"Death talk": debating euthanasia and physician-assisted suicide in Australia.
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[Suicide and suicide prevention. Could the physician do more? Results of a questionnaire of relatives of suicide attempters and suicide victims].
Relatives of 50 attempted and 50 successful suicides were interviewed with a semi-structured set of questions. This report presents the results of the questions which related to the role of the physician and his reaction to the event, and to the reaction of the relatives. 80% of all cases were seeing a doctor, and the physicians concerned reported that they were very surprised by the suicide attempts and suicides in 36% and 48% of cases respectively. Many patients had a history of suicide attempts and/or threats; earlier suicide attempts were not known to the physicians in 67% (attempted suicide) and 38% (successful suicide), and threats in 73% and 50% respectively. The author had the impression that the diagnosis of depressive illness and the indication for treatment with antidepressive medication was often missed. The practical implications of these results are discussed.
Adult↗
Worst-point suicidal plans: a dimension of suicidality predictive of past suicide attempts and eventual death by suicide.
Among 440 psychiatric outpatients with current suicidal ideation, we examined the empirical distinction between the "plans" vs. "desire" dimensions of suicidality, focusing for conceptual and empirical reasons on a worst-point assessment strategy. Factor analyses were consistent with the distinction, but more importantly, among the current ideators included in this study, the worst-point "plans" dimension was the only predictor significantly related to both of two important indices, history of past attempt and eventual suicide. These findings bear on the trajectory of suicidal behavior over time, as well as inform the clinical assessment of suicidal patients.
Adult↗
Suicide risk assessment: a review of risk factors for suicide in 100 patients who made severe suicide attempts. Evaluation of suicide risk in a time of managed care.
A study of 100 patients who made a severe suicide attempt suggested that the managed care criteria often applied for approving admission to hospitals for potentially suicidal patients were not, in fact, predictive of features seen in patients who actually made such attempts. Severe anxiety, panic attacks, a depressed mood, a diagnosis of major affective disorder, recent loss of an interpersonal relationship, recent abuse of alcohol or illicit substances coupled with feelings of hopelessness, helplessness, worthlessness, global or partial insomnia, anhedonia, inability to maintain a job, and the recent onset of impulsive behavior were excellent predictors of suicidal behavior. The presence of a specific suicide plan or suicide note were not. Patients with managed care were overrepresented by 245% in the study.
Adolescent↗
Peripubertal suicide attempts in offspring of suicide attempters with siblings concordant for suicidal behavior.
OBJECTIVE: The authors sought to determine 1) whether the risk for familial transmission of suicidal behavior is greater with increased family loading for suicide attempts, and 2) whether the transmission of suicidal behavior is mediated by impulsive aggression. METHOD: A reanalysis of a high-risk study compared the offspring of three mood disorder proband groups: suicide attempters with a sibling who also attempted suicide (N=19), suicide attempters whose siblings never made a suicide attempt (N=73), and nonsuicidal probands whose siblings also never engaged in suicidal behavior (N=73). Probands and offspring were assessed with respect to psychopathology, suicide attempt history, impulsive aggression, and exposure to familial adversity. RESULTS: Offspring of suicide attempters with siblings concordant for suicidal behavior showed a higher risk of suicide attempt than did offspring of nonsuicidal probands and had an earlier age at onset of suicidal behavior than offspring of suicide attempters with siblings discordant for suicidal behavior. Probands from sibling pairs concordant for suicidal behavior and their offspring reported greater lifetime impulsive aggression compared with each of the other two proband/offspring groups. In the offspring, impulsive aggression was the most powerful predictor of early age at first suicide attempt. CONCLUSIONS: Familial loading for suicide attempts may affect rates of transmission as well as age at onset of suicidal behavior, and its effect may be mediated by the familial transmission of impulsive aggression.
Adolescent↗
Seasonality in suicides: the influence of suicide method, gender and age on suicide distribution in Italy.
