Lucas Giner

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.

Association study of two polymorphisms of the serotonin-2A receptor gene and suicide attempts

Serotonin (5‐HT) receptors may have a role in suicidal behavior. Previous studies have shown an association between the T102C polymorphism of the 5‐HT2a receptor gene and suicidal behavior. However, negative findings have also been reported. We examined the association between the T102C and C1354T (His452Tyr) polymorphisms of the 5‐HT2a receptor gene and suicide attempts. Four hundred forty‐one suicide attempters, 339 psychiatric patients, and 410 healthy controls were compared for genotypes of the T102C and C1354T (His452Tyr) polymorphisms. There were significant differences in the distribution of the three genotypes (TT, TC, and CC) of the T102C polymorphism in the three groups (controls, psychiatric patients, and suicide attempters). There was an excess of C/C genotypes in the suicide attempter group compared with the control group, but there were no significant differences between suicide attempters and psychiatric controls. We found no association between the C1354T polymorphism and suicide attempts. The C allele of the T102C polymorphism of the 5‐HT2A receptor gene may be associated with biological susceptibility for suicidal behavior or psychiatric conditions.

Can We Really Prevent Suicide

Every year, suicide is among the top 20 leading causes of death globally for all ages. Unfortunately, suicide is difficult to prevent, in large part because the prevalence of risk factors is high among the general population. In this review, clinical and psychological risk factors are examined and methods for suicide prevention are discussed. Prevention strategies found to be effective in suicide prevention include means restriction, responsible media coverage, and general public education, as well identification methods such as screening, gatekeeper training, and primary care physician education. Although the treatment for preventing suicide is difficult, follow-up that includes pharmacotherapy, psychotherapy, or both may be useful. However, prevention methods cannot be restricted to the individual. Community, social, and policy interventions will also be essential.

Violent and Serious Suicide Attempters: One Step Closer to Suicide?

BACKGROUND The use of violence in a suicide attempt and its medical consequences can be used to characterize specific subpopulations of suicide attempters that could be at higher risk of ever completing suicide. METHOD A population of 1,148 suicide attempters was consecutively recruited from 2001 to 2010. Violent suicide attempts were classified using Asbergs criteria. An overdose requiring hospitalization in an intensive care unit was considered a serious suicide attempt. In this exploratory study, we retrospectively compared 183 subjects who made a serious suicide attempt, 226 that made a violent suicide attempt, and 739 without any history of serious or violent suicide attempts with regard to demographic, clinical, and psychological characteristics and features of the suicide attempts using univariate and multivariate analyses. RESULTS In comparison with subjects whose attempts were neither violent nor serious, violent attempters and serious attempters were more likely to make repeated suicide attempts (OR = 3.27 [95% CI, 1.39-7.70] and OR = 2.66 [95% CI, 1.29-5.50], respectively), with higher medical lethality (OR = 6.66 [95% CI, 4.74-9.38] and OR = 3.91 [95% CI, 2.89-5.29], respectively). Additionally, violent attempts were associated with male gender (OR = 6.79; 95% CI, 3.59-12.82) and family history of suicidal behavior (particularly if serious or violent: OR = 6.96; 95% CI, 2.82-17.20), and serious attempters were more likely to be older (OR = 1.49, 95% CI, 1.12-1.99). CONCLUSIONS One of every 3 attempters in our sample had made violent or serious suicide attempts in their lifetime. Violent attempters and serious attempters presented differential characteristics, closer to those of suicide completers, compared to the rest of the sample.

Impulsive-aggressive traits and suicidal adolescents and young adults with alcoholism.

Suicidal behavior and alcohol use disorders among adolescents and young adults are serious public health problems. In the study of suicidal behavior among young people with alcoholism, it has been shown that aggression and impulsivity are higher among those who attempted suicide. Impulsivity has been related to suicidal and self-destructive behaviors within different psychiatric conditions, i.e. alcohol and substance use disorders, mood disorders, conduct disorder, impulse control disorders, antisocial personality disorder, and borderline personality disorder. The term impulsivity has been used to define different constructs such as (1) personality trait or cognitive style in which disinhibition is the core characteristic, (2) a tendency to act immediately in response to external or internal stimuli, and (3) a group of psychiatric disorders with behavioral dyscontrol. Among adolescents suicidal behavior is transmitted in families independently of psychiatric conditions, but not independently of impulsivity/aggression. Two causal links between impulsiveness and alcoholism have been proposed: (1) adolescents who develop alcoholism possess higher premorbid levels of impulsiveness than those who do not develop alcoholism, and (2) levels of impulsiveness differentiate both populations only after the development of alcoholism, with higher levels of impulsiveness among those adolescents who developed alcoholism. Cognitive behavioral techniques have shown promising results in the treatment of adolescents with alcohol and substance use disorder and suicidality. The relative frequency of suicidal behavior among adolescents and young adults suffering from alcoholism and its subsequent devastating effects on individuals, families and society merits further research and development of prevention strategies.

