RxPG News : Suicide

Understanding gender differences in suicide methods

Tue, 30 Aug 2011 23:00:00 PST

( from http://www.rxpgnews.com ) Women who commit suicide are more likely than men to avoid facial disfiguration, but not necessarily in the name of vanity. Valerie Callanan from the University of Akron and Mark Davis from the Criminal Justice Research Center at the Ohio State University, USA, show that there are marked gender differences in the use of suicide methods that disfigure the face or head. While firearms are the preferred method for both men and women, women are less likely to shoot themselves in the head. The study is published online in Springer's journal Sex Roles.

Although a number of studies have looked at gender differences in suicide risk, few have examined gender differences in suicide methods. Understanding gender differences in suicide methods has important implications for suicide prevention efforts.

Callanan and Davis examined the medical examiner's files of 621 suicide cases in Summit County, Ohio in the US, covering a 10-year period (1997-2006). They found that women were significantly less likely than men to use suicide methods with the potential to disfigure the face or head. Indeed, men were nearly twice as likely as women to have used such methods.

The researchers also found that for every one-unit increase in blood alcohol level, the odds of using a disfiguring method increased by nearly 10 percent. Gender, age, stressful life events and prior suicide attempts all predicted the use of methods that disfigure the face and head.

The authors conclude: To suggest that women are less likely to shoot themselves in the face or head because they are more concerned about their appearance than men is to minimize the significance of the act of suicide. What we do know is that those experiencing stressful life events are at far greater risk of employing an especially lethal method of suicide than those not experiencing such events.

Countries with high happiness levels also have high suicide rates

Fri, 22 Apr 2011 06:15:28 PST

( from http://www.rxpgnews.com ) The happiest countries and happiest U.S. states tend to have the highest suicide rates, according to research from the UK’s University of Warwick, Hamilton College in New York and the Federal Reserve Bank of San Francisco.

The new research paper titled Dark Contrasts: The Paradox of High Rates of Suicide in Happy Places has been accepted for publication in the Journal of Economic Behavior & Organization. It uses U.S. and international data, which included first-time comparisons of a newly available random sample of 1.3 million Americans, and another on suicide decisions among an independent random sample of approximately 1 million Americans.

The research confirmed a little known and seemingly puzzling fact: many happy countries have unusually high rates of suicide. This observation has been made from time to time about individual nations, especially in the case of Denmark. This new research found that a range of nations - including: Canada, the United States, Iceland, Ireland and Switzerland, display relatively high happiness levels and yet also have high suicide rates. Nevertheless the researchers note that, because of variation in cultures and suicide-reporting conventions, such cross-country scatter plots are only suggestive. To confirm the relationship between levels of happiness and rates of suicide within a geographical area, the researchers turned to two very large data sets covering a single country, the United States.

The scientific advantage of comparing happiness and suicide rates across U.S. states is that cultural background, national institutions, language and religion are relatively constant across a single country. While still not absolutely perfect, as the States are not identical, comparing the different areas of the country gave a much more homogeneous population to examine rather than a global sample of nations.

Comparing U.S. states in this way produced the same result. States with people who are generally more satisfied with their lives tended to have higher suicide rates than those with lower average levels of life satisfaction. For example, the raw data showed that Utah is ranked first in life-satisfaction, but has the 9th highest suicide rate. Meanwhile, New York was ranked 45th in life satisfaction, yet had the lowest suicide rate in the country.

The researchers then also tried to make their comparison between States even fairer and yet more homogeneous by adjusting for clear population differences between the states including age, gender, race, education, income, marital status and employment status. Even with these adjustments. This still produced a very strong correlation between happiness levels and suicide rates although some states shifted their positions slightly. Hawaii then ranks second in adjusted average life satisfaction but has the fifth highest suicide rate in the country. At the other end of the spectrum, for example, New Jersey ranked near the bottom in adjusted life satisfaction (47th) and had one of the lowest adjusted suicide risks (coincidentally, also the 47th highest rate).

The researchers (Professor Andrew Oswald from the University of Warwick, Associate Professor of Economics Stephen Wu of Hamilton College and Mary C. Daly and Daniel Wilson both from the Federal Reserve Bank of San Francisco) believe the key explanation that may explain this counterintuitive link between happiness and suicide rates draws on ideas about the way that human beings rely on relative comparisons between each other.

University of Warwick researcher Professor Andrew Oswald said:

“Discontented people in a happy place may feel particularly harshly treated by life. Those dark contrasts may in turn increase the risk of suicide. If humans are subject to mood swings, the lows of life may thus be most tolerable in an environment in which other humans are unhappy.”

Professor Stephen Wu of Hamilton College said:

"This result is consistent with other research that shows that people judge their well-being in comparison to others around them. These types of comparison effects have also been shown with regards to income, unemployment, crime, and obesity."

More than half college students have suicidal thoughts

Mon, 18 Aug 2008 13:15:47 PST

( from http://www.rxpgnews.com ) Washington, Aug 18 - More than half of 26,000 students surveyed across 70 colleges and universities across the US admitted having at least one episode of suicidal thinking at some point in their lives.

Furthermore, 15 percent of them reported having seriously considered attempting suicide and more than five percent reported making a suicide attempt at least once in their lifetime.

The survey was administered in early 2006 and gathered information about a range of suicidal thoughts and behaviours among college students. The survey was reviewed by the campus counselling directors as well as two experts in suicidology.

Six percent of undergraduates and four percent of graduates reported seriously considering suicide within the 12 months prior to answering the survey. Therefore, the researchers posit, at an average college with 18,000 undergraduate students, some 1,080 undergraduates will seriously contemplate taking their lives at least once within a single year.

Approximately two-thirds of those who contemplate suicide will do so more than once in a 12-month period.

The majority of students described their typical episode of suicidal thinking as intense and brief, with more than half the episodes lasting one day or less. The researchers found that, for a variety of reasons, more than half of students who experienced a recent suicidal crisis did not seek professional help or tell anyone about their suicidal thoughts.

The researchers used separate samples of undergraduate and graduate students. College sizes ranged from 820 to 58,156 students, with 17,752 being the average. For the 15,010 undergraduates, 62 percent were female and 38 percent were percent male. Seventy-nine percent were white and 21 percent were minorities.

Ninety-five percent identified themselves as heterosexual and five percent identified as bisexual, gay or undecided. The average age was 22. For the 11,441 graduates, 60 percent were female and 40 percent were male.

Seventy-two percent were white and 28 percent were minorities. Ninety-four percent identified themselves as heterosexual and 6 percent identified as bisexual, gay or undecided. The average age was 30.

Both undergraduate and graduate students gave these reasons for their suicidal thinking, in the following order: - wanting relief from emotional or physical pain; - problems with romantic relationships; - the desire to end their life; and - problems with school or academics.

Fourteen percent of undergraduates and eight percent of graduate students who seriously considered attempting suicide in the previous 12 months made a suicide attempt. Nineteen percent of undergraduate attempters and 28 percent of graduate student attempters required medical attention. Half of attempters reported overdosing on drugs as their method, said the authors.

From the survey, the authors found that suicidal thoughts are a frequently recurring experience akin to substance abuse, depression and eating disorders. They also found that relying solely upon the current treatment model, which identifies and helps students who are in crisis, is insufficient for addressing reducing all forms of suicide behavior on college campuses.

These findings were presenting on Sunday at the 116th Annual Convention of the American Psychological Association, by psychologist David J. Drum, and co-authors at the University of Texas, based on a survey conducted by the National Research Consortium of Counselling Centres in Higher Education.

Sleep disturbances among the elderly linked to suicide

Fri, 15 Jun 2007 16:00:00 PST

( from http://www.rxpgnews.com ) Self-reported sleep complaints among the elderly serve as a risk factor for completed suicide.

The study, conducted by Rebecca Bernert of Florida State University, focused on data that were collected among 14,456 community elders over a 10-year period. During this time frame, 21 individuals died by suicide. When each suicide was matched to 20 randomly-selected controls, it was discovered that disturbances in sleep, independent of depression, predicted an increased risk for eventual death by suicide.

This suggests that, as a warning sign, poor sleep quality constitutes a significant and modifiable risk factor for completed suicide, said Bernert. Evaluating sleep among at-risk patients may therefore guide and importantly inform both clinical decision-making and suicide risk assessment.

It is recommended that older adults get seven to eight hours of sleep each night for good health and optimum performance. Unfortunately, many older adults often get less sleep than they need. One reason is that they often have more trouble falling asleep.

