ABSTRACTS

Suicide Life Threat Behav 2002 Summer;32(2)
Sexual assault history and suicidal behavior in a national sample of women.
Ullman SE, Brecklin LR.

This study examined demographic and psychosocial correlates of suicidal ideation and suicide attempts in women with histories of sexual assault in childhood and/or adulthood identified from a national sample of women. Multivariate analyses showed that women with histories of sexual assault in both childhood and adulthood reported significantly greater odds of lifetime suicide attempts, controlling for demographic factors and other psychosocial characteristics.

As predicted, younger age (marginal), stressful life events (marginal), depression, PTSD, and alcohol dependence symptoms were also significantly associated with suicidal ideation. Furthermore, number of lifetime traumatic events and depression were each associated with lifetime odds of suicide attempts. Implications for studying the role of sexual trauma and other psychosocial factors in relation to women's suicidal behavior are discussed.



Arch Gen Psychiatry 2002 Aug;59(8)
Childhood adversities, interpersonal difficulties, and risk for suicide attempts during late adolescence and early adulthood.
Johnson JG, Cohen P, Gould MS, Kasen S, Brown J, Brook JS.

BACKGROUND: Data from a community-based longitudinal study were used to investigate the association between childhood adversities, interpersonal difficulties during adolescence, and suicide attempts during late adolescence or early adulthood.

METHODS: A community sample of 659 families from Upstate New York was interviewed in 1975, 1983, 1985 to 1986, and 1991 to 1993. During the 1991-1993 interview, the mean age of the offspring was 22 years.

RESULTS: Maladaptive parenting and childhood maltreatment were associated with an elevated risk for interpersonal difficulties during middle adolescence and for suicide attempts during late adolescence or early adulthood after age, sex, psychiatric symptoms during childhood and early adolescence, and parental psychiatric symptoms were controlled statistically.

A wide range of interpersonal difficulties during middle adolescence were associated with risk for suicidal behavior after the covariates were controlled. Profound interpersonal difficulties during middle adolescence mediated the association between maladaptive parenting or childhood maltreatment and suicide attempts during late adolescence or early adulthood.

CONCLUSIONS: Maladaptive parenting and childhood maltreatment may be associated with a risk for severe interpersonal difficulties during adolescence. These interpersonal difficulties may play a pivotal role in the development of suicidal behavior. Youths who are at an elevated risk for suicide may tend to be in need of mental health services that can help them to cope with an extensive history of profound interpersonal difficulties, beginning in childhood and continuing through adolescence.



Acta Psychiatr Scand 2002 Aug;106(2)
Suicidal behaviour of psychiatric in-patients.
Spiessl H, Hubner-Liebermann B, Cording C.

OBJECTIVE: The study aimed to examine suicidal behaviour before and during in-patient care in a psychiatric state hospital.

METHOD: Based upon a psychiatric basic documentation system prevalence and risk factors of in-patient suicides, suicide attempts and suicidal thoughts were investigated over an 11-year period from 1989 until 1999.

RESULTS: A total of 30 in-patient suicides were found among 21 062 patients. According to the multivariate logistic regression analysis the risk of hospital suicide increases for patients with schizophrenia, higher cumulative length of stay, previous suicide attempt, part-time employment and training/retraining. Predictors of suicide attempt during hospitalization are suicide attempt on admission, personality disorder, suicidal thoughts on admission, schizophrenia and affective disorder.

CONCLUSION: As Schizophrenics represent the high-risk group of in-patient suicide, suicide prevention should be a major goal in their treatment. More frequent suicide risk assessment is recommended particularly before granting a leave or an outing.



Br J Psychiatry 2002 Jul
Sudden death and suicide: a comparison of brain weight.
Hamilton SJ, McMahon RF.

BACKGROUND: Recent evidence suggests that the brain weight of individuals over the age of 60 who commit suicide is significantly higher than in those who die of natural causes.

AIMS: To ascertain whether brain weight is different in people of a younger age who commit suicide than in those who die accidentally.

METHOD: A retrospective review of post-mortem reports collecting height, weight and brain weight in 100 suicide victims (87 males, mean age 38.5 years) and 100 age/gender-matched controls who died accidentally or of natural causes (87 males, mean age 38.7 years). Comparison by t-test was made of brain weight in isolation as well as brain weight corrected for height, weight and body mass index.

