Default mode dysfunction underpins suicidal activity in mood disorders.

Association between rumination, suicidal ideation and suicide attempts in persons with depressive and other mood disorders and healthy controls: A systematic review and meta-analysis

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessLong-Term Study Backs Link Between Smoking, SuicidalityJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:15 Apr 2005https://doi.org/10.1176/pn.40.8.00400052While Americans worry about whether cigarette smoking will cause lung cancer, perhaps they should also pay attention to a lesser-known risk factor for the habit—suicide. Epidemiological studies going back at least a quarter century have linked cigarette smoking with suicide. And now another large epidemiological study does as well.This latest investigation was headed by Naomi Breslau, Ph.D., a professor of epidemiology at Michigan State University. Results appeared in the March Archives of General Psychiatry.In 1988, Breslau and her colleagues selected some 1,000 young adults to participate in their study. All were members of a health maintenance organization in the Detroit area. All were interviewed at baseline and at three, five, and 10 years after the study started. During each interview, their psychiatric health, smoking habits, and occurrence of suicidal thoughts and of suicidal attempts since the last interview were ascertained.As it turned out, subjects reported only 19 suicide attempts during the 10-year study period. Since 19 suicide attempts were not enough for a meaningful statistical analysis, Breslau and her team decided to lump suicidal attempts and suicidal thoughts together. Combining these gave 17 suicide attempts with the reporting of suicidal thoughts; two suicide attempts without the reporting of suicidal thoughts; and 130 suicidal thoughts without suicide attempts, for a total 132 suicidal thoughts and/or attempts.Breslau and her colleagues then attempted to see whether smoking at baseline, at the three-year assessment, and at the five-year assessment could be statistically linked with the combined number of suicidal thoughts or attempts during the subsequent study periods.The answer was yes. Compared with subjects who had never smoked, current smokers (those who had smoked during the past 12 months) were at a statistically significant increased risk of suicidal thoughts or attempts. In contrast, past daily smokers were not at increased risk for subsequent occurrence of suicidal thoughts or attempts.Moreover, this link between current cigarette smoking and suicidal thoughts or attempts held even when potentially confounding factors—prior suicidal thoughts or attempts, current or past major depression, and current or past substance abuse—were taken into consideration.And even though the study results did not find current cigarette smoking to be as grave a risk factor for suicidal thoughts or attempts as prior suicidal thoughts or attempts, or current or past major depression, they do suggest some practical implications.“Clinical psychiatrists should always be concerned and inquire about suicidality, self-destructive thoughts, et cetera,” Glenn Davis, M.D., a professor of psychiatry at Michigan State University and one of the study authors, said in an interview. “But with added knowledge that there is a connection between smoking and risk for suicidal behavior, they should be particularly sensitive to smoking history in their evaluation of patients.”“By highlighting current smoking, [this study further reinforces] the benefits of smoking cessation,” Donald Klein, M.D., a professor of psychiatry at Columbia University, pointed out to Psychiatric News.How current cigarette smoking might trigger suicidal thoughts or attempts is not known. Yet if it does play a causal role, Breslau and her team suspect that it may do so via an intermediary culprit—the enzyme monoamine oxidase (MAO), which is found in the liver and the central nervous system. It is crucial to the functions of the neurotransmitter serotonin. Low levels of MAO have been found in blood cells of current cigarette smokers, but not in those of ex-smokers, and low blood-cell levels of MAO in turn have been linked with violence and suicide.This investigation has several advantages over past ones on the subject. It took major depression, a well-established risk factor for suicide, into consideration, and it was quite sophisticated in design. Klein explained that it “incorporated major methodological advances by using prospective multiwave longitudinal psychiatric diagnoses in estimating whether smoking independently increases suicide-related behaviors.”The study had a weakness, however, which Breslau and her group acknowledged in their report: The researchers did not gather data about subjects' completed suicides, only about their suicidal thoughts and attempts.The study was funded by the National Institute of Mental Health.An abstract of “Smoking and the Risk of Suicidal Behavior” is posted online at<http://archpsyc.ama-assn.org/cgi/content/abstract/62/3/328>.▪ Arch Gen Psychiatry 2005 62 328 ISSUES NewArchived

