Anhedonia and suicide: a 6.5-yr. follow-up study of patients hospitalised for a suicide attempt

This was a prospective follow-up study of suicidal patients to assess the association of anhedonia, depression, and completed suicides. Survival analysis as well as Cox's regression makes it possible to weigh the influence of variables. A cohort of 106 patients (81 women, 25 men, M age=33 yr., SD=9.9) admitted to medical or surgical departments after a suicide attempt was followed during a 6.5-yr. mean observation period. In total, 6.7% of patients completed suicide. High proportion of male subjects (71.4%) and low anhedonia, assessed on the Physical Anhedonia Scale, decreased survival time of the cohort and characterized subjects who deceased by suicide. These results suggested that the people who completed suicide were characterized by low anhedonia. Further research is needed on people who attempt suicide and present with specific psychiatric diagnoses.     

Attempted Suicides—35 Years Afterward

ABSTRACT: Most follow-up studies of suicides are made after a relatively short period of time. The present study involved 229 attempted suicides (93 men and 136 women) hospitalized during the years 1933–1942. It was possible to trace 96.8% of the men and 95.6% of the women. An earlier investigation 0 to 12 years after hospitalization showed that in the first 4 years 9 men (9.7%) and 5 women (3.7%) had committed suicide. The observation time for the present study ranges from 21 to 42 years, with a mode of 35 years. It was found that an additional 4 men and 7 women had committed suicide in the interim—in the cases of 2 men and 6 women, 15 years or more after the initial attempt. This incidence of suicide so long after the original attempt, at least in the case of the women, statistically exceeds the expected incidence. In the time now elapsed, 10.9% of the study sample (14% of the men and 8.8% of the women) have taken their own lives.     

Revisiting the association of aggression and suicidal behavior in schizophrenic inpatients

Our study investigated the association of aggression and suicidal behavior in schizophrenic inpatients. Eight thousand nine hundred one admissions for schizophrenia (1998-2007) to a psychiatric university hospital were included. Schizophrenic suicides (n = 7)/suicide attempters (n = 40) were compared to suicides (n = 30)/suicide attempters (n = 186) with other diagnoses and to schizophrenic non-attempters regarding aggression. Logistic regression analysis was performed to explore risk factors for attempted suicide. Schizophrenic suicides/suicide attempters did not differ from other suicides/suicide attempters or from schizophrenic non-attempters with regard to aggression. Risk of inpatient suicide attempt was increased for patients with attempted suicide at admission, high school graduation, and disorganized subtype. Aggression could not be found to be a predictor of attempted suicide. Aggression seems to have a minor role for suicidal behavior in schizophrenia.     

Brooding and reflective rumination among suicide attempters: Cognitive vulnerability to suicidal ideation

Previous research suggests that the brooding subtype of rumination is associated with increased suicidal ideation, but findings are inconsistent with respect to reflection, considered to be the more adaptive form of rumination. This study investigated the circumstances under which reflective rumination might be associated with increased suicidal ideation by examining whether a suicide attempt history moderated the relationship between the ruminative subtypes and current suicidal ideation. Thirty-seven young adults who reported a past suicide attempt and fifty-nine young adults without a suicide attempt history completed measures of rumination and depression symptoms in an initial study session. They then completed a measure of suicidal ideation and hopelessness during a second study session. Overall, brooding was associated with higher self-reported suicidal ideation, whereas reflection was not significantly associated with ideation. However, reflection - but not brooding - interacted with suicide attempt history to statistically predict suicidal ideation, even after adjusting for symptoms of depression and hopelessness, whereas brooding no longer predicted ideation after adjusting for these symptoms. These findings qualify earlier suggestions that reflection is a more adaptive form of rumination by indicating that among vulnerable individuals - in particular those with a history of a suicide attempt - a higher degree of reflective rumination is associated with increased suicidal ideation.     