RESULTS: These results reveal no significant difference in brain weight in suicide cases compared to the general population (P > 0.05). The brain weight of those who died by hanging was significantly higher than of those who died by overdose.

CONCLUSIONS: Whatever the significant neuropsychiatric elements are that influence suicidal behaviour, they do not consistently affect brain weight in the population studied.



Br J Psychiatry 2002 Jun
Violence and schizophrenia: examining the evidence.
Walsh E, Buchanan A, Fahy T.

BACKGROUND: It is now accepted that people with schizophrenia are significantly more likely to be violent than other members of the general population. A less acknowledged fact is that the proportion of societal violence attributable to schizophrenia is small.

AIMS: To critically examine the epidemiological evidence for the association between violence and schizophrenia and estimate the impact of this association on society.

METHOD: A selective review of the key literature on the epidemiology of violence and schizophrenia. Population-attributable risks for violence in schizophrenia are calculated from population-based studies.

RESULTS: Most studies confirm the association between violence and schizophrenia. Recent good evidence supports a small but independent association. Comorbid substance abuse considerably increases this risk. The proportion of violent crime in society attributable to schizophrenia consistently falls below 10%.

CONCLUSIONS: Less focus on the relative risk and more on the absolute risk of violence posed to society by people with schizophrenia would serve to reduce the associated stigma. Strategies aimed at reducing this small risk require further attention, in particular treatment for substance misuse.



Suicide Life Threat Behav 2002 Spring;32(1)
A case control study of suicide and attempted suicide in older
adults. Beautrais AL.

Risk factors for serious suicidal behavior among older adults were examined in a case control study of 53 adults aged 55 and older who died by suicide or made medically serious suicide attempts and who were compared with 269 randomly selected comparison subjects.

Multivariate analyses suggested that risk of serious suicidal behavior was elevated among those with current mood disorders (OR = 179, CI = 52.8-607.6), psychiatric hospital admission within the previous year (OR = 24.4, CI = 1.9-318.7), limited social network (OR = 4.5, CI = 1.4-14.6).

The predominant role of mood disorders was confirmed by population attributable risk (PAR) estimates (73.6%), suggesting that the improved detection, treatment and management of mood disorders should be the primary focus of suicide prevention strategies for older adults.



Suicide Life Threat Behav 2002 Spring;32(1)
Assault victimization and suicidal ideation or behavior within a national sample of U.S. adults.
Thomas R. Simon, Mark Anderson, Martie P. Thompson, Alex Crosby, Jeffrey J. Sacks

Data from a nationally representative sample of 5,238 U.S. adults were used to examine the extent to which physical assault victimization was associated with suicidal ideation or behavior (SIB). The results from multivariable logistic regression analyses indicate that physical assault victimization was positively associated with SIB after adjusting for sociodemographic characteristics and alcohol use (OR = 3.6; 95% CI = 2.4-5.5).

Those who were injured during the most recent physical assault (OR = 2.7; 95% CI = 1.2-6.0) and those who were assaulted by a relative (OR = 3.4; 95% CI = 1.0-11.0) or intimate partenr (OR = 7.7; 95% CI = 2.7-22.5) were significantly more like to report SIB than victims who were not injured or were assaulted by a stranger.

Also, those who were victimized but not injured (OR = 5.6; 95% CI = 3.8-8.2) and those who were victimized by a stranger (OR = 2.9; 95% CI = 1.4-6.0) were more likely to report SIB than non-victims. These results highlight the need for legal, medical, mental health, and social service providers to address the co-occurence of violent victimization and suicidal ideation, particulary, but not exclusively, victimization by familiar members and intimates.



Suicide Life Threat Behav 2002 Spring;32(1)
Psychiatric inpatients' perceptions of written no-suicide agreements: an exploratory study.
Davis SE, Williams IS, Hays LW.

One hundred thirty-five psychiatric inpatients admitted for suicidal danger were surveyed regarding their views on the benefits/limitations of written no-suicide agreements. A survey instrument developed for this study revealed that these inpatients, for the most part, rated written no-suicide agreements in a positive manner and in ways consistent with clinical opinion expressed in a number of qualitative/expert-opinion articles.

Positive views of no-suicide agreements were not materially influenced by social desirability or age, nor were they moderated by gender, presence/absence of Axis II disorders, or admission suicidal danger. However, patient suicide attempt history (no attempts, one attempt, or more than one attempt) exerted a moderating effect on patients' ratings of the helpfulness of these contracts. Multiple attempters viewed written no-suicide agreements as less helpful than those patients with a single or no prior attempts.

