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.     

Risk factors associated with suicide attempts and other self-injury among Hong Kong adolescents

This study examined 1,361 Chinese adolescents who reported self-injurious behaviors. Groups A and B both acknowledged deliberate self-injury, but only Group A had made a suicide attempt. Group C reported accidental self-injury. Deliberate self-injurers (Groups A and B) were more frequently girls, older, and with more suicidal ideation. Group A had more psychopathology, environmental and suicide-related risk factors than group B and C. Group C had higher depressive symptoms than noninjured controls. The study clarifies differences among self-injurious behavior groups based on expressed deliberate self-injury and self-reported suicide attempt. These three groups appear to present a continuum of risk.     

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.     

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.     

Discerning reported suicide attempts within a youthful offender population

With suicide being the third leading cause of death among young people, early identification of risk is critical, particularly for those involved with the juvenile courts. In this study of court-involved youth (N = 433) in two Midwest counties, logistic regression analysis identified some expected and unexpected findings of important demographic, educational, mental health, child welfare, and juvenile court-related variables that were linked to reported suicide attempts. Some of the expected suicide attempt risk factors for these youth included prior psychiatric hospitalization and related mental health services, residential placement, and diagnoses of depression and alcohol dependence. However, the most unexpected finding was that a court disposition to shelter care (group home) was related to a nearly tenfold increased risk in reported suicide attempt. These findings are of importance to families, mental health professionals, and juvenile court personnel to identify those youth who are most at risk and subsequently provide appropriate interventions to prevent such outcomes.     

Six year follow-up of health status changes in Danish adults with suicide tendency in 1994

The purpose of this study was to determine whether suicidal ideation and/ or suicide attempts have any long-term health effects. The relationship between suicidal thoughts and/or a previous suicide attempt in 1994 and the presence of suicidal ideation in 2000 was analyzed. We found that health status in 1994 differed significantly between the groups with and without suicidal ideation or a previous suicide attempt and that the differences persisted or even deepened (not significant) after 6 years. Further, people who had suicidal ideation or a suicide attempt in 1994 had a significantly greater risk (OR = 7.4) of having suicidal ideation in 2000 than people who had not.     

Inpatient suicide in a Chinese psychiatric hospital

Little is known about the risk factors for suicide among psychiatric inpatients in China. In this study we identified the risk factors of suicide among psychiatric inpatients at Guangzhou Psychiatric Hospital. All psychiatric inpatients who died by suicide during the 1956-2005 period were included in this study. Using a case-control design, 64 inpatients with schizophrenia who died by suicide were compared with a matched 64 controls. The results indicate that the rate of suicide was 133.1/100,000 admissions (95%CI 103.4-162.9). There were no significant differences in the method, location, or time of suicide between male and female inpatients. The number of hospitalizations was significantly larger in the suicide group than that in the control group. In logistic regression analyses, guilty thought, depressive mood, and suicidal ideation and suicide attempt 1 month before hospital admission were identified as independent predictors of suicide among inpatients with schizophrenia. The findings of risk factors for schizophrenic inpatient suicide should be taken into account when developing interventions to prevent suicide among these patients.     

Youth suicide risk and sexual orientation

Using a broad suicide risk assessment (suicidal ideation, hopelessness, hostility) with 100 youth ages 17 to 19, this study examined the relationship between sexual orientation and youth suicide risk. Participants were compared across sexual orientation, as well as level of perceived external support, which may be a mitigating variable in suicide risk. The suicide risk demonstrated by sexual minorities in this study was no greater than that of their heterosexual peers. Youth who reported more external support demonstrated lower overall suicide risk and, specifically, lower levels of hostility, hopelessness, and suicidal ideation. The results indicated that suicide risk is not determined by demographic criteria alone, and may be influenced by psychosocial variables, such as support.     

Suicidal ideation and attitudes toward suicide

Although hopelessness and depression are known risk factors for suicide, most individuals who are hopeless or depressed never make a suicide attempt. In this study, we tested the hypothesis that college students' (n = 230) attitudes toward suicide (the degree to which they see it as an acceptable option under some circumstances) would moderate the link between both hopelessness and depressive symptoms and their levels of suicidal ideation. This moderation hypothesis was supported, but only among men. Specifically, among men, levels of hopelessness and depressive symptoms were significantly related to suicidal ideation among only those with relatively positive attitudes toward suicide.     

