Science of Suicidality, Suicidality
October 2017: Science of Suicidality (SOS)
Sep
X. Gonda, J. Sarginson, N. Eszlari, P. Petschner, Z. G. Toth, D. Baksa, G. Hullam, I. M. Anderson, J. F. W. Deakin, G. Juhasz, & G. Bagdy.
This study investigated the effect of rs3219151 of GABRA6 gene in interaction with recent negative life events on current and lifetime depression, current anxiety, and lifetime suicidality. The authors used regression models in a non-psychiatric sample of 2,283 white European subjects and a sub-sample of 204 subjects with either Major Depressive Disorder or an anxiety disorder. They found no association between rs3219151 and trait impulsiveness. They report finding no main effect of GABRA6 rs3219151 in the full sample. The authors found the GABRA6 T allele increased current anxiety and depression, suicidal and death-related ideation, hopelessness, restlessness and agitation, insomnia and impulsiveness in sub-sample subjects exposed to a recent negative life event.
Those with a history of suicidality and those with a history of deliberate self-harm were both grouped together into the ‘suicidal’ group. Since deliberate self-harm does not necessarily contain the intent to die from the event of self-harm, by definition it is not necessarily suicidality. This study should be repeated making the distinction between subjects with a history of suicidality and those with a history of deliberate self-harm to determine if including both of these groups into the ‘suicidal’ group impacted study results.
Please note, in some sections of this article they refer to the ‘suicidal’ group as having a “history of suicide or deliberate-self harm” and in other sections of the article they refer to this group as having a “history of suicide attempt/deliberate self-harm”. It is unclear if subjects in this group 1) had a history of suicide attempt and / or deliberate self-harm or if they 2) had a history of suicidality and / or deliberate self-harm.
[https://dx.doi.org/10.1038/s41598-017-12776-8]
Antidepressants and suicide risk in depression
P. Courtet & J. Lopez-Castroman.
This brief, 1-page article provides an historical overview of the finding of an increased risk of suicidality in those under age 40 who take antidepressants. It also provides insight into the need for the development of evidence-based, anti-suicidality treatments.
This article should be read by anyone not aware of the rationale behind the boxed warnings cautioning the potential of treatment-emergent suicidality which were added into the prescribing information for antidepressants and other psychiatric medications available in the United States.
[https://dx.doi.org/10.1002/wps.20460]
Can we usefully stratify patients according to suicide risk?
M. M. Large, C. J. Ryan, G. Carter, & N. Kapur.
This brief 3-page article provides an overview of the utility of suicide risk stratification in identifying patients who later die by suicide. The authors recommend against relying upon these suicide risk stratifications. They provide thoughtful recommendations on how to communicate with suicidal patients.
The authors of this article provided the draft manuscript to 4 suicidal patients for feedback and then amended the article with consideration of this patient feedback. The authors report, “All four patients were critical of suicide risk stratification and strongly supported individualized assessments leading to treatment plans based on their preferences and needs.” When possible and appropriate, more publications should consider obtaining patient feedback on draft manuscripts before publication.
[https://dx.doi.org/10.1136/bmj.j4627]
Characterising violent deaths of undetermined intent: a population-based study, 1999–2012
J. Lachaud, P. Donnelly, D. Henry, K. Kornas, T. Fitzpatrick, A. Calzavara, C. Bornbaum, & L. Rosella.
This study investigated sex differences, age differences, and socioeconomic gradients between those who died by suicide and those who died by violent deaths classified as undetermined intent (UD) in Ontario, Canada. The authors used data from the Institute for Clinical Evaluative Sciences which links vital statistics with Census data including 2,812 deaths with UD and 14,822 deaths by suicide from 1999 through 2012. They found a higher proportion of deaths by suicide (11.8%) than UD deaths (6.7%) in those from 15 through 24 years-old. They found rates of UD deaths were highest for men from 45 through 64 years-old residing in the most residentially unstable (8.1 per 100 000 population) and materially deprived (7.9) neighborhoods. The authors report death by suicide rates were highest in these groups of men of the same age at 30.1 and 30.7, respectively. They report similarities between deaths by suicide and UD deaths suggest that at least some UD deaths may be misclassified cases of death by suicide.
Please note the abstract and text have different death by suicide rates in men ages 45 to 64 years-old per 100,000 population than are listed in Table 2 of the article. Data above are taken from Table 2.
[https://dx.doi.org/10.1136/injuryprev-2017-042376]
Childhood trauma and risk for suicidal distress in justice-involved children ********
M. E. Johnson.
This study investigated the cumulative and individual effects of childhood trauma on suicidal distress among justice-involved children (JIC). The author studied Florida Department of Juvenile Justice (FLDJJ) data on 2,367 youth aged 12 to 16 years-old taken from the Positive Achievement Change Tool (PACT) assessment used at arrest intake. He reports that about 97% of JIC reported 1 or more traumatic events. The author found, “For one unit increase in the trauma score, the risk for suicidal distress increased 25%, so that JIC who experienced 5 types of traumas were 2.4 times more likely to experience suicidal distress as JIC who experienced a single trauma.” He recommends 1) further investment in suicide prevention resources and mental health services in the juvenile justice system and 2) trauma-tailored interventions, including interventions for those who experience multiple types of trauma. The author cautions that policies which manage JIC as kid criminals, instead of seeing them as traumatized children, may increase their problematic behavior and suicidality.
