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.     

Habits of nervous tension and suicide

In a prospective study of 1,046 male medical students, those who later committed suicide showed a heightened sensitivity in stressful situations as assessed by the Habits of Nervous Tension Questionnaire (HNT). Survival analyses specified 2 of the 25 HNT items as the strongest suicide predictors: Irritability (relative risk 5.5; 95% confidence interval 1.76-17.17) and Urinary Frequency (3.3; 1.07-10.32). No other risk factors for suicide emerged from family background measures or individual medical school measures. It appears that types of sensitivity reflect psychological characteristics that are long-term precursors of suicide.     

Adolescent suicide, gender, and culture: A rate and risk factor analysis

The current paper provides a comprehensive research review of gender differences in rates of and risk factors for adolescent suicidal behavior in four main U.S cultural subgroups: African Americans, Native Americans, Asian Americans, and Latino Americans. The paper highlights substantial findings from the most recent literature and provides direction for future research and clinical work. The data presented suggest that clinicians and interventionists relying on nonfatal expressions of suicide will continue to fail to identify adolescent males at risk for suicide, as females are more likely to report suicide ideation and attempts across all cultural groups reviewed. We conclude that researchers and clinicians should utilize indirect, broad measures of suicide proneness, as opposed to the traditional direct self-report tools. Although past research has examined cultural and gender differences in risk factors for suicidal behavior, these investigations have been primarily isolated from each other. Therefore, we sought to examine adolescent suicidal behavior and how it operates as a function of both gender and culture.     

Self‐Esteem and Suicide Ideation in Psychiatric Outpatients

Depression, hopelessness, and low self‐esteem are implicated as vulnerability factors for suicide ideation. The association of self‐esteem with suicide ideation after controlling for depressed mood and hopelessness was examined. Adult psychiatric outpatients (N = 338) completed measures of self‐esteem, suicide ideation, hopelessness, and depression. Self‐esteem was operationalized as beliefs about oneself (self‐based self‐esteem) and beliefs about how other people regard oneself (other‐based self‐esteem). Each dimension of self‐esteem was negatively associated with suicide ideation after controlling for depression and hopelessness. Of the two dimensions of self‐esteem, other‐based self‐esteem was the more robust predictor of suicide ideation. These findings suggest that even in the context of depression and hopelessness, low self‐esteem may add to the risk for suicide ideation.     

Uncovering the mystery: factors of African American suicide

Traditionally, African Americans have registered lower rates of suicide than other ethnic groups. In the last 20 years this pattern has changed, particularly among young African Americans. To date, the research conducted regarding this phenomenon has been limited for a variety of reasons and previous research has been inconclusive in determining risk factors of African American suicide. The purpose of this paper is to identify risk and protective factors specific to African American suicide. To determine the factors, the 1993 National Mortality Follow-back Survey was analyzed. The risk factors identified include being under age 35, southern and northeastern residence, cocaine use, firearm presence in home, and threatening others with violence. Some of the protective factors associated with African American suicide include rural residence and educational attainment. These results provide valuable information about completed African American suicides in relation to Whites. Several of these factors are unique to African Americans.     

The glass half-full or a hopeful outlook: Which explains more variance in interpersonal suicide risk in a psychotherapy clinic sample?

Recent research has suggested that constructs in the field of positive psychology may be important for understanding suicide risk. Specifically, both hope theory and dispositional optimism have been linked to lower levels of suicidal ideation and interpersonal suicide risk. Despite these encouraging findings, no study has investigated the relationships between hope, optimism, and suicide risk in a clinical sample. The current study aimed to address this gap and to determine if hope or optimism was more important for understanding suicide risk as operationalized by the interpersonal-psychological theory and suicidal ideation. Results of hierarchical regression analyses revealed that both hope and optimism predicted lower levels of burdensomeness and thwarted belongingness, but were not significant predictors of suicidal ideation. Further, results revealed that when both hope and optimism were entered into a hierarchical regression in the final step, only optimism remained significant. Theoretical and clinical implications of these findings are discussed.     

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.     

Assessing African American adolescents' risk for suicide attempts: attachment theory

The threat of separation from a parent theoretically increases the risk of adolescent suicide attempts. The present study evaluated this and other hypothesized risk factors in a sample of adolescent suicide attempters and nonsuicidal controls, using the Psychiatric Consultation Checklist (Lyon, 1987). Stepwise logistic regression was used to predict group membership. It was found that threat of separation from a parental figure, insomnia, neglect, substance abuse, suicidal ideation, and failing grades were the strongest predictors of suicide attempt. Ten predictor variables correctly identified 97% of suicide attempters and 86% of nonattempters. Unexpected findings included high levels of truancy, threatening others, and separation from a parent before the age of 12 among nonattempters.     

