Is sexual violence associated with symptoms of depression and suicide attempts

Sexual assault, depression, and suicide are all very serious issues among youth today. This study sought to quantify the association between sexual violence, symptoms of depression, and suicide attempts through the use of 2007 Youth Risk Behavior Survey (YRBS) data. The YRBS is a nationally representative dataset of United States high school students, grades 9-12. It was hypothesized that sexual violence is significantly associated with symptoms of depression and suicide attempts. Through multivariate logistic regression, it was determined that students who had ever experienced forced sex were 3.10 (2.7-3.6) times as likely to be depressed, in the past 12 months, and 4.22 (3.5-5.1) times as likely to have attempted suicide. Female victims were 3.43 (2.9-4.0) times as likely to be depressed; male victims were 5.40 (3.7-7.9) times as likely to have attempted suicide. Sexual violence is significantly associated with both symptoms of depression and suicide attempt when stratified by gender, grade, and race/ethnicity. These results indicate that further study of the association between sexual violence and symptoms of depression and suicide attempts need to be conducted in order to establish temporality.^

Suicide in developing countries (3) Prevention efforts

Until now, suicide prevention efforts have been limited in developing countries, although there are pockets of excellent achievement. Various universal, selective, and indicated interventions have been implemented, many of which target a different pattern of risk factors to those in developed countries. In the absence of sufficient mental health services, developing countries rely heavily on nongovemment organizations (NGOs) to provide crisis interventions for suicidal individuals, as well as proactive interventions aimed at raising community awareness and building resilience. Often these NGOs work within a social and public health framework, collaborating with others to provide nested suicide prevention programs that are responsive to local community needs. There is a clear need to develop appropriate, relevant and effective national suicide prevention plans in developing countries, since, to date, only Sri Lanka has done so. These plans should focus on a range of priority areas, specify the actions necessary to achieve positive change in these priority areas, consider the range of collaborators required to implement these actions, and structure their efforts at national, regional, and local levels. The plans should also promote the collection of accurate data on completed and attempted suicide, and should foster evaluation efforts.

Media guidelines on the reporting of suicide

There is strong evidence for the existence of the Werther effect, or the phenomenon of an observer copying suicidal behavior he or she has seen modelled in the media. As a consequence, a number of countries have developed guidelines that promote responsible reporting of suicide. Using nine such guidelines as examples, this paper demonstrates that they tend to have similar content (emphasizing, for example, that suicide should not be,glamorized or sensationalized and that explicit descriptions should be avoided, and stressing the importance of providing information about help services), but differ in the way in which they have been developed (e.g., the extent to which media professionals have been involved) and implemented (e.g., whether their roll-out has involved a considered dissemination strategy). The paper also reviews the evidence from evaluations of media guidelines, and concludes that it is too limited to determine whether the guidelines have had an impact on the behavior of media professionals or on completed and attempted suicide rates. It makes recommendations for further evaluative work, and suggests that the lessons from well-designed evaluations should be shared.

The relationship between media reporting of suicide and actual suicide in Australia

This study aimed to determine whether media items about suicide were associated with differential increases in actual suicides. Data were available on 4635 suicide-related items appearing in Australian newspapers and on radio and television news and current affairs shows between March 2000 and February 2001. These data were combined with national data on completed suicides occurring during the same period, by a process that involved identifying the date and geographical reach of the media items and determining the number of suicides occurring in the same location in selected weeks pre- and post-item. Regression analyses were conducted to determine whether the likelihood of an increase in post-item suicides could be explained by particular item characteristics. We found that 39% of media items were followed by an increase in mate suicides, and 31% by an increase in female suicides. Media items were more likely to be associated with increases in both male and female suicides if they occurred in the context of multiple other reports on suicide (versus occurring in isolation), if they were broadcast on television (versus other media), and if they were about completed suicide (versus attempted suicide or suicidal ideation). Different item content appeared to be influential for males and females, with an increase in male suicides being associated with items about an individual's experience of suicide and opinion pieces, and an increase in female suicides being associated with items about mass- or murder-suicide. Item prominence and quality were not differentially associated with increases in male or female suicides. Further research on this topic is required, but in the meantime there is a need to remain vigilant about how suicide news is reported. Mental health professionals and suicide experts should collaborate with media professionals to try to balance 'public interest' against the risk of harm. (c) 2005 Published by Elsevier Ltd.

