A Naturalistic, European Multi-Center Clinical Study of Electrodermal Reactivity and Suicide Risk Among Patients With Depression

Background: Electrodermal hyporeactivity has been proposed as a marker of suicidal risk. The EUDOR-A study investigated the prevalence of electrodermal hyporeactivity among patients with depression and its association with attempted and completed suicide.Methods: Between August 2014 and March 2016, 1,573 in- and outpatients with a primary diagnosis of depression (active or remission phase) were recruited at 15 European psychiatric centers. Each patient was followed-up for 1 year. Electrodermal activity was assessed at baseline with the ElectroDermal Orienting Reactivity Test. Data on the sociodemographic characteristics, clinical diagnoses, and treatment of the subjects were also collected. The severity of the depressive symptoms was assessed through the Montgomery–Asberg Depression Rating Scale. Information regarding number, time, and method of suicide attempts was gathered at baseline and at the end of the 1-year follow-up. The same data were collected in case of completed suicide.Results: Hyporeactive patients were shown to be significantly more at risk of suicide attempt compared to reactive patients, both at baseline and follow-up. A sensitivity of 29.86% and a positive predictive value (PPV) of 46.77% were found for attempted suicide at baseline, while a sensitivity of 35.36% and a PPV of 8.92% were found for attempted suicide at follow-up. The sensitivity and PPV for completed suicide were 25.00 and 0.61%, respectively. However, when controlled for suicide attempt at baseline, the association between hyporeactivity and follow-up suicide attempt was no longer significant. The low number of completed suicides did not allow any analysis.

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Risk of suicide after attempted suicide in the population of Slovenia from 1970 to 1996

European Psychiatry ◽

10.1016/j.eurpsy.2005.04.006 ◽

2006 ◽

Vol 21 (6) ◽

pp. 396-400 ◽

Cited By ~ 11

Author(s):

Slavko Ziherl ◽

Bojan Zalar

Keyword(s):

Suicide Attempt ◽

Attempted Suicide ◽

Suicide Attempts ◽

Categorical Variables ◽

Frequency Table ◽

Completed Suicide ◽

The Republic ◽

And Gender ◽

Log Linear ◽

Commit Suicide

AbstractObjective:All suicide attempts cannot predict suicide, therefore we examined those characteristics of suicide attempt which could most accurately predict completed suicide.Subject and methods:Subjects were all individuals registered as committed suicides (N = 16,522) or attempted suicides (N = 15,057) in the register of suicides of the Republic of Slovenia between 1970 and 1996. Log linear analysis of a frequency table was used to uncover relationship between categorical variables.Results:The model we found fit between variables: mode, number of repetitions and type, then between number of repetitions, type and gender, and between mode, type and gender.Discussion:The risk of suicide in those who previously attempted suicide is approximately 773 times higher than the risk of suicide without a previous suicide attempt. Those who attempt suicide by hanging (hanging being in Slovenia the most frequent mode of completed suicide) are at even greater risk to commit suicide.Conclusion:Our data suggests that clinicians should heighten their awareness that any suicide attempt can in some 20% predict suicide. Someone who has attempted suicide by hanging is at the highest risk of suicide.

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S210. COMPARATIVE EFFECTIVENESS OF ANTIPSYCHOTICS FOR RISK OF ATTEMPTED OR COMPLETED SUICIDE AMONG PERSONS WITH SCHIZOPHRENIA

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa031.276 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S118-S119

Author(s):

Heidi Taipale ◽

Markku Lähteenvuo ◽

Antti Tanskanen ◽

Ellenor Mittendorfer-Rutz ◽

Jari Tiihonen

Keyword(s):

