Psychiatric Diagnoses as Predictors of Suicide

1990 ◽  
Vol 157 (3) ◽  
pp. 339-344 ◽  
Author(s):  
Peter Allebeck ◽  
Christer Allgulander
Keyword(s):  
Patient Care ◽  
Psychiatric Diagnosis ◽  
Military Service ◽  
Suicide Risk ◽  
Psychiatric Care ◽  
Strong Predictor ◽  
Neurotic Disorder ◽  
Increased Risk ◽  
Almost All

In a cohort of 50 465 Swedish men conscripted for military service in 1969–70, the relative risk for suicide was 3.1 (95% CI 2.3–4.0) among those who had a psychiatric diagnosis at conscription, and 16.7 (95% CI 13.8–20.1) among those who had a psychiatric diagnosis in in-patient care during a 13-year follow-up. Of the diagnoses at conscription, only neurotic disorder, personality disorder and drug dependence were associated with a significantly increased risk for future suicide. Among those who were admitted to hospital, almost all inpatient diagnoses were associated with a significantly increased suicide risk. Although a psychiatric diagnosis in in-patient care was a strong predictor of suicide, only 44% of all 247 men who committed suicide had ever been treated in in-patient psychiatric care.

scholarly journals An Emulation of Randomized Trials of Administrating Antipsychotics in PTSD Patients for Outcomes of Suicide-Related Events

2021 ◽  
Vol 11 (3) ◽  
pp. 178
Author(s):  
Noah R. Delapaz ◽  
William K. Hor ◽  
Michael Gilbert ◽  
Andrew D. La ◽  
Feiran Liang ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Previous History ◽  
Current Treatment ◽  
Careful Consideration ◽  
P Value ◽  
Post Traumatic Stress ◽  
Increased Risk ◽  
History Of ◽  
Almost All

Post-traumatic stress disorder (PTSD) is a prevalent mental disorder marked by psychological and behavioral changes. Currently, there is no consensus of preferred antipsychotics to be used for the treatment of PTSD. We aim to discover whether certain antipsychotics have decreased suicide risk in the PTSD population, as these patients may be at higher risk. A total of 38,807 patients were identified with a diagnosis of PTSD through the ICD9 or ICD10 codes from January 2004 to October 2019. An emulation of randomized clinical trials was conducted to compare the outcomes of suicide-related events (SREs) among PTSD patients who ever used one of eight individual antipsychotics after the diagnosis of PTSD. Exclusion criteria included patients with a history of SREs and a previous history of antipsychotic use within one year before enrollment. Eligible individuals were assigned to a treatment group according to the antipsychotic initiated and followed until stopping current treatment, switching to another same class of drugs, death, or loss to follow up. The primary outcome was to identify the frequency of SREs associated with each antipsychotic. SREs were defined as ideation, attempts, and death by suicide. Pooled logistic regression methods with the Firth option were conducted to compare two drugs for their outcomes using SAS version 9.4 (SAS Institute, Cary, NC, USA). The results were adjusted for baseline characteristics and post-baseline, time-varying confounders. A total of 5294 patients were eligible for enrollment with an average follow up of 7.86 months. A total of 157 SREs were recorded throughout this study. Lurasidone showed a statistically significant decrease in SREs when compared head to head to almost all the other antipsychotics: aripiprazole, haloperidol, olanzapine, quetiapine, risperidone, and ziprasidone (p < 0.0001 and false discovery rate-adjusted p value < 0.0004). In addition, olanzapine was associated with higher SREs than quetiapine and risperidone, and ziprasidone was associated with higher SREs than risperidone. The results of this study suggest that certain antipsychotics may put individuals within the PTSD population at an increased risk of SREs, and that careful consideration may need to be taken when prescribed.

