The relationship between suicide and violence in schizophrenia: analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) dataset

Background

Suicide and violence often co-occur in the general population as well as in mentally ill individuals. Few studies, however, have assessed whether these suicidal behaviors are predictive of violence risk in mental illness.

Aims

The aim of this study is to investigate whether suicidal behaviors, including suicidal ideation, threats, and attempts, are significantly associated with increased violence risk in individuals with schizophrenia.

Method

Data for these analyses were obtained from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) trial, a randomized controlled trial of antipsychotic medication in 1460 adults with schizophrenia. Univariate Cox regression analyses were used to calculate hazard ratios (HRs) for suicidal ideation, threats, and attempts. Multivariate analyses were conducted to adjust for common confounding factors, including: age, alcohol or drug misuse, major depression, antisocial personality disorder, depression, hostility, positive symptom, and poor impulse control scores. Tests of discrimination, calibration, and reclassification assessed the incremental predictive validity of suicidal behaviors for the prediction of violence risk.

Results

Suicidal threats and attempts were significantly associated with violence in both males and females with schizophrenia with little change following adjustment for common confounders. Only suicidal threats, however, were associated with a significant increase in incremental validity beyond age, diagnosis with a comorbid substance use disorder, and recent violent behavior.

Conclusions

Suicidal threats are independently associated with violence risk in both males and females with schizophrenia, and may improve violence risk prediction.

Suicidality in Obsessive-Compulsive Disorder: Prevalence and Relation to Symptom Dimensions and Comorbid Conditions

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

An exploratory dimensional approach to premenstrual manifestation of obsessive-compulsive disorder symptoms: A multicentre study

Objective: In women with obsessive-compulsive disorder (OCD), symptom severity appears to fluctuate over the course of the menstrual cycle. The objective of this paper was to compare female OCD patients with and without premenstrual worsening of obsessive-compulsive symptoms (OCS), in terms of the clinical characteristics of OCD. Methods: This was a cross-sectional study involving 455 women with OCD, of whom 226 (49.7%) had experienced premenstrual OCS worsening and 229 (50.3%) had not (PMOCS-worse and PMOCS-same groups, respectively). Data were collected with the original and dimensional versions of the Yale-Brown Obsessive-Compulsive Scale, as well as with the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Results: We found significant differences between the PMOCS-same and PMOCS-worse groups, the latter showing a higher frequency of suicidal ideation (P<.001), suicide attempts (P=.027), current use of selective serotonin reuptake inhibitors (P=.022), lifetime use of mood stabilisers (P=.015), and sexual/religious obsessions (P<.001; OR. =1.90), as well as higher scores on the BDI (P<.001) and BAI (P<.001). Conclusion: Underscoring the fact that OCD is a heterogeneous disorder, there appears to be a subgroup of female OCD patients in whom the premenstrual period is associated with a higher frequency of sexual/religious obsessions, depression, anxiety, and suicidality. This might be attributable to hormonal fluctuations. Further studies are warranted in order to investigate this hypothesis by evaluating such patients at different phases of the menstrual cycle, as well as measuring hormonal levels. © 2012 Elsevier Inc.

Suicide attempts are associated with worse quality of life in patients with bipolar disorder type I

Background: The association between suicidal behavior and quality of life (QoL) in bipolar disorder (BD) is poorly understood. Worse QoL has been associated with suicide attempts and suicidal ideation in schizophrenic patients, but this relationship has not been investigated in BD. This study tested whether a history of suicide attempts was associated with poor QoL in a well-characterized sample of patients with BD, as has been observed in other psychiatric disorders and in the general population. Methods: One hundred eight patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition BD type I (44 with previous suicide attempts, 64 without previous suicide attempts) were studied. Quality of life was assessed using the World Health Organization's Quality of Life Instrument Short Version. Depressive and manic symptoms were assessed using the Hamilton Depression Rating Scale-17 items and the Young Mania Rating Scale. Results: Patients with BD and previous suicide attempts had significantly lower scores in all the 4 domains of the World Health Organization's Quality of Life Instrument Short Version scale than did patients with BD but no previous suicide attempts (physical domain P=.001; psychological domain P <.0001; social domain P=.001, and environmental domain P=.039). In the euthymic subgroup (n=70), patients with previous suicide attempts had significantly lower scores only in the psychological and social domains (P=.020 and P=.004). Limitations: This was a cross-sectional study, and no causal associations can be assumed. Conclusions: Patients with BD and a history of previous suicide attempts seem to have a worse QoL than did patients who never attempted suicide. Poorer QoL might be a marker of poor copying skills and inadequate social support and be a risk factor for suicidal behavior in BD. Alternatively, poorer QoL and suicidal behavior might be different expressions of more severe BD. (C) 2012 Elsevier Inc. All rights reserved.