******** The author of this article is affiliated with the University of Florida (UF). The editor of the Science of Suicidality and an owner of Harm Research (the website on which the Science of Suicidality is published) also has affiliation with UF.
[https://dx.doi.org/10.1016/j.childyouth.2017.10.034]
Demographic and clinical factors associated with suicide in gastric cancer in the United States
M. B. Bowden, N. J. Walsh, A. J. Jones, A. M. Talukder, A. G. Lawson, & E. J. Kruse.
This study investigated death by suicide rates among patients diagnosed with gastric cancer between 1973 and 2013. The authors studied data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database, including data on 210 patients with gastric cancer who died by suicide, and data from the United States Centers for Disease Control and Prevention’s Web-based Injury Statistics Query and Reporting System (WISQARS). They found 161 of the deaths by suicide (77%) occurred within the first year after diagnosis. They report an increased standard mortality rate in those who are White (4.08), female (8.54), under the age of 40 (3.06), and between 70 and 79 years-old (2.90) when compared to the general population. The authors aim to develop screening strategies to help in the identification of suicidality in those with gastric cancer and recommend management of psychosocial stressors in these patients to prevent deaths by suicide.
Their finding that 85% of the deaths by suicide in those with gastric cancer were in those over 79 years-old merits further investigation.
Given these high rates of death by suicide in patients with gastric cancer within the first year after diagnosis, it may be prudent to routinely assess suicidality in all patients diagnosed with gastric cancer.
[https://dx.doi.org/10.21037/jgo.2017.08.02]
J. McGinty, M. S. Haque, & R. Upthegrove.
This literature review and meta-analysis investigated the influence of depressive symptoms during first episode psychosis (FEP) on later suicidal behavior. The authors included 13 studies using a longitudinal design and published before January 25th, 2017 in their analysis, including 3,002 participants (428 who had suicidal behavior during the studies). They found significantly increased odds ratio of suicidal behavior in participants who had depressive symptoms during FEP compared to those without depressive symptoms during FEP (OR = 1.59). The authors recommend acknowledgment of this association in early management planning and recommend large scale clinical trials to identify effective ways to manage depression during FEP.
[https://doi.org/10.1016/j.schres.2017.09.040]
Implementation and evaluation of the Victorian Suicide Register
G. Sutherland, A. Milner, J. Dwyer, L. Bugeja, A. Woodward, J. Robinson, & J. Pirkis.
This article describes an overview of the Victorian Suicide Register (VSR) in Victoria, Australia. The VSR is a state-based suicide surveillance system containing detailed information on people who die by suicide and the circumstances surrounding their death. The article describes an evaluation of the register, using the Centers for Disease Control and Prevention guidelines for surveillance system evaluation as a framework. The authors investigated whether the VSR 1) embodies the attributes of a good public health surveillance system and 2) can be used to inform community-based suicide prevention efforts. The authors report identifying key challenges in the systematic collection of data on deaths by suicide, including issues with the quality of data collected as part of a death investigation. They report, “The VSR fills an important gap in the sustained and systematic collection of comprehensive information on suicide.”
[https://doi.org/10.1111/1753-6405.12725]
C. Wilks, Q. Yin, S. Y. Ang, B. Matsumiya, A. Lungu, & M. Linehan.
This article describes a pilot study protocol designed to investigate the feasibility and effectiveness of 8 weeks of Internet-delivered Dialectical Behavioral Therapy Skills Training (iDBT-ST) on reduction of suicidal ideation, alcohol problems, and emotion dysregulation in suicidal individuals who engage in heavy episodic drinking. The authors will study 59 participants randomized into 2 groups (30 immediately receiving iDBT and 29 waitlisted for 8 weeks) over 16 weeks. Data collection occurred between June 2016 and February 2017. The authors discuss their plans to assess the impact of iDBT on suicidal ideation, alcohol problems, and emotional dysregulation. Their preliminary data suggests that technologically-assisted interventions may be beneficial alternatives to traditional therapy, or may mediate adaptive help-seeking in underserved and at-risk populations.
The participants were sent brief daily surveys about their use of DBT skills, engagement level, and urges to stop treatment only when they were in active treatment, allowing for the potential that these surveys impacted study results. To eliminate this potential, the larger study further exploring the effectiveness of iDBT needs to be conducted using somewhat similar daily surveys (as a proxy control) even when the participant is not in active treatment.
