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PubMed2003

[In-patient suicide -- a comparison of psychiatric in-patient suicides versus a control group of inpatients from the same treatment era without suicide].

In our study we compare n = 64 in-patient suicides with a group of non-suicide in-patients which received psychiatric treatment during the same period. The matched patient was the next admitted patient. We found a significantly higher portion of schizophrenic and depressed patients in the suicide group, whereas suicides showed more depressive symptoms, more suicidal ideations before the suicide and more subjective suffering. Suicides received more psychopharmaca.

Adolescent↗
PubMed1997

Support in suicidal crises: the Swedish National Program to Develop Suicide Prevention. The Swedish National Council for Suicide Prevention.

The Swedish National Program to Develop Suicide Prevention was created through collaboration between the National Board of Health and Welfare, the National Institute of Public Health, and the Centre for Suicide Research and Prevention. These institutions aim to provide joint support for the development of suicide prevention in Sweden by, for example, encouraging educational and development project. The program was signed for the National Council for Suicide Prevention by Agneta Dreber, Director-General, National Institute of Public Health; Danula Wasserman, Professor of Psychiatry and Suicidology, Head, National Centre for Suicide Research and Prevention; and Claes Ortendahl, Director-General, National Board of Health and Welfare. This article, edited by Jan Beskow, Professor of Psychiatry at the Centre for Suicide Research and Prevention, is an abridged version submitted to Crisis at the request of the Editors.

Adolescent↗
PubMed1996

[Patient suicide in the psychiatric hospital: selected results of the Clinic Suicide Working Group Study I/II 1970-1992 of the "Suicidal Behavior and the Psychiatric Hospital" Study Group].

Data of the Baden-Württemberg and Bavarian inpatient suicide study (1970-1984) and (1985-1989) and (1990-1992) are presented comparing these different observation periods. The total group comprises 59% men and 41% women of 585 suicides, 51% younger than 50 year (main group 21-30 years: 26%). An increase of suicides in the seventies and a plateau in the eighties is observed. 53% of the total group are schizophrenic and 26% depressive inpatients. There is a impressive shortening of the time period from index admission to suicide over the years: (1970-1984) 56% (1985-1989) 85% and (1990-1992) again 83% of the total group committed suicide during the first six month of inpatient treatment. Suicides of psychiatric inpatients seem to be a problem of acute psychiatry.

Adolescent↗
PubMed1977

Suicidal wishes and depression in suicidal ideators: a comparison with attempted suicides.

A depression inventory was administered to a sample of psychiatric patients who had some suicidal ideation. A factor analysis of their responses to the inventory resulted in a factorial structure similar to that obtained for attempted suicides. The suicidal ideators were found to have higher depression scores on the inventory than the attempted suicides. It was suggested that this study supported the notion that individuals who show differing kinds of suicidal behavior nonetheless may show similar psychological phenomena.

Cognition↗
PubMedDate not supplied

[Psychotherapy of acute suicidality. "The anti-suicide promise" as a method of preventing suicide].

A trustful therapeutic relationship is considered to be the most important suicide-preventing measure. Furthermore, it has frequently been recommended to have the severely suicidal patient promise not to commit suicide within a certain period of time. Using three clinical examples the unreliability of this suicide-preventing method is demonstrated. When the patient can give such a promise responsibly, it probably is no longer necessary. Also, the patient's giving such a promise can negatively influence the development of the therapeutic relationship. A reciprocal contract should be preferred: the patient contacts the therapist whenever he feels to loose control over his suicidal potential whereas the therapist offers his availability to the patient.

Acute Disease↗
PubMed2006

Core features of repeated suicidal behaviour: a long-term follow-up after suicide attempts in a low-suicide-incidence population.