The methodological problems and generalizability concerns associated with these results are discussed and future research needs are suggested.



Suicide Life Threat Behav 2002 Spring;32(1)
Prevention of youth suicide: how well informed are the potential gatekeepers of adolescents in distress?
Scouller KM, Smith DI.

Australia has one of the higher rates of suicide among young people. Although a role for doctors and teachers in the prevention of youth suicide has been suggested, no prior Australian study has assessed adequately the level of suicide knowledge held by these professionals.

Knowledge about adolescent suicide was investigated using the Adolescent Suicide Behaviour Questionnaire, a 39-item instrument developed for the purpose. The stratified random sample comprised 404 general practitioners and 481 teachers from 56 secondary schools.

General practitioners and teachers scored, on average, 71% and 59% of the questionnaire items correct, respectively. There was wide individual variability: The number of items correct ranged from 4 to 38 for general practitioners and 0 to 34 for teachers. Strengths and deficits in knowledge across the two professions are discussed in terms of the potential gatekeeping role of these professionals in suicide prevention.



Suicide Life Threat Behav 2002 Spring;32(1)
Mass suicide: historical and psychodynamic considerations.
Mancinelli I, Comparelli A, Girardi P, Tatarelli R.

Mass suicide can be defined as the simultaneous suicide of all the members of a social group and is closely linked to the human dimension of existence, although the social and cultural context may vary. In fact, the term mass suicide can also be used to describe situations in which a particular population has reacted to oppression by denying all normal activities of sustenance, with the intention of bringing about a traumatic metamorphosis in a cultural context (colonization, exploitation by other populations), thus transforming a catastrophe in which a passive role is played into one constructed actively.

Therefore, mass suicides can be subdivided into two categories: (a) hetero-induced, typical of defeated and colonized populations forced to escape from a reality that does not acknowledge their human dignity and (b) self-induced, in which the motivation is related to a distorted evaluation of reality, without there being either an intolerable situation or a real risk of death.

The mass suicides that have taken place in the last 20 years are all related to the establishment of religious sects; the mystic delirium created within the sect leads to the self-destruction of the group as being interpreted as an act of self-assertiveness.

 

1: Biol Psychiatry. 2005 Aug 24; [Epub ahead of print]

 STin2 Variant and Family History of Suicide as Significant Predictors of Suicide Completion in Major Depression.

de Lara CL, Dumais A, Rouleau G, Lesage A, Dumont M, Chawky N, Alda M, Benkelfat C, Turecki G.

McGill Group for Suicide Studies (CL, AD, MD, NC, GT), Douglas Hospital Research Center, Montreal.

BACKGROUND: Suicide is the most serious outcome of major depression, yet not all depressed patients will commit suicide. Genes, along with other factors, might account for this difference. Serotonergic alterations have been observed in suicide and depression and impulsive-aggressive behaviors. Therefore, we aimed to identify predictors of suicide, considering genetic variation at the serotonin transporter (5-HTT) gene. METHODS: We investigated the 5-HTT gene-linked polymorphic region (5-HTTLPR) and intron 2 (STin2) variants of this gene and their relationship to behavioral and clinical risk factors for suicide in a sample of depressed suicides (n =106) and depressed control subjects (n =152), diagnosed by means of proxy-based interviews. RESULTS: We found a significant association of suicide completion with having at least one copy of the STin2 10 allele [chi(2)(1) = 10.833, p = .002]. No differences were found for the 5-HTTLPR variable number of tandem repeats. After controlling for behavioral and clinical risk factors for suicide, the STin2 variant remained a significant predictor of suicide in major depression when jointly considered with a family history of suicide (odds ratio 5.560, 95% confidence interval 1.057-29.247). CONCLUSIONS: The STin2 locus might account, at least in part, for the observed familial aggregation of suicidal behavior. These results should be further explored in families where clustering of suicidal behavior is observed.

 

2: JAMA. 2005 Aug 3;294(5):563-70.
 Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial.

Brown GK, Ten Have T, Henriques GR, Xie SX, Hollander JE, Beck AT.

