Association between tryptophan hydroxylase 2 gene polymorphism and completed suicide

The association between suicide and a single nucleotide polymorphism (rs1386483) was examined in the recently identified tryptophan hydroxylase 2 (TPH2) gene. Blood samples of 143 suicide victims and 162 age- and sex-matched controls were examined. The frequency of the TT genotype in the TPH2 polymorphism was higher in suicide victims than in controls (17.5% vs. 8.6%; p = 0.02), particularly in those with a history of repeated suicide attempts (53.3% vs. 8.6%; p < 0.0001). The examined TPH2 polymorphism was found to be associated with suicide. This genetic marker may be particularly important in understanding risk of multiple suicide attempts. Further analyses are needed to confirm these results.     

Effects of stressful life events on human brain structure: a longitudinal voxel-based morphometry study

Although stressful life events (SLEs) have been associated with an increased risk of illness and mental disorder, their impact on brain anatomy remains poorly understood. Using a longitudinal design, we tested the hypothesis that SLEs are significantly associated with changes in gray matter volume (GMV) in brain regions previously implicated in post-traumatic stress disorder (PTSD) in a group of clinically healthy adults. Magnetic resonance imaging was used to acquire an anatomical scan from 26 subjects (13 males and 13 females; mean age ± SD: 25.2 ± 4.3 years), with no psychiatric diagnosis, at two time points with a 3-month interval. Voxel-based morphometry was used to examine an association between SLEs and gray matter changes during this period. The number of SLEs was associated with a decrease in GMV in the anterior cingulate, hippocampus, and parahippocampal gyrus (p < 0.001). In contrast, there were no areas where the number of SLEs was associated with an increase in GMV. These results provide evidence that, in adults with no formal psychiatric diagnosis, SLEs are associated with GMV decreases in a subset of regions implicated in PTSD, and that these alterations can be observed within a period as short as 3 months.     

Factors of Early Suicide after Discharge: A National Linkage Study for Suicide Victims in Taiwan

Patients recently discharged from psychiatric inpatient care have a higher suicide rate. The study aimed to identify the characteristics associated with early suicide of those patients discharged from psychiatric wards in Taiwan. The results indicated that among 672 suicide victims who died within one year post‐discharge from psychiatric wards in Taiwan between 2000 and 2004, diagnosis of schizophrenia, shorter disease duration, and co‐morbidity with cancer were all significantly associated with suicide occurring within one month of discharge. Clinical diagnosis of psychiatric disorders, recent psychiatric diagnosis, and co‐morbidity with severe physical illnesses should receive special monitoring for potential suicide after discharge.     

Circulating Levels of Brain‐Derived Neurotrophic Factor and History of Suicide Attempts in Women

A growing body of research examining biological factors associated with suicidal behaviors highlights the role of brain‐derived neurotropic factor (BDNF), involved in neurogenesis and synaptic plasticity. There is evidence suggesting that suicide attempters have lower BDNF levels than those with no history of suicide attempts. The key question addressed in the current investigation is whether differences in circulating BDNF levels persist beyond the current suicidal episode and would be observed in those with a past history of suicide attempts (SA). Plasma levels of BDNF were assessed in 73 women from the community. We found that women with a history of SA exhibited lower levels of BDNF than women with no SA history and this difference was maintained after statistically controlling for the influence of other potential psychiatric or demographic factors. These findings support and extend existing research by suggesting that circulating BDNF levels are decreased among individuals with a history of SA compared to individuals with no history of SA. This relation appeared to be specific to women's history of SA and was not explained by other potential psychiatric or demographic factors, which further highlights the role of BDNF as a promising biomarker for suicidal behavior.     

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.     

Suicide, schizophrenia, and schizoid-type psychosis: role of life events and childhood factors

The first objective was to identify the provoking events of suicide in patients with schizophrenia or schizoid-type disorder, and to assess the humiliation component of these events. The second objective was to verify if quality of care during childhood is a vulnerability factor for suicide in patients with schizophrenia or schizoid-type psychosis. Thirty-three cases of suicide with a diagnosis of schizophrenia or schizoid-type psychosis were compared with 34 living patients with a similar diagnosis. The psychological autopsy method was used. The assessments were made with the Structured Clinical Interview for the Diagnostic and Statistical Manual for Axis I mental disorders, the Life Events and Difficulties Schedule, and the Child Experiences and Child Abuse Interview. The suicide group (SG) experienced more often a recent severe event, usually of a humiliation nature, than the control group (CG). It also experienced more severe events associated with aggressive behavior or with psychiatric impairment. Contrary to expectations, the CG had worse scores than the SG for quality of care during childhood. In conclusion, suicide in schizophrenia is related both to environmental stress and to psychiatric impairment.     

