Background: In addition to psychiatric disorders, childhood adversities may increase the risk of suicidal behavior. In previous studies, the effects of clinical co-morbidity and overlap of childhood ...adversities has rarely been taken into account.
Aim: The study aims to search associations of psychiatric diagnoses and childhood adversities and trauma (CAT) with suicide risk.
Methods: Altogether 415 adult patients attending primary and psychiatric outpatient care filled in the Trauma and Distress Scale, including assessment of five core CAT domains (emotional, physical and sexual abuse, and emotional and physical neglect). The study patients' current psychiatric disorders and suicide risk were assessed by the Mini International Neuropsychiatric Interview.
Results: Age, poor perceived health, poor social support, current psychiatric treatment, all psychiatric disorders, except hypomania, emotional and physical abuse, and emotional neglect did associate significantly with suicide risk. Number of psychiatric disorders and CAT domains had dose-dependent effects on suicide risk. In multivariate analysis, current psychiatric treatment, current and life-time major depression, social phobia, alcohol, and drug dependency, as well as emotional abuse had direct associations with suicide risk. In females, manic disorders and drug dependence, and in males, dysthymia, social phobia, and emotional abuse associated with suicide risk.
Conclusions: Psychiatric disorders and most CAT domains associate with suicide risk. However, when the effect of co-morbidity and overlap of CAT domains is controlled, major depression, social phobia, alcohol, and drug dependency and emotional abuse seem to increase the risk of suicide. The risk profile varies between the genders.
Drugs increase the risk of suicide in the elderly Kędziora-Kornatowska, Kornelia; Winiarek, Karolina; Murawska, Joanna ...
Journal of education, health and sport,
11/2022, Letnik:
13, Številka:
1
Journal Article
Recenzirano
Odprti dostop
The purpose of this paper is a systematic review of articles and research in the context of drugs used and suicide in elderly patients. Suicide in the elderly may be much more frequent than in the ...younger population. In addition to factors such as mental illness, dementia, deteriorating health, or problems with adapting to old age, the impact of chronic and reliever medications in this age group should also be considered. The greatest challenge of pharmacotherapy in the elderly is polypharmacy, drug interactions, different metabolism, pharmacokinetics and pharmacodynamics of the drugs used, as well as the side effects appearing in chronic therapy. In elderly patients, strong groups of drugs such as benzodiazepines and opioids are used extensively and sometimes too often. These drugs can cause addiction and overdose. Prescribing benzodiazepines alone carries a high risk of suicide. On the other hand, opioids often lead to addiction and abuse of these drugs, which may be associated with the development of respiratory depression. According to estimates by the Centers for Disease Control and Prevention (CDC), suicide accounts for approximately 7% of all opioid overdose deaths. Therapy should be carefully selected with regard to the use of other medications, drug interactions, and possible dependence and drug abuse by patients.The use of some classes of drugs in the elderly requires increased vigilance and control in the context of depression and episodes of suicide attempts. Drugs such as B blockers, digitalis glycosides, NSAIDs, opioids, ACEIs, calcium channel blockers, corticosteroids, diuretics, levodopa, and benzodiazepines can cause symptoms of depression. Older people are more susceptible to side effects of drugs, for example because of polypharmacy and the chronicity of treatment.
Suicide is a major public health problem throughout the world, occurring in over 800,000 people annually. Mood disorders are a common psychopathology and are a signficiant risk factor for ...suicidality. Lithium pharmacotherapy has been shown to reduce symptoms of suicidal behavior, especially in long-term patient interventions. Reasons for this remain unclear. Lithium treatment for individuals with affective disorders appears underutilized. Use of lithium is thought to reduce risk for suicidality, even if mood stabilization is not achieved and serum concentration is lower than the conventionally accepted therapeutic blood level ranges. In this article, the authors review the currently available literature on lithium's effect on suicidality and provide discussion on proposed mechanisms of action. This brief report serves as an important reminder to clinicians to include lithium pharmocotherapy in their armamentarium for treatment of affective disorders, especially when symptoms of suicidality are present.
There is limited quantitative evidence to investigate short-term suicide rates although the risk of suicide in psychiatric patients is exceptionally high in the early post-discharge period. This ...study aimed to explore the trends of the 30 days suicide rate after discharge using population-based data from Korea.
This study was conducted on psychiatric patients aged 15 years or older discharged between 2010 and 2018. Patients were extracted from the National Health Insurance Claim Database (NHICD) and information on suicide was obtained from the National Statistical Office. Age-standardized suicide rate (ASR) and Standardized Mortality Ratio (SMR) within 30 days after discharge was estimated and tested using joinpoint regression.
Of the 1,576,028 patients discharged from hospitals from 2010 to 2018, 53.9 % were male and 47.9 % were aged between 40 and 59 years. The 30 days ASRs for psychiatric patients after discharge varied from 174.9 to 218.0 per 100,000 patients with no clear trend excluding patients with schizophrenia and anxiety disorder. The SMR for suicide within 30 days after discharge was 66.8 in 2016–2018, and patients aged 20 to 39, female, and patients with depression had high SMRs compared to other groups.
Factors that may impact the suicide were not considered in this study. Since the NHICD data is collected for payment of medical expenses, there may be scope for inaccuracies.
The 30 days suicide rate after psychiatric discharge has failed to decrease between 2010 and 2018. This study recommends early interventions after discharge and intensive interventions for patient groups who may be vulnerable to suicide.