In order to ascertain if and how age, gender and choice of lethal means influence the seasonal distribution of suicide in Italy, data concerning all suicides registered in Italy from 1984 to 1995 have been analyzed, taking these variables into account. In the age group 14-65 years and over a total of 31771 male suicides (mean yearly rate, 12.6 per 100000) and 11984 female suicides (mean yearly rate, 4.4 per 100000) have been identified in Italy during the study period. Suicides in the younger age ranges, both among males and females, show a less marked asymmetrical seasonal distribution than those in the older age groups. Only suicides committed by violent methods (ICD 953-958) show clear evidence of seasonality, with a peak in spring and a low in late autumn. Suicides committed by non-violent methods (950-952) follow no seasonal trend in either sex. Spectral analysis reveals a circannual rhythm for violent suicides (ICD 953-958) in both genders. For male non-violent suicides (ICD 950-952), a period with a frequency of 0.0833 (12 months) has been identified, but with a polarity opposite to that of male violent suicides. For female non-violent suicides, no period of frequency of 0.0833 could be identified, but, as for female violent suicides, a period with frequency close to 0.2500 (4 months) has been found. Changes in climate, then, correlate with the monthly distribution of violent and non-violent suicides in opposite ways: male violent suicides show a significant positive relationship with indicators of temperature and exposure to the sun, and a significant negative relationship with indicators of humidity and rainfall. Female suicides show less significant relationships with climate indicators. Work aimed at suicide prevention should therefore take into account the complex influence of seasonal climate both on human biological rhythms (particularly on 5-HT related functions and their actions on mood and impulsivity) and on sociorelational habits.
Adolescent↗
Risk factors for adolescent suicide. A comparison of adolescent suicide victims with suicidal inpatients.
The characteristics of adolescent suicide victims (n = 27) were compared with those of a group at high risk for suicide, suicidal psychiatric inpatients (n = 56) who had either seriously considered (n = 18) or actually attempted (n = 38) suicide. The suicide victims and suicidal inpatients showed similarly high rates of affective disorder and family histories of affective disorder, antisocial disorder, and suicide, suggesting that among adolescents there is a continuum of suicidality from ideation to completion. However, four putative risk factors were more prevalent among the suicide victims: (1) diagnosis of bipolar disorder; (2) affective disorder with comorbidity; (3) lack of previous mental health treatment; and (4) availability of firearms in the homes, which taken together accurately classified 81.9% of cases. In addition, suicide completers showed higher suicidal intent than did suicide attempters. These findings suggest a profile of psychiatric patients at high risk for suicide, and the proper identification and treatment of such patients may prevent suicide in high-risk clinical populations.
Adolescent↗
Self-reported life-weariness, death-wishes, suicidal ideation, suicidal plans and suicide attempts in general population surveys in the north of Sweden 1986 and 1996.
BACKGROUND: The aims of present study were to assess the prevalence of suicidal expression in the general population, to compare prevalences over time, to identify risk groups and to examine the evidence regarding the proposition that there is a continuous sequence of suicidal expressions with an underlying gradient of severity. METHOD: Two postal questionnaire studies were conducted, in 1986 and in 1996, involving representative samples of about 700 and 1000 persons respectively, in the age range 18-65 years. Response rates of 76% and 64%, respectively, were obtained. RESULTS: A higher proportion (34%) reported some degree of suicidal expression during the past year in the 1996 survey, compared to 1986 (23%). This was mainly attributed to higher reporting of life-weariness and death-wishes, since there was a simultaneous lower reporting of suicidal ideation (12.5% vs 8.6%). The total lifetime incidence of suicidal expression was identical (52%) in both studies. Respective proportions of 0.6% and 0.2% reported that they had made a suicide attempt during the last year, and 2.6% and 2.7%, respectively, during their lifetime. Higher prevalences of combined suicidal expression during the previous year were reported by women, younger persons, those living alone and women living in urban areas. Concerning suicidal ideation during last year, no gender differences were found. For a total of 21% of those reporting some degree of suicidal expressions during the past year, no simple cumulative relationship between the different types of suicidal expression was found. CONCLUSIONS: It is possible to use a postal questionnaire approach for studies on suicidal expression in the general population, and the study indicates that such suicidal expression is fairly prevalent. The pronounced gender differences concerning most types of suicidal behaviours and expression are not valid for suicidal ideation, which is important to consider in a preventional context.
Adult↗
Suicidal ideation and suicide attempt in Polish adolescents: is it a suicidal process?
