Pathways to Suicide Among People With a Diagnosed Mental Illness in Victoria, Australia

Abstract. Background: People who have mental illness are at increased risk of suicide. Therefore, identifying "typical" trajectories to suicide in this population has the potential to improve the effectiveness of suicide prevention strategies. Aim: The aim of this study was to explore the pathways to suicide among a sample of Victorians with a diagnosed mental illness. Method: Victorian Suicide Register (VSR) data were used to generate life charts and identify typical life trajectories to suicide among 50 Victorians. Results: Two distinct pathways to suicide were identified: (1) where diagnosis of mental illness appeared to follow life events/stressors; and (2) where diagnosis appeared to precede exposure to life events/stressors. Some events acted as distal factors related to suicide, other events were more common as proximal factors, and still others appeared to act as both distal and proximal factors. Limitations: The data source might be biased because of the potential for incomplete information, or alternatively, the importance of some factors in a person's life may have been overstated. Conclusion: Strategies to reduce suicide need to consider the chronology of exposure to stressors in people's lives and clearly need to be different depending on whether proximal or distal risk factors are the target of a given strategy or intervention.

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Suicide prevention: A study of patients' views

The British Journal of Psychiatry ◽

10.1192/bjp.182.3.261 ◽

2003 ◽

Vol 182 (3) ◽

pp. 261-265 ◽

Cited By ~ 53

Author(s):

John M. Eagles ◽

Dawn P. Carson ◽

Annabel Begg ◽

Simon A. Naji

Keyword(s):

Social Networks ◽

Mental Illness ◽

Suicide Prevention ◽

Psychiatric Illness ◽

Structured Interview ◽

Psychiatric Services ◽

Prevention Strategies ◽

Psychiatric Illnesses ◽

Service Models ◽

The Media

BackgroundSuicide prevention strategies are usually formulated without seeking the views of people with psychiatric illnesses.AimsTo establish what helped patients with severe psychiatric illness when they felt suicidal.MethodA semi-structured interview was constructed following transcribed interviews with 12 patients. This was administered to 59 out-patients with serious and enduring mental illness, focusing on factors they found helpful or unhelpful when at their most despairing.ResultsThree-quarters of patients were in contact with psychiatric services when feeling at their lowest, and this contact was generally deemed to be helpful. Social networks were considered just as helpful as psychiatric services by the half of patients who discussed their feelings with friends or relatives. Religious beliefs and affiliations were helpful. Negative influences included the media and the stigma of psychiatric illness.ConclusionsEfforts at suicide prevention might usefully focus on enhancing patients' social networks, increasing the likelihood of early contact with psychiatric services and decreasing the stigma attached to psychiatric illness. Larger studies of patients exposed to different service models would be informative.

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Incidence and risk factors of non–device-associated pneumonia in an acute-care hospital

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.300 ◽

2019 ◽

Vol 41 (1) ◽

pp. 73-79 ◽

Cited By ~ 2

Author(s):

Paula D. Strassle ◽

Emily E. Sickbert-Bennett ◽

Michael Klompas ◽

Jennifer L. Lund ◽

Paul W. Stewart ◽

...

Keyword(s):

