Science of Suicidality, Suicidality
September 2017: Science of Suicidality (SOS)
Aug
S. Pu, S. Setoyama, & T. Noda.
This study investigated the association between suicidal ideation and cognitive function in patients with Major Depressive Disorder (MDD). The authors studied 233 patients with MDD using the Brief Assessment of Cognition in Schizophrenia (BACS) and Hamilton Depression Rating Scale (HAM-D). Question 3 of the HAM-D was used to assess suicidal ideation. They found 59.2% of the patients (138) had suicidal ideation. The authors report the motor speed function (ρ = −0.16, p < 0.005), executive function (ρ = −0.19), and composite scores (ρ = −0.16) of the BACS were negatively correlated with the severity of suicidal ideation in these patients with MDD.
[https://dx.doi.org/10.1038/s41598-017-12142-8]
R. Evans, J. White, R. Turley, T. Slater, H. Morgan, H. Strange, & J. Scourfield.
This article reports on a systematic review and meta-analysis comparing the prevalence of suicidal ideation, suicide attempt, and death by suicide in children and young people placed in out-of-home care (e.g., extended family or foster care) (in-care) with those who remain with their birth family (non-care). The authors analyzed 5 studies published between 2001 and 2011 and included 2,448 incidents of suicidal ideation, 3,456 suicide attempts, and 250 deaths by suicide in a total of 9,321 in the in-care group and 373,674 in the comparator (non-care) group. They estimate suicidal ideation was prevalent in 11.4% of the non-care group compared to 24.7% of the in-care group. The authors report prevalence of suicide attempts was 0.8% compared to 3.6%, respectively. They found prevalence of death by suicide was lower for the in-care group for one study (0% vs 0.9%), but higher in the other study (0.27% vs 0.06%). The authors recommend targeted interventions to reduce suicidality in those placed in out-of-home care.
[https://dx.doi.org/10.1016/j.childyouth.2017.09.020]
Methodological barriers to studying the association between the economic crisis and suicide in Spain
J. Alvarez-Galvez, J. A. Salinas-Perez, M. L. Rodero-Cosano, & L. Salvador-Carulla.
This article investigated phases of association between different periods of suicide rates and economic recession. The authors studied to sets of suicide mortality data from 1995 to 2006 (a comparison period) and from 2007 to 2014 (the Great Recession) obtained from the Spanish Statistical Office using an interrupted time series analyses of different predictors, regions in Spain, and data sources and periods. They found a positive, significant relationship between the Great Recession and suicide rates during the second period of economic recession (i.e., between 2011 and 2014). The authors found a non-significant decrease during the Great Recession’s first recession period (i.e., between 2007 to 2011). The authors report trends seem to demonstrate that the Spanish population experienced a double-loss during the last years of economic crisis: 1) lost economic wealth, and 2) lost the buffer of previous social policies. They believe this double-loss may be related to increased death by suicide rates.
The similar patterns found in the yearly death by suicide rates for each sex in many Spanish provinces from between 1980 and 2014 merits further investigation to determine if a similar pattern holds true in other Spanish provinces or in other nearby provinces outside of Spain.
[https://dx.doi.org/10.1186/s12889-017-4702-0]
S. Brovelli, Y. Dorogi, A. S. Feiner, P. Golay, F. Stiefel, C. Bonsack, & L. Michaud.
This study investigated the acceptability and feasibility of a multicomponent intervention for suicide attempters (SA) admitted to an emergency unit (EU). The intervention included a joint crisis plan (JCP), phone contacts during 3 months after suicide attempt, and an early meeting with relatives and the existing care network coordinated by a case manager. Although 107 SA were admitted to the EU during the study period, only 19 could be included in the study for logistical, consent, and other reasons. The authors found the intervention was most frequently declined by first-time attempters. They report the JCP and meetings were viewed as less acceptable because of implementation difficulties.
There were 3 patients (16%) who reattempted suicide and 1 who died by suicide within the 3-month follow-up. The patient who died by suicide had a Beck Hopelessness Scale (BHS) score of 3 at baseline, after the initial admission for a suicide attempt. This suggests that the BHS score is not predictive of those who die by suicide within the next 3 months.
[https://doi.org/10.3389/fpsyt.2017.00188]
Perinatal suicide in Ontario, Canada: a 15-year population-based study
S. Grigoriadis, A. S. Wilton, P. A. Kurdyak, A. E. Rhodes, E. H. VonderPorten, A. Levitt, A. Cheung, & S. N. Vigod.
This study investigated health service use related to and the epidemiology of death by suicide during pregnancy and during the first postpartum year. The authors studied health administrative databases and coroner death records from between 1994 and 2008 in Ontario, Canada by comparing clinical features, health service use (1 year and 30 days before death) and sociodemographic characteristics in 3 groups: 1) 255 living perinatal women, 2) 1,597 women who died by suicide outside of the perinatal period, and 3) 51 women who died by suicide in the perinatal period. They report a perinatal death by suicide rate of 5.3% and found only 39.2% of them had mental health contact in the 30 days before death (compared to 47.7% who died by suicide non-perinatally). Those who died by suicide up to 1-year post-partum were less likely to have pediatric contact in the 30 days before death (64.5% [20 / 31]) than the living post-partum women (88.4% [137 / 155). The authors recommend all health care providers are “vigilant in assessing risk” throughout the entire perinatal period.
