Primary Care Depression Study) were interviewed at baseline, at 18 months, and in VDS and PC-VDS at 5 years. Personality disorders (PDs) at baseline, number of previous SAs, life-charted time spent in major depressive episodes (MDEs), and precise timing of SAs during follow-up were determined and investigated. Results: Overall, 219 (36.7%) patients had a total of 718 lifetime SAs; 88 (14.7%) patients had 242 SAs during the prospective follow-up. Having any PD diagnosis increased the SA rate, both lifetime and prospectively evaluated, by 90% and 102%, respectively. All PD clusters increased the rate of new SAs, although cluster C PDs more than the others. After adjusting for time spent in MDEs, only cluster C further increased the SA rate (by 52%). Mediation analyses of PD effects on prospectively ascertained SAs indicated significant mediated effects through time at risk in MDEs, but also some direct effects. Limitations: Findings generalizable only to patients with mood disorders. Conclusions: Among mood disorder patients, comorbid PDs increase the risk of SAs to approximately two-fold. The excess risk is mostly due to patients with comorbid PDs spending more time in depressive episodes than those without. Consequently, risk appears highest for PDs that most predispose to chronicity and recurrences. However, also direct risk-modifying effects of PDs exist.
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    • "Another mediating factor seems to be the degree of religiosity and religious affiliation, which modify the risk for SBs (Gearing & Lizardi, 2009). The examination of a large international sample may clarify the cross-cultural influence of religious affiliation, gender and other cultural factors (Oquendo et al., 2007). -Aggression traits and their relation to suicide (Turecki, 2005). "
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    ABSTRACT: Current methodologies employed in collecting data for suicide research present several limitations. In this article, we describe a novel method and tool to prospectively study suicidal behavior and its related risk and protective factors in different countries. This tool is a web-based database, which will initially be developed and piloted by suicide research groups from Brazil, Chile, Dubai, France, Italy, Mexico, Spain, Sweden and the US. The database will develop and integrate research tools key to collaboration, permit exploration of ethical considerations, and provide a universal interface in English, Spanish, French, Portuguese, Italian and German that will make it possible to incorporate new groups from different countries to the network. The common database resulting of this cross-national effort will allow researchers to share and compare data across countries in a large sample of patients. Using electronic records of patients, we will: 1) determine the impact of risk and protective factors (viz. aggression and religious affiliation) in different socio-cultural environments; 2) develop a clinical model of suicidal behavior that integrates the multiple dimensions implicated; 3) try differentiating the effects of biological, environmental and cultural factors on suicidal behavior, and 4) offer the global psychiatric research community a tool that will standardize assessment across nations allowing for better generalization.
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    • "Another mediating factor seems to be the degree of religiosity and religious affiliation, which modify the risk for SBs (Gearing & Lizardi, 2009). The examination of a large international sample may clarify the cross-cultural influence of religious affiliation, gender and other cultural factors (Oquendo et al., 2007). -Aggression traits and their relation to suicide (Turecki, 2005). "
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    ABSTRACT: Current methodologies employed in collecting data for suicide research present several limitations. In this article, we describe a novel method and tool to prospectively study suicidal behavior and its related risk and protective factors in different countries. This tool is a web-based database, which will initially be developed and piloted by suicide research groups from Brazil, Chile, Dubai, France, Italy, Mexico, Spain, Sweden and the US. The database will develop and integrate research tools key to collaboration, permit exploration of ethical considerations, and provide a universal interface in English, Spanish, French, Portuguese, Italian and German that will make it possible to incorporate new groups from different countries to the network. The common database resulting of this cross-national effort will allow researchers to share and compare data across countries in a large sample of patients. Using electronic records of patients, we will: 1) determine the impact of risk and protective factors (viz. aggression and religious affiliation) in different socio-cultural environments; 2) develop a clinical model of suicidal behavior that integrates the multiple dimensions implicated; 3) try differentiating the effects of biological, environmental and cultural factors on suicidal behavior, and 4) offer the global psychiatric research community a tool that will standardize assessment across nations allowing for better generalization.
    Full-text · Article · Dec 2014 · Archives of Suicide Research
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