Reply to Ploderl and Hengartner: learning about the course of suicidal behavior but not about the effects of SSRIs

Objective: Research in adults has identified an association between bipolar disorder and suicidal behavior. This relationship, however, has been insufficiently investigated in adolescents to date. Methods: 1,117 adolescents from 13 German schools (mean age = 14.83, SD = .63; 52.7% females) completed an extended German version of the Center for Epidemiological Studies Depression Scale (CES-D), which assesses depressive and manic symptoms during the last week, as well as the Self-Harm Behavior Questionnaire (SHBQ) for the assessment of lifetime suicidal behavior. Results: In the present sample 39.4% of the girls and 23.1% of the boys reported lifetime suicidal thoughts and 7.1% of the girls as well as 3.9% of the boys a lifetime history of suicide attempts. 18.7% of the adolescent sample revealed elevated symptoms of depression and 9% elevated levels of mania symptoms. Elevated sum scores of depression and mania were associated with a higher number of suicidal ideations and suicide attempts. A block-wise regression analysis revealed that sum scores of depression and mania predicted suicidal ideations best. Concerning suicide attempts, the best predictors were age as well as depression and mania sum scores. Conclusions: Suicidal behavior was reported more often when adolescents demonstrate symptoms of mania as well as symptoms of depression than when they demonstrate only depressive symptoms. The presence of bipolar symptoms in adolescents should alert clinicians to the heightened possibility of suicidal behavior.

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Suicidal Behavior in Black South Africans

Crisis ◽

10.1027//0227-5910.24.1.24 ◽

2003 ◽

Vol 24 (1) ◽

pp. 24-28 ◽

Cited By ~ 17

Author(s):

Lourens Schlebusch ◽

Naseema B.M. Vawda ◽

Brenda A. Bosch

Keyword(s):

South African ◽

Suicidal Behavior ◽

Health Care Facilities ◽

South African Society ◽

South Africans ◽

The Past ◽

The People ◽

Care Facilities ◽

Black South Africans ◽

To Come

Summary: In the past suicidal behavior among Black South Africans has been largely underresearched. Earlier studies among the other main ethnic groups in the country showed suicidal behavior in those groups to be a serious problem. This article briefly reviews some of the more recent research on suicidal behavior in Black South Africans. The results indicate an apparent increase in suicidal behavior in this group. Several explanations are offered for the change in suicidal behavior in the reported clinical populations. This includes past difficulties for all South Africans to access health care facilities in the Apartheid (legal racial separation) era, and present difficulties of post-Apartheid transformation the South African society is undergoing, as the people struggle to come to terms with the deleterious effects of the former South African racial policies, related socio-cultural, socio-economic, and other pressures.

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Emergency Department Admission and Mortality Rate for Suicidal Behavior

Crisis ◽

10.1027/0227-5910/a000282 ◽

2014 ◽

Vol 35 (6) ◽

pp. 406-414 ◽

Cited By ~ 10

Author(s):

Raimondo Maria Pavarin ◽

Angelo Fioritti ◽

Francesca Fontana ◽

Silvia Marani ◽

Alessandra Paparelli ◽

...

Keyword(s):

Emergency Department ◽

Metropolitan Area ◽

Suicidal Behavior ◽

Mortality Risk ◽

Illicit Drugs ◽

Attempted Suicide ◽

Cox Model ◽

Emergency Department Admission ◽

Completed Suicide

Background: The international literature reports that for every completed suicide there are between 8 and 22 visits to an Emergency Department (ED) for attempted suicide/suicidal behavior. Aims: To describe the characteristics of admission to emergency departments (EDs) for suicide-related presenting complaints in the metropolitan area of Bologna; to estimate the risk for all-cause mortality and for suicide; to identify the profiles of subjects most at risk. Method: Follow-up of patients admitted to the EDs of the metropolitan area of Bologna between January 2004 and December 2010 for attempted suicide. A Cox model was used to evaluate the association between sociodemographic variables and the general mortality risk. Results: We identified 505 cases of attempted suicide, which were more frequent for female subjects, over the weekend, and at night (8:00 p.m./8:00 a.m.). The most used suicide methods were psychotropic drugs, sharp or blunt objects, and jumping from high places. In this cohort, 3.6% of subjects completed suicide (4.5% of males vs. 2.9% of females), 2.3% within 1 year of the start of follow-up. The most common causes of death were drug use and hanging. In the multivariate analysis, those who used illicit drugs 24 hr prior to admission to the ED (hazard ratio [HR] = 3.46, 95% CI = 1.23–9.73) and patients who refused the treatment (HR = 6.74, 95% CI = 1.86–24.40) showed an increased mortality risk for suicide. Conclusion: Deliberate self-harm patients presenting to the ED who refuse treatment represent a specific target group for setting up dedicated prevention schemes.

