Science of Suicidality, Suicidality
April 2017: Science of Suicidality (SOS)
Mar
Burden of suicide in Poland in 2012: how could it be measured and how big is it?
K. Orlewska & E. Orlewska.
This study attempts to estimate the economic and health-related burden of suicide in Poland during 2012. The authors analyzed data from the Polish Central Statistics Office database to estimate the years of life lost (YLL), local expected YLL (LEYLL), standard expected YLL (SEYLL), and premature mortality costs. They report total LEYLLs of 109,338 and SEYLLs of 279,425 due to suicide. They report, “the cost of male premature mortality (2,808,854,532 Polish zloty [PLN] {≈ $830,690,639.29 USD}) was substantially higher than for females (177,852,804 PLN [≈ $52,598,188.25 USD]).” The authors report local public health policymakers may find the LEYLLs and premature mortality costs useful.
Of particular interest are their findings that, “suicide accounted for 3% of all-cause mortality-related LEYLL and SEYLL and 10% [of] the total premature mortality cost in Poland” even though it accounted for only 2% of all deaths. Death by suicide caused a disproportionally higher impact on LEYLL, SEYLL, and total premature mortality costs than other causes of death.
[http://dx.doi.org/10.1007/s10198-017-0892-8]
S. Exbrayat, C. Coudrot, X. Gourdon, A. Gay, J. Sevos, J. Pellet, B. Trombert-Paviot, & C. Massoubre.
This study investigates the efficacy of 3 telephone follow-up calls (8 days, 30 days, and 60 days) on prevention of additional suicide attempts in the following year. The authors studied 823 patients (436 patients in the study group between January and December of 2010, and 387 in a control group of patients from the year before study initiation) who had been referred to a university emergency psychiatric unit in France following a suicide attempt. They sent letters to those in the control group who did not respond to the follow-up calls (24 hours, 7 days, 1 month, 2 months, 3 months, 4 months, and 5 months). The authors found that early telephone follow-up calls after a suicide attempt may help prevent future attempts.
This study merits replication using a randomized design, correcting for the lack of patient-reported assessment of additional suicide attempt(s) at endpoint, correcting for the differing years of group data collection, and including a 3rd treatment group designed to explore the impact of letters sent to those in the treatment group who did not answer the phone.
[http://dx.doi.org/10.1186/s12888-017-1258-6]
M. E. Thase, J. Edwards, S. Durgam, C. Chen, C. T. Chang, M. Mathews, & Carl P. Gommoll.
This post-hoc analyses investigates the effects of vilazodone on suicidal ideation and behavior in adults with Major Depressive Disorder (MDD) or Generalized Anxiety Disorder (GAD). The authors used pooled data from 4 MDD and 3 GAD vilazodone trials all of which used the Columbia – Suicide Severity Rating Scale (C-SSRS). The authors used a shift from baseline C-SSRS category to identify treatment emergent suicidal ideation. They report, “data from placebo-controlled studies indicate little or no risk of treatment-emergent suicidal ideation or behavior with vilazodone in adults with MDD or GAD.”
***** The published results of one of the studies used in this ad-hoc analysis was co-authored by one of the co-founders of Harm Research Press (DS) (the publisher of the Science of Suicidality) and Harm Research Institute (the owner of the website on which the Science of Suicidality is published).
[http://dx.doi.org/10.1097/YIC.0000000000000180]
J. D. Ribeiro, P. M. Gutierrez, T. E. Joiner, R. C. Kessler, M. V. Petukhova, N. A. Sampson, M. B. Stein, R. J. Ursano, & M. K. Nock on behalf of the Army STARRS Collaborators.
This study investigates whether soldiers that died by suicide accessed health care in the weeks and months before their death. The authors retrospectively studied 569 Regular, U.S. Army soldiers on active duty who died by suicide between 2004 and 2009, and 5,690 matched controls. The authors report, “approximately 50% of suicide decedents accessed health care in the month prior to their death, and over 25% of suicide decedents accessed health care in the week prior to their death.” The authors give recommendations on how to use risk assessments to increase the documentation of suicidal ideation and behavior.
[http://dx.doi.org/10.1037/ccp0000178]
R. Gilissen, D. De Beurs, J. Mokkenstorm, S. Mérelle, G. Donker, S. Terpstra, C. Derijck, The SUPRANET (Suicide Prevention Action Network) Research Group, & G. Franx.