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.     

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.     

Characteristics of a French African Caribbean Epidemiological Psychiatric Sample with a History of Suicide Attempt

Research on vulnerability factors among ethnic groups, independent of primary psychiatric diagnosis, may help to identify groups at risk of suicidal behavior. French African Caribbean general psychiatric patients (N = 362) were recruited consecutively and independently of the primary psychiatric diagnosis. Demographic and clinical characteristics and lifetime history of suicide attempts were recorded. Sixty‐five patients (18%) had a history of at least one suicide attempt. Presence of professional qualifications, children, poor social contacts, treatment with benzodiazepine at inclusion, and poor treatment compliance were all associated with a lifetime history of suicide attempts.     

Suicide mortality of suicide attempt patients discharged from emergency room, nonsuicidal psychiatric patients discharged from emergency room, admitted suicide attempt patients, and admitted nonsuicidal psychiatric patients

The suicide mortality rate and risk factors for suicide completion of patients who presented to an emergency room (ER) for suicide attempt and were discharged without psychiatric admission, patients who presented to an ER for psychiatric problems other than suicide attempt and were discharged without psychiatric admission, psychiatric inpatients admitted for suicide attempt, and psychiatric inpatients admitted for other reasons were examined. The records of 3,897 patients who were treated at a general hospital in Seoul, Korea, from July 2003 to December 2006 were reviewed. Forty-three of the 3,897 subjects died by suicide during the 2.5-year observation period. Compared to the general Korean population, the suicide mortality rate was 82-fold higher for suicide attempt patients, admitted; 54-fold higher for suicide attempt patients, discharged; 21-fold higher for nonsuicidal patients, admitted; and 11-fold higher for nonsuicidal patients, discharged. In all four groups, diagnosis of a depressive disorder and suicide attempt at presentation were each significant independent risk factors for suicide completion. These results highlight the need for suicide prevention strategies for depressed patients who present to the ER or are admitted to a psychiatric ward after a suicide attempt.     

Risk Factors of a Suicide Reattempt by Seasonality and the Method of a Previous Suicide Attempt: A Cohort Study in a Japanese Primary Care Hospital

Suicide has a great impact on the individual whose life is lost and the bereaved family members. The risk of a suicide reattempt is particularly high during the first 12 months after a suicide attempt. In this cohort study, risk factors for a suicide reattempt were explored among 291 patients at suicide risk. Clinical and demographic data were collected from a Japanese primary care hospital. Past psychiatric history and multiple diagnoses were associated with suicide reattempts in both genders. Drug overdose, past psychiatric history, and the summer season were linked to suicide reattempts among males. Past psychiatric history and multiple diagnoses were linked to suicide reattempts among females. Appropriate assessment of past psychiatric history, season and method of suicide attempt, gender, and diagnosis may play a role in preventing suicide.     

Personality patterns of suicide attempters: gender differences in Ukraine

In the present study, an attempt has been made to investigate the complete 'pattern' of a suicide attempter (SA) within the set of Big Five traits. Two models were used: M1, which includes the five main dimensions of Big Five in the analysis; and M2, which includes facets of those dimensions which were identified as important in M1. The study consisted of a group of SA (men - 326, women - 299) and a group of healthy volunteers (HV) (men - 143, women - 190) with a similar age range. Discriminant analysis (DA) showed that the factors most significant in discriminating the personality pattern of a male SA are (in decreasing order): (E) Extraversion, (N) Neuroticism, (C) Conscientiousness and (O) Openness; and for a female SA these factors were (E) Extraversion, (C) Conscientiousness and (A) Agreeableness. In M2 for men, the largest contribution to pattern recognition is (N3) Depression. Moreover, in M2 for men significant characteristics were (in descending order): (E6) Positive Emotions, (O1) Fantasy, (E4) Activity, and also (N2) Angry Hostility, (C3) Dutifulness, (C4) Achievement Striving, (C2) Order and (O6) Values; and for women: (E4) Activity, (C6) Deliberation, (C2) Order, (A6) Tender-Mindedness, (E5) Excitement Seeking, (E6) Positive Emotions, (C4) Achievement Striving, (A2) Straightforwardness, (C5) Self-Discipline and (E1) Warmth. Analysis of the obtained data demonstrates that suicide attempts amongst males, can largely be associated with personality variables reflecting negative emotions; while female suicide attempts are primarily associated with variables regarding activity and self-regulation.     