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Self-Report vs. Computerized Measures of Impulsivity as a Correlate of Suicidal Behavior

Crisis ◽

10.1027//0227-5910.22.1.27 ◽

2001 ◽

Vol 22 (1) ◽

pp. 27-31 ◽

Cited By ~ 47

Author(s):

Netta Horesh

Keyword(s):

Suicidal Behavior ◽

Attention Deficit Disorder ◽

Impulse Control ◽

Performance Test ◽

Adolescent Suicide ◽

Continuous Performance Test ◽

Self Report ◽

Suicide Attempters ◽

Computerized Measures ◽

Adolescent Suicide Attempters

Objectives: To compare the use of a self-report form of impulsivity versus a computerized test of impulsivity in the assessment of suicidal adolescent psychiatric inpatients. Methods: Sixty consecutive admissions to an adolescent in patient unit were examined. The severity of suicidal behavior was measured with the Childhood Suicide Potential Scale (CSPS), and impulse control was measured with the self report Plutchik Impulse Control Scale (ICS) and with the Test of Variables of Attention (TOVA), a continuous performance test (CPT). The TOVA is used to diagnose adolescents with attention deficit disorder. Results: There was a significant but low correlation between the two measures of impulsivity. Only the TOVA commission and omission errors differentiated between adolescent suicide attempters and nonattempters. Conclusions: Computerized measures of impulsivity may be a useful way to measure impulsivity in adolescent suicide attempters. Impulsivity appears to play a small role only in nondepressed suicidal adolescents, especially boys.

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Validity of Proxy-Based Reports of Impulsivity and Aggression in Chinese Research on Suicidal Behavior

Crisis ◽

10.1027/0227-5910/a000019 ◽

2010 ◽

Vol 31 (3) ◽

pp. 137-142 ◽

Cited By ~ 17

Author(s):

Jing An ◽

Michael R. Phillips ◽

Kenneth R. Conner

Keyword(s):

Risk Factors ◽

Suicidal Behavior ◽

Rural China ◽

Suicide Attempters ◽

Barratt Impulsiveness Scale ◽

Single Location ◽

Aggression Questionnaire ◽

Community Controls

Background: In studies about the risk factors for suicidal behavior, the assessment of impulsiveness and aggression often depend on information from proxy informants. Aims: To assess the validity of proxy informants’ reports on impulsiveness and aggression in China. Methods: Modified Chinese versions of the Barratt Impulsiveness Scale (BIS-CV) and the Buss-Perry Aggression Questionnaire (AQ-CV) were administered to 131 suicide attempters treated at a hospital in rural China, to coresident relatives about the attempters, to 131 matched community controls, and to coresident relatives about the controls. Results: BIS-CV and AQ-CV total scores and subscale scores were all significantly higher for suicide attempters than for matched controls. Proxy informants considered subjects slightly more impulsive and aggressive than the subjects reported themselves. Subject-proxy concordance for total BIS-CV and AQ-CV scores were excellent for both attempters and controls (ICCs = 0.76–0.83). Concordance for the three BIS-CV subscales was 0.74–0.81 for attempters and 0.74–0.83 for controls. Concordance for the five AQ-CV subscales was 0.66–0.85 for attempters and 0.56–0.82 for controls. Limitations: Results are based on respondents from a single location in rural China. Conclusions: The results support the validity of the BIS-CV and AQ-CV and of research on suicidal behavior in China that uses proxy-based reports of impulsiveness and aggression.

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Serotonergic Genes and Suicidality

Crisis ◽

10.1027//0227-5910.22.2.54 ◽

2001 ◽

Vol 22 (2) ◽

pp. 54-60 ◽

Cited By ~ 42

Author(s):

Lisheng Du ◽

Gabor Faludi ◽

Miklos Palkovits ◽

David Bakish ◽

Pavel D. Hrdina

Keyword(s):