This article describes a study protocol designed to implement the Dutch version of European Alliance against Depression (EAAD), called the Suicide Prevention Action NETwork (SUPRANET) Community in seven Dutch pilot regions. The authors describe the 4 levels of implementation: 1. Increasing the suicide awareness through local media campaigns; 2. Local gatekeeper training; 3. Targeting those at high-risk; and 4. Training primary health care professionals. They describe how they plan to determine the impact and feasibility of SUPRANET. The authors intend to use their findings to facilitate national implementation of EAAD in The Netherlands.
[http://dx.doi.org/10.3390/ijerph14040349]
Multiple sclerosis and suicide
A. Feinstein & B. Pavisian.
This article provides a short, 4-page, overview of suicidality in patients with multiple sclerosis (MS). The authors review epidemiological and risk factor data. They recommend training neurology clinic staff about suicidality and recommend providing quick referral to mental health care when appropriate. The authors summarize the case of a patient with MS and Bipolar Disorder who planned his suicide attempt for weeks and died by suicide the night after appointments with both his neurologist and his psychiatrist.
[https://doi.org/10.1177/1352458517702553]
K. Andreasson, J. Krogh, P. Bech, H. Frandsen, N. Buus, B. Stanley, A. Kerkhof, M. Nordentoft, & A. Erlangsen.
This article describes a trial protocol designed to determine whether a newly-developed, mobile safety plan app (MyPlan) is more effective in reducing suicidal ideation than a paper-version safety plan. The authors describe plans to enroll a total of 546 participants, 273 in each arm, recruited from Danish Suicide Prevention Clinics. They report planning for both groups to receive standard, short-term psychosocial therapeutic care. The authors plan follow-up interviews at 3-, 6-, 9- and 12-months and selected a reduction in suicidal ideation, as assessed using the Beck Suicide Ideation Scale (BSS), after 12 months as the primary outcome. The authors hope the trial will increase knowledge on whether modern technology can augment the effects of traditional personalized safety planning.
The MyPlan app group was encouraged to use the app for 15 minutes a day to evaluate old strategies and develop new ones. Without similar encouragement of 15-minutes daily focused on personal suicide prevention strategies for the paper-version group, it is impossible to determine if any study results in favor of the MyPlan app would be due to this distinction between treatment groups. If this study is replicated, the paper-version safety plan group needs to have a similar recommendation of 15-minutes per day focused on suicide prevention strategies.
[http://dx.doi.org/10.1186/s13063-017-1876-9]
E. H. Gebremariam, M. M. Reta, Ze. Nasir, & F. Z. Amdie.
This study explores factors associated with suicidal ideation and suicide attempt in people living with HIV / AIDS. The authors studied a sample of 417 HIV-positive patients receiving care at Zewditu Memorial Hospital, Addis Ababa, Ethiopia, during 2 months of 2014. They used the Composite International Diagnostic Interview (CIDI), Patient Health Questionnaire (PHQ-9), and an HIV-related stigma scale. The authors report 22.5% experienced suicidal ideation and 13.9% had made a suicide attempt. They report details on the timing of suicidality following the HIV diagnosis. The authors emphasize the importance of early diagnosis and treatment of depression and opportunistic infections, and the early initiation of antiretroviral therapy in HIV-positive adults.
Only 30 (51.7%) of those who made a suicide attempt had also made a suicide plan. To put it another way, 28 (48.3%) patients made a suicide attempt without having a suicide plan. This finding needs to be investigated further.
[https://doi.org/10.1155/2017/2301524]
N. Tsujii, W. Mikawa, E. Tsujimoto, T. Adachi, A. Niwa, H. Ono, & O. Shirakawa.
This study investigates frontotemporal hemodynamic responses in patients with Major Depressive Disorder (MDD) and a history of suicide attempts. The authors studied matched patients with MDD with and without a history of suicide attempt (30 and 38, respectively) with 40 healthy controls using 52-channel NIRS during a during a verbal fluency task (VFT). They found that the pattern of VFT-induced NIRS signal changes differed between MDD patients with and without a history of suicide attempt, even if they had similar clinical symptoms.
No significant differences were observed on the Barratt Impulsiveness Scale between the patients with MDD and a history of suicide attempt versus patients with MDD and no history of suicide attempt. This is contrary to the usual assumption that patients with a history of suicide attempt are more impulsive than those without such a history.