The role of suicide risk in the decision for psychiatric hospitalization after a suicide attempt

BACKGROUND: Suicide prevention can be improved by knowing which variables physicians take into account when considering hospitalization or discharge of patients who have attempted suicide. AIMS: To test whether suicide risk is an adequate explanatory variable for predicting admission to a psychiatric unit after a suicide attempt. METHODS: Analyses of 840 clinical records of patients who had attempted suicide (66.3% women) at four public general hospitals in Madrid (Spain). RESULTS: 180 (21.4%) patients were admitted to psychiatric units. Logistic regression analyses showed that explanatory variables predicting admission were: male gender; previous psychiatric hospitalization; psychiatric disorder; not having a substance-related disorder; use of a lethal method; delay until discovery of more than one hour; previous attempts; suicidal ideation; high suicidal planning; and lack of verbalization of adequate criticism of the attempt. CONCLUSIONS: Suicide risk appears to be an adequate explanatory variable for predicting the decision to admit a patient to a psychiatric ward after a suicide attempt, although the introduction of other variables improves the model. These results provide additional information regarding factors involved in everyday medical practice in emergency settings.

Quality of the written information about suicide attempters

INTRODUCTION: The aim of the study was to assess the quality of the clinical records of the patients who are seen in public hospitals in Madrid after a suicide attempt in a blind observation. METHODS: Observational, descriptive cross-sectional study conducted at four general public hospitals in Madrid (Spain). Analyses of the presence of seven indicators of information quality (previous psychiatric treatment, recent suicidal ideation, recent suicide planning behaviour, medical lethality of suicide attempt, previous suicide attempts, attitude towards the attempt, and social or family support) in 993 clinical records of 907 patients (64.5% women), ages ranging from 6 to 92 years (mean 37.1±15), admitted to hospital after a suicide attempt or who committed an attempt whilst in hospital. RESULTS: Of patients who attempted suicide, 94.9% received a psychosocial assessment. All seven indicators were documented in 22.5% of the records, whilst 23.6% recorded four or less than four indicators. Previous suicide attempts and medical lethality of current attempt were the indicators most often missed in the records. The study found no difference between the records of men and women (z=0.296; p=0.767, two tailed Mann-Whitney U test), although clinical records of patients discharged after an emergency unit intervention were more incomplete than the ones from hospitalised patients (z=2.731; p=0.006), and clinical records of repeaters were also more incomplete than the ones from non-repeaters (z=3.511; p<0.001). CONCLUSIONS: Clinical records of patients who have attempted suicide are not complete. The use of semi-structured screening instruments may improve the evaluation of patients who have self- harmed.

Can we predict agitation in patients with suicide attempts in the emergency department?

Background: The agitation in patients presenting to the emergency department (ED) after suicide attempts is common and an important problem. Objective: To establish whether we can predict agitated patients among suicide attempt patients in ED. Methods: This is a cross-sectional observational study of adult suicide attempt events in ED. Information was collected prospectively on a specially designed data-collection form. Patients aged 16 years old and above who presented to the ED for care due to suicide attempts were included in the study. Suicide attempts were grouped as aggressive and non-aggressive attempts. Results: A total of 533 patients were included. Forty-three of these patients had agitation in ED (8%). Non-aggressive suicide attempts were referred to psychiatry services more than aggressive ones (73.6%, n=345 vs 32.8%, n=21, P<0.0001). Agitation in ED and being male increased aggressive suicide attempt risk 3.5 (95% CI:1.6-7.6) and 3.2 times (95% CI:1.8-5.5), respectively. Agitation was statistically more frequent among these patients: those on antidepressant overdose, with previous suicide attempt; with aggressive suicide attempt; and those with confusion; and unconsciousness (P<0.05). Conclusion: Patients who attempted suicide and whose risk of harm to others included those with: antidepressant overdose, aggressive suicide attempt and the unconscious. Response teams should be prepared for these subgroups.