UNLABELLED: The objective of our study was to assess the prevalence and possible predictors of suicide attempts and ideation in the school population of adolescents in the city of Lodz. METHOD: A self-administered anonymous questionnaire was distributed to a representative (random) sample of 1,663 students, aged 14 to 21 years. Adolescents reporting no suicide behaviour constitute the control group; characteristics of this group were compared to those of the group concerned, with exploration of the correlation between different variables in terms of relative risk, separately for suicidal ideation and suicide attempts. RESULTS: About 31% of students reported suicidal ideation (SSI), and 8%--suicide attempts (SSA). Among the factors related to the highest relative risk of suicide attempts in the examined students and differentiated SSA and SSI, the most significant factor appeared to be previous psychiatric treatment and/or psychotherapy (OR = 9), run away from home (OR = 7), suicidal deaths among relatives and friends (OR = 6), drug abuse (OR = 5), and "fascination with death" (OR = 4). CONCLUSIONS: There are separate predictors of suicide attempt and suicidal ideation in Polish adolescents. Suicidal ideation as a common phenomenon (occurring in every third pupil) probably should be included into the specificity of the puberty process and considered as a separate phenomenon from suicide attempt. The presence of previous psychiatric diagnosis is most strongly related to the occurrence of suicide attempts (including those repeated), but is not related to suicidal ideation.
Adolescent↗
Suicide and suicide attempts in Ankara in 1998: results of the WHO/EURO Multicentre Study of Suicidal Behaviour.
BACKGROUND: The rates and associated basic demographic features of attempted and completed suicides in a catchment area in Turkey were investigated as part of the WHO/Euro Multicentre Study of Suicidal Behaviour. METHOD: All hospitals in the catchment area were screened in order to identify attempted suicides. Statistics for completed suicides were obtained from the State Institute of Statistics (SIS). RESULTS: The rates of attempted and completed suicides per 100,000 inhabitants over 15 years of age were 31.9 for males and 85.6 for females, and 9.9 for males and 5.6 for females, respectively. The majority of attempted suicides were in the 15-24-year-old age group, as is the case in all other European countries. The majority of completed suicides were also in the 15-24-year-old age group, although in other European centers most completed suicides occur in the 40+ age group. The most frequent methods were overdose for attempted suicide and hanging for completed suicide. The rates of both attempted and completed suicides were lower than those of other participating centers in Europe. CONCLUSION: Male sex is a risk factor for completed suicide and female sex is a risk factor for attempted suicide, while an age of 15-24 years may be a risk factor for both groups.
Adolescent↗
Is suicide contagious? A study of the relation between exposure to the suicidal behavior of others and nearly lethal suicide attempts.
This study sought to determine the association between nearly lethal suicide attempts and exposure to the suicidal behavior of parents, relatives, friends, or acquaintances and to accounts of suicide in the media. The authors conducted a population-based case-control study in Houston, Texas, from November 1992 through July 1995. They interviewed 153 victims of attempted suicide aged 13--34 years who had been treated at emergency departments in Houston and a random sample of 513 control subjects. After controlling for potentially confounding variables, the authors found that exposure to the suicidal behavior of a parent (adjusted OR = 1.5; 95% CI: 0.6, 3.6; p = 0.42) or a nonparent relative (adjusted OR = 1.2; 95% CI: 0.7, 2.0; p = 0.55) was not significantly associated with nearly lethal suicide attempts. Both exposure to the suicidal behavior of a friend or acquaintance (adjusted OR = 0.6; 95% CI: 0.4, 1.0; p = 0.05) and exposure to accounts of suicidal behavior in the media (adjusted OR = 0.2; 95% CI: 0.1, 0.3; p = 0.00) were associated with a lower risk of nearly lethal suicide attempts. Exposure to accounts of suicidal behavior in the media and, to a lesser extent, exposure to the suicidal behavior of friends or acquaintances may be protective for nearly lethal suicide attempts, but further research is needed to better understand the mechanisms underlying these findings.
Adolescent↗
[Railroad suicides and attempted suicides in Austria 1990-1994. Extending the hypothesis mass media transmission of suicidal behavior].
Suicide on railways (either by being run over by or jumping in front of a train) is one of the "hardest' suicide methods. In Austria, 617 suicides or attempted suicides on railways were registered between 1990 and 1994. This amounts to 5.73% of all suicides committed in this period with women showing a higher percentage than men. In both men and women there was a predominance of younger age groups; the mean age was higher in women than in men (48.0 vs 40.4 years). There was a significant increase in suicides or attempted suicides on railways after a television report on the stress suffered by train drivers concerning possible suicides. Persuading the mass media to treat the subject of "suicide' with reserve and with greater caution, even when not presenting a distinct suicide model, may be of importance in general suicide prevention.
Adolescent↗
Sex differences in risk factors for suicide after attempted suicide-a follow-up study of 1052 suicide attempters.