Not sleeping well can lead to a number of problems. Older adults who have poor nighttime sleep are more likely to have a depressed mood, attention and memory problems, excessive daytime sleepiness, more nighttime falls, and use more over-the-counter or prescription sleep aids. Poor sleep is also associated with a poorer quality of life. Insomnia, the most common sleep complaint, affects almost half of adults 60 and older.

Those who think they might have a sleep disorder are encouraged to consult with their primary care physician, who will refer them to a sleep specialist.

Genetic variations may predispose some men to suicidal thoughts during treatment for depression

Thu, 07 Jun 2007 16:00:00 PST

( from http://www.rxpgnews.com ) Genetic variations may help explain why some men with depression develop suicidal thoughts and behaviors after they begin taking antidepressant medications, while most do not, according to a report in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Although most patients with depression respond favorably to antidepressant medications, a very small subgroup may experience worse symptoms after beginning treatment, according to background information in the article. "Regardless of treatment specificity, nearly all antidepressant medication studies find that some patients experience suicidality [suicidal thoughts and behaviors] after treatment initiation," the authors write. "Identification of this subpopulation before treatment would have tremendous clinical utility."

Roy H. Perlis, M.D., of Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues studied 1,447 individuals with depression who were part of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, which was conducted from July 2001 to September 2006, and who did not express suicidal thoughts at the beginning of the study. The participants were men and women ages 18 to 75 years who had been diagnosed with non-psychotic major depressive disorder. They took the antidepressant citalopram hydrobromide for up to 12 weeks, following a protocol that advised follow-up treatment visits at two, four, six, nine and 12 weeks, with an optional visit at 14 weeks if needed. The patients' DNA was analyzed for common types of mutations nearby or within the CREB1 gene, which codes for a protein previously suggested to be involved in both antidepressant effects and suicide.

Of the 1,447 patients, 123 (8.5 percent) reported suicidal thoughts or behaviors during at least one follow-up visit, including 54 (10 percent) of the 539 men. Two of five single nucleotide polymorphisms (SNPs) - variations that occur when a single building block of DNA is altered - were significantly and strongly associated with the onset of suicidality in men, but not in women.

The researchers performed additional analyses suggesting these variations are not linked to suicidal thoughts and behaviors in men before treatment. "No statistically significant association was noted between any SNP and the presence or absence of baseline suicidality," the authors write. "Likewise, no evidence of association was noted between any SNP and history of lifetime suicide attempt."

Studies that link genes to illnesses are most compelling when there is additional evidence of that gene's function, the authors note. "We recently observed an association between the same CREB1 polymorphisms and a measure of anger expression among males but not females in a sample of 94 patients with major depressive disorder; hostility and anger expression have also been associated with suicide," they write.

"If replicated, this finding would suggest that pharmacogenetic testing could facilitate the identification of the small subset of individuals at greater risk during short-term antidepressant treatment," the authors conclude.

Sleep disorder may cause suicidal tendencies

Sun, 07 Jan 2007 12:27:35 PST

( from http://www.rxpgnews.com ) London, Jan 7 - People with sleep disorders and nightmares may be prone to developing suicidal tendencies, says a new study.

A nightmare is a distressing dream, which usually forces at least partial awakening. The dreamer facing the disorder may feel any number of disturbing emotions like anger, guilt, sadness or depression, but the most common feelings are fear and anxiety.

Nightmares are very common, with 50-85 percent of adults reporting having a nightmare at least on one occasion. They tend to become less frequent with age, reported health portal Health Central.

Nisse Sjostrom and colleagues from Sahlgrenska University Hospital in Goteborg, Sweden, studied 165 people who had been admitted to the hospital after a suicide attempt.

The study, published in the Jan 1 issue of journal 'Sleep', found that 89 percent of the participants reported some type of sleep disturbance, with the most common disturbances being difficulties staying asleep, nightmares, and early morning awakening.

Having nightmares was associated with a five-fold increase in risk for high suicidal tendency, the researchers said.

People who experience nightmares should see a sleep specialist who can diagnose the problem and make referrals to counsellors or psychologists when necessary, they added.

'Our finding of an association between nightmares and suicidality does not imply causality,' said Sjostrom.

'However, our findings should inspire clinicians to include questions concerning sleep disturbance, especially nightmares, in the clinical assessment of suicidal patients.'

Suicide rate among NY's ethnic women population alarming

Sat, 09 Dec 2006 18:31:46 PST

( from http://www.rxpgnews.com ) New York, Dec 9 - Driven often by cultural or linguistic isolation, young Hispanic women and elderly Asian women here are at exceptionally high risk of attempting or committing suicide, mental health experts have warned.

The problem is mainly fuelled by cultural and linguistic isolation, the stress of immigration and a shortage of psychiatric and counselling services, according to advocates who attended a hearing in Lower Manhattan on Friday.

In New York, Asian women 65 and older have a suicide rate of 11.6 per 100,000, more than double the rate for non-Hispanic white women in that age group, according to Dr. Lloyd I. Sederer, the executive deputy commissioner of the city department of health and mental hygiene.

Teenage Hispanic girls are hospitalised for depression at a rate of 388 per 100,000 - and are hospitalised after attempting suicide or talking about it at a rate of 95.5 per 100,000 -, according to the New York Times.

The causes of depression in Asian women seem to be less understood. Two advocates at non-profit groups - Ruchika Bajaj of the Coalition for Asian American Children and Families and Sandeep Bathala of Sakhi for South Asian Women - said that mental health services for women from India, Pakistan, Bangladesh and other South Asian countries were particularly scarce. Women who are not proficient in English do not get help, Ms. Bajaj said, 'until symptoms reach crisis proportions.'

Similarly, Cao K.O, executive director of the Asian American Federation of New York, said a survey in 2000 of older Asians in the city found that 40 percent reported symptoms of depression. A separate study of the effects of 9/11 on Asians in the city, Cao said, found that they 'largely perceived professional mental health services to be unhelpful, inappropriate or irrelevant.'

Suicide Risk associated with Pre- and Postnatal and Early Childhood Factors

Fri, 01 Dec 2006 17:16:46 PST

( from http://www.rxpgnews.com ) Low birth weight, having one or more older siblings, a young mother and parents with non-professional jobs are all independent risk factors for higher suicide risk in later life, according to a new study.

Published in the December issue of the British Journal of Psychiatry, the research used Scottish birth and death records to examine the relationship between pre- and postnatal circumstances and subsequent young adult suicide.

Information was analysed on 1,061,830 people born between 1969 and 1986 for whom an electronic Scottish Morbidity Record was available. This included anonymised data on birth weight, gestational age at birth, maternal age, number of elder children in the family and parental occupations.

These records were linked to the register of Scottish deaths, and people who died between 1981 and 2003 by suicide (death by self-inflicted injury or undetermined death) were identified.

Self-inflicted injury was recorded as the cause of death in 1053 cases, and undetermined death in 411, so that 1464 cases were identified as suicide. 1166 of these were male and 298 female.

A significant association was found between offspring suicide (and death from other causes) and whether the mother already had children.

People born to women aged 24 or younger were at significantly greater risk of subsequent suicide (and death from other causes) compared to those with older mothers. The risk of offspring suicide was higher among those born to women aged 19 or under.

Low birth weight (less than 2500g) raised the risk of later suicide, as well as death from other causes. However, no significant association was found between gestational age at birth and later suicide, suggesting that premature birth is not a risk factor for suicide.

Compared with parents in professional occupations, children of parents in skilled occupations and unskilled occupations were more likely to have died by suicide.

The authors of the study comment that it is the first to show an association between how many children a woman has and later offspring completed suicide. This risk was significantly higher even in those born to mothers who had just one completed pregnancy.

Suicide is strongly correlated with mental disorders, and there is a well-documented link between mental disorder and an increased risk of premature death, not only from suicide, but also from other causes. The findings of this study on the effects of already having children, and maternal age, would be consistent with the idea that these factors affect susceptibility to mental illness.

Theoretically, it is possible that mothers experience greater stress during pregnancy if they are teenagers, have an older child to care for, or are financially disadvantaged. The results of this study are consistent with the maternal-foetal origins hypothesis of the causes of mental illness, which suggests that maternal stress has a negative influence on foetal brain development.

Further research is needed to clarify how the risk factors identified in this study operate. They may be influencing attachment processes, altering gene expression through antenatal maternal stress, or directly increasing stress and stress hormone levels in the infant or young child.

It needs to be established to what extent the pre- and postnatal risk factors are associated with mental illness in general, and how they influence causes of death other than suicide.