Evidence for an emotion-cognition interaction in the statistical prediction of suicide attempts

Suicidal behavior is a prevalent problem among adolescents and young adults. Although most theoretical models of suicide suggest that this behavior results from the interaction of different risk factors, most prior studies have tested only bivariate associations between individual risk factors and suicidal behaviors. The current study was designed to address this limitation by testing the effect of an emotion–cognition interaction on suicide attempts among youth. Specifically, we hypothesized that the interaction of emotion reactivity and problem-solving skills would statistically predict the probability of a recent suicide attempt among 87 adolescents and young adults. Results revealed a significant interaction, such that emotion reactivity was strongly associated with the probability of a suicide attempt among those with poor problem-solving skills, moderately associated among those with average problem-solving skills, and not significantly associated among those with good problem-solving skills. The next generation of studies on suicidal behavior should continue to examine how risk factors interact to predict this dangerous outcome.     

Identifying the role of sociodemographic factors in major depressive disorder and suicidality among Spanish-speaking Latino patients in a federally qualified health center

Rates of suicide and major depressive disorder (MDD) are currently at the highest point in the history of the United States (US). However, these rates are not distributed evenly among the population and Latinos show disproportionately high rates of both suicide and MDD. Yet, past research has infrequently explored factors related to suicide and MDD in primary care settings that serve as the major community portal for mental health among the Latino population. Thus, the current study investigated sociodemographic variables (marital status, nativity, education, employment, primary language, age, and gender) in terms of their relations with suicidal ideation, suicide risk, MDD, and MDD symptom severity among Latino primary care patients in a Federally Qualified Health Center (N = 634, M _age = 39.46, SD = 11.46, 87.1% female). Results indicated that gender and Nativity were associated with suicidal ideation, older age was associated with suicide risk, and higher education and having a partner were negatively associated with MDD and depressive symptom severity. These results provide novel insight into the role of sociodemographic factors predicting suicide and MDD among Latinos in primary care, and suggest greater scientific and clinical attention can be focused on certain sociodemographic factors to offset mental health disparities among this group.     

A comprehensive and concise assessment of suicide risk

Because suicide is one of the few fatal consequences of psychiatric illness and is a source of extraordinary stress for loved ones and the clinician, accurate assessment of suicidal risk is an essential aspect of the mental health profession. Innumerable individual differences, along with the low base rate of suicide, make assessment a challenging task in clinical practice that is both delicate and time consuming. In this article, the authors recommend examining and incorporating each patient's personal characteristics, dispositional factors, situational factors, and current presentation of symptoms into a unique individual picture of suicidal risk. This portrait of potential for suicidal behavior can, in turn, be used to evaluate risk and design a course of action. This thorough yet concise approach will likely reduce omissions in assessment, and hopefully lead to fewer false negatives and fewer deaths of suicidal patients.     

Differences in risk factors for suicidality between African American and White patients vulnerable to suicide

Risk factors for suicidal ideation and attempts have been shown to differ between African Americans and Whites across the lifespan. In the present study, risk factors for suicidality were examined separately by race/ethnicity in a population of 131 older adult patients considered vulnerable to suicide due to substance abuse and/or medical frailty. In adjusted analyses, social support was significantly associated with suicidality in African American patients, while younger age and the presence of an anxiety disorder were significantly associated with suicidality in White patients. The results suggest that race/ethnicity-specific risk profiles may improve the detection of suicidality in vulnerable populations.     

Epidemiology of suicide in the elderly.

Suicide rates in the United States and most other countries are higher among the elderly than among the population as a whole. Typically, rates peak in older adulthood. Epidemiological data for the current levels and trends in suicide among the elderly are presented with a focus on United States figures. Age, sex, race, marital status, and methods of suicide as factors in suicide among the old are detailed, followed by a discussion of past trends and future predictions of changes in elderly suicide rates. In addition to fatal suicidal behaviors, the data and literatures on parasuicide and survivors of elderly suicide are briefly noted.     

Personal and professional factors and suicide intervention skills

This research investigated the relationship of professional and personal factors to the ability of counselors to respond appropriately to suicidal verbalizations using the Suicide Intervention Response Inventory (SIRI). Level of training, experience with suicidal clients, and death acceptance were positively related to suicide intervention competencies. A personal history of suicidality and a belief that suicide is a personal right were negatively related to such skills. Regression analysis revealed that personal history of suicidality and attitude toward suicide as a personal right accounted for a modest, but significant, percentage of the variance in SIRI scores, beyond that accounted for by professional factors. Post hoc analysis indicated that the negative relationship between personal history of suicidal behaviors and suicide counseling skills was significant in the professionally trained participants. These results highlight the importance of attitudes toward suicide and personal history of suicidality, as well as training and experience, in effectively counseling potentially suicidal clients.     

Comparing suicide attempters, suicide ideators, and nonsuicidal homeless and runaway adolescents.

