The authors examined the extent to which the genetic and environmental etiology of suicide attempt and suicide death is shared or unique.
The authors used Swedish national registry data for a large ...cohort of twins, full siblings, and half siblings (N=1,314,990) born between 1960 and 1990 and followed through 2015. They conducted twin-family modeling of suicide attempt and suicide death to estimate heritability for each outcome, along with genetic and environmental correlations between them. They further assessed the relationship between suicide attempt by young people compared with adults.
In bivariate models, suicide attempt and death were moderately heritable among both women (attempt: additive genetic variance component A=0.52, 95% CI=0.44, 0.56; death: A=0.45, 95% CI=0.39, 0.59) and men (attempt: A=0.41, 95% CI=0.38, 0.49; death: A=0.44, 95% CI=0.43, 0.44). The outcomes were substantially, but incompletely, genetically correlated (women: rA=0.67, 95% CI=0.55, 0.67; men: rA=0.74, 95% CI=0.63, 0.87). Environmental correlations were weaker (women: rE=0.36, 95% CI=0.29, 0.45; men: rE=0.21, 95% CI=0.19, 0.27). Heritability of suicide attempt was stronger among people ages 10-24 (A=0.55-0.62) than among those age 25 and older (A=0.36-0.38), and the genetic correlation between attempt during youth and during adulthood was stronger for women (rA=0.79, 95% CI=0.72, 0.79) than for men (rA=0.39, 95% CI=0.26, 0.47).
The genetic and environmental etiologies of suicide attempt and death are partially overlapping, exhibit modest sex differences, and shift across the life course. These differences must be considered when developing prevention efforts and risk prediction algorithms. Where feasible, suicide attempt and death should be considered separately rather than collapsed, including in the context of gene identification efforts.
Objective To shed light on the difficulties faced by relatives, friends, and colleagues in interpreting signs of suicidality and deciding whether and how to intervene.Design Qualitative study of ...completed suicides, based on in-depth interviews with multiple informants.Setting London, southwest England, and south Wales.Participants 31 lay informants (one to five for each case), including parents, partners, siblings, friends, and colleagues of 14 cases of suicide in which the deceased was aged 18-34 and was not in contact with secondary mental health services.Results Informants described both intellectual and emotional barriers to awareness and intervention within the family and social network. They reported that signs and communications of distress were often oblique and difficult to interpret, that they may have disregarded warning signals and focused instead on positive signs, and that, even when they were aware that something was seriously wrong, taking any action at all involved considerable personal risks.Conclusions As the suicidal process unfolds, significant others are faced with a highly complex task. Their proximity to the suicidal person and their emotional investment in the relationship make it difficult for them to see what is happening, to say anything to the person or to other members of the network, or to seek help outside the network. Efforts to strengthen the capacity of lay people to play a role in preventing suicide are urgently needed and should be informed by a thorough understanding of these difficulties. They should highlight the ambiguous nature of warning signs and should focus on helping people to acknowledge and overcome their fears about intervening.
Chronic pain has long been considered an important risk factor for suicidal behavior. Less well understood are the factors associated with the increased risk for suicide death within chronic pain ...populations. The purpose of this review is to examine recent research with regard to rates of and risk factors for suicide mortality in patients with chronic musculoskeletal pain. We conclude that patients with a number of chronic pain states are at increased risk for suicide death, and that this risk appears to be due, at least in part, to other well-known correlates of pain such as depression and substance use disorders. However, in all likelihood, there are aspects of chronic pain itself that add uniquely to an individual’s suicide risk profile. Lastly, we address a theoretical perspective and offer recommendations for clinical practice.
Sleep and circadian rhythm disorders are very common in adolescents and have been linked to suicidal ideation. However, little is known about adolescent sleep before a suicide attempt (SA). The ...objectives of this study were to compare the sleep of adolescents aged 13 to 18 over a period of 4 weeks before a SA compared to a non-SA group, then to analyze the association between sleep, support social and well-being based on information from validated questionnaires. In 2015, 250 adolescents were included, 55 were recruited the day after a SA in French hospitals (before SA evaluations were retrospective). Logistic regression analyzes showed that during school days, bedtime was equivalent in both groups, but sleep onset latency was significantly longer in SA (86 min vs. 52 min, p = 0.016), and wake-up time was earlier (6 h 22 vs. 6 h 47, p = 0.002), resulting in a shorter total sleep time of 44 min (OR = 0.76, CI 95% 0.61-0.93) the month preceding SA. Adolescents with longer sleep time performed better on perceived psychological well-being (p = 0.005), relationship with parents (p = 0.011) and school environment (p < 0.001). Results indicate a significant change in the quantity and quality of adolescents' subjective sleep in the 4 weeks preceding SA requiring objective measures to study the predictive properties of sleep in SA.
