Karolina Krysinska

Post-traumatic stress disorder and suicide risk: a systematic review.

There is a gap in the literature regarding suicide risk among traumatized individuals with post-traumatic stress disorder (PTSD) and this article aims to systematically review literature on the relationship between PTSD and suicidal behavior and ideation. A meta-analysis of 50 articles that examined the association between PTSD and past and current suicidal ideation and behavior was conducted. There was no evidence for an increased risk of completed suicide in individuals with PTSD. PTSD was associated with an increased incidence of prior attempted suicide and prior and current suicidal ideation. Controlling for other psychiatric disorders (including depression) weakened, but did not eliminate, this association. The evidence indicates that there is an association between PTSD and suicidality with several factors, such as concurrent depression and the pre-trauma psychiatric condition, possibly mediating this relationship. There are significant clinical implications of the reported relationship for suicide risk assessment and therapy, and further studies might help to understand the mediating pathways between PTSD and increased suicide risk.

Suicide in young men

Suicide is second to only accidental death as the leading cause of mortality in young men across the world. Although suicide rates for young men have fallen in some high-income and middle-income countries since the 1990s, wider mortality measures indicate that rates remain high in specific regions, ethnic groups, and socioeconomic groups within those nations where rates have fallen, and that young men account for a substantial proportion of the economic cost of suicide. High-lethality methods of suicide are preferred by young men: hanging and firearms in high-income countries, pesticide poisoning in the Indian subcontinent, and charcoal-burning in east Asia. Risk factors for young men include psychiatric illness, substance misuse, lower socioeconomic status, rural residence, and single marital status. Population-level factors include unemployment, social deprivation, and media reporting of suicide. Few interventions to reduce suicides in young men have been assessed. Efforts to change help-seeking behaviour and to restrict access to frequently used methods hold the most promise.

Suicide and deliberate self-harm in personality disorders

Purpose of review This article reviews literature published over the period January 2004–May 2005 on suicidal behaviour and self-harm in personality disorders. Recent findings Studies have confirmed that personality disorders and their co-morbidity with other psychiatric conditions are risk factors for both fatal and nonfatal suicidal behaviours, and self-mutilation. Negative life events, childhood sexual abuse, difficulties in social functioning, deficits in future-directed thinking and time perception, as well as familial and neurocognitive factors may be related to increased suicide risk in individuals with borderline and other personality disorders. Findings seem to confirm that suicidality and self-injurious behaviour are efficient DSM-IV diagnostic criteria for borderline personality disorder. Out of several psychosocial and pharmacological interventions for treating suicidality in personality disorders, only one randomized, controlled study has recently been published. Medico-legal concerns related to the clinical management of chronically suicidal patients, including hospitalization and alternative treatment approaches, are also discussed. Summary Although recent studies have contributed to the theoretical knowledge and clinical practice, there are unsettled questions that should be addressed in the future. More randomized, controlled trials evaluating the efficacy of interventions in suicidal individuals with personality disorders should be conducted. As the majority of studies conducted to date have concentrated on borderline personality disorder and antisocial personality disorder, the prevalence and risk factors for suicidal behaviours and self-mutilation in other personality disorders require further clarification. The introduction of unified nomenclature related to suicidal behaviours and self-mutilation would facilitate comparability of results across studies.

Suicide on Railway Networks: Epidemiology, Risk Factors and Prevention

The aim of the present study was to review international literature on the incidence of suicide on railway networks, describe risk factors associated with it, and examine existing prevention practices. Searches on Medline and PsycINFO for the period 1966–2007 were performed. Thirty original studies published in English on epidemiology of rail suicide were included in the review along with peer-reviewed articles on risk factors and prevention of rail suicide. Internationally, suicide by collision with a train accounted for 1–12% of all suicides, with up to 94% of all attempts resulting in death. Suicide by train seriously affects not only survivors, but also train drivers and bystanders. Correlations between density of rail network, number of passengers and number of suicides by train have been found. Conflicting data exist on gender ratio of this type of suicide, but studies are homogenous in identifying young adults (20–40year of age) as those most exposed to train suicide. Documented psychiatric diagnoses were found in up to 83% of cases. Mid-seasonal peaks were also identified, with events occurring mostly during late morning and early afternoon. Limited evidence exists for effective suicide prevention practices. Successful examples are represented by pits and sliding door systems (Singapore Mass Rapid Transit System) and responsible media reporting (Viennese Subway). Suicide by train involves emotional and financial costs to individuals and society as a whole. A combination of different strategies might significantly reduce its effect.

Telecommunication and Suicide Prevention: Hopes and Challenges for the New Century

Development of information technology has created new opportunities and challenges in suicide prevention, research, and clinical practice. This article presents an overview of the wide range of telecommunication-based suicide prevention approaches. Interventions using the Internet, telephone, and videoconferencing are discussed, including crisis intervention, referral, and support, suicide risk assessment, psychotherapy for individuals at risk, and online-based suicide prevention training and education. Research regarding effectiveness of telecommunication-based suicide prevention in various demographic and clinical populations is reviewed, as well as concerns regarding this type of intervention. Future areas of research and development in the use of telecommunication media in prevention of suicide are discussed.

Interventions to reduce suicides at suicide hotspots: a systematic review and meta-analysis.