Ethical issues in research on adolescent depression and suicidal behaviour

Argues that the codes of ethical conduct of the Australian Psychological Society and the American Psychological Association imply that researchers of adolescent depression and suicidal behavior must plan to intervene to assess risk where a participant in a study indicates an intention to commit suicide. Participants in research of this kind need to be advised of this possibility in advance. The obligation to intervene, and to advise of the possibility of intervention, poses practical and methodological problems for research in this area but does not, it is argued, absolve the researcher of the primary responsibility to contribute to the welfare of the research participant. This obligation exists only when there is indication of harm but not, for instance, in the case of depression without suicidal intent.

An Assessment of Undergraduate Paramedic Students’ Empathy Levels

Abstract: Objectives Evidence suggests that improved empathy behaviours among healthcare professionals directly impacts on healthcare outcomes. However, the ‘nebulous’ properties of empathic behaviour often means that healthcare profession educators fail to incorporate the explicit teaching and assessment of empathy within the curriculum. The objective of this study was to assess the extent of empathy in paramedic students across seven Australian universities. Methods A cross-sectional study using a paper-based questionnaire employing a convenience sample of first, second, and third year undergraduate paramedic students. Student empathy levels were measured using the Medical Condition Regard Scale (MCRS). Results A total of 783 students participated in the study of which 57% were females. The medical conditions: intellectual disability, attempted suicide, and acute mental illness all produced mean scores above 50 suggesting good empathetic regard, while patients presenting with substance abuse produced the lowest mean score M= 41.57 (SD=12.29). There was a statistically significant difference between males (M= 49.79) and females (M=51.61) p=0.006, for patients with intellectual disability. Conclusions The findings from this study found that student reported poor empathetic regard for patients with substance abuse, while female students report higher levels of empathy than their male colleagues across each medical condition. The overall findings provide a framework for educators to begin constructing guidelines focusing on the need to incorporate, promote and instil empathy into paramedic students in order to better prepare them for future out-of-hospital healthcare practice.

Discrimination experienced by HIV/AIDS infected persons and its associations with mental health in an Indian sample

Purpose The purpose of this study was to investigate the nature and prevalence of discrimination against people living with HIV/AIDS in West Bengal, India, and how discrimination is associated with depression, suicidal ideation and suicidal attempts. Method Semi-structured interviews and the Beck Depression Inventory were administered to 105 HIV infected persons recruited by incidental sampling, at an Integrated Counseling and Testing Center (ICTC) and through Networks of People Living with HIV/AIDS, in the West Bengal area. Results Findings showed that 40.8% of the sample has experienced discrimination at least in one social setting – such as family (29.1%), health centers (18.4%), community (17.5%) and workplace (6.8%). About two-fifths (40.8%) reported experiencing discrimination in multiple social settings. Demographic factors associated with discrimination were gender, age, occupation, education, and current residence. More than half of the sample was suffering from severe depression while 8.7% had attempted suicide. Discrimination in most areas was significantly associated with suicidal ideation and suicidal attempts. Conclusions Prevalence of discrimination associated with HIV/AIDS is high in our sample from West Bengal. While discrimination was not associated with depressive symptomatology, discrimination was associated with suicidal ideation and attempts. These findings suggest that there is an urgent need for interventions to reduce discrimination of HIV/AIDS in the West Bengal region.