BACKGROUND: The aim of this article was to study repeated suicidal behaviour in a low-incidence population to elucidate robust risk factors. METHODS: A cohort of first-ever suicide attempters from 1960 to 1982 on the Faroe Islands was followed up for a minimum of 20 years. The cohort was initially characterized in psychiatric and social terms. RESULTS: The incidence of suicidal behaviour for the cohort years (age 15 years and older) was 37.9 per 100,000 per year (95% confidence interval 31.5-45.1). It was associated, as expected, with gender, age, residence, marital status, occupation, diagnosis, previous psychiatric admission, alcohol intoxication and the method and planning of the act. Factors of the index episode predicting repetition at 5 years were gestures and alcohol intoxication and at 20 years were physical methods, suicide letter and alcohol intoxication. CONCLUSIONS: Alcohol intoxication and the level of determination behind the suicide attempt emerge as targets for prevention. Alcohol intoxication at the initial episode seems to be a strong long-term as well as short-term risk factor.

Adolescent↗
PubMed1987

Suicide risk factors: a comparison of suicide attempters with suicide completers.

Fifty cases of attempted suicide were compared with 50 cases of completed suicide on variables reported to measure suicide risk: the seriousness of the attempt, and the circumstances in which the act occurred discriminated best. Depressive symptoms were more frequent in the suicide group and in the serious attempters' group than in the non-serious attempters' group.

Age Factors↗
PubMed2005

Suicide prevention: critical elements for managing suicidal clients and counselor liability without the use of a no-suicide contract.

Despite its entrenchment as a standard of practice, no-suicide contracts fail to achieve their purpose as an effective part of treatment or as an effective method of inoculating counselors against potential lawsuits should a client commit suicide. Critical elements for managing suicidal clients and counselor liability without reliance on the no-suicide contract are presented. Therapeutic considerations include evaluating clients to determine (a) no referral for hospitalization needed, (b) referral for voluntary hospitalization, or (c) referral for involuntary hospitalization.

Algorithms↗
PubMed2004

[Suicidal behavior and suicide attempts in adolescents and young adults--epidemiology, risk factors, prevention and treatment].

According to WHO, every year, suicide is committed by at least 1 mln people in the world. In Europe, suicide is committed by about 43 thousand people a year, most frequently by middle-aged and elderly males, and attempted by 700 thousand people. In Poland, in 2002, 5100 people committed suicide. The number of suicide attempts is probably ten times higher. The aim of the study is to investigate the current state of knowledge concerning suicidal behaviour and attempted suicide in adolescents and young adults. The literature on the subject is analysed, and special attention is paid to the issue of suicide epidemiology, risk factors, prevention and treatment. Definitions of suicidal behaviour and presuicidal syndrome are debated. In the chapter concerning treatment, Bohme's model of crisis intervention in the case of suicidal patients is discussed, and detailed indications for treatment are presented. Suicide attempts are undertaken most frequently by young people, especially by teenage girls and young women. The ratio of suicide in this age group increased significantly in the last few years. Phenomena which are of special importance for the prevention of suicide among adolescents include suicidal thoughts, attempted suicide, and completed suicide. Multicentre study into suicidal behaviour conducted by WHO indicate that the highest average yearly European coefficients of suicide attempts have been detected in young females ranging in age from 15 to 24 years. Polish and foreign literature on the subject is dominated by publications regarding completed suicide. The issue of attempted suicide is treated rather marginally, which may be due to the scantiness of reliable data concerning large populations. The past few years, however, brought a significant advancement of the research into the epidemiology, etiology, and treatment of suicidal behaviour in adolescents. It is difficult to establish linear correspondence between risk factors and suicidal behaviour. The cause is usually a combination of constitutional factors including genetic ones, earlier personal experiences, and precipitating stressful events. Paradoxically, the risk of suicide among adolescents increases in highly developed countries, where the quality of life has undergone a significant improvement. In conclusion, the authors have stressed the importance of an interdisciplinary approach to work with individuals endangered by the risk of suicide. Attention has also been drawn to the importance of personal contact and the necessity to accompany the individual in suicidal crisis from the beginning to the end of the therapy.

Adolescent↗
PubMedDate not supplied

[Concurrent validation of the suicidal risk assessment scale (R.S.D.) with the Beck's suicidal ideation scale].