Many initiatives aimed at tackling youth suicide focus on the current environment of young adults. The results of this study suggest that paying attention to early childhood, even antenatal environments, may have an impact on suicide rates in years to come.

Antidepressants are of questionable benefit in teenage suicide cases

Thu, 14 Sep 2006 17:01:00 PST

( from http://www.rxpgnews.com ) There has been much controversy in recent years regarding the correlation between teenage suicide and the use of antidepressant drugs. At an FDA meeting reviewing this topic, the majority of clinical trials examined did not show that the drugs were effective in treating depression in children and adolescents.

In a recent study published in the September issue of the Journal of Clinical Pharmacology, Dr. Richard Malone, from the Department of Psychiatry at Drexel University College of Medicine and Philadelphia Health & Education Corporation, and colleagues suggest that the short duration of depressive symptoms in this age group makes it difficult to distinguish drug efficacy from placebo.

Using a naturalistic study design, the researchers advise using multiple assessments to establish a continuous baseline before randomizing patients to treatment, which would remove those who spontaneously recover in a very short period of time. In addition to having an impact on the accuracy of future clinical trials, this approach may help decrease the number of children who are exposed to unnecessary long-term drug therapy and possible side effects, since those who spontaneously recover quickly would not be started on drug therapy.

The article "Impersistence of Depression in Youth: Implications for Drug Study Design" can be accessed at no-charge for a limited time at The Journal of Clinical Pharmacology's web site.

Cancer survivors at risk for suicidal thoughts

Sat, 19 Aug 2006 17:42:00 PST

( from http://www.rxpgnews.com ) A survey of adult survivors of childhood cancers found that more than one out of eight reported having suicidal thoughts or previous attempts to take their lives many years after they were treated, say scientists at Dana-Farber Cancer Institute.

The suicidal symptoms were reported by more than 12 percent - a greater proportion than had been expected -- of patients seen at a clinic providing care for adult cancer survivors, the researchers write in the August 20 issue of the Journal of Clinical Oncology. The findings should prompt providers at survivor clinics to consider the interaction of physical and emotional factors in their follow-up evaluations of patients, they said.

"Most people are doing fine, but there is a serious concern about the minority of survivors who have thoughts of ending their lives," said Christopher Recklitis, PhD, MPH, a psychologist and director of research in the Perini Family Survivors' Center at Dana-Farber. He is lead author of the paper.

The senior author is Lisa Diller, MD, chief medical officer of Dana-Farber/Children's Hospital Cancer Care and clinical director of Pediatric Oncology at Dana-Farber Cancer Institute and Children's Hospital Boston.

Previous studies have noted a temporary rise in suicidal thoughts among patients in the months after a cancer diagnosis. The new study is the first to substantiate a significant level of suicidality many years or even decades after treatment for childhood cancers, and to suggest a link with physical functioning in the survivorship period

Recklitis and colleagues conducted the study with the participation of 226 adult survivors of childhood cancer 100 men and 126 women with a mean age of 28.

The participants were interview an average of 18 years after their initial diagnosis with a range of childhood cancers including lymphomas, leukemias, sarcomas, and Wilms' tumor. Individuals diagnosed with brain tumors were not included in the group.

The study participants completed standard rating scales evaluating quality-of-life, suicidal thoughts, signs of depression, pain, and physical health. All together 29 survivors reported some suicidal symptoms.

Nineteen patients reported suicidal thoughts alone, one had made a previous attempt but no longer was troubled by suicidal thoughts, and nine participants said they had made suicide attempts and were currently thinking about suicide. Only 11 of these 29 survivors were considered to be significantly depressed on the basis of their rating scales, suggesting that identifying survivors with suicidal thoughts requires more than asking patients about depression.

Data analysis showed that factors associated with more suicidal symptoms included younger age at diagnosis, a greater time having passed since diagnosis, and radiation treatments to the head. The latter form of treatment used less frequently and in smaller doses today can cause growth retardation and physical disfigurement, impairments in memory and cognitive functions, and increased risk of second cancers.

Patients were also more likely to report suicidal symptoms if they felt depressed or hopeless, were in pain, had problems with physical function, or were concerned about their appearance.

"The association with physical health and pain is important," the authors wrote, "because these represent potentially treatable conditions for which survivors may seek follow-up care."

In revealing the complex relationships of physical and mental well being with suicidality, the study "underscores the need for a multidisciplinary approach to survivor care."

With the growth of survivors' clinics across the country, it is important to improve psychological screening methods "that aren't intrusive, but get us to this important information," said Recklitis, who is also a clinical instructor in psychology at Harvard Medical School.

Dialectical Behavior Therapy (DBT) reduced suicide attempts by half - Study

Mon, 10 Jul 2006 20:57:00 PST

( from http://www.rxpgnews.com ) Dialectical Behavior Therapy (DBT) reduced suicide attempts by half compared with other types of psychotherapy available in the community in patients with borderline personality disorder, an NIMH-funded study has found. DBT also excelled at reducing use of emergency room and inpatient services and more than halved therapy dropout rates compared to the mostly traditional approaches, report Marsha Linehan, Ph.D., University of Washington, and colleagues in the July 2006 issue of Archives of General Psychiatry.

"All treatments are not equal for such suicidal patients," said Linehan.

Borderline personality disorder is a difficult-to-treat mental illness affecting up to two percent of adults, 5.8-8.7 million Americans, mostly young women. People with this disorder of emotion regulation experience intense bouts of anger, depression, and anxiety that may last only hours, often in response to perceived rejection. They typically have tumultuous work and family life and may engage in risky, impulsive behaviors. Cutting, burning and other forms of self-harm are common, with up to 9% ultimately killing themselves. Although they account for at least 20 percent of psychiatric inpatient admissions, and frequently seek mental health services, patients with the disorder often fail to respond to commonly available treatments.

Hence, NIMH has supported the development and testing of DBT by Linehan and her colleagues over the past two decades. This variation on cognitive behavioral therapy specifically targets suicidal behavior, behaviors that interfere with treatment, and risky social behaviors. While previous controlled trials had demonstrated DBT's usefulness, whether this was attributable to psychotherapy generally rather than to specific features of DBT remained unclear.

To help resolve this issue, the researchers created a more tightly-defined comparison condition. They treated for one year 101 female patients with borderline personality disorder, ages 18-45, in the Seattle area with either currently available "Treatment By Experts" (TBE) in the community, or therapists specifically trained in DBT.

The 52 patients randomly assigned to the DBT group received one hour of individual therapy and 2.5 hours of group skills training each week, in addition to phone consultations. DBT focused on improving patients' coping skills and motivation by helping them reduce interfering emotions and thinking and reinforce functional behaviors. Their 16 DBT therapists also met weekly to enhance their motivation and skills.

The 49 patients who received TBE were offered one weekly therapy session plus additional treatment as needed, at the therapists' discretion. Most of them received psychodynamic therapy that focused on gaining insight into unconscious motives, needs and defenses rather than directly on behavior change. Their 25 therapists, nominated by community mental health leaders for their skill in dealing with difficult patients, had the option of attending a weekly supervisory group convened at a prestigious local psychoanalytic institute.

Although DBT patients were provided with significantly more therapy within the study, the two groups ended up with about the same total therapy hours, since TBE patients were more prone to switching therapists and seeing therapists outside the study. The risk of dropping out of therapy was nearly three times higher among the TBE group â 59 percent dropped their first assigned therapist, compared to 25 percent of DBT patients. More than twice as many of the former also dropped out of the study entirely. Fewer DBT patients continued taking psychotropic medications during the study year, perhaps reflecting their therapists' behaviorally-focused treatment philosophies.

While there were no completed suicides, 46.7 percent of the TBE and 23.1 percent of the DBT patients attempted suicide during the study year. Among TBE patients, 57.8 percent visited emergency rooms for psychiatric problems, compared with 43.1 percent among DBT patients; 48.9 percent of TBE patients had at least one psychiatric hospitalization, often for suicidal thoughts, in contrast to 19.6 percent of DBT patients. No significant differences emerged between the groups in proneness to non-suicidal self-injury. And both therapies reduced patients' suicidal thinking and strengthened their appreciation of life.

Noting that DBT is the only psychosocial treatment shown in multiple randomized clinical trials to be effective for borderline personality disorder, the researchers suggested that "DBT may be uniquely effective in treating suicidal individuals."

Oldest Description of Suicidal Thoughts found in an Egyptian Poem

Mon, 10 Jul 2006 20:38:00 PST

( from http://www.rxpgnews.com ) Analysis of an ancient Egyptian poem by a psychiatrist and an Egyptologist shows that it describes the psychopathology of suicide with great accuracy.