AIM: This study aims to investigate suicide risk factors after attempted suicide and whether and how these risk factors differ between the sexes. METHOD: A total of 1052 suicide attempters admitted to the Medical Emergency Inpatient Unit, Lund University Hospital, Sweden were followed up concerning suicide and death from other causes after a median period of 6 years and 5 months. In all, 50 persons committed suicide during follow-up. At the index suicide attempt, socio-demographic data and information about clinical characteristics were gathered in a standardised manner. Risk factors were identified among these data using survival analyses for the whole sample and for each sex separately. RESULT: Men had a higher frequency of suicide and a greater overall mortality than women. Cox regressions showed that suicide attempt(s) prior to the index attempt and the use of a violent method for the index attempt were risk factors for men only, whereas older age and a high suicidal intent (Beck SIS score) were female ones. Major depression was a risk factor for both sexes. CONCLUSION: More attention probably needs to be paid to the importance of gender in assessment of suicide risk and treatment of suicide attempters.
Adult↗
Moderators of the relationship between alcohol dependence and suicide and medically serious suicide attempts: analyses of Canterbury Suicide Project data.
BACKGROUND: Preliminary data indicate that age, gender, and mood disorder moderate the association of alcohol dependence and suicide. The purpose of this study was to evaluate potential moderators of the relationship between alcohol dependence and suicide and medically serious suicide attempts by using case-control data gathered in the Canterbury region of New Zealand for the Canterbury Suicide Project. METHODS: Data on 193 suicide decedents, 240 medically serious suicide attempters, and 984 community controls, all age 18 and over, were gathered by using psychological autopsy methodology. Multinomial logistic analyses were used to compare the two case groups to controls on demographic and diagnostic variables. Moderating effects were evaluated based on significant statistical interactions of predictors with alcohol dependence. RESULTS: The association of alcohol dependence and suicide (but not medically serious attempts) was amplified with increased age. Neither mood disorder nor gender moderated the relationship between alcohol dependence and suicide. Increased age amplified the association of mood disorder and suicide, whereas decreased age strengthened the association of mood disorder and medically serious suicide attempts. CONCLUSIONS: Older age may serve as a marker for a construct (e.g., aggression/impulsivity) that underlies the failure to mature out of alcoholism, or a late-onset subtype of alcoholism prone to negative affect, accounting for the association of older age and suicide in this population. Older age also may merely reflect longer duration of the deleterious effects of alcoholism.
Adolescent↗
Suicide ideation: its relation to depression, suicide and suicide attempt.
A random sample of 3,935 adults from a general population were interviewed and asked to report how often they had thoughts of suicide as well as their opinion on the frequency of suicide ideation in others. Depression was found to be related to the respondent's reports of his/her own suicidal thoughts and to reports of frequent suicide ideation in others. A total of 5.4 percent of the respondents reported some degree of suicide ideation in the previous month and 9.1 percent reported that others think about suicide once a month or more. When the demographic characteristics of those who report suicide ideation in themselves or others were compared to those of suicide attempters and committers, some consistencies were found, suggesting that such questions may be useful in identifying those "at risk." Nevertheless, sufficient discrepancies were found which suggest that there may be a number of factors which increase or decrease the likelihood that someone with thoughts of suicide will attempt or commit suicide. Follow-up studies are necessary to uncover such factors and the degrees to which they influence the occurrence of suicide.
Adolescent↗
Risk factors for suicide and medically serious suicide attempts among alcoholics: analyses of Canterbury Suicide Project data.
OBJECTIVE: Alcohol dependence is a potent risk factor for completed suicide and medically serious attempts, but data are limited on factors that distinguish risk within this high-risk population. The purpose of this study is to identify risk factors for serious suicidal behavior among individuals with alcohol dependence. METHOD: Data on completed suicides and medically serious suicide attempters and controls were gathered in the Canterbury region of New Zealand, using psychological autopsy methodology. A subsample of adult alcoholic subjects was selected for analyses yielding 38 completed suicides, 62 medically serious suicide attempters and 46 community controls, all with alcohol dependence (past month). Multinomial logistic analyses were used to compare the two case groups to controls on demographic and diagnostic variables. RESULTS: Mood disorders and financial difficulties were more frequent among medically serious attempters than controls. Completed suicides were older and were more likely to be male, to have mood disorders, partner-relationship difficulties and other interpersonal life events than were controls. Completed suicides were older and more likely to be male than were medically serious attempters. CONCLUSIONS: Risk factors in alcoholics are generally consistent with reports based on general samples of suicide and medically serious suicide attempts. Suicide prevention efforts in alcoholics, if they are to be successful, must include a focus on depression as well as interpersonal factors, including partner-relationship difficulties.
Adolescent↗
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↗
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↗