Klaus Georgi

Impact of employment status and work-related factors on risk of completed suicide A case-control psychological autopsy study

The objective of this study was to determine the impact of work-related factors on risk for completed suicide. Psychiatric disorders and socio-demographic factors including work-related factors were assessed by a semi-structured interview using the psychological autopsy method in 163 completed suicide cases and by personal interview in 396 living population-based control persons. Unemployment (in particular, for more than six months), (early) retirement, or homemaker status were associated with highly significantly increased suicide risk, independently of categorized psychiatric diagnosis. In addition, adverse psychosocial working conditions, such as monotonous work, increased responsibility and pronounced mental strain due to contact with work clients, significantly increased suicide risk as well, again independently of categorized psychiatric diagnosis. These findings demonstrate that negative consequences of unemployment, homemaker status with no outside occupation, or (early) retirement, as well as adverse psychosocial working conditions, present relevant risk factors contributing to suicidal behavior, independently of diagnosed psychiatric disorders. Employment and a positive modification of working conditions, may possibly be preventive to important adverse mental health outcomes, including suicidality.

Concordance of DSM-IV Axis I and II diagnoses by personal and informant's interview.

The validity and reliability of using psychological autopsies to diagnose a psychiatric disorder is a critical issue. Therefore, interrater and test-retest reliability of the Structured Clinical Interview for DSM-IV Axis I and Personality Disorders and the usefulness of these instruments for the psychological autopsy method were investigated. Diagnoses by informants interview were compared with diagnoses generated by a personal interview of 35 persons. Interrater reliability and test-retest reliability were assessed in 33 and 29 persons, respectively. Chi-square analysis, kappa and intraclass correlation coefficients, and Kendalls tau were used to determine agreement of diagnoses. Kappa coefficients were above 0.84 for substance-related disorders, mood disorders, and anxiety and adjustment disorders, and above 0.65 for Axis II disorders for interrater and test-retest reliability. Agreement by personal and relatives interview generated kappa coefficients above 0.79 for most Axis I and above 0.65 for most personality disorder diagnoses; Kendalls tau for dimensional individual personality disorder scores ranged from 0.22 to 0.72. Despite of a small number of psychiatric disorders in the selected population, the present results provide support for the validity of most diagnoses obtained through the best-estimate method using the Structured Clinical Interview for DSM-IV Axis I and Personality Disorders. This instrument can be recommended as a tool for the psychological autopsy procedure in post-mortem research.

Can response to partial sleep deprivation in depressed patients be predicted by regional changes of cerebral blood flow

The possible predictive value of regional cerebral perfusion patterns with respect to the response to partial sleep deprivation (PSD) was evaluated in 15 major depressive patients (mean age = 54.9 years, mean Hamilton depression score = 21.6). Patients were studied with single photon emission computed tomography with technetium-99 m-D,L-hexamethyl-propylene amine oxime. Scans were performed on the morning before and after (at 08.00 h) PSD. Responders to PSD had significantly higher perfusion in the right orbitofrontal cortex than did non-responders before PSD. Multiple regression analysis indicated that right orbitofrontal/basal cingulate perfusion (r = -0.77, P < 0.001) before PSD, and left inferior temporal perfusion (r = 0.59, P = 0.01) after PSD, were fairly accurate predictors of change in Hamilton depression scores. Thus, it appears that the orbitofrontal cortex and the cingulate are involved in PSD and may serve as predictors of therapeutic response.

Correlation of platelet MAO activity with introversion: A study on a German rural population

Platelet monoamine oxidase (MAO) activity and personality characteristics were correlated in a sample of 52 men (37 +/- SD 13 years) and 54 women (37 +/- SD 15 years) from a rural community. Personality characteristics were measured by using the Freiburger Persönlichkeitsinventar (FPI-A). In males, weak but significant linear correlations (Pearson product-moment and Spearman rank correlations) were found between platelet MAO activity (p-tyramine and benzylamine as substrates) and the extraversion/introversion dimension. In the females, however, there were no consistent significant correlations between MAO activity and FPI test scores. Comparing the top and bottom 25% of the platelet MAO distribution resulted in a significant difference for the second order factor extraversion in the group of men but not in the group of women. The significant correlation between MAO and introversion could not be attributed to cigarette smoking, food consumption, alcohol, or drugs. In accord with previous biochemical-behavior research, it is suggested that reduced platelet MAO activity may, to some extent, reflect an impulsive personality type.

Evaluation of the effects of total sleep deprivation on cerebral blood flow using single photon emission computerized tomography

HMPAO‐single photon emission computerized tomography (SPECT) is a useful technique in studying cerebral blood flow (CBF). This method is suitable to evaluate the differences of CBF with reference to total sleep deprivation (TSD) within 24 h because of the short half‐life of the radiopharmaceutical compound. In the present study, CBF before and after TSD was analysed in patients suffering from major depression. The morning before and after TSD, Tc‐HMPAO‐SPECT was performed in 20 patients. Hamilton Rating Scale for Depression scores and subjective ratings were obtained daily. Eleven patients responded to TSD; 9 were nonresponders. The main finding was a significant left temporal and mainly right parietal increase of CBF, which was observed in the responders only. CBF values and the severity of depression correlated inversely.

