Sex differences in completed suicide by schizophrenic patients: a meta-analysis

A meta-analysis was conducted on all studies of suicide mortality in follow-up studies of schizophrenic patients that presented data for male and female patients separately. The percentage of deaths from suicide was significantly greater for the male schizophrenic patients than for the female schizophrenic patients in studies where both sexes were included. Regression equations devised to predict the percentage of deaths from suicide after all of the sample had died estimated that 0.50% of male schizophrenic patients would die from suicide as compared to 0.20% of female schizophrenic patients. Suggestions are made for future research.     

Help‐Seeking Behavior Prior to Nearly Lethal Suicide Attempts

T he association between help‐seeking and nearly lethal suicide attempts was evaluated using data from a population‐based, case‐control study of 153 13‐ to 34‐year‐old suicide attempt case‐patients treated at emergency departments in Houston, Texas, and a random sample of 513 control‐subjects. Measures of help‐seeking included whether the participant sought help for health/emotional problems in the past month, type of consultant contacted, and whether suicide was discussed during the interaction. Overall, friends/family were consulted most frequently (48%). After controlling for potential confounders, case‐patients were less likely than control‐subjects to seek help from any consultant (OR = 0.5, 95% CI = 0.3–0.8) or a professional (e.g., physician, counselor) consultant (OR = 0.5, 95% CI = 0.29–0.8). Among those who sought help, case‐patients were more likely than to discuss suicide (OR = 2.6, 95% CI = 1.2–5.4), particularly with professionals (OR = 11.8, 95% CI = 3.2–43.2). Our findings suggest that efforts to better understand the role of help‐seeking in suicide prevention, including help sought from family and friends, deserves further attention.     

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.     

Current suicide ideation and prior suicide attempts of bipolar patients as influences on caregiver burden

We examined whether caregivers of bipolar patients reporting current suicidal ideation and/or a history of a suicide attempt reported higher levels of burden and/or poorer health compared to caregivers of patients without these suicidality indices. In a cross-sectional design, caregivers (N = 480) associated with (a) patients with current suicidal ideation or (b) patients with a positive lifetime history of at least one suicide attempt, reported lower general health scores than caregivers associated with patients with neither of these indices. Parents of patients with at least one lifetime attempt reported more burden secondary to role dysfunction than spouses. Levels of depression in caregivers varied with whether the caregiver was a spouse or a parent, and whether patients had a history of suicide attempts, current suicidal ideation, or both.     

Suicidality and psychosis: beyond depression and hopelessness

The present study examined recent suicide attempters with and without psychotic disorders in order to understand factors that contribute to suicide ideation during and following the suicide attempt. Patients with psychotic disorders endorsed higher levels of suicide ideation than patients without psychotic disorders. Even when depression, hopelessness, substance abuse, and social problem solving were controlled for, there was a significant association between psychotic disorder and suicide ideation. During the follow-up period, patients with psychotic disorders subsequently attempted suicide at a significantly higher rate than patients without psychotic disorders. The clinical relevance of these findings is discussed.     

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.     

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.     

Parent, mother or father loss in childhood and suicidal behavior in adulthood

Information respecting loss of one or both parents in childhood was elicited at certain fixed intervals among 170 suicides and 200 each of attempted suicide cases, and hospitalised neurological and ophthalomological patients. It was discovered that among the cases of suicide and attempted suicide, cases where one or both parents were lost in childhood were 2 1/2 to 4 times more frequent than in the control groups. Especially notable is the high frequency of cases where the father was the lost parent.     

A thematic comparison of suicide notes drawn from Northern Ireland and the United States

Suicide is a global concern hence cross-cultural research ought to be central to national suicide prevention strategies. This study sought to investigate suicide notes drawn from Northern Ireland and the United States as these countries have broadly similar suicide rates but markedly different cultures. A theoretical-conceptual analysis of sixty suicide notes drawn from these countries, matched for age and sex, was undertaken based on a thematic model of suicide developed by Leenaars (1996) across countries. The results suggested that there were more psychological commonalities than differences. Two differences emerged which suggested that aspects of the interpersonal components may be more salient in Northern Irish rather than American suicides. It is argued that more wide-ranging cross-cultural studies are required to enhance our ability to identify and predict those most at risk from suicide.     

