Factors associated with suicide after parasuicide in young people.

OBJECTIVE--To determine factors associated with completed suicide in young parasuicide patients. DESIGN--Case-control study. SETTING--Regional poisoning treatment centre in a teaching general hospital. SUBJECTS--Patients who, between 1968 and 1985 when aged 15-24 years, were admitted to the regional poisoning treatment centre because of deliberate self poisoning or self injury. Cases (n = 62) consisted of those who by the end of 1985 had died locally from either suicide (n = 41) or possible suicide (n = 21). Controls (n = 124) were patients who were known not to have died locally during the study period. Two controls were selected for each case, matched by sex, age (within two years), and length of follow up. MAIN OUTCOME MEASURES--Possible predictors of completed suicide. RESULTS--Univariate analysis (conditional logistic regression) showed that risk of death due to suicide and possible suicide was associated with six factors: social class V (odds ratio 2.7, 95% confidence interval 1.1 to 6.7), unemployment (2.8, 1.4 to 5.8), previous inpatient psychiatric treatment (4.9, 2.2 to 10.9), substance misuse (3.3, 1.6 to 6.8), personality disorder (2.1, 1.03 to 4.4), and previous attempted suicide (2.3, 1.2 to 4.4). Multivariate analysis identified two factors as significantly contributing to the model that best discriminated between the cases and controls: substance misuse (alcohol or drugs, or both) (adjusted odds ratio 3.9) and previous inpatient psychiatric treatment (3.7). These factors seemed to be associated with suicide after attempted suicide in both the short term (less than 12 months) and the long term (one year or more) and were also identified when the analysis was restricted to subjects who definitely died by suicide and their controls. CONCLUSIONS--Suicide after parasuicide in young people is associated with substance misuse. This suggests that prevention of suicide in young people who attempt suicide might be improved by close liaison between general hospital services for patients who have attempted suicide and services for young substance misusers and by measures aimed at preventing substance misuse in young people.     

Individual psychological traits of pilots of civil aviation with cerebral atherosclerosis

The study of individual typological traits of pilots of civil aviation was performed. Fifty-eight healthy pilots (the control group) and 67 pilots with cerebral atherosclerosis, including 23 subjects with atherosclerotic plaques, were examined. The individual typological questionnaire developed by L.N. Sobchik was used in the study. Accentuated personality traits were found in pilots with cerebral atherosclerosis, which appeared mainly as alterations in personality traits. These alterations could be used by experts during aeromedical examination for estimation of health and professional prospects of pilots.     

“We Went Out to Explore,But Gained Nothing But Illness”: Immigration Expectations,Reality, Risk and Resilience in Chinese-Canadian Women with a History of Suicide-Related Behaviour

Suicide is a complex and tragic outcome driven by biological, psychological, social and cultural factors. Women of Chinese descent and women who have immigrated to other countries have higher rates of suicidal ideation and behaviour, and immigration-related stress may contribute. To understand the experiences of immigration and their relationship with distress and suicide-related behaviour in Chinese women who have immigrated to Canada. 10 semi-structured qualitative interviews with Chinese women who have immigrated to Toronto, Canada and have a history of suicide-related behaviour were completed and analyzed using a constructivist grounded theory methodology. Immigration-related and acculturation stress stemmed from unmet expectations and harsh realities. These repeated experiences resulted in hopelessness, helplessness, and alienation, which are risk factors for suicide and suicide-related behaviour. However, immigration-related support can also increase hope, self-efficacy and connectedness to foster recovery and resilience. This is the first qualitative study focusing on immigration experiences and its relationship to suicide-related behaviour in Chinese immigrant women. Knowledge of immigration and acculturation stressors can a) help identify and support women at risk for suicide and b) form a target for social intervention for all immigrant women, regardless of suicide risk.     