Suicidal ideation and attempts are growing public health concerns globally. Evidence from high-income countries suggests that individuals with psychosis and bipolar disorder are at increased risk of suicidal ideation and attempts, but there is a scarcity of evidence from South Asia. To estimate the prevalence of suicidal ideation and attempts in individuals with psychosis and bipolar disorder in South Asia. In this systematic review and meta-analysis, four databases (PsycINFO, Web of Science, EMBASE and Medline) were searched until December 2022. Pooled prevalence was estimated with random-effects models. Heterogeneity was quantified with the I2-statistic. The pooled sample size across the 21 studies was 3745 participants, 1941 (51.8%) of which were male. The pooled prevalence of suicide attempts in South Asian people with either psychosis or bipolar disorder was 22% (95% CI 17-27; n = 15). The pooled prevalence of suicidal ideation with psychosis or bipolar disorder combined was 38% (95% CI 27-51; n = 10). Meta-regression, subgroup and sensitivity analysis showed that the pooled prevalence estimates for both suicide attempt and ideation remained unaffected by variations in critical appraisal ratings and study designs. Only one study reported data on suicide-related deaths. One in four individuals diagnosed with psychosis or bipolar disorder have reported suicide attempts, whereas up to one in three have experienced suicidal ideation. These findings underscore the urgent need for clinicians to regularly assess and monitor suicidal ideation and attempts among individuals with these disorders in South Asia.

Background Illicit drug use and dependence is a well-established risk factor for self-harm and suicide. The present comparative study aimed to evaluate the prevalence of suicidal ideation and suicide attempt among Iranian women. Methods With a cross-sectional design, a total of 787 Iranian women who reported using illicit drugs and 406 women without drug use history were recruited and invited to answer questions regarding their socio-demographic status, individual health conditions, interpersonal information, e.g. experience of sexual, verbal, or physical violence, illicit drug use, and history of suicidal ideation and suicide attempt. Data were collected through gender-matched interviews. Generalized Linear Models (GLM) with Poisson family and log link function were used to report adjusted prevalence ratios (APR) of the associated factors of the study outcomes. Results The mean age (SD) of women with and without drug use was 34.3 (9.2) and 30.5 (11.0) years, respectively. Prevalence of lifetime history of both suicidal ideation (38.54 vs 19.01%) and suicide attempt (26.25 vs 6.55%) was significantly higher among women reporting drug use compared to those reporting no drug use. The APR of the associated factors ranged from 1.8 to 3.1 and from 3.3 to 4.8 for suicidal ideation and suicide attempt, respectively. Conclusion Women who use drugs are at greater risk of suicidal ideation and suicide attempt compared with their peers who do not use drugs. Although further studies are required to explore possible causal relationships between drug use and suicide among Iranian women, a comprehensive package of care and treatment in addition to predominantly drug-related harm reduction programs may help address such critical health issues among Iranian women who use drugs.