The prevention of suicide is a top priority in mental health. The determination of high risk suicidal groups is not sufficient. The expressing suicidal ideas is not a protective factor, but in contrary a risk factor to take into account, or even to search and to quantify: 80% of the subjects who attempt to commit suicide or commit suicide express such ideas months before. Several evaluation instruments try to help the practitioners or the research workers in this reasoning. The suicidal risk assessment scale RSD can be cited in particular. It is composed of eleven sections. The 0 level corresponds to the absence of particular ideas of death or suicide. Levels 1 and 2, the presence of ideas of death. Levels 3-4-5, the presence of suicidal ideas. The difference compared to the majority of the other scales consecrated to the same subject, the passif desire of death, occupies a place totally particular in the RSD (level 6). From the level 7, the risk of acting out seems to become more important. It stops being a simple idea of suicide, but becomes a real will of dying, firstly retained by something or someone (level 7), the fear of causing suffering to dear ones or a religious belief., then determined (level 8). Finally, the patient has elaborated a concrete plan (level 9) or he has already started the preparation of acting out (level 10). It is just necessary to evaluate and to note the highest level of the scale. The inclusion of the suicidal risk assessment scale RSD and of the Suicidal Ideation Scale by Beck in an international multicenters, phase IV, double-blind study, according to two parallel groups, with a fixed dose of fluoxétine or fluvoxamine for six weeks, allowed to search correlations which could exist between the two scales. The ana-lysis before the beginning of the treatment was done on 108 outpatients depressive, male and female, aged 18 or over. It finds a satisfactory concurrent validity between the suicidal risk assessment scale RSD and the Suicidal Ideation Scale by Beck (r=0.69; p<0.0001) as well as between the RSD and the item "suicide" of the Depression scale by Hamilton (r=0.60; p<0.0001). On the other hand, it is less satisfactory between the suicidal risk assessment scale RSD and the Hamilton Depression scale overall score (r=0.35; p=0.0002). During the evolution under the treatment, the suicidal risk assessment scale RSD shows an improvement significantly faster than the Hamilton Depression scale or the Beck's Suicidal Ideation Scale (p<0.0001). This statement of fact arouses some questions about the suicidal risk of which the evolution in the case of a treated depressive episode could be quicker than first thought. All the more so as this difference is affected by the type of the treatment (p=0.015). Moreover, a score of 7 and more on the suicidal risk assessment scale RSD seems to represent a risk level judged particularly significant by the experimenters. In effect, the existence of such a suicidal risk was a criteria of exclusion and no patient with a level superior to 6 on suicidal risk assessment scale RSD was included. In conclusion, the utilisation of the suicidal risk assessment scale RSD could be interesting in the prevention of suicide.

Adolescent↗
PubMed2001

Suicides and serious suicide attempts: two populations or one?

BACKGROUND: Few studies have examined the extent to which populations of suicides and attempted suicides are similar, or different. This paper compares suicides and serious suicide attempts in terms of known risk factors for suicidal behaviour. METHODS: Using case-control methodology, risk factors for suicidal behaviour were examined in 202 individuals who died by suicide, 275 individuals who made medically serious suicide attempts and 984 randomly selected control subjects. Based on data from significant others, measures used spanned sociodemographic factors, childhood experiences, psychiatric morbidity and psychiatric history, exposure to recent stressful life events and social interaction. RESULTS: Multiple logistic regression identified the following risk factors that were common to suicide and serious suicide attempts: current mood disorder; previous suicide attempts; prior outpatient psychiatric treatment; admission to psychiatric hospital within the previous year; low income; a lack of formal educational qualifications; exposure to recent stressful interpersonal, legal and work-related life events. Suicides and suicide attempts were distinguished in the following ways: suicides were more likely to be male (OR = 1.9, 95% CI 1.1, 3.2); older (OR = 1.03, 95% CI 1.02, 1.04); and to have a current diagnosis of non-affective psychosis (OR = 8.5, 95% CI 2.0, 35.9). Suicide attempts were more likely than suicides to have a current diagnosis of anxiety disorder (OR = 3.5, 95% CI 1.6, 7.8) and to be socially isolated (OR = 2.0, 95% CI 1.2, 3.5). These findings were confirmed by discriminant function analysis, which identified two functions that described the three subject groups: the first function discriminated the two suicide groups from control subjects on a dimension corresponding to risk factors for suicide; the second function discriminated suicide from suicide attempt subjects on a series of factors including gender, non-affective psychosis and anxiety disorder. CONCLUSIONS: Suicides and medically serious suicide attempts are two overlapping populations that share common psychiatric diagnostic and history features, but are distinguished by gender and patterning of psychiatric disorder.

