Menstruation and suicide: an exploratory study

Previous research has reported mixed findings on the effect of the menstrual cycle on suicidal behavior. The contribution of menstruation to completed suicide is also controversial, though the studies are very limited and have not been carefully designed. To explore the relationship, 217 autopsies on completed suicides were performed, matched to a control group at the All India Institute of Medical Sciences in New Delhi. The results show that 54.46% of people who died by suicide were menstruating (results excluded pregnancies), compared to 6.75% of the control group. Menstruation in those who completed suicide, compared to a control group, appeared to have an association with suicide. More research is warranted.     

Suicide in Texas: a cohort analysis of trends in suicide rates, 1945-1980

Recent clusters of teenage suicides in Texas suburban communities have focused national attention on the rise in teenage suicidal behavior. This study sought to clarify the teenage suicide phenomenon by using a cohort method of data analysis. Beginning with suicide rates for white males aged 15-19 in 1945, suicide rates were calculated and plotted for each 5-year age cohort entering the late teenage years, when suicide risk factors dramatically increase. Our analysis of these cohort patterns confirmed the ever-rising risk factor associated with the ages of 15-19. This trend is consistent with many studies suggesting that teenage suicide is a function of socioeconomic and psychological factors operating across community and national boundaries. In addition, our study revealed that as white males 15-19 years of age in 1945 aged, their suicide rates also increased, confirming earlier findings that the suicide risk factor increases with age. In fact, Texas data for 1980 revealed that older persons, not teenagers, had the highest suicide rates-a finding that confirms other studies' results. Finally, Texas cohort patterns for suicide revealed the recent curvilinearity tendencies of older adult male suicide rates. By 1980 Texas data revealed a bimodal distribution of high suicide risk, with white males in their late 20s and ages 55 and over having the highest rates.     

Adolescent suicide, gender, and culture: A rate and risk factor analysis

The current paper provides a comprehensive research review of gender differences in rates of and risk factors for adolescent suicidal behavior in four main U.S cultural subgroups: African Americans, Native Americans, Asian Americans, and Latino Americans. The paper highlights substantial findings from the most recent literature and provides direction for future research and clinical work. The data presented suggest that clinicians and interventionists relying on nonfatal expressions of suicide will continue to fail to identify adolescent males at risk for suicide, as females are more likely to report suicide ideation and attempts across all cultural groups reviewed. We conclude that researchers and clinicians should utilize indirect, broad measures of suicide proneness, as opposed to the traditional direct self-report tools. Although past research has examined cultural and gender differences in risk factors for suicidal behavior, these investigations have been primarily isolated from each other. Therefore, we sought to examine adolescent suicidal behavior and how it operates as a function of both gender and culture.     

Exposure to suicide: incidence and association with suicidal ideation and behavior: United States, 1994

Exposure to the suicide of another is common, but the magnitude and effects of such exposure are not well quantified. From a national random telephone survey of U.S. adults, we estimated the 12-month incidence of exposure to suicide and its association with suicidal ideation, planning, and behavior. Of 5,238 respondents, 342 (a weighted 7.0% representing 13.2 million persons) reported knowing a suicide decedent from the previous year. Univariate analysis showed persons reporting such exposure were significantly more likely to describe suicidal ideation and behavior than those unexposed; multivariate analysis showed no association. Though the risk related to suicide exposure may be small, given the magnitude of exposure, it may warrant intervention efforts because of its potential societal impact.     

African American and Caucasian attempters compared for suicide risk factors: a preliminary study

The aim of the study was to compare African American and Caucasian substance dependent suicide attempters for risk factors for suicidal behavior. One hundred and fifty-eight African American and 95 Caucasian substance dependent patients who had attempted suicide were interviewed and their family history of suicidal behavior recorded. Patients completed the Childhood Trauma Questionnaire, the Eysenck Personality Questionnaire, and the Foulds Hostility and Direction of Hostility Questionnaire. The results revealed that there were no significant differences between the African American and Caucasian suicide attempters for marital status, age, childhood abuse, or for personality scores for neuroticism, extraversion, psychoticism, or hostility. However, the African American attempters had significantly lower childhood emotional neglect scores. Also, significantly more of the Caucasian attempters had a family history of suicide and current legal problems. Further studies seem warranted examining for differences between African Americans and Caucasians for risk factors for suicidal behavior.     

Biology of elderly suicide.

Most studies of suicide in younger patients have demonstrated significant alterations in the serotonin system. Although a high percentage of completed suicides occur in late-life, to date very few studies of the biology of suicide have focused on this age group. This chapter describes age-related changes in the central nervous system pertinent to the biology of suicide, then reviews post-mortem biological studies of the brains of suicides and suicide attempters. As suicide attempts in the elderly are characterized by the use of violent means, biologic studies of impulsive violence are discussed. Finally we describe data on the effect of degenerative diseases on the serotonin system and the possible link to increased suicidal behavior in affected patients. This review underscores the need for further study of the biology of suicide in the geriatric age group.     

Gender and suicide in the elderly.

