Comparative analysis of suicidality in two Bulgarian regions

IntroductionSuicidality is still an understudied problem in Bulgaria especially on a subnational (regional) level.ObjectivesTo collect data on suicidality in two major regions of Bulgaria with a population over 250,000 each (Plovdiv and Pleven) for a six years period (2009–2015).AimsTo analyze demographic, health-related and other characteristics associated with suicidal behavior as well as motives and methods of suicide.MethodsData were extracted from relevant documentation (medical records, public health reports, etc.) and statistically processed upon collection.ResultsMajority of suicide victims were males between 45 and 64 years while most suicide attempts occurred among 18–29 years old females.Leading method of suicide was hanging, followed by jumping from high places and use of firearm.Prevailing suicidal motives were psychotic symptoms, serious somatic illnesses and family problems. Depression accounted for 25% of all suicide cases and in another 25% motivation could not be identified because of insufficient data.The proportion of unemployed among suicide committers was not significantly higher than that of employed and retired.ConclusionsSevere mental disorders are a major trigger of suicidal behavior.Personal relationships should be targeted by suicide prevention interventions.Somatic illnesses are increasingly important suicide risk factor driven by the ongoing process of population aging.Frontline healthcare professionals should be trained to explore underlying suicidal motives and actively probe for depression in each case of suicidal behavior.Unemployment related suicide risk is most likely mediated through an adaptation crisis mechanism induced by the abrupt change of social status.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Perceptions of Adjunctive Mindfulness-Based Cognitive Therapy to Prevent Suicidal Behavior Among High Suicide-Risk Outpatient Participants

Crisis ◽

10.1027/0227-5910/a000519 ◽

2018 ◽

Vol 39 (6) ◽

pp. 451-460 ◽

Cited By ~ 2

Author(s):

Megan S. Chesin ◽

Beth S. Brodsky ◽

Brandon Beeler ◽

Christopher A. Benjamin-Phillips ◽

Ida Taghavi ◽

...

Keyword(s):

Cognitive Therapy ◽

Suicidal Behavior ◽

Group Treatment ◽

Suicide Risk ◽

Qualitative Data ◽

Descriptive Analysis ◽

Treatment Engagement ◽

Suicidal Thinking ◽

Prevention Interventions ◽

Risk Patients

Abstract. Background: Few investigations of patient perceptions of suicide prevention interventions exist, limiting our understanding of the processes and components of treatment that may be engaging and effective for high suicide-risk patients. Aims: Building on promising quantitative data that showed that adjunct mindfulness-based cognitive therapy to prevent suicidal behavior (MBCT-S) reduced suicidal thinking and depression among high suicide-risk patients, we subjected MBCT-S to qualitative inspection by patient participants. Method: Data were provided by 15 patients who completed MBCT-S during a focus group and/or via a survey. Qualitative data were coded using thematic analysis. Themes were summarized using descriptive analysis. Results: Most patients viewed the intervention as acceptable and feasible. Patients attributed MBCT-S treatment engagement and clinical improvement to improved emotion regulation. A minority of patients indicated that factors related to the group treatment modality were helpful. A small percentage of patients found that aspects of the treatment increased emotional distress and triggered suicidal thinking. These experiences, however, were described as fleeting and were not linked to suicidal behavior. Limitations: The sample size was small. Conclusion: Information gathered from this study may assist in refining MBCT-S and treatments to prevent suicidal behavior among high suicide-risk patients generally.

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Restricting Access to Methods of Suicide

Crisis ◽

10.1027/0227-5910.28.s1.4 ◽

2007 ◽

Vol 28 (S1) ◽

pp. 4-9 ◽

Cited By ~ 81

Author(s):

Keith Hawton

Keyword(s):

Suicide Prevention ◽

Suicidal Behavior ◽

Suicide Attempts ◽

Prevention Strategies ◽

Long Term Survivors ◽

Methods Of Suicide

Abstract. Restriction of access to means for suicidal behavior, especially dangerous methods, is a key element in most national suicide prevention strategies. In this paper the rationale for this is discussed, including the fact that suicidal impulses are often brief, that availability of a method may influence both the occurrence and outcome of a suicidal act, and that if a favored means becomes less available it does not always result in substitution by another method. Examples of evidence for the effectiveness of restricting availability of suicidal methods on subsequent suicidal behavior are presented, plus the supporting findings from studies of long-term survivors of serious suicide attempts in which only a minority have gone on to die in subsequent suicide attempts. Finally, factors likely to determine the effectiveness of modifying access to means for suicide are considered, together with the main elements that need to be addressed in evaluation.