Risk Factors ◽

Infection Prevention ◽

Acute Care Hospital ◽

Future Research ◽

Ventilator Associated Pneumonia ◽

Care Hospital ◽

Prevention Strategies ◽

Increased Risk ◽

Academic Teaching Hospital ◽

Male Sex

AbstractObjective:To update current estimates of non–device-associated pneumonia (ND pneumonia) rates and their frequency relative to ventilator associated pneumonia (VAP), and identify risk factors for ND pneumonia.Design:Cohort study.Setting:Academic teaching hospital.Patients:All adult hospitalizations between 2013 and 2017 were included. Pneumonia (device associated and non–device associated) were captured through comprehensive, hospital-wide active surveillance using CDC definitions and methodology.Results:From 2013 to 2017, there were 163,386 hospitalizations (97,485 unique patients) and 771 pneumonia cases (520 ND pneumonia and 191 VAP). The rate of ND pneumonia remained stable, with 4.15 and 4.54 ND pneumonia cases per 10,000 hospitalization days in 2013 and 2017 respectively (P = .65). In 2017, 74% of pneumonia cases were ND pneumonia. Male sex and increasing age we both associated with increased risk of ND pneumonia. Additionally, patients with chronic bronchitis or emphysema (hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.40–3.06), congestive heart failure (HR, 1.48; 95% CI, 1.07–2.05), or paralysis (HR, 1.72; 95% CI, 1.09–2.73) were also at increased risk, as were those who were immunosuppressed (HR, 1.54; 95% CI, 1.18–2.00) or in the ICU (HR, 1.49; 95% CI, 1.06–2.09). We did not detect a change in ND pneumonia risk with use of chlorhexidine mouthwash, total parenteral nutrition, all medications of interest, and prior ventilation.Conclusion:The incidence rate of ND pneumonia did not change from 2013 to 2017, and 3 of 4 nosocomial pneumonia cases were non–device associated. Hospital infection prevention programs should consider expanding the scope of surveillance to include non-ventilated patients. Future research should continue to look for modifiable risk factors and should assess potential prevention strategies.

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Cues for different diagnostic patterns of interpersonal violence in a psychiatric sample: an observational study

10.21203/rs.2.12758/v1 ◽

2019 ◽

Author(s):

Dalila Talevi ◽

Alberto Collazzoni ◽

Alessandro Rossi ◽

Paolo Stratta ◽

Monica Mazza ◽

...

Keyword(s):

Risk Factors ◽

Mental Illness ◽

Mood Disorder ◽

Personality Disorders ◽

Interpersonal Violence ◽

Mental Illnesses ◽

Health Concern ◽

People With Mental Illness ◽

Violent Behaviors ◽

Increased Risk

Abstract Background. Interpersonal violence has increased as a health concern especially in the psychiatry practice over the last decades; nevertheless, most patients with stable mental illness do not present an increased risk of violence and a mental disorder is not a necessary or sufficient cause of violent behaviors. People with mental illness endorse more often a number of risk factors for violence that could confound this association, such as young age and male gender. The aim of this study was to investigate the effect of age, gender, and diagnosis on reported levels of interpersonal violence in a sample of people with severe mental illnesses. Methods. The sample was composed of 160 inpatients: 73 with psychosis, 53 with mood disorder and 34 with personality disorder. All patients enrolled in the study were assessed for experiences of victimization and perpetration of interpersonal violence using the Karolinska Interpersonal Violence Scale interview. Demographic variables were also collected. Results. Violence negatively correlated with age. Compared to males, females were exposed to higher degree of violence (for both victimizations in childhood and adulthood), whereas males were more involved in the perpetration of violence (only for perpetration in childhood). Among diagnoses, personality disorders are associated with higher levels of interpersonal violence. An interaction effect of gender and diagnosis was also observed for expression of violence in adulthood. Distinct patterns of interpersonal violence did emerge for the diagnostic entities with mood disorder showing a victimization pattern, personality disorders a perpetration pattern and psychoses a less defined pattern. Conclusions. The main finding is that psychoses, mood disorders and personality disorders have different patterns of violent experiences when combined with age and gender. This study offers a step towards a better understanding of the extent to which gender and age could affect violent behaviors. Moreover, study findings may increase the comprehension of the reason why some mental disorders, compared to others, are more associated with the risk of victimization or perpetration of violence. These patterns could have pathophysiological or pathoplastic meaning addressing clinical and diagnostic trajectories interacting with other intervening risk factors.

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Association Between Changes in Risk Factor Status and Suicidal Ideation Incidence and Recovery

Crisis ◽

10.1027/0227-5910/a000343 ◽

2015 ◽

Vol 36 (6) ◽

pp. 390-398 ◽

Cited By ~ 1

Author(s):

Yi Zhang ◽

Paul Siu Fai Yip ◽

Shu-Sen Chang ◽

Paul Wai Ching Wong ◽

Frances Yik Wa Law

Keyword(s):