Dispute over Suicide was a poem written by an unnamed Egyptian writer between 2000 and 1740 BC on papyrus in hieroglyphics.

The writer is known as The Eloquent Peasant, and was commissioned by King Meri-ka-re to write a poem in order to dissuade people from committing suicide.

Suicide as a form of human behaviour is probably as ancient as man himself. Attitudes towards those who take their own lives have veered between condemnation and tolerance throughout the ages.

It is possible that moral and cultural views about suicide have affected its incidence, statistics on suicide, and even coroners verdicts. An historical approach makes it possible to understand what meaning suicide has for people with different experiences from different backgrounds and generations.

Dr. George Tadros, a consultant psychiatrist, and Dr. Ahmes Pahor, an Egyptologist and ENT consultant, used a computer programme with special software for qualitative analysis to assess the poem.

The Eloquent Peasant gives a detailed description of negative thoughts, hopelessness and helplessness, which are characteristic of the state of mind of a person contemplating suicide. The poem presents an accurate picture of depressive mood, and the negative thought pattern that accompanies it.

The poet also gives a unique illustration of magical thinking, which is frequently associated with suicide. Surely he who is yonder shall be a living God Punishing the sin of him who commits it.

Death is by my sight today The poet gives a detailed account of the feeling of suicide as approaching death, and demonstrates how desperate people could see suicide as a desirable outcome.

However, The Eloquent Peasant also offers a solution of reconciliation to resolve the conflict for people contemplating suicide.

What my soul said to me.
Put care aside, my comrade and brother.
Make an offering on the brazier and cling to life

The authors of the study comment that the Ancient Egyptians appear to have had a significant grasp of the psychopathology of suicide. It would be interesting, they say, to study wider mental health issues and practice in ancient Egypt.

Babies born in spring may face suicide risk

Tue, 02 May 2006 23:02:00 PST

( from http://www.rxpgnews.com ) Babies born in spring may have increasing risk of committing suicide, British researchers have found in a new study that links personality disorders to months in which people are born.

Researchers studied 26,916 suicides in England and Wales and found babies born in April, May or June had a 17 percent higher risk of suicide than those born in autumn, reported the online edition of BBC News.

The study by researchers from St. Helen's and Liverpool University and the Institute of Child Health at University College London, which is published in the British Journal of Psychiatry, found that several diseases are linked to seasons.

The researchers suggested that the increased risk reflected the fact that more people with alcoholism, depression and mood disorders are born in these months.

"We are born all the same but some of us are more vulnerable than others to certain diseases," they said.

Scientists have established seasonal birth trends for a number of diseases, including some cancers, heart disease and brain tumours.

Other research has found more patients with schizophrenia, brain degenerating disease Alzheimer's, epilepsy and sleep disorder narcolepsy are born in December than any other month.

Nearly 30 percent more suicides were committed among women by those born in spring. Among men the rate was nearly 14 percent higher than those born in autumn.

The authors said: "Our results support the hypothesis that there is a seasonal effect in the monthly birth rates of people who kill themselves and that there is a disproportionate excess of such people born between late spring and midsummer compared with the other months."

Children of men with stressful jobs face suicide risk

Mon, 27 Mar 2006 12:39:00 PST

( from http://www.rxpgnews.com ) The children of men with stressful jobs are at a higher risk of attempting suicide than others, says a study.

Researchers from the University of British Columbia and several other institutions in Canada and Britain studied approximately 30,000 men - who were working or had worked at sawmills in British Columbia - and their children, reported science portal EurekAlert.

They collected data on the men's history of employment, their physical work environment and their psychosocial work conditions - these included the level of responsibility, control over everyday tasks and time constraints, which govern levels of stress.

The results of the study showed that 250 of the approximately 20,000 children in the study attempted or committed suicide over the 15-year period from 1985 to 2001.

Fathers' work conditions while their children were less than 16 years of age had an impact on attempted and completed suicides among their children.

In particular, the female children of men with low control over their work seemed to be at higher risk for attempted suicide during childhood and young adulthood than the female children of fathers in jobs with more control, the researchers said.

The sons of fathers working in jobs with low psychological demand may be particularly at risk of completed suicides, it said.

Grieving parents at higher suicide risk

Sun, 19 Mar 2006 20:12:00 PST

( from http://www.rxpgnews.com ) Bereaved parents who have cared for their dying child could be at higher risk of suicide and need care, according to research. Little research has been done on suicide rates for such parents, according to two papers published in this week's British Medical Journal.

There is substantial evidence that parents who have lost a child suffer deeper and more long-lasting grief than others suffering bereavements, it said.

Parents are at heightened suicide risk especially in the month following the death of their young child, it said.

Recent advances in caring for the terminally ill - palliative care - mean that more and more of these patients are being cared for at home. After the loved one has died, parents or other carers are encouraged to return any unused morphine or other painkillers (opioids) to the pharmacy for safe disposal.

But despite the best efforts of medical staff, this may not happen - resulting in powerful drugs being left in the hands of grieving loved ones.

Looking after the carer before, during and in the aftermath of death is essential. Much more research is needed on how these families can best be supported at this difficult time, authors of the study conclude.

Suicide: Practice and Perfection

Thu, 12 Jan 2006 05:54:00 PST

( from http://www.rxpgnews.com ) Every year, close to 1 million people around the world kill themselves.

Florida State University Bright-Burton Professor of Psychology Thomas Joiner has spent much of his career trying to find out why. After all, lots of people are hopeless and depressed, many severely. Why do some people choose to end their own lives and others don't? The answer, he believes, could save lives.

"There's an idea that suicide is a mode of death that stands apart from others, but there are clear reasons why people die by suicide," said Joiner, an internationally recognized suicide expert. "Just like heart disease, if you understand it, you can prevent it."

In a groundbreaking theory outlined in his new book, "Why People Die By Suicide," (Harvard University Press), Joiner says that those who kill themselves not only want to die, they have learned to overcome the instinct for self-preservation.

The desire for death, according to Joiner, is composed of two psychological states: a perception of being a burden to others and a feeling of not belonging. Alone, neither of these states is enough to instill the desire for death, but together they produce a desire that can be deadly when combined with the acquired ability to enact self-injury.

So how does one overcome the natural instinct for self-preservation? In a word: Practice. In Joiner's theory, suicide victims literally "work up" to the act by getting used to danger, fear and pain. They may do this in a variety of ways over their lifetime.

For some this practice is deliberate. They engage in reckless behavior, cut or otherwise hurt themselves or have repeated suicide attempts. Others may have a history of accidents or medical procedures while still others become inured vicariously. Perhaps like physicians - who have an elevated risk of suicide - they are exposed through their work to pain and suffering on a daily basis. Eventually, self-injury and dangerous situations become unthreatening and mundane, according to Joiner, making suicide easier to carry out.

"Some people think that those who commit suicide are weak," he said. "It's actually about fearlessness. You cannot do it unless you are fearless, and this is behavior that is learned."

Joiner's theory explains why seemingly disparate groups of people, such as anorexics, athletes, prostitutes and physicians, have higher than normal rates of suicide. The lifestyles of all of these people expose them to pain - either that of their own or others - and in a sense harden them against suffering, Joiner said.

It also explains why a relatively large number of people want to kill themselves but only a fraction do. Likewise, many people are capable of killing themselves but most do not. There are relatively few people in the dangerous convergence zone of desire and capacity for suicide, according to Joiner, and these are the people who are at greatest risk for serious suicidal behavior.

But knowing the risk factors makes prevention possible, Joiner said, noting that maintaining good interpersonal relationships is essential. This is perhaps the downfall of many older white men - the demographic that has the highest suicide rates of all. "If you think you belong or that you are contributing, you are going to be protected from suicide no matter what else is going on," he said.

Scare campaigns such as those that are sometimes targeted at teenagers do not work as prevention tools and may, in fact, backfire because they further habituate the at-risk patient to the idea of suicide. Joiner noted that rock singer Kurt Cobain repeatedly watched news footage of a government official who committed suicide during a news conference before carrying out his own suicide in 1994.

While Joiner's book is based on his own experience as a clinical psychologist as well as studies that he and other researchers have conducted, the book is also personal. Joiner was a graduate student when his father took his own life - an event that came as a shock to his family and friends. But Joiner now understands why it happened, and that's information that he wants to share with the 2,500 other families who learn the news of a loved one's suicide every day.

Perhaps, he said, one day that number will be less.

