The prevalence of suicidal ideation and suicide attempt in patients with rheumatic diseases: a systematic review and meta-analysis

A number of studies have reported the suicidal ideation (SI) or suicide attempts (SA) of patients with rheumatic diseases. However, the estimated prevalence of those disorders varies substantially between studies. This systematic review aimed to describe the prevalence of SI and SA in rheumatic diseases. Literature search was done using Web of Science, Embase, the Cochrane database library, PubMed and CNKI database through June 2017. Studies were screened according to inclusion and exclusion criteria and the qualities of included studies were evaluated. The data was analyzed using STATA version 12.0. A random-effect meta-analysis was conducted on all eligible data. A total of 17 identified studies matched the inclusion criteria, involving 5174 participants with systemic lupus erythematosus (SLE), osteoarthritis (OA), rheumatoid arthritis (RA) and fibromyalgia (FM). Meta-analysis showed that rheumatic diseases patients have high prevalence of SI (26%, 95% CI: 19%-32%, I²=96.2%) and SA (12%, 95% CI: 3%-21%, I²=96.6%). We also found the prevalence of SI and SA in females may be higher than in males. All of these indicated that rheumatologists should screen for SI and SA in their patients. Early appropriate intervention is therefore essential to promote the patients’ good mental health.     

Suicidality, clinical depression, and anxiety disorders are highly prevalent in men who have sex with men in Mumbai, India: findings from a community-recruited sample

In India men who have sex with men (MSM) are a stigmatized and hidden population, vulnerable to a variety of psychosocial and societal stressors. This population is also much more likely to be HIV-infected compared to the general population. However, little research exists about how psychosocial and societal stressors result in mental health problems. A confidential, quantitative mental-health interview was conducted among 150 MSM in Mumbai, India at The Humsafar Trust, the largest non-governmental organization serving MSM in India. The interview collected information on sociodemographics and assessed self-esteem, social support and DSM-IV psychiatric disorders using the Mini International Neuropsychiatric Interview (MINI). Participants' mean age was 25.1 years (SD?=?5.1); 21% were married to women. Forty-five percent reported current suicidal ideation, with 66% low risk, 19% moderate risk, and 15% high risk for suicide per MINI guidelines. Twenty-nine percent screened in for current major depression and 24% for any anxiety disorder. None of the respondents reported current treatment for any psychiatric disorder. In multivariable models controlling for age, education, income, and sexual identity, participants reporting higher levels of self-esteem and greater levels of satisfaction with the social support they receive from family and friends were at lower risk of suicidality (self-esteem AOR?=?0.85, 95% CI: 0.78-0.93; social support AOR?=?0.76, 95% CI: 0.62-0.93) and major depression (self-esteem AOR?=?0.79, 95% CI: 0.71-0.89; social support AOR?=?0.68, 95% CI: 0.54-0.85). Those who reported greater social support satisfaction were also at lower risk of a clinical diagnosis of an anxiety disorder (AOR?=?0.80; 95% CI: 0.65-0.99). MSM in Mumbai have high rates of suicidal ideation, depression, and anxiety. Programs to improve self-esteem and perceived social support may improve these mental health outcomes. Because they are also a high-risk group for HIV, MSM HIV prevention and treatment services may benefit from incorporating mental health services and referrals into their programs.     

Childbirth and Alcohol Consumption Impact of Recent Childbirth on Alcohol Consumption

While the devastating effects of parental alcohol use on children’s health are well known, the specific impact of childbirth on parental alcohol consumption has rarely been examined in the general population. We sought to examine patterns of alcohol use associated with childbirth. Data were drawn from the US National Epidemiologic Survey on Alcohol and Related Conditions. We compared successively the characteristics of alcohol use among females living with a child under 1 year with (i) those of females not living with children under 1 year and (ii) those of females living with an older child. Mean daily ethanol intake was lower among females living with a child under 1 than among females either not living with children under 1 year (p?<?0.001) or living with an older child (p?<?0.01). Moreover, low-to-mild drinking frequencies fell among females living with a child under 1, compared with females either not living with children under 1 year (adjusted odds ratio (AOR)?=?0.56; 95% CI [0.40, 0.80] for at least once a month and AOR?=?0.40; 95% CI [0.27, 0.58] for less than once a month) or living with an older child (AOR?=?0.52; 95% CI [0.36, 0.75] for at least once a month and AOR?=?0.66, 95% CI [0.46, 0.94] for less than a month). No significant difference was found for males. Our study suggests that childbirth, as opposed to motherhood per se, reduces several (though not all) dimensions of alcohol consumption in females, but not in males.     

