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

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.

Crisis ◽  
2014 ◽  
Vol 35 (1) ◽  
pp. 60-66 ◽  
Author(s):  
Amanda Venta ◽  
Carla Sharp

Background: Identifying risk factors for suicide-related thoughts and behaviors (SRTB) is essential among adolescents in whom SRTB remain a leading cause of death. Although many risk factors have already been identified, influential theories now suggest that the domain of interpersonal relationships may play a critical role in the emergence of SRTB. Because attachment has long been seen as the foundation of interpersonal functioning, we suggest that attachment insecurity warrants attention as a risk factor for SRTB. Aims: This study sought to explore relations between attachment organization and suicidal ideation, suicide attempts, and self-harm in an inpatient adolescent sample, controlling for demographic and psychopathological covariates. Method: We recruited 194 adolescents from an inpatient unit and assigned them to one of four attachment groups (secure, preoccupied, dismissing, or disorganized attachment). Interview and self-report measures were used to create four variables reflecting the presence or absence of suicidal ideation in the last year, single lifetime suicide attempt, multiple lifetime suicide attempts, and lifetime self-harm. Results: Chi-square and regression analyses did not reveal significant relations between attachment organization and SRTB, although findings did confirm previously established relations between psychopathology and SRTB, such that internalizing disorder was associated with increased self-harm, suicide ideation, and suicide attempt and externalizing disorder was associated with increased self-harm. Conclusion: The severity of this sample and methodological differences from previous studies may explain the nonsignificant findings. Nonsignificant findings may indicate that the relation between attachment organization and SRTB is moderated by other factors that should be explored in future research.


2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Anna Hansen ◽  
Dessi Slavova ◽  
Gena Cooper ◽  
Jaryd Zummer ◽  
Julia Costich

Abstract Background Non-suicidal self-injury and suicide attempts are increasing problems among American adolescents. This study developed a definition for identifying intentional self-harm (ISH) injuries in emergency department (ED) records coded with International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes. The definition is based on the injury-reporting framework proposed by the Centers for Disease Control and Prevention. The study sought to estimate the definition’s positive predictive value (PPV), and the proportion of ISH injuries with intent to die (i.e., suicide attempt). Methods The study definition, based on first-valid external cause-of-injury ICD-10-CM codes X71-X83, T14.91, T36-T65, or T71, captured 207 discharge records for initial encounters for ISH in one Kentucky ED. Medical records were reviewed to confirm provider-documented diagnosis for ISH, and identify intent to die or suicide ideation. The PPV of the study definition for capturing provider-documented ISH injuries was reported with its 95% confidence interval (95% CI). Results The estimated PPV for the study definition to capture ISH injuries was 88.9%, 95% CI (83.8%, 92.8%). The estimated percentage of ISH with intent to die was 45.9, 95% CI (47.1, 61.0%). The ICD-10-CM code “suicide attempt” (T14.91) captured only 7 cases, but coding guidelines restrict assignment of this code to cases in which the mechanism of the suicide attempt is unknown. Conclusions The proposed case definition supported a robust PPV for ISH injuries. Our findings add to the evidence that the current ICD-10-CM coding system and coding guidelines do not allow identification of ISH with intent to die; modifications are needed to address this issue.


2020 ◽  
Author(s):  
Craig Sewall ◽  
Jeffrey M. Girard

ABSTRACTBackground: Youth with bipolar disorder (BD) are at high risk for suicidal thoughts and behaviors and frequently experience interpersonal impairment, which is a risk factor for suicide. Yet, no study to date has examined the longitudinal associations between relationship quality in family/peer domains and suicidal thoughts and behaviors among youth with BD. Thus, we investigated how between-person differences--reflecting the average relationship quality across time--and within-person changes, reflecting recent fluctuations in relationship quality, act as distal and/or proximal risk factors for suicidal ideation (SI) and suicide attempts. Methods: We used longitudinal data from the Course and Outcome of Bipolar Youth Study (N=413). Relationship quality variables were decomposed into stable (i.e. average) and varying (i.e. recent) components and entered, along with major clinical covariates, into separate Bayesian multilevel models predicting SI and suicide attempt. We also examined how the relationship quality effects interacted with age and sex. Results: Poorer average relationship quality with parents (β= -0.33, 95% Bayesian Highest Density Interval (HDI) [-0.54, -0.11]) or friends (β= -0.33, 95% HDI [-0.55, -0.11]) were longitudinally associated with increased risk of SI but not suicide attempt. Worsening recent relationship quality with parents (β= -0.10, 95% HDI [-0.19, -0.03]) and, to a lesser extent, friends (β= -0.06, 95% HDI [-0.15, 0.03]), were also longitudinally associated with increased risk of SI. Worsening recent relationship quality with parents may also be associated with increased risk of suicide attempt (β= -0.13, 95% HDI [-0.29, 0.03]). The effects of certain relationship quality variables were moderated by gender but not age. Conclusions: Among youth with BD, having poorer average relationship quality with peers and/or parents represents a distal risk factor for SI but not suicide attempts. Additionally, worsening recent relationship quality with parents that is may be a time-sensitive indicator of increased risk for SI or suicide attempt.


