Further suicidal behavior among medically serious suicide attempters

Analysis of rates of further suicidal behavior among individuals making medically serious suicide attempts may help to predict suicide and suicide attempt from baseline characteristics of the individual and the index suicide attempt. Data are drawn from a 5-year study of 302 individuals making medically serious suicide attempts with information collected by personal interview at baseline, 6, 18, 30, and 60 months after the index attempt. Within 5 years, 6.7% died by suicide; 37% made at least one nonfatal suicide attempt. Although baseline characteristics permitted a modest prediction of suicide attempt, only a very limited prediction of suicide was possible. Almost half of those who made serious suicide attempts made a further fatal or nonfatal attempt within 5 years. These findings imply the need for enhanced follow-up, treatment, and surveillance of all patients making serious suicide attempts.     

Suicide ideation at its worst point: a predictor of eventual suicide in psychiatric outpatients.

Scales for measuring current suicide ideation (SSI-C), suicide ideation at its worst point in the patient's life (SSI-W), and hopelessness (BHS) were administered to 3,701 outpatients seeking psychiatric treatment. Thirty patients from this sample eventually committed suicide, within a mean of 4 years from the initial assessment. Based on cut-off scores derived from receiver operating characteristic (ROC) analyses, the SSI-W had an odds ratio of 13.84 for predicting suicide, whereas the SSI-C and the BHS had odds ratios of 5.42 and 6.43, respectively. The assessment of suicide ideation at its worst point identifies a subgroup of patients at relatively high risk for eventual suicide. Robust interventions and periodic monitoring for suicide ideation and hopelessness are recommended to reduce long-term suicide risk.     

Suicides in the developing world: case study from Pakistan

There are no official data on suicide from Pakistan, a conservative South Asian Islamic country with traditionally low suicide rates. Both suicide and attempted suicide are illegal acts, as well as socially and religiously condemned, making research in this area difficult. Recent reports suggest an increase in suicide rates. In this study, police data from the Sindh province were examined to provide a unique picture of trends of suicide over 15 years (1985-1999). During this period there were 2,568 reported suicides (71% men, 39% women; ratio 1.8). The lowest number was 90 in 1987 and maximum was 360 in 1999. Poisoning by organophosphates was the most common method followed by hanging. This study, although limited in scope, provides evidence of an increase in suicide rates in Pakistan, from one data source. There is urgent need for further research on suicide in Pakistan; interventions for suicide prevention in the country can then be planned.     

The effectiveness of family-based cognitive-behavior grief therapy to prevent complicated grief in relatives of suicide victims: the mediating role of suicide ideation

Grief interventions are more effective for high risk individuals. The presence of suicide ideation following suicide bereavement was examined to determine whether it indicates a high risk status. Using data from a randomized controlled trial (n = 122) on the effectiveness of cognitive-behavior therapy, the effect of suicide ideation on the effectiveness of grief therapy on the bereavement outcome at 13 months post loss was examined. Results show that suicide ideators more often have a history of mental disorder and suicidal behavior than non-ideators, and suicide ideation indicates a high risk for adverse bereavement outcome. Grief therapy likely reduces the risk of maladaptive grief reactions among suicide ideators. Therefore, suicide ideators may benefit from grief therapy following a loss through suicide.     

Suicide: a 15-year review of the sociological literature. Part I: cultural and economic factors

Cultural and economic patterns from 130 sociological works on suicide from 1981 to 1995 are reviewed in this article. The traditional Durkheimian perspective on suicide was often questioned by research on the impact of the mass media, alcohol, class, modernization, religion, and politics. Major theoretical developments included the application of differential identification theory to Phillips's model of copycat suicide, the application of criminology's opportunity theory to suicide, and new explanations for the link between alcohol and the social suicide rate. Explanations are reviewed for the major new suicide trend: after half a century of convergence, male and female suicide rates are diverging. Finally, the review notes patterns of continued stability in suicide research findings in areas such as racial differences and economic strain.     

Clarifying the Relationship of Parental Bonding to Suicide Ideation and Attempts

Suicide and suicidal behavior are major public health problems, especially among adolescents and young adults. Previous research has established links between parental bonding and suicidality; however, it remains unclear whether parental bonding is associated with suicide ideation, the progression from suicide ideation to suicide attempts, or both. This study examined the relation of parental bonding to suicide ideation and suicide attempts in adolescents from two settings: (1) acute psychiatric care (n = 172) and (2) high school (n = 426). All participants were administered validated measures of parental bonding, suicide ideation, and suicide attempts, as well as emotion dysregulation, loneliness, and self‐worth. In the psychiatric sample, lower parental care significantly differentiated adolescents with a history of suicide attempts from those with suicide ideation only or without histories of suicidality. This pattern remained even after controlling for other known correlates of suicidality (i.e., emotional dysregulation, loneliness, and low self‐worth). Similar effects were found in the community sample, although these findings failed to reach statistical significance. In both samples, parental overprotection was not associated with suicide ideation or suicide attempts. Results suggest that parental care may be an important risk factor for youth suicidal behavior and may help differentiate suicide attempters from suicide ideators.     