•The annual age-standardized suicide rates varied from 174.9 to 218.0 per 100,000 patients and there were no significant decrease between 2010 and 2018 in Korea•The standardized mortality ratio for suicide indicated a steady decline over time.•Patients aged 20 to 59, female, and patients with depression had high standardized mortality ratios compared to other groups.
Objective:
Continued engagement with primary mental health services has been associated with the prevention of subsequent suicidal behaviour; however, there are few studies that identify determinants ...of treatment disengagement among those at risk of suicide in primary care settings. This study investigated determinants of treatment disengagement of those at risk of suicide who were referred to primary mental health care services in Western Sydney, Australia.
Method:
This study used routinely collected data of those referred for suicide prevention services provided through primary mental health care services between July 2012 and June 2018. Associations between sociodemographic, diagnostic, referral- and service-level factors and treatment non-attendance and early treatment cessation were investigated using a series of multivariable generalised estimation equations.
Results:
There were 1654 suicidal referrals for 1444 people during the study period. Those identified with a risk of suicide were less likely to never attend treatments (16.14% vs 19.77%), but were more likely to disengage earlier from subsequent service sessions (16.02% vs 12.41%), compared to those with no risk of suicide. A higher likelihood of non-attendance to any primary mental health care service sessions was associated with those aged 25–44, lower socioeconomic status, a presentation for substance use and a referral from acute care (either emergency department or hospital). Among those who attended an initial treatment session, younger age (18–24 years) and a longer waiting time for an initial follow-up appointment were associated with a higher likelihood of early treatment cessation from primary mental health care services.
Conclusion:
These findings can inform potential strategies in routine primary mental health care practice to improve treatment engagement among those at risk of suicidal behaviour. Youth-specific interventions, behavioural engagement strategies and prompt access to services are policy and service priorities.
To verify the association between mood and anxiety disorders, and suicide risk during pregnancy and their relationship with premature birth in a population of pregnant adolescents attending prenatal ...care in the public health system of Pelotas, a southern city in Brazil.
This was a cohort study with all pregnant adolescents attending antenatal public services in the urban area of Pelotas between October 2009 and May 2011. The first assessment occurred between the 20th and 22 nd week of pregnancy and the second occurred one month after delivery. We used the Mini International Neuropsychiatric Interview (MINI) to assess mood and anxiety disorders and suicide risk.
A total of 645 pregnant women aged between 12 and 19 years old were interviewed. An anxiety disorder was present in 9.1% of the pregnant adolescent, and 28.5% had a mood disorder. The prevalence of suicide risk was 12.6%, and 15.3% of the babies were born premature. A multivariate analysis adjusted for maternal education, number of previous pregnancies and previous preterm birth indicated that adolescents who had suicide risk during pregnancy were approximately twice as likely to give birth prematurely when compared to those who were not diagnosed with suicide risk (PR 1.79; CI 1.06–3.03).
Our findings suggest that pregnant adolescents who were at risk of suicide during pregnancy were more likely to have premature babies. It is important to pay attention to the mental health of this specific population to prevent obstetric complications and consequently improve the health of the children.
Purpose
The risk of death from suicide after self-poisoning has been known to be significantly higher as compared to the general population. Nevertheless, the change in suicide risk before and after ...self-poisoning is still unclear.
Methods
The database of territory-wide medical records collected by the Hospital Authority of Hong Kong was used to identify inpatients who have survived the first-ever self-poisoning but died by suicide between January 1, 2001, and December 31, 2010. A self-controlled case series (“SCCS”) design controlling for time-invariant patient confounders was used to explore the temporal change in suicide risk after the first self-poisoning episode.
Results
During the study period, 227 people in the database died from suicide after surviving one episode of self-poisoning. A significant increase of the risk of suicide in the first 12 months after the first lifetime self-poisoning—Risk Ratio (“RR”) 2.88 (95% CI 1.74–4.76)—was detected. The RR gradually returned to baseline levels after the second post-poisoning period.
Conclusion
By within-person comparison, the net increase of the suicide risk caused by the first self-poisoning was quantitatively modeled, demonstrating that the first lifetime self-poisoning event itself is a modifiable risk factor of subsequent suicide death.
Patients in specialist mental healthcare services who are at risk of suicide may experience their struggles as existential in nature. Yet, research on meaning in life has been relatively scarce in ...suicidology. This qualitative study aimed to explore how patients at risk of suicide perceived their encounters with specialist healthcare professionals after a suicide attempt (SA), with special reference to meaning in life experiences. The study was conducted in specialised mental healthcare services in Norway. Data were collected via individual interviews with eight patients aged 20–75 years. Using a four-step procedure, the interviews were analysed by systematic text condensation. The participants understood their feelings of shame, self-contempt and challenging life experiences as contributing factors to their SA. They perceived that existential themes in relation to financial difficulties, shame and trauma were resolved, while issues associated with the SA, such as death, loss and beliefs, were given less attention. The participants were either ambivalent about continuing to live or wished to rebuild a meaningful life. Overall, their experiences of meaningfulness were hampered. Assisting patients with meaning in life experiences may help them alter their life interpretations and increase their ability to rebuild their lives as meaningful. The present study should be seen as a contribution to meaning-informed approaches in specialist mental healthcare services. More research is needed to equip healthcare personnel in their overall aims of preventing suicide and supporting patients at risk in their efforts to live a meaningful life.
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