July 2017: Science of Suicidality (SOS)

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July 2017: Science of Suicidality (SOS)

A Risk Algorithm for the Persistence of Suicidal Thoughts and Behaviors During College **

P. Mortier, G. Kiekens, R. P. Auerbach, P. Cuijpers, K. Demyttenaere, J. G. Green, R. C. Kessler, M. K. Nock, A. M. Zaslavsky, & R. Bruffaerts.

This study investigated patterns of suicidal thoughts and behavior (STB) among college students who had a history of STB prior to college.  This article describes development of a risk-screening algorithm to identify students with STB prior to college who are likely to continue to experience STB within the first 2 years of college.  The authors studied 2,566 KU Leuven University freshmen during 2012 and 2013 using web-based self-report surveys.  The authors report, “Results are promising for accurately predicting highly persistent STB cases in a prospective way; however, results for relapsing-remitting STB were less favorable.”

** 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.



Comprehensive Screening for Suicide Risk in Primary Care

G. S. Diamond, J. L. Herres, E. S. Krauthamer Ewing, T. O. Atte, S. W. Scott, M. B. Wintersteen, & R. J. Gallop.

This study investigated social stress and profiles of risk behaviors associated with suicidality in adolescents and young adults.  The authors studied screening data from a convenience sample of 2,513 adolescent and young adult aged primary care patients using the Behavioral Health Screen collected between 2008 and 2012 at 10 sites in rural and semi-urban areas in Northeastern Pennsylvania.  They identified a low and high risk profile group which was primarily influenced by substance use, sexual assault, and sexual behavior.  The high risk group was 3 times more likely to have recent suicidal ideation, 5 times more likely to have history of suicidal ideation and behavior, and 11 times more likely to have made a suicide attempt.  The authors believe it may be helpful for primary care providers to screen for more than just depression when attempting to identify youth experiencing suicidality.



Demographics as predictors of suicidal thoughts and behaviors: A meta-analysis

X. Huang, J. D. Ribeiro, K. M. Musacchio, & J. C. Franklin.

This meta-analysis investigated the clinical utility and effect strength of demographic factors as predictors of suicidal ideation, suicide attempt, or death by suicide.  The authors included 159 longitudinal studies published before January 1st, 2015 and included 752 unique statistical tests in their analysis.  They report the overall effects of demographic factors as risk factors were significant but weak and report demographic factors as protective factors were non-significant.  The authors found adjusting for publication bias further reduced effect estimates.  They found no specific demographic factors appeared to be strong predictors.



Help seeking and suicidality among people with epilepsy in a rural low income country setting: cross‑sectional survey

R. Tsigebrhan, C. Hanlon, G. Medhin, & A. Fekadu.

This article investigated suicidality, patterns of help-seeking, and the association with duration of untreated epilepsy (DUE) among people with epilepsy (PWE).  The authors studied 298 PWE in a rural district (Sodo) in Ethiopia using the Composite International Diagnostic Interview (CIDI), Patient Health Questionnaire (PHQ-9), and Alcohol Use Disorder Identification Test (AUDIT).  They found 30.2% PWE reported suicidality in the prior year.  The authors found no association between DUE and suicidality.  They report, “The adjusted odds of suicidality among PWE were statistically significantly higher among people who were married (OR 2.81, 95% CI 1.22, 6.46), had higher levels of depressive symptoms (OR 1.17 for each 1 point increase in PHQ-9 score, 95% CI 1.10, 1.26) and those with perceived very low relative wealth (OR 2.67, 95% CI 1.07, 6.68).”

Their findings that 95.6% of PWE had at least mild depressive symptoms and that 9.4% of PWE had attempted suicide in the last year warrant further investigation.



Increased risk of attempted suicide in Australian veterans is associated with total and permanent incapacitation, unemployment and posttraumatic stress disorder severity

K. Kerr, M. Romaniuk, S. McLeay, A. Khoo, M. T Dent, & M. Boshen.

This retrospective study investigated significant psychological and demographic differences between veterans with Posttraumatic Stress Disorder (PTSD) who had and had not attempted suicide.  The authors studied 229 former service personnel diagnosed with PTSD who had attended a Military Service Trauma Recovery Day Program as outpatients at Toowong Private Hospital in Australia from 2007 to 2014 using self-report questionnaires assessing symptoms of PTSD, alcohol use, anger, depression, anxiety, and quality of life.  They found that veterans with PTSD, unemployment, psychopathology severity, and total and permanent incapacity status were significantly more likely to have a suicide attempt history.  The authors report, “Findings demonstrated an individual’s likelihood to attempt suicide increased by 2% per additional point on the CAPS-IV frequency or intensity symptom rating scale.”



Interparental Conflict and Chinese Adolescents’ Suicide Ideation and Suicide attempts: The Mediating Role of Peer Victimization

T. Ai, Q. Xu, X. Li, & D. Li.

This study investigated the relationships between inter-parental conflict and both suicidal ideation and suicide attempts of Chinese adolescents.  This study also investigated the role of peer victimization in mediating these relationships.  The authors studied 2,758 students from 10 middle schools in southern China using the revised Children’s Perception of Marital Conflict Scale, 7-item Adolescent Peer Victimization Questionnaire, and 2 items adapted from the Youth Self-Report.  They report inter-parental conflict were positively correlated with both suicidal ideation and suicide attempts after controlling for demographic variables.  They report the relationships between inter-parental conflict and both suicidal ideation and suicide attempts was partially mediated by peer victimization.