Crisis ◽  
2010 ◽  
Vol 31 (6) ◽  
pp. 317-327 ◽  
Author(s):  
Omobolawa Y. Kukoyi ◽  
Faisal M. Shuaib ◽  
Sheila Campbell-Forrester ◽  
Lisabeth Crossman ◽  
Pauline E. Jolly

Background: Although extensive studies on adolescent suicidal behavior have been conducted in developed countries such as the United States, little data exist on risk factors for suicide among adolescents in culturally and socially disadvantages settings, such as Jamaica. Aims: To conduct a preliminary investigation of risk factors associated with suicide ideation and attempt among youths in Western Jamaica. Methods: We conducted a cross-sectional study of 342 adolescents aged 10–19 years from 19 schools. Results: Multivariate analysis showed that a history of self-violence, violent thoughts toward others, mental health diagnoses other than depression, and a history of sexual abuse were positively associated with suicide attempt. Sexual abuse, mental health diagnoses other than depression, self-violence, and ease of access to lethal substances/weapons were positively associated with suicide ideation. Conclusions: We found a relatively high prevalence of suicide ideation and suicide attempts among adolescents living in Western Jamaica. An accurate understanding of the prevailing risk factors for suicide attempts will promote a more sympathetic approach to victims and facilitate prevention efforts.


Author(s):  
Leah Shelef ◽  
Jessica M Rabbany ◽  
Peter M Gutierrez ◽  
Ron Kedem ◽  
Ariel Ben Yehuda ◽  
...  

Past suicide attempts are a significant risk factor for future suicidality. Therefore, the present military-based study examined the past suicidal behavior of soldiers who recently made a severe suicide attempt. Our sample consisted of 65 active-duty soldiers (61.5% males), between the ages of 18 and 28 years old (M = 20.4, SD ± 1.3). The inclusion criterion was a recent severe suicide attempt, requiring at least a 24 h hospitalization. This sample was divided into two groups, according to previous suicidal behavior, namely whether their first suicide attempt was before or after enlistment (n = 25; 38.5% and n = 40; 61.5%, respectively). We then examined the lethality and intent of the recent event in regard to this division. Four measures were used to assess the subjects’ suicidal characteristics: the Columbia Suicide Severity Rating Scale, the Self-Harm Behavior Questionnaire, the Suicidal Behaviors Questionnaire-Revised, and the Beck Scale for Suicide Ideation. No significant difference in the severity of the suicide attempts (either actual or potential severity) were found between those who had suicide attempts before enlistment and those who had their first attempt in the service. As a matter of fact, most of the suicide attempts that occurred for the first time during military service had used a violent method (58.3%, n = 21). Finally, using multivariate analyses, we found that current thoughts and behavior, rather than past suicidality, was the strongest predictor for the lethality of suicide attempts.


2018 ◽  
Vol 212 (4) ◽  
pp. 234-238 ◽  
Author(s):  
Kai-Lin Huang ◽  
Han-Ting Wei ◽  
Ju-Wei Hsu ◽  
Ya-Mei Bai ◽  
Tung-Ping Su ◽  
...  

BackgroundAttention-deficit hyperactivity disorder (ADHD) increases the risk of suicidal behaviours through psychiatric comorbidities; however, a significant direct association has not been observed between ADHD and suicide attempts.AimsTo evaluate the risk of suicide attempt in adolescents and young adults with ADHD.MethodUsing a nationwide, population-based insurance claims database, this longitudinal cohort study enrolled 20 574 adolescents and young adults with ADHD and 61 722 age- and gender-matched controls between 2001 and 2009. Any suicide attempt was identified from enrolment to 31 December 2011. The association between ADHD medications and the likelihood of suicide attempt was assessed.ResultsADHD was an independent risk factor for any suicide attempt (hazard ratio = 3.84, 95% CI = 3.19–4.62) and repeated suicide attempts (hazard ratio = 6.52, 95% CI = 4.46–9.53). Subgroup analyses of men, women, adolescents and young adults demonstrated the same trend. Methylphenidate or atomoxetine treatment did not increase the risk of suicide attempt or repeated suicide attempts. Long-term methylphenidate treatment was associated with a significantly decreased risk of repeated suicide attempts in men (hazard ratio = 0.46, 95% CI = 0.22–0.97).ConclusionADHD was a risk factor for suicide attempt and a stronger predictor of repeated suicide attempts, independent of comorbidities. Further investigation is warranted to explore the mechanism underlying the association between ADHD and suicidal behaviours.Declaration of interestNone.