The structure of psychopathological symptoms and the associations with DSM-diagnoses in treatment seeking individuals

BACKGROUND: Research on comorbidity of psychiatric disorders identifies broad superordinate dimensions as underlying structure of psychopathology. While a syndrome-level approach informs diagnostic systems, a symptom-level approach is more likely to represent the dimensional components within existing diagnostic categories. It may capture general emotional, cognitive or physiological processes as underlying liabilities of different disorders and thus further develop dimensional-spectrum models of psychopathology. METHODS: Exploratory and confirmatory factor analyses were used to examine the structure of psychopathological symptoms assessed with the Brief Symptom Inventory in two outpatient samples (n=3171), including several correlated-factors and bifactor models. The preferred models were correlated with DSM-diagnoses. RESULTS: A model containing eight correlated factors for depressed mood, phobic fear, aggression, suicidal ideation, nervous tension, somatic symptoms, information processing deficits, and interpersonal insecurity, as well a bifactor model fit the data best. Distinct patterns of correlations with DSM-diagnoses identified a) distress-related disorders, i.e., mood disorders, PTSD, and personality disorders, which were associated with all correlated factors as well as the underlying general distress factor; b) anxiety disorders with more specific patterns of correlations; and c) disorders defined by behavioural or somatic dysfunctions, which were characterised by non-significant or negative correlations with most factors. CONCLUSIONS: This study identified emotional, somatic, cognitive, and interpersonal components of psychopathology as transdiagnostic psychopathological liabilities. These components can contribute to a more accurate description and taxonomy of psychopathology, may serve as phenotypic constructs for further aetiological research, and can inform the development of tailored general and specific interventions to treat mental disorders.

Myocardial Infarction - Stress PRevention INTervention (MI-SPRINT) to reduce the incidence of posttraumatic stress after acute myocardial infarction through trauma-focused psychological counseling: study protocol for a randomized controlled trial

BACKGROUND Posttraumatic Stress Disorder (PTSD) may occur in patients after exposure to a life-threatening illness. About one out of six patients develop clinically relevant levels of PTSD symptoms after acute myocardial infarction (MI). Symptoms of PTSD are associated with impaired quality of life and increase the risk of recurrent cardiovascular events. The main hypothesis of the MI-SPRINT study is that trauma-focused psychological counseling is more effective than non-trauma focused counseling in preventing posttraumatic stress after acute MI. METHODS/DESIGN The study is a single-center, randomized controlled psychological trial with two active intervention arms. The sample consists of 426 patients aged 18 years or older who are at 'high risk' to develop clinically relevant posttraumatic stress symptoms. 'High risk' patients are identified with three single-item questions with a numeric rating scale (0 to 10) asking about 'pain during MI', 'fear of dying until admission' and/or 'worrying and feeling helpless when being told about having MI'. Exclusion criteria are emergency heart surgery, severe comorbidities, current severe depression, disorientation, cognitive impairment and suicidal ideation. Patients will be randomly allocated to a single 45-minute counseling session targeting either specific MI-triggered traumatic reactions (that is, the verum intervention) or the general role of psychosocial stress in coronary heart disease (that is, the control intervention). The session will take place in the coronary care unit within 48 hours, by the bedside, after patients have reached stable circulatory conditions. Each patient will additionally receive an illustrated information booklet as study material. Sociodemographic factors, psychosocial and medical data, and cardiometabolic risk factors will be assessed during hospitalization. The primary outcome is the interviewer-rated posttraumatic stress level at three-month follow-up, which is hypothesized to be at least 20% lower in the verum group than in the control group using the t-test. Secondary outcomes are posttraumatic stress levels at 12-month follow-up, and psychosocial functioning and cardiometabolic risk factors at both follow-up assessments. DISCUSSION If the verum intervention proves to be effective, the study will be the first to show that a brief trauma-focused psychological intervention delivered within a somatic health care setting can reduce the incidence of posttraumatic stress in acute MI patients. TRIAL REGISTRATION ClinicalTrials.gov: NCT01781247.