Adolescent↗
PubMed2003

Suicidal depressed vs. non-suicidal depressed adolescents: differences in recent psychopathology.

BACKGROUND: Few studies have focused on the differences between two depressed groups of patients in child psychiatry: the suicidal and the non-suicidal adolescent population. As in other countries, depression is one of the most prevalent diagnoses in adolescents in Hungary. AIMS: The present study was designed to determine (a) whether there are specific symptoms to differentiate between two clinical samples of depressed children: patients expressing suicidal behaviour and their peers with no suicide attempts, and (b) if there are significant differences between parents' and adolescents' reports of the same symptoms. METHODS: Using a recently developed semi-structured interview (Diagnostic Evaluation Schedule for Children and Adolescents-Hungarian version, ), 132 symptoms were assessed for two clinical groups of depressed adolescents: a suicidal group (N=54) [corrected], and a non-suicidal group (N=78) [corrected]. The suicidal group had all made an unsuccessful suicide attempt and/or had had frequent suicidal thoughts during the 6 months prior to the study. The non-suicidal group had neither attempted suicide, nor had had suicidal thoughts during the previous 6 months. All cases were selected from a larger sample of 490 consecutively referred new outpatient children over a 1 year period in five psychiatric facilities in Hungary. Only 13-17-year-old adolescents participated in the study. Both samples were identified using operationalised computer algorithm criteria of DSM-IV major depressive disorder episode (MDD) irrespective of the current clinical diagnosis of the patients. The Pearson Chi-square test with Monte Carlo correction was used to evaluate the differences between the suicidal and the non-suicidal depressed samples. RESULTS: Hopelessness, negative self-esteem and violent behaviour were the only significant discriminators between the two study groups according to the parent interviews, with increased problem scores in the suicidal sample compared to the non-suicidal sample. Suicidal depressed adolescents view themselves as more depressed and violent than do non-suicidal depressed individuals and were less anxious about their parents. CONCLUSIONS: The two depressed samples (suicidal vs. non-suicidal individuals) have only very few dissimilarities. There are, however, some essential differences between the parental and adolescent perceptions of the suicidal and depressive symptoms of the adolescent. The findings of the study underscore the necessity of collecting data from both the parent and the adolescent. LIMITATIONS: Cross-sectional, no lifetime psychopathology, referred samples, no blind estimation of the suicidal status of patients.

Adolescent↗
PubMed2005

Exposure to suicide and suicidal behaviors among Hong Kong adolescents.

Suicidal behaviors (deliberate self-injury with the intent to hurt or kill oneself) have been little examined outside the West. The aims of this study were to (a) determine the correlates of suicidal behaviors, and (b) examine whether depression and suicide ideation moderated the effects of exposure to completed and attempted suicide on suicidal behaviors among a community sample of Hong Kong youth ages 12-17. Adolescents responded to questions regarding self-injurious behaviors, and also indicated presence of intention to hurt or kill themselves in the past 12 months. Based on their responses, two groups of interest were formed: 96 youths reported both self-injurious behaviors and the intent to hurt or kill themselves, and formed the "suicidal behaviors" group; and, 1213 adolescents reported neither self-injurious behaviors nor intent to hurt self or die, and formed the control group. The participants also responded to questions about depressive symptoms, anxiety, suicidal ideation and attempt, alcohol/drug use, stressful life events, and family relationships. They indicated whether anyone they knew had attempted or completed suicide in the previous 12 months. Logistic regression indicated that depressive symptoms, stressful life events, suicidal ideation and exposure to suicide attempt (but not completed suicide) contributed unique variance to the presence of suicidal behaviors, after controlling for demographic variables. Depression (and at trend levels, suicidal ideation) moderated the effect of exposure to suicide attempt by others on suicidal behaviors. Our results indicate that completed suicide in the social network increases risk for suicidal behaviors, but not when other risk factors are controlled. By contrast, a suicide attempt independently increases risk for suicidal behaviors. Furthermore, those youths who experience depressive symptoms or suicidal ideation are at particularly high risk for engaging in suicidal behaviors when an exposure to suicide attempt occurs.