Risk Factors ◽

Suicidal Ideation ◽

Life Events ◽

Irrational Beliefs ◽

Psychiatric Treatment ◽

Economic Status ◽

Incidence Rates ◽

Increased Risk ◽

Persistent Unemployment

Abstract. Background: Little is known about risk factors associated with the incidence of and recovery from suicidal ideation. Aims: To examine the association between potential risk factors and their change in status over the follow-up period and the incidence of and recovery from suicidal ideation. Method: A 12-month follow-up survey was conducted among 997 adults aged between 20 and 59 years living in Hong Kong. Results: The incidence rates of suicidal ideation increased in individuals who were divorced, separated, or widowed, in low economic status, had a history of psychiatric treatment, and experienced bereavement at baseline. Experiencing three or more life events and persistent unemployment over the follow-up period was associated with increased incidence of suicidal ideation. Increased levels of depression, anxiety, hopelessness, and irrational beliefs were associated with suicidal ideation incidence in men but not in women (p = .009–.067 for interactions). Among individuals who had suicidal ideation at baseline, those who had increased severity of depression, anxiety, and hopelessness over the follow-up period were less likely to recover from suicidal ideation. Conclusion: Life events and persistent unemployment were associated with increased risk of suicidal ideation. Gender differences were detected in the association between changes in the status of psychological factors and the occurrence of suicidal ideation.

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Defining Youth Suicide

Treating and Preventing Adolescent Mental Health Disorders ◽

10.1093/med-psych/9780199928163.003.0021 ◽

2017 ◽

pp. 483-496

Author(s):

Herbert Hendin ◽

Ann P. Haas ◽

Jill Harkavy-Friedman ◽

Maggie Mortali

Keyword(s):

Risk Factors ◽

Young Adults ◽

Environmental Factors ◽

Protective Factors ◽

Suicide Prevention ◽

Risk And Protective Factors ◽

Research Needs ◽

Youth Suicide ◽

Prevention Strategies ◽

What Works

This chapter looks at suicide among adolescents and young adults. Although true suicide causation is difficult to empirically establish, an accumulated body of research points to a number of individual and environmental factors that have been closely and fairly consistently associated with youth suicidal behaviors. These risk factors are identified and briefly discussed here. The chapter looks the behavioral and environmental factors for suicide. The main aim of this chapter is to examine current youth suicide prevention strategies and interventions with an eye towards identifying what works, what does not appear to work, and what research needs to be undertaken to move the field forward. Given the multiplicity of risk and protective factors that have been related to youth suicide, it is understandable that many different approaches have been taken in the attempt to prevent this behaviour.

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Risk factors for mental illness in adults with atopic eczema or psoriasis: protocol for a systematic review

BMJ Open ◽

10.1136/bmjopen-2020-038324 ◽

2020 ◽

Vol 10 (12) ◽

pp. e038324

Author(s):

Elizabeth I Adesanya ◽

Yochai Schonmann ◽

Joseph F Hayes ◽

Rohini Mathur ◽

Amy R Mulick ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Mental Illness ◽

Atopic Eczema ◽

Skin Diseases ◽

Grey Literature ◽

Evaluation Framework ◽

Mental Illnesses ◽

Cochrane Library ◽

Increased Risk

IntroductionEvidence indicates that people with the common inflammatory skin diseases atopic eczema or psoriasis are at increased risk of mental illness. However, the reasons for the relationship between skin disease and common mental disorders (ie, depression and anxiety) or severe mental illnesses (ie, schizophrenia, bipolar disorder and other psychoses) are unclear. Therefore, we aim to synthesise the available evidence regarding the risk factors for mental illness in adults with atopic eczema or psoriasis.Methods and analysisWe will conduct a systematic review of randomised controlled trials, cohort, case–control and cross-sectional studies. We will search the following databases from inception to March 2020: Medline, Embase, Global Health, Scopus, the Cochrane Library, Web of Science, Base, PsycInfo, the Global Resource of Eczema Trials, and the grey literature databases Open Grey, PsycExtra and the New York Academy of Medicine Grey Literature Report. We will also search the bibliographies of eligible studies and relevant systematic reviews to identify additional relevant studies. Citation searching of large summary papers will be used to further identify relevant publications. Two reviewers will initially review study titles and abstracts for eligibility, followed by full text screening. We will extract data using a standardised data extraction form. We will assess the risk of bias of included studies using the Quality in Prognosis Studies tool. We will synthesise data narratively, and if studies are sufficiently homogenous, we will consider a meta-analysis. We will assess the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation framework.Ethics and disseminationEthical approval is not required for a systematic review. Results of the review will be published in a peer-reviewed journal and disseminated through conferences.PROSPERO registration numberCRD42020163941.

