scholarly journals S135. EXPOSURE TO COMMON INFECTIONS AND RISK OF SUICIDE AND SELF-HARM – A LONGITUDINAL GENERAL POPULATION STUDY

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S86-S87
Author(s):  
Maija Lindgren ◽  
Minna Holm ◽  
Niina Markkula ◽  
Tommi Härkänen ◽  
Faith Dickerson ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Regression Models ◽  
Suicide Attempts ◽  
Herpes Viruses ◽  
Suicidal Thoughts ◽  
Self Harm ◽  
Antibody Levels ◽  
Common Infections ◽  
Hsv 1

Abstract Background Common infectious agents, such as Toxoplasma gondii (T. gondii) and several human herpes viruses, have been linked to increased risk of self-harm. As the infections may be prevented and treated, information on the possible association on common infections and suicidal outcomes may help prevent self-harm. We aimed to investigate the associations between self-harm and seropositivity to T. gondii, Epstein-Barr virus (EBV), Herpes Simplex virus Type 1 (HSV-1), and Cytomegalovirus (CMV). As depression is a major risk factor for suicidality, we also investigated whether being seropositive to the studied herpes viruses was associated with depressive symptoms. Methods IgM and IgG antibodies to T. gondii, EBV, HSV-1, and CMV were measured in a large Finnish population survey, the Health 2000 project, in year 2000. The 6250 participants were followed for 15 years via health care register and causes of death register. In addition, lifetime suicidal ideation and suicide attempts were assessed in a smaller subsample of 694 participants, based on systematically-evaluated self-report, medical records, and register data. The participants in the subsample were screened for possible psychotic symptoms or were controls; we controlled for this screen status in the regression models. Results We found no significant cross-sectional associations between baseline depressive symptom and the herpes infections, when controlling for background variables related to infection seropositivity. During the follow-up, 18 of the 6250 participants (0.3%) had either died by suicide or had a self-harm diagnosis. In Cox regression models, serological evidence of lifetime or acute infections was not found to be associated with these suicidal outcomes. In the subsample, 31% had had suicidal thoughts and 13% had attempted suicide. There were no significant associations between suicidal thoughts and infection seropositivity / antibody levels. However, those seropositive for IgG class antibodies for CMV, measuring latent infection, had fewer suicide attempts compared to those seronegative in multinomial logistic regression models adjusting for gender, age, education, childhood family size, regional residence, and screen status (OR for multiple attempts compared to no attempts =0.45, 95% confidence interval 0.22‒0.91, p=.026). Genders were investigated separately in post-hoc analyses and there were significant associations only in males: suicide attempts were associated negatively with CMV and positively with EBV. Looking separately at diagnosis groups, the CMV association was significant among those with a mood disorder and not among those with a psychotic disorder. C-reactive protein (CRP) measuring inflammation seemed to explain some but not all of the associations. Discussion In a large sample nationally representative of the whole Finnish adult population, antibodies to CMV, EBV, or HSV-1 were not associated with depressive symptoms. Seropositivity or antibody levels of T. gondii or herpes viruses were not associated with risk of subsequent death by suicide or intentional self-harm diagnoses at a 15 year follow-up. In the subsample consisting mostly of participants with severe mental disorders, in males, EBV antibody level was associated with a history of a suicide attempt and none of the other infection variables were associated with a heightened risk for suicidal thoughts or acts. We found a heightened risk for multiple suicide attempts in persons belonging to the CMV seronegative minority. This “protective effect” of being infected with CMV calls for further research.

Cathartic Effect of Suicide Attempts Not Limited to Depression

Crisis ◽  
2003 ◽  
Vol 24 (2) ◽  
pp. 73-78 ◽  
Author(s):  
Yves Sarfati ◽  
Blandine Bouchaud ◽  
Marie-Christine Hardy-Baylé
Keyword(s):  
Quality Of Life ◽  
Depressive Symptoms ◽  
Personality Traits ◽  
Rating Scales ◽  
Suicide Attempts ◽  
World Health ◽  
Life Questionnaire ◽  
Short Term

