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PubMed2006

[Suicide notes and their importance to suicide research. The representativeness of suicide note writers].

BACKGROUND: Suicide notes provide direct information from suicide victims and often are written shortly before the suicide act. An important question is whether those who write such notes are representative for suicide victims who do not. METHODS: A consecutive series of suicides investigated at the Department of Forensic Medicine in Vienna from April 2002 to March 2003 was examined for the existence of suicide notes. Note writers were compared with non-note writers according to the variables age, sex, family status, occupational status, psychiatric care, suicide motive, and method. RESULTS AND CONCLUSIONS: Suicide victims who leave suicide notes do not differ statistically significantly from non-note-leavers in sex, age, family status, psychiatric care, motive, or method. This means they are representative for all suicide victims concerning important demographic factors.

Age Distribution↗
PubMed2003

Rates and risk factors for suicide, suicidal ideation, and suicide attempts in chronic epilepsy.

Studies of causes of death among people with epilepsy suggest that the lifetime prevalence rate of suicide is elevated. Although not all of the studies have reported an increased risk for suicide, the collective data yield an average rate of approximately 12% among people with epilepsy, compared with 1.1-1.2% in the general population. The increased risk for suicide appears to affect children and adolescents as well as adults. Rates of suicide attempts have also been reported to be elevated among people with epilepsy. A suicide attempt is a significant risk factor for completed suicide. Certain psychiatric disorders, including primary mood disorders, also increase the risk for suicide. Among people with epilepsy, psychiatric comorbidity is common, and rates of mood disorders, particularly major depression, have consistently been reported to be elevated. Other potential risk factors are family issues, physical health, personality, life stress, previous suicidal behavior, and access to firearms. Assessing severity of risk helps to determine the appropriate level of intervention. The suicidality module of the Mini-International Neuropsychiatric Interview is a practical tool to help quantify current suicide risk.

Chronic Disease↗
PubMed2004

Level of suicidal intent predicts overall mortality and suicide after attempted suicide: a 12-year follow-up study.

BACKGROUND: The aim of this study was to comprehensively examine clinical risk factors, including suicide intent and hopelessness, for suicide and risk of death from all causes after attempted suicide over a 12-year follow-up period. METHODS: A systematic sample of 224 patients from consecutive cases of attempted suicide referred to health care in four Finnish cities between 1 January and 31 July 1990 was interviewed. RESULTS: After 12 years of follow-up 22% of these patients had died, 8% by committing suicide. The only statistically significant risk factor for eventual suicide was high scores on Beck's Suicidal Intention Scale. Male gender, older age, physical illness or disability and high scores on Beck's Suicidal Intention Scale predicted death overall. CONCLUSIONS: Following attempted suicide, high intention to kill oneself is a significant risk factor for both death from all causes and suicide.

Adolescent↗
PubMed2003

Suicide, suicidality and suicide prevention in affective disorders.

OBJECTIVE: It is well known that functional psychiatric disorders are one of the main causes of suicidal behaviour. This paper discusses the epidemiology and risk factors of suicidal behaviour in affective disorders and goes on to describe the treatment and prevention of such suicidal behaviour. METHOD: A narrative overview of relevant epidemiological and drug studies. RESULTS: About 60-70% of patients with acute depression experience suicidal ideas. There is a high incidence of suicide (10-15%) in depressive patients. Psychopharmacological treatment with antidepressants and/or mood stabilizers is the most successful approach to avoid the risk of suicidal behaviour. In addition, psychotherapeutic and psychosocial interventions are of importance. CONCLUSION: Suicidal behaviour and suicide must be considered when treating patients with affective disorders. The complex causation of suicidality has to be borne in mind when considering methods of suicide prevention. In order to obtain the best results, psychosocial, psychotherapeutic and psychopharmacological approaches should be combined, depending on the risk factors of each individual patient.

Affect↗
PubMed2005

[Committed suicide in the background of the history of previous suicide attempts--a 5-year prospective study of suicide attempts].