Chronotype differences in suicidal behavior and impulsivity among suicide attempters

Morning- and evening-type individuals differ on a number of psychological and biological variables. There has been increasing interest in the relationship between chronotype and personality traits. The aim of this study was to investigate the relationship between impulsivity and chronotype in suicide attempters. Eighty-nine suicide attempters were included in the study, and systematic information on suicide attempts was recorded. The Morningness-Eveningness Questionnaire was applied to determine chronotype, and attempter impulsivity was measured by the total score of the Barratt Impulsiveness Scale. Significant differences between chronotype and impulsivity scores were found. Evening-type subjects reported significantly higher impulsivity scores than both neither- and morning-types. A significant association between chronotype and type of suicide attempt was detected. The largest proportion of violent suicide attempters were evening-type subjects. Violent suicide attempters also reported significantly higher impulsivity scores than nonviolent attempters. Previous studies have pointed out possible relations between eveningness and impulsivity. Current findings suggest that eveningness may be a risk factor for violent suicide attempts by increasing impulsivity.     

Prevention of suicide.

We reviewed the epidemiologic features of suicide in Canada and evaluated suicide prevention programs. Three groups were found to be at increased risk for suicide: men aged 70 years or more, women aged 65 to 69 and men aged 20 to 24. The other groups, in decreasing order of risk, were the mentally ill, people who have attempted suicide, those with a life-threatening illness, native people, people with a family history of suicide and prisoners. Studies that evaluated suicide prevention programs showed that none significantly reduced the incidence of suicide; however, the studies were found to be methodologically inadequate or used noncomparable systems of data collection. On the basis of our findings we recommend that primary care physicians routinely evaluate suicide risk among patients in high-risk groups and that intervention include counselling, follow-up and, if necessary, referral to a psychiatrist. Close follow-up is recommended for newly discharged psychiatric patients and those who recently attempted suicide.     

Gene insertion and deletion polymorphism in the serotonin transporter gene and personality traits measured by MMPI

Polymorphisms of the serotonin transporter gene are known to be associated with some personality traits measured by means of various psychological inventories. In the present work we attempted to find an association between genetic variants of serotonin transporter (loci VNTR-17 and 5-HTTLPR) and psychological traits scored by the MMPI inventory in 125 mentally healthy donors. No statistically significant differences in personality traits were found between carriers of different VNTR-17 genotypes. At locus 5-HTTLPR, significant between-genotype differences were revealed on the Schizophrenia scale (F = 3.49; P = 0.034) and on the validity scale F (F = 3.24; P = 0.042). The ss genotype carriers had the lowest scores on these scales. The score on the Psychopathic Deviate scale was significantly lower in the carriers of the ss genotype than in the combined group of the carriers of genotypes ll and ls (t = 2.07; P = 0.041). The differences on the validity scale K between the carriers of the ll and ss genotypes were also statistically significant (t = 2.49; P = 0.015). These results suggest that polymorphism of the serotonin transporter gene may be associated with the expression of schizoid traits (namely, social introversion, internal tension, weird thoughts and actions) in mentally healthy individuals. In the context of social adaptation, the personality profile configuration and data of statistical analysis indicate that the carriers of the ss genotype are more inclined to observe social norms than the carriers of the ll and ls genotypes.     

Suicide and attempted suicide among South Asians in England: who is at risk?

Evidence from both large-scale and small-scale studies suggests differences and similarities in patterns of suicide and attempted suicide between South Asians and the total population in England. Among South Asians, the excess of females among both suicides and attempted suicides is even more marked; the traditional view of a strong family structure among Asians is confirmed, although cultural conflict between generations is apparent. The technique of suicide by burning among Asians appears to be waning. Asians who attempt or complete suicide are more likely to be suffering from stress, but less likely to have been diagnosed as mentally ill. Their psychological problems appear to have been frequently overlooked by general practitioners, or not presented to them. Differences in religion, with Hindus producing higher rates than Muslims, and demographic, geographical, financial and cultural differences, contribute to the need for disaggregation and up-to-date research.     