Ethnic identity and risky health behaviors in school-age Mexican-American children

The study examined the relationship between ethnic identity and risky health behaviors in 1,892 Mexican-American students (M age= 14.6, SD= 1.35; 50.3% male) in South Texas. The Ethnic Identity Scale assessed ethnic identity and questions from the Youth Risk Behavior Survey measured risky health behaviors (mixed use of alcohol and drugs, heavy drinking, driving under the influence, regular marijuana use, regular cigarette smoking, lack of regular exercise, not eating breakfast regularly, and carrying a gun or knife to school). Logistic regression tested the relationships between ethnic identity and report of risky health behaviors controlling for potential confounders (sex, free school lunch status, grade, and self-reported school grade). Adjusted odds ratio (AOR) and confidence intervals were calculated. Results indicated that being associated with Mexican-American cultural identity was significantly associated with a decreased mixed use of alcohol and drugs (AOR= .97), heavy drinking (AOR= .98), and regular marijuana use (AOR= .97). A stronger ethnic identity was protective against engaging in risky health behaviors among these Mexican-American adolescents.     

Immigration, suicidal ideation and deliberate self-injury in the Boston youth survey 2006

The prevalence and immigration-related correlates of deliberate self-injury (DSI) and suicidal ideation (SI) were estimated in a sample of Boston public high school students in 2006. Compared with U.S.-born youth, immigrant youth were not at increased risk for DSI or SI, even if they had experienced discrimination due to their ancestry. By contrast, U.S.-born youth who reported having been discriminated against because of their ancestry had an increased risk of deliberate self-injury (odds ratio [OR] = 3.1, 95% confidence interval [CI] = 1.6-5.9) and suicidal ideation (OR = 2.1, 95% CI = 1.2-3.8). The combination of being U.S.-born and experiencing ancestry-based discrimination identifies youth at increased risk for suicidal behavior.     

Basic Psychological Needs,Suicidal Ideation,and Risk for Suicidal Behavior in Young Adults

Associations between the satisfaction of basic psychological needs of autonomy, competence, and relatedness with current suicidal ideation and risk for suicidal behavior were examined. Two logistic regressions were conducted with a cross‐sectional database of 440 university students to examine the association of need satisfaction with suicidal ideation and risk for suicidal behavior, while controlling for demographics and depressive symptoms. Suicidal ideation was reported by 15% of participants and 18% were found to be at risk for suicidal behavior. A one standard deviation increase in need satisfaction reduced the odds of suicidal ideation by 53%, OR (95% CI) = 0.47 (0.33–0.67), and the odds of being at risk for suicidal behavior by 50%, OR (95% CI) = 0.50 (0.37–0.69). Young adults whose basic psychological needs are met may be less likely to consider suicide and engage in suicidal behavior. Prospective research is needed to confirm these associations.     

Dental pain related to quality of life and mental health in South Korean adults

High levels of stress, anxiety and depression have been reported in patients with orofacial pain. Dental pain has the potential to reduce quality of life (QOL), and pain relief is important aspect of QOL. The purpose of this study was to assess the relationships of dental pain with QOL and mental health using a nationally representative, population-based study. This study analyzed data from the 2012 Korea National Health and Nutrition Examination Survey (N = 5469). Oral health status was assessed using the oral health questionnaire, and oral examination was performed by trained dentists. Health-related QOL (HRQOL) was evaluated using EQ-5D and EQ-VAS, and mental health was evaluated by questionnaires. Logistic regression was applied to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI). Among 5469 adults, 1992 (36.42%) presented self-reported dental pain. Participants with anxiety/depression or pain/discomfort, and participants with stress, melancholy, suicidal thought or depression showed significantly higher prevalence of dental pain. After adjusting for covariates, five aspects of QOL and five aspects of mental health were related with dental pain. The AORs (95% CI) for dental pain were 1.39 (1.06–1.81) for mobility, 1.77 (1.19–2.63) for self-care, 1.38 (1.02–1.85) for usual activities, 1.73 (1.43–2.09) for pain/discomfort and 1.50 (1.13–1.98) for anxiety/depression. For mental health status factors, the AORs (95% CI) for dental pain were 1.29 (1.11–1.51) for stress, 1.37 (1.09–1.74) for melancholy, 1.26 (1.01–1.58) for suicidal thoughts, 1.43 (.93–2.19) for consultation to psychiatrist and 1.53 (1.07–2.19) for depression. This study showed that dental pain has an association with lower HRQOL and worse mental health status in South Korean adults.     