The aim of the study was to estimate the risk factors for eventual suicide in the case of individuals hospitalised for a suicide attempts (or attempted suicide). The group examined comprised 238 patients, who, in the years 2000-2001, were hospitalised in the Department of Clinical Toxicology CM UJ in Kraków for suicidal self-intoxication with medical drugs. The group consisted of 63 males and 175 females ranging in age from 17 to 79 years (the mean age was 36 years). The instruments applied in the examination included a structured interview and a set of psychological tests; complementary information was obtained from the patients' case histories. In the year 2005, on the basis of the data from the Institute of Forensic Medicine in Kraków, it was established that 10 of the patients under consideration--6 females, and 4 males--had eventually committed suicide within the period concerned. The retrospective analysis of the case of each of these 10 individuals revealed that the majority of them had been treated psychiatrically for depression or alcoholic addiction, had experienced parental or marital bereavement, or had experienced serious financial difficulties. The subjects' case histories informed also about the cases of suicidal death in the families of several subjects. As should be pointed out, the results of psychological tests obtained earlier by the 10 subjects concerned did not unequivocally indicated high endangerment by the risk of eventually committing suicide. Finally, it is necessary to observe that alcoholism and depression were the most frequently diagnosed mental disorders in the case of the male suicides. In the case of the female suicides, the results of the analysis reveal a variety of psychological, psychiatric and socio-demographic factors that, eventually, could lead to suicide.

Adolescent↗
PubMed1998

Physiological reactions to a suicide film: suicide attempters, suicide ideators, and nonsuicidal patients.

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

Adult↗
PubMed2004

MMPI inmate profiles: suicide completers, suicide attempters, and non-suicidal controls.

Results from the Minnesota Multiphasic Personality Inventory (MMPI) were compared for three groups of male inmates in federal penitentiaries: 47 suicide completers, 43 suicide attempters and, 123 non-suicidal controls. Analyses show that the groups differed on all 10 clinical scales and on at least 8 after Bonferroni correction. Attempters obtained the highest scores on 4 of 8 scales; they also posted the highest scores on 3 others, but differences were significant only against non-suicidal controls. Completers posted the highest score on only one scale (Mf), but the difference was significant only against non-suicidal controls. All told, completers proved more similar to non-suicidal controls than to attempters. Regarding profiles, completers are more strongly correlated with non-suicidal controls (r=0.95) than with attempters (r=0.86); non-suicidal controls are less strongly correlated with attempters (r=0.88). The fact that attempters seem more pathological than the others can mislead clinicians screening for suicide risk.

Depressive Disorder↗
PubMed1995

Project plan for studies on suicide, attempted suicide, and suicide prevention.

Completed and attempted suicide are major public health problems in most western countries. The importance of suicidal behavior as a health problem, particularly among adolescents and young adults, has been emphasized by the European Union, the WHO (Europe), as well as the Finnish authorities. Due to the exceptionally high suicide mortality, suicide prevention has been one of the main targets of Finnish health policy since the late 1980s. However, to develop feasible strategies for suicide prevention, better knowledge of the phenomenon of self-destruction is necessary. The Department of Mental Health of the National Public Health Institute has been actively involved in suicide research and the development of suicide strategies both in Finland and western Europe since 1986. The success is based on a long tradition of suicide research in Finland, the representative and reliable suicide data, a highly motivated research group, and also the necessary economic support by both the National Public Health Institute and the Finnish Academy. This article outlines our groups research plan for the next few years.

Adolescent↗
PubMed2002

Familial pathways to early-onset suicide attempt: risk for suicidal behavior in offspring of mood-disordered suicide attempters.

BACKGROUND: Although adoption, twin, and family studies have shown that suicidal behavior is familial, the risk factors for familial transmission from parent to child remain unclear. METHODS: A high-risk family study was conducted comparing the offspring of 2 mood-disordered groups: suicide attempters and nonattempters. Recruited from 2 sites, probands were 81 attempters and 55 nonattempters, with 183 and 116 offspring, respectively. Offspring were assessed by investigators masked to proband status. Probands and offspring were assessed with respect to psychopathologic findings, suicide attempt history, impulsive aggression, and exposure to familial environmental stressors. RESULTS: Offspring of attempters had a 6-fold increased risk of suicide attempts relative to offspring of nonattempters. Familial transmission of suicide attempt was more likely if (1) probands had a history of sexual abuse and (2) offspring were female and had a mood disorder, substance abuse disorder, increased impulsive aggression, and a history of sexual abuse. CONCLUSIONS: The offspring of mood-disordered suicide attempters are at markedly increased risk for suicide attempts themselves. Familial transmission of suicidal behavior in families with mood disorders almost always requires transmission of a mood disorder and is also related to the offspring's impulsive aggression and the familial transmission of sexual abuse. Early treatment of mood disorders and targeting impulsive aggression and sexual trauma may be helpful in the prevention and treatment of suicidal behavior in families with mood disorders.