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Characteristics of suicide attempters with a high lethality means

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1804 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s889-s889

Author(s):

C.T. Lee ◽

S.Y. Lee ◽

K.U. Lee ◽

H.K. Lee ◽

Y.S. Kweon

Keyword(s):

Clinical Judgment ◽

Suicide Risk ◽

Suicide Attempts ◽

Demographic Variables ◽

Suicide Attempters ◽

Exact Test ◽

Factors Associated ◽

History Of ◽

Competing Interest ◽

Lethal Means

IntroductionSuicide attempts with higher lethality increase the likelihood of suicide completion. Accumulating knowledge on risk factors contributing to higher suicide lethality may help clinicians to allocate their limited resources to more endangered people.ObjectivesTo explore the factors associated with higher lethality in suicide attempts.MethodsAll suicide attempters, who visited the emergency department of Uijeongbu St. Mary's hospital from January 2014 to December 2015, were reviewed retrospectively. We compared between the high vs. the low lethality group, of which had been recorded based on clinical judgment using t-test or Chi2/Fisher's exact test with two-sided P-value of 0.05.ResultsAmong the 753 suicide attempters, the assessed lethality was recorded in 736 cases. Low and highly lethal attempters were 426 (57.9%) and 310 (42.1%), respectively. For demographic variables, the high lethality attempters were significantly more likely to be older (48.3 vs. 44.78; P = 0.009), unemployed (61.0% vs. 56.5%; P = 0.042, without religion (90.9% vs. 84.9%; P = 0.017). For clinical variables, the high lethality attempters were significantly more likely have hopelessness (67.7% vs. 58.2%; P = 0.013) and a history of schizophrenia (4.5% vs. 1.4%; P = 0.023, while they did display any difference for mood disorders. The low lethality suicide attempts were more frequent in patients with comorbid personality disorders (9.2% vs. 4.9%; P = 0.031).ConclusionsThese results are in line with literatures reporting higher suicide risk in people, who are old, unemployed, not having a religion, psychotic and hopeless. These may have been moderated by committing a higher lethal means of suicide at least in part and warrants additional investigations.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Psychiatric comorbidity and suicide risk in patients with psoriasis

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1421 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S395-S396 ◽

Cited By ~ 1

Author(s):

M. Pompili ◽

M. Innamorati ◽

D. Erbuto ◽

A. Costanzo

Keyword(s):

Suicidal Ideation ◽

Suicide Risk ◽

Psychiatric Comorbidity ◽

Rating Scale ◽

Suicide Attempts ◽

The Other ◽

Depression And Anxiety ◽

Melanoma Patients ◽

Competing Interest ◽

Hamilton Rating Scale

IntroductionPsoriasis has a significant impact on the mental and emotional functioning.ObjectiveIt has been reported that the risk of psychiatric comorbidity increases with the severity of the disorder, and the most frequent associations appear to be those with depression and anxiety.AimsTo analyze the association between psoriasis, mental disorders and suicidal ideation in a sample of patients affected by psoriasis. To investigate the differences between psoriasis patients and patients with other dermatologic diseases.MethodsParticipants were 242 consecutive patients (142 women and 100 men), 112 patients with psoriasis (46.3%), 77 with melanoma (31.8%) and 53 with allergy (21.0%). All patients were administered a structured sociodemographic interview and the following measures: the Hamilton Rating Scale for Depression (HAM-D) and the Hamilton Rating Scale for Anxiety (HAM-A). We also assessed current and previous suicidal ideation and previous suicide attempts.ResultsPatients with psoriasis (compared to other groups of patients) more frequently had a comorbid mood disorder (16.1% vs 3.9% and 0.0%, respectively for patients with melanoma and patients with allergy; χ22 = 14.98; P < 0.001), past suicidal ideation (33.9% vs 15.6% and 18.9%, respectively for patients with melanoma and patients with allergy; χ22 = 2.05; P < 0.01) and attempts (6.3% vs 0.0% and 0.0%, for the other groups of patients; χ22 = 8.37; P < 0.05). Patients with psoriasis reported higher HAM-D scores than melanoma patients.ConclusionsThe clinical evaluation of patients with psoriasis should include the assessment of psychiatric comorbidities and the routinely assessment of suicide risk.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Do risk factors for suicidal behavior differ by affective disorder polarity?

Psychological Medicine ◽

10.1017/s0033291708004078 ◽

2008 ◽

Vol 39 (5) ◽

pp. 763-771 ◽

Cited By ~ 25

Author(s):

J. G. Fiedorowicz ◽

A. C. Leon ◽

M. B. Keller ◽

D. A. Solomon ◽

J. P. Rice ◽

...