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.

Neuroinflammation in suicide: Toward a comprehensive model

Objectives. Suicidal behaviour (SB) entered the DSM-5, underlying a specific biological vulnerability. Then, recent findings suggested a possible role of the immune system in SB pathogenesis. The objective of this review is to present these main immune factors involved in SB pathogenesis. Methods. We conducted a review using Preferred Reporting Items for Systematic reviews and Meta-Analysis criteria, and combined (“Inflammation”) AND (“Suicidal ideation” OR “Suicidal attempt” OR “suicide”). Results. Post mortem studies demonstrated associations between suicide and inflammatory cytokines in the orbitofrontal cortex, a brain region involved in suicidal vulnerability. Also, microgliosis and monocyte–macrophage system activation may be a useful marker of suicide neurobiology. Kynurenine may influence inflammatory processes, and related molecular pathways may be involved in SB pathophysiology. Few recent studies associated inflammatory markers with suicidal vulnerability: serotonin dysfunction, impulsivity and childhood trauma. Interestingly, the perception of threat that leads suicidal individuals to contemplate suicide may activate biological stress responses, including inflammatory responses. Conclusions. Translational projects would be crucial to identify a specific marker in SB disorders, to investigate its clinical correlations, and the interaction between inflammatory cytokines and monoamine systems in SB. These researches might lead to new biomarkers and novel directions for therapeutic strategies.

Pathological personality traits and suicidal ideation among older adolescents and young adults with alcohol misuse: a pilot case-control study in a primary care setting.

OBJECTIVE To compare the clinical and demographic characteristics of older adolescents and young adults with and without alcohol misuse in a primary care setting. METHODS This study is a case-control study. Eighty-one 18-30 year old adolescents and young adults attending a primary care center were assessed with the CAGE questionnaire, the PRIME-MD instrument and the IPDE screening questionnaire. Sub-samples of positive screen for alcohol misuse (n = 21) and a negative age- and gender matched group (n = 21) were compared. RESULTS Of those with alcohol misuse, 71.9% had a comorbid psychiatric diagnosis. Depressive and anxiety disorders appeared to be more prevalent among the subjects with alcohol misuse than among controls. Among those patients with depressive or anxiety disorders and alcohol misuse, 22.2% reported suicidal ideation as compared to none among the controls suffering from depressive or anxiety disorders. 69.1% of subjects with alcohol misuse had a comorbid personality disorder. Significantly more adolescents and young adults with alcohol misuse exhibited borderline personality traits (p = 0.03) and there was also a trend towards a greater proportion exhibiting histrionic traits (p = 0.07) than among those without alcohol misuse. CONCLUSIONS Adolescents and young adults with alcohol misuse in a primary care center have a high prevalence of psychiatric comorbidity. Cluster B personality disorders may be more prevalent in the population with alcohol misuse. Adolescents and young adults with alcohol misuse may be more likely to report suicidal ideation while suffering from depressive or anxiety disorders. Further studies that evaluate the clinical and demographic characteristics of adolescents and young adults with alcohol misuse attended in a primary care center are needed.

Suicide in early childhood: a brief review.

The rate of suicide in the United States among prepubertal children and young adolescents had increased by 120% from 1980 to 1992. From 1992 to the present the rate has decreased slightly by 33%. We address a brief review of the most relevant findings in literature that are related to the risk of suicide. Although the most reported findings were child mood disorder, any type of family distress and family history of suicide attempts, the severity of those does not seem to increase the risk of suicide. However, there were other environmental factors that may influence the risk of suicide, such as the access to firearms. It is critical to detect risk factors and triggers in prepubertal populations in order to reduce the incidence of suicide in this age group and older age groups.