Suicide attempts: Patients with and without an affective disorder show impaired autobiographical memory specificity

A number of studies have shown reduced recall of specific autobiographical memories (AMs) in patients after attempted suicide, but in all of them the study samples were confounded with diagnoses of affective disorders. The present study aims to demonstrate impaired specific autobiographical memory in patients after a suicide attempt without a diagnosis of an affective disorder. Four groups were compared: (1) patients with an actual major depression and a suicide attempt; (2) patients after a suicide attempt without a lifetime history of an affective diagnosis; (3) patients currently suffering from major depression without a suicide attempt; and (4) control persons not suffering from either of the two conditions during their entire life. Individuals with major depression and a suicide attempt showed reduced specificity of AM and, most importantly, patients with a suicide attempt—despite the absence of an affective disorder—were equally impaired with recall of specific AMs as were patients with major depression. The authors propose that reduced specific AM is a common vulnerability factor that can lead either to the development of an affective disorder and/or to a suicide attempt.     

Incidence of suicidal ideation and behavior in the United States, 1994.

Completed suicides reflect only a portion of the impact of suicidal behavior; sublethal behaviors cause morbidity and can signal treatable problems such as depression. There is no national quantification of nonlethal suicidal behaviors. The present study used a random-digit-dialed telephone survey to estimate the 12-month incidence of suicidal ideation, planning, and attempts among U.S. adults. Of 5,238 respondents, 5.6% (representing about 10.5 million persons) reported suicidal ideation, 2.7% (about 2.7 million) made a specific suicide plan, and 0.7% (about 700,000) made a suicide attempt (estimate = 1.1 million attempts). Hence, suicidal behaviors are not uncommon and occur along a continuum ranging from ideation to completed suicides. Preventing nonlethal precursor behaviors may prevent deaths.     

Suicide related to the assassination of President John F. Kennedy.

In complicated ways depression is related to suicide. If the national climate could be made depressive by mass media coverage of a depressing event (for example, the assassination of President John F. Kennedy), the suicide rate theoretically ought to increase, unless depression were not related to suicide during time of great national focus. This hypothesis was investigated by using a questionnaire survey requesting information concerning suicide rate for the period November 22--30 for the 17 years 1956--1972. Sixty-one cities were randomly selected and contacted; 29 responded. A total of 74 suicides--48 males and 26 females--were reported during the 17 years studied. The hypothesis that more suicides should have occurred during 1963 was not supported. No suicides occurred during November 22--30 in 1963, the year of the Kennedy assassination. The results were significant at the .01 level. The finding that during a time of focused national crisis fewer suicides occur coincides with the findings of Durkheim (1897/1951).     

Mental disorders and communication of intent to die in indigenous suicide cases, Queensland, Australia

In comparing Indigenous to non-Indigenous suicide in Australia, this study focussed on the frequency of the association between some psychiatric conditions, such as depression and alcohol abuse, and some aspect of suicidality, in particular communication of suicide intent. Logistic regression was implemented to analyze cases of Indigenous (n = 471) versus non-Indigenous suicides (n = 6,655), using the Queensland Suicide Register as a data source. Compared to non-Indigenous suicides, Indigenous cases had lower odds of being diagnosed with unipolar depression, seeking treatment for psychiatric conditions or leaving a suicide note. Indigenous suicides had greater odds of verbally communicating suicide intent and having a history of alcohol and substance use. The magnitude of these differences is remarkable, underscoring the need for culturally sensitive suicide prevention efforts.     

Early suicide following discharge from a psychiatric hospital

Social and clinical risk factors for completed suicide occurring shortly after discharge from a psychiatric hospital were examined in this case-control study. Seventy-seven individuals who received "suicide" or "undetermined death" verdicts at inquest, and who had been previously discharged from psychiatric hospitals in Bradford, U.K., were compared with a control group. A history of deliberate self-harm was significantly associated with early suicides compared with both late suicides and controls. A diagnosis of mood disorder, specifically depression, and longer case-notes were also significantly associated with early suicides compared to controls. This study has implications for risk management of recently discharged psychiatric patients.     

Attempted suicide among Iranian population

Predictors of suicide attempts in Iran, to distinguish any similarities and differences of these predictors between suicide attempts in Iran and other developed and developing countries and to investigate the relation between general psychiatric symptoms and repetition of suicidal attempts were assessed. The validated Farsi version of the General Health Questionnaire-28 (GHQ-28) was used to assess multiple dimensions of quality of life of suicide attempters as depression, anxiety, social dysfunction, and somatic symptoms. Pivotal differences emerged in the clinical profiles of suicide attempters living in a developing country versus developed countries. In developing countries, those who attempt suicides are more likely to have no psychiatric disorder and are less likely to have used alcohol as part of the suicide attempt, but are more likely to have been assaulted physically or verbally. The results on the GHQ-28 indicate that the process through which individuals move from suicidal thought to action may decrease multiple dimensions of quality of life.     