BACKGROUND Various interventions have been introduced to try to prevent suicides at suicide hotspots, but evidence of their effectiveness needs to be strengthened. METHODS We did a systematic search of Medline, PsycINFO, and Scopus for studies of interventions, delivered in combination with others or in isolation, to prevent suicide at suicide hotspots. We did a meta-analysis to assess the effect of interventions that restrict access to means, encourage help-seeking, or increase the likelihood of intervention by a third party. FINDINGS We identified 23 articles representing 18 unique studies. After we removed one outlier, interventions that restricted access to means were associated with a reduction in the number of suicides per year (incidence rate ratio 0.09, 95% CI 0.03-0.27; p<0.0001), as were interventions that encourage help-seeking (0.49, 95% CI 0.29-0.83; p=0.0086), and interventions that increase the likelihood of intervention by a third party (0.53, 95% CI 0.31-0.89; p=0.0155). When we included only those studies that assessed a particular intervention in isolation, restricting access to means was associated with a reduction in the risk of suicide (0.07, 95% CI 0.02-0.19; p<0.0001), as was encouraging help-seeking (0.39, 95% CI 0.19-0.80; p=0.0101); no studies assessed increasing the likelihood of intervention by a third party as a lone intervention. INTERPRETATION The key approaches that are currently used as interventions at suicide hotspots seem to be effective. Priority should be given to ongoing implementation and assessment of initiatives at suicide hotspots, not only to prevent so-called copycat events, but also because of the effect that suicides at these sites have on people who work at them, live near them, or frequent them for other reasons. FUNDING National Health and Medical Research Council, Commonwealth Department of Health.

Essential Questions on Suicide Bereavement and Postvention

During the past decades public and research interest in postvention, i.e., support for families and communities after a suicide, has increased. However, the postvention field is still facing a number of important challenges and questions. This article aims to discuss a series of essential issues on suicide bereavement and postvention, regarding the current state of the art and future developments. Who is a suicide survivor and how many suicide survivors are there? Is suicide bereavement different from other types of bereavement? What are the needs of suicide survivors and what is postvention from a clinical perspective and from a public health perspective? Can postvention be prevention? With this last question, the article concludes with a series of recommendations in order to strengthen the potential of postvention as prevention.

Suicidal behaviour by train collision in Queensland, 1990–2004

Objective: A study on the incidence of suicide in the train system and a description of main characteristics of victims and attempters was commissioned by Queensland Rail in response to an apparent increase of suicide phenomena and their consequences. Methods: Two sources of data were used for the analyses: the Queensland Suicide Register (QSR) and the Queensland Rail Incident Surveillance Information System (ISIS). Data on suicide were cross-checked on the two systems for the years 1990–2004. ISIS provided information on cases of attempted suicide for the period 1993–2206. Results: One hundred and sixty-one train suicide victims were identified. Globally, they represented 2% of all cases of suicide in Queensland. During the examined period no significant changes in trends of suicide through that method were found. Of all suicide cases, 59 (36.6%) included victims aged 15–24years. The ratio of male:female was 4:1, equal to the sex distribution of suicide with all methods in Queensland. Positive blood alcohol content was found in nearly 50% of young people and in 29.8% of the total sample. A psychiatric diagnosis was documented in 40.4% of all train suicide victims. Only 18 suicide attempters were identified through the ISIS database; of them, 15 were male and three were female, with a gender ratio similar to that of suicide victims. Conclusions: This study involved the largest dataset ever published in Australia on this topic. In Queensland, train suicides presented a stable trend during 1990–2004. Subjects of very young age (15–24) seem to be particularly exposed to this method; in this age group one in two individuals had positive blood alcohol content.

Best strategies for reducing the suicide rate in Australia

Objectives: There is accumulating evidence about effectiveness of a number of suicide prevention interventions, and a multilevel systems approach seems promising in reducing suicide risk. This approach requires that components ranging from individual-level to public health interventions are implemented simultaneously in a localised region. This paper presents estimated reductive effects on suicide attempts and deaths that might be expected in Australia if active components of the systems approach were to be implemented. Method: The study estimated population preventable fractions which indicate the extent to which suicide attempts and deaths might be decreased if the each of the proposed interventions was fully implemented. The population preventable fractions were based on the best available evidence available in the literature for the risk ratio for each intervention. Prevalence estimates were assessed for each component of the proposed systems approach: reducing access to suicide means, media guidelines, public health campaigns, gatekeeper programmes, school programmes, general practitioner training, psychotherapy and co-ordinated/assertive aftercare. Results: There was insufficient evidence available for the impact of a number of strategies, including frontline staff gatekeeper training, on either suicide attempts or deaths. Taking prevalence of exposure to the intervention into consideration, the strategies likely to bring about the strongest reduction in suicide attempts were psychosocial treatments and co-ordinated/assertive aftercare. The greatest impact on reductions in suicide deaths was found for psychosocial treatment, general practitioner training, gatekeeper training and reducing access to means of suicide. Conclusion: The evidence regarding the overall efficacy of the systems approach is important in identifying what strategies should be prioritised to achieve the biggest impact. The findings of the population preventable fraction calculations indicate that the systems approach could lead to significant reduction in suicide attempts and suicide deaths in Australia. Potential synergistic effects between strategies included in the approach could further increase the impact of implemented strategies.

On-Line Support and Resources for People Bereaved through Suicide: What Is Available?

The Internet is a potentially valuable source of information for the bereaved, but the current knowledge regarding the type and quality of online material on suicide bereavement is very limited. This study was designed to explore the types of online information and support available for people bereaved by suicide and the quality of such resources. Four popular Internet search engines were searched using terms related to suicide bereavement and support. Although a wide range of Internet resources exist for people bereaved by suicide, these resources may not meet basic quality standards. It is unknown who uses these sites, how such material is used, and whether it helps people to cope effectively with grief after suicide.