Anxiety Disorders Increase Risk Of Suicide

Tue, 08 Nov 2005 17:39:00 PST

( from http://www.rxpgnews.com ) A pre-existing anxiety disorder significantly increases the risk of a subsequent onset of suicidal thoughts and suicide attempts, according to a study in the November issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

Suicidal thoughts and suicide attempts are strong risk factors for completed suicides, according to background information in the article. Mood disorders such as depression, substance abuse disorders and schizophrenia are well established risk factors for suicidal thoughts and suicide attempts but, the authors suggest, because anxiety disorders often co-exist with these mental disorders, the impact of anxiety disorders on risk for suicidal thoughts and suicide attempts has been difficult to assess.

Jitender Sareen, M.D., F.R.C.P.C., of the University of Manitoba, Winnipeg, and colleagues analyzed data from interviews of a random sampling of people from the Netherlands to determine whether anxiety disorders are risk factors for subsequent suicidal thoughts or attempts. In two follow up assessments, one year and three years following the baseline interview, the researchers examined whether anxiety disorders at baseline were associated with incidence of suicidal thoughts or suicide attempts.

At the first (one-year) and second (three-year) follow-up periods, there were 41 and 44 new cases of suicidal ideation, respectively (total of 85 new cases at either assessment), and 24 and 15 news cases of suicide attempts, respectively, (total of 39 new cases). After adjusting for other mental disorders and other social factors, the researchers found that presence of anxiety disorder more than doubled the risk of suicidal thoughts or attempts for the 7,076 participants in the baseline interview. For the 4,796 people who participated in all three interviews, the presence of anxiety disorders at baseline more than doubled the risk of subsequent suicidal thoughts and more than tripled the risk of subsequent suicide attempts. "Further analysis demonstrated that the presence of any anxiety disorder in combination with a mood disorder was associated with a higher likelihood of suicide attempts in comparison with a mood disorder alone," the authors report.

"This is the first study to demonstrate that a pre-existing anxiety disorder is an independent risk factor for subsequent onset of suicidal ideation [thoughts] and attempts," the authors conclude. "Moreover, the data clearly demonstrate that co-morbid anxiety disorders amplify the risk of suicide attempts in persons with mood disorders. Clinicians and policymakers need to be aware of these findings, and further research is required to delineate whether treatment of anxiety disorders reduces the risk of subsequent suicidal behavior."

Substantial underrecognition of mental illness in emergency departments following self harm

Thu, 06 Oct 2005 21:04:00 PST

( from http://www.rxpgnews.com ) Deliberate self harm, such as self-poisoning and self-cutting or piercing, is an important risk factor for subsequent suicide, according to background information in the article. Although previous studies indicate that following self-poisoning young people are at extremely high risk of suicide, little is known about emergency department assessment, treatment and discharge following an act of deliberate self harm. Previous studies in Europe suggest that mental health evaluations may not be uniformly provided in emergency care of youth who deliberately harm themselves, but no information from the U.S. has been available.

Mark Olfson, M.D., M.P.H., of the Columbia University Medical Center, New York, and colleagues analyzed data from a nationally representative sample of emergency department visits from 1997 to 2002 by young people, aged seven to 24 years, after deliberate self-harm. The researchers assessed the data to determine the frequency with which young people making such emergency visits are diagnosed with mental disorders, are provided various medical and psychiatric treatments and are referred for inpatient and outpatient care.

The researchers found that between 1997 and 2002, the annual overall rate of emergency visits by persons seven to 24 years old for deliberate self-harm was 225.3 per 100,000 population. The rate was significantly higher for persons 15 to 19 and 20 to 24 years of age than for persons seven to 14. "Self-poisoning (67.2 percent) accounted for a majority of the deliberate self-harm visits followed by self-cutting/piercing (25.8 percent)," the researchers report. "Overall, roughly one-half (56.1 percent) of the patient visits resulted in a mental disorder diagnosis including 15.1 percent resulting in a depressive disorder diagnosis and 7.3 percent resulting in a substance use disorder diagnosis. Psychotropic medications [medications with psychological effects] were provided in 12.1 percent of the patient visits, most commonly anxiolytics [anti-anxiety drugs] (6.2 percent)."

"Slightly more than one-half of the patient visits (56.1 percent) resulted in inpatient admission," the authors write. "In addition, 29.0 percent of the visits resulted in outpatient care referral; 5.8 percent resulted in referral to the emergency department for continuing care, 4.9 percent resulted in no follow-up care, and follow-up care was unspecified in 3.4 percent of the visits." A diagnosis of depressive disorder, a well-known and powerful risk factor for youth suicide, was strongly associated with inpatient admission.

"Mental disorders were diagnosed in roughly one-half of emergency visits by young people treated for episodes of deliberate self-harm," the authors conclude. "This suggests substantial underrecognition of mental illness and likely inadequate referral for follow-up mental health care. Further research is clearly needed to better understand the extent and reasons for problems with the detection of mental disorders during emergency department evaluations of young people following self-harm. In the meantime, efforts should be made to fortify mental health assessments. One promising strategy involves routine administration of rapid and efficient diagnostic instruments to all young people following deliberate self-inflicted harm. Improving mental health assessment of these young people provides an important opportunity for secondary prevention."

Poorest people are at Highest risk of Suicide

Tue, 05 Jul 2005 22:23:00 PST

( from http://www.rxpgnews.com ) The more socio-economic disadvantages a person suffers, the higher the risk of suicide, according to a new European comparative study.

Published in the July issue of the British Journal of Psychiatry, this is the first European overview of socio-economic inequalities in suicide mortality in men and women, co-ordinated by the Erasmus MC in Rotterdam.

The researchers used a prospective follow-up of population censuses linked to mortality registries throughout an average follow-up period of four years in ten European countries or cities: Norway, Finland, England and Wales, Denmark, Belgium, Switzerland, Austria, Turin, Barcelona and Madrid.

In eight out of ten countries it was found that, for men, the suicide risk was significantly higher in those with a low level of education compared with the highly educated group.

Suicide inequalities were smaller and less consistent in women. For example, a lower level of educational attainment was a significant, positive but weak risk factor for suicide only in Belgium and Finland. A lower educational level, by contrast, proved to be a protective risk factor for women in Norway, Denmark and Switzerland.

In most countries, the greater the socio-economic disadvantage, the higher the risk of suicide. The intermediate socio-economic groups (high level of education and tenant; low level of education and house owner) were at less risk of suicide than the lowest group.

In Turin, socio-economic status was associated only slightly with suicide risk.

The authors of the study comment that, in line with previous studies, housing tenure seems to be a more important risk factor than education, and shows more consistent results in both men and women.

Overall, the findings of this study are similar to those of a previous worldwide meta-analysis of socio-economic risk factors for mental disorders, a main risk factor for suicide.

Why is there no suicide inequality in Turin, whilst the largest inequalities were found in Madrid? The authors speculate that the outstanding mental health care system in Italy may play a part.

The large educational inequalities found in Madrid (and in some analyses also in Barcelona) may be due to the higher prevalence of drug misuse in these Spanish cities compared with other countries in the European Union. Suicide is a frequent cause of death among drug users in southern Europe.

The strong association between socio-economic status and suicide calls for an improvement in access to psychiatric care for lower socio-economic groups, say the authors of the study.

People of lower socio-economic status are more likely to receive such care in countries (such as Italy and The Netherlands) that have succeeded in integrating mental health within the primary and community care sectors.

Schizophrenia and suicide: systematic review of risk factors.

Tue, 05 Jul 2005 22:23:00 PST

( from http://www.rxpgnews.com ) The most comprehensive review of the international evidence to date on suicide in schizophrenia has found that the key risk factors are: depression, previous suicide attempts, drug misuse, agitation or restlessness, fear of mental disintegration, poor compliance with treatment and recent loss.

Suicide risk is greatly increased in schizophrenia, and detection of those at risk is clinically important. Published in the July issue of the British Journal of Psychiatry, this study systematically reviewed the world literature on patients with schizophrenia or related conditions in which suicide was reported.

28 eligible studies were identified. It was found that suicide risk in patients with schizophrenia was related less to the core psychotic symptoms of the disorder, such as hallucinations and delusions, and more to affective symptoms, agitation or restlessness, and to awareness that the illness was affecting mental functioning.

Previous suicidal behaviour was a strong risk factor. Drug misuse and loss also appeared to increase risk. Compliance with treatment was important in reducing risk.

Positive psychotic symptoms were not associated with increased risk. Indeed, hallucinations were actually associated with decreased risk, as were delusions. It is likely that the negative symptoms of schizophrenia are also associated with decreased risk of suicide.