Report of the WPA section of pharmacopsychiatry on the relationship of antiepileptic drugs with suicidality in epilepsy

INTRODUCTION This report from the World Psychiatric Association Section on Pharmacopsychiatry examines the possible relationship of antiepileptic drugs with suicide-related clinical features and behaviors in patients with epilepsy. MATERIALS AND METHODS A systematic review of the MEDLINE search returned 1039 papers, of which only 8 were considered relevant. A critical analysis of the Food and Drug Administration (FDA) report on the increase risk for patients under antiepileptics to manifest suicidality is also included in this report. RESULTS The analysis of these studies revealed that the data are not supportive of the presence of a "class effect" on suicide-related behavior; on the contrary, there are some data suggesting such an effect concerning treatment with topiramate, lamotrigine, and levetiracetam for which further research is needed. DISCUSSION For the majority of people with epilepsy, anticonvulsant treatment is necessary and its failure for any reason is expected to have deleterious consequences. Therefore, clinicians should inform patients and their families of this increased risk of suicidal ideation and behavior, but should not overemphasize the issue. Specific subgroups of patients with epilepsy might be at a higher risk, and deserve closer monitoring and follow-up. Future research with antiepileptics should specifically focus on depression and suicidal thoughts.

Workshop: ASSIP - Attempted Suicide Short Intervention Program. Theory, Practice, and 24 Months Follow-up RCT.

Background: ASSIP is a manualized brief therapy based on a model of suicide as goal-directed action, aimed at establishing a therapeutic alliance in a patient-oriented, collaborative approach. The main goals of the three-session program ASSIP are for patients to understand, from an observer’s position, patterns leading to a suicidal crisis, recognize triggers and warning signs, and to establish individual safety strategies for future suicidal crises. An ongoing therapeutic support is provided with regular letters over 24 months. Method: The study was conducted in a naturalistic setting. 120 Patients were randomly assigned to an intervention group (60 participants) treated with ASSIP combined with follow-up contact through letters, and a control group (60 participants) receiving a single session of clinical assessment. Both groups had treatment as usual. Patients completed a set of psychosocial and clinical questionnaires every six months over a period of 24 months. Results: In the ASSIP group 5 patients made a total of 5 reattempts, compared to 15 patients with 41 reattempts in the control group. The survival analysis yielded a significant difference with a Wald Chi2 of .000003. The ASSIP group had significantly lower suicidal ideation and fewer days of inpatient treatment compared to the control group. Higher scores in the Penn Helping Alliance Questionnaire were associated with lower suicidal ideation during follow-up. Conclusions: ASSIP is a highly effective brief therapy for patients with recent suicide attempts. Forming a strong therapeutic alliance is considered to be a major factor for outcome. ASSIP can be used with minimal training by experienced therapists. An English version of the manual will be published in May 2015.

Social capital and adolescent health risk behavior in El Salvador

An emerging body of research suggests that the social capital available in one's social environment, as defined by supportive and caring interpersonal relationships, may provide a protective effect against a number of youth risk behaviors. In exploring the potential protective effect of social capital at school and at home on adolescent health and social risk behavior, a comprehensive youth risk behavior study was carried out in El Salvador during the summer of 1999 with a sample of 984 secondary school students attending 16 public rural and urban schools. The following dissertation, entitled Social Capital and Adolescent Health Risk Behavior in El Salvador, presents three papers centered on the topics of social capital and risk behavior. ^ Paper #1. Dangers in the Adolescent River of Life: A Descriptive Study of Youth Risk Behavior among Urban and Rural presents prevalence estimates of four principal youth risk behavior domains—aggression, depression, substance use, and sexual behaviors among students primarily between the ages of 13 and 17 who attend public schools in El Salvador. The prevalence and distribution of risk behaviors is examined by gender, geographic school location, age, and subjective economic status. ^ Paper #2. Social Capital and Adolescent Health Risk Behavior among Secondary School Students in El Salvador explores the relationship between social resources (social capital) within the school context and several youth risk behaviors. Results indicated that students who perceived higher social cohesion at school and higher parental social support were significantly less likely to report fighting, having been threatened or hurt with a weapon, suicidal ideation, and sexual intercourse than students with lower perceived social cohesion at school and parental social support after adjusting for several socio-demographic variables. ^ Lastly, paper #3. School Health Environment and Social Capital : Moving beyond the individual to the broader social developmental context provides a theoretical and empirical basis for moving beyond the predominant individual-focus and physical health concerns of school health promotion to the larger social context of schools and social health of students. This paper explores the concept of social capital and relevant adolescent development theories in relation to the influence of social context on adolescent health and behavior. ^