Cognitive and Social Factors Associated with NSSI and Suicide Attempts in Psychiatrically Hospitalized Adolescents

Although non-suicidal self-injury (NSSI) and suicide attempts (SA) frequently co-occur among youth, there is increasing evidence that both the risk factors and the phenomenology of the behaviors are distinct. This study examined how individuals who engage in NSSI only, individuals who attempt suicide only, and those who have histories of both NSSI and at least one suicide attempt may differ in terms of cognitions and perceived social support. Participants were 185 adolescents (78.1 % female) between the ages of 13 and 18 recruited from a psychiatric inpatient facility in the northeastern United States. One hundred forty-eight teens were identified with a history of self-injurious behavior and divided into three groups: NSSI only (n?=?45), SA only (n?=?24) or both NSSI and SA (NSSI+SA; n?=?79). Analyses showed that the NSSI+SA group exhibited more cognitive errors, negative self-statements, and negative views of self, world, and future, as well as less perceived familial support than either the NSSI or SA only groups. There were no differences between groups on perceived support from teachers or peers. No significant demographic or diagnostic differences were found between the NSSI and SA groups. Limitations and clinical implications of the current research are discussed.     

Psychache and suicide: a preliminary investigation

Shneidman's Psychological Pain Assessment Scale (PPAS; 1999) was administered to 88 psychiatric patients. Both current and worst-ever psychache were significantly higher in those patients judged by a psychiatrist, on the basis of a structured clinical interview, to be at risk of suicide. However, current and worstever psychache were not associated with having attempted suicide in the past. Thus, for the present sample of psychiatric patients, the PPAS appears to be more sensitive to current suicidality than to past suicidality. Further, there are validity issues with the PPAS, with the need for multi-item measures and probably a multifactor measure.     

Timing of Stressful Life Events Affects Stability and Change of Neuroticism

Neuroticism is a predictor of many health problems. To study the determinants of within‐subject change in neuroticism, three hypotheses were tested: (i) subjects who experienced stressful life events (SLEs) show an increase in neuroticism; (ii) high baseline neuroticism moderated this effect; and (iii) recent SLEs had a greater impact on neuroticism than distant SLEs. Data came from the Finnish Twin Cohort. Neuroticism data were collected in 1975 and 1981 and SLEs data in 1981 (n = 21 085). By entering baseline neuroticism as a predictor for neuroticism at follow‐up, the outcome measure was change in neuroticism. Changes in neuroticism were predicted from SLE indices or their interaction with baseline neuroticism. Timing of SLEs was taken into account by distinguishing recent from distant SLEs. To control for confounding by shared genes and environments, both within‐twin pair and between‐twin pair effects were tested for monozygotic and dizygotic twin pairs separately. Neuroticism's six‐year stability was high (r = .58, p < .001). Exposure to SLEs modestly increased neuroticism (βs > .55, ps < .001), unconfounded by shared genes. This effect was not moderated by high baseline neuroticism. Recent SLEs (.09 < βs < .15) had more impact than distant SLEs (.03 < βs < .11; ps < .01). In conclusion, the findings strongly supported a model of environmentally driven SLEs causing dynamic fluctuations around a person's set point of neuroticism. Copyright © 2013 John Wiley & Sons, Ltd.     

Suicide in Psychiatric Patients: Age Distribution

ABSTRACT: In eight years, 21183 San Diego County residents killed themselves. Of these, 52 had been at some time patients of one private psychiatric group. The suicide rate increased with age for the county population but not for the psychiatric patients. This difference was highly significant. Although older people generally are at greater risk for suicide, older psychiatric patients may be more responsive to treatment.     