[https://dx.doi.org/10.2196/resprot.7767]
V. Rachamallu, M. M. Song, H. Liu, C. L. Giles, & T. McMahon.
This case report provides a brief overview of articles that describe Obsessive-Compulsive Disorder (OCD) occurring with suicidal obsessions in patients with a long-standing diagnosis of OCD. This case report describes, “a 28-year-old male, who works as a first responder, who presented with new onset symptoms characteristic of MDD and PTSD, with no past history of OCD or suicidality who developed OCD with suicidal obsessions.” The authors provide a 20-day timeline beginning at the patient’s 1st hospitalization and ending at discharge after the 2nd hospitalization, including the treatment regimen prescribed.
Due to the description of these suicidal thoughts as being “intrusive, recurrent, [and] distressing” and a “sudden intrusive thought of hanging himself”, and because the patient “begins to think about ‘hanging [him]self’ to make them go away”, among other examples, this case example needs to be differentiated diagnostically from Impulse Attack Suicidality Disorder (IASD).
A longer-term follow-up of this patient would be helpful to the field and merits further consideration by the authors.
[https://doi.org/10.1155/2017/4808275]
P. I. Arias Vázquez, R. G. Castillo Avila, M. d. C. Dominguez Zentella, Y. Hernández-Díaz, T. B. González-Castro, C. A. Tovilla-Zárate, I. E. Juárez-Rojop, M. L. López-Narváez, & A. Frésan.
This study investigated the prevalence of suicide attempts and depression in Mexican patients with limb amputations. The authors studied 40 patients in Tabasco, Mexico who had undergone 1 or more limb amputations. They report 11 patients (27.5%) made a suicide attempt, including 2 who died by suicide, between the time when the patient was informed of the limb amputation until the moment of evaluation (range of 12.22 to 23.79 weeks after limb amputation). The authors report 92.5% (37) of the patients were depressed and 57.5% (23) were completely functionally dependent. The authors recommend holistic interventions to increase functionality and to decrease depression and suicidal behavior in those faced with limb amputation.
[https://dx.doi.org/10.1097/MRR.0000000000000259]
A. Z. Ivey-Stephenson, A. E. Crosby, S. P. D. Jack, T. Haileyesus, & M. Kresnow-Sedacca.
This study investigated demographic trends and mechanisms of death among and within urbanization levels in the United States between 2001 and 2015. The authors obtained mortality data from the National Vital Statistics System (NVSS) include demographic, geographic, and cause of death information derived from death certificates (including International Classification of Diseases, 10th Revision death codes). County data were transformed into 3 urbanization levels based on the 2006 National Center for Health Statistics classification scheme. The authors report death by suicide rates in rural / nonmetropolitan counties were higher than in metropolitan counties. They found these trends were observed by age group, sex, race/ethnicity, and mechanism of death.
[https://stacks.cdc.gov/view/cdc/48505]
S. T. Wilkinson, E. D. Ballard, M. H. Bloch, S. J. Mathew, J. W. Murrough, A. Feder, P. Sos, G. Wang, C. A. Zarate, & G. Sanacora.
This article provides a systematic review and an individual participant data meta-analysis investigating the effects of 1 dose of ketamine on suicidal ideation. The authors studied individual participant data from 10 of the 11 identified comparison intervention studies which used either midazolam or saline as a control. They analyzed data from 176 participants who had suicidal ideation at baseline. Suicidal ideation was measured using question(s) from the following scales in the various studies: 1) Montgomery-Åsberg Depression Rating Scale (MADRS), 2) Hamilton Depression Rating Scale (HAM-D), 3) Quick Inventory of Depressive Symptomatology–Self Report (QIDS-SR), and 4) Beck Depression Inventory (BDI). The authors report the effect of ketamine on suicidal ideation up to 1 week after baseline remained significant for clinician-ratings even after adjusting for the concurrent changes in depressive symptom severity. The authors caution the need for additional research into the efficacy of ketamine in reducing suicidal ideation before clinical implementation.#
The finding of statistically significant differences between ketamine and the control treatments on the individual suicidality items of the HAM-D, MADRS, and QIDS-SR, but not the suicidal ideation question of the BDI merits further investigation.
# Please note that ketamine is not approved by any regulatory agency for antidepressant or anti-suicidality efficacy at this time.
[https://doi.org/10.1176/appi.ajp.2017.17040472]
Trends in incidence and associated risk factors of suicide mortality among breast cancer patients
A. Gaitanidis, M. Alevizakos, M. Pitiakoudis, & D. Wiggins.
This study investigated trends in the incidence of suicide mortality and in risk factors among patients with breast cancer. The authors conducted a retrospective examination of 1973 through 2013 data from the National Cancer Institute’s Surveillance Epidemiology and End Results database. The authors found 773 patients died by suicide out of the 474,128 patients with breast cancer who died by any cause identified within the database. They report finding no identifiable improvements in preventing death by suicide in patients with breast cancer within the United States over the last 3 decades.
[https://doi.org/10.1002/pon.4570]About the Science of Suicidality (SOS)