Clinicians should routinely discuss suicidality with patients in the perinatal period because it is likely that many more than the 5.3% who died by suicide experienced other suicidality during this period.
[https://doi.org/10.1503/cmaj.170088]
Preventing Suicide: A Resource for Media Professionals, Update 2017
Task Force on Media Recommendations for Suicide Reporting of IASP.
This resource booklet summarizes current evidence on the impact of media reporting of deaths by suicide. It provides information for media professionals on how to report on suicide, including suggestions on how best to ensure reporting is accurate, appropriate, and responsible. The information and recommendations are designed for both digital and traditional media professionals.
Although this booklet was designed to reduce the negative impact of a death by suicide on those hearing or reading reports in the media, many of the suggestions in the booklet seem to significantly censor the media’s discussion of death by suicide. The authors write, “[…] reports should not […] describe the suicide method in detail. A focus on the celebrity’s life, how he or she contributed to society, and how their death negatively affects others is preferable to reporting details of the suicidal act or providing simplistic reasons for why the suicide occurred.” While it is not helpful to sensationalize reports of deaths by suicide, it is also not helpful to purposely suppress the reality of death by suicide. The authors write, “Providing personal narratives of people who managed to cope with adverse circumstances and suicidality may help others in difficult life situations to adopt similar positive coping strategies.” If the only stories out there are about how people are able to overcome their suicidality, and an individual continues to struggle even after using the same techniques suggested in these positive stories, then the lack of honest stories of people who were not able to get relief for their suicidality from these techniques can help make this individual feel even more hopeless. They may take the mindset that ‘these things work for others, but won’t work for me, so I must be to blame’. The recommendations in this booklet seem designed to cover up and hide the reality of suicidality in order to downplay the unpleasant details of this serious and potentially life-threatening health condition. Society is not likely to find appropriate solutions to treat suicidality until there is honest communication about all aspects of suicidality.
One patient with a history of chronic suicidality reviewed the booklet and stated, “It feels like this is the ‘abstinence only’ approach to talking about suicide. ‘If we don’t provide sex education to young people (talk about details related to death by suicide), no one will have sex (die by suicide).’ This booklet takes a less insightful and less helpful approach than it could have, to one of the leading causes of death in the world.” Suicidality is a very complex issue and merits more evidence to intelligently inform the challenge tackled in this booklet. It needs more input from a diversity of perspectives, especially those who are chronically suicidal and those who suffer from a spectrum of suicidality disorders.
[http://apps.who.int/iris/bitstream/handle/10665/258814/WHO-MSD-MER-17.5-eng.pdf]
Psychosocial job stressors and suicidality: a meta-analysis and systematic review
A. Milner, K. Witt, A. D. LaMontagne, & I. Niedhammer.
This article describes a comprehensive systematic review and meta-analysis of the literature on the role of job stressors as risk factors for suicidality. The authors analyzed 22 studies published before February 2017 and identified through searching 7 electronic databases. They report elevated odds of suicidal ideation across all psychosocial exposures. The authors found only 2 studies which investigated suicide attempt, both of which suggested an adverse effect of exposure to job stressors. They found an increased odds ratio (OR) of death by suicide with some job-related stressors (e.g., lower supervisor and collegial support [OR 1.16] and low job control [1.23], but found no significant associations between job strain (0.92) or job demands (1.08). The authors caution readers about the potential of publication bias, which would skew their results, and recommend further longitudinal research to more thoroughly investigate these associations.
[https://dx.doi.org/10.1136/oemed-2017-104531]
K. R. Mollan, C. Tierney, J. N. Hellwege, J. J. Eron, M. G. Hudgens, R. M. Gulick, R. Haubrich, P. E. Sax, T. B. Campbell, E. S. Daar, K. R. Robertson, D. Ventura, Q. Ma, D. R. Velez Edwards, D. W. Haas, & the AIDS Clinical Trials Group.
This study investigated associations between suicidality and genotypes that predict plasma efavirenz exposure, specifically CYP2B6 and CYP2A6 polymorphisms. The authors studied 1,833 participants from 4 studies within the AIDS Clinical Trials Group study in the United States. They found increased suicidality associated with the CYP2B6/CYP2A6 genotypes in the participants randomly assigned to efavirenz-containing regimens. They found efavirenz slow metabolizers were at increased likelihood of suicidality. The authors report these associations were attenuated in black participants and most apparent in white participants.
This article is unclear on how suicidality was assessed in each of the studies included in analysis. Presumably, suicidality data was pulled from adverse event reports. Systematic assessment of suicidality at regular study visits would have likely increased the number of suicidal participants identified within each of the studies used for this analysis. Without systematic assessment of suicidality, it is possible some in the ‘not-suicidal’ group were actually experiencing suicidality, but went unidentified. Similar studies should be conducted with more detailed, systematic, and standardized suicidality assessments at regular study visits to determine whether this impacted the results of this study.