P1818Descending aortic thoracic diameter: a risk marker for major adverse cardiovascular outcomes in women

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
O L Rueda Ochoa ◽  
L R Bons ◽  
S Rohde ◽  
K E L Ghoud ◽  
R Budde ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Risk ◽  
Cardiovascular Mortality ◽  
Total Mortality ◽  
Population Based ◽  
Cardiovascular Outcomes ◽  
Increased Risk ◽  
Almost All

Abstract Background Thoracic aortic diameters have been associated with cardiovascular risk factors and atherosclerosis. However, limited evidence regarding the role of thoracic aortic diameters as risk markers for major cardiovascular outcomes among women and men exist. Purpose To evaluate the independent associations between crude and indexed ascending and descending aortic (AA and DA) diameters with major cardiovascular outcomes among women and men and to provide optimal cutoff values associated with increased cardiovascular risk. Methods and results 2178 women and men ≥55 years from the prospective population-based Rotterdam Study underwent multi-detector CT scan of thorax. Crude diameters of the AA and DA were measured and indexed by height, weight, body surface area (BSA) and body mass index (BMI). Incidence of stroke, coronary heart disease (CHD), heart failure (HF), cardiovascular and all-cause mortality were evaluated during 13 years of follow-up. Weight-, BSA-, or BMI-indexed AA diameters showed significant associations with total or cardiovascular mortality in both sexes and height-indexed values showed association with HF in women. Crude AA diameters were associated with stroke in men and HF in women. For DA, crude and almost all indexed diameters showed significant associations with either stroke, HF, cardiovascular or total mortality in women. Only weight-, BSA- and BMI-indexed values were associated with total mortality in men. For crude DA diameter, the risk for stroke increased significantly at the 75th percentile among men while the risks for HF and cardiovascular mortality increased at the 75th and 85th percentiles respectively in women. Conclusions Our study suggests a role for descending thoracic aortic diameter as a marker for increased cardiovascular risk, in particular for stroke, heart failure and cardiovascular mortality among women. The cut points for increased risk for several of cardiovascular outcomes were below the 95th percentile of the distribution of aortic diameters.

scholarly journals Repetition of deliberate self-harm and subsequent suicide risk: Long-term follow-up study of 11 583 patients

2004 ◽  
Vol 185 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Daniel Louis Zahl ◽  
Keith Hawton
Keyword(s):  
Relative Risk ◽  
Suicide Risk ◽  
Single Episode ◽  
Deliberate Self Harm ◽  
Young Females ◽  
Follow Up Study ◽  
Increased Risk ◽  
Self Harm

BackgroundRepetition of deliberate self-harm (DSH) is a risk factor for suicide. Little information is available on the risk for specific groups of people who deliberately harm themselves repeatedly.AimsTo investigate the long-term risk of suicide associated with repetition of DSH by gender, age and frequency of repetition.MethodA mortality follow-up study to the year 2000 was conducted on 11583 people who presented to the general hospital in Oxford between 1978 and 1997. Repetition of DSH was determined from reported episodes prior to the index episode and episodes presenting to the same hospital during the follow-up period. Deaths were identified through national registers.ResultsThirty-nine percent of patients repeated the DSH. They were at greater relative risk of suicide than the single-episode DSH group (2.24; 95% CI 1.77–2.84). The relative risk of suicide in the repeated DSH group compared with the single-episode DSH group was greater in females (3.5; 95% C11.3–2.4) than males (1.8; 95% C1 2.3–5.3) and was inversely related to age (up to 54 years). Suicide risk increased further with multiple repeat episodes of DSH in females.ConclusionsRepetition of DSH is associated with an increased risk of suicide in males and females. Repetition may be a better indicator of risk in females, especially young females.

Examining the link between prior suicidality and subsequent suicidal ideation among high-risk US military service members

2018 ◽  
Vol 49 (13) ◽  
pp. 2237-2246 ◽  
Author(s):  
Melanie A. Hom ◽  
Mary E. Duffy ◽  
Megan L. Rogers ◽  
Jetta E. Hanson ◽  
Peter M. Gutierrez ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Military Service ◽  
Suicide Risk ◽  
Self Report ◽  
Service Members ◽  
Thwarted Belongingness ◽  
Us Military ◽  
Military Service Members ◽  
The Relationship