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Suicidal behaviors among Bangladeshi university students: Prevalence and risk factors

PLoS ONE ◽

10.1371/journal.pone.0262006 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0262006

Author(s):

M. Rasheduzzaman ◽

Firoj al-Mamun ◽

Ismail Hosen ◽

Tahmina Akter ◽

Moazzem Hossain ◽

...

Keyword(s):

Mental Health ◽

Risk Factors ◽

Mental Illness ◽

Suicide Attempt ◽

University Students ◽

Life Events ◽

Stressful Life Events ◽

Suicidal Behaviors ◽

Family Mental Health ◽

Academic Study

Background Bangladeshi university students are considered to be highly suicide-prone compared to other populations and cohorts. However, no prior epidemiological studies have assessed the suicidality (i.e., past-year suicidal ideation [SI], lifetime suicide plan [SP], and lifetime suicide attempt [SA]) among Bangladeshi students, including the variables such as past-year stressful life events and family mental health history. This is arguably a major knowledge gap in the country. Therefore, the present study investigated the prevalence and associated risk factors for suicidal behaviors among Bangladeshi university students. Methods A cross-sectional study was conducted utilizing a convenience sampling method among a total of 1844 university students between October and November 2019. Data were collected based on the information related to socio-demographics, perceived health-related questions, past-year stressful life events, family mental health history, and suicidal behaviors (i.e., SI, SP, and SA). Chi-square tests and binary logistic regressions were used to analyze the data utilizing SPSS statistical software. Results The prevalence of past-year suicidal ideation, lifetime suicide plans, and suicide attempts were 13.4%, 6.0%, and 4.4%, respectively. Females reported significantly higher suicidal behavior than males (i.e., 20.6% vs.10.2% SI; 9% vs. 4.6% SP; and 6.4% vs.3.6% SA). Risk factors for SI were being female, year of academic study, residing in an urban area, using psychoactive substances, experiencing both past year physical and mental illness, experiencing any type of stressful past-year life events, experiencing campus ragging (i.e., senior students abusing, humiliating and/or harassing freshers or more junior students), experiencing family mental illness history, and having family suicide attempt history. SP was associated with several factors including being female, year of academic study, using psychoactive substance, experiencing both past-year physical and mental illness, and experiencing any type of stressful past-year life events. Risk factors for SA were being female, year of academic study, using psychoactive substances, experiencing past-year mental illness, experiencing any type of stressful past-year life events, and having family suicide attempt history. Conclusions University students appear to be a vulnerable group for experiencing suicidal behaviors. The present findings warrant rigorous action and early intervention programs such as counseling and other mental health professional services by university authorities. Longitudinal studies are highly recommended involving countrywide representative samples.

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Completed Suicide With Violent and Non-violent Methods by the Elderly in Rural China: A Psychological Autopsy Study

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.624398 ◽

2021 ◽

Vol 12 ◽

Author(s):