Association between intimate partner violence during pregnancy and maternal pregnancy complications among recently delivered women in Bangladesh

Intimate partner violence (IPV), an actual or threatened physical, sexual, or psychological abuse by a current or former partner or spouse, is a common global public health issue. Understanding both the prevalence of IPV during pregnancy and its potential impact on the health of pregnant women is important for the development and implementation of interventions to prevent maternal morbidity and mortality. The purpose of this study was to explore the association between maternal experiences of IPV during pregnancy and pregnancy complications. A health‐facility‐based cross‐sectional study was conducted from July 2015 to April 2016 among 400 randomly selected women who were admitted to the postnatal wards of Rajshahi Medical College Hospital for delivery. Data were collected through face‐to‐face interviews using a structured questionnaire. Multivariable logistic regressions were performed to assess relationships between variables of interest after controlling for potential confounders. Results indicated that 39.0% of women reported physical IPV and 26.3% of women reported sexual IPV during pregnancy. Additionally, 69.5% of women experienced medical complications (MCs); of this group, 44.3% experienced obstetric complications (OCs) and 79.3% experienced any pregnancy complication (AC) during their last pregnancy. The experience of physical IPV during pregnancy was significantly associated with the experience of MCs (adjusted odds ratio (AOR): 2.05, 95% confidence interval (CI): 1.15–4.01), OCs (AOR: 4.23, 95% CI: 2.01–7.12) and AC (AOR: 5.26, 95% CI: 2.98–10.52). Women who experienced sexual IPV during pregnancy were also at increased risk of suffering from any MC, any OC, and AC. Maternal experience of IPV during pregnancy is positively associated with pregnancy complications. Preventing IPV directed at pregnant women might reduce maternal morbidity and mortality in Bangladesh.

     

Ethnic differences in adolescents' mental distress, social stress, and resources

Limited data on ethnic group differences among young adolescents exist regarding the prevalence of mental distress, social stress, and resources. The aim of this cross-sectional study was to examine ethnic differences among African American (AA), European American (EA), Hispanic American (HA), and Asian American adolescents in mental distress, social stress, and resources. A total of 316 adolescents completed the self-administered questionnaire: The DSD, Somatic Symptom Scale, SAFE-C, FES, Coping, and Rosenberg's Self-Esteem Scale. The findings revealed that (1) Asian Americans and HAs reported significantly higher scores on social stress and mental distress and lower scores on resources than EAs; (2) Compared to EAs, AAs and HAs were more likely to experience social stress (2.2 < or = OR < or = 4.3), and HAs are more likely to have suicidal ideation (OR = 2.04; 95% CI = 1.04-3.98). Findings highlighted the importance of understanding the role of social stress in the development of adolescents' mental distress. Identified ethnic minority adolescents are vulnerable groups who require additional research and attention from health care providers.     

Medical Conditions and Nearly Lethal Suicide Attempts

P hysical illness has been studied as a risk factor for suicidal behavior, but little is known about this relationship among younger persons. We conducted a population‐based, case‐control study in Houston, Texas, from November 1992 through September 1995. The final sample consisted of 153 case‐ and 513 control‐subjects aged 13 to 34 years. Case patients were identified at hospital emergency departments and met criteria for a nearly lethal suicide attempt. Control subjects were recruited via a random‐digit‐dial telephone survey. Case patients were more likely than controls to report having any serious medical conditions (crude OR = 3.23; 95% CI = 2.12–4.91). After controlling for age, race/ethnicity, alcoholism, depression, and hopelessness, the adjusted odds ratio for men was 4.76 (95% CI = 1.87–12.17), whereas the adjusted odds ratio for women was 1.60 (95% CI‐0.62–4.17), suggesting that young men with medical conditions are at increased risk for nearly lethal suicide attempts. Increased efforts to identify and appropriately refer these patients are needed.     

Stigma Towards Homosexuality and AIDS Among Students of a Large Hispanic-Serving University

Homosexuality and AIDS-related stigma lead to failures in testing, disclosure of HIV status, and treatment for HIV. This study explored stigma towards AIDS and homosexuality among students of a large Hispanic-serving university in the southeastern United States (US). An online anonymous survey was emailed to 8000 randomly selected students. Two multiple choice questions about attitudes towards a professor with AIDS and a gay classmate were analyzed using Chi-square tests, simple and multivariable logistic regression to examine the association of stigma with other factors. Most (60%) of the 632 respondents were women. Only 7.8% of study participants reported stigmatizing attitudes of wanting to drop a class, sitting further away from, or feeling less comfortable in a class with a professor diagnosed with AIDS. Similarly, 7.8% of respondents would stigmatize a gay classmate by trying to avoid social contact or feeling uncomfortable talking with him. Males (adjusted odds ratio [AOR] 3.71, 95% confidence interval [CI] 1.95, 7.04) and non-Hispanic students (AOR 2.03, 95% CI 1.08, 3.81) had a higher—and those born in the US had a lower (AOR 0.43, 95% CI 0.23, 0.81)—odds of stigmatizing a gay classmate. No variables were significantly associated with stigmatizing attitudes towards a professor with AIDS. Stigmatizing attitudes towards a faculty member with AIDS or a gay classmate do not appear to be a major problem among students at this Hispanic-serving university. Interventions designed to further reduce gay-related stigma might focus on non-Hispanic young men who are born outside of the United States.     