AbstractBackgroundResearch is needed to identify the factors that explain the link between prior and future suicidality. This study evaluated possible mediators of the relationship between: (1) the severity of prior suicidality and (2) suicidal ideation severity at 3-month follow-up among a sample of high-risk military personnel.MethodsUS military service members referred to or seeking care for suicide risk (N = 624) completed self-report psychiatric domain measures and a clinician interview assessing prior suicidality severity at baseline. Three months later, participants completed a self-report measure of suicidal ideation severity. Three separate percentile bootstrap mediation models were used to examine psychiatric factors (i.e. alcohol abuse, anxiety sensitivity, hopelessness, insomnia, posttraumatic stress symptoms, suicidal ideation, and thwarted belongingness) as parallel mediators of the relationship between prior suicidality severity (specifically, suicidal ideation, suicide attempt, and overall suicidality – i.e. ideation/attempt severity combined) at baseline and suicidal ideation severity at follow-up.ResultsHopelessness, specifically, and the total effect of all mediators, each significantly accounted for the relationship between prior suicidality severity and subsequent ideation severity across models. In the models with attempt severity and overall suicidality severity as predictors, thwarted belongingness was also a significant mediator.ConclusionsHopelessness, thwarted belongingness, and overall severity of psychiatric indices may explain the relationship between prior suicidality severity and future suicidal ideation severity among service members at elevated suicide risk. Research is needed to replicate these findings and examine other possible mediators.

scholarly journals Loneliness as a risk factor for frailty transition among older Chinese people

2020 ◽  
Author(s):  
SHA SHA ◽  
Yuebin Xu ◽  
Lin Chen
Keyword(s):  
Strong Predictor ◽  
Frailty Index ◽  
Outcome Variable ◽  
Physical Frailty ◽  
Healthy Longevity ◽  
Increased Risk ◽  
Older Chinese ◽  
Definition Of ◽  
High Level

Abstract Background: Previous literature has reported that loneliness is a strong predictor of frailty risk. However, less is known about the role of loneliness in frailty transition types. This study aimed to examine whether and how loneliness are related to frailty transition among older Chinese people.Methods: Our study used participants (aged ≥60 years) from 2008/2009, 2011/2012 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Loneliness was assessed by a single question asking how often the respondent feels lonely. The FRAIL Scale was created to measure physical frailty for our study, and frailty was also assessed by a broader definition of the frailty index. Frailty transition as an outcome variable has been designed as two types according to the measurement of frailty.Results: Greater loneliness at baseline reduced the possibility of remaining in a robust or prefrail physical frailty state after 3 years (OR=0.78, 95%CI: 0.68–0.91, p<0.01). Greater loneliness was associated with an increased risk of worsening physical frailty over time: compared with those who had never felt lonely, the odds ratios for people who often felt lonely were 1.19 (95%CI: 1.01–1.41, p<0.05) after 3 years and 1.34 (95%CI: 1.08–1.66, p<0.01) after 6 years. The association between loneliness and change in the frailty index differed in the survey periods: loneliness at baseline was found to increase the possibility of participants remaining in frailty (seldom loneliness: OR= 1.78, 95%CI: 1.25–2.55, p<0.01; often loneliness: OR= 1.74, 95%CI: 1.21–2.50, p<0.01) after 6 years, but no significance was shown in the 3-year follow up. Additionally, loneliness at baselines was significantly associated with frailty transition at follow up among the male participants. However, a similar association was not observed among the female participants.Conclusion: Older people with a high level of loneliness tend to be frail in the future, and greater loneliness is related to an increased risk of worsening frailty and remaining frail. Male elderly with a high level of loneliness were more likely to have a worse frailty transition than female elderly in China.

Prognostic Significance of Visit-To-Visit Variability, Maximum and Minimum LDL Cholesterol in Diabetes Mellitus

2021 ◽  
Author(s):  
Chang-Sheng Sheng ◽  
Ya Miao ◽  
Lili Ding ◽  
Yi Cheng ◽  
Dan Wang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Placebo Group ◽  
Primary Outcome ◽  
Total Population ◽  
Therapy Group ◽  
Strong Predictor ◽  
Prognostic Significance ◽  
Total Mortality ◽  
Increased Risk