Although this meta-analysis has shown that some of the risk factors for suicide in schizophrenia are similar to those for suicide in the general population, it has highlighted certain risk factors that are clearly specific to schizophrenia and its consequences.

The risk for suicide in men compared with women with schizophrenia of 1.57 is somewhat less than the ratio observed in the general populations of most countries. In contrast to the risk in the general population, being single or divorced was not associated with greater risk.

The living circumstances of patients appeared to be important, in that those living alone, or not living with their families, were at increased risk, a finding that might reflect the severity of the disorder.

Life events in the form of recent losses appear to be associated with suicide risk in patients, as is the case for suicide risk in general.

The most robust findings were of risk of suicide being strongly associated with affective disorders, such as depression; specific affective symptoms (agitation, sense of worthlessness and hopelessness); a history of suicidal thinking; threats of suicide; and (especially) non-fatal suicidal acts.

Further support for the importance of depression as a risk factor came from the positive association of risk with a family history of affective disorders. A family history of suicide was also a risk factor in the largest study that examined this area.

The meta-analysis provides some support for the idea that a higher level of education is associated with suicide risk, and this may also be the case with higher IQ. Fear of mental disintegration was also associated with increased risk.

Surprisingly, given the significance of alcohol misuse as a major risk factor for suicide in the general population, it does not appear to be a risk factor in schizophrenia. On the other hand, drug misuse or dependence was strongly associated with risk. Drug misuse is twice as common among people with schizophrenia as in the general population.

Suicide risk is considerably increased in patients who adhere poorly to treatment. Prevention of suicide is likely to result from active treatment of affective symptoms; improving compliance with treatment; use of medication that may have special anti-suicidal effects; and maintaining special vigilance in patients with risk factors, especially after significant loss events.

Potential role of close friends in preventing suicide - study

Fri, 24 Jun 2005 19:57:00 PST

( from http://www.rxpgnews.com ) The British Journal of General Practice (BJGP) has reported research showing that close friends and relatives play a key role in determining whether or not suicidal people seek help from their GP.

The study which analysed sixty-six interviews was conducted as part of a psychological autopsy with family members or friends of suicide victims. The paper highlights the importance of lay networks and suggests that a combination of medical and non-medical strategies are essential in helping to prevent suicide.

Participants in the study were asked whether or not suicidal individuals had sought medical help in the month leading up to their death. It found that half of the suicide victims had consulted in their final month and that many were persuaded to do so by a relative or close friend.

Of those who did not consult, some were characterised as help-resisters, but others had failed to do so because no one around them was aware of the depth of their distress or considered it to be medically significant.

Dr Christabel Owens of the Peninsula Medical School in Exeter and principal author said: A huge amount of research has been done on the factors associated with suicide and on what can be done to prevent it. For a long time, there has been a very heavy focus on mental illness and on the role of doctors in detecting and treating it but, of course, they have no opportunity to do so unless individuals consult. We know very little about how people make help-seeking decisions at times of emotional crisis. This study is a first step towards a better understanding of that process.

Suicide Risk Increases after Spousal Suicide

Fri, 15 Apr 2005 16:25:00 PST

( from http://www.rxpgnews.com ) The author used national Danish population, employment, and health registers to obtain information on causes of death, admissions to psychiatric units, marital status, family size, and socioeconomic factors.

Women whose partner had first been admitted to a psychiatric unit within the preceding two years were almost seven times as likely to commit suicide as women with partners whose mental health was good. This was almost double the risk of men in the same circumstances, who ran nearly a fourfold risk.

But men who had lost their partner to suicide were 46 times as likely to commit suicide themselves. This was around three times the risk of women bereaved by suicide.

Men might be less likely to seek support, or have untreated or undetected mental illness, suggests the author, in a bid to explain the differences between the sexes.

Being separated or divorced roughly doubled the risk of suicide, but affected both sexes to the same extent.

The loss of a child through suicide or other causes roughly doubled the risk of suicide in both parents, although parenthood seemed to be a protective factor in women.

Risk factors for attempted suicide in depressed psychiatric patients

Wed, 06 Apr 2005 18:32:00 PST

( from http://www.rxpgnews.com ) Suicide attempts among psychiatric patients with major depression are strongly associated with the presence and severity of depressive symptoms, and are predicted by the lack of a partner, previous suicide attempts and time spent in depression.

Published in the April issue of the British Journal of Psychiatry, this new research from Finland is one of the few prospective studies on risk factors for attempted suicide among psychiatric in- and out-patients with major depression.

The Vantaa Depression Study was carried out in Finland's fourth largest city. It included 269 patients diagnosed with major depressive disorder using semi-structured interviews, who were then followed up six months and 18 months later.

During the 18-month follow-up period, 8% of the patients attempted suicide. The risk of an attempt was nearly eight times higher during a major depressive episode, compared with a period of full remission, when the patient was not depressed. The risk was 2.5 times higher during a period of partial remission.

Other factors associated with depression include anxiety, substance use and personality disorder, all of which independently increase the risk of suicide attempts.

The authors of the study interpret the findings as evidence for the causal role of depression in suicide attempts. Reducing the time spent in depression could be a credible method of preventing them.

Surprising rate of hidden suicidality among people attending A & E Departments

Wed, 06 Apr 2005 18:32:00 PST

( from http://www.rxpgnews.com ) There was a surprising rate of hidden suicidality among those attending a hospital Accident and Emergency department for non-psychiatric reasons, a new study has found.

The study published in the April 2005 issue of the British Journal of Psychiatry found that more that 11% of the patients studied had thoughts that they would 'be better off dead', and more than 8% reported that they had thought about killing themselves.

A review of the medical records, revealed that 25 of the 31 patients actively planning suicide were undetected during their visit to & A&E.

This American study was designed to assess the feasibility of using a computerised test to measure mood, anxiety and substance-related symptoms. Patients reporting suicidality were divided into three categories:

* passive ideation - frequent thoughts of death and thinking that they would 'be better off dead'
* active ideation - specific thoughts about self-harm
* ideation with intent/planning - agreement with the statement 'I am planning to kill myself'.

A cross-sectional sample of patients over 17 years-old in the waiting room of the emergency department of Parkland Memorial Hospital in Dallas, Texas, were assessed during randomised time blocks over a 45-day period.

Only patients whose chief complaint was unrelated to mental health were recruited, and all patients gave permission to the researchers to access their medical records.

Sufficient data for analysis were available for 1590 patients who completed the computerised questionnaire. Nearly 100% of all those reporting passive and active ideation, as well as suicidal intent, acknowledged underlying psychological symptoms indicating mood disorder and/or anxiety and/or substance-related disorder.

Depression was most common, and was associated with severity of ideation (68% of those with passive ideation v. 74% of those planning suicide), as were panic attacks (43% v. 55%). Roughly a third of each group also endorsed substance misuse (36% - 38%).

Four of the 31 patients expressing suicidal intent at the start of the study attempted suicide within 45 days. All survived.

The authors of the study comment that the prevalence of current suicidal ideation with intent to attempt suicide in this sample was 2%, which is consistent with rates found in other settings. Yet even seriously suicidal people in this study were not identified during routine care.

Compared with the general population, those att&g A&E departments may be at significant risk of suicide. Given the hidden and insidious nature of this problem, future work will need to consider strategies for unmasking this largely undetected threat to public health.

Any prospective screening for psychotherapy &e A&E department should make provision for discovery and treatment of suicidal individuals.

HIV-positive Women are more likely to Attempt Suicide

Wed, 23 Mar 2005 00:17:00 PST

( from http://www.rxpgnews.com ) Women who are HIV-positive or are abused are more likely to think about or attempt suicide, according to a new study by researchers from the Johns Hopkins Bloomberg School of Public Health, George Washington University and St. Michaels Hospital, in Toronto, Canada. The Hopkins study, consistent with previous research, sheds new light on the extent to which being in an abusive relationship compounds suicide risk for HIV-positive women in particular. This latest study is published in the March/April 2005 issue of Womens Health Issues.

Given that suicide is the fourth leading cause of death for women ages 15-44, there is a need for further research on risk and opportunities for prevention, said Andrea C. Gielen, ScD, ScM, lead author of the study and deputy director of the Center for Injury Research and Policy at the Bloomberg School of Public Health.

The researchers used data from Project WAVE (Women, AIDS and the Violence Epidemic) to examine the rates of suicidal thoughts and attempts, as well as to gauge anxiety and depression. They also set out to learn how these outcomes differed based on womens HIV and abuse experiences. The women were all living in low-income, urban neighborhoods in Baltimore, Md.