Purpose
The purpose of the study was to identify demographic risk factors associated with depression and suicidality among medical school students in Serbia, as well as to determine the prevalence of ...symptoms of depression and suicide attempts in the student population.
Method
This was a cross-sectional study conducted on the sample of 1,296 students recruited from the School of Medicine, University of Belgrade. Following questionnaires were assigned to participating subjects: PHQ-9, Suicide Behaviors Questionnaire, and Social-demographic survey.
Results
PHQ-9 scores in our sample ranged from 0 to 27, averaging at 6.21 (SD = 4.96). Symptoms of depression were associated with grade point average, age, relationship status, and gender. Reported history of suicide attempts was associated with PHQ-9 scores, grade point average, relationship status, gender, history of mental illness and drug use.
Conclusion
Our findings suggest that medical school students in Serbia may be considered an “at-risk” population. Preventative programs in the future should target symptoms of depression and should provide students with adequate mechanisms to cope successfully with school-related pressure. Alternative stress management strategies may also be useful, especially for younger students who seem to be at greater risk for depression and suicide.
Suicide is a leading cause of death worldwide and perhaps the most puzzling and devastating of all human behaviors. Suicide research has primarily been guided by verbal theories containing vague ...constructs and poorly specified relationships. We propose two fundamental changes required to move toward a mechanistic understanding of suicide. First, we must formalize theories of suicide, expressing them as mathematical or computational models. Second, we must conduct rigorous descriptive research, prioritizing direct observation and precise measurement of suicidal thoughts and behaviors and of the factors posited to cause them. Together, theory formalization and rigorous descriptive research will facilitate abductive theory construction and strong theory testing, thereby improving the understanding and prevention of suicide and related behaviors.
Due to scientific advances, there have been significant declines in many once-leading causes of death over the past 100 years, yet global suicide rates have remained fairly stable for decades. The lack of progress in understanding, predicting, and preventing suicide is due in part to the limitations of current scientific theories of suicide.After providing a brief history of suicide theories, we argue that these theories are limited due to two fundamental factors: (i) they are imprecise, comprising vaguely defined components and underspecified relationships among those components, precluding concrete theory predictions that could be tested; and (ii) there is a lack of rigorous descriptive research that is necessary to inform the generation, testing, and development of more precise theories.We provide several guiding principles to address these limitations, focusing on the need to formalize theories as mathematical and computational models and to collect rigorous and intensive descriptive research on key suicidal outcomes and the factors posited to give rise to those outcomes.
Abstract Background In 2012, over 1.3 million U.S. adults reported that they attempted suicide in the past year, and 39,426 adults died by suicide. This study estimated national suicide case fatality ...rates among adult suicide attempters (fatal and nonfatal cases) and examined how they varied by sociodemographic characteristics. Methods We pooled data on deaths by suicide (n=147,427, fatal cases in the U.S.) from the 2008-2011 U.S. mortality files and data on suicide attempters who survived (n=2,000 nonfatal cases) from the 2008-2012 National Surveys on Drug Use and Health. Descriptive analyses and multivariable logistic regression models were applied. Results Among adult suicide attempters in the U.S., the overall 12-month suicide case fatality rate was 3.2% (95% confidence interval (CI)=2.9%-3.5%). It varied significantly by sociodemographic factors. For those aged 45 or older, the adjusted suicide case fatality rate was higher among men (7.6%) than among women (2.6%) (suicide case fatality rate ratio (SCFRR)=3.0, 95% CI=1.83-4.79), was higher among non-Hispanic whites (7.9%) than among non-white minorities (0.8-2.5%) (SCFRRs=3.2-9.9), and was higher among those with less than high school education (16.0%) than among college graduates (1.8%) (SCFRR=8.8, 95% CI=3.83-20.16). Across male and female attempters, being aged 45 or older and non-Hispanic white and having less than secondary school were at a higher risk for death by suicide. Conclusions Focusing on these demographic characteristics can help identify suicide attempters at higher risk for death by suicide, inform clinical assessments, and improve suicide prevention and intervention efforts by increasing high-risk suicide attempters’ access to mental health treatment.