Perceived burdensomeness and suicide ideation in older adults

Older adults have the highest risk of death by suicide in the United States. Improving our understanding of the factors that lead to increased risk of suicide in older adults will greatly inform our ability to prevent suicide in this high-risk group. Two studies were conducted to test the effect of perceived burdensomeness, a component of the interpersonal-psychological theory of suicide (Joiner, 2005), on suicide ideation in older adults. Further, gender was examined as a moderator of this association to determine if perceived burdensomeness exerted a greater influence on suicide ideation in males. The results of these studies suggest that perceived burdensomeness accounts for significant variance in suicide ideation, even after predictors such as depressive symptoms, hopelessness, and functional impairment are controlled. Gender did not moderate the association. The implications of these findings for treatment of older adults with suicide ideation and elevated suicide risk are discussed.     

Positive and negative attitudes mediating suicide ideation.

Both the presence of negative expectancies (Beck, Weissman, Lester, & Trexler, 1974) and the absence of positive reasons for living (Linehan, Goodstein, Nielsen & Chiles, 1983) have been offered as partial explanations for why individuals consider suicide. The independent viability of these two explanations is evaluated in three studies that assess: (1) the distinctiveness of the nomological networks of measures of these two approaches; and (2) the latent variables that might account for any observed distinctiveness and for how two relatively independent constructs could both be related to suicide. Results obtained from both nonclinical and clinical samples consistently indicate distinct nomological nets for measures of "hopelessness" and "reasons for living." Results suggest that these measures are both related to suicide because measured suicide intent is a bi-factorial construct and measures of hopelessness and reasons for living are related to different underlying factors. Suicide intent is related to latent variables labelled "neuroticism" and "psychoticism;" hopelessness is related to these two factors and to "extraversion;" reasons for living is primarily related to psychoticism.     

Factors associated with outcome of cognitive-behavioural treatment of chronic post-traumatic stress disorder

The study examined factors that were associated with outcome in the treatment of PTSD. A trial of cognitive therapy compared to imaginal exposure of chronic PTSD showed that although clinical improvements were obtained after treatment and at 6 month follow-up one type of treatment was not significantly superior to the other. Characteristics of the patient, the trauma and treatment and of pretreatment clinical measures were investigated as predictors of PTSD outcome. Eleven variables were significantly associated with the pre- to post-treatment change in CAPS severity scores. Of these, three (duration of therapy, gender and suicide risk) were selected into a step-wise multiple regression equation to explain 36.5% of the outcome. Similarly, nine variables were significant associated with the pretreatment to follow-up change with three variables (number of missed therapy sessions, residential status and co-morbid GAD) being selected into the equation and explaining 36.9% of the outcome. The best predictor of outcome was inconsistent attendance at therapy.     

The Association Between Anhedonia,Suicide Ideation,and Suicide Attempts: A Replication in a Persian Student Sample

Research suggests that anhedonia, a common symptom of depression, may be uniquely associated with suicidal behavior. However, little research has examined this association across cultures. To address this limitation, this study attempted to replicate a recent anhedonia and suicide study (conducted in a western culture) in a Persian sample using the Specific Loss of Interest and Pleasure Scale, Persian version. Participants consisted of 404 students who were recruited from a Persian university. Surprisingly, our results indicated that anhedonia levels were more than double those found in similar American student sample. Despite this marked difference in anhedonia symptoms, we found that anhedonia was associated with suicide risk, even when it was statistically accounting for other depressive symptoms. These findings suggest that anhedonia is a robust predictor of suicide risk across these two cultures. Further, anhedonia may be a particularly important treatment target among Persian students.     

The role of objective personality inventories in suicide risk assessment: an evaluation and proposal.

Objective personality assessment instruments offer a comparatively underutilized source of clinical data in attempts to evaluate and predict risk for suicide. In contrast to focal suicide risk measures, global personality inventories may be useful in identification of long-standing styles that predispose persons to eventual suicidal behavior. This article reviews the empirical literature regarding the efficacy of established personality inventories in predicting suicidality. The authors offer several recommendations for future research with these measures and conclude that such objective personality instruments offer only marginal utility as sources of clinical information in comprehensive suicide risk evaluations. Personality inventories may offer greatest utility in long-term assessment of suicide risk.     

Are Eating Disorders and Related Symptoms Risk Factors for Suicidal Thoughts and Behaviors? A Meta‐analysis

This meta‐analysis addressed whether eating disorders (EDs) are risk factors (i.e., longitudinal predictors) for suicidal thoughts and behaviors. We identified 2,611 longitudinal studies published through August 1, 2017. Inclusion required studies include at least one longitudinal analysis predicting suicide ideation, attempt, or death using an ED diagnosis and/or symptom. Fourteen studies (42 prediction cases) met criteria. Results indicated that clinically diagnosed EDs and disordered eating symptoms were significant but weak predictors of suicide attempts but not death. Effects remained weak when moderators were considered. By reviewing the methodological limitations of previous research, these results highlight avenues for future research.     

Risk Factors,Warning Signs,and Drivers of Suicide: What Are They,How Do They Differ,and Why Does It Matter?