Of the 611 women interviewed, 31 percent reported having thought about suicide and 16 percent reported having attempted suicide. Abused women were four times more likely than non-abused women to have thought about suicide. The researchers also found that, among HIV-positive women, those recently diagnosed thought about suicide more frequently.

In addition, one-half of the study participants reported problems with depression and 26 percent reported problems with anxiety. Twenty-four percent of non-abused, HIV-negative women had problems with depression, whereas 72 percent of abused, HIV-positive women reported the same.

Abused, HIV-positive women were 7 times more likely to report problems with depression, 4.9 times more likely to have problems with anxiety, 3.6 times more likely to have thought about suicide and 12.5 times more likely to have attempted suicide, when compared to HIV-negative, non-abused women. The researchers also note that abused, HIV-negative women were at an elevated risk for depression, anxiety, suicidal thoughts and suicide attempts, indicating that the abuse is associated with the negative outcomes.

Health care and service providers who interact with women who may be HIV-positive or are in an abusive relationship should routinely look for mental health issues, such as suicidal thoughts. It may be the case that crisis intervention is needed to help women in these situations, said Dr. Gielen, who is also a professor in the Bloomberg School of Public Healths Department of Health Policy and Management.

Suicidal behaviour caused by antidepressants 'cannot be ruled out'

Fri, 18 Feb 2005 17:28:00 PST

( from http://www.rxpgnews.com ) Antidepressant drugs may be associated with an increased risk of suicidal behaviour, particularly in the early stages of treatment, shows new evidence in this week's BMJ.

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed class of antidepressant, yet concerns have arisen that these drugs may induce or worsen suicidal feelings in vulnerable patients. Three studies published in this issue of BMJ shed new light on the benefits and harms of these drugs.

In the first study, researchers analysed 702 trials involving over 87,000 patients with depression and other clinical conditions to establish whether a link exists between use of SSRIs and suicide attempts.

They found that patients taking SSRIs were twice as likely to attempt suicide compared with patients taking placebo. However, no increase in risk was seen when only fatal suicidal attempts were compared between SSRIs and placebo. Finally, they found no difference between patients taking SSRIs and those taking other drugs, known as tricyclic antidepressants.

The authors point out that, while the absolute risk of suicide is low, the widespread use of SSRIs makes this a population health concern. They also warn that major limitations in the published trials may have led to underestimates of the risk of suicide attempts.

The second study reviewed 477 trials submitted by drug companies to the safety review of the Medicines and Healthcare products Regulatory Agency (MHRA). These trials compared SSRIs with placebo in adults with depression and other clinical conditions.

The research team found no evidence that SSRIs increased the risk of suicide. They found weak evidence of an increased risk of self harm, but no evidence of an increased risk of suicidal thoughts.

Increased risks of suicide and self harm caused by SSRIs cannot be ruled out, say the authors, but larger trials with longer monitoring periods are needed to assess the balance of risks and benefits fully. They recommend that patients should be warned of the potential hazard and monitored closely in the early weeks of treatment.

The final study was based on information from the General Practice Research Database and analysed the risk of self harm and suicide in over 146,000 patients taking SSRIs and tricyclic antidepressants for the first time.

Risks of self harm and suicide were no different in patients prescribed SSRIs compared with those prescribe tricyclics. However, under 18s prescribed SSRIs seemed to be at increased risk of self harm.

The finding that SSRIs and tricyclic antidepressants have a similar risk profile with respect to suicide and self harm is reassuring, say the authors. They call for further research to assess the short and long term risks and benefits of antidepressants.

Despite several limitations, these studies provide some useful insights for clinical practice, write experts in an accompanying editorial. For instance, they should make doctors aware that SSRIs and tricyclics may induce or worsen suicidal behaviour during the early phases of treatment and encourage them to monitor patients closely. They should also discourage the routine prescribing of antidepressant drugs in children and adolescents.

"The debate is not yet done, but these papers crystallise arguments that have been drifting in the ether these past months," says Kamran Abbasi, BMJ Acting Editor. "How many people who turned to 'happy pills' would not have done so if they had been fully aware of the potential harms?"

SSRIs Cannot Be Blamed For Increased Suicide Rates, a new study shows

Tue, 08 Feb 2005 09:40:00 PST

( from http://www.rxpgnews.com ) Challenging recent claims linking antidepressant use to suicidal behavior, a new study at University Of California, Los Angeles,(UCLA)shows that American suicide rates have dropped steadily since the introduction of Prozac and other serotonin reuptake inhibitor(SSRI) drugs.

In research published Feb.1 in the journal Nature Reviews Drug Discovery,the authors caution that regulatory actions to limit SSRI prescriptions may actually increase death rates from untreated depression,the No.1 cause of suicide.

"The recent debate has focused solely on a possible link between antidepressant use and suicide risk without examining the question within a broader historical and medical context,"said Dr.Julio Licinio,a professor of psychiatry and endocrinology at the David Geffen School of Medicine and a researcher at the UCLA Neuropsychiatric Institute."We feared that the absence of treatment may prove more harmful to depressed individuals than the effects of the drugs themselves."

"The vast majority of people who commit suicide suffer from untreated depression," he said."We wanted to explore a possible SSRI-suicide link while ensuring that effective treatment and drug development for depression were not halted without cause."

Licinio worked with fellow psychiatrist Dr. Ma-Ling Wong to conduct an exhaustive database search of studies published between 1960 and 2004 on antidepressants and suicide. The team reviewed each piece of research in great detail and created a timeline of key regulatory events related to antidepressants. Then they generated charts tracking antidepressant use and suicide rates in the United States.

What they found surprised them.

"Suicide rates rose steadily from 1960 to 1988 when Prozac, the first SSRI drug, was introduced," Licinio said. "Since then, suicide rates have dropped precipitously, sliding from the eighth to the 11th leading cause of death in the United States."

Several large-scale studies in the United States and Europe also screened blood samples from suicide victims and found no association between antidepressant use and suicide.

"Researchers found blood antidepressant levels in less than 20 percent of suicide cases," Licinio said. "This implies that the vast majority of suicide victims never received treatment for their depression."

"Our findings strongly suggest that these individuals who committed suicide were not reacting to their SSRI medication," he added."They actually killed themselves due to untreated depression.This was particularly true in men and in people under 30."

Licinio and Wong fear that overzealous regulatory and medical reaction, public confusion and widespread media coverage may persuade people to stop taking antidepressants altogether. They warn that this would result in a far worse situation by causing a drop in treatment for people who actually need it.

The UCLA study also looked at other reasons that may contribute to suicidal behavior by people taking SSRIs for depression.

Before the introduction of SSRIs, patients taking early drug treatments for depression were susceptible to overdoses and serious side effects, such as irregular heart rates and blood pressure increases. As a result, doctors prescribed the drugs in small doses and followed patients closely.

In contrast, toxic side effects are rare in SSRIs. Physicians often prescribe the drugs in larger doses and may not see the patient again for up to two months. This scenario, Licinio warns, can set the stage for suicide risk.

"When people start antidepressant therapy, the first symptom to be alleviated is low energy, but the feeling that life isn't worth living is the last to go," he said. "Prior to taking SSRIs, depressed people may not have committed suicide due to their extreme lethargy. As they begin drug therapy, they experience more energy, but still feel that life isn't worth living. That's when a depressed person is most in danger of committing suicide."

Licinio stresses the need for even closer monitoring of SSRI use by children.

"The only antidepressant proven to be effective for treating children with depression is Prozac," he said. "Children should receive Prozac only and should be followed very closely by their physicians during treatment."