Discrimination and mental health

The purpose of this study was to investigate the nature and prevalence of discrimination against people living with HIV/AIDS in West Bengal, India, and how discrimination is associated with depression, suicidal ideation and suicidal attempts. Semi-structured interviews and the Beck Depression Inventory were administered to 105 HIV infected persons recruited by incidental sampling, at an Integrated Counseling and Testing Center (ICTC) and through Networks of People Living with HIV/AIDS, in the West Bengal area. Findings showed that 40.8% of the sample has experienced discrimination at least in one social setting – such as family (29.1%), health centers (18.4%), community (17.5%) and workplace (6.8%). About two-fifths (40.8%) reported experiencing discrimination in multiple social settings. Demographic factors associated with discrimination were gender, age, occupation, education, and current residence. More than half of the sample was suffering from severe depression while 8.7% had attempted suicide. Discrimination in most areas was significantly associated with suicidal ideation and suicidal attempts. Prevalence of discrimination associated with HIV/AIDS is high in our sample from West Bengal. While discrimination was not associated with depressive symptomatology, discrimination was associated with suicidal ideation and attempts. These findings suggest that there is an urgent need for interventions to reduce discrimination of HIV/AIDS in the West Bengal region.

Suicidal behaviour in bipolar disorder

The Jorvi Bipolar Study (JoBS) is a collaborative ongoing bipolar research project between the Department of Mental Health and Alcohol Research of the National Public Health Institute, Helsinki, and the Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital (HUCH), Espoo, Finland. The JoBS is a prospective, naturalistic cohort study of secondary level care psychiatric out-and inpatients with a new episode of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) bipolar disorder (BD). Altogether, 1630 patients (aged 18-59) years were screened using the Mood Disorder Questionnaire (MDQ) for a possible new episode of DSM-IV BD. 490 patients were interviewed with semi-structured interview [the Structured Clinical Interview for DSM-IV Disorders, research version with Psychotic Screen (SCID-I/P)]. 191 patients with new episode of DSM-IV BD were included in the bipolar cohort study. Psychiatric comorbidity was evaluated using semi-structured interviews. At 6- and 18-month follow-up, the interviews were repeated and life-chart methodology was used to integrate all available information about nature and duration of all different phases. Suicidal behaviour was examined both at intake and follow-up by psychometric scale [Scale for Suicidal Ideation (SSI)], interviewer s questions and medical and psychiatric records. The aim of this thesis was to evaluate prevalence of suicidal behaviour and incidence of suicide attempts, and examine the wide range of risk factors for attempted suicide both, at intake and follow-up, in representative secondary-level sample of psychiatric in- and outpatients with BD. In this study suicidal behaviour was common among psychiatric patients with BD. During the episode when patients were included into cohort study (index episode), 20% of the patients had attempted suicide and 61% had suicidal ideation. Severity of depressive episode and hopelessness were independent risk factors for suicidal ideation, whereas hopelessness, comorbid personality disorder and previous suicide attempt predicted suicide attempts during the index episode. There were no differences in prevalence of suicidal behaviour between bipolar I and II disorder; the risk factors were overlapping but not identical. During the index episode, suicide attempts took place during depressive, mixed and depressive mixed phases. Furthermore, there were marked differences regarding level of suicidal ideation during different phases, with the highest levels during the mixed phases of the illness. Hopelessness was independently associated with suicidal behaviour during the depressive phase. A subjective rating of severity of depression (Beck Depression Inventory) and younger age predicted suicide attempts during mixed phases. During the 18-month follow-up 20% of patients attempted suicide. Previous suicide attempts, hopelessness, depressive phase at index episode and younger age at intake were independent risk factors for suicide attempts during follow-up. Taken altogether, 55% patients attempted suicide before index episode, during index episode or during follow-up. The incidence of suicide attempts was 37-fold during combined mixed and depressive mixed states and 18-fold during major depressive phase as compared with other phases. Prior suicide attempt and time spent in combined mixed phases - mixed and depressive mixed - and depressive phases independently predicted the suicide attempt during follow-up. More than half of the patients have attempted suicide during their lifetime, a finding which highlights the public health importance of suicidal behaviour in bipolar disorder. Clinically, it is crucial to recognize BD and manage the mixed and depressive phases of bipolar patients fast and effectively, as time spent in depressive and mixed phases involves a remarkably high risk of suicide attempts.