2018 ◽  
Vol 24 (1) ◽  
pp. 37-45
Author(s):  
Jessica Yakeley ◽  
William Burbridge-James

SUMMARYRates of suicide and self-harm are rising in many countries, and it is therapeutically important to explore the personal stories and relationships that underlie this behaviour. In this article psychoanalytic and psychodynamic principles and concepts in relation to violence towards the self are introduced and the various unconscious meanings of suicide and self-harm are explored within a relational context and attachment framework. We describe how a psychodynamic approach may enhance the risk assessment and treatment of patients presenting with self-harm and suicidality, particularly examining the role of transference and countertransference within the therapeutic relationship.LEARNING OBJECTIVES•Understand historical and contemporary psychoanalytic theories and concepts regarding the aetiology of suicide and self-harm•Understand the different meanings and expressions of acts of suicide and self-harm•Understand the use of countertransference in the risk assessment and management of self-harm and suicide attemptsDECLARATION OF INTERESTNone.


2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e45-e45 ◽  
Author(s):  
Rachel Mitchell ◽  
Cornelius Ani ◽  
James Irvine ◽  
Claude Cyr ◽  
Ari Joffe ◽  
...  

Abstract Background Suicide is the second leading cause of death among Canadian adolescents. Youth who make near fatal suicide attempts, such as those requiring intensive care unit (ICU) level care, are the closest proxy to those that die by suicide; however, there is limited data on this group. Objectives To evaluate the minimum incidence rate and patterns of presentation of youth (under 18 years of age) admitted to the ICU for medically serious self-inflicted injury. Design/Methods From January 2017 to December 2018, over 2,700 paediatricians/subspecialist members of the Canadian Paediatric Surveillance Program were electronically surveyed on a monthly basis regarding cases of medically serious self-harm. Participants completed a detailed questionnaire about the reported case and descriptive statistics were used for analyses. Results Ninety-four cases (71 female; mean age 15.2 years) of confirmed (n=87) and suspected/probable (n=7) medically serious self-harm were reported. The majority (87%) of cases were reported from 4 out of 13 provinces and territories in Canada (Alberta, British Columbia, Ontario, Quebec). There were 11 deaths by suicide (M>F; p<.05). Medication ingestion was the most common method of self-harm among females (76% F vs. 52% M; p=.03) compared with hanging among males (14% F vs. 39% M; p=.009). More females than males had a prior suicide attempt (62% F vs. 32% M; p=.07) and a history of non-suicidal self-injury (NSSI) (65% F vs. 14% M; p<.05), although only history of NSSI reached significance. More females than males had a past psychiatric diagnosis (77% F vs. 55% M; p=.05), and past use of mental health services (69% F vs. 30% M; p<.001), although only service use reached significance. Half of the youth left evidence of intent (54%) and 33% of parents of included youth were aware that their child was considering suicide. Family conflict was the most common precipitating factor for suicide attempt in both females and males (46%). Conclusion These Canadian findings are consistent with international epidemiologic data that observe a gender paradox of higher rates of suicide attempts in females and greater mental health care engagement but increased suicide mortality in males with decreased involvement with mental health care. This study suggests that family conflict is a potential target for suicide prevention interventions among youth. Future research focusing on gender-specificity in risk factor identification and effectiveness of primary prevention interventions among youth is warranted.


2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S86-S87
Author(s):  
Maija Lindgren ◽  
Minna Holm ◽  
Niina Markkula ◽  
Tommi Härkänen ◽  
Faith Dickerson ◽  
...  

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.


1967 ◽  
Vol 21 (3) ◽  
pp. 745-751 ◽  
Author(s):  
Sherman Eisenthal

Suicide-attempt, suicide-ideation, and non-suicidal control groups of VA neuro-psychiatric patients were divided into psychotic and neurotic subgroups ( ns = 15). Ss viewed two classes of slides, a series of death scenes and one of unpleasant scenes. Each series contained both aggressive and non-aggressive content. Analyses of this 3 × 2 × 2 factorial design, with repeated measures, were based on measures of viewing time, rated tension, and rated liking. Aggressive slides induced greater threat than non-aggressive slides to a significant degree in the death slide series and to a lesser degree in the unpleasant slide series. Suicidal patients did not manifest a consistent style of response to aggressive slides in either series. The measure of aggressive mood also was not different for suicidal and non-suicidal patients. Suicide ideators did not differentiate aggressive and non-aggressive slides but attempters and controls did. The role of anxiety level was discussed.


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