Suicidal Ideation ◽

Suicidal Behavior ◽

Tryptophan Hydroxylase ◽

Association Studies ◽

Receptor Gene ◽

Brain Regions ◽

Depressive Illness ◽

Control Group ◽

Serotonergic Activity ◽

Completed Suicide

Summary: Several lines of evidence indicate that abnormalities in the functioning of the central serotonergic system are involved in the pathogenesis of depressive illness and suicidal behavior. Studies have shown that the number of brain and platelet serotonin transporter binding sites are reduced in patients with depression and in suicide victims, and that the density of 5-HT2A receptors is increased in brain regions of depressed in suicide victims and in platelets of depressed suicidal patients. Genes that code for proteins, such as tryptophan hydroxylase, 5-HT transporter, and 5-HT2A receptor, involved in regulating serotonergic neurotransmission, have thus been major candidate genes for association studies of suicide and suicidal behavior. Recent studies by our group and by others have shown that genetic variations in the serotonin-system-related genes might be associated with suicidal ideation and completed suicide. We have shown that the 102 C allele in 5-HT2A receptor gene was significantly associated with suicidal ideation (χ2 = 8.5, p < .005) in depressed patients. Patients with a 102 C/C genotype had a significantly higher mean HAMD item #3 score (indication of suicidal ideation) than T/C or T/T genotype patients. Our results suggest that the 102T/C polymorphism in 5-HT2A receptor gene is primarily associated with suicidal ideation in patients with major depression and not with depression itself. We also found that the 5-HT transporter gene S/L polymorphism was significantly associated with completed suicide. The frequency of the L/L genotype in depressed suicide victims was almost double of that found in control group (48.6% vs. 26.2%). The odds ratio for the L allele was 2.1 (95% CI 1.2-3.7). The association between polymorphism in serotonergic genes and suicidality supports the hypothesis that genetic factors can modulate suicide risk by influencing serotonergic activity.

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Incarcerated Adolescents' Distress and Suicidality in Relation to Parental Bonding Styles

Crisis ◽

10.1027//0227-5910.20.4.164 ◽

1999 ◽

Vol 20 (4) ◽

pp. 164-170 ◽

Cited By ~ 12

Author(s):

Elizabeth L McGarvey ◽

Ludmila A Kryzhanovskaya ◽

Cheryl Koopman ◽

Dennis Waite ◽

Randolph J Canterbury

Keyword(s):

At Risk ◽

Attachment Theory ◽

Suicidal Behavior ◽

Parental Bonding ◽

Psychosocial Problems ◽

Self Esteem ◽

Suicidal Thoughts ◽

Parental Bonding Instrument ◽

Significant Relationships ◽

Incarcerated Adolescents

This study examines the relationships between the bonding style of an incarcerated adolescent with parents and his/her current feelings of self-esteem, hopelessness, and suicidal thoughts and attempts. It also investigates differences between bonding to mother and bonding to father. Some 296 incarcerated adolescents were interviewed using the Parental Bonding Instrument. Significant relationships were found between youths' self-esteem, hopelessness, and suicidal behavior and their bonding style. Youths whose parent(s) had a parental bonding style of affectionless control reported the greatest distress, and youths whose parent(s) had an optimal bonding style reported the least distress. Differences were found between bonding styles with the mother and with the father. Attachment theory may be useful in targeting incarcerated youths who have affectionless control bonding with parent(s) for special interventions since these youths are most at risk for psychosocial problems.

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Outreach Psychiatric Emergency Service

Crisis ◽

10.1027/0227-5910/a000651 ◽

2020 ◽

Vol 41 (5) ◽

pp. 375-382

Author(s):

Remco F. P. de Winter ◽

Mirjam C. Hazewinkel ◽

Roland van de Sande ◽

Derek P. de Beurs ◽

Marieke H. de Groot

Keyword(s):

General Practitioner ◽

General Hospital ◽

Suicidal Behavior ◽

Emergency Service ◽

Attempted Suicide ◽

Emergency Services ◽

Psychiatric Emergency ◽

Psychiatric Emergency Services ◽

Psychiatric Emergency Service ◽

Suicidal Patients

Abstract. Background: Outreach psychiatric emergency services play an important role in all stages of a suicidal crisis; however, empirical assessment data are scarce. This study describes characteristics of patients assessed by these services and involved in suicidal crises. Method: During a 5-year period, detailed information from psychiatric emergency service assessments was recorded; 14,705 assessments were included. Characteristics of patients with/without suicidal behavior and with/without suicide attempts were compared. Outcomes were adjusted for clustering of features within individual patients. Results: Suicidal behavior was assessed in 32.2% of patients, of whom 9.2% attempted suicide. Suicidal behavior was most commonly associated with depression or adjustment disorder and these patients were referred to the service by a general practitioner or a general hospital, whereas those who attempted suicide were less likely to be referred by a general practitioner. Those who attempted suicide were more likely to be female and have had a referral by a general hospital. Self-poisoning by medication was the most common method of attempting suicide. Limitations: Bias could be due to missed or incomplete assessments. Primary diagnoses were based on clinical observation at the time of the assessment or on the primary diagnosis previously recorded. In addition, suicidal behavior or attempted suicide might have been underestimated. Conclusions: Suicidal behavior is commonplace in assessments by psychiatric emergency services. Suicidal patients with/without a suicide attempt differed with respect to demographic features, primary diagnoses, and referring entities, but not with respect to treatment policy. About 40% of the suicidal patients with/without an attempt were admitted following assessment.

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