Abstract BACKGROUND Current guidelines for dyslipidemia management recommended that the LDL_C goal could be lower to less than 70 mg/dL. The present study was to investigate the prognostic significance of the visit-to-visit variability in LDL_C, and minimum and maximum LDL_C during follow-up in Diabetes mellitus. METHODS We studied the risk of outcomes in relation to visit-to-visit LDL_c variability in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Lipid trial. LDL_c variability indices were coefficient of variation (CV), variability independent of the mean (VIM), and average real variability (ARV). Multivariable Cox proportional hazards models were employed to estimate adjusted hazard ratio (HR) and 95% confidence interval (CI). RESULTS Compared with the placebo group (n=2667), Fenofibrate therapy group (n=2673) had significantly (P<0.01) lower mean of plasma triglyceride (152.5 vs. 178.6 mg/dl), total cholesterol (158.3 vs.162.9 mg/dl), but similar mean LDL_C during follow-up (88.2 vs.88.6 mg/dl, P>0.05). All three variability indices were associated with primary outcome, total mortality and cardiovascular mortality both in total population and in Fenofibrate therapy group, but only with primary outcome in the placebo group. The minimum LDL_C but not the maximum during follow-up was significantly associated with various outcomes in total population, fenofibrate therapy and placebo group. The minimum LDL_C during follow-up ≥70 mg/dl was associated with increased risk for various outcomes. CONCLUSIONS Visit-to-visit variability in LDL_C was a strong predictor of outcomes, independent of mean LDL_C. Patients with LDL_C be controlled to less than 70 mg/dl at least once during follow-up might have a benign prognosis.

scholarly journals Cannabis and suicide: longitudinal study

2009 ◽  
Vol 195 (6) ◽  
pp. 492-497 ◽  
Author(s):  
Ceri Price ◽  
Tomas Hemmingsson ◽  
Glyn Lewis ◽  
Stanley Zammit ◽  
Peter Allebeck
Keyword(s):  
Mental Health ◽  
Longitudinal Study ◽  
Suicidal Ideation ◽  
Military Service ◽  
Mental Health Problems ◽  
Strong Association ◽  
Cannabis Use ◽  
Completed Suicide ◽  
Increased Risk

BackgroundSome studies suggest that cannabis use is associated with suicidal ideation, but no detailed longitudinal study has examined suicide as an outcome.AimsTo examine the association between cannabis use and completed suicide.MethodA longitudinal study investigated 50 087 men conscripted for Swedish military service, with cannabis use measured non-anonymously at conscription. Suicides during 33 years of follow-up were identified by linkage with the National Cause of Death Register.ResultsThere were 600 (1.2% of cohort) suicides or deaths from undetermined causes. Cannabis use was associated with an increased risk of suicide (crude OR for ‘ever use’ 1.62, 95% CI 1.28–2.07), but this association was eliminated after adjustment for confounding (adjusted OR = 0.88, 95% CI 0.65–1.20).ConclusionsAlthough there was a strong association between cannabis use and suicide, this was explained by markers of psychological and behavioural problems. These results suggest that cannabis use is unlikely to have a strong effect on risk of completed suicide, either directly or as a consequence of mental health problems secondary to its use.

scholarly journals Suicidal ideation and subsequent completed suicide in both psychiatric and non-psychiatric populations: a meta-analysis

2016 ◽  
Vol 27 (2) ◽  
pp. 186-198 ◽  
Author(s):  
A. A. M. Hubers ◽  
S. Moaddine ◽  
S. H. M. Peersmann ◽  
T. Stijnen ◽  
E. van Duijn ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Suicide Risk ◽  
Psychiatric Patients ◽  
Meta Analysis ◽  
First Year ◽  
Completed Suicide ◽  
Increased Risk ◽  
Different Populations ◽  
Risk Ratios

Aims.Several authors claimed that expression of suicidal ideation is one of the most important predictors of completed suicide. However, the strength of the association between suicidal ideation and subsequent completed suicide has not been firmly established in different populations. Furthermore, the absolute suicide risk after expression of suicidal ideation is unknown. In this meta-analysis, we examined whether the expression of suicidal ideation predicted subsequent completed suicide in various populations, including both psychiatric and non-psychiatric populations.Methods.A meta-analysis of cohort and case–control studies that assessed suicidal ideation as determinant for completed suicide in adults. Two independent reviewers screened 5726 articles for eligibility and extracted data of the 81 included studies. Pooled risk ratios were estimated in a random effects model stratified for different populations. Meta-regression analysis was used to determine suicide risk during the first year of follow-up.Results.The risk for completed suicide was clearly higher in people who had expressed suicidal ideation compared with people who had not, with substantial variation between the different populations: risk ratio ranging from 2.35 (95% confidence interval (CI) 1.43–3.87) in affective disorder populations to 8.00 (95% CI 5.46–11.7) in non-psychiatric populations. In contrast, the suicide risk after expression of suicidal ideation in the first year of follow-up was higher in psychiatric patients (risk 1.40%, 95% CI 0.74–2.64) than in non-psychiatric participants (risk 0.23%, 95% CI 0.10–0.54). Past suicide attempt-adjusted risk ratios were not pooled due to large underreporting.Conclusions.Assessment of suicidal ideation is of priority in psychiatric patients. Expression of suicidal ideation in psychiatric patients should prompt secondary prevention strategies to reduce their substantial increased risk of suicide.