Adolescent↗
PubMed1996

[Suicidal process and suicidal motives. Suicide illustrated by the art, life and illness of Vincent van Gogh].

A suicide will naturally be a shock to the surroundings, unexpected and brutal as it is. Suicide survivors will often emphasize the unexpected. Nevertheless a suicide must be regarded as the end result of a long process. In this paper the extremely well-documented case of Vincent van Gogh is used to study suicidal processes and suicidal motives. In van Gogh's case, an early childhood trauma initiated a life-long suicidal process. His difficulties as regards attachment to and separation from his parents continued throughout his life and his emotional instability, intensity and lowered tolerance to frustration seem to portray a borderline personality. Vincent van Gogh's chronic suicidal ideation and behaviour led to a series of crises throughout his life, escalating during the last 18 months before his suicide in 1890. It is possible to identify at least three prominent suicidal motives in van Gogh's case. The first is unbearable emotional pain related to personal experience of loss which reactivated the childhood trauma. The second is introverted murderous rage arising from conflicts with other persons. The third motive described is the need for a cathartic release of energy and emotion.

France↗
PubMed2006

Risk factors of future suicide in suicide attempters--a comparison between suicides and matched survivors.

The objective of this study was to find risk factors for suicide by looking for clinical and care/treatment consumption differences between 15 hospitalized suicide attempters, who later committed suicide ("completers"), and 15 suicide attempters who did not ("non-completers"), matched according to sex, age and principal diagnosis. Completers had significantly more often attempted suicide after the index admission. After index, completers had received more psychiatric care and treatment than non-completers. Comorbidity was common in both groups of patients. Personality disorders according to the DSM III-R, axis II, Cluster B, however, tended to be more common in the completer group. Increased comorbidity over time could also be seen to a larger extent in completers. In spite of the matching of principal diagnosis, completers tended to have higher Montgomery-Asberg Depression Rating Scale ratings than non-completers. They also had significantly higher Suicide Assessment Scale (SUAS) scores. From this study, it is apparent that suicide attempters at risk of future suicide have major and multiple psychiatric problems, which cause difficulties in the care and treatment.

Adult↗
PubMed2006

Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review.

OBJECTIVE: Involvement of personality traits in susceptibility to suicidality has been the subject of research since the 1950s. Because of the diversity of conceptual and methodological approaches, the extent of their independent contribution has been difficult to establish. Here, we review conceptual background and empirical evidence investigating roles of traits in suicidal behaviors. METHOD: We selected original studies published in English in MEDLINE and PsycINFO databases, focusing on suicidal ideation, suicide attempts, or suicide completions, and using standardized personality measures. RESULTS: Most studies focused on investigating risk for suicide attempts. Hopelessness, neuroticism, and extroversion hold the most promise in relation to risk screening across all three suicidal behaviors. More research is needed regarding aggression, impulsivity, anger, irritability, hostility, and anxiety. CONCLUSION: Selected personality traits may be useful markers of suicide risk. Future research needs to establish their contributions in relation to environmental and genetic variation in different gender, age, and ethnocultural groups.

Humans↗
PubMed2001

The validity of proxy-based data in suicide research: a study of patients 50 years of age and older who attempted suicide. II. Life events, social support and suicidal behavior.