Background: Alcohol is one of commonly used psychoactive substances. Harmful use of alcohol results in a cluster of behavioral and physical symptoms known as Alcohol use disorder. WHO suggests that harmful use of alcohol to be an individual risk factor for suicidal behavior, accounting for 25-50% of all suicides linked to alcohol and other substance. Many studies were done on alcohol and suicidal ideation and attempt. Most of these studies suggest that alcohol have association with suicidal ideation and attempt. But there are studies with no association between alcohol use disorder and suicidal ideation and attempt. Objective: To assess the prevalence of suicidal ideation and attempt among alcohol use disorder patients attending addiction clinic at Amanuel Mental Specialized Hospital (AMSH). It also determines the association of alcohol use disorder and suicidal ideation and attempt. Method: This was a hospital based cross-sectional study, that include 120 patients of age above and equal 18 years. Data were collected by using ASSIST 3.1 (Alcohol, Smoking and Substance Involvement Screening Test), to assess alcohol use disorder, CSSRS (Colombia suicide severity rating scale) to assesssuicidal ideation and attempt, and PHQ-9 (patient health questioners-9) to assess the depression and severity of depressive symptoms. Chi square and binary logistic regression was used to assess factor relation. Result: The overall prevalence of suicide ideation and attempt among alcohol use disorder patients was 30.6% for the past month and 31.7% for past year of time of data collection. Suicide attempt was 14.9% and 13.3% respectively. Older age was associated significantly with suicidal ideation and attempt (X2 =6.128, P=0.047). Alcohol use disorder had no association with suicidal ideation and attempt for both past month (OR = 0.827; 95% CI 0.116, 5.914) (P = 0.850) and the past year (OR=1.360; 95% CI 0.122,15.165) (P=0.803) of data collection. Major depressive disorder was significantly associated with alcohol use disorder (P=0.047). Conclusion: Suicide ideation and attempt was significantly associated with advancement of age among alcohol use disorder patients. Alcohol use disorder has no association with suicide ideation and attempt among the respondents. Alcohol use disorder and major depressive disorder was significantly associated with and could lead to suicidal ideation and attempt indirectly. Recommendation: Further researches on alcohol use disorder, depression and suicide are necessary to assess the relationship each character.

Suicidal attempts (SA) represent heterogeneous behaviours ranging in their seriousness from fatal and near-fatal (high-lethality) cases to those that do not require medical attention (low lethality). These considerations stress the need to identify high-risk individuals for high lethality SA in order to target suicide preventive interventions. The present study aims at evaluating the role of sociodemographic and clinical variables and examining personality pathological features in predicting high lethality SA. The sample was composed by 94 patients who were consecutively admitted to the Mood Disorders Unit of the San Raffaele Turro Hospital in Milan. The results of binary logistic regression analyses showed that previous SA and current suicide ideation play a role in predicting serious SA. Considering the DSM-5 personality dysfunctional domains assessed by the Personality Inventory for DSM-5, our logistic regression analyses suggested that high lethality SA was associated with Detachment PID-5 domain. Finally, binary hierarchical regression analysis showed that Detachment domain remained a significant predictor of serious SA over and above the effect of previous SA and suicide ideation. As a whole, our results highlight the importance of a multidimensional approach to develop adequate assessment, effective treatments and prevention of high lethality SA risk.

To examine associations between health risk behaviours and suicidal ideation and attempts in Canadian adolescents aged 12 to 13 years. Young adolescents think about and attempt suicide. However, most existing research on suicide has been conducted on individuals aged 15 years and older. The present study examined a nationally representative Canadian sample of adolescents aged 12 to 13 years (n=2090). Health risk behaviours included disruptive (shoplifting, physical fighting, damaging property, fighting with a weapon, carrying a knife, and gambling), sexual (petting below the waist and sexual intercourse), and substance use behaviours (smoking cigarettes, consuming alcohol, marijuana or hash, and glue or solvents). Unadjusted and adjusted (for all significant health risk behaviour and psychiatric symptoms) models were tested. All health risk behaviours were common among male and female adolescents. In unadjusted models, almost all health risk behaviours were associated with suicidal ideation and attempts among adolescent boys. In adjusted models, only damaging property, sexual intercourse, and smoking cigarettes remained statistically associated with suicidal ideation, while smoking cigarettes and using marijuana or hash remained statistically associated with suicide attempts among adolescent boys. All health risk behaviours were statistically associated with suicidal ideation and attempts among female adolescents in unadjusted models. In adjusted models, only carrying a knife remained statistically associated with suicidal ideation, while shoplifting and gambling remained statistically associated with suicide attempts among adolescent girls. Health risk behaviours among young adolescents are associated with suicidal ideation and attempts among young adolescents. Recognizing health risk behaviours among young adolescents may be one means of understanding who among them is at increased risk of suicidality.