A Comparison of Suicide Note Writers with Suicides Who Did Not Leave Notes

There is disagreement in the suicide literature on the value of suicide notes as a data source, particularly regarding the extent to which suicide decedents who write notes differ from those who do not. Using 10 years of suicide cases from Summit County, Ohio, these two groups were compared on 40 variables including sociodemographic characteristics, reported affect before death, precipitating events, physical and mental health status and care, and method of suicide. The only differences found were that note writers were more likely to have lived alone and had made prior suicide threats. These findings suggest that for research purposes, suicide cases with and without notes are essentially similar.     

Impact of Firearm Availability and Gun Regulation on State Suicide Rates

Past studies on suicide have investigated the association of firearm ownership and suicide risk in the United States. The aim of the present study was to build on previous work by examining the impact of firearm storage practices and the strictness of firearm regulation on suicide rates at the state level. Data were compiled from primarily three sources. Suicide and firearm ownership information was obtained from the Centers for Disease Control and Prevention. Strictness of handgun regulation was derived from figures available at the Law Center to Prevent Violence, and controls were taken from the US Bureau of the Census. Mixed models were fitted to the data. Household firearm ownership was strongly associated with both suicide by all mechanisms, and firearm suicide. Storage practices had especially elevated consequences on suicide rates. Percent with loaded guns and gun readiness increased suicide rates, and strictness of gun regulation reduced suicide rates. Ready access to firearms can make a difference between life and death. Loaded and unlocked firearms within reach become risk factors for fatal outcomes from suicidal behavior. Future research might want to examine ways of obtaining more recent data on individual firearm ownership. This study proposes several policy recommendations for suicide prevention.     

Laying down one's life for oneself.

Roman Catholicism has long opposed suicide. Although Scripture neither condones nor condemns suicide explicitly, cases in the Bible that are purported to be suicides fall into several different categories, and the Roman Catholic tradition can show why some of these should be considered morally wrong and some should not. While Christian martyrdom is praised, it is not correct to argue that this Christian outlook invites suicide, or that it recommends physician-assisted suicide for altruistic motives. Church Tradition, from its earliest days, has clearly distinguished martyrdom from suicide. The principles of double effect and cooperation, mainstays in Roman Catholic moral theology, enable one to see the moral difference between martyrdom and suicide, and to appreciate why physician-assisted suicide is wrong for both patient and physician.     

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.     

Differentiating Suicide Ideators from Attempters: Violence—A Research Note

Which factors distinguish suicide attempters from suicide ideators is a relatively neglected question in suicidology. Data from the 2001 Youth Risk Behavior Survey, encompassing 1,439 youth suicide ideators and 1,097 attempters, was used to explore which factors best differentiate suicide attempters from ideators, with a focus on violence involvement. Measures of violence include the contexts of fights, dating, and weapons carrying. Controls were incorporated for psychiatric disorders, risky sexual behavior, school integration, and demographics. Controlling for the other variables, violence differentiated attempts from ideation: fighting (OR = 2.18) and weapon carrying (OR = 1.13). Psychiatric factors that predicted attempts over ideation included major depression (OR = 1.86), use of cocaine (OR = 2.34), and having a suicide plan (OR = 2.69), while demographic factors included gender, age, residence in the Midwest, and Hispanic, African American, or Asian ethnicity. A supplementary analysis (N = 11,546) determined that violence also helped to differentiate suicide ideators from nonsuicidal youth. Four factors (including violence involvement, eating disorders, and gender consistently) differentiated both between suicide attempts and ideation, and also between suicide ideators and nonsuicidal youth. The link between violence involvement and suicidality is interpreted in terms of the capability for suicide from the interpersonal theory of suicide.     

Examining the narrative roles in suicide notes

The present study examines suicide notes, using a sample of suicide notes from published corpora (N = 50), combined with a sample of recent suicide notes from a suicide website (N = 50). The present study proposes a model of differentiation in completed suicides. The characteristics of the suicide notes were analysed using a content dictionary developed by Giles in 2007, and the data subjected to smallest space analysis. Four themes of suicide completer were discovered: Egoistic Victim, Anomic Hero, Altruistic Professional and Fatalistic Revenger. The implications of these findings and the potential use in therapy work with suicide survivors and those with suicidal ideation are discussed, as well as suggestions for the direction of future research.     