Summary: The cathartic effect of suicide is traditionally defined as the existence of a rapid, significant, and spontaneous decrease in the depressive symptoms of suicide attempters after the act. This study was designed to investigate short-term variations, following a suicide attempt by self-poisoning, of a number of other variables identified as suicidal risk factors: hopelessness, impulsivity, personality traits, and quality of life. Patients hospitalized less than 24 hours after a deliberate (moderate) overdose were presented with the Montgomery-Asberg Depression and Impulsivity Rating Scales, Hopelessness scale, MMPI and World Health Organization's Quality of Life questionnaire (abbreviated versions). They were also asked to complete the same scales and questionnaires 8 days after discharge. The study involved 39 patients, the average interval between initial and follow-up assessment being 13.5 days. All the scores improved significantly, with the exception of quality of life and three out of the eight personality traits. This finding emphasizes the fact that improvement is not limited to depressive symptoms and enables us to identify the relative importance of each studied variable as a risk factor for attempted suicide. The limitations of the study are discussed as well as in particular the nongeneralizability of the sample and setting.

scholarly journals The prospective relationship between social cohesion and depressive symptoms among older adults from Central and Eastern Europe

2018 ◽  
Vol 73 (2) ◽  
pp. 117-122 ◽  
Author(s):  
Carla Bertossi Urzua ◽  
Milagros A Ruiz ◽  
Andrzej Pajak ◽  
Magdalena Kozela ◽  
Ruzena Kubinova ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Eastern Europe ◽  
Social Cohesion ◽  
Regression Models ◽  
Central And Eastern Europe ◽  
The Czech Republic ◽  
Logistic Regression Models ◽  
Z Scores ◽  
Prospective Association

BackgroundSocial cohesion has a potential protective effect against depression, but evidence for Central and Eastern Europe is lacking. We investigated the prospective association between social cohesion and elevated depressive symptoms in the Czech Republic, Russia and Poland, and assessed whether alcohol drinking and smoking mediated this association.MethodsCohort data from 15 438 older urban participants from the Health, Alcohol and Psychosocial factors In Eastern Europe project were analysed. Baseline social cohesion was measured by five questions, and depressive symptoms were measured 3 years later by the 10-item Center for Epidemiological Depression (CES-D) Scale. Nested logistic regression models estimated ORs of elevated depressive symptoms (CES-D 10 score ≥4) by z-scores and tertiles of social cohesion.ResultsPer 1 SD decrease in social cohesion score, adjusted ORs of elevated depressive symptoms were 1.13 (95% CI 1.05 to 1.23) and 1.05 (95% CI 0.99 to 1.13) in men and women, respectively. Further adjustment for smoking and drinking did not attenuate these associations in either men (OR=1.13, 95% CI 1.05 to 1.22) or women (OR=1.05, 95% CI 0.99 to 1.13). Similarly, the fully adjusted ORs comparing the lowest versus highest social cohesion tertile were 1.33 (95% CI 1.10 to 1.62) in men and 1.18 (95% CI 1.01 to 1.39) in women.ConclusionsLower levels of social cohesion was associated with heightened depressive symptoms after a 3-year follow-up among older Czech, Russian and Polish adults. These effects appeared stronger in men, and alcohol and smoking played no appreciable role in this association.

scholarly journals The effect of sexual abuse and dissociation on suicide attempt

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Silje Støle Brokke ◽  
Thomas Bjerregaard Bertelsen ◽  
Nils Inge Landrø ◽  
Vegard Øksendal Haaland
Keyword(s):  
Sexual Abuse ◽  
Risk Factor ◽  
Suicide Attempt ◽  
Indirect Effects ◽  
Suicide Ideation ◽  
Suicide Attempts ◽  
Suicidal Thoughts ◽  
Dissociative Experiences ◽  
Self Harm

Abstract Background Suicide attempt is the most predictive risk factor of suicide. Trauma – especially sexual abuse – is a risk factor for suicide attempt and suicide. A common reaction to sexual abuse is dissociation. Higher levels of dissociation are linked to self-harm, suicide ideation, and suicide attempt, but the role of dissociation in suicidal behavior is unclear. Methods In this naturalistic study, ninety-seven acute psychiatric patients with suicidal ideation, of whom 32 had experienced sexual abuse, were included. Suicidal behaviour was assessed with The Columbia suicide history form (CSHF). The Brief trauma questionnaire (BTQ) was used to identify sexual abuse. Dissociative symptoms were assessed with Dissociative experiences scale (DES). Results Patients who had experienced sexual abuse reported higher levels of dissociation and were younger at onset of suicidal thoughts, more likely to self-harm, and more likely to have attempted suicide; and they had made more suicide attempts. Mediation analysis found dissociative experiences to significantly mediate a substantive proportion of the relationship between sexual abuse and number of suicide attempts (indirect effects = 0.17, 95% CI = 0.05, 0.28, proportion mediated = 68%). Dissociative experiences significantly mediated the role of sexual abuse as a predictor of being in the patient group with more than four suicide attempts (indirect effects = 0.11, 95% CI = 0.02, 0.19, proportion mediated = 34%). Conclusion The results illustrate the importance of assessment and treatment of sexual abuse and trauma-related symptoms such as dissociation in suicide prevention. Dissociation can be a contributing factor to why some people act on their suicidal thoughts.