[https://dx.doi.org/10.1093/infdis/jix248]
F. Pedrotti Moreira, C. Jackson Borges, C. David Wiener, P. Moraes da Silva, L. Valmor Portela, D. R. Lara, R. Azevedo da Silva, L. D. de Mattos Souza, K. Jansen, & J. Pierre Oses.
This study investigated differences in Brain Derived Neurotrophic Factor (BDNF) serum levels in individuals with Major Depressive Disorder (MDD) and with or without a history of suicide attempt (SA). The authors studied 147 subjects between 18 and 35 years of age in three groups matched by sex and age: 1) 49 healthy controls, 2) 49 subjects with MDD and no SA (MDD – SA), and 3) 49 subjects with MDD and SA (MDD + SA). They found BDNF serum levels were significantly reduced in subjects with MDD + SA (8.72 ng/mL) and MDD – SA (8.09 ng/mL) compared to the healthy controls (26.95 ng/mL; p ≤ 0.001). The authors found no significant differences in BDNF serum levels between the MDD – SA and MDD + SA groups.
** 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 royalties from the sale and / or use of the MINI.
[https://dx.doi.org/10.1016/j.psychres.2017.09.033]
Social Support, Depression and Suicidal Ideation in Adults with Autism Spectrum Disorder
D. Hedley, M. Uljarević, M. Wilmot, A. Richdale, & C. Dissanayake.
This study investigated whether the perception of social support functions as a potential protective factor for suicidal ideation and for depressive symptoms in adults with Autistic Spectrum Disorder (ASD). The authors studied 76 adults with ASD who were seeking employment using a computerized survey which included the Abridged Version of the Autism Spectrum Quotient (AQ-Short), Waisman Activities of Daily Living scale (W-ADL), Interpersonal Support Evaluation List-12 Item Version (ISEL-12), and Patient Health Questionnaire-9 (PHQ-9). They found that 20% of respondents had suicidal ideation and 25% had depression in the clinical range within the past 2 weeks. The authors report the appraisal and belonging ratings of social support were not associated with depression or suicidal ideation. They found the perception of material (tangible) support indirectly impacted suicidal ideation through its impact on depression, suggesting material support serves as a protective factor against suicidal ideation.
This study should be repeated using a more comprehensive measure of suicidality phenomena, with a longer lookback timeframe than only 2 weeks for suicidality and depression, and in a larger and more diverse sample of persons with Autistic Spectrum Disorders.
[https://dx.doi.org/0.1007/s10803-017-3274-2]
Suicidality and Death by Suicide Among Middle-Aged Adults in the United States
K. D. Piscopo.
This study investigated suicidal ideation, suicide attempt, and death by suicide rates in adults aged 18 to 64 in the United States from 2009 to 2014. The authors studied data obtained from 2 sources: 1) the National Vital Statistics System (NVSS) Mortality data file from the U.S. Department of Health and Human Services (HHS) National Center for Health Statistics (NCHS) and 2) the National Survey on Drug Use and Health (NSDUH) from the Substance Abuse and Mental Health Services Administration (SAMHSA). They found 18 to 25-year-olds had the highest percentages of suicidal ideations and suicide attempts (6.9% and 1.2%, respectively) while middle-aged adults had a significantly lower percentage (3.5% and 0.3%, respectively). The authors found that the trend for middle-aged suicidal ideation and suicide attempts remained stable between 2009 and 2014, even while the death by suicide rates for this age group increased from 1999 to 2014.
[https://www.samhsa.gov/data/report/suicidality-and-death-suicide-among-middle-aged-adults-united-states]
Y. Jiang, D. N. Pearlman, J. Hill, & S. Viner-Brown.
This brief article investigated spatial patterning and characteristics of adults 25 years of age and older who died by suicide in Rhode Island. The authors studied data on deaths by suicide between 2004 and 2014 from the Rhode Island Violent Death Reporting System (RIVDRS), which includes data from law enforcement reports, death certificates, and medical examiner records. They report finding 1,065 deaths by suicide. The authors found that 45.4% (n = 482) were in mental health treatment and only 53.4% (566) had a current mental health diagnosis.
The format of this brief article provides a model that can be used to better understand suicidality in other states.
[http://www.rimed.org/rimedicaljournal-2017-09.asp]
G. Falcone, A. Nardella, D. A. Lamis, D. Erbuto, P. Girardi, & M. Pompili.
This article provides a literature review of the role of new technologies (NT) and brief interventions (BI) (e.g., snail mail, telephone contacts, text messages, online interventions) in preventing suicide attempts and deaths by suicide when used in conjunction with the standard of care. The authors discuss studies showing the efficacy of NT and BI. Many of the studies focused on reducing subsequent suicide attempt post-discharge. They found evidence that BI may help reduce suicide attempts and / or self-harm after discharge and can be easily implemented. The authors recommend further research into the efficacy of NT and BI alongside the usual standard of care.
This article will be helpful to anyone considering the implementation of NT and BI in suicidality prevention.
[https://doi.org/10.5498/wjp.v7.i3.163]About the Science of Suicidality (SOS)