Adolescent↗
PubMed1995

Survival analysis of suicide risk after attempted suicide.

Survival analysis of suicide risk by sex and age after attempted suicide was studied in a cohort of 1573 suicide attempters referred to the psychiatric emergency room at the Karolinska Hospital from 1981 to 1988. The time course of suicide risk and the overall prognosis after attempted suicide and, in particular, the possible usefulness of sex and age as risk factors for the prediction of suicide risk after attempted suicide was analyzed. Nearly two thirds of the sample were women and most of the suicide attempters were young (in their twenties and thirties), and the median age was 35 years. The overall mortality after a 5-year mean observation period after attempted suicide was 11%, and the suicide mortality was 6%. The suicide risk after attempted suicide among men (8.3%) was nearly twice the female suicide risk (4.3%). Age as a possible suicide risk factor was analyzed for each sex separately by median split subgrouping. It was concluded that both older and younger male suicide attempters are at high risk of suicide (7% and 10% respectively), and older women are at higher risk than younger (6% vs 2%). The suicide risk is particularly high during the first year after the suicide attempt. The high suicide risk group of young adult male suicide attempters is one of the main feasible targets of psychiatric intervention research programs on suicidal behavior. Suicide among young men is a major cause of years of life lost.

Adolescent↗
PubMed2005

Suicidal tendencies and attitude towards freedom to choose suicide among Lithuanian schoolchildren: results from three cross-sectional studies in 1994, 1998, and 2002.

BACKGROUND: Suicidal behaviour is increasingly becoming a phenomenon associated with young people and an important public health issue in Lithuania. However, there are very few studies evaluating impact of young peoples' attitudes towards suicide to their suicidal behaviour. A better understanding of the relations among the variables associated with suicidal ideation and threats in the normal population of adolescents may eventually result in a better understanding of the more serious forms of adolescent suicidal behaviour. The aim of the present study was to evaluate prevalence of suicidal tendencies among Lithuanian schoolchildren and to estimate its association with an attitude towards suicide in 1994-2002. METHODS: Three country representative samples of schoolchildren, aged 11, 13 and 15, were surveyed in 1994 (n = 5,428), 1998 (n = 4,513), and 2002 (n = 5,645) anonymously in conformity with the methodology of the World Health Organization Cross--National study on Health Behaviour in School-aged Children (HBSC). RESULTS: About one third of respondents reported about suicidal ideation, plans or attempts to commit suicide. In the study period of eight years, the percentage of adolescents who reported sometime suicidal ideation decreased but the percentage of adolescents who declared serious suicidal behaviour remained on the same high level (8.1%, 9.8% and 8.4% correspondingly in 1994, 1998 and 2002). Moreover, the number of suicidal attempts changed from 1.0% in 1994 to 1.8% in the year 1998 and to 1,7% in the year 2002. The schoolchildren's attitude towards suicide became more agreeable: 36.6%, 41.9% and 62.5% of respondents, correspondingly in 1994, 1998 and 2002, answered that they agree with a person's freedom to make a choice between life and suicide. A multiple logistic regression analysis with low level of suicidality and high level of suicidality versus non suicidal behaviour as dependent variables for gender, age, year of the survey and attitude towards freedom to choose suicide as independent variables approved a significant association between studied covariates over the entire study period. CONCLUSION: Suicidal tendencies are quite frequent among Lithuanian adolescents. An increasing number of schoolchildren are expressing an agreeable attitude towards suicide. The approving attitude towards suicide among adolescents correlates with suicidal ideation and behaviour.

Adolescent↗