Attempted Suicide in Bipolar Disorder: Risk Factors in a Cohort of 6086 Patients

Objective

Bipolar disorder is associated with high risk of self-harm and suicide. We wanted to investigate risk factors for attempted suicide in bipolar patients.

Method

This was a cohort study of 6086 bipolar patients (60% women) registered in the Swedish National Quality Register for Bipolar Disorder 2004–2011 and followed-up annually 2005–2012. Logistic regression was used to calculate adjusted odds ratios for fatal or non-fatal attempted suicide during follow-up.

Results

Recent affective episodes predicted attempted suicide during follow-up (men: odds ratio = 3.63, 95% CI = 1.76–7.51; women: odds ratio = 2.81, 95% CI = 1.78–4.44), as did previous suicide attempts (men: odds ratio = 3.93, 95% CI = 2.48–6.24; women: odds ratio = 4.24, 95% CI = 3.06–5.88) and recent psychiatric inpatient care (men: odds ratio = 3.57, 95% CI = 1.59–8,01; women: odds ratio = 2.68, 95% CI = 1.60–4.50). Further, those with many lifetime depressive episodes were more likely to attempt suicide. Comorbid substance use disorder was a predictor in men; many lifetime mixed episodes, early onset of mental disorder, personality disorder, and social problems related to the primary group were predictors in women.

Conclusion

The principal clinical implication of the present study is to pay attention to the risk of suicidal behaviour in bipolar patients with depressive features and more severe or unstable forms of the disorder.     

Chronotype Differences in Suicidal Behavior and Impulsivity Among Suicide Attempters

Morning- and evening-type individuals differ on a number of psychological and biological variables. There has been increasing interest in the relationship between chronotype and personality traits. The aim of this study was to investigate the relationship between impulsivity and chronotype in suicide attempters. Eighty-nine suicide attempters were included in the study, and systematic information on suicide attempts was recorded. The Morningness-Eveningness Questionnaire was applied to determine chronotype, and attempter impulsivity was measured by the total score of the Barratt Impulsiveness Scale. Significant differences between chronotype and impulsivity scores were found. Evening-type subjects reported significantly higher impulsivity scores than both neither- and morning-types. A significant association between chronotype and type of suicide attempt was detected. The largest proportion of violent suicide attempters were evening-type subjects. Violent suicide attempters also reported significantly higher impulsivity scores than nonviolent attempters. Previous studies have pointed out possible relations between eveningness and impulsivity. Current findings suggest that eveningness may be a risk factor for violent suicide attempts by increasing impulsivity. (Author correspondence: dryavuzselvi@yahoo.com)     

Correlates of Adult Binge Drinking: Evidence from a British Cohort

Objective

To investigate whether parental social class and cognitive ability in childhood, as well as social and psychological factors, particularly personality traits, are independently associated with binge drinking in 50 year old adults assessed in a longitudinal birth cohort study.

Method

17,415 babies born in Great Britain in 1958 and followed up at 11, 33, and 50 years of age. Their binge drinking alcohol abuse at aged 50 was the outcome measure.

Results

6,478 participants with data on parental social class, childhood cognitive ability, educational qualifications at age 33, personality traits, psychological distress, occupational levels, and alcohol consumption (all measured at age 50) were included in the study. Using logistic regression analyses, results showed that parental social class, childhood intelligence, educational qualifications, occupational levels, personality traits (Extraversion and Disagreeableness), as well as psychological distress, were all significantly and independently associated with adult excessive alcohol use. Men tended to binge drink more than women (22% in men and 9.8% in women).

Conclusion

Both social and psychological factors influence adult excessive alcohol consumption. Personality traits play a more important role than previously understood. There appears to be a distinction between the frequency and dose level of alcohol consumption.     