Attitudes toward suicide are complex and multifaceted. Their predictive roles and how they interact with mental health in suicidal ideation and suicide attempts are not well understood. Elaborating on attitudes toward suicide can help contribute to suicide prevention. The current study examined whether and how attitudes toward suicide and depression levels are involved in suicidal ideation and suicide attempts among college students. A cross-sectional survey was administered to 1,427 Chinese college students (61.32% females; mean age, 22.42 years), of whom 570 reported suicidal ideation. Participants completed questionnaires to assess their endorsed attitude toward suicide, stigmatized attitude toward suicide, self-stigma toward suicide, depression, suicidal ideation, and suicide attempts. Structural equation modeling revealed that the associations between the three types of attitudes, i.e., endorsed attitude, stigmatized attitude, and self-stigma, and suicidal ideation and suicide attempts were fully or partially mediated by depression. The results suggested that attitudes toward suicide significantly influence suicidal behaviors through depression levels and future suicide prevention efforts should consider these influences.

Interpersonal factors and depression are believed to be some of the main drivers of suicidal thoughts and behaviors, but other factors may be equally or more important. Drawing on psychodynamic (mentalization) theory, we propose that personality functioning, in particular an incoherent sense of self, may be an important driver of suicidal thoughts and behaviors over and above factors of interpersonal functioning and depression. To evaluate this, we examined associations between personality functioning and suicidal ideation and suicide attempt in young adults. Participants (N=153; Mage=20.93) were recruited from a college sample (N=90) and a clinical sample with borderline personality disorder (N=63). Personality functioning (self and interpersonal components) was measured with the Level of Personality Functioning Scale - Brief Form 2.0. Suicidal ideation was measured with the Personality Assessment Inventory. Suicide attempt history was assessed with the Columbia-Suicide Severity Rating Scale. Depression symptoms were measured with the Symptom Checklist 90. Regressions examined relationships between personality functioning, depression symptoms, and suicidal ideation or attempt while controlling for age and gender. Overall personality functioning was significantly associated with suicidal ideation (β=.584, p<.001) and suicide attempt (β=.384, p<.001). Overall personality functioning was a stronger predictor than depression symptoms, age, and gender when included in the same model predicting suicidal ideation or attempt. Both the self and interpersonal components of personality functioning were significantly associated with suicidal ideation and attempt, with larger effect sizes for self-functioning. Findings underscore the importance of considering personality functioning, especially self-functioning, in suicide risk assessment and treatment.

Background: Previous work suggests that reasons for living (RFL) are associated with suicide ideation; however, the relationship between RFL and suicide attempts among individuals with suicide ideation remains unclear. Such an examination is necessary to delineate whether RFL are associated with suicide attempts above and beyond their association with suicide ideation. Aims: This study examined the relationship between RFL and suicide attempts among young adults with a lifetime history of suicide ideation. Method: Undergraduate students (N=163) completed surveys assessing demographics, suicidal thoughts and behaviors, and RFL. Results: Individuals with a history of both suicide ideation and attempt reported significantly lower RFL than individuals with a history of suicide ideation but no suicide attempt. Among individual RFL-YA subscales, only Coping Beliefs was significantly associated with a suicide attempt history. Limitations: The cross-sectional nature of this study precludes any conclusions about the potential protective effects of RFL against suicide attempts, and the college student sample limits generalizability of the findings. Conclusion: Further research is needed to understand whether RFL prospectively predict suicide attempts among individuals with suicide ideation and whether interventions that bolster RFL might reduce suicide risk.

