2.3 suicidality Flashcards
method
(Dejong et al, 2009)
Apples to oranges?: A direct comparison between suicide attempters and suicide completers
directly compares suicide attempters and completers to assess which patients are at the highest risk for suicide
Suicide attempters and family member informants of suicide completers participated in a thorough psychosocial evaluation
To maximize comparisons with completers, suicide attempters were sub classified based on the lethality of their attempt
results
(Dejong et al, 2009)
Apples to oranges?: A direct comparison between suicide attempters and suicide completers
lethality of the suicidal act:
completers - more likely to use highly lethal methods in their suicidal act
attempters - used methods of low to moderate lethality
age and gender:
completers: significantly older than and more likely to be male
attempters: were more likely to be female
marital status: no sig diff
presence of symptoms: very similar patterns
previous attempts & hospitalization:
attempters were sig more likely to have previously attempted suicide
only 42% of completers had previously attempted suicide
suicide note: completers significantly more likely to leave a suicide note than attempters
substance use prior to act:
completers: over half consumed alcohol/drugs prior to the act
attempters: fewer attempters reported consuming alcohol or drugs prior to their attempt
stressful life events prior to act:
completers: sig more likely to have struggled with job stress and financial problems prior to their suicidal crisis
did not differ w/regard to recent interpersonal conflict, living alone, or recent divorce or romantic breakup
conclusion
(Dejong et al, 2009)
Apples to oranges?: A direct comparison between suicide attempters and suicide completers
most depressive symptoms did not discriminate between suicide completers and highly lethal attempters
study provides evidence that suicide attempters and completers are similar in many ways
however, differences between these two groups were observed on the presence of job stress, financial problems, substance use, and the likelihood of writing a suicide note
epidemiology of suicide
(Turecki & Brent, 2015)
Suicide and suicidal behaviour
non-fatal suicidal behaviours are more common than suicides
in high-income countries, suicide is most common among middle-aged and elderly men
higher rates of ideation and suicide attempts among women, however, rates of suicide deaths are generally higher among men
contemporary models of suicide risk
(Turecki & Brent, 2015)
Suicide and suicidal behaviour
suicide risk is modulated by a range of factors at both population and individual levels
individual risk factors can be grouped into:
- distal (or predisposing)
- developmental (or mediating)
- proximal (or precipitating)
many of these interact to contribute to the risk of developing suicidal behaviors
most models emphasize the interaction between predisposing and precipitating factors
Factors & associated mechanisms that increase risk of suicide
population-level risk factors
(Turecki & Brent, 2015)
Suicide and suicidal behaviour
population-level social factors: suicide is rare in homogeneous socities with high social cohesion, common values, and moral objections to suicide
- economic crises resulting in unemployment and decreased personal income are correlated w/increases in suicide, particularly in men (no causality tho)
media reporting of suicide: affects suicide rates, particularly within the first 30 days of publicity
increases in the rate of suicide proportional to the amount of publicity, when:
- details of a method are provided
- the decedent was a celebrity
- the suicide was romanticised
Factors & associated mechanisms that increase risk of suicide
individual risk factors - distal (or predisposing) factors
(Turecki & Brent, 2015)
Suicide and suicidal behaviour
suicidal behavior runs in families: the risk of attempts is higher in relatives of ppl who died by suicide/attempted suicide
- genetics
sexual orientation: belonging to a sexual minority is universally linked w/increased rates of suicide attempts irrespective of sex
early-life adversity: generally defined as parental neglect or childhood physical, sexual, or emotional abuse
Factors & associated mechanisms that increase risk of suicide
individual risk factors - developmental (or mediating) factors
(Turecki & Brent, 2015)
Suicide and suicidal behaviour
distal factors probably act through personality traits and cognitive styles that mediate their association w/suicidal behaviour
depression and anxiety contribute to risk of suicidal behavior
adolescents and YA - interpersonal conflict, impulsive aggression, conduct disorder, anti-social behavior, and alcohol/drug misuse are salient for suicidal behavior in this age group
early-life adversity
Factors & associated mechanisms that increase risk of suicide
individual risk factors - proximal (or precipitating) factors
(Turecki & Brent, 2015)
Suicide and suicidal behaviour
proximal factors are temporally associated w/suicidal behaviours and act as their precipitants
psychopathology is the most important predictor of suicide and strongly associates w/ other forms of suicidal behaviour
psychopathologies most strongly linked to suicide: MDE, alcohol & drug related disorders, EDs & personality disorders
molecular brain changes: altered levels of serotonin and serotonin signalling are observed in individuals exhibiting suicidal behaviours
interventions to prevent or treat suicidal behavior
prevention
(Turecki & Brent, 2015)
Suicide and suicidal behaviour
school-based interventions reduce the incidence of suicide ideation or suicidal behaviour
among older people: interventions to decrease isolation and augment social support through activity groups and telephone outreach reduce suicide mortality
educate general practitioners about risk factors: websites for physicians, increasing liaison between physicians and psychiatric facilities etc
interventions to prevent or treat suicidal behavior
interventions for detection and treatment of suicidal behaviours
(Turecki & Brent, 2015)
Suicide and suicidal behaviour
detection of patients at risk of suicide: people who attempt and complete suicide often seek medical help within 12 months of their suicide/suicide attempt, most often consulting primary care services
assessing the degree of risk: often, primary care doctors do not adequately assess suicide risk at the last visit before a patient’s death
defining the level of intervention: treatment should be selected on the basis of the patient’s profile and manifestations of suicidal behaviors
treatments
- drug treatment
- behavioural therapy
- repeated transcranial magnetic stimulation applied to the left PFC
- electroconvulsive therapy
- psychotherapy
suicidality
(Lonqvist, 2021)
Mood and anxiety disorders in suicide and suicide attempters
can be conceptualized as a continuum ranging from suicidal ideation and communications to suicidal behaviour - in extreme cases even to completed suicide
anxious and depressed mood, somatic symptoms, helplessness and hopelessness can predispose to suicidal feelings and behaviour to avoid a chaotic situation
depressive disorders & suicide
(Lonqvist, 2021)
Mood and anxiety disorders in suicide and suicide attempters
the most common depressive symptom for suicidal ideation is hopelessness
the most common depressive symptoms for suicidal thoughts are guilt, loss of interest and low self-esteem
the risk of suicide varies markedly across the subclasses of depressive disorders
depression of suicide victims differs from that of living controls - it is more severe and more often accompanied by insomnia, weight or appetite loss, fellings of worthlessness or inappropriate guilt, and thoughts of death/suicidal ideation
antidepressant treatment and suicide
(Lonqvist, 2021)
Mood and anxiety disorders in suicide and suicide attempters
inadequate and inefficient antidepressant treatment of depressed suicide victims and suicide attempters is consistently observed
evidence has not shown that the use of any antidepressant medication directly decreases the risk of suicide
the use of antidepressants has been accused for increasing the risk of suicidal behavior, especially among adolescents
bipolar disorders and suicide
(Lonqvist, 2021)
Mood and anxiety disorders in suicide and suicide attempters
prevention, early recognition and effective treatment of bipolar disorders are suitable and proper tools for suicide prevention
1/4 of ppl with bipolar attempt suicide
risk factors for suicide:
- severity of depressive episode
- previous attempts
- comorbid personality disorder
- hopelessness
lithium reduced the risk of suicide in patients w/mood disorders (not only bipolar)
