February 2017: Science of Suicidality (SOS)

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February 2017: Science of Suicidality (SOS)

A comparison of the frequency of familial suicide attempts across eating disorder diagnoses ****

E. M. Pisetsky, C. B. Peterson, J. E. Mitchell, S. A. Wonderlich, R. D. Crosby, D. Le Grange, L. Hill, P. Powers, & S. J. Crow.

This study investigated prevalence of suicide attempts among family members of patients with an eating disorder (ED).  The authors studied a sample of 1870 patients presenting for ED treatment between 1975 and 2004 at a Midwestern ED treatment center.  They used the Eating Disorders Questionnaire to determine whether family members had made a suicide attempt.  The authors report, “individuals with bulimia nervosa had a higher prevalence of any familial suicide attempt and mother suicide attempt than individuals with [ED Not Otherwise Specified].”

****  An author of this article is affiliated with the University of South Florida (USF).  The editor of the Science of Suicidality and the owners of Harm Research (the website on which the Science of Suicidality is published) also have affiliations with USF.



Association between lifetime headache and history of suicide attempts in the elderly **

R. Calati, P. Courtet, J. Norton, K. Ritchie, & S. Artero.

This retrospective study investigated the association between lifetime headache and lifetime suicide attempts (SA) and explored the socio-demographic and clinical features of these groups.  The authors studied a sample of 1965 subjects (75 with a lifetime SA and 1,890 without a lifetime SA) from a cohort of community-dwelling persons aged 65 years and over without dementia.  They report, “different factors were identified as being associated with lifetime SA in participants with lifetime headache (female gender, a lower level of high-density lipoprotein cholesterol, insomnia, lifetime major depression) versus participants without headache (glycemia and lifetime major depression)”.  The authors recommend a careful screening for suicidality in patients “who are women and report the co-occurrence of headache and insomnia as well as lifetime major depression”.

** The Mini International Neuropsychiatric Interview (MINI) was used in this study.  Harm Research Press (the publisher of the Science of Suicidality), Harm Research Institute (the owner of the website on which the Science of Suicidality is published), the editor of the Science of Suicidality, and the owners of Harm Research own or receive proceeds from the sale and / or use of the MINI.



Determinants of Suicidality and of Treatment Modalities in a Community Psychiatry Sample of Asylum Seekers

N. Premand, R. Baeriswyl-Cottin, M. Gex-Fabry, N. Hiller, D. Framorando, A. Eytan, P. Giannakopoulos, & J. Bartolomei.

This cross-sectional study investigates similar clinical characteristics of asylum seekers (ASs) and permanent residents (PRs), including the frequency of suicidal thoughts or behavior and the utilization of outpatient crisis intervention and inpatient care.  The authors retrospectively studied a sample of 119 ASs and 120 PRs at the main public psychiatric facility in Geneva.  They report the frequency of suicidal thoughts was similar in both groups (>30%) and ASs benefited from outpatient crisis intervention more frequently than PRs (26.9% vs. 5.8%).  They report this is the first study to document suicidal thoughts or behavior in ASs receiving treatment in a community psychiatry clinic.



Evaluating Active Parental Consent Procedures for School Programming: Addressing the Sensitive Topic of Suicide Prevention ****

C. M. Wienke Totura, K. Kutash, C. D. Labouliere, & M. S. Karver.

This study investigated 5 active methods for obtaining consent from parents for youth participation in school-based suicide prevention programs (e.g., in-person, students taking forms home, mailing, mailing preceded by primers, mailing followed by reminder calls).  The authors studied a sample of 4 high schools with a combined enrollment of 8,709 students to determine response rates, acceptance rates, and participation rates.  They report “in-person methods provided higher [participation] rates than less interpersonal methods, such as mailing or students taking consents home”.  They recommend in-person, active consent methods to balance parental awareness and successful student recruitment.

****  Authors of this article are affiliated with the University of South Florida (USF).  The editor of the Science of Suicidality and the owners of Harm Research (the website on which the Science of Suicidality is published) also have affiliations with USF.



Evidence-based national suicide prevention taskforce in Europe: A consensus position paper

G. Zalsman, K. Hawton, D. Wasserman, K. van Heeringen, E. Arensman, M. Sarchiapone, V. Carli, C. Höschl, P. Winkler, J. Balazs, G. Purebl, J. P. Kahn, P. A. Sáiz, J. Bobes, D. Cozman, U. Hegerl, E. Rancāns, G. Hadlaczky, C. Van Audenhove, H. Hermesh, M. Sisask, A. M. Peschayan, N. Kapusta, V. Adomaitiene, V. Steibliene, I. Kosiewska, V. Rozanov, P. Courtet, & J. Zohar, European Evidence-Based Suicide Prevention Program [EESPP] Group by the Expert Platform on Mental Health, Focus on Depression.

This article provides a brief overview of consensus recommendations from the European Evidence-Based Suicide Prevention Program [EESPP] Group.  Their recommendations include suicide prevention strategies that were found to have the highest levels of evidence, a statement of principles of national suicide prevention programs for every European country, and suggestions for a national suicide prevention taskforce in each European country.  The 4 essential strategies were 1. Restriction of access to lethal means; 2. Treatment of depression; 3. Providing a chain of healthcare; 4. Universal school-based prevention.



