Exploring the Clinical Implications of the International CS Reference Data for Children and Adolescents (Meyer,Erdberg, & Shaffer, 2007)

As part of an ongoing study on the prediction of suicide, a replication study was carried out on the Neuropsychiatric Hospital Suicide Potential Scale (NPHSPS), a recently constructed schedule for prediction of potentiality for committed suicide among hospitalized neuropsychiatric patients at the time of release from the hospital. The population consisted of 54 patients who had committed suicide and 50 patients who had not. Overall accuracy of the scale was 81.7 percent, with 95.2 percent accuracy for prediction of the high risk group and 80.0 percent accuracy for prediction of nonsuicidal controls. By computation of posterior probability, the scale is shown to increase accuracy of prediction more than five-fold over use of the base rate (or prior probability) alone, but it is also evident the level of prediction of suicide is still too minimal to permit individual clinical application.     

Suicide Attempters in Norway

ABSTRACT: A personal follow-up study is presented of 74 patients consecutively admitted to a Norwegian psychiatric hospital who had attempted suicide during the six months prior to admission. The mean observation time subsequent to discharge was eight years. Of these 74 patients, 5 later committed suicide (6.8 percent) and 16 (26 percent of the living) repeated the suicide attempt. The clinical and social course for the living patients is described. A previous report of a similar follow-up study on patients in a psychiatric department had demonstrated a much lower frequency of subsequent suicide and suicide attempts and a higher percentage of clinical cure and social rehabilitation. These differences are discussed and ascribed mainly to the greater proportion of psychotic patients in the hospital sample (82 percent versus 34 percent).     

Patterns of suicide among hospitalized mentally disordered offenders

The case records of 29 mentally disordered offenders who committed suicide in a state hospital were reviewed. Information was collected on demographic and clinical characteristics; time, method and location of the suicides; and the presence of suicide indicators. Comparisons were made between the characteristics of the suicide patients and those of the current hospital population. Major findings were: 80 percent of the suicides were committed by psychotic patients and 66 percent were by patients with diagnoses which included paranoia; 48 percent of the suicide patients had been charged with or convicted of murder or attempted murder; most suicides occurred in individual patient rooms; nearly 50 percent of the patients had a history of suicide attempts; and other common indicators of suicide risk were often masked by psychotic symptomatology. Several recommendations for identifying and managing potentially suicidal patients in this population are presented.     

Eventual suicide in interrupted and uninterrupted attempters: a challenge to the cry-for-help hypothesis

A total of 499 patients hospitalized for suicide attempts (attempters) between 1970 and 1975 were followed until 1982; of this group, 28 (5.6%) eventually committed suicide. Six (14.6%) of the 41 patients who had been interrupted during their initial attempts eventually committed suicide, whereas only 22 (4.8%) of the 458 patients who had not been interrupted eventually committed suicide. The interrupted attempters were approximately three times more likely to commit suicide than the uninterrupted attempters.     

Methods of Suicide Among Cancer Patients: A Nationwide Population‐Based Study

A 3‐year nationwide population‐based data set was used to explore methods of suicide (violent vs. nonviolent) and possible contributing factors among cancer patients in Taiwan. A total of 1,065 cancer inpatients who committed suicide were included as our study sample. The regression shows that those who had genitourinary cancer were 0.55 times (p = 0.047) less likely to use violent methods to commit suicide than those who had respiratory cancer. Among those who committed suicide out of town, the odds of using violent methods were 1.39 (p = 0.015) of their counterparts who had committed suicide in their hometowns. Those who had income between NT$15,841～NT$25,000 were 0.70 (p = 0.042) times less likely to use violent methods to commit suicide than those who had no income.     

Suicide Risk Factors In Alcohol Abuse

ABSTRACT: The “clinical model” approach to estimating suicide risk assumes that persons sharing specific attributes will also share certain indicators of vulnerability to suicide. This would warrant an empirically derived risk assessment scale applicable only to persons with those attributes. Nine hundred seventy eight persons at risk for suicide who met our criteria for alcohol abuse were interviewed at length and followed for two years, during which 53 (5.5 percent) committed suicide. Eleven variables which best differentiated those who suicided from those who did not in an index set were then applied to an independent validation set. Clinical implications of the findings are discussed.     