This study considers variables that best distinguish among attempters, ideators, and nonsuicidal youth in a sample of 527 homeless and runaway adolescents from four Midwestern states. Univariate results indicate that attempters are significantly more likely than ideators and nonsuicidal youth to have experienced physical or sexual abuse by an adult caretaker, to have experienced sexual victimization while on their own, and to have a friend who attempted suicide. Multivariate analyses reveal five variables that best distinguish among the three groups: self-esteem, depression, physical abuse, sexual abuse, and having a friend who attempted suicide. Further analysis suggests that the accumulation of these risk factors greatly increases the chance that these youth will engage in suicidal behavior.     

Current suicide proneness and past suicidal behavior in adjudicated adolescents

Youth recently assigned to probation (n = 233) were assessed for current suicide proneness, depression, and hopelessness, as well as for recent suicide ideation, previous suicide ideation, or suicide attempt(s). The Life Attitudes Schedule-Short Form (LAS-SF) was used to assess suicide proneness. As per the LAS-SF, suicide proneness was defined broadly to include current engagement in overtly suicidal behavior as well as in risk-taking and potentially injury-producing behaviors, coupled with a lack of engagement in health and safety behaviors, or self-enhancement behaviors. As expected, current suicide proneness was significantly associated with a history of suicide ideation and attempts, recent ideation, and current depression and hopelessness for adjudicated youth. Gender differences were obtained between the strength of the association between suicide proneness and depressive symptoms. A subgroup of adjudicated youth (n = 39) was then interviewed about their suicidal behaviors. Among other things, these youth indicated that the majority of their previous suicide attempts were committed impulsively.     

Hopelessness and Lack of Connectedness to Others as Risk Factors for Suicidal Behavior Across the Lifespan: Implications for Cognitive-Behavioral Treatment

The rates of suicide attempts and death by suicide vary considerably over the lifespan, highlighting the influence of different contextual, risk, and protective factors at different points in development (Daniel & Goldston, 2009). Hopelessness and lack of connectedness to others are two factors that have been associated with increased risk for suicidal thoughts and behaviors across the lifespan. The primary purposes of this paper are to describe how hopelessness and lack of connectedness to others may contribute to risk for suicidal behaviors, and to outline empirically supported cognitive-behavioral interventions for these difficulties at three developmental periods during which suicidal behavior is prevalent: (a) adolescence and young adulthood, (b) middle adulthood, and (c) older adulthood. This paper is not intended as an exhaustive review, but rather an overview of selected developmental issues related to hopelessness and lack of connectedness to others as risk factors for suicidal behavior. Special emphasis is given to clinical implications for cognitive-behavioral interventions, which are illustrated through case conceptualizations and examples at each developmental period.     

Childhood abuse as a risk factor for suicidal behavior in borderline personality disorder

A childhood history of sexual or physical abuse is highly prevalent in borderline personality disorder (BPD) and is associated with self-destructive behavior in clinical and nonclinical samples. Viewing BPD as a "high risk" disorder, we asked if childhood abuse was a risk factor for adult suicidal behavior or if it was related to other known risk factors for suicide in BPD. A semistructured Abuse History was obtained in 61 criteria-defined BPD patients, who were characterized by structured interviews and self-reports for Axis I disorders, Suicide History, BPD severity, hopelessness, impulsivity, impulsive-aggression, and antisocial traits. Occurrence and severity of childhood sexual abuse, but not physical abuse, predicted adult suicidal behavior independent of other known risk factors. The odds of a sexually abused patient attempting suicide in adulthood was over 10 times that of a patient who was never sexually abused. Given a history of childhood sexual abuse, the risk of adult suicidal behavior in BPD was increased by antisocial traits, severity of BPD, hopelessness, or comorbid major depressive episode (MDE).     

Nonlinear change processes and the emergence of suicidal behavior: A conceptual model based on the fluid vulnerability theory of suicide

Although ideation-to-action theories of suicide aim to explain the emergence of suicidal behaviors, researchers have primarily focused on the content of underlying mechanisms (i.e., who dies by suicide). Much less attention has focused on the temporal dynamics of suicide risk (i.e., when suicide occurs). The fluid vulnerability theory conceptualizes suicide as an inherently dynamic construct that follows a nonlinear time course. Newer research implicates the existence of multiple nonlinear change processes among suicidal individuals, some of which appear to be associated with the emergence of suicidal behavior. The cusp catastrophe model provides a useful model for conceptualizing these change processes and provides a foundation for explaining a number of poorly understood phenomena including sudden emergence of suicidal behavior without prior suicidal planning. The implications of temporal dynamics for suicide-focused theory, practice, and research are discussed.