Subjective sleepiness and physiological sleep tendency in healthy young morning and evening subjects

SUMMARY  The Multiple Sleep Latency Test (MSLT) was performed twice after 8h and after 4h of night sleep in 15 healthy young subjects (mean age: 23 y). Seven subjects could be regarded as morning, 8 subjects as evening types. After 8h of sleep significantly more evening types napped at 08.00 hours and at 12.00 hours. Evening types rated themselves more sleepy on an hourly administered visual analogous scale (VAS). Sleep onset latencies (SOL) decreased, and the amount of Stages 1 and 2 increased in all subjects dependent on the sleep restriction condition. No significant differences between morningness and eveningness concerning SOL and structure of nap structure could be observed. After 4 h of sleep there was a marked increase in subjectively rated sleepiness during the morning hours in both groups.

Incorporation of 14C-arachidonic acid into platelet phospholipids of untreated patients with schizophreniform or schizophrenic disorders

The incorporation rate of 14C-labeled arachidonic acid (14C-AA) into membrane phospholipids was measured in a group of untreated (greater than 6 months) psychiatric patients (n = 33) and healthy controls (n = 31). Platelets from controls and from patients with schizophrenia (n = 10), schizophreniform disorder (n = 11), schizoaffective disorder (n = 6), major depression (n = 2), or an atypical psychosis (n = 4), diagnosed according to DSM-III, were incubated with 14C-AA. Platelets from patients with a schizophreniform and a schizoaffective disorder incorporated greater than 50% less 14C-AA than the platelets from controls. The incorporation rates of platelets from schizophrenic patients were slightly (18%), but not significantly, reduced compared to controls. Characterization of variables affecting arachidonic acid and phospholipid metabolism may be helpful in studies focused on the assessment of first-episode psychotic patients and in long-term outcome studies.

How do personality disorders modify suicide risk

There is a lack of psychological autopsy studies assessing the influence of axis II disorders on other risk factors for suicide. Therefore, we investigated if the estimated suicide risk for axis I disorders and socio-demographic factors was modified by personality disorders. Psychiatric disorders were evaluated by a semi-structured interview including the Structured Clinical Interview for DSM-IV Axis I (SCID-I) and Personality Disorders (SCID-II) by psychological autopsy method in 163 completed suicides and by personal interview in 396 population-based control persons. Personality disorders modify suicide risk, differently for affective disorders, substance use disorders, smoking, life events during the last three months, and socio-demographic factors such as being single. Estimated suicide risk for socio-demographic factors and life events is not substantially altered following adjustment for affective disorders or substance use disorders. These findings suggest that treatment of personality disorders is essential for suicide prevention.

Does sport have a protective effect against suicide

AIM The association between sporting activities, or lack there of, and suicidal behaviour has not yet been clarified. The objective of this study was to determine, if sports participation has an impact on risk for completed suicide. METHODS Axis I and Axis II disorders, sociodemographic factors, and current and former sports activities, including various sports disciplines, were assessed by a semi-structured interview by psychological autopsy method in 163 suicides and by personal interview in 396 living population-based control persons. RESULTS Current sports activities (OR = 0.24, 95%CI, 0.15 to 0.39; OR = 0.27, 95%CI, 0.16 to 0.45) and sports activities at some point in life (OR = 0.33, 95%CI, 0.18 to 0.62; OR = 0.40, 95%CI, 0.23 to 0.68, after adjustment for axis I and II disorders or educational level, each) were associated with decreased suicide risk. CONCLUSIONS Current sports activities and sports activities at some point in life may reduce suicide risk.

Eine Feldstudie zur psychosozialen Situation Wohnungsloser in Frankfurt am Main

ZusammenfassungIn einer Feldstudie wurden 71 wohnungslose Männer im mittleren Alter von 34,5 Jahren mit einem halbstandardisierten Interview untersucht. Soziodemographisch fallen niedriger Schulabschluß (47,9% erreichten den Hauptschulabschluß, 18,3% verließen die Schule ohne Abschluß), hohe Arbeitslosigkeit und geringes Einkommen auf. Haupteinnahmequelle waren regelmäßige staatliche Hilfen. Die meist unverheirateten und kinderlosen Probanden führten selten in ihrem Leben eine längerdauernde Partnerschaft. Psychosoziale Konflikte (59,2%) wurden am häufigsten als Ursache für das Hineingeraten in Wohnungslosigkeit genannt. Hier betrug das Durchschnittsalter 28,1 Jahre. Neben interpersonellen Konflikten waren Entlassung aus dem Gefängnis und Arbeitslosigkeit die erstgenannten Ursachen der aktuellen Phase der Wohnungslosigkeit. 42,3% berichteten von psychiatrischen Kliniksaufenthalten, v.a. im Zusammenhang mit Alkoholabusus. Die erhobenen Befunde weisen darauf hin, daß wohnungslose Männer frühzeitig in ihrer biographischen Entwicklung in soziale Isolation geraten und der Anteil an psychiatrischer Morbidität hoch ist.SummaryIn a current field-study a sample of 71 homeless men (mean age 35,4 years) was investigated with a semi-standardized interview. Sociodemographically, a low education level, a high unemployment rate and low income were noted. The income was gained mainly through regular social welfare support. Mostly unmarried and without children, the participants seldom lived in a stable partnership during their life. Psychosocial conflicts (59,2%) were one of the most important causes for homelessness at an average age of 28,1 years. Interpersonal conflicts, release from jail and loss of job were the most frequently reported causes of current homelessness. 42,3% had been treated in psychiatric hospitals in the past, the majority because of alcoholism. In summary the current findings indicate that homeless men experience social isolation early during their maturation and that the frequency of psychiatric disorders is high.