Keyword(s):

Risk Factors ◽

Substance Abuse ◽

Affective Disorder ◽

Suicidal Behavior ◽

Active Substance ◽

Affective Disorders ◽

Suicide Risk ◽

Suicide Attempts ◽

Age Of Onset ◽

Suicide Risk Factors

BackgroundSuicide is a leading cause of death and has been strongly associated with affective disorders. The influence of affective disorder polarity on subsequent suicide attempts or completions and any differential effect of suicide risk factors by polarity were assessed in a prospective cohort.MethodParticipants with major affective disorders in the National Institute of Mental Health (NIMH) Collaborative Depression Study (CDS) were followed prospectively for up to 25 years. A total of 909 participants meeting prospective diagnostic criteria for major depressive and bipolar disorders were followed through 4204 mood cycles. Suicidal behavior was defined as suicide attempts or completions. Mixed-effects, grouped-time survival analysis assessed risk of suicidal behavior and differential effects of risk factors for suicidal behavior by polarity. In addition to polarity, the main effects of age, gender, hopelessness, married status, prior suicide attempts and active substance abuse were modeled, with mood cycle as the unit of analysis.ResultsAfter controlling for age of onset, there were no differences in prior suicide attempts by polarity although bipolar participants had more prior severe attempts. During follow-up, 40 cycles ended in suicide and 384 cycles contained at least one suicide attempt. Age, hopelessness and active substance abuse but not polarity predicted suicidal behavior. The effects of risk factors did not differ by polarity.ConclusionsBipolarity does not independently influence risk of suicidal behavior or alter the influence of well-established suicide risk factors within affective disorders. Suicide risk assessment strategies may continue to appraise these common risk factors without regard to mood polarity.

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Lethality of Previous Suicidal Behavior among Patients Hospitalized for Suicide Risk Predicts Lethality of Future Suicide Attempts

Suicide and Life-Threatening Behavior ◽

10.1111/sltb.12538 ◽

2018 ◽

Vol 49 (5) ◽

pp. 1431-1438 ◽

Cited By ~ 2

Author(s):

Sasha M. Rojas ◽

Kayla D. Skinner ◽

Matthew T. Feldner ◽

Demian E. Rodante ◽

Soledad Puppo ◽

...

Keyword(s):

Suicidal Behavior ◽

Suicide Risk ◽

Suicide Attempts

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Suicide in Schizophrenia: An Educational Overview

Medicina ◽

10.3390/medicina55070361 ◽

2019 ◽

Vol 55 (7) ◽

pp. 361 ◽

Cited By ~ 9

Author(s):

Sher ◽

Kahn

Keyword(s):

Suicidal Behavior ◽

Suicide Risk ◽

Protective Factor ◽

Psychotic Disorders ◽

Public Health Problem ◽

Psychotic Symptoms ◽

Comprehensive Treatment ◽

Negative Feeling ◽

Comorbid Depression ◽

Important Public Health Problem

Suicide is an important public health problem. The most frequent psychiatric illnesses associated with suicide or severe suicide attempt are mood and psychotic disorders. The purpose of this paper is to provide an educational overview of suicidal behavior in individuals with schizophrenia. A lifetime suicide rate in individuals with schizophrenia is approximately 10%. Suicide is the largest contributor to the decreased life expectancy in individuals with schizophrenia. Demographic and psychosocial factors that increase a risk of suicide in individuals with schizophrenia include younger age, being male, being unmarried, living alone, being unemployed, being intelligent, being well-educated, good premorbid adjustment or functioning, having high personal expectations and hopes, having an understanding that life’s expectations and hopes are not likely to be met, having had recent (i.e., within past 3 months) life events, having poor work functioning, and having access to lethal means, such as firearms. Throughout the first decade of their disorder, patients with schizophrenia are at substantially elevated suicide risk, although they continue to be at elevated suicide risk during their lives with times of worsening or improvement. Having awareness of symptoms, especially, awareness of delusions, anhedonia, asociality, and blunted affect, having a negative feeling about, or non-adherence with, treatment are associated with greater suicide risk in patients with schizophrenia. Comorbid depression and a history of suicidal behavior are important contributors to suicide risk in patients with schizophrenia. The only reliable protective factor for suicide in patients with schizophrenia is provision of and compliance with comprehensive treatment. Prevention of suicidal behavior in schizophrenia should include recognizing patients at risk, delivering the best possible therapy for psychotic symptoms, and managing comorbid depression and substance misuse.