Suicide attempts in the Epidemiologic Catchment Area Study

This study examines risk factors for attempted suicide in the general community. Data from the five-site NIMH Epidemiologic Catchment Area (ECA) Study were used to estimate lifetime prevalence and identify risk factors for suicide attempts. Occurrence of suicide attempts and lifetime diagnosis of psychiatric disorder were ascertained, using the NIMH Diagnostic Interview Schedule (DIS). Of 18,571 adult respondents aged 18 and over, 2.9 percent reported that they had attempted suicide at some time in their lives. A weighted logistic regression model was constructed to ascertain significant (p less than .0028 with Bonferroni correction) risk factors for attempted suicide. Persons who had a lifetime diagnosis of a psychiatric disorder had the highest risk of attempted suicide (odds ratio [OR] = 8.4). Females (OR = 3.3), separated or divorced persons (OR = 2.5), Whites (OR = 1.7), persons in the two lowest socioeconomic quartiles (ORs = 2.2, 2.3), and respondents from the Los Angeles ECA (OR = 1.8) were also more likely to have attempted suicide. These findings contribute to an understanding of suicide and suicidal behavior in general populations, outside the clinical setting.     

Situating Suicide as an Anthropological Problem: Ethnographic Approaches to Understanding Self-Harm and Self-Inflicted Death

More than a century after Durkheim's sociological classic placed the subject of suicide as a concern at the heart of social science, ethnographic, cross-cultural analyses of what lie behind people's attempts to take their own lives remain few in number. But by highlighting how the ethnographic method privileges a certain view of suicidal behaviour, we can go beyond the limited sociological and psychological approaches that define the field of 'suicidology' in terms of social and psychological 'pathology' to engage with suicide from our informants' own points of view-and in so doing cast the problem in a new light and new terms. In particular, suicide can be understood as a kind of sociality, as a special kind of social relationship, through which people create meaning in their own lives. In this introductory essay we offer an overview of the papers that make up this special issue and map out the theoretical opportunities and challenges they present.     

血清血管内皮细胞生长因子和碱性成纤维细胞生长因子水平变化对服药自杀青少年心理状况的影响

摘要 目的：研究服药自杀青少年血清血管内皮细胞生长因子（VEGF）和碱性成纤维细胞生长因子（bFGF）变化,及其与患者心理状况的相关性。方法：纳入2018年1月到2020年12月四川大学华西医院收治的服药自杀青少年81例（研究组）,同时纳入81例健康志愿者作为对照（对照组）。检测两组研究对象血清VEGF和bFGF水平,并使用汉密顿抑郁量表（HAMD）、抑郁自评量表（SDS）和自杀意念自评量表（SlOSS）评估两组患者心理状态。结果：两组研究对象性别、年龄、身高以及体质指数（BMI）具有可比性（P>0.05）;研究组吸烟者比例（16/81）和有家族精神病史比例（13/81）均显著高于对照组（6/81和3/81）（P<0.05）。研究组服药自杀青少年血清VEGF（699.72±103.42）ng/mL和bFGF（348.31±65.13）ng/mL水平均高于与对照组健康志愿者[（620.31±85.32）ng/mL和（265.37±35.23）ng/mL]（P<0.05）,并且与是否吸烟或有无家族精神疾病史无关（P<0.05）。Pearson相关性分析结果显示：服药自杀青少年血清VEGF和BFGF均与HAMD和SDS评分无相关,与SIOSS评分均呈正相关（r=0.278和r=0.302,均P<0.05）。结论：服药自杀青少年血清VEGF和bFGF水平升高,与自杀意念自评量表得分有正相关。     

Suicidal process,suicidal communication and psychosocial situation of young suicide attempters in a rural Vietnamese community