Research investigating suicide attempts and deaths by suicide has yielded many specific risk factors and warning signs for future suicidal behaviors. Yet, even though these variables are each valuable for suicide prevention efforts, they may be limited in their applicability to clinical practice. The differences among risk factors, warning signs, and “drivers,” which are person‐specific variables that lead individuals to desire death by suicide, are highlighted. The scarce evidence on drivers is described and specific recommendations for conducting future drivers‐focused research and targeting them in clinical practice are suggested.     

Family Factors Predicting Categories of Suicide Risk

We compared family risk and protective factors among potential high school dropouts with and without suicide-risk behaviors (SRB) and examined the extent to which these factors predict categories of SRB. Subjects were randomly selected from among potential dropouts in 14 high schools. Based upon suicide-risk status, 1,083 potential high school dropouts were defined as belonging to one of four groups; 573 non-suicide risk, 242 low suicide risk, 137 moderate suicide risk and 131 high suicide risk. Results showed significant group differences in all youth self-reported family risk and protective factors. Increased levels of suicide risk were associated with perceived conflict with parents, unmet family goals, and family depression; decreased levels of risk were associated with perceived parental involvement and family support for school. Perceived conflict with parents, family depression, family support satisfaction, and availability of family support for school were the strongest predictors of adolescent SRB. Our findings suggest that suicide vulnerable youth differ from their non-suicidal peers along the dimensions of family risk and protective factors.     

Suicide risk assessment: Clinicians’ confidence in their professional judgment

Suicide risk assessment is a critical component of mental health practice for which the stakes are high and the outcomes uncertain. This research examines the consistency with which clinicians make determinations of suicide risk and factors influencing clinical confidence. Seventy-one social workers interviewed two standardized patients performing in scenarios depicting suicidal ideation, judged whether the patient required hospitalization, and completed standardized suicide risk assessment measures. Self-ratings and qualitative interviews explored participants’ confidence in their judgment of risk. Participants had highly divergent views regarding whether or not the risk of suicide was sufficiently high to require hospitalization. However, regardless of the ultimate decision reached, participants were equally confident when recommending either clinical course of action. The variation in risk assessment appraisals in this study, despite at times high rates of confidence in risk appraisals, speaks to the need for ongoing training, consultation, and increased decision support strategies.     

Personality traits and cognitive styles as risk factors for serious suicide attempts among young people.

The contribution of a series of measures of personality and/or cognitive style to serious suicide attempt risk in young people was examined in a case-control study. Individuals making suicide attempts had elevated odds of hopelessness, neuroticism, introversion, low self-esteem, impulsiveness, and external locus of control. When allowance was made for intercorrelations between these measures, hopelessness, neuroticism, and external locus of control remained significant risk factors for serious suicide attempt; self-esteem, extraversion, and impulsiveness were not significantly associated with suicide attempt risk. Nonsignificant findings were explained by the presence of substantial correlations between these measures and measures of hopelessness, neuroticism, and external locus of control.     

The Predictors of Suicidality in Previous Suicide Attempters following Case Management Services

Suicide attempts constitute a serious clinical problem. People who have attempted suicide are at an elevated risk for additional suicide attempts, but there is limited evidence regarding the predictors of suicidality of suicide attempters following case management services. In the present study the indicators of suicidality after case management were examined. A total of 1,056 subjects who had recently attempted suicide were recruited from January 1, 2011, to June 30, 2011. The suicide prevention center of Kaohsiung City in Taiwan provided case management services and followed up on suicide attempt cases for 6 months. The salient factors for repeat suicide attempts were estimated using a logistic regression analysis. The results showed that multiple factors, including a “willingness to receive mental health services during a crisis,” “social support,” “a history of mental disorders,” and “a history of suicide,” could predict repeat suicide attempts with hazard ratios (0.58, 0.54, 3.84, 1.51) and 95% confidence interval (0.39–0.86, 0.36–0.83, 2.41–6.10, 1.03–2.21). The four factors mentioned above were the most accurate predictors of subsequent suicidality when case management services were utilized after 6 months of follow‐up. The findings of our study could help clarify future strategies for suicide prevention.     

Risk Factors for Attempting Suicide in Heroin Addicts

In order to examine risk factors for attempting suicide in heroin dependent patients, a group of 527 abstinent opiate dependent patients had a psychiatric interview and completed the Childhood Trauma Questionnaire. Patients who had or had never attempted suicide were compared on putative suicide risk factors. It was found that 207 of the 527 heroin abusers (39.3%) had attempted suicide. Attempters were younger; more were female, reported childhood trauma, a family history of suicidal behavior, a history of aggression, treatment with antidepressant medication, and alcohol and cocaine dependence. Logistic regression revealed that a family history of suicidal behavior, alcohol dependence, cocaine dependence, and treatment with antidepressant medication were significant predictors of attempting suicide. These results suggest that attempting suicide is common among opiate dependent patients and that both distal and proximal risk factors may play a role.