Risks of Mortality of Suicide Attempters Compared with Psychiatric and General Populations

ABSTRACT: This study compares mortality risk among suicide attempters, psychiatric patients, and members of the general population using demographic data from the Monroe County (New York) Psychiatric Case Register for 1960 to 1970. During this 11-year period there were 172 deaths reported for the suicide attempt group, 6,108 for the Psychiatric Register population, and 58,542 for the general population. The relative risk of death from all causes of the suicide attempt group was nearly twice that of the general population and slightly higher than that of the psychiatric group. High risks of mortality were differentially associated with several demographic and treatment variables. Implications for predictive criteria and interventive strategies are discussed.     

Testing the Four Main Predictions of the Interpersonal–Psychological Theory of Suicidal Behavior in an Inpatient Sample Admitted Due to Severe Suicidality

This study aimed to evaluate four main predictions of the Interpersonal Psychological Theory of Suicide (IPTS): the importance of perceived burdensomeness (PB), thwarted belongingness (TB), hopelessness (H), and capability for suicide (CS) for (passive/active) suicide ideation, suicide intent and suicide attempts. N = 308 psychiatric inpatients admitted due to severe suicidality (53.6% female: n = 165; age: M = 36.82, SD = 14.30, range: 18–81) completed self-report measures of TB, PB, H, CS and suicide ideation as well as interviews on suicide intent and suicide attempts. TB and PB were associated with (passive/active) suicidal ideation, whereas the three-way interaction PB, TB, and H was not associated with active suicide ideation. Fearlessness about death in conjunction with active suicidal ideation was not associated with suicide intent and the interaction of PB, TB, and CS was neither predictive of recent suicide attempt status nor lifetime number of suicide attempts. Given the cross-sectional nature of the data, conclusions on causality should be handled carefully. The results challenge the theoretical validity of the IPTS and its clinical utility—at least within the methodological limitations of the current study. Yet, findings underscore the importance of PB in understanding suicidality.     

Psychiatric and Self‐Injury Profiles of Adolescent Suicide Attempters versus Adolescents Engaged in Nonsuicidal Self‐Injury

To better delineate the unique correlates of self‐injurious behaviors (SIB), psychiatric profiles of mutually exclusive groups of adolescents who made a suicide attempt (SA) versus those engaged in nonsuicidal self‐injury (NSSI) were examined. Contrary to hypotheses, the NSSI group endorsed earlier onsets of SIB and suicidal ideation (SI), as well as higher rates of depression and anxiety compared with their SA counterparts. Future work is warranted to understand the role of SI, including duration of SI and anxiety in the development of NSSI, and to identify risk and resiliency factors useful in predicting an adolescent's SIB status.     

Peer Victimization and Suicidal Thoughts and Behaviors in Depressed Adolescents

Suicide is a leading cause of death among youth worldwide, and depressed adolescents are at a significantly elevated risk to report suicidal ideation, planning, and attempts. Peer victimization is a robust predictor of adolescent suicidal thoughts and behaviors (STBs), but little research has focused on why bullying leads to suicidal thoughts and behaviors. To address this empirical gap, we recruited 340 (246 female) depressed adolescents ages 13–19 (M = 15.59, SD = 1.41) within 48 h of admission for acute psychiatric treatment. At the initial assessment, participants were administered clinical interviews characterizing psychopathology, nonsuicidal self-injury, and STBs (ideation, plans, and attempts). Further, they completed questionnaires assessing 3 forms of victimization (overt, relational, and reputational), recent risky behavior engagement, and psychiatric symptom severity. Controlling for internalizing symptoms and age, overt and reputational bullying were associated with more frequent past month suicide attempts, but not suicide ideation. Past month risky behavior engagement, but not NSSI, mediated the relation between victimization and attempts. However, sex differences revealed that this effect only held for males whereas bullying was directly associated with suicide attempts among females. In contrast, overt and relational bullying were non-linearly associated with suicide plans, and these relations were not mediated by risky behaviors or NSSI. Results highlight the complex network of factors that lead victimized adolescents to engage in STBs and may inform targeted suicide prevention and intervention programs.