Correlates of suicide in the older adult population in Quebec

This study was undertaken to describe the characteristics of adults aged 60 years and over who committed suicide in Quebec in 1998-1999. In this study, 42.6% of the suicide cases presented mental disorders at the time of their death, mainly depression. Sixty-five (65.3%) percent of the suicide cases would have been considered as having a mental health disorder if sub-threshold depression cases were included. Only 27.7% of the cases did not express any idea of death during the 6-month period preceding their suicide. One interesting finding was that 53.5% of the suicide cases consulted a general practitioner or specialist during the 2-week period preceding their death. Our results showed that only 8.1% had a severe level of functional limitations at the time of their death. This result leads us to interpret with caution the conclusion of some studies suggesting that physical frailty is a major causal factor associated with suicide among the elderly.     

The Future Fate of Suicide Attempters

A review is made of studies of suicide attempters in which there was a personal follow-up examination. Two studies by the author are presented: suicide attempters admitted to a psychiatric clinic and suicide attempters admitted to a traditional psychiatric hospital. The committed suicide rate among the hospital cases was three to six times higher than in the clinic cases (6.8 percent versus 1.4 to 2.8 percent). In the hospital material, 28 percent of the subjects had repeated the attempt without lethal outcome compared to 14 percent of the clinic cases. A correlation with the higher incidence of psychosis in the mental hospital cases is suggested.     

Assessing vulnerability to suicide.

Three hundred members of the American Association of Suicidology (30% of those who apparently received the questionnaire) participated in a survey in which case histories of two men who had committed suicide and two who had not were presented. Respondents assessed the vulnerability to suicide of each man, recorded their levels of confidence in their assessments, and provided information about themselves. The two men who killed themselves were rated as less vulnerable to suicide than the other two men, and as less vulnerable than one would expect by chance. Respondent characteristics that predicted to accuracy in assessing vulnerability were gender and level of involvement in research. The findings are discussed in terms of the limitations of theoretical models as well as characteristics of the respondents and nature of the study design.     

Adolescents' experience with and response to suicidal peers.

The present study investigated a sample of 325 suburban high school students' knowledge of suicidal peers, whether they had ever talked to a suicidal peer, and, if so, what they actually did in that situation. Sixty-eight percent of the females and 42.5% of the males reported knowing a teen who had committed or attempted suicide. Ninety-seven students reported having talked to a peer who was definitely considering suicide; of these, 63% talked to their peer about his or her concerns, 24.7% told an adult, and 12% did nothing in response to the encounter. Ninth graders were significantly more likely to do nothing as compared to eleventh graders. A mixed pattern of results was found as to the relationship of the response of youth to suicidal peers and their general experience with suicidal peers. The results confirm the importance of adolescents themselves for the prevention of youth suicide, and the need to convince adolescents to report at-risk peers to an adult.     

Self-Poisoning with Follow-Up Considerations

ABSTRACT: One hundred patients who in 1963 had attempted self-poisoning and were subsequently admitted to the intoxication ward of a psychiatric hospital were studied twice: immediately after the attempted self-poisoning and 8 years after the attempt. It was found that within the follow-up period a total of nine patients had died, four of whom had committed suicide. The risk of suicide per years is .5%. According to the literature the range of the annual suicide risk is .9% to 2.5%.     

Some Results from an Automated Statewide Comparison among Attempted,Committed, and Nonsuicidal Patients

ABSTRACT: In the Missouri Division of Mental Health statewide automated Standard System of Psychiatry, 151 patients who had attempted suicide were compared with 424 who had not and with 97 who had committed suicide. Much of the data was provided from relatives using an automated history. Compared with nonattempters, attempters were younger and more often female, depressed, assaultive, and had a family history of suicide. Actual suicides were more often male, better educated, and in general more resembled the attempters than nonattempters.     

Suicide intervention trainees' knowledge of myths about suicide

The responses of 70 trainees in suicide intervention to 10 Suicide Opinion Questionnaire items were evaluated for accuracy of their knowledge about suicide myths. Participants were Canadian adults (62 women, 8 men, M (age) = 35 yr.) representing a wide variety of occupations and educational backgrounds. Analysis indicated knowledge for most items was high but less accurate for items concerning the most common method of suicide and suicide risk across the lifespan. Those trained in suicide intervention were more knowledgeable on four items than those awaiting training; they more frequently knew that most suicides are not triggered by an argument with a spouse, people who are depressed are more likely to commit suicide, a person whose parent has committed suicide is at greater risk for suicide, and that shooting is the most common method of suicide in Canada.     