OBJECTIVE: To investigate the validity of proxy respondent reports of stressful life events, social support and suicidal behavior among individuals who attempted suicide. METHOD: Subjects were 80 psychiatric in-patients admitted following a suicide attempt. Data based on structured interviews with proxy respondents were compared with data based on interviews with subjects (gold standard). RESULTS: Specificity was higher than sensitivity across life event categories, and agreement was substantial for public and observable events (e.g. parent's death) but lower for more ambiguous events. Proxies were good judges of subject reports of frequency of social interaction but not perceived emotional support. Proxies were good judges of past history of suicide attempts and level of suicidal intent. CONCLUSION: Results support proxy-based data on suicidal behavior and certain aspects of social support and stressful life events in research of suicidal behavior in this age group, with potential implications for interpreting postmortem research of completed suicide.

Aged↗
PubMed2001

The utility of MMPI-2 suicide items for assessing suicidal potential: development of a Suicidal Potential Scale.

The assessment of suicidal potential is one of the most challenging and stress-inducing tasks facing clinicians. Studies that have attempted to identify specific MMPI codetypes, scales, or individual items predictive of completed suicide have produced inconsistent findings. This study focused on the relationship between the six most direct MMPI-2 suicide items (Items 150, 303, 506, 520, 524, and 530) and verbally reported history of suicidal ideation and behavior among a sample of psychotherapy outpatients (n =116). These six MMPI-2 suicide items provided valuable information regarding suicidal ideation and behavior above and beyond that of verbal self-report. These items were grouped together to create a single scale, the Suicidal Potential Scale (SPS) that manifested strong internal consistency. The SPS provides the clinician with a reliable method of assessing for self-reported suicidal ideation and behavior.

Adult↗
PubMed1995

An epidemiological and clinical approach to adolescent suicide. A comparison between suicidal and non-suicidal clinical groups in a health foundation center for French students.

Suicidal behaviour among young people represents a major public health problem. This study seeks to compare the major sociological, clinical, schooling and family features of suicidal and non-suicidal subgroups of adolescents hospitalised in the Health Foundation Center for French Students of neufmoutiers en Brie (France). All these adolescents suffered from the severe mental disorders. The adolescents from the suicidal subgroup presented significantly fewer psychoses and more mood disorders than those of the non-suicidal subgroup. Half of the patients from the suicidal subgroup presented some features of personality disorders, mostly borderline personality disorders. Nevertheless, their global functioning was more frequently improved between admission and discharge than was the case for the non-suicidal group.

Adolescent↗
PubMed2000

The suicide assessment scale: an instrument assessing suicide risk of suicide attempters.

The Suicide Assessment Scale (SUAS), a scale constructed to measure suicidality over time, was administered to 191 suicide attempters. Its predictive validity was tested. SUAS ratings were compared to ratings from other scales, and related to age and psychiatric diagnoses including co-morbidity. Eight patients committed suicide within 12 months after the SUAS assessment. Apart from advanced age, high scores in the SUAS were significant predictors of suicide. From a receiver operating characteristic (ROC) analysis, we identified cutoff SUAS scores which alone and in combination with certain diagnostic and demographic factors are of apparent value in the clinical evaluation of suicide risk after a suicide attempt.

Adolescent↗
PubMed2004

The general public's views on suicide and suicide prevention, and their perception of participating in a study on attitudes towards suicide.

The aim of the presented study was to investigate whether common myths about suicide still prevail, what people in general think are the most common causes for suicide, whether suicide can be prevented, and if so, how. How subjects perceived their participation in a study on attitudes towards suicidal behavior, was also investigated. The Attitudes Towards Suicide questionnaire was sent to a random sample of 1,000 Norwegians. The data were analyzed both quantitatively and qualitatively. The results showed that the common myths still prevail, that people in general mainly assign intrapersonal causes to suicide, with the belief that suicide can be prevented, and that they perceived their participation in the study positively. The value of the general public in suicide prevention and the need for increased openness and competence building were emphasized.

Journal Article↗
PubMed1990

A comparison of suicide notes written by suicide completers and suicide attempters.

Suicide notes written by completed suicides were compared with suicide notes written by attempted suicides for the three motives for suicide described by Menninger. The motives of escape from pain and anger directed toward others did not differentiate the two samples of notes, but suicide notes written by completed suicides were more likely to have the motive of self-blame.

Adult↗