Why people engage in parasuicide: a cross-cultural study of intentions

Information obtained at interview from 1,646 parasuicide patients in 14 regions in 13 European countries participating in the WHO/EURO Multicentre Study on Suicidal Behaviour was used to study self-reported intentions involved in parasuicide. Comparisons were made across cultures, genders, and age groups. Although some statistically significant differences were found, the effect sizes were very small. The main finding from this study is thus that parasuicide patients in different countries tend to indicate that similar types of intentions are involved in their acts of parasuicide, and that the intentions do not vary greatly with gender or age. The hypothesis that rates of suicide and parasuicide vary between regions with the frequency with which suicidal intention is indicated by the patients was also tested, but was supported only for women and in relation to national suicide rates. The findings from this study are likely to be generalizable to other settings and have implications for clinical practice.     

Hotel room suicide

The objective of our research was to quantify the increased risk of suicide associated with registering in local hotels/motels. Medical examiner case files of suicide in King County, Washington, were reviewed for years 2002-2004. The incidence of suicide in local residents registering in local hotels/motels was 223/100,000 which is significantly greater than the incidence of suicide in the general population of King County (11.7/100,000 p < 0.0001). Hotel/motel guests from outside Washington had a significantly reduced incidence of suicide (3.9/100,000 p = 0.002). The study results suggest that there is an increased risk of suicide in local residents who register in local hotel rooms.     

A thematic comparison of suicide notes drawn from Northern Ireland and the United States

Suicide is a global concern hence cross-cultural research ought to be central to national suicide prevention strategies. This study sought to investigate suicide notes drawn from Northern Ireland and the United States as these countries have broadly similar suicide rates but markedly different cultures. A theoretical-conceptual analysis of sixty suicide notes drawn from these countries, matched for age and sex, was undertaken based on a thematic model of suicide developed by Leenaars (1996) across countries. The results suggested that there were more psychological commonalities than differences. Two differences emerged which suggested that aspects of the interpersonal components may be more salient in Northern Irish rather than American suicides. It is argued that more wide-ranging cross-cultural studies are required to enhance our ability to identify and predict those most at risk from suicide.     

Suicide after suicide attempt in severe depression: a long-term follow-up

The temporal relation between completed suicide and first-ever suicide attempt was investigated in 58 future suicides with a primary severe depression/melancholia. The median survival after a first attempted suicide was 6.7 years. Male patients with initial ratings of psychomotor retardation lived significantly longer after their initial attempt than those who were not retarded. They also had more depressive episodes compared to other male suicides and retarded controls. Thus a slow suicidal process in the men with a severe depression and psychomotor retardation is proposed. Severity, repetition, and method of suicide attempt did not decrease the survival time.     

The Big Ten Student Suicide Study: A 10-Year Study of Suicides on Midwestern University Campuses

The Big Ten Student Suicide Study was undertaken from 1980–1990 to determine the suicide rates on Big Ten University campuses. The study design attempted to address many of the statistical and epidemiological flaws identified in previous studies of campus student suicides. The 10-year study collected demographic and correlational data on 261 suicides of registered students at 12 midwestern campuses. The largest number of suicides for both males and females were in the 20–24-year-old age group (46%), and amongst graduate students (32%). The overall student suicide rate of 7.5/100,000 is one half of the computed national suicide rate (15.0/100,000) for a matched sample by age, gender, and race. Despite the overall lower suicide rate, the analyses revealed that students 25 and over have a significantly higher risk than younger students. Although women have rates roughly half those of men throughout their undergraduate years, graduate women have rates not significantly different from their male counterparts (graduate women 9.1/100,000 and graduate men 11.6/100,000).     

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.     