Suicidal ideation and attempts among psychiatric patients with major depressive disorder

This study is part of an ongoing collaborative research and development project, the Vantaa Depression Study (VDS), between the National Public Health Institute, Helsinki and the Department of Psychiatry of Helsinki University Hospital (HUCH), Peijas hospital, Vantaa. The VDS is a prospective, naturalistic cohort study of 269 secondary-level care psychiatric out- and inpatients with a new episode of DSM-IV major depressive disorder (MDD). 269 patients (Nmales=72, Nfemales=197) with a current DSM-IV MDD were interviewed with semistructured interviews to assess all other psychiatric diagnoses. At 6- and 18-month follow-up the interviews were repeated. Suicidal behaviour was investigated both at intake and follow-up by using a psychometric scale (Scale for Suicidal Ideation) and interviewer's questions as well as the patient's psychiatric records. Patients, who reported suicidal ideation while entering the study were followed up weekly, and their level of suicidal ideation, hopelessness, anxiety and depression was measured. In this study suicidal ideation was common among psychiatric patients with MDD. Almost 60% of the depressed patients reported suicidal ideation and 15% of patients attempted suicide at the baseline. Patients with suicidal ideation or attempts had a clearly higher level of overall psychopathology than non-suicidal patients. During the 18-month follow-up period 8% of patients attempted suicide. The risk of an attempt was markedly higher (RR=7.54) during an episode of major depression compared with a period of remission. Suicide attempt during the follow-up period was predicted by lack of partner, a history of previous suicide attempts and time spent in depression. Suicidal ideation resolved for most of the suicidal patients during the first 2 to 3 months. The duration of suicidal ideation was longer for patients with an initially higher level of psychopathology. Declines both in depression and hopelessness independently predicted the subsequent decline in suicidal ideation. They both could have a causal role in reversing the suicidal process. Thus effective treatment of depression is a credible measure in suicide prevention. Patients with suicidal behaviour often received more antidepressants and had more frequent appointments with mental health professionals than non-suicidal patients. Suicidal patients had also more favourable attitudes towards antidepressant treatment and comparable adherence to treatment than those not suicidal. This study does not support the conception that patient attitudes or adherence to treatments would be a factor differentiating suicidal patients from non-suicidal. Instead, problems with adherence or attitudes seem to be generic to all psychiatric care.

Mental Disorders among Burn Patients

ABSTRACT Mental disorders and suicide attempts among acute burn patients were investigated in a collaborative research project between National Institute for Health and Welfare and Departments of Psychiatry and Plastic surgery in University of Helsinki in Finland. This project was realized in two parts. The first cohort of burn patients consisted of all burn patients admitted to the Helsinki Burn Centre during 1989 97. In this retrospective cohort, 5.7% (N=46) of the total of 811 burn patients had attempted suicide. The burn severity of suicide attempters was markedly higher than in the other burn patients. Suicide attempters were more often unemployed or on disability pension and had psychiatric history before the injury. The second sample was a prospective cohort of all acute consecutive burn patients admitted to the Helsinki Burn Centre during 18 months in 2006- 2007. All subjects (N=107) of the cohort were interviewed with the Structured Clinical Interview for DSM-IV for Axis I and II mental disorders (SCID-I and SCID-II) at baseline and then 86 % of all (N=92) with SCID-I at the end of six-month follow-up. Most (61%) patients had at least one lifetime mental disorder before burn; 47 % substance-related, 10% psychotic and 23% personality disorders. The overall prevalence of Axis I mental disorders increased significantly from the month prior to burn to acute care but decreased significantly from acute care to six months. However, more than one half (55%) of the cohort suffered from some mental disorder during follow-up. Less than one half of the burn patients with estimated need for psychiatric care received psychiatric care. Burn severity independently and strongly predicted risk for mental disorders during follow-up and pre-burn psychiatric history, severe burns and estimated need for psychiatric care significantly predicted psychiatric care received. The proportion of patients with self-inflicted burns is not high but mental disorders are common among burn patients. Mental disorders may predispose to burns. After burn injury, more than half of the patients suffer from mental disorders and a strong relationship exists between burn severity and some post-burn mental disorders. A minority of the patients with unequivocal need for psychiatric care actually receive it. Psychiatric consultations and care follow mainly the course of acute burn treatment.