scholarly journals Comparison of suicide risk and other outcomes among boys and girls who self-harm

2020 ◽  
Vol 29 (12) ◽  
pp. 1741-1746 ◽  
Author(s):  
Anna Ohlis ◽  
Johan Bjureberg ◽  
Paul Lichtenstein ◽  
Brian M. D’Onofrio ◽  
Alan E. Fruzzetti ◽  
...  
Keyword(s):  
Sex Differences ◽  
Suicide Attempts ◽  
Psychiatric Hospitalization ◽  
Economic Status ◽  
Adverse Outcomes ◽  
Hazard Ratios ◽  
Self Harm ◽  
Males And Females ◽  
Drug Use Disorder

Abstract Little is known about sex differences in outcomes of self-harm, and there are inconclusive results concerning the association between sex, self-harm, and suicide attempts. The aim of this study was to explore sex differences in outcomes of self-harm in adolescence. In this cohort study, all individuals (0–17 years) enrolled at the child- and adolescent mental health services (CAMHS) in Stockholm between 2001 and 2015 (N = 110,072) were followed in national registers from their last contact with the CAMHS, until end of 2015. Exposure was self-harm as reason for contact, outcome measures were: alcohol-/substance use disorder, psychiatric hospitalization, non-violent or violent crime, and suicide. Differences in outcomes rates between exposed versus unexposed males, and exposed versus unexposed females, were examined using Cox regressions, expressed as hazard ratios (HR) with 95% confidence intervals (CI). Median follow-up time was 5.8 years (Q1: 2.3 years; Q3: 9.7 years). Self-harm was documented in 2.2% (N = 1241) males and 8.7% (4716) females. Exposed individuals had higher HR for all outcomes as compared with unexposed individuals of their own sex. Exposed females had more pronounced risk for drug use disorder (HR 11.2; 95% CI 9.9–12.7) compared with exposed males (HR 6.5, 95% 5.2–8.0). Both males and females who had engaged in self-harm had elevated risks for future suicide. Adjusting for socio-economic status and age at start of follow-up only marginally affected the associations. Females and males with self-harm had similarly elevated risk for suicide, and self-harm was also an important risk marker for other adverse outcomes within both sexes.

Incidence and Predictors of Suicide Attempts in Bipolar I and II Disorders: A Five-year Follow-up

2017 ◽  
Vol 41 (S1) ◽  
pp. S87-S87
Author(s):  
S. Pallaskorpi ◽  
K. Suominen ◽  
M. Ketokivi ◽  
H. Valtonen ◽  
P. Arvilommi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Models ◽  
Suicide Attempts ◽  
Incidence Rates ◽  
Personality Factors ◽  
Long Term Study ◽  
Major Depressive Episodes ◽  
Depressive Episodes

IntroductionAlthough suicidal behavior is very common in bipolar disorder (BD), few long-term studies have investigated incidence and risk factors of suicide attempts (SAs) specifically related to illness phases of BD.ObjectivesWe examined incidence of SAs during different phases of BD in a long-term prospective cohort of bipolar I (BD-I) and II (BD-II) patients and risk factors specifically for SAs during major depressive episodes (MDEs).MethodsIn the Jorvi bipolar study (JoBS), 191 BD-I and BD-II patients were followed using life-chart methodology. Prospective information on SAs of 177 patients (92.7%) during different illness phases was available up to five years. Incidence of SAs and their predictors were investigated using logistic and Poisson regression models. Analyses of risk factors for SAs occurring during MDEs were conducted using two-level random-intercept logistic regression models.ResultsDuring the five-year follow-up, 90 SAs per 718 patient-years occurred. Compared with euthymia the incidence was highest, over 120-fold, during mixed states (765/1000 person-years [95% confidence interval (CI) 461–1269]) and also very high in MDEs, almost 60-fold (354/1000 [95%CI 277–451]). For risk of SAs during MDEs, the duration of MDEs, severity of depression and cluster C personality disorders were significant predictors.ConclusionsIn this long-term study, the highest incidences of SAs occurred in mixed phases and MDEs. The variations in incidence rates between euthymia and illness phases were remarkably large, suggesting that the question “when” rather than “who” may be more relevant for suicide risk in BD. However, risk during MDEs is likely also influenced by personality factors.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Influencing Factors of Multiple Adverse Outcomes Among Schizophrenia Patients Using Count Regression Models: A Cross-Sectional Study