Gender is one of the most important predictors of suicide in the elderly. In North America, older women are less likely to be suicidal than older men. So far, suicidologists have either ignored gender differences or have focused on the presumed causes of older men's suicidal behavior. In this paper, the focus is on older women's low rates of suicidal mortality. On the basis of a review of the literature, several hypotheses are suggested. One is that gender differences in suicide mortality reflect differences in coping. Another hypothesis is that gender differences are influenced by gender norms of suicidal behavior. Directions for prevention are proposed.     

The effect of the September 11 terrorist attacks on suicide and deliberate self-harm: a time trend study

Suicide rates may be affected by world news. Our objective was to investigate the possible impact of the terrorist attacks of September 11, 2001, on suicidal behavior in the Netherlands. There was evidence of an increase in rates of suicide and deliberate self-harm in the weeks immediately following the attacks. These findings contrast with Durkheim's (1897) original suggestion that suicide rates decline in times of war and outside threat but are in line with findings of increases in suicidal behavior after media coverage of lethal violence.     

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.     

The utility of MMPI-2 suicide items for assessing suicidal potential: development of a Suicidal Potential Scale

The assessment of suicidal potential is one of the most challenging and stress-inducing tasks facing clinicians. Studies that have attempted to identify specific MMPI codetypes, scales, or individual items predictive of completed suicide have produced inconsistent findings. This study focused on the relationship between the six most direct MMPI-2 suicide items (Items 150, 303, 506, 520, 524, and 530) and verbally reported history of suicidal ideation and behavior among a sample of psychotherapy outpatients (n =116). These six MMPI-2 suicide items provided valuable information regarding suicidal ideation and behavior above and beyond that of verbal self-report. These items were grouped together to create a single scale, the Suicidal Potential Scale (SPS) that manifested strong internal consistency. The SPS provides the clinician with a reliable method of assessing for self-reported suicidal ideation and behavior.     

Psychopathy, antisocial personality, and suicide risk

H. Cleckley (1976) maintained that psychopaths are relatively immune to suicide, but substantial evidence exists for a relationship between antisocial deviance and suicidal acts. This study was the first to explicitly examine suicidal history among psychopathic individuals as defined by R. D. Hare's (1991) Psychopathy Checklist--Revised (PCL-R). Male prison inmates (N = 313) were assessed using the PCL-R and DSM-III-R and DSM-IV criteria (American Psychiatric Association, 1987, 1994) for antisocial personality disorder (APD), and they completed A. Tellegen's (1982) Multidimensional Personality Questionnaire (MPQ). Presence or absence of prior suicide attempts was coded from structured interview and prison file records. Suicide history was significantly related to PCL-R Factor 2 (which reflects chronic antisocial deviance) and to APD diagnosis but was unrelated to PCL-R Factor 1, which encompasses affective and interpersonal features of psychopathy. Higher order MPQ dimensions of Negative Emotionality and low Constraint were found to account for the relationship between history of suicidal attempts and antisocial deviance, indicating that temperament traits may represent a common vulnerability for both.     

Ancestry, genes, and suicide: a test of the Finno-Ugrian Suicide Hypothesis in the United States

There is now convergent evidence from classic quantitative genetics (family, twin, and adoption studies) and molecular genetic studies for specific genetic risk factors for suicidal behavior. This emerging research field has recently been supplemented by geographical studies concerned with the Finno-Ugrian Suicide Hypothesis (FUSH), which states that population differences in genetic risk factors may partially account for conspicuous geographical patterns seen in suicide prevalence. In particular, the European high-suicide-rate nations constitute a contiguous, J-shaped belt, spanning from Finland to Austria. This area maps onto the second principal component identified for European gene distribution, most likely reflecting a major migration event of the past (i.e., the ancestral adaptation to cold climates and the Uralic language dispersion) still detectable in modern European populations. The present research tested the hypothesis in the United States. Consistent with the hypothesis, available historical (1913-1924 and 1928-1932) U.S. state suicide rates were uniformly positively associated with available state proportions of reported American ancestries from European high-suicide-rate countries (Hungary, Lithuania, Poland, Russia, Slovakia, and the Ukraine). However, contrary to the hypothesis, available contemporary (1990-1994) suicide rates were uniformly negatively associated with these ancestry proportions. The findings of this first test outside Europe are therefore conflicting. A proposal based on the geographical study approach is offered to further the progress of investigations into the genetics of suicide.     

The Sexual Harassment–Suicide Connection in the U.S. Military: Contextual Effects of Hostile Work Environment and Trusted Unit Leaders

Sexual harassment has been associated with suicidal behaviors, and with the rise in suicides in the U.S. military, sexual harassment's role in suicide has been of growing interest. Lacking are studies that examine group‐ or unit‐level variables in the relationship of sexual harassment to suicidal behaviors (thoughts, plans, and attempts). In this study, survey data from soldiers (12,567 soldiers in 180 company‐sized units) who completed the Unit Risk Inventory administered during calendar year 2010 were analyzed using hierarchical linear modeling. At the individual level, sexual harassment was associated with a fivefold increase for risk of suicide. Reporting that leaders could be trusted was associated with a decreased suicide risk by about one‐third. There was no statistically significant interaction between sexual harassment and trusted leaders in predicting the suicidal behaviors. At the group level, units or companies having higher levels of sexual harassment also had soldiers three times more at risk for suicide. A cross‐leveling effect was also observed: Among units having higher levels of sexual harassment, the negative correlation (buffering effect of unit leaders on suicidal behaviors) was diminished. Implications of findings for preventing sexual harassment and suicide risk are discussed.     