Drug Use ◽

Comparative Effectiveness ◽

Attempted Suicide ◽

Suicide Attempts ◽

Antipsychotic Therapy ◽

Completed Suicide ◽

Hazard Ratios ◽

Persons With Schizophrenia ◽

Swedish Cohort

Abstract Background Suicidal attempts and suicide are rather common phenomena in persons with schizophrenia whom are 6–14 times more likely to die due to suicide than the general population. Very little is known on effectiveness of antipsychotics in preventing suicide attempts and completed suicides among patients with schizophrenia. Whether all antipsychotics are effective in preventing attempted or completed suicides also remains unclear. The objective of our study was to investigate comparative effectiveness of antipsychotics for risk of attempted or completed suicide among all patients with schizophrenia in Finland and Sweden. Methods Two nationwide register-based cohort studies were conducted including all individuals with schizophrenia in Finland (N=61889) and Sweden (N=29823). The Finnish cohort included all persons treated for schizophrenia in inpatient care (1972–2014), with follow-up for drug use and outcomes during 1996–2017. The Swedish cohort included all persons with treatment contact due to schizophrenia in inpatient or specialized outpatient care, sickness absence, or disability pension (2006–2013), with follow-up for drug use and outcomes during 2006–2016. The main exposure included the ten most commonly used antipsychotic monotherapies, and also adjunctive pharmacotherapies (antidepressants, mood stabilizers, lithium, benzodiazepines and related drugs were investigated). The main outcome measure was attempted or completed suicide which was analyzed with within-individual models by comparing use and non-use periods in the same individual. Sensitivity analyses were conducted by between-individual models, with attempted suicide (hospitalization only) as an outcome, and by censoring first 30 days from each exposure. Results are reported as hazard ratios (HRs) with 95 % confidence intervals (95% CI). Results Compared with no use of antipsychotics, clozapine was the only antipsychotic therapy consistently associated with a decreased risk of suicidal outcomes. Hazard ratios (HRs) and 95% CI for attempted or completed suicide were 0.64 (95% CI 0.49–0.84) in the Finnish cohort, and 0.66 (0.43–0.99) in the Swedish cohort, and for attempted suicide 0.60 (0.46–0.79) in the Finnish cohort and 0.62 (0.40–0.95) in the Swedish cohort. No other antipsychotic was associated with a reduced risk of attempted and/or completed suicide than clozapine. Regarding adjunctive pharmacotherapies, benzodiazepines and Z-drugs were associated with an increased risk of suicide attempts or deaths (HRs for benzodiazepines 1.29–1.30 and 1.33–1.62 for Z-drugs, not reaching statistical significance in the Swedish cohort). Discussion The results from two large nationwide cohorts provide the first evidence on comparative real-world effectiveness of specific antipsychotics in the prevention of severe suicidal behavior. Clozapine was the only pharmacological treatment associated with a substantially decreased risk of attempted or completed suicide and should be considered as a first-line treatment for patients with suicidal ideation or behavior.

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Suicide attempters: Clinical characteristics and management

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2242 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S601-S601

Author(s):

E. Gattoni ◽

A. Feggi ◽

C. Gramaglia ◽

P. Bergamasco ◽

I. Coppola ◽

...

Keyword(s):

Depressive Symptoms ◽

Suicide Attempt ◽

Clinical Characteristics ◽

Depressive Disorders ◽

Attempted Suicide ◽

Rating Scale ◽

Suicide Attempts ◽

Suicidal Risk ◽

Suicide Attempters ◽

History Of

BackgroundSuicide attempts, defined as self-inflicted, potentially injurious behaviors with a nonfatal outcome, and with evidence of intent to die are extremely prevalent. Literature suggests that suicide is more common among males, while attempted suicide is more frequent among females. Depression, mental disorders, substance use disorders and history of suicidal behavior are important risk factors for suicide: the risk of suicide attempt is 3 to 12 times higher in psychiatric patients than in the general population.AimThe aim of our study was to compare severity of depressive symptoms in a sample of suicide attempters with a diagnosis of bipolar and related disorders or depressive disorders and in a sample of sex- and diagnosis-matched patients who do not commit a suicide attempt. The severity of attempted suicide and the suicidal risk in the hospital will be assessed as well.Material and methodsWe collected a sample of inpatients who committed a suicide attempt during 2015. For each attempter, we selected another sex- and diagnosis-matched patient with no history of attempted suicide. Socio-demographic and clinical characteristics of the sample were gathered. Assessment included: Montgomery-Asberg Depression Rating Scale (MADRS) for severity of depressive symptoms in both groups, Suicide Intent Scale (SIS) for the severity of attempted suicide and the suicidal risk with a nurse assessment for suicide.ResultsData collecting is still ongoing. We expected to find more severe symptoms in patients who attempted suicide. Clinical implication will be discussed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Construction of an Index for Predicting Suicide Attempts in Depressed Adolescents

The British Journal of Psychiatry ◽

10.1192/bjp.159.5.676 ◽

1991 ◽

Vol 159 (5) ◽

pp. 676-682 ◽

Cited By ~ 28

Author(s):