BackgroundChildhood maltreatment (CM) is prevalent among patients with mood disorders and considered an important risk factor for suicide in the general population. Despite mood disorders being implicated in up to 60 % of completed suicides, the predictive role of CM on suicide attempt (SA) among early mood disorder patients remains poorly understood. MethodsWe enrolled 480 participants diagnosed with early-onset major depressive disorder (MDD), bipolar I disorder (BD I), and bipolar II disorder (BD II). Over an average of 60 weeks, participants underwent follow-up assessments at 12-week intervals. Using multivariate logistic regression, we examined the association between CM and SA history at baseline. Further, the Cox proportional hazard model assessed the predictive role of childhood maltreatment in SA during follow-up. ResultsAt baseline, 38 % of the total participants reported SA history, with a follow-up prevalence of 10 %. Childhood maltreatment was significantly associated with past SAs and was a robust predictor of future SA, adjusting for relevant clinical risk factors. Emotional abuse and sexual abuse related to SA history, and physical abuse increased future SA risk. LimitationsPotential biases in reporting SA and childhood maltreatment, along with unexplored factors such as additional environmental and familial risks, may affect the study's findings. ConclusionsChildhood maltreatment emerged as a robust predictor of SA among early-onset mood disorder patients. Systematic evaluation of CM early in the clinical process may be crucial for effective risk management. Additionally, our findings highlight the importance of implementing proactive interventions for CM to prevent the onset of adverse psychological trajectories.

Background: Suicidal ideation and attempt are more frequent in HIV patients than general population Objective: The aim of this study was to assess the suicidal ideation and attempt among HIV patients in Omdurman National Voluntary Counseling and Testing Center, Khartoum state, Sudan. Methods: Descriptive cross-sectional institutional based study was conducted among HIV patients attending Omdurman national voluntary counseling and testing Center. Systematic random sampling technique was used to select 235 participants from March to May 2021, data was collected by using a questionnaire consisted of sociodemographic and clinical characteristics and validated tool (Mini international neuropsychiatric interview for suicidality- the Arabic version), data was analyzed using SPSS 26 edition and Chi squire test, the t test and Multivariate test were used for the associations between variables Results: Suicidal ideation in the last month was (14.5%), suicidal attempt in the last month was (0.4%) and lifetime suicidal attempt was (4.3%). Suicide risk were high in (2.5%), moderate in (10.6%) and low in (12.7%). Marital status, occupation, duration of diagnosis, WHO stages and opportunistic infections were significantly associated with suicidal ideation, whereas opportunistic infections and marital status were significantly associated with suicidal attempt. Conclusion: The suicidal ideation and attempt in the HIV patients in the last month were 14.5% and 0.4% respectively, and the lifetime suicidal attempt was 4.3%. There is significant association between suicidal ideation and attempt and some sociodemographic and clinical characteristics of the patients.

Longitudinal associations of cannabis and illicit drug use with depression, suicidal ideation and suicidal attempts among Nova Scotia high school students

Suicide is a potentially preventable public health issue. It is therefore important to examine its immediate precursors, including suicidal ideation and attempts, to help in the development of future public health interventions. The present study reports the prevalence of suicidal ideation and attempts in the past 12 months in children and adolescents and identifies correlates of such behaviors in a large and diverse sample of middle and high school students. Data were drawn from a representative sample of Ottawa students (n=1922) aged 11-20 years (14.4±1.9 years) from three cycles (2009, 2011 and 2013) of the Ontario Student Drug Use and Health Survey (OSDUHS), a cross-sectional school-based appraisal of students in grades 7-12 across Ontario, Canada. Overall, 10.8% of students exhibited suicidal ideation and 3.0% reported suicide attempts in the past 12 months. The conditional probability of making an attempt was 25.5% among suicide ideators. Multivariable analyses indicated that being a girl and using alcohol and cannabis were positively associated with suicidal ideation, while tobacco was positively associated with suicide attempts. Being a victim of school bullying was significantly associated with reports of suicidal ideation and attempts, whereas school connectedness had protective effects against both suicidal ideation and attempts. These results indicate that suicidal ideation and attempts are related to other risky behaviors. Suicide-prevention efforts should be integrated within broader health-promoting initiatives.

Suicide Prevention in an International Context.