Styles of problem solving in suicidal individuals

This study compared qualitative aspects of problem solving among suicide attempters, suicide ideators, and nonsuicidal patients. The subjects completed a suicidal intent scale and a problem-solving task involving three dilemmas. Problem solving was analyzed along eight qualitative categories: versatility of the various solutions, reliance on self versus others, activity versus passivity, confrontation versus avoidance, relevance of the solution to the problem, positive versus negative affect, reference to the future, and extremity of the solution. The statistical analysis yielded differences among the three groups. In general, the solutions of suicidal patients showed less versatility, more avoidance, less relevance, more negative affect, and less reference to the future than the solutions of the nonsuicidal patients. The suicide attempters and nonsuicidal patients offered more active solutions than did the suicide ideators. Our findings emphasize the importance of general coping styles, as well as energetic/motivational aspects and affective aspects of the problem-solving process. Some applications to therapy are discussed.     

14 Culture and Suicide: From a Japanese Psychiatrist's Perspective

There have been numerous papers focusing on culture and suicide, but it seems that they have often emphasized cultural differences excessively, thus running the risk of increasing prejudice toward different cultures and reinforcing overgeneralizations. From my albeit limited knowledge and experience, it appears that there are more similarities than differences in suicide among various cultures. Most cases of suicide reflect complex human factors that are found universally among cultures. Despite the fact that some cultural differences in suicide admittedly exist in different societies and that these are important, they cannot explain every aspect of suicide. This article explains how I, as a Japanese psychiatrist, diagnose and treat suicidal patients against the backgrounds of Japanese culture by presenting my way of thinking in daily practice in order to show similarities and differences that exist in Japanese suicide, treatment, and prevention.     

Suicidal behavior among inpatients with schizophrenia and mood disorders in Chengdu, China

This study evaluated the characteristics of suicidal behavior (suicide attempt or suicidal ideation) among 230 consecutively admitted inpatients with schizophrenia and mood disorders in a university hospital in China. The rate of lifetime suicidal behavior was found to be significantly higher in patients with mood disorders (62.4%) than in patients with schizophrenia (38.6%). The rate of suicidal behavior was significantly higher in patients with major depressive disorder (86.8%) than those with bipolar disorders (42.6%). Patients with schizophrenia attempted suicide for the first time earlier in life than the patients with mood disorders. Mood disorder patients, especially those with major depressive disorder, had more and more serious suicide attempts than the patients with schizophrenia.     

Suicide attempts: Patients with and without an affective disorder show impaired autobiographical memory specificity

A number of studies have shown reduced recall of specific autobiographical memories (AMs) in patients after attempted suicide, but in all of them the study samples were confounded with diagnoses of affective disorders. The present study aims to demonstrate impaired specific autobiographical memory in patients after a suicide attempt without a diagnosis of an affective disorder. Four groups were compared: (1) patients with an actual major depression and a suicide attempt; (2) patients after a suicide attempt without a lifetime history of an affective diagnosis; (3) patients currently suffering from major depression without a suicide attempt; and (4) control persons not suffering from either of the two conditions during their entire life. Individuals with major depression and a suicide attempt showed reduced specificity of AM and, most importantly, patients with a suicide attempt—despite the absence of an affective disorder—were equally impaired with recall of specific AMs as were patients with major depression. The authors propose that reduced specific AM is a common vulnerability factor that can lead either to the development of an affective disorder and/or to a suicide attempt.     

Alcohol use disorders and risk factor interactions for adolescent suicidal ideation and attempts.

Four hundred eighty-two adolescents who were diagnosed with at least one mental disorder were studied to determine the predictors of suicidal ideation and suicide attempts. Major depression was predictive of suicidal ideation and suicide attempts for both genders. Chronic stress was found predictive of male suicidal ideation, while low self-esteem and high family dysfunction were found to be predictive of suicidal ideation in females. Statistical trends suggest that females with comorbid alcohol use/conduct disorder were approximately three times more likely to have attempted suicide than those with only one of these conditions. Clinicians working with adolescents should be aware that, while depression remains the number one clinical risk forsuicidal behavior, risk factors for suicidal ideation may be different than those for attempted suicide and may vary by gender.