C. W. M. Kienhorst ◽

E. J. De Wilde ◽

R. F. W. Diekstra ◽

W. H. G. Wolters

Keyword(s):

Logistic Regression ◽

Suicide Attempt ◽

Attempted Suicide ◽

Suicide Attempts ◽

Stepwise Logistic Regression ◽

Regression Analyses ◽

One Year

A group of 48 adolescents who recently attempted suicide and 66 depressed adolescents were compared on sociodemographic, behavioural, psychological and relational variables. The variables which proved significant were used in different combinations in stepwise logistic regression analyses, resulting in seven variables which served as the content of an index of risk. The sensitivity of the index was 90% and the specificity 83%. At one-year follow-up the occurrence of a suicide attempt correlated with score on the instrument.

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Risk of Repetition of Suicide Attempt, Suicide or all Deaths after an Episode of Attempted Suicide: A Register-Based Survival Analysis

Australian & New Zealand Journal of Psychiatry ◽

10.1080/00048670601172749 ◽

2007 ◽

Vol 41 (3) ◽

pp. 257-265 ◽

Cited By ~ 134

Author(s):

Erik Christiansen ◽

Børge Frank Jensen

Keyword(s):

Mental Illness ◽

Survival Analysis ◽

Suicide Attempt ◽

Attempted Suicide ◽

Suicide Attempts ◽

Cox Regression ◽

High Risk Group ◽

Suicide Attempters ◽

Psychiatric Staff

Objective: This study was undertaken in order to estimate the incidence of repetition of suicide attempt, suicide and all deaths, and to analyse the influence of psychiatric illness and socio-demographic factors on these. Method: The study is a Danish register-based survival analysis that retrieved personal data on socio-economic, psychiatric and mortality conditions from various registers. Hazards were estimated using Cox regression with a time-dependence covariate. Suicide-attempters (2.614) and non-attempters (39.210)were analysed being matched by gender, age and place of residence. Results: The average follow-up period for suicide-attempters was 3.88 years, during which 271 (10.37%) of them died. By comparison, death occurred four times more often among suicide-attempters than among non-attempters. Suicide was far more common among attempters (61, 2.33%) than among non-attempters (16, 0.04%). A proportion of the attempters (31.33%) repeated their attempt within the follow-up period. The most reliable predictors for suicide and death were repetition, suicide attempt method and treatment for mental illness. The most reliable predictors for repetition were age, gender and mental illness. Discussion: Individuals with a history of suicide attempts form a well-defined high-risk group for suicide, and are in need of treatment immediately after the episode. Somatic and psychiatric staff must be informed about the risk factors for subsequent suicidal behaviour after an episode of attempted suicide. Furthermore, departments that are in contact with suicidal individuals need action plans to ensure that all such individuals are discharged to proper treatment immediately after the suicide attempt.

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Analysis of Deliberate Self-Wrist-Cutting Episodes Presenting to the Emergency Department

Crisis ◽

10.1027/0227-5910/a000361 ◽

2016 ◽

Vol 37 (2) ◽

pp. 155-160 ◽

Cited By ~ 2

Author(s):

Jin Kim ◽

Han Joon Kim ◽

Soo Hyun Kim ◽

Sang Hoon Oh ◽

Kyu Nam Park

Keyword(s):

Emergency Department ◽

Medical Records ◽

Attempted Suicide ◽

Suicide Attempts ◽

Psychiatric Interview ◽

Clinical Variables ◽

Completed Suicide ◽

Number Of Patients ◽

Group A ◽

Efficacy Of Treatment

Abstract. Background: Previous suicide attempts increase the risk of a completed suicide. However, a large proportion of patients with deliberate self-wrist cutting (DSWC) are often discharged without undergoing a psychiatric interview. Aims: The aims of this study were to investigate the differences in the characteristics and outcomes of patients with DSWC and those with deliberate self-poisoning (DSP) episodes. The results of this study may be used to improve the efficacy of treatment for DSWC patients. Method: We retrospectively reviewed the medical records of 598 patients with DSWC and DSP who were treated at the emergency department of Seoul Saint Mary's Hospital between 2008 and 2013. We assessed sociodemographic information, clinical variables, the reasons for the suicide attempts, and the severity of the suicide attempts. Results: A total of 141 (23.6%) patients were included in the DSWC group, and 457 (76.4%) were included in the DSP group. A significantly greater number of patients in the DSWC group had previously attempted suicide (p = .014). A total of 63 patients (44.7%) in the DSWC group and 409 patients (89.5%) in the DSP group underwent psychiatric interviews. Conclusion: More DSWC patients had previously attempted suicide, but fewer of them underwent psychiatric interviews compared with the DSP patients.