Accessible summary
What is known on the subject?
Self‐confident health professionals with positive and understanding attitudes can take better care of people with suicidal behaviour, but the factors ...associated with these attitudes are not known.
What this paper adds to existing knowledge?
The majority of nursing professionals had no experience or training in mental health or suicide. They were less self‐confident and had more negative attitudes.
Nurses and nursing assistants who worked before in mental health services were more understanding with people with suicidal behaviour.
Nurses and nursing assistants who were working in prehospital services were less self‐confident to taking care of people with suicidal behaviour.
Some members of the nursing team had already seriously considered committing suicide.
What are the implications for practice?
The practicing, support and training in mental health may improve the nurses’ attitudes and emotional competencies.
It is important to know why few nurses had suicide‐related training, despite the relevance of this issue.
Training in mental health or suicide need to include attitudinal and emotional competencies.
It is important to offer emotional support to emergency nursing professionals.
Background
The attitudes towards suicide of emergency nurses may affect the care provided. However, the factors associated with these attitudes remain unclear.
Objective
To investigate attitudes towards suicidal behaviour and associated factors among nursing professionals working in emergency settings.
Methods
A cross‐sectional observational study including 28 nurses and 118 who were nursing assistants employed at two emergency services in Brazil was conducted. Data were collected in 2015 using a self‐administered sociodemographic questionnaire and the Suicide Behavior Attitude Questionnaire (SBAQ).
Results
The majority of participants reported having no experience or training in mental health or suicide. They reported more negative feelings towards the patient and a lower self‐perception of professional competence regarding suicidal behaviours, and these attitudes seemed to reinforce each other. Nurses who worked in mental health services reported less moralistic/judgemental attitudes. Working in prehospital services was associated with having a lower self‐perception of professional competence. There were professionals who reported thinking seriously about committing suicide.
Conclusion
When combined with support and training, practicing mental health nursing may serve as an opportunity to develop favourable attitudes and emotional competences, and these issues need to be addressed in suicide education strategies.
Self-harm, whether attributed to suicidal or non-suicidal motives, is associated with several poor outcomes in young people, including eventual suicide. Much of our understanding of self-harm in ...young people is based on literature from Europe (particularly, the UK), North America, and Australia. We aimed to synthesise the available evidence on prevalence, the commonly reported self-harm methods, correlates, risk and protective factors, and reasons for self-harm, in adolescents (aged 10-25 years) in sub-Saharan Africa.
We searched MEDLINE, PsycINFO, PubMed, African Journals OnLine, and African Index Medicus for records from 1950 through August 2019, without language restrictions. We supplemented the database searches by searching relevant portals for postgraduate theses, reference harvesting, contacting authors for unpublished studies, and hand searching relevant print sources. We applied narrative synthesis to the evidence.
Seventy-four studies from 18 sub-Saharan African countries met the inclusion criteria. The median lifetime prevalence estimate was 10·3% (interquartile range IQR 4·6% - 16·1%); median 12-month prevalence estimate was 16·9% (IQR: 11·5% - 25·5%); median 6-month prevalence estimate was 18·2% (IQR: 12·7% - 21·8%); and the median 1-month prevalence estimate was 3·2% (IQR: 2·5-14·8%). Studies from Western sub-Saharan Africa reported the highest 12-month prevalence estimates (median = 24·3%; IQR = 16·9% - 27·9%). Clinical samples commonly reported overdose, whereas self-cutting was most commonly reported in non-clinical samples. Academic failure, sexual, emotional, and physical abuse, romantic relationship problems, family conflict, depression, and previous self-harm were identified as key correlates of self-harm. No study reported protective factors against self-harm.
Variation in estimates was explained by small sample sizes and variation in definitions and measures used. Exploration of associations, risks and protective factors was based upon concepts and measures derived from high income countries. More detailed and culturally sensitive research is needed to understand the context-specific risks and protective factors for self-harm in adolescents in sub-Saharan Africa.
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