Hopelessness Predicts Suicide Ideation But Not Attempts: A 10-Year Longitudinal Study

T. Qiu, E. D. Klonsky, & D. N. Klein.

This study investigated the role of hopelessness (as measured by the Beck Hopelessness Scale) in predicting suicidal ideation and suicide attempts (as measured by the SCID for DSM-III-R and the Longitudinal Interval Follow-Up Evaluation).  The authors studied a sample of 140 depressed patients (78 with lifetime histories of suicidality and 62 with no history of suicidality) over the course of 10 years with regular follow-ups at 30, 60, 90, and 120 months by in-person visits whenever possible and over the phone.  They report hopelessness failed to meaningfully distinguish suicide attempters from suicide ideators in both retrospective and prospective analyses.  They report “[their] findings suggest hopelessness is best conceptualized as a risk factor for suicide[al] ideation but not progression from ideation to attempts”.



Increased risk of suicide in schizophrenia patients with linkage to chromosome 13q

P. J. Malherbe, M. Karayiorgou, R. Ehlers, & J.L. Roos.

This study investigated the phenotypic characteristics (e.g., diagnosis, suicidality, medication use, and substance use) of patients grouped by genetic linkage to Schizophrenia and Schizoaffective Disorder.  The authors studied a sample of 92 subjects (51 with linkage to chromosome 13q, 23 with linkage to chromosome 1p, and 18 with linkage to combined chromosomes 13q & 1p).  They report, “[Schizoaffective Disorder] patients were estimated to be 3.73 (90% CI: (1.27,10.94)) times more likely to display suicidality than patients diagnosed with [Schizophrenia].  Patients with a linkage to chromosome 13q were 1.87 times more likely to complete suicide than those with linkage to chromosome 1p.



Reciprocal relationships between substance use and disorders and suicidal ideation and suicide attempts in the Collaborative Study of the Genetics of Alcoholism

A. Agrawal, R. Tillman, R. A. Grucza, E. C. Nelson, V. V. McCutcheon, L. Few, K. R. Conner, M. T. Lynskey, D. M. Dick, H. J. Edenberg, V. M. Hesselbrock, J. R. Kramer, S. Kuperman, J. I. Nurnberger Jr., M.A. Schuckit, B. Porjesz, & K. K. Bucholz.

This study investigated associations between suicidal ideation and attempt and onset of alcohol, nicotine and cannabis use and dependence.  The authors studied a sample from the prospective cohort of the Collaborative Study of the Genetics of Alcoholism, which included baseline data for 3,277 participants and 2, 4, 6, 8, and 10-year follow-up data on some participants.  They report limited evidence that early substance use was related to subsequent onset of suicidal ideation or suicide attempt.  They report “suicide attempts are associated with increased likelihood of onset of substance dependence.”



Service Use in the Month and Year Prior to Suicide Among Adults Enrolled in Ohio Medicaid

C. A. Fontanella, L. A. Warner, D. L. Hiance-Steelesmith, H. A. Sweeney, J. A. Bridge, R. McKeon, & J. V. Campo.

This study investigated incidence of death by suicide among adult Medicaid enrollees by describing their clinical profiles and service utilization patterns.  The authors studied Ohio Medicaid data in a sample of 1,338 adults (ages 19 to 65) who died by suicide between January 1, 2008, and December 31, 2013.  They report 79% of visits in the year before death by suicide were outpatient general medical visits.  They report those with serious psychiatric disorders were more likely to attend only mental health visits than those without serious psychiatric disorders.  They report “those with chronic general medical conditions were more likely than those without such conditions to make only general medical visits.”

If these patterns hold true when this sample is compared to a control group, it may be possible to identify patterns of patient visits of those that died by suicide and use that data to flag patients with similar visit patterns.  It is possible that each suicidality disorder phenotype has a different service utilization profile which could be used to identify those at higher likelihood of suicide attempts / death by suicide.



Suicidal patients’ experiences regarding their safety during psychiatric in-patient care: a systematic review of qualitative studies

S. H. Berg, K. Rørtveit, & K. Aase.

This meta-analysis investigated how to describe suicidal patients’ experiences regarding safety during psychiatric in-patient care.  The authors adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines while reviewing results of systematic searches of 6 databases that resulted in 20 studies.  They report three components, (i.e., connection, protection, and control) were vital to patient experiences of safety.  The authors report, “A system that is designed to physically prevent patients from committing suicide but that neglects their need for a connection with health care professionals may not be successful, as patients may exhibit increased suicidality despite the implementation of procedures to prevent this outcome.”  They recommend integrating the concepts of connection, protection, and control into patient safety processes during psychiatric inpatient care.  This article provides an overview of insights which can assist clinicians in building a better rapport with suicidal inpatients.



Suicide prevention for physicians: identification, intervention and mitigation of risk

A. Cole-King & S. Platt.

This article provides a thoughtful, short, 4-page, overview of suicidality assessment by non-psychiatric clinicians.  It offers recommendations and tips for asking about suicidality; highlights the importance of providing individualized care; contains recommendations for treating patients with suicidality, including when to refer to psychiatric services and an overview of safety planning; and contains additional resources for patients and clinicians.


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