Department of Psychiatry, University of Pennsylvania, Philadelphia 19104, USA. gregbrow@mail.med.upenn.edu

CONTEXT: Suicide attempts constitute a major risk factor for completed suicide, yet few interventions specifically designed to prevent suicide attempts have been evaluated. OBJECTIVE: To determine the effectiveness of a 10-session cognitive therapy intervention designed to prevent repeat suicide attempts in adults who recently attempted suicide. DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled trial of adults (N = 120) who attempted suicide and were evaluated at a hospital emergency department within 48 hours of the attempt. Potential participants (N = 350) were consecutively recruited from October 1999 to September 2002; 66 refused to participate and 164 were ineligible. Participants were followed up for 18 months. INTERVENTION: Cognitive therapy or enhanced usual care with tracking and referral services. MAIN OUTCOME MEASURES: Incidence of repeat suicide attempts and number of days until a repeat suicide attempt. Suicide ideation (dichotomized), hopelessness, and depression severity at 1, 3, 6, 12, and 18 months. RESULTS: From baseline to the 18-month assessment, 13 participants (24.1%) in the cognitive therapy group and 23 participants (41.6%) in the usual care group made at least 1 subsequent suicide attempt (asymptotic z score, 1.97; P = .049). Using the Kaplan-Meier method, the estimated 18-month reattempt-free probability in the cognitive therapy group was 0.76 (95% confidence interval [CI], 0.62-0.85) and in the usual care group was 0.58 (95% CI, 0.44-0.70). Participants in the cognitive therapy group had a significantly lower reattempt rate (Wald chi2(1) = 3.9; P = .049) and were 50% less likely to reattempt suicide than participants in the usual care group (hazard ratio, 0.51; 95% CI, 0.26-0.997). The severity of self-reported depression was significantly lower for the cognitive therapy group than for the usual care group at 6 months (P= .02), 12 months (P = .009), and 18 months (P = .046). The cognitive therapy group reported significantly less hopelessness than the usual care group at 6 months (P = .045). There were no significant differences between groups based on rates of suicide ideation at any assessment point. CONCLUSION: Cognitive therapy was effective in preventing suicide attempts for adults who recently attempted suicide.

 

3: Arch Gen Psychiatry. 2005 Aug;62(8):860-6.

Suicide risk in patients treated with lithium.

Kessing LV, Sondergard L, Kvist K, Andersen PK.

Department of Psychiatry, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen O, Denmark. lars.kessing@rh.dk

CONTEXT: Prior observational studies suggest that treatment with lithium may be associated with reduced risk of suicide in bipolar disorder. However, these studies are biased toward patients with the most severe disorders, and the relation to sex and age has seldom been investigated. OBJECTIVE: To investigate whether treatment with lithium reduces the risk of suicide in a nationwide study. DESIGN: An observational cohort study with linkage of registers of all prescribed lithium and recorded suicides in Denmark during a period from January 1, 1995, to December 31, 1999. SETTING: All patients treated with lithium in Denmark, ie, within community psychiatry, private specialist practice settings, and general practice. PARTICIPANTS: A total of 13 186 patients who purchased at least 1 prescription of lithium and 1.2 million subjects from the general population. MAIN OUTCOME MEASURE: All suicides identified on the basis of death certificates completed by doctors at the time of death. RESULTS: Patients who purchased lithium had a higher rate of suicide than persons who did not purchase lithium. Purchasing lithium at least twice was associated with a 0.44 reduced rate of suicide (95% confidence interval, 0.28-0.70) compared with the rate when purchasing lithium only once. Further, the rate of suicide decreased with the number of prescriptions of lithium. There was no significant interaction between continued lithium treatment and sex and age regarding the suicide rate. CONCLUSION: In a nationwide study including all patients treated with lithium, it was found that continued lithium treatment was associated with reduced suicide risk regardless of sex and age.
 
 

4: J Affect Disord. 2005 Jul 27; [Epub ahead of print] 
Variability in suicidal ideation: A better predictor of suicide attempts than intensity or duration of ideation?

Witte TK, Fitzpatrick KK, Joiner TE Jr, Schmidt NB.

Department of Psychology, Florida State University, Tallahassee, FL 32306-1270, United States.