Suicide as an outcome for mental disorders

1997 ◽  
Vol 170 (3) ◽  
pp. 205-228 ◽  
Author(s):  
E. Clare Harris ◽  
Brian Barraclough
Keyword(s):  
Mental Disorders ◽  
Suicide Risk ◽  
English Language ◽  
Common Mental Disorders ◽  
Meta Analysis ◽  
Strong Association ◽  
Search Terms ◽  
Increased Risk ◽  
Mortality Ratio

BackgroundMental disorders have a strong association with suicide. This meta-analysis, or statistical overview, of the literature gives an estimate of the suicide risk of the common mental disorders.MethodWe searched the medical literature to find reports on the mortality of mental disorders. English language reports were located on MEDLINE (1966–1993) with the search terms mental disorders', ‘brain injury’, ‘eating disorders’, ‘epilepsy’, ‘suicide attempt’, ‘psychosurgery’, with ‘mortality’ and ‘follow-up studies’, and from the reference lists of these reports. We abstracted 249 reports with two years or more follow-up and less than 10% loss of subjects, and compared observed numbers of suicides with those expected. A standardised mortality ratio (SMR) was calculated for each disorder.ResultsOf 44 disorders considered, 36 have a significantly raised SMR for suicide, five have a raised SMR which fails to reach significance, one SMR is not raised and for two entries the SMR could not be calculated.ConclusionsIf these results can be generalised then virtually all mental disorders have an increased risk of suicide excepting mental retardation and dementia. The suicide risk is highest for functional and lowest for organic disorders with substance misuse disorders lying between. However, within these broad groupings the suicide risk varies widely.

scholarly journals Predictors of Symptom Increase in Subsyndromal PTSD Among Previously Deployed Military Personnel

2021 ◽  
Author(s):  
Robyn M Highfill-McRoy ◽  
Jordan A Levine ◽  
Gerald E Larson ◽  
Sonya B Norman ◽  
Emily A Schmied ◽  
...  
Keyword(s):  
Risk Factors ◽  
Military Service ◽  
Military Veterans ◽  
Baseline Survey ◽  
Ptsd Symptoms ◽  
Logistic Regression Models ◽  
Positive Coping ◽  
Increased Risk ◽  
Ptsd Symptomatology

ABSTRACT Introduction Subsyndromal PTSD (sub-PTSD) is associated with functional impairment and increased risk for full PTSD. This study examined factors associated with progression from sub-PTSD to full PTSD symptomatology among previously deployed military veterans. Materials and Methods Data were drawn from a longitudinal survey of Navy and Marine Corps personnel leaving military service between 2007 and 2010 administered immediately before separation (baseline) and ~1 year later (follow-up). Survey measures assessed PTSD symptoms at both times; the baseline survey also assessed potential predictors of symptom change over time. Logistic regression models were used to identify predictors of progression from sub-PTSD to full PTSD status. Results Compared to those with no or few PTSD symptoms at baseline, individuals with sub-PTSD were almost three times more likely to exhibit full PTSD symptomatology at follow-up. Risk factors for symptom increase among those with sub-PTSD included moderate or high levels of combat exposure and utilization of fewer positive coping behaviors. Use of prescribed psychotropic medication was protective against symptom increase. Conclusion This study identified several predictors of symptom increase in military veterans with sub-PTSD. Interventions targeting modifiable risk factors for symptom escalation, including behavioral and pharmacological treatments, may reduce rates of new-onset PTSD in this population.

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