Suicidality in primary health care and national suicide rates

The incidence of suicidal symptoms for primary health care patients did not predict national suicide rates in a sample of 10 nations.     

Incidence of near-death experiences following attempted suicide

Near-death experiences (NDEs), profound subjective experiences occurring during a close brush with death and containing transcendental or mystical elements, have been reported to reduce suicidal ideation, despite their "romanticization" of death. Among 61 consecutive hospital admissions for attempted suicide, 16 patients (26.2%) reported NDEs precipitated by the attempt. NDEs were not significantly associated with any demographic factors. In light of the frequency of NDEs following attempted suicide, further studies are indicated in regard to the effect of those experiences on subsequent suicidal behavior.     

Evaluation of a youth suicide prevention school program

Adolescent suicide is a subject of increasing national concern. In California, this problem was addressed through the implementation of a three-year youth suicide prevention school program established by legislative mandate in 1983. Findings for the first two years of the program indicate significant gains in understanding of youth suicide prevention techniques for those high school students who completed a four-hour training course. School staff and parents completing 90-minute youth suicide awareness seminars indicated that they most appreciated receiving practical advice and resources they could use in responding to a potentially suicidal young person.     

Prevalence, course, incidence, and 1-year prediction of deliberate self-harm and suicide attempts in early Norwegian school adolescents

In this survey of early Norwegian school adolescents, the prevalence, course, and incidence of self-harm behavior with or without suicide intent were examined, in addition to predictors of self-harm for a 1-year follow-up period. Lifetime prevalence rates of self-harm without suicide intent and suicide attempts were 2.9% and 3.0%, respectively, while 1-year incidence rates were 3.6% and 1.7%, respectively. In multivariate analysis, five predictors significantly differentiated self-harmers from non-self-harming adolescents. Early school adolescents having frequent or intense suicidal ideation over an extended time period and attempting self-harm repeatedly with or without suicide intent should be identified and offered treatment.     

Affective, behavioral, and cognitive functioning in adolescents with multiple suicide attempts

The purpose of this study was to examine affective, behavioral, and cognitive functioning in adolescents with multiple suicide attempts. Forty-seven adolescents with a history of multiple suicide attempts (MA) were compared to 74 single suicide attempters (SA) on psychiatric diagnosis, depressive symptoms, affect regulation, self-mutilation, alcohol use, and hopelessness. Results revealed that the MA group was more likely to be diagnosed with a mood disorder, and reported more severe depressive symptoms and anger, in comparison to the SA group. Behaviorally, the MA group had higher rates of disruptive behavior disorders and higher levels of affect dysregulation and serious self-mutilation than the SA group. Further, greater levels of hopelessness were reported by the MA than the SA group. After controlling for a mood disorder diagnosis, only differences in anger, affect dysregulation, and serious self-mutilation remained significant. Overall, results suggest that treatment with adolescent suicide attempters might specifically target anger and affect dysregulation to reduce risk for future suicidal behavior.     

A case control study of suicide and attempted suicide in older adults

Risk factors for serious suicidal behavior among older adults were examined in a case control study of 53 adults aged 55 and older who died by suicide or made medically serious suicide attempts and who were compared with 269 randomly selected comparison subjects. Multivariate analyses suggested that risk of serious suicidal behavior was elevated among those with current mood disorders (OR = 179, CI = 52.8-607.6), psychiatric hospital admission within the previous year (OR = 24.4, CI = 1.9-318.7), limited social network (OR = 4.5, CI = 1.4-14.6). The predominant role of mood disorders was confirmed by population attributable risk (PAR) estimates (73.6%), suggesting that the improved detection, treatment and management of mood disorders should be the primary focus of suicide prevention strategies for older adults.     

Psychosocial Correlates of Suicide Attempts Among Junior and Senior High School Youth

Three groups of junior and senior high schools students (total N = 1050) recruited in rural counties of a mid-Atlantic state–those who had made a prior suicide attempt, those reporting high levels of depressed mood or suicidal ideation, and those who were not depressed or suicidal – were compared with regard to their reports of a number of potential risk factors for suicidal behavior. Adolescents with a history of a suicide attempt reported more frequent stresses related to parents, lack of adult supports outside of the home, police, and sexuality (i.e., concerns about pregnancy, pressure to have sex, getting sexually transmitted diseases), compared with both depressed/suicide ideators and nondepressed adolescents. Suicide attempters were also more likely than the other adolescents to report that they were physically hurt by a parent, that they ran away from home, that they lived apart from both parents, and that they knew someone who had completed suicide. Results are discussed in the context of prior studies of adolescent suicidal behavior in community and clinical samples.