BACKGROUND: Much of the suicidology literature focuses on establishing contextual risk factors for suicidal behavior. However, the study of the parameters of suicidal behavior (e.g., intensity, duration, and variability) has been somewhat neglected . Having previously established a relationship between variability in suicidal ideation and a previous history of suicide attempts [], we felt it important to assess the liability conferred by a variable pattern of ideation compared to the intensity and duration of suicidal thoughts. We also examined if there was an interaction between gender and the parameters of intensity, duration, and variability. METHOD: One hundred eight participants (54 non-attempters, 35 single attempters, and 19 multiple attempters) completed the Suicide Probability Scale every day for 4 weeks, allowing us to measure the parameters of interest. These variables were entered into a regression model as predictors of previous suicide attempts. RESULTS: Consistent with prediction, high variability of ideation was the only significant predictor of previous attempt status. In addition, an interaction between gender and variability in suicidal ideation suggested that variability appeared more critical in predicting previous attempts for males. LIMITATIONS: The limited number of multiple attempters in our sample and the use of college students limit the current study. CONCLUSIONS: Variability appears to be the most potent predictor of attempt status among the parameters of suicidal ideation examined in the current study. This relationship appears to be particularly important in males, suggesting that fluctuating levels of suicidal ideation may confer future risk for suicide.

 

  
 5: Br J Gen Pract. 2005 Jul;55(516):503-9.
A qualitative study of help seeking and primary care consultation prior to suicide.

Owens C, Lambert H, Donovan J, Lloyd KR.

Peninsula Medical School, University of Exeter. c.v.owens@ex.ac.uk

BACKGROUND: Many suicides may be preventable through medical intervention, but many people do not seek help from a medical practitioner prior to suicide. Little is known about how consulting decisions are made at this time. AIM: To explore how distressed individuals and members of their lay networks had made decisions to seek or not to seek help from a medical practitioner in the period leading up to suicide. DESIGN OF STUDY: Qualitative analysis of psychological autopsy data. SETTING: One large English county. METHOD: Semi-structured interviews with close relatives or friends of suicide victims were conducted as part of a psychological autopsy study. Sixty-six interviews were transcribed verbatim and analysed using a thematic approach. RESULTS: Relatives and friends often played a key role in determining whether or not suicidal individuals sought medical help. Half the sample had consulted in their final month and many were persuaded to do so by a relative or friend. Of those who did not consult, some were characterised as help-resisters but many others had omitted to do so because no-one around them was aware of the seriousness of their distress or considered it to be medically significant. A range of lay interventions and coping strategies was identified, including seeking non-medical help. CONCLUSION: Greater attention needs to be given to the potential role of lay networks in managing psychological distress and preventing suicide. A balanced approach to suicide prevention is recommended that builds on lay knowledge and combines medical and non-medical strategies.

 

 
6: J Clin Psychiatry. 2005 Jun;66(6):717-25.
Suicidal ideation and suicide attempts in body dysmorphic disorder.

Phillips KA, Coles ME, Menard W, Yen S, Fay C, Weisberg RB.

Butler Hospital, Providence, RI 02906, USA. Katharine_Philips@brown.edu

OBJECTIVE: Because suicidality in body dys-morphic disorder (BDD) has received little investigation, this study examined rates, correlates, predictors, and other aspects of suicidal ideation and suicide attempts in this disorder. METHOD: From January 2001 to June 2003, 200 subjects with DSM-IV BDD recruited from diverse sources were assessed with standard measures. RESULTS: Subjects had high rates of lifetime suicidal ideation (78.0%) and suicide attempts (27.5%). Body dysmorphic disorder was the primary reason for suicidal ideation in 70.5% of those with a history of ideation and nearly half of subjects with a past attempt. Suicidal subjects often did not reveal their BDD symptoms to their clinician. In univariate analyses, both suicidal ideation and suicide attempts were associated with lifetime functional impairment due to BDD (p < .001), current functional impairment (p < .001 to < .05), lifetime bipolar disorder (p < .05), any personality disorder (p < .05 to .001), and comorbid borderline personality disorder (p < .01 to < .001). A history of suicidal ideation (but not suicide attempts) was additionally associated with comorbid lifetime major depression (p = .001). A history of suicide attempts (but not suicidal ideation) was additionally associated with delusional appearance beliefs (p = .01) and lifetime posttraumatic stress disorder (PTSD), an eating disorder, or a substance use disorder (p < .001 to < .05). In logistic regression analyses, suicidal ideation was significantly predicted by comorbid major depression (p = .010) and greater lifetime impairment due to BDD (p = .003); suicide attempts were significantly predicted by PTSD (p = .011), a substance use disorder (p = .011), and greater lifetime impairment due to BDD (p = .005). CONCLUSION: Individuals with BDD have high rates of suicidal ideation and suicide attempts. Lifetime impairment due to BDD and certain comorbid disorders are associated with suicidality.