2021 ◽  
Author(s):  
Lichang Chen ◽  
Wenyan Tan ◽  
Xiao Lin ◽  
Haicheng Lin ◽  
Junyan Xi ◽  
...  
Keyword(s):  
Risk Factor ◽  
Influencing Factors ◽  
Violent Crime ◽  
Regression Models ◽  
Negative Binomial ◽  
Suicide Attempts ◽  
Adverse Outcomes ◽  
Different Types ◽  
History Of ◽  
Self Harm

Abstract Background: Schizophrenia patients have increased risks of several adverse outcomes, including violent crime, aggressiveness and suicide. However, studies of different adverse outcomes in the same population are rare and the influencing factors for these outcomes need clarification by appropriate models. This study aimed to identify influencing factors of these adverse outcomes by examining and comparing different count regression models.Methods: This study included schizophrenia patients who had at least once follow-up record in the Guangdong Mental Health Center Network Medical System during 2020. Three types of adverse outcomes including a) aggressiveness with police dispatch or violence crime, b) aggressiveness without police dispatch, and c) self-harm or suicide attempts. First, we investigated the incidence of these adverse outcomes in each type. Second, the Poisson, negative binomial (NB), zero-inflated Poisson (ZIP), and zero-inflated negative binomial (ZINB) regression models were fitted and compared for their intensity. Finally, We analysed associations between these adverse outcomes intensity and sociodemographic, clinical factors with the best model. Results: A total of 130474 schizophrenia patients were selected. Each type of adverse outcomes was reported by less than 1% of schizophrenia patients in 2020. NB regression model is the best model for fitting the number of aggressiveness without police dispatch because of the best goodness of fit and relatively simple interpretation, whereas ZINB models for the other two outcomes. Age, sex, and history of adverse outcomes were influencing factors shared across these adverse outcomes. Higher educational level, employment were protective factors shared between aggressiveness with police dispatch or violent crime , and aggressiveness without police dispatch. Aggressiveness without police dispatch , and self-harm or suicide attempts shared older onset age (≥18 years) as a risk factor. Family history of mental disease was a risk factor of self-harm or suicide attempts individually.Conclusions: NB and ZINB models were selected for fitting the number of adverse outcomes in our studies. Influencing factors for adverse outcomes intensity included both those shared across different types and those individual to specific types. Therefore, combined and customized tools in risk assessment and intervention for different types of these outcomes might be necessary.

Prevalence and Predictors of Physically Self-Destructive Acts over Time

2018 ◽  
pp. 87-98
Author(s):  
Mary C. Zanarini
Keyword(s):  
Major Depression ◽  
Help Seeking ◽  
Suicide Attempts ◽  
Survival Strategies ◽  
Affective States ◽  
Self Mutilation ◽  
Suicide Threats ◽  
Self Harm ◽  
Over Time

Self-mutilation and help-seeking suicide threats and attempts are among the few almost pathognomonic symptoms of BPD. This chapter assesses predictors of self-harm and reasons for self-harm over time. It also assesses predictors of suicide threats and attempts over the years of prospective follow-up. Each outcome has a different set of multivariate predictors, but some appear in several multivariate models. More specifically, sexual adversity in childhood and adulthood, major depression, and severity of dissociation are predictors of self-mutilation; and sexual adversity in adulthood, major depression, and severity of dissociation are predictors of suicide attempts. However, these factors do not play a role in predicting suicide threats. Instead, two dysphoric affective states and two outmoded interpersonal survival strategies are the best set of predictors of suicide threats.

scholarly journals An exploratory randomised trial of a simple, brief psychological intervention to reduce subsequent suicidal ideation and behaviour in patients admitted to hospital for self-harm

2016 ◽  
Vol 208 (5) ◽  
pp. 470-476 ◽  
Author(s):  
Christopher J. Armitage ◽  
Wirda Abdul Rahim ◽  
Richard Rowe ◽  
Rory C. O'Connor
Keyword(s):  
Suicidal Ideation ◽  
Suicide Attempts ◽  
Psychological Intervention ◽  
Implementation Intentions ◽  
Randomised Trial ◽  
Implementation Intention ◽  
High Risk Group ◽  
Coping Responses ◽  
Self Harm