Ethnic differences in adolescents' mental distress

Objectives. The aims of this cross-sectional study were to (1) examine differences among four ethnic groups of middle school students (Anglos, African Americans [AAs], Hispanics, and Asians) on (a) three indicators of mental distress (depression, somatic symptoms, suicidal ideation) (b) social stress (general social stress, process-oriented stress, discrimination) and resources (family relationships, coping, self-esteem) and (2) identify significant risk factors and resources for each ethnic group by examining the moderating effects of ethnicity. ^ Methods. Respondents included 316 students from three schools (144 Anglos, 66 AAs, 77 Hispanics, 29 Asians/Others) who completed self-administered questionnaires. Social stress and somatic symptoms were measured by using the SAFE-C and Somatic Symptom Scale, respectively. The DSD was used to assess depression and suicidal ideation. Resources were measured by using the FES, age-appropriate adaptations of two existing coping scales, and Rosenberg's Self-Esteem Scale. For specific aims, descriptive statistics, ANOVA, ANCOVA, and logistic regression analysis were used. ^ Findings. No statistically significant ethnic group or gender differences were observed in depression and somatic symptoms, but the odds of experiencing depression symptoms were about 9.7 times greater for Hispanic females than for the referent group, Anglo males. Hispanics were also 2.04 times more likely to have suicidal ideation than Anglos ( P < 0.05). AAs and Hispanics reported significantly higher levels of stress than Anglos (OR: 2.2–4.3, 0.00 ≤ P ≤ 0.03). These findings imply that adolescents in these ethnic groups may be exposed to considerable amounts of stress even if they do not exhibit significant symptoms of mental distress yet. Negative moderating effects for ethnicity were found by the significant interaction between ethnicity and social stress in somatic symptoms among AAs and Hispanics. This finding indicates that AA and Hispanic adolescents may require higher levels of social stress to exhibit the same amount of somatic symptoms as Anglo adolescents. Observed ethnic differences in social stress and interaction between social stress and ethnicity in relation to somatic symptoms demonstrated a need for subsequent longitudinal studies, and provided a rationale for incorporating social stress as a critical component not only in research but also in culturally sensitive prevention programs. ^

The association between academic achievement and health status among eighth -grade Hispanic students in Houston

This cross-sectional study examines the association between health and academic achievement among Hispanic eighth-grade students in the Houston Independent School District. As part of the district's 3 year Safe Schools/Healthy Students Initiative to enhance comprehensive educational programs, a brief anonymous questionnaire was administered in the classroom to 359 students in two schools during a one-month period in the early part of the 2001 school year. ^ The primary study questions are: Among this sample of Hispanic adolescents, is there a significant association between academic achievement and health status? and in this same population, is there a significant association between health risk behavior and health status? The specific aims of this research are: (1) to describe the association between academic achievement and health status; (2) to describe the association between health risk behaviors and health status; and (3) to describe the relative contribution of health risk behaviors and academic achievement to adolescent health status among this sample of Hispanic adolescents. ^ The survey instrument was a 32-item questionnaire that incorporated: several academic achievement questions measuring usual grades, school-related performance, attendance, student and perceived parental satisfaction with academic achievement, and educational aspirations; two health and quality of life scales measuring adolescent self-reported health; and specific measures of health risk behavior, e.g., frequency of tobacco cigarette smoking, alcohol and other drug use, aggression, and suicidal ideation and behavior that were incorporated from the national Youth Risk Behavior Survey. Questions pertaining to sexual behavior and pregnancy were omitted to comply with school district guidelines. ^ Analysis revealed that strong associations between academic achievement and health status and between health risk behaviors and health status were observed after controlling for the covariates. Eight factors were found to be significantly associated with poor health status: usual grades (low), academic performance (low), academic achievement beliefs (low), classroom and homework performance satisfaction (low), ever drinking alcohol (6 or more times), suicidality (ever thought about, planned for, or sought medical help after attempting suicide), gender (female), and age (15 years and older). (Abstract shortened by UMI.) ^

