Julio A. Guija

Personality disorders and health problems distinguish suicide attempters from completers in a direct comparison.

BACKGROUND Whether suicide attempters and completers represent the same population evaluated at different points along a progression towards suicide death, overlapping populations, or completely different populations is a problem still unresolved. METHODS 446 Adult suicide attempters and knowledgeable collateral informants for 190 adult suicide probands were interviewed. Sociodemographic and clinical data was collected for both groups using semi-structured interviews and structured assessments. Univariate analyses and logistic regression models were conducted to explore the similarities and differences between suicide attempters and completers. RESULTS Univariate analyses yielded significant differences in sociodemographics, recent life events, impulsivity, suicide intent, and distribution of Axis I and II disorders. A logistic regression model aimed at distinguishing suicide completers from attempters properly classified 90% of subjects. The most significant variables that distinguished suicide from attempted suicide were the presence of narcissistic personality disorder (OR=21.4; 95% CI=6.8-67.7), health problems (OR=20.6; 95% CI=5.6-75.9), male sex (OR=9.6; 95% CI=4.42-20.9), and alcohol abuse (OR=5.5; 95% CI=2.3-14.2). LIMITATIONS Our study shares the limitations of studies comparing suicide attempters and completers, namely that information from attempters can be obtained from the subject himself, whereas the assessment of completers depends on information from close family or friends. Furthermore, different semi-structured instruments assessed Axis I and Axis II disorders in suicide attempters and completers. Finally, we have no data on inter-rater reliability data. CONCLUSIONS Suicide completers are more likely to be male and suffer from alcohol abuse, health problems (e.g. somatic illness), and narcissistic personality disorder. The findings emphasize the importance of implementing suicide prevention programs tailored to suicide attempters and completers.

Número de suicidios en España: diferencias entre los datos del Instituto Nacional de Estadística y los aportados por los Institutos de Medicina Legal

BACKGROUND AND OBJECTIVES To be able to prevent suicides, The exact magnitude of suicides must be known in order to prevent them. There is evidence that data provided on the number of suicides by the Spanish Statistical Office (Instituto Nacional de Estadística [INE]) differs from that identified by forensic pathologists. This paper aims to determine whether the INE data are to the same as those recorded by the agencies responsible for conducting autopsies in Spain (IML), and calculate the number of missing cases. METHOD IML were requested to provide the number of suicides in a five year period (2006-2010) and this was compared with those offered by INE in its site. A new rate of suicides per 100,000 was obtained and used to calculate the number of suicides in Spain. RESULTS For every year of the studied period, the number of suicides reported by the INE was lower than that obtained directly from the IML. Using the highest annual suicide rate registered by province and the total, a count was obtained of identified suicides that for some reason had not been recorded in the INE or the IML data. Based on these figures, the mean rate of suicides per 100,000 was 0.97 (SD 0.10) higher than official INE data, which indicates a mean loss of 443.86 (SD 46.72) cases reported each year. Possible factors that may influence the missing recorded cases are discussed. CONCLUSIONS According to the results, there is a discrepancy between INE and IML about the number of suicides in Spain. Neither of the two sources can be considered more reliable than the other.

Protocolo breve de evaluación del suicidio, fiabilidad interexaminadores

INTRODUCTION Inter-rater agreement is a crucial aspect in the planning and performance of a clinical trial in which the main assessment tool is the clinical interview. The main objectives of this study are to study the inter-rater agreement of a tool for the assessment of suicidal behavior (Brief Suicide Questionnaire) and to examine whether the inter-examiner agreement when multiple ratings are made on a single subject is an efficient method to assess the reliability of an instrument. METHOD In the context of designing a multicenter clinical trial, 32 psychiatrists assessed a videotaped clinical interview of a patient with suicidal behavior. In order to identify those items in which a greater level of discordance existed and detect the examiners whose ratings differed significantly from the average ratings, we used the DOMENIC method (Detecion of Multiple Examiners Not in Consensus). RESULTS Inter-rater agreement was between poor (<70%) to excelent (90-100%. Inter-rater agreement in Brughas list of threatening experiences ranged from 75.5 and 100%; in the Global Assessment of Functioning (GAF) Scale was 82.58%; in the Becks Suicidal Intent Scale, ranged from 67.5 and 97%; in the Becks Scale for Suicide Ideation, ranged from 63.5 and 100%; and in the Lethality Rating Scale was 88.39%. On the whole, the level of agreement among raters, both in general scores and in particular items, was appropriate. CONCLUSION The proposed design allows the assessment of the inter-rater agreement in an efficient way (only in one session). In addition, regarding the Brief Suicide Questionnaire, inter-raters agreement was appropriate.

Necesidad de mejora en la gestión estadística y proceso de comunicación de los casos de suicidio identificados

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Nomenclature and Definition of Suicidal Behavior

Today we understand suicidal behavior as a spectrum of actions and thought processes. This framework is the result of centuries of thought and study on the subject. This chapter will provide a historical context for attempts to classify and understand the various manifestations of suicidal behavior. This chapter traces the evolution of the study of suicidal behavior from the first appearances of the word “suicide” in text up to the present state of our conceptualization. Various models for classifying suicidal behavior will be described. This chapter aims to provide the reader with a thorough understanding of both the historical and the contemporary definitions of the terms suicidal behavior, suicide, suicide attempt, and suicidal ideation. The impact of the theories of a diverse group of thinkers will be discussed, especially the framework described in the DSM-5. Multiple contemporary and historic diagnostic criteria will be described, as well as the intersections of suicidal behavior and other mental disorders.