The study aimed to explore the suicidal process, suicidal communication and psychosocial situation of young suicide attempters in a rural community in Hanoi, Vietnam. Semi-structured interviews were conducted, in a community setting, with 19 suicide attempters aged 15-24 who had been consecutively hospitalized in an intensive care unit. In 12 of 19 cases, the first pressing, distinct and constant suicidal thoughts appeared less than one day before the suicide attempt in question. However, distress and mild, fleeting suicidal thoughts had been present up to six months before the suicide attempt in 16 cases. Five respondents had a suicide plan one to three days before attempting suicide. Altogether, 13 engaged in some form of suicidal communication before their attempt. This communication was, however, difficult for outsiders to interpret. Twelve of the respondents were victims of regular physical abuse and 16 had suffered psychological violence for at least one year before attempting suicide. Eighteen of the respondents used pesticides or raticides in their suicide attempts. None sought advice or consultation in the community despite long-standing psychosocial problems. The strategy of reducing the availability of suicide means (e.g., pesticides or raticides) in Asian countries should be complemented with a long-term suicide-preventive strategy that targets school dropouts and domestic violence, and promotes coping abilities and communication about psychological and social problems as well as recognition of signs of distress and suicidal communication.     

A Novel Brief Therapy for Patients Who Attempt Suicide: A 24-months Follow-Up Randomized Controlled Study of the Attempted Suicide Short Intervention Program (ASSIP)

Background

Attempted suicide is the main risk factor for suicide and repeated suicide attempts. However, the evidence for follow-up treatments reducing suicidal behavior in these patients is limited. The objective of the present study was to evaluate the efficacy of the Attempted Suicide Short Intervention Program (ASSIP) in reducing suicidal behavior. ASSIP is a novel brief therapy based on a patient-centered model of suicidal behavior, with an emphasis on early therapeutic alliance.

Methods and Findings

Patients who had recently attempted suicide were randomly allocated to treatment as usual (n = 60) or treatment as usual plus ASSIP (n = 60). ASSIP participants received three therapy sessions followed by regular contact through personalized letters over 24 months. Participants considered to be at high risk of suicide were included, 63% were diagnosed with an affective disorder, and 50% had a history of prior suicide attempts. Clinical exclusion criteria were habitual self-harm, serious cognitive impairment, and psychotic disorder. Study participants completed a set of psychosocial and clinical questionnaires every 6 months over a 24-month follow-up period.The study represents a real-world clinical setting at an outpatient clinic of a university hospital of psychiatry. The primary outcome measure was repeat suicide attempts during the 24-month follow-up period. Secondary outcome measures were suicidal ideation, depression, and health-care utilization. Furthermore, effects of prior suicide attempts, depression at baseline, diagnosis, and therapeutic alliance on outcome were investigated.During the 24-month follow-up period, five repeat suicide attempts were recorded in the ASSIP group and 41 attempts in the control group. The rates of participants reattempting suicide at least once were 8.3% (n = 5) and 26.7% (n = 16). ASSIP was associated with an approximately 80% reduced risk of participants making at least one repeat suicide attempt (Wald χ² ₁ = 13.1, 95% CI 12.4–13.7, p < 0.001). ASSIP participants spent 72% fewer days in the hospital during follow-up (ASSIP: 29 d; control group: 105 d; W = 94.5, p = 0.038). Higher scores of patient-rated therapeutic alliance in the ASSIP group were associated with a lower rate of repeat suicide attempts. Prior suicide attempts, depression, and a diagnosis of personality disorder at baseline did not significantly affect outcome. Participants with a diagnosis of borderline personality disorder (n = 20) had more previous suicide attempts and a higher number of reattempts.Key study limitations were missing data and dropout rates. Although both were generally low, they increased during follow-up. At 24 months, the group difference in dropout rate was significant: ASSIP, 7% (n = 4); control, 22% (n = 13). A further limitation is that we do not have detailed information of the co-active follow-up treatment apart from participant self-reports every 6 months on the setting and the duration of the co-active treatment.

Conclusions

ASSIP, a manual-based brief therapy for patients who have recently attempted suicide, administered in addition to the usual clinical treatment, was efficacious in reducing suicidal behavior in a real-world clinical setting. ASSIP fulfills the need for an easy-to-administer low-cost intervention. Large pragmatic trials will be needed to conclusively establish the efficacy of ASSIP and replicate our findings in other clinical settings.

