Risk Factors Associated With Various Severities of Suicidal and Non-Suicidal Self-Harm Among Israel Defense Forces Soldiers—A Nested Case–Control Study

ABSTRACT Objective Severe suicide attempt is a major risk factor for completed suicide. The aim of the present study was to focus on suicide behavior and timing to gain better understanding of these populations. Method The nested case–control retrospective study based on medical records of 246,866 soldiers, who demonstrated suicide attempts of varying severity, including death by suicide were compared with soldiers who did not demonstrate such behavior. Results Risk for death by suicide was associated with males, military seniority of less than 12 months. High frequency of visits with mental health care professionals was associated with being severe suicide attempters (SAs). Moderate suicide attempts were associated with being a male, visiting a primary care physician frequently, and belonging to one of the two latest immigrant groups in Israel (Ethiopians and former Soviet Union). Mild suicide attempts were associated with having a psychiatric diagnosis on the enlistment day, visiting a mental health care professional at high or average frequency, visiting a primary care physician at high or average frequency, being a male, and being born in the former Soviet Union. While the proportion of males demonstrating suicidal behavior was higher than the females’, severe SAs were higher among females. There was a clear tendency of female suicide attempters at all levels to act toward the end of their military service. Conclusions Although half of the SAs were females, their characteristics may be similar to those of the male SAs, contrary to the sex differences in suicide behavior among civilians.

Attempted Suicide in the Older Adults: A Case Series From the Psychiatry Ward of the University Hospital Maggiore Della Carità, Novara, Italy

Introduction: As suicide rates increase with age, it is mandatory to carefully assess old age suicidal behaviors. Our aim was to describe the main socio-demographic and clinical features of a sample of suicide attempters aged 65 years and older, and to assess differences within the sample (men vs. women; patients with vs. without a previous history of suicide attempt; patients with vs. without a previous psychiatric history).Methods: Retrospective study conducted at the Maggiore della Carità University Hospital, Novara, Italy.Results: A higher percentage of female patients in our sample were treated by or referred to mental health services, while a greater percentage of male patients required a prolonged clinical observation in the Emergency Room (ER) or in non-psychiatric wards before psychiatric admission. The percentage of patients without previous psychiatric history taking anxiolytic and sedative medications was 25%.Conclusion: It is likely that different clusters and types of suicide attempters exist. Women in our sample appeared more proactive in asking for help, and more likely to be already treated by or referred to a psychiatric service, suggesting the need to facilitate the access to psychiatric services for the male population aged 65 years and older, or to offer support and care for the non-psychiatric reasons (comorbidities, pain, and loss of autonomy) possibly underlying suicidal behavior in this specific group. The use of medications deserves more attention considering the possible critical diagnostic issues in this age group.

Risk Assessment on Suicide Death and Attempt among Chinese Rural Youths Aged 15–34 Years

Background: Although many suicide risk assessment tools are available in the world, their validity is not adequately assessed. In this study, we aimed to develop and evaluate a suicide risk assessment model among Chinese rural youths aged 15–34 years. Method: Subjects were 373 suicide deaths and 507 suicide attempters aged 15–34 years in three Chinese provinces (Shandong, Liaoning, and Hunan). Information about the community residents was also collected as the control groups. Social-demographic, social and psychological variables were examined for the suicides, suicide attempters, and community residents. Logistic regressions based on subjects from Shandong and Liaoning provinces were conducted to establish the suicide risk assessment models. Receiver operating characteristic (ROC) curves were drawn, and area under the ROC curves (AUC) were calculated to show how well the models separated the group being tested into those with and without suicide attempt or suicide. Results: The assessment model for suicide death included education years (OR = 0.773, p < 0.001), agricultural worker (OR = 2.091, p < 0.05), physical health (OR = 0.445, p < 0.05), family suicide history (OR = 6.858, p < 0.001), negative life events (OR = 1.340, p < 0.001), hopelessness (OR = 1.171, p < 0.001), impulsivity (OR = 1.151, p < 0.001), and mental disorder (OR = 8.384, p < 0.001). All these factors were also supported in the assessment model for suicide attempt, with an extension of very poor economic status (OR = 1.941, p < 0.01) and social interaction (OR = 0.855, p < 0.001). The AUC was 0.950 and 0.857 for the sample used to establish the assessment models of suicide death and attempt, respectively. The AUC was 0.967 and 0.942 for the sample used to verify the established assessment models of suicide death and attempt, respectively. Conclusions: Compared with some other assessment tools, the models for suicide death and attempt in the current study performed well among Chinese rural youths aged 15–34 years. A reliable suicide risk assessment approach, which includes multiple risk factors, should be evaluated in various cultures and populations.