Depression is a complex disorder that affects some 10 percent of men and 20 percent of women in the United States during their lifetime. Ten percent to 15 percent of depressed people commit suicide. Depression plays a role in at least one-half of all adult suicides and in 76 percent of suicides committed by children. Suicide is the most common cause of death in children age 5 to 14, the third most common cause of death in people age 15 to 24 and the fourth most common cause in people age 25 to 44.
~~~~~~~~~
Funding from the National Institute of General Medical Sciences and an award from the Dana Foundation supported the research.

First case-control study to investigate the relevance of criminal history, psychiatric problems and social integration to suicide in prison

Sun, 05 Dec 2004 06:15:00 PST

( from http://www.rxpgnews.com ) All staff should take suicidal behaviour seriously in custodial institutions, according to a new study published in the December issue of the British Journal of Psychiatry.

Suicide rates in prisons exceed the rates in the general population worldwide. Risk factors include long sentences after highly violent crimes, overcrowding, isolation, psychiatric disorders and alcohol and drug misuse. Evidence for suicidal behaviour as a predictor of suicide in prison has been conflicting until now.

This was the first case-control study to investigate the relevance of criminal history, psychiatric problems and social integration to suicide in prison.

For every suicide that occurred in an Austrian correctional institution between 1975 and 1999, two controls were selected, matched for correctional institution, gender, nationality, age, custodial status and time of admission.

Psychiatric characteristics, previous suicidal behaviour, criminal history and indicators of social integration were compared. Of 250 suicides, 220 personal files were available and matched with 440 controls.

The most important predictors of suicide in custody were a history of suicidality (status following attempted suicide and suicide threat), a psychiatric diagnosis, psychiatric medication, being in prison for a highly violent offence and single-cell accommodation (as a facilitating factor for suicide).

Professional education and working status before and during incarceration were significantly different between suicide cases and controls. The authors of the study believe that further studies are necessary to prove the relevance of social factors for suicide in custody.

Indicators of social integration could easily be asked about during admission proceedings; questions about working status before incarceration, or professional education, would be far less stigmatising than questions about psychiatric history and previous suicidal behaviour, they say.

The authors conclude that a significant finding of the study is the importance of suicidal behaviour as an indicator of risk of suicide in prison, which until now has been a matter for debate.

It is vital that all prison staff take suicidal behaviour seriously.

Paper reference
Fruehwald S, Matschnig T, Koenig F, Bauer P and Frottier P (2004) Suicide in custody. Case-control study. British Journal of Psychiatry, 185, 494-498.

New australian study shown that social and economic disadvantage cause mental disorders and suicide attempts

Thu, 02 Dec 2004 06:07:00 PST

( from http://www.rxpgnews.com ) Findings from a new study from Australia suggest that mental disorders and suicide attempts are caused by social factors. There is a need for social and economic responses beyond provision of mental health services.
Currently, responses to mental disorders usually focus on diagnosis and treatment; socio-economic conditions are less likely to be considered.

Published in the December issue of the British Journal of Psychiatry, this study used information from the 1997 Australian Survey of Mental Health and Wellbeing to estimate associations between socio-economic status, mental disorders and attempted suicide.

Mental disorders selected were substance use disorders, affective disorders (including depression) and anxiety disorders. Lifetime history of one or more suicide attempts was also examined.

Socio-economic characteristics assessed were education level, occupational status, income source and employment status.

Significantly increasing rates of mental disorders were found to be associated with decreasing socio-economic status, using educational attainment and occupational status (in the employed), for both men and women.

Similar associations were found for suicide attempts, which decreased after taking mental disorders into account, but remained significant in the working-age employed.

Government benefit as the main income source and unemployment were associated with higher rates of mental disorders and suicide attempts.

There was a higher prevalence of mental disorder and suicide attempts in women than in men. Women showed a stronger association of substance use disorder with suicide attempts than men. Men tended to show stronger associations between suicide attempts and anxiety disorders than women, despite the higher prevalences of substance use disorders in men and anxiety disorders in women.

The results of this study are consistent with other research into psychological disturbance and measures of socio-economic status. Previous studies have also shown a relationship between low socio-economic status and suicide attempts.

The authors of the study conclude that their results are most likely to be due to social causation. The significant socio-economic status relationship with suicide attempts, after taking mental illness into account, suggests a direct (independent) relationship between status and suicide attempts.

The implication of these findings is that mental disorders and suicide attempts are not just individual phenomena to be addressed solely by medical diagnosis and treatment. Mental disorders (particularly depression) and suicide attempts are also a consequence of material life circumstances, which are much more difficult to contend with for people at the lower end of the social spectrum.

Beyond mental health services and drug treatments, social and economic responses are needed to reduce relative disadvantage. Programmes enhancing perceived life prospects through improved employment opportunities and job security could have an effect on suicide attempts and mental illness just as much as - if not more than - improved mental health services.

Paper reference:
Taylor R, Page A, Morrell S, Carter G and Harrison J (2004) Socio-economic differentials in mental disorders and suicide attempts in Australia. British Journal of Psychiatry, 185, 486-493.

Suicidal thoughts, but not suicide, more common among women

Tue, 02 Nov 2004 15:14:00 PST

( from http://www.rxpgnews.com ) One in 38 women and one in 50 men in Britain develop suicidal thoughts each year. But less then one in 200 of these people kill themselves, according to new work published in the November issue of the British Journal of Psychiatry. The research was carried out by the Office of National Statistics and the University of Bristol.
Surprisingly, whilst more men commit suicide than women, suicidal thoughts are more common in women. The authors comment that possible reasons for the sex-differences in the incidence of suicidal thoughts and suicide may be the differing patterns of help-seeking in men and women or use of more lethal methods by men.

Until now, the evidence of suicidal thoughts in the British population was unknown. This study is thought to be the largest prospective investigation of the incidence of suicidal thoughts worldwide. 8,580 adults aged 16 - 74 were interviewed in the second national Survey of Psychiatric Morbidity of adults living in private households in Britain. This study was an 18-month follow-up survey of 2,404 members of the sample.

Suicidal thoughts are more frequent in those aged 16 - 24 (although suicide rates are lowest in this age group). The different age patterns of suicide and suicidal thoughts may be because suicidal thoughts, and consequent impulsive actions, are an indicator of the rapid mood swings and changes in life circumstances that surround the move from childhood to young adulthood. People who are not married, cohabitating or who are widowed; people with low levels of social support or who have experienced several stressful life events; those from poor socio-economic backgrounds; and the unemployed also have more frequent thoughts of suicide.

Over half of those with suicidal thoughts at baseline had recovered by the 18-month follow-up interview.

Further study into explanations for the differences in the epidemiology of suicidal thoughts and suicide is crucial to understanding the pathways both protective and precipitating linking suicidal thoughts to complete suicide, and should inform suicide prevention strategies.

Is suicide contagious? New study suggests imitative suicide occurs among mentally ill

Sun, 25 Jul 2004 23:00:00 PST

( from http://www.rxpgnews.com ) A new study has provided indirect evidence that imitative suicide occurs among mentally ill populations, and may account for 10% of suicides by current and recent patients.

Most previous investigations of imitative suicide have reported clustering in the general population. This may be clustering at a given time, following suicides publicised in the media, or may be in a given space, geographically localised.

Few studies, however, have investigated imitative suicide by looking for space-time clustering over a wide geographical area, or have investigated imitative suicide in mentally ill populations.

The researchers in this study analysed a national case register of suicides who had had recent contact with mental health services. This information was collected by the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness.

Highly significant space-time and space-time-method (of suicide) clustering was found in a sample of 2741 suicides over four years who had had recent contact with one of 105 mental health trusts.

For example, four mentally ill patients being looked after by a catchment area mental health team committed suicide by jumping from heights over a six-week period (a relatively uncommon method) compared with an average rate for that team over seven years, and for other teams in the locality, of about one suicide per year (all methods).

The authors of the study comment that if imitation is a causal factor in a significant percentage of suicides, it will be important to consider how best to reduce its impact as part of a drive to cut the national suicide rate among the mentally ill.

Deliberate self-harm among elderly indicates high suicide intent

Wed, 14 Jul 2004 23:15:00 PST

( from http://www.rxpgnews.com ) The majority of elderly people who deliberately harmed themselves had high suicide intent, according to a new case control study.

Suicide is a tragic ending of life and is a cause of considerable distress for family, carers and health professionals. This study set out to examine the mental health and social factors, and life events, involved in deliberate self-harm (DSH) in the elderly.

It also aimed to determine risk factors that might help to identify older adults suffering from depression, and most at risk of DSH and suicide.

A case control study was conducted, comparing 76 older adults who had deliberately harmed themselves with 50 depressed older adults referred to mental health services. Assessments were made of suicidal intent, depression, hopelessness, social contacts and networks, and life events and difficulties.

High levels of suicide intent were found among the majority of elderly who deliberately harmed themselves. 70% were depressed, and 29% had been to see their general practitioner within one week of the episode.

DSH subjects were frequently living alone, with an isolated lifestyle and poor physical health. Compared with depressed controls, DSH subjects were significantly more likely to have a poorly integrated social network, and were less likely to receive visits from health, social and voluntary services.

Hopelessness was an important factor in identifying elderly people who are depressed and at risk of self-harm. The proportions of DSH subjects and depressed controls experiencing a severe life event were similar.

The authors of the study conclude that the elderly who have deliberately harmed themselves are usually failed suicides with high intent scores, which makes them a useful group for studying suicidal behaviour in general.

More assertive strategies are needed to identify isolated and depressed older adults in the community,