Suicide Attempts within 12 Months of Treatment for Substance Use Disorders

There are limited prospective data on suicide attempts (SA) during the months following treatment for substance use disorders (SUD), a period of high risk. In an analysis of the Drug Abuse Treatment Outcomes Study, a longitudinal naturalistic multisite study of treated SUDs, variables associated with SA in the 12 months following SUD treatment were examined. Participants included 2,966 patients with one or more SUDs. By 12 months, 77 (2.6%) subjects had attempted suicide. Multivariate logistic regression analyses were used to identify variables associated with SA. Variables collected at baseline that were associated with SA included lifetime histories of SA, suicidal ideation (SI), depression, cocaine as primary substance of use, outpatient methadone treatment, and short‐term inpatient treatment. Male sex, older age, and minority race or ethnicity were associated with lower likelihood of SA. After controlling for baseline predictors, variables assessed at 12 months associated with SA included SI during follow‐up and daily or more use of cocaine. The data contribute to a small but growing literature of prospective studies of SA among treated SUDs, and suggest that SUDs with cocaine use disorders in particular should be a focus of prevention efforts.     

Non-Suicidal Self-Injury Among Ethnically and Racially Diverse Emerging Adults: Do Factors Unique to the Minority Experience Matter?

This study investigated clinically-significant non-suicidal self-injury (NSSI), defined as five or more lifetime episodes of NSSI, among racially and ethnically diverse emerging adults with a focus on factors unique to the minority experience. Seven hundred and nine emerging adults at an urban university, 85 % of whom were non-White, completed questionnaires assessing NSSI, racism, ethnic identity, Borderline Personality Disorder (BPD) characteristics such as impulsive behavior, emotion and interpersonal dysregulation and identity disturbance, suicidal behavior, and current depression and anxiety symptoms. Overall, 13 % of the sample reported a history of clinically-significant NSSI. Asian and White emerging adults reported significantly higher rates of NSSI than Hispanics and Blacks. Logistic regression analyses revealed positive relationships between BPD characteristics and NSSI and current anxiety and NSSI, which were not attenuated by increased ethnic identification. Experience with racism did not predict NSSI in the multivariate model. These findings are discussed as they pertain to current understanding and prevention of NSSI among racial and ethnic minority emerging adults.     

Collective identity and wellbeing of Roma minority adolescents in Bulgaria

In Europe and particularly in Bulgaria, Roma represent the largest low‐status minority group that is subjected to marked public intolerance and discrimination. This study examined links among Roma (N = 207) and Bulgarian (N = 399) adolescents’ ethnic, familial, and religious identities as salient identity aspects for their psychological wellbeing. Results indicated that, as expected, Roma youth reported lower levels of wellbeing than Bulgarian youth. The latter revealed a weaker religious identity than Roma youth, whereas no ethnic group differences emerged regarding Bulgarian or familial identity. Furthermore, we observed that collective identity was higher in older participants of both groups. Finally, a multigroup analysis using structural equation modeling showed that collective identity was a positive predictor of wellbeing for both Roma and Bulgarian adolescents. Findings demonstrated differences in salience as well as structural communalities regarding ways in which collective identity affects wellbeing of youth from two ethnically diverse communities.     

Suicidal Ideation and Associated Factors Among School-Going Adolescents in Harare,Zimbabwe

This study determined the prevalence and associated factors of suicidal ideation among school-going adolescents in Harare, Zimbabwe. Data on 1970 respondents were obtained from a cross sectional study of the Global School-based health survey. Respondents were selected using a two-stage probability sampling technique. The prevalence of suicidal ideation was 21.6%. Males were less likely to have suicidal ideation than females (OR=0.70; 95% CI 0.54,0.91). Worrying (OR=1.81; 95% CI 1.29,2.56), feeling of loneliness (OR=2.04; 95% CI 1.43,2.90), cigarette smoking (OR=1.87; 95% CI 1.11, 3.16), and drinking alcohol (OR=1.74; 95% CI 1.17, 2.60) were associated with suicidal ideation. Public health programs designed to control cigarette smoking and alcohol use may also impact positively on suicidal ideation.     