History of suicide attempts and COVID-19 infection in Veterans with schizophrenia or schizoaffective disorder: moderating effects of age and body mass index

Introduction: Relative to the general population, patients with schizophrenia or schizoaffective disorder have higher rates of suicide attempts and mortality from COVID-19 infection. Therefore, determining whether a history of suicide attempt is associated with COVID-19 in patients with schizophrenia or schizoaffective disorder has implications for COVID-19 vulnerability stratification in this patient population. Methods: We carried out cross-sectional analyses of electronic health records (EHR) of veterans with a diagnosis of schizophrenia or schizoaffective disorder that received treatment at any United States Veterans Affairs Medical Center between January 1, 2020 to January 31, 2021. We used logistic regression to estimate unadjusted and adjusted (including age, sex, race, marital status, body mass index (BMI), and a medical comorbidity score) odds ratios (ORs) for COVID-19 positivity in suicide attempters relative to non-attempters. Results: A total of 101,032 Veterans [mean age 56.67 ± 13.13 years; males 91,715 (90.8%)] were included in the analyses. There were 2,703 (2.7%) suicide attempters and 719 (0.7%) patients were positive for COVID-19. The association between history of suicide attempt and COVID-19 positivity was modified by age and BMI, such that the relationship was only significant in patients younger than 59 years, and in obese (BMI ≥ 30) patients (adjusted OR 3.42, 95% CI 2.02 - 5.79 and OR 2.85, 95% CI 1.65 - 4.94, respectively). Conclusions: Higher rates of COVID-19 in young or obese suicide attempters with a diagnosis of schizophrenia or schizoaffective disorder might be due to elevated risk for the infection in this sub-group of patients.

Exploring the risk factors of suicide attempters among young individuals

Suicide has been described as the act of intentionally ending one’s own life. Suicide is one of the leading causes of death and major public health concern. The present study was designed to examine the potential causes of suicidal acts through qualitative research design.Sample includes 30 individuals admitted in Jinnah hospitalwho attempted suicide were selected by purposive sampling and the data were gathered by qualitative semi-structured individual interviews. Data were analysed by conventional approach of qualitative content analysis.Results indicate four main themes emerged from this current study which includes family factors, social factors, environmental factors and individual factors which leadto suicide attempts. These results have important implications for the prevention of suicide. Psychological clinics and prevention programs should include these factors in their assessment.

Mapping the genetic architecture of suicide attempt and suicide death using polygenic risk scores for clinically-related psychiatric disorders and traits

Background Suicidal behavior is moderately heritable and a consequence of a combination of the diathesis traits for suicidal behavior and suicide-related major psychiatric disorders. Here, we sought to examine shared polygenic effects between various psychiatric disorders/traits and suicidal behavior and to compare the shared polygenic effects of various psychiatric disorders/traits on non-fatal suicide attempt and suicide death. Methods We used our genotyped European ancestry sample of 260 non-fatal suicide attempters, 317 suicide decedents and 874 non-psychiatric controls to test whether polygenic risk scores (PRSs) obtained from large GWASs for 22 suicide-related psychiatric disorders/traits were associated with suicidal behavior. Results were compared between non-fatal suicide attempt and suicide death in a sensitivity analysis. Results PRSs for major depressive disorder, bipolar disorder, schizophrenia, ADHD, alcohol dependence, sensitivity to environmental stress and adversity, educational attainment, cognitive performance, and IQ were associated with suicidal behavior (Bonferroni-corrected p < 2.5 × 10−4). The polygenic effects of all 22 psychiatric disorders/traits had the same direction (p for binomial tests = 4.8 × 10−7) and were correlated (Spearman's ρ = 0.85) between non-fatal suicide attempters and suicide decedents. Conclusions We found that polygenic effects for major psychiatric disorders and diathesis-related traits including stress responsiveness and intellect/cognitive function contributed to suicidal behavior. While we found comparable polygenic architecture between non-fatal suicide attempters and suicide decedents based on correlations with PRSs of suicide-related psychiatric disorders/traits, our analyses are limited by small sample size resulting in low statistical power to detect difference between non-fatal suicide attempt and suicide death.

The Revised Attentional Fixation on Suicide Experiences Questionnaire (AFSEQ-R) and its Relationship with Suicidal Ideation and Behavior

Introduction: Attentional fixation is a cognitive process characterized by a preoccupation with a certain topic. The Attentional Fixation on Suicide Experiences Questionnaire (AFSEQ) was developed to measure fixation on suicide. The current study aimed to investigate a revised version of this measure (AFSEQ-R) and examine differences between recent suicide attempters and those with suicidal ideation (SI) only. Method: Participants were 57 inpatients who attempted suicide within 14 days of study participation and 57 inpatients who presented with SI but no suicidal behavior within the past year. Analyses included an exploratory factor analysis (EFA) of the AFSEQ-R, bivariate correlations between AFSEQ-R total score (and its factors) with related constructs, and logistic regression of attentional fixation as a moderator of the association between SI and attempt status. Results: EFA revealed a two-factor structure for the AFSEQ-R: Cognitive Stuckness (and AFSEQ-R total score) correlated with SI, anxiety, impulsivity, and specific problem-solving deficits, while Cognitive Dysfunction acted as a moderator of the association between Stuckness and SI. AFSEQ-R scores did not moderate the relationship between current SI and attempt status. Conclusion: Attentional fixation on suicide may contribute to the distress associated with SI. Interventions aimed at reducing attentional fixation may reduce suffering.