中老年危机热线来电者的应激源与自杀危险性

Objective: Psychosocial crisis and psychiatric disorders are two stressors for suicide action. This study will explore the differences on demographic characteristics, severity of depression, and suicidality of middle-aged and elder crisis line callers under the influences of psychosocial crisis or psychiatric disorders or two simultaneously-mixed stressors, in order to develop effective intervention strategies for crisis line. Methods: Analysis data of 1,092 cases selected from national crisis line callers aged 45 and over who were assessed with “Suicide risk assessment” during the period from December, 2002 to December, 2008. The sample were divided into three groups of psychosocial crisis, mental health problems, and mixed-stressors of three types of general callers (48.2%, 32.3%, 19.5%), callers with current suicide ideation (43.7%, 33.0%, 23.3%) and callers attempted suicide 2 weeks prior to the call (33.6%, 42.3%, 24.1%) respectively according to the operators’ judgments of the callers’ claimed difficult situations and classification system of crisis line database. X2 test and Tukey-type and Multinomial Logistic Regression multiple comparison methods are applied to analysis the differences of the three groups. Results: In agreement with previous studies, more females (71.3%, X2=13.45, P<0.001), especially females influenced by relationship stressors (76.8%, X2=25.12, P<0.001) made the call for crisis. Among general callers, the check-out rates of Major Depression Episode of mixed-stressor callers (78.5%, P<0.001) and problem callers (68.7%, P<0.05) were significantly higher than that of crisis callers (57.1%). The check-out rates of suicide ideation of mixed-stressor callers (71.4%) were significantly higher than that in crisis callers (53.8%, P<0.001) and problem callers (60.9%, P<0.05). The check-out rates of prior suicide attempts of mixed-stressor (16.6%, P<0.05) and problem callers (18.5%, P<0.01) were significantly higher than that of crisis callers (9.8%). More than half of the mixed-stressor callers (51.8%) reported over 50% degree of hopelessness, which was significantly higher than that of crisis callers (35.6%, P<0.01) and problem callers (38.2%, P<0.05). Fewer crisis callers sought medical help than problem and mixed-stressor callers among three types of callers (X2=241.35, 146.56, 50.87; P<0.001). Compare to non-compound crisis callers, the proportion of minor, severe depression and prior depression diagnosis (14.0% vs. 17.4%; 54.9% vs. 65.2%; 0 vs. 2.2%; X2=14.35，P<0.01), suicide ideation (51.1% vs. 64.0%, P<0.05) and prior suicide attempts (8.4% vs. 15.0%, P<0.05) in compound crisis callers were significantly higher. There were more compound crisis callers with over 50% hopelessness (51.9% vs. 31.0%，X2=11.96，P<0.01). Conclusion: As predicted, among middle-aged and elderly participants, mixed-stressor and compound crisis callers were higher in degree of severity of depression and suicidality. Intervention strategies should be developed addressing to specific stressor or stressors. The promotions of crisis callers’ medical help seeking behavior need to be emphasized.