Suicide attempts and ideation: adolescents evaluated on a pediatric ward

This study compared psychological, familial, and demographic data for 42 suicidal, 16 suicide ideation, and 42 control pediatric patients. Chaotic families and behavior problems, as well as depression, constriction, and lack of insight, differentiated the suicide attempt group from the control group. The suicide ideation group was similar to both the control and suicide attempt groups and seen as "intermediate" between these two. In assessing lethality of the attempt, constriction was the only predictor differentiating the serious from less serious suicide attempt.     

The Epidemiology of Homicide followed by Suicide: A Systematic and Quantitative Review

This systematic review of population based studies of homicide followed by suicide was conducted to examine the associations between rates of homicide‐suicide, rates of other homicides and rates of suicide. The review analysed 64 samples, including the case of an outlier (Greenland) that were reported in 49 studies. There was a significant association between the rates of homicide‐suicide and those of other homicides in studies from the U.S.A. Outside the U.S.A. there was no clear association between homicide‐suicide and other homicide but there was modest but significant association between rates of suicide and homicide‐suicide. Homicide‐suicide appears to be closer in epidemiological terms to homicide than suicide in regions with high rates of homicide and measures to reduce homicide in these regions may also reduce homicide‐suicide.     

National differences in intelligence and population rates of suicidal ideation, suicide plans, and attempted suicide

Population rates of suicidal ideation, suicide plans or attempted suicide from three independent multinational epidemiological surveys (the WHO/EURO and WHO SUPRE-MISS studies and a third one) were not significantly associated with national IQ figures. This result conflicts with previous evidence from cross-national studies (by Lester and by Voracek) of a positive ecological correlation between level of national intelligence and rates of completed suicide. Across nations, the indicators for the prevalence of suicidal behavior also lacked close correspondence with suicide rates, which may be due to the higher unreliability of assessing covert suicidal behavior (suicide ideas, thoughts, plans, and, to a lesser extent, also suicide attempts) as compared to suicidal behavior that is indisputably overt (completed suicide). Several alternative explanations for the current nil findings are also discussed.     

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.     

Changing age patterns of U.S. male and female suicide rates, 1934-1983

Changes in the age patterns of U.S. male and female suicide rates from 1934 to 1983 are examined, using official suicide data. Among whites, the age patterns of male and female suicide rates have become less concordant since about 1960. In contrast, the age patterns of nonwhite male and female suicide rates have become more concordant since the mid-1950s. A review of sociological theories of suicide identifies problems in accounting for such changes--problems stemming in part from what has been a theoretical emphasis on cross-sectional relations.     

Changing the Direction of Suicide Prevention in the United States

It is axiomatic that the goal of suicide prevention is the prevention of suicide. Yet in spite of significant efforts to this end since the middle of the last century, and most notably in the last decade, the rate of suicide in the U.S. has not declined; rather, it has increased. To address this issue, Suicide Awareness Voices of Education (SAVE) brought together leading prevention specialists from other public health problems where successes have been achieved, representatives from countries where suicide rates have declined, and U.S. based suicide prevention researchers and program directors, to “think outside the box” and propose innovative, scalable approaches that might better drive success in achieving desired results from U.S. suicide prevention efforts. The recommendations should challenge our preconceptions and force us outside our own mental constraints to broaden our perspectives and suggest catalysts for real change in suicide prevention.     

Marital status integration, suicide disapproval, and societal integration as explanations of marital status differences in female age-specific suicide rates

Sociological analyses of suicide have often neglected female suicide rates. Three competing explanations are tested to determine why the suicide rates of married women are, typically, lower than the suicide rates of women who are not married: (1) marital status integration, (2) societal integration, and (3) a nation's normative order about disapproval of suicide. Data refer to age and marital status-specific female suicide rates from 12 developed countries. The results provide the strongest support for the marital status integration theory and consistent support for the social integration perspective. There is also mixed support for the cultural disapproval of suicide hypothesis.     

MMPI ratings of suicide risk.

Among past attempts to use MMPI data to predict suicidal behavior, there has been a lack of research on the ability of clinicians to identify MMPI profiles of suicidal persons. In this study, the MMPI profiles of 20 male psychiatric patients who committed suicide and the MMPI profiles of 20 male patients who did not attempt or commit suicide were presented to six clinical psychologists with expertise in MMPI interpretation. The clinicians were asked to classify each MMPI profile as coming from a patient who did or did not later commit suicide, and to rate eight variables thought to be relevant to the assessment of suicide risk. Data analysis revealed that the clinicians could not identify suicide and nonsuicide patients from their MMPI profiles. Furthermore, the ratings of the eight suicide variable did not differentiate suicide and nonsuicide patients.