Perfil sociodemográfico dos sujeitos que tentaram o suicídio no município de Arapiraca, Alagoas

Introdução: as tentativas de suicídio são uma das causas mais frequentes de atendimento nos serviços de urgência no Brasil. Poucos estudos abordam as características epidemiológicas das tentativas de suicídio, principalmente na região nordeste. Diante da importância de se conhecer as características das tentativas de suicídio e propor estratégias de minimização é que o presente estudo caracterizou o perfil sociodemográfico das pessoas que tentaram suicídio em Arapiraca – AL, no período de 2009 a 2013. Metodologia: Trata-se de um estudo descritivo de série histórica, com dados obtidos através da ficha de notificação/ investigação individual de Intoxicação Exógena do SINAN, de pacientes que foram atendidos no serviço de urgência e emergência da Unidade de Emergência Doutor Daniel Houly em Arapiraca. Foram analisadas as seguintes variáveis das tentativas de suicídios: faixa etária, sexo, raça, idade gestacional, zona de residência, vínculo empregatício, agente tóxico, hospitalização e evolução. Resultados: Do ano de 2009 a 2013 o total de atendidos por tentativas de suicídios na referida unidade foi de 1.184 indivíduos, sendo 71,54% do sexo feminino e 28,46% do sexo masculino. A faixa etária de maior frequência foi à de 20-29 anos, correspondendo a 33 % e a raça parda foi a que apresentou maior número de casos, 21% (n= 239). Em relação à residência 77% (n = 922) dos casos residiam em zona urbana, e o principal agente tóxico utilizado nas tentativas de suicídio, foi a ingestão medicamentosa (n = 822, 72%). Cerca de 73% (n=865) tiveram que ser hospitalizados e 95% tiveram tratamento adequado, evoluindo para cura. Conclusão: A partir dos dados foi possível traçar o perfil sociodemográfico das tentativas de suicídio, alcançando os objetivos propostos. A discussão do tema bem como a implementação da educação em saúde se constituem em elementos primordiais para a identificação dos sujeitos com ideação suicida e a busca da evitabilidade de novos casos. Ações de vigilância são necessárias para minimizar as taxas de suicídio, bem como a formação e articulação de rede de assistência no agreste alagoano. Ainda ressalta-se a necessidade de mais estudos com a população que apresenta comportamento suicida no município. Palavras-chave: Tentativa de Suicídio. Saúde Pública. Saúde Mental.

A qualitative analysis of health care provider perceptions of depression and suicidality in Mozambique

Thesis (Master's)--University of Washington, 2016-06

Telephone counselling for adolescent suicide prevention: Changes in suicidality and mental state from beginning to end of a counselling session

Telephone counselling is an accessible and confidential means by which distressed young people can seek help. Telephone counselling services were funded under Australia's National Youth Suicide Prevention Strategy between 1997 and 2000. In this study, the effectiveness of telephone counselling for young people seeking help in the context of suicidal ideation or intent was evaluated in an investigation of calls made by suicidal young people to a telephone counselling service. Independent raters measured callers' suicidality and mental state at the beginning and, end of 100 taped counselling sessions. Changes in suicidality and mental state were measured using a reliable rating scale developed for the study. Significant decreases in suicidality and significant improvement in mental state were found to occur during the course of counselling sessions, suggesting positive immediate impact.-Limitations of the study with respect to longer-term outcomes and the relevance of the results for suicide prevention are discussed. Notwithstanding the study limitations, the results lend support for continuing development of hotline services.

A genetically informed study of the processes underlying the association between parental marital instability and offspring adjustment

Parental divorce is associated with problematic offspring adjustment, but the relation may be due to shared genetic or environmental factors. One way to test for these confounds is to study offspring of twins discordant for divorce. The current analyses used this design to separate the mechanisms responsible for the association between parental divorce, experienced either before or after the age of 16, and offspring well-being. The results were consistent with a causal role of divorce in earlier initiation of sexual intercourse and emotional difficulties, in addition to a greater probability of educational problems, depressed mood, and suicidal ideation. In contrast, the increased risk for cohabitation and earlier initiation of drug use was explained by selection factors, including genetic confounds.