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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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Suicidal Behavior in Four Ethnic Groups in The Hague, 2002–2004

Crisis ◽

10.1027/0227-5910.30.2.63 ◽

2009 ◽

Vol 30 (2) ◽

pp. 63-67 ◽

Cited By ~ 22

Author(s):

Irene Burger ◽

Albert M. van Hemert ◽

Willem J. Schudel ◽

Barend J.C. Middelkoop

Keyword(s):

Suicide Attempt ◽

Ethnic Groups ◽

Suicidal Behavior ◽

Emergency Service ◽

Attempted Suicide ◽

Public Health Problem ◽

Specific Rate ◽

Completed Suicide ◽

The Hague ◽

Psychiatric Department

Background: Suicidal behavior is a severe public health problem. Aims: To determine the rates of attempted and completed suicide among ethnic groups in The Hague, The Netherlands (2002–2004). Methods: By analyzing data on attempted and completed suicide (from the psychiatric department of general medical hospitals; the psychiatric emergency service and the municipal coroners). Results: Turkish and Surinamese females aged 15–24 years were at highest risk for attempted suicide (age-specific rate 545 / 100,000 and 421 / 100,000 person-years, respectively). Both rates were significantly higher than in the same age group of Dutch females (246 / 100,000 person-years). Turkish (2%) and Surinamese (7%) had lower repeat suicide-attempt rates than did Dutch (16%) females aged 15–24. Significantly lower suicide-attempt rates were found for Surinamese than for Dutch females aged 35–54 years. Differences were not explained by socioeconomic living conditions. The ratio fatal/nonfatal events was 4.5 times higher in males than in females and varied across age, gender, and ethnicity strata. Completed suicide was rare among migrant females. No completed suicides were observed in the Turkish and Surinamese females aged 15–24 years. Conclusions: The study demonstrates a high risk of attempted suicide and a low risk of completed suicide among young Turkish and Surinamese females.

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Gender Differences in Suicidal Intent and Choice of Method Among Suicide Attempters

Crisis ◽

10.1027/0227-5910.29.4.209 ◽

2008 ◽

Vol 29 (4) ◽

pp. 209-212 ◽

Cited By ~ 23

Author(s):

Merete Nordentoft ◽

Jacob Branner

Keyword(s):

Gender Differences ◽

Attempted Suicide ◽

Suicide Attempts ◽

Suicidal Intent ◽

Suicide Intent ◽

Suicidal Intention ◽

National Patient ◽

Prevention Center ◽

Suicide Prevention Center

The objective was to examine gender differences in choice of method and suicidal intent among persons referred to a suicide prevention center. A total of 351 consecutive patients who had attempted suicide were interviewed using the European Parasuicide Study Interview Schedule I (EPSIS I) while participating in a 2-week inpatient treatment program. They were invited to a 1-year follow-up interview, and followed in the National Patient Register. Compared to women, men who had attempted suicide were older, had better self-esteem, fewer depressive symptoms, and higher total suicidal intention scores, but they were not more likely to use violent methods. Neither use of violent method nor dangerousness of the attempt was associated with suicidal intention. Although men had higher suicide intent scores than women, there were no significant gender differences in the number of repeat suicide attempts during a 1-year follow-up period. Suicidal intent was not related to dangerousness of suicide method.

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The Role of Past Suicidal Behavior on Current Suicidality: A Retrospective Study in the Israeli Military

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020649 ◽

2021 ◽

Vol 18 (2) ◽

pp. 649

Author(s):

Leah Shelef ◽

Jessica M Rabbany ◽

Peter M Gutierrez ◽

Ron Kedem ◽

Ariel Ben Yehuda ◽

...

Keyword(s):

Suicide Attempt ◽

Suicidal Behavior ◽

Military Service ◽

Suicide Ideation ◽

Rating Scale ◽

Suicide Attempts ◽

Significant Risk ◽

Significant Risk Factor ◽

Severity Rating ◽

Significant Difference

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.

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