Associations between delinquency and suicidal behaviors in a nationally representative sample of adolescents

Suicide was the second leading cause of death for 14-17 years olds in 2002. Prior studies indicate that suicidal behaviors are especially common among juvenile delinquents, yet this association has not been examined in a national sample. The 2003 Youth Risk Behavior Surveillance System was used to examine associations between suicidal behaviors and delinquency in a nationally representative sample of 14-17 year olds. Results indicated that delinquent adolescents were more likely to have seriously considered suicide (adjusted odds ratio [AOR] = 5.44), made a suicide plan (AOR = 4.90), attempted suicide (AOR = 10.08), and required medical treatment after attempting suicide (AOR = 14.61) compared to their nondelinquent counterparts. Delinquency was significantly related to suicidal behaviors for boys and girls, but the magnitudes of effects were larger for girls. This finding suggests that delinquent youth, particularly delinquent girls, should be targeted in interventions to reduce suicidal behaviors.     

Suicidal behavior in adolescent and young adult gay men

The relationship of homosexuality to suicidal behavior was explored by questionnaire responses from 52 men in gay-and-lesbian college organizations and 56 men in gay rap groups. A family background of alcoholism and physical abuse, social supports perceived as rejecting of homosexuality, and no religious affiliation were associated with a history of suicidal ideation, reported by 55% of the participants. Racial/ethnic minorities tended to be overrepresented among suicidal as compared to nonsuicidal gay men. Suicide attempts, reported by 20% of the sample, were most often associated with intrapersonal distress, and occurred most often while individuals were "closeted" and/or in the context of recent rejection for being homosexual. Nearly all attempters were aware of their homosexual feelings, but had not yet established a "positive gay identity" at the time of their first suicide attempt. Suicidal behavior in gay youths may be the product both of familial factors that predispose youths to suicidal behavior, and for social and intrapersonal stressors involved in coming to terms with an emerging homosexual identity.     

Transgender youth and life-threatening behaviors

Sexual minority status is a key risk factor for suicide among lesbian, gay, and bisexual youth; however, it has not been studied among transgender youth. Fifty-five transgender youth reported on their life-threatening behaviors. Nearly half of the sample reported having seriously thought about taking their lives and one quarter reported suicide attempts. Factors significantly related to having made a suicide attempt included suicidal ideation related to transgender identity; experiences of past parental verbal and physical abuse; and lower body esteem, especially weight satisfaction and thoughts of how others evaluate the youths' bodies. Sexual minority status is a key risk factor for life-threatening behaviors among transgender youth.     

The Association of Multiple Identities with Self‐Directed Violence and Depression among Transgender Individuals

Transgender individuals have a high prevalence of self‐directed violence; however, there is scant literature focusing on their unique experiences. The differences in self‐harm, suicidal ideation, suicide attempt, and depression based on racial/ethnic identity and sexual orientation were examined among transgender individuals. Data were gathered from the Fall 2008 and Spring 2009 National College Health Assessment. Across racial/ethnic identities, greater proportions of transgender students endorsed self‐directed violence than their cisgender peers. Among transgender individuals, sexual minorities were more likely to report suicidal ideation than their heterosexual peers, and racial/ethnic minorities had higher odds of attempting suicide than non‐Hispanic White individuals.     

Childhood Parental Death and Lifetime Suicide Attempt of the Opposite‐Gender Offspring in a Nationwide Community Sample of Korea

Although previous studies have shown that childhood parental death influences suicide attempts of their offspring, few studies have examined influence of gender and age at exposure. Koreans show the third highest suicide rate in the world, and many children and adolescents lost their parents during and after the Korean War. A total of 12,532 adults, randomly selected through a one‐person‐per‐household method, completed the Korean version of the Composite International Diagnostic Interview and questionnaire for suicidal ideation, plan, and attempt (response rate 80.2%). A total of 2,332 subjects experienced biological parental death in childhood (18.6%). Male suicide attempts were associated with age of exposure to maternal death from 0 to 4 years (adjusted OR = 4.48, 95% CI 1.32–15.18) and from 5 to 9 years (adjusted OR = 5.52, 95% CI 1.97–16.46), but not with paternal death, after adjusting for age, education years, marital status, monthly income, and psychiatric comorbidities. Female suicide attempts were associated with paternal death from 5 to 9 years (adjusted OR = 2.20, 95% CI 1.13–4.27), but not with maternal death. Childhood parental death is significantly associated with lifetime suicide attempt in the opposite‐gender offspring, especially when exposure occurs before age 10.