** 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://doi.org/10.1371/journal.pone.0175249]
M. D. Anestis, E. A. Selby, & S. E. Butterworth.
This study examined: 1. The relationship between overall suicide rates and both firearm and non-firearm suicide rates over a 16-year period (1999 – 2015); 2. Means substitution by examining the association between firearm and non-firearm suicide rates; and 3. Whether handgun ownership laws were associated with an attenuated trajectory in suicide rates during a 6-year period (2009 – 2015). The authors used information from the Law Center for the Prevention of Gun Violence, Webbased Injury Statistics Query and Reporting System (WISQARS), US Census Bureau (2017), US Geological Survey (2015), and state gun ownership rates imputed based on the findings of Kalesan et al. (2015). The authors report that reduction in firearm suicide rates were associated with a reduction in overall suicide rates. They report a more steeply rising trajectory of statewide suicide rates in the absence of universal background checks and without a mandatory waiting period.
[http://dx.doi.org/10.1016/j.ypmed.2017.04.032]
Suicide in Europe: an on-going public health concern
F. McNicolas.
This article provides a summary of suicidality in Europe. The author reviews trends in suicide rates, risks associated with suicide, and information about suicide prevention programs. The author recommends suicide prevention using, “a combined multifaceted approach at the individual and community level”.
[https://hrcak.srce.hr/178943]
Suicide Risk Assessment Doesn’t Work
D. Murray & P. Devitt.
This brief article provides an overview of potential pitfalls from relying on a formula to predict suicide risk. It highlights some of the possible reasons behind actions of clinicians which are not based upon sound scientific evidence. The authors recommend clinicians focus on treating mental illness and reducing the pain of patients and families, instead of wasting valuable resources on predicting suicide by risk assessment.
Although attempting to accurately predict suicide at the individual level via such suicide risk assessments is a statistically futile exercise, it is prudent for any clinician interacting with a suicidal patient to have a proper understanding of the suicidality the patient has already experienced, for example, through the use of a suicidality tracking scale.
[https://www.scientificamerican.com/article/suicide-risk-assessment-doesnt-work/]
The Association of Baseline Suicidality With Treatment Outcome in Psychotic Depression
K. S. Bingham, A. J. Rothschild, B. H. Mulsant, E. M. Whyte, B. S. Meyers, S. Banerjee, K. Szanto, & A. J. Flint on behalf of the STOP-PD Study Group.
This study investigates the relationship between baseline suicidality and outcome of major depression. The authors investigated this relationship as a secondary study to a randomized controlled trial comparing olanzapine plus sertraline with olanzapine plus placebo as treatments for psychotic depression between 2002 and 2007, known as STOP-PD. They studied 258 adults diagnosed with major depressive disorder with psychotic features using the Hamilton Depression Rating Scale (HDRS), Schedule for Affective Disorders and Schizophrenia (SADS), Scale for Suicide Ideation (SSI), and Structured Clinical Interview for DSM-IV (SCID). The authors report, “participants with suicidality had a better outcome when treated with the combination of olanzapine and sertraline than when treated with olanzapine plus placebo.”
This study is of particular importance because it is one of the few studies where patients with a range of existing suicidality were given the autonomy to consent to participation in a randomized, double-blind, placebo-controlled clinical trial. With proper safeguards in place, more randomized, double-blind, placebo-controlled clinical trials need to be conducted to investigate the anti-suicidality efficacy of medication treatments.
[https://doi.org/10.4088/JCP.16m10881]
I. Kinchin & C. M. Doran.
This retrospective analysis attempts to quantify the economic cost of death by suicide and suicidal behavior in the Australian workforce. The authors examine the potential impact of introducing suicide prevention intervention in the workplace. They used data from the National Coronial Information System (NCIS) for 2014 to explore production disturbance, human capital, medical, administrative, transfer, and other costs. The authors report 903 workers died by suicide, and estimate thousands seriously disabled themselves and more than ten thousand caused self-injury requiring short-term work absence. They report death by suicide and suicidal behavior resulted in an estimated economic cost of $6.73 billion. The authors also estimate the positive financial return from investment in universal suicide prevention intervention in the workplace.
[http://dx.doi.org/10.3390/ijerph14040347]About the Science of Suicidality (SOS)