Temperamental Vulnerability and Suicide Risk After Attempted Suicide

The aim was to extend recent findings of suggested temperamental features in attempted suicide and to explore possible domains of vulnerability to suicide risk after attempted suicide. Fifty-four psychiatric inpatients hospitalized after a suicide attempt underwent lumbar puncture for analysis of CSF 5-HIAA concentration and also completed the Karolinska Scales of Personality (KSP) before discharge from the hospital. Suicide attempters scored high on Somatic Anxiety, Psychic Anxiety, and Muscular Tension, and low on Socialization, findings that support recent findings in suicide attempters followed up after an emergency room visit. Five patients committed early suicide, i.e., within 3 years, and the overall long-term suicide mortality after attempted suicide was 13%. There were significant correlations between survival time among early suicides and CSF 5-HIAA (r = .87;p = .054), and the following KSP scale t scores: Somatic Anxiety (r = ?.96;p < .05), Impulsivity (r = ?.88; p < .05), and Socialization (r = .90; p < .05). KSP Socialization showed correlations with CSF 5-HIAA (r = .89; p = .046) among the early suicides. Features of temperamental vulnerability to suicide risk after attempted suicide might involve anxiety proneness, impulsivity, low socialization, and low CSF 5-HIAA.     

Correlates of motives for suicide

Analysis of a large sample of suicide notes from 262 suicides in Australia showed separated/divorced suicides and suicides who abused alcohol were more likely to give love/romance as a precipitant for suicide while those who used gas (natural or car exhaust) were more likely to give depression and guilt as a motive.     

Suicide Disclosure in Suicide Attempt Survivors: Does Family Reaction Moderate or Mediate Disclosure's Effect on Depression?

Existing literature has found a link between disclosure of a stigmatized identity and improved mental health; however, research on the impact of suicide disclosure to family members is scarce. Suicide attempt survivors (n = 74) in the United States were examined to assess whether family reaction moderates or mediates the relationship between suicide disclosure and subsequent depression symptoms. Family reaction did not moderate but did mediate the relationship between disclosure and depression symptoms while controlling for time since most recent attempt. Higher rates of disclosure predicted more positive family reactions, which in turn predicted less severe depression symptoms. Findings indicate that family members can play an essential role in the recovery process after an attempt occurs, which has important implications for both researchers and clinicians who seek to decrease stigma for attempt survivors while simultaneously decreasing the likelihood of future attempts.     

Suicide attempts and family history of suicide in three psychiatric populations

The influence of a family history of suicide on suicide attempt rate and characteristics in depression, schizophrenia, and opioid dependence was examined. One hundred sixty inpatients with unipolar depression, 160 inpatients with schizophrenia, and 160 opioid-dependent patients were interviewed. Overall, a family history of suicide was associated with a higher risk for suicide attempt, with high-lethality method, with repeated attempts, and with number of attempts, while the interaction between family history and diagnostic group was not significant. Thus, a positive family history of suicide was a risk factor for several suicide attempt characteristics independent of psychiatric diagnosis.     

Suicide Prevention in Adults (Age 30–65)

Relatively little is known about midlife suicides, compared to adolescent and elderly suicides. A life-span model of suicidal behaviors is suggested as a heuristic conceptual tool. General midlife tasks and crises, as outlined by Levinson and Erikson, are reviewed. However, more than routine midlife developmental problems occur in most suicides. Some of the possible distinctive traits of midlife suicides (versus younger and older suicides) include: loss of spouse, years of heavy drinking, reaching the age of high depression risk, and occupational problems (including unemployment, inability to work, and retirement). Midlife suicide rates tend to be highest among white males, although female suicide rates peak in midlife. The paper concludes with a review of assessment and treatment issues related to a half-dozen high-risk midlife suicide types.     