 

 7: J Med Ethics. 2005 Jun;31(6):311-7.
The acceptability of ending a patient's life.

Guedj M, Gibert M, Maudet A, Munoz Sastre MT, Mullet E, Sorum PC.

Centre d'Etudes et de Recherches en Psychopathologie, MDR, Universite du Mirail, Toulouse, France.

OBJECTIVES: To clarify how lay people and health professionals judge the acceptability of ending the life of a terminally ill patient. DESIGN: Participants judged this acceptability in a set of 16 scenarios that combined four factors: the identity of the actor (patient or physician), the patient's statement or not of a desire to have his life ended, the nature of the action as relatively active (injecting a toxin) or passive (disconnecting life support), and the type of suffering (intractable physical pain, complete dependence, or severe psychiatric illness). PARTICIPANTS: 115 lay people and 72 health professionals (22 nurse's aides, 44 nurses, six physicians) in Toulouse, France.Main measurements: Mean acceptability ratings for each scenario for each group. RESULTS: Life ending interventions are more acceptable to lay people than to the health professionals. For both, acceptability is highest for intractable physical suffering; is higher when patients end their own lives than when physicians do so; and, when physicians are the actors, is higher when patients have expressed a desire to die (voluntary euthanasia) than when they have not (involuntary euthanasia). In contrast, when patients perform the action, acceptability for the lay people and nurse's aides does not depend on whether the patient has expressed a desire to die, while for the nurses and physicians unassisted suicide is more acceptable than physician assisted suicide. CONCLUSIONS: Lay participants judge the acceptability of life ending actions in largely the same way as do healthcare professionals.

 

8: Compr Psychiatry. 2005 Mar-Apr;46(2):121-7.
Predictors of aggression on the psychiatric inpatient service.

Serper MR, Goldberg BR, Herman KG, Richarme D, Chou J, Dill CA, Cancro R.

Department of Psychology, Hofstra University, Hempstead, NY 11549, USA. mark.serper@nyu.edu

Patients with severe mental illness are at increased risk to commit acts of aggression in the inpatient hospital setting. Aggressive behaviors have severe negative consequences for the patient, victims, clinical staff, and the therapeutic community as a whole. While risk factors of community and inpatient aggression overlap, many predictive factors diverge between the two settings. For example, while medication noncompliance has been a robust predictor of community aggression, this factor has little predictive value for inpatient settings where patients' pharmacotherapy is closely monitored. Relatively fewer investigators have examined a wide range of predictive factors associated with aggressive acts committed on the psychiatry inpatient service, often with conflicting results. The present study examined demographic, clinical, and neurocognitive performance predictors of self, other, object, and verbal aggressiveness in 118 acute inpatients. Results revealed that the arrival status at the hospital (voluntary vs involuntary), female gender, and substance abuse diagnosis were predictors of verbal aggression and aggression against others. Impaired memory functioning also predicted object aggression. Fewer symptoms, combined with higher cognition functioning, however, were significant predictors of self-aggressive acts committed on the inpatient service. The need for relating predictors of specific types of aggressiveness in schizophrenia is discussed.

9: Aggression, impulsivity, and plasma sex hormone levels in a group of rapists, in relation to their history of childhood attention-deficit/hyperactivity disorder symptoms

Giotakos-O; Markianos-M; Vaidakis-N

J-FORENSIC-PSYCHIATRY-PSYCHOL. Journal-of-Forensic-Psychiatry-and-Psychology. 2005; 16(2): 423-433