Physiological Reactions to a Suicide Film: Suicide Attempters,Suicide Ideators,and Nonsuicidal Patients

A film about two teenagers who commit suicide was shown to three groups of psychiatric inpatients: 17 who had attempted suicide, 20 who had expressed suicidal thoughts, and 10 who were not suicidal. Anxiety before and after the film was evaluated with psychometric (anxiety rating scale) and physiological tools (heart and respiration rate, blood pressure, electromyogram). Values noted before and after screening, and the degree of change in these values, were compared. In addition, psychomotor agitation was rated at several points during the film. Most results were negative. The suicide attempters had significantly lower postscreening heart rates and a significantly lesser change in heart and respiration rates than the other two groups. The suicide attempters revealed an increase in psychomotor agitation until the discovery of the suicide and a decrease thereafter, whereas the agitation of the nonsuicidal patients continued to increase from the start to the end of the film. The study suggests that on some parameters, suicide attempters reveal less anxiety than nonsuicidal psychiatric patients following exposure to a simulated suicide. The reaction of suicide ideators falls somewhere between the two groups.     

A Follow-up Study of 53 Suicides Known to a Suicide Prevention Center

ABSTRACT: The operation of the Cleveland Suicide Prevention Center is reviewed, and 53 known suicides during the Center's first four years of operation are discussed. A suicide rate of 288 per 100,000 suggests that persons contacting the Center represented a high suicide risk group. Of the suicides, 57 percent were women. This high proportion of females was statistically significant when compared to the smaller percentage of female suicides for Cuyahoga County, Ohio. Of the persons who committed suicide, 26 percent initiated direct contact with the Center themselves, and none recontacted the Center just prior to death. The question is raised whether contact initiated by another may in itself be suggestive of greater suicidal risk. Some of the practical problems in evaluation and referral are discussed.     

Inadequate Response to Therapy as a Predictor of Suicide

The role of response to cognitive therapy as a predictor of suicide was investigated by comparing 17 outpatients with mood disorders who committed suicide with 17 matched patients who did not commit suicide. The suiciders attended significantly fewer sessions of cognitive therapy and dropped out of therapy more frequently: 88% of the suiciders, compared to 53% of the controls, were rated by their therapists as requiring more treatment at termination. They also had higher levels of hopelessness at the termination of therapy. The results suggest that premature termination of therapy and inadequate response to treatment have unfavorable prognostic significance for eventual suicide.     

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.     

Reported childhood trauma and suicide attempts in schizophrenic patients

Childhood traumas are associated with suicidal behavior but this aspect has not been examined in relation to schizophrenia. In this study, 50 chronic schizophrenic patients who had attempted suicide were compared with 50 chronic schizophrenic patients who had never attempted suicide for their scores on the 34-item Childhood Trauma Questionnaire (CTQ). It was found that schizophrenics who had attempted suicide reported significantly higher CTQ scores for emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect than schizophrenics who had never attempted suicide. Therefore, childhood trauma may be a risk factor predisposing schizophrenic patients to attempt suicide.     

Depression and suicide in schizophrenic patients

This study supports the idea that schizophrenic patients represent a distinctive subgroup of patients who can suffer from a major depressive illness and also can commit suicide. The study showed that 22.4% of the schizophrenic population in a medium-sized psychiatric facility showed severe depressive symptoms that met the criteria for the diagnosis of a major depressive episode according to the DSM-III classification. Seven patients committed suicide during the acute phase of the illness--five during hospitalization, and two within a year of discharge. Nine patients attempted suicide during the hospitalization period, and 10 attempted suicide within a year of discharge. Nearly one-third (215) of the patients were readmitted during that year because of a recurrence of acute schizophrenic symptoms; of these, 84 were having severe depressive symptoms. The study also provides indications of the causes of suicide in these patients.     

Turkish Imams’ Experience with and Their Attitudes Toward Suicide and Suicidal Persons

This study investigated the experience with and attitudes toward suicide and suicidality in 70 consenting imams serving in mosques in the province of Aydin which is located at the southwest part of Turkey. A self-report questionnaire was used to collect the data. Attitudes of imams to suicide and suicidality were compared with attitudes of male university students. Only 4 imams (5.7 %) reported having had suicidal thoughts in past, and none reported having attempted suicide. Almost 50 % said that someone in communities they serve has commited suicide and nearly 40 % reported leading funeral ceremony for someone who committed suicide. Majority of imams (64.3 %) were of the opinion that a funeral ceremony should be arranged for people who suicide and 87.1 % were of the opinion that people who suicide can be buried in a common cemetery, but only 21.4 % said that someone who attempted suicide can be appointed as imam. Compared to male medical students, imams saw suicide as an unacceptable option and those engaging in suicidal behavior to be punished after death. But they displayed socially accepting and helping reactions to an imagined close friend who attempted suicide. Therefore, it was concluded that imams might exhibit preventive reactions to suicide when they offer counseling for persons from their congregations during times of suicidal crises.