Trial registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT02505373","term_id":"NCT02505373"}}NCT02505373     

Negative Life Events and Attempted Suicide in Rural China

Objective

This study aimed to examine the association between negative life events (NLEs) and attempted suicide in rural China.

Methods

Six rural counties were selected from disease surveillance points in Shandong province, China. A total of 409 suicide attempters in rural areas between October 1, 2009, and March 31, 2011, and an equal number of matched controls were interviewed. We compared negative life events experienced within 1 month, 1–3 months, 3–6months, and 6–2 months prior to attempted suicide for cases and prior to interview for controls. We used multivariate logistic regression to examine the association between NLEs and attempted suicide.

Results

Suicide attempters experienced more NLEs within the last year prior to suicide attempt than controls prior to interview (83.1% vs. 33.5%). There was a significant dose-response relationship between NLEs experienced within the last year and increased risk of attempted suicide. Timing of NLEs analysis showed that NLEs experienced in the last month and 6–12 months prior to suicide attempt were significantly associated with elevated risk of attempted suicide, even after adjusting for mental disorders and demographic factors. Of NLEs, quarrelling with spouse, quarrelling with other family members, conflicting with friends or neighbors, family financial difficulty, and serious illness were independently related to attempted suicide.

Conclusion

NLEs are significantly associated with increased risk for attempted suicide in rural China. Stress management and intervention may be important to prevent suicidal behavior in rural China.     

The persistence of gender stereotypes in the face of changing sex roles: Evidence contrary to the sociocultural model

Prevailing explanations for gender differences rest upon the sociocultural model, which treats personality as a consequence of socialization for social roles. Though sex roles and attitudes toward them have changed dramatically in the United States over the past three decades, a review of 18 longitudinal studies of gender stereotypes and self-ratings shows stability in perceptions of sex-typed personality traits. Our study of 3600 students surveyed in six waves from 1974 to 1991 also shows stability and even a slight increase in sex typing. This accumulating evidence is inconsistent with the sociocultural explanation. It is more consistent with the currently emerging sociobiological research that holds gender differences reflect innate differences between the sexes resulting from their different reproductive strategies. We conclude that valid social psychological explanations for gendered personality traits cannot rest upon sociocultural models alone but must include interaction of this unchanging genetic underlay with changeable social structures and processes.     

Social class in childhood and general health in adulthood: questionnaire study of contribution of psychological attributes

ObjectiveTo determine the contribution of psychological attributes (personality characteristics and coping styles) to the association between social class in childhood and adult health among men and women.DesignPartly retrospective, partly cross sectional study conducted in the framework of the Dutch GLOBE study.SubjectsSample of general population from south east Netherlands consisting of 2174 men and women aged 25-74 years. Baseline self reported data from 1991 provided information on childhood and adult social class, psychological attributes, and general health.ResultsIndependent of adult social class, low childhood social class was related to self rated poor health (odds ratio 1.67 (95% confidence interval 1.02 to 2.75) for subjects whose fathers were unskilled manual workers versus subjects whose fathers were higher grade professionals). Subjects whose fathers were manual workers generally had more unfavourable personality profiles and more negative coping styles. External locus of control, neuroticism, and the absence of active problem focused coping explained about half of the association between childhood social class and self rated poor health. The findings were independent of adult social class and height.ConclusionsA higher prevalence of negative personality profiles and adverse coping styles in subjects who grew up in lower social classes explains part of the association between social class in childhood and adult health. This finding underlines the importance of psychological mechanisms in the examination of the negative effects of adverse socioeconomic conditions in childhood.

Key messages

• Regardless of adult social class, low social class in childhood is related to poor general health in adulthood
• Adverse personality profiles and negative coping styles are more common in people who grew up in lower social classes
• Psychological attributes, such as low perceived control, explain a substantial part of the direct association between childhood social class and adult health
• Psychological mechanisms may explain adverse health outcomes in adults who have a low socioeconomic background