Neuropathology of suicide: recent findings and future directions

P. E. Lutz, N. Mechawar, & G. Turecki.

This article reviews current knowledge of suicidality and discusses how neurobehavioural epigenetics may be used to better understand, and possibly prevent, suicidal behavior.  The authors discuss their model of suicide risk, including genetic contributors, the functional genomics of biological circuits and their relation to suicide, and current challenges and future areas for functional genomic research on suicidal behavior.



Resisting the Silence: The Impact of Digital Communication on Young People’s Talk About Suicide

K. Gibson, J. Wilson, J. Le Grice, & F. Seymour.

This study investigated opportunities and constraints for youth to talk about suicide in New Zealand.  The authors studied data from 9 focus groups including 38 young people using a thematic analysis.  They report the youth viewed adults as unwilling to talk with them about suicide and the youth were reluctant to seek help for suicidality from mental health professionals.  The authors report youth were more willing to communicate with their peers about suicidality via digital communication than in-person-communication.  Authors felt that digital communication with peers seemed to undermine willingness to communicate with adults about suicidality.

This article provides a number of insightful quotes from the youth in the focus groups that would be beneficial to those working with youth or in youth suicide prevention.

Youth interested in participating in the focus groups were evaluated for suicide risk.  Any youth for whom there was current concerns about mental health or suicidality was not allowed to participate in the focus groups.  This study needs to be repeated allowing young people who are currently suicidal to provide their perspective of the opportunities and constraints to talking about their suicidality.



Spatio-Temporal Analysis of Suicide-Related Emergency Calls

M. Marco, A. López-Quílez, D. Conesa, E. Gracia, & M. Lila.

This study investigated the use of an autoregressive approach to spatio-temporal disease mapping to model the number of suicide-related emergency calls.  The authors investigated 6,537 suicide-related emergency calls in Valencia, Spain between 2010 and 2016 by area patterns (552 census block groups) and seasonality (28 trimesters).  They found suicide-related emergency calls were spatially patterned.  The results suggest that suicide-related emergency calls peak in the second (April to June) and third (July to September) trimester.

Regular use of spatio-temporal disease mapping may help identify areas at need for additional suicide prevention resources within a community.



Suicidal Ideation in Adult Patients with Atopic Dermatitis: A German Cross-sectional Study

J. Dieris-Hirche, U. Gieler, F. Petrak, W. Milch, B. te Wildt, B. Dieris, & S. Herpertz.

This retrospective cross-sectional study investigated the relationship between suicidality, depression, and anxiety symptoms and skin-specific factors in adult patients with atopic dermatitis (AD).  The authors studied 245 German patients (181 with AD and 64 age and sex similar controls with healthy skin) using Pöldinger’s Scale, Hospital Anxiety and Depression Scale (HADS), Dermatology Life Quality Index (DLQI), Patient-Oriented Scoring Atopic Dermatitis (PO-SCORAD), and Skin Satisfaction Questionnaire (SSQ).  They report high prevalence of suicidal ideation among patients with AD (21.5%) and recommend psychiatric screening in patients with AD.



Suicide following acute admissions for physical illnesses across England and Wales

S. E. Roberts, A. John, U. Kandalama, J. G. Williams, R. A. Lyons, & K. Lloyd.

This study investigated death by suicide rates after acute admissions for all major physical illnesses.  The authors studied data from 11,004,389 acute admissions for physical illnesses across England (involving 8,970,811 patients) and 713 496 across Wales (involving 577,474 patients) from 2004 through 2011 and found 1,781 and 131 deaths by suicide, respectively.  They report acute admissions for most physical illnesses were associated with little or no increased suicide mortality.  They found, “high consistent suicide mortality (significant SMR >3) in both countries for constipation (SMR = 4.1 in England, 7.5 in Wales), gastritis (4.4 and 4.9) and upper gastrointestinal bleeding (3.4 and 4.5).”

Table 2 and 3 are of particular interest as they show the SMR related to the 48 physical illnesses and the adjusted odds ratio of the high risk physical illnesses investigated in this study.  Similar studies need to be conducted on data from other countries.



Teachers’ Attitudes toward Youth Suicide and its Relationship with Their Own Quality of Life

R. Taketani, E. Tsujimoto, & H. Ono.

This study investigated attitudes of teachers about youth death by suicide and whether it is related to the teacher’s quality of life (QOL).  The authors studied 77 teachers in Western Japan between 2009 and 2012 using a self-rated questionnaire and The Medical Outcome Study 36-Item Short-Form Health Survey version 2 (SF-36v2).  They report teachers with a lower role-social QOL score were more likely to have positive views of death by suicide for social reasons.  The authors also report that teachers with higher physical QOL scores were less likely to have positive views death by suicide for social reasons.  They found 26% of teachers did not view death by suicide as an unacceptable way to solve problems.

Similar studies should be conducted in larger and more diverse samples.



Why We Need to Enhance Suicide Postvention Evaluating a Survey of Psychiatrists’ Behaviors after the Suicide of a Patient

M. D. Erlich, S. A. Rolin, L. B. Dixon, D. A. Adler, D. W. Oslin, B. Levine, J. L. Berlant, B. Goldman, S. Koh, M. B. First, C. Pabbati, & S. G. Siris.

This study investigated postvention procedures following the death of a patient by suicide.  The authors surveyed a convenience sample of 90 psychiatrists at the fall 2015 meeting of the Group for the Advancement of Psychiatry (GAP).  They report most respondents sought support for themselves and had contact with the patient’s family within 6 months of the patient’s death.  They found that only 9% used a suicide postvention procedure or toolkit and that 10% stopped accepting patients thought to be at high risk of suicide.  The authors recommend further research on and the improvement of postvention procedures to better address care of those treating a patient who dies by suicide.


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