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Self-Image and Risk of Suicide in Eating Disorders

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.128 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S281-S281

Author(s):

A. Birgegård ◽

M. Andersen

Keyword(s):

Eating Disorders ◽

Suicide Risk ◽

Suicide Attempts ◽

High Specificity ◽

Lower Sensitivity ◽

Longitudinal Models ◽

Self Image ◽

Competing Interest ◽

Separate Regression ◽

Variance Explained

IntroductionSuicide risk is increased in eating disorders (ED), and detection is key to prevention. Self-image as operationalized in the structural analysis of social behavior (SASB) model has been shown to be associated with symptoms, treatment dropout, and outcome. SASB is a circumplex organizing self-directed behaviors along affiliation (love vs. hate) and autonomy (set free vs. control) dimensions. In a recent study, SASB related to health care-detected suicide attempts in ED. Methodology in that study ensured high specificity but risked lower sensitivity in suicide variables, and with such a high-threat outcome, research is needed on additional variables related to risk.Objectives and aimsWe aimed to study associations between SASB self-image and clinician- and self-rated suicidality at presentation and predicted over 12 months in ED patients.MethodsAdult patients (n = 551) from a Swedish clinical database included 19% anorexia, 32% bulimia, 7% binge ED, and 42% other ED. We ran separate regression models for these diagnostic groups using SASB questionnaire data, also controlling for general psychiatric and ED symptoms, and in longitudinal models including baseline of each outcome.ResultsSASB alone was associated with suicidality at presentation (9–67% variance explained) and predictively over 12 months (7–29%), and in the majority of models explained additional variance beyond baseline and clinical variables. Both affiliation and autonomy related to dependent variables in diagnosis-specific patterns.ConclusionsThe findings have implications for both theory and detection tools for suicide risk, as well as suggesting intervention targets to mitigate risk in treatment based on the well-validated SASB theory.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Brain imaging biomarkers in personalizing pharmacotherapy of suicidal depressed patients

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.928 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S53-S54

Author(s):

J.J. Mann

Keyword(s):

Decision Making ◽

Suicidal Behavior ◽

Suicide Attempts ◽

Imaging Biomarkers ◽

Mood Regulation ◽

Imaging Data ◽

Neurotransmitter Systems ◽

Dopaminergic Systems ◽

Competing Interest ◽

Suicidal Patients

BackgroundNew knowledge has emerged about decision-making, mood regulation, social distortions and learning that is relevant for the diathesis for suicidal behavior. All four domains have identified underlying neural circuits and for decision-making and mood regulation also specific neurotransmitter systems.MethodsWe have conducted PET studies of the serotonergic system and CSF studies of the serotonin, norepinephrine and dopamine neurotransmitter systems in patients surviving suicide attempts to determine whether they have neurotransmitter abnormalities that resemble those found in the brain after suicide. We found alterations in the serotonin transporter and the 5-HT1A receptor that are similar to those seen in suicides and moreover the severity of the abnormality in 5-HT1A binding is correlated with the lethality of suicidal behavior. Other studies examining CSF levels of 5-HIAA are consistent with imaging data and extend the findings to the noradrenergic and dopaminergic systems. Finally, we will present data on use of these biomarkers to predict treatment outcome. Abnormal decision-making and mood regulation in suicidal patients is linked to abnormal brain biology and has direct implications for clinical practice in terms of selecting specific types of medication and how these may be best combined with psychotherapies.Disclosure of interestThe author has not supplied his declaration of competing interest.

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Can Postdischarge Follow-Up Contacts Prevent Suicide and Suicidal Behavior?

Crisis ◽

10.1027/0227-5910/a000158 ◽

2013 ◽

Vol 34 (1) ◽

pp. 32-41 ◽

Cited By ~ 97

Author(s):

David D. Luxton ◽

Jennifer D. June ◽

Katherine Anne Comtois

Keyword(s):

Suicidal Behavior ◽

Suicide Attempts ◽

Empirical Studies ◽

Secondary Analysis ◽

Inpatient Psychiatry ◽

Time Period ◽

Prevention Interventions ◽

Specific Factors ◽

E Mail

Background: The time period following discharge from inpatient psychiatry and emergency department (ED) treatment is one of heightened risk for repeat suicide attempts for patients. Evidence reported in the literature shows that follow-up contacts might reduce suicide risk, although there has not been a comprehensive and critical review of the evidence to date. Aims: To evaluate evidence for the effectiveness of suicide prevention interventions that involve follow-up contacts with patients. Methods: Published empirical studies of follow-up interventions with suicidal behaviors (suicide, attempts, and ideation) as outcomes were searched. Study populations were inpatient psychiatric or ED patients being discharged to home. Contact modalities included phone, postal letter, postcards, in-person, and technology-based methods (e-mail and texting). Results: Eight original studies, two follow-up studies, and one secondary analysis study met inclusion criteria. Five studies showed a statistically significant reduction in suicidal behavior. Four studies showed mixed results with trends toward a preventative effect and two studies did not show a preventative effect. Conclusions: Repeated follow-up contacts appear to reduce suicidal behavior. More research is needed, however, especially randomized controlled trials, to determine what specific factors might make follow-up contact modalities or methods more effective than others.

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