Suicidal behavior in borderline personality disorder: prevalence, risk factors, prediction, and prevention

Suicidal behavior is frequent in patients with borderline personality disorder (BPD); at least three-quarters of these patients attempt suicide and approximately 10% eventually complete suicide. Borderline patients at greatest risk for suicidal behavior include those with prior attempts, comorbid major depressive disorder, or a substance use disorder. Comorbidity with major depression serves to increase both the number and seriousness of the suicide attempts. Hopelessness and impulsivity independently increase the risk of suicidal behavior, as does a turbulent early life and the presence of antisocial traits. In summary, because BPD is frequently complicated by suicidal behavior, clinicians must avoid the mistake of thinking that a pattern of repeated attempts indicates little desire to die. Clinicians have an important role in preventing suicide attempts and completed suicides by understanding the risk factors.     

Variations in stress responses following involvement in a railway suicide or attempted suicide

Three train drivers were interviewed one month after their involvement in a railway suicide or suicide attempt. The case studies demonstrate that reactions to these incidents vary from the severe and debilitating (concurrent diagnoses of post-traumatic stress disorder and neurotic depression) to the relatively mild (few reported symptoms). All train drivers reported a significant reduction in symptoms at a follow-up interview six months after the incident. Although the psychological effects of these incidents may be severe they appear to be time-limited.     

Dependent children and suicide of married parents.

In an attempt to analyze the relatively neglected relationship between the presence of dependent children and suicide of married parents, the suicides of both married and single persons in the Chicago-Cook County region for 1970 and 1974 were examined. Single suicides and married suicides with dependent children were compared to similar groups in the general population. It was found that while marrieds with dependent children experienced the lowest average suicide rate, they also had a larger mean number of children than the population as a whole and exhibited a tendency for having children at a very young age or children at an older age in life. These findings contradict contemporary notions that an increasing number of children in a marriage tend to inhibit suicide potential. It appears that the relationship between marital suicide and dependent children is far more complex than previously indicated and requires further research for elaboration.     

Schizophrenia--a high-risk factor for suicide: clues to risk reduction.

Suicide is the chief cause of premature death among schizophrenic persons. The lifetime incidence of suicide for patients with schizophrenia is 10% to 13% compared to a general population estimate of about 1%, and is quite close to that observed among those with major affective disorder. The magnitude of increased risk for suicide among schizophrenics peaks before middle age and declines thereafter, although schizophrenic persons tend to be at increased risk throughout the life span. Among psychiatric patients, schizophrenics are overrepresented among suicides, and often schizophrenics constitute the majority of inpatient suicides. It is important in evaluating suicide risk among schizophrenic persons to assess depression and suicidal ideation especially during index admission and during acute phases of the illness. It is noteworthy that schizophrenic persons often commit suicide as the overall level of psychopathology decreases during a nonpsychotic phase. Research has yielded salient risk factors for suicide in schizophrenic persons and "types" of especially vulnerable patients, even though statistical prediction of individual suicides has not proven effective.     

Toward an integrative model of suicide attempt: a cognitive psychological approach.

Applying a cognitive approach, the purpose of the present study was to expand previous research on stress-vulnerability models of depression and problem-solving deficits, as it relates to suicide attempt. Structural equation modelling, involving latent variables, was used to evaluate (a) whether low self-esteem, a low sense of self-efficacy, loneliness, and divorce constituted vulnerability factors for the development of depression; (b) whether hopelessness and suicidal ideation mediated the relationship between depression and suicide attempt; and (c) whether problem-solving deficits mediated the relationship between the vulnerability factors and suicide attempt, separate from depression/hopelessness. A total of 123 individuals, aged 18-75 years, participated in the study (72 suicide attempters and 51 psychiatric outpatients with no history of suicidal behavior). The results indicated a two path model of suicide attempt. The first path began with low self-esteem, loneliness, and separation or divorce, which advanced to depression, and was further mediated by hopelessness and suicidal ideation which led to suicide attempt. The second path developed from low self-esteem and a low sense of self-efficacy and advanced to suicide attempt, mediated by a negative appraisal of one's own problem-solving capacity, and poor interpersonal problem-solving skills. The importance of addressing both depression/hopelessness, and problem-solving deficits when working with suicide attempters is noted.