BackgroundImplementation intentions link triggers for self-harm with coping skills and appear to create an automatic tendency to invoke coping responses when faced with a triggering situation.AimsTo test the effectiveness of implementation intentions in reducing suicidal ideation and behaviour in a high-risk group.MethodTwo hundred and twenty-six patients who had self-harmed were randomised to: (a) forming implementation intentions with a ‘volitional help sheet’; (b) self-generating implementation intentions without help; or (c) thinking about triggers and coping, but not forming implementation intentions. We measured self-reported suicidal ideation and behaviour, threats of suicide and likelihood of future suicide attempt at baseline and then again at the 3-month follow-up.ResultsAll suicide-related outcome measures were significantly lower at follow-up among patients forming implementation intentions compared with those in the control condition (ds>0.35). The volitional help sheet resulted in fewer suicide threats (d = 0.59) and lowered the likelihood of future suicide attempts (d = 0.29) compared with patients who self-generated implementation intentions.ConclusionsImplementation intention-based interventions, particularly when supported by a volitional help sheet, show promise in reducing future suicidal ideation and behaviour.

scholarly journals Understanding and managing suicide risk

2020 ◽  
Vol 134 (1) ◽  
pp. 73-84
Author(s):  
Tiago C Zortea ◽  
Seonaid Cleare ◽  
Ambrose J Melson ◽  
Karen Wetherall ◽  
Rory C O’Connor
Keyword(s):  
Suicide Risk ◽  
Suicide Attempts ◽  
Psychosocial Interventions ◽  
Crisis Response ◽  
Individual Risk ◽  
Global Public Health ◽  
Self Harm ◽  
Meta Analyses ◽  
Better Than

Abstract Background Suicidal behaviours and non-suicidal self-harm (NSSH) are global public health concerns that affect millions of lives. Sources of data This review is a narrative synthesis of systematic reviews, meta-analyses of randomized control trials (RCTs) and landmark studies published in scientific journals. Areas of agreement Restricting access to lethal means reduces the likelihood of future suicide deaths. Areas of controversy Our ability to predict future suicidal behaviour is no better than chance. No individual risk prediction instrument offers sufficient sensitivity and specificity to inform clinically useful decision-making. Growing points Different types of psychosocial interventions may be effective in preventing future suicide attempts; such interventions include clinical assessment, tailored crisis response and safety plans and follow-up contact. Areas timely for developing research Whilst some psychosocial interventions can be effective in reducing suicide risk, little is known about the mechanisms of recovery from suicidal thoughts and behaviours.

scholarly journals The impact of trauma, substance abuse, and psychiatric illness on suicidal and self-harm behaviours in a cohort of migrant detainees: An observational, prospective study

2020 ◽  
pp. 002076402097900
Author(s):  
Mattia Marchi ◽  
Cecilia Artoni ◽  
Fedora Longo ◽  
Federica Maria Magarini ◽  
Giovanni Aprile ◽  
...  
Keyword(s):  
Substance Abuse ◽  
Suicide Attempts ◽  
War Trauma ◽  
Migration Trauma ◽  
History Of ◽  
Self Harm ◽  
Measure Of Association ◽  
Migration Experiences ◽  
The Impact

Background: According to the WHO, detainees attempt suicide ten times more than the general population. Aims: To investigate the impact of migration trauma on Suicidal and Self-Harm Behaviours (SSHB) of migrants in jail and to explore how substance use and other psychiatric features affect this relationship. Methods: Prospective cohort study, conducted at the ‘Sant’Anna’ jail in Modena (Italy) between February 2017 and September 2019. Socio-demographic, psychiatric features and records of previous SSHB were collected. Experience of migration-related trauma was assessed with the LiMEs (List of Migration Experiences) checklist. Participants were followed-up for the occurrence of further SSHB. Survival analysis was performed and Cox’s Hazard Ratios (HR) were used as a measure of association of comparisons. Results: Amongst the 112 subjects (96% male, median age 33), the prevalence of any mental disorder was 26% and of substance abuse 59%. History of SSHB was present in 36% of the sample. Median follow-up time was 80 days. During follow-up, 11 events were observed (of which three were suicide attempts). Cumulative survival probability was 85%. Having experienced trauma related to war and violence was significantly associated with SSHB, HR: 7.05. No SSHB were recorded amongst subjects without substance abuse. Conclusions: Migrants in custody who experienced trauma in the post-migration period, attempt SSHB seven times more frequently than those without traumas at any time. War trauma and post-migration trauma due to exposure to violence seem to be more strongly associated with SSHB, also controlling for psychiatric diagnosis, ongoing psychopharmacological therapy and substance abuse. Further research and possible intervention programs should focus on addressing post-migration living-difficulties.

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