The aim of this study was to investigate the relationships between retrospectively assessed childhood attention-deficit/hyperactivity disorder (ADHD) symptoms, aggression-impulsivity, and plasma sex hormone levels, in a group of 44 rapists. All participants completed the Wender Utah Rating Scale (WURS), the Aggression Questionnaire, the Life-Time History of Aggression, the Barratt Impulsivity Scale, the Suicide Risk Scale, and the Temperament and Character Inventory. Levels of testosterone, dihydrotestosterone, luteinizing hormone, and follicle stimulating hormone were estimated in plasma samples, and free androgen index was calculated. The subgroup of rapists with WURS score of 46 or higher (n = 27) evidenced significantly higher levels of self-reported aggression, life-time history of aggression, and impulsivity, as well as significantly higher scores on novelty seeking and self-transcendence and significantly lower scores on self-directedness and cooperativeness, in comparison with the subgroup with WURS scores of 45 and lower. The WURS score showed a positive correlation with aggression, impulsivity, and suicidality. Plasma sex hormone levels did not show any differences between the two rapist subgroups. History of childhood ADHD symptoms in this sample of rapists was linked to higher levels of aggression, impulsivity, and suicidality, a temperament profile characterized by frequent exploratory activity and quick loss of temper, and a character profile characterized by purposeless, difficulty accepting others, and lack of empathy. Lastly, a history of childhood ADHD symptoms does not seem to be linked to adult plasma sex hormone levels. < copyright > 2005 Taylor & Francis Group Ltd.

 

10: Is suicide ideation a surrogate endpoint for geriatric suicide?

 Links-PS; Heisel-MJ; Quastel-A

SUICIDE-LIFE-THREAT-BEHAV. Suicide-and-Life-Threatening-Behavior. 2005; 35(2): 193-205.

The present study explored the validity of treating suicide ideation as a surrogate endpoint that can serve as a proxy for suicide in clinical intervention research with suicidal seniors. Two criteria; that suicide ideation is modulated by the proposed intervention and that modulation of suicide ideation leads to a quantitative reduction in suicide rates, were the focus of this review. A series of literature searches of the PsychINFO and Medline databases were conducted on the terms geriatric, elderly, seniors, suicide, self-destruction, clinical, randomized, trial, treatment, intervention, and ideation. Articles were analyzed if they provided sufficient information to examine whether an intervention effectively led to a reduction in suicide ideation among seniors. Two hundred and eight articles were considered for potential inclusion in this study, with 19 articles meeting final inclusion criteria. The articles reviewed were divided into three broad categories: articles supporting suicide ideation as a surrogate endpoint for geriatric suicide (n = 6); those not supporting this hypothesis (n = 1); and those providing insufficient information to test the hypothesis (n = 12). The present analysis provided modest evidence for suicide ideation as a surrogate endpoint for geriatric suicide, due, in part, to a paucity of randomized controlled trials of treatment interventions for suicidal seniors, thus demonstrating a clear need for research in this area. Implications of utilizing surrogate endpoints in suicide research are discussed. < copyright > 2005 The American Association of Suicidology.

 

11: Suicide attempts and impulsivity

Baca-Garcia-E; Diaz-Sastre-C; Garcia-Resa-E; Blasco-H; Braquehais-Conesa-D; Oquendo-MA; Saiz-Ruiz-J; De-Leon-J

EUR-ARCH-PSYCHIATRY-CLIN-NEUROSCI. European-Archives-of-Psychiatry-and-Clinical-Neuroscience. 2005; 255(2): 152-156.

Impulsivity in suicidal behavior can describe the attempt (state) or the attempter (trait). There are no studies simultaneously measuring attempt impulsivity and attempter impulsivity in representative samples of suicide attempts. A one-year study of 278 suicide attempts in a general hospital tested the continuous versus dichotomous relationship between attempter impulsivity (Barratt Impulsiveness Scale) and attempt impulsivity (low scores in the planning subscale of Beck's Suicidal Intent Scale). Attempter impulsivity was not a good predictor of attempt impulsivity independently of how both dimensions were measured (continuous or dichotomous ways). Impulsive attempts were associated with low lethality and lack of depression. Opportunities for prevention of suicide attempts in major depression and some personality traits may exist but require attentive monitoring of suicidal ideation and intent.

 

12: Occult suicidality in an emergency department population

Claassen-CA; Larkin-GL

BR-J-PSYCHIATRY. British-Journal-of-Psychiatry. 2005; 186(APR.): 352-353.

The prevalence and severity of suicidal ideation was established in a patient sample seeking emergency treatment for non-psychiatric reasons. Using a computerised mental health screening panel, data were collected from waiting-room patients during randomised shifts over a 45-day period. Of 1590 screened patients, 185 (11.6%) acknowledged suicidal ideation and 31 (2%) reported planning to kill themselves. Almost all of those with suicidal ideation (97%) acknowledged symptoms consistent with mood, anxiety and/or substance-related disorders. Structured medical record review revealed that 25 of the 31 patients planning suicide were undetected during their index visit, and that 4 attempted suicide within 45 days of the visit. All survived.