Rong-Ting Zhu ◽

Zhen-Yu Ma ◽

Cun-Xian Jia ◽

Liang Zhou

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Depressive Symptoms ◽

Life Events ◽

Suicide Prevention ◽

Rural Areas ◽

Rural China ◽

Psychological Autopsy ◽

Elderly Individuals ◽

Completed Suicide

Background: Late-life suicide is a severe public health problem in rural China; however, knowledge regarding the specific characteristics and risk factors for completed suicide via violent and non-violent methods among elderly individuals in rural China is limited.Methods: Subjects aged 60 years or older were selected from rural areas in Shandong, Hunan, and Guangxi provinces in China. This study was a 1:1 matched case-control design conducted by using the psychological autopsy method.Results: According to the univariate analyses, the presence of mental disorder, higher degree of depression, loneliness, lack of social support, hopelessness, impulsivity, and increased quantity of life events were associated with suicide in both violent and non-violent methods. For violent suicide, another risk factor was the lack of pesticides at home. For non-violent suicide, other risk factors were not currently married, family suicide history, and alcohol use disorder (P < 0.05). Variables that remained in the logistic regression model were the severity of depressive symptoms for both violent and non-violent suicide. For non-violent suicide, the degree of hopelessness was another independent risk factor. In addition, violent suicides were more likely to lack pesticides at home, choose the spring season and have an increased quantity of life events than those who died by suicide via non-violent methods.Conclusion: The major risk factor for both violent and non-violent suicide was the severity of depressive symptoms. Suicide prevention measures that focus on depression among this vulnerable population are urgently needed. Moreover, the characteristics of suicides via violent methods differed from those via non-violent methods among elderly individuals. Suicide prevention efforts should be tailored to the specific characteristics of the different suicide methods utilized by older adults in rural areas.

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Where is the social in the biopsychosocial model of suicide prevention?

International Journal of Social Psychiatry ◽

10.1177/00207640211027210 ◽

2021 ◽

pp. 002076402110272

Author(s):

José Eduardo Rodríguez-Otero ◽

Xiana Campos-Mouriño ◽

David Meilán-Fernández ◽

Sarai Pintos-Bailón ◽

Graciela Cabo-Escribano

Keyword(s):

Risk Factors ◽

Protective Factors ◽

Suicide Prevention ◽

Suicidal Behavior ◽

Biopsychosocial Model ◽

Risk And Protective Factors ◽

Prevention Strategies ◽

Theoretical Frameworks ◽

Prevention Policies

Background: Each year, around 800,000 people die by suicide. The prevalence of suicidal behaviors is much higher when suicidal attempts and persistent self-injurious ideation are included. Therefore, suicide is a public health concern. Research has been sensitive to this problem, deepening the study of risk factors and the development of theoretical frameworks of suicidal behavior, with the aim of generating effective suicide prevention policies around the biopsychosocial model. Aim: We aimed to explore the role of relational, community, and social factors in current suicide prevention strategies. Method: Studies of risk and protective factors for suicidal behavior and the consequent development of theoretical frameworks were reviewed to verify if this knowledge was really used in suicide prevention policies. Results: Studies of risk and protective factors focus mainly on the individual, while theoretical frameworks emphasize the role of the relational, community, and social. Suicide prevention strategies more closely follow individual models derived from studies of risk factors. Conclusions: Suicide prevention strategies should broaden their individual narrative to include relational, community, and social interventions as anti-suicide measures.

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Physical and psychiatric comorbidity among patients with severe mental illness as seen in Uganda

10.1101/2020.11.04.20225813 ◽

2020 ◽

Author(s):

Richard Stephen Mpango ◽

Wilber Ssembajjwe ◽

Godfrey Zari Rukundo ◽

Carol Birungi ◽

Allan Kalungi ◽

...

Keyword(s):

Risk Factors ◽

Mental Illness ◽

Sexual Abuse ◽

Logistic Regression ◽

Severe Mental Illness ◽

Physical Abuse ◽

Psychiatric Comorbidity ◽

Increased Risk ◽

Physical Disorders ◽

Associated Risk Factors

AbstractThis study established the prevalence of physical and psychiatric comorbidity and associated risk factors among 1,201 out-patients with severe mental illness (SMI) attending Butabika and Masaka hospitals in Uganda. Participants completed an assessment battery; structured, standardized and locally translated instruments. SMIs were established using the MINI International Neuropsychiatric Interview version 7.2. We used logistic regression to determine the association between physical and psychiatric comorbidity and risk factors. Prevalence of physical and psychiatric comorbidity was 13.1 %. Childhood sexual abuse (aOR 1.06, 95% CI 1.03 -1.10, P=0.001), sexual abuse in adulthood (aOR 2.22, 95% CI 1.60 - 3.08, P<0.001), childhood physical abuse (aOR 1.07, 95% CI 1.03 - 1.10, P<0.001) and physical abuse in adulthood (aOR 1.69, 95% CI 1.30 - 2.20, P<0.001) were associated with an increased risk of having comorbid psychiatric and physical disorders. Emerging healthcare models in Uganda should optimise care for people with physical and psychiatric comorbidity.

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