Michel Tousignant

Risk factors for completed suicide in schizophrenia and other chronic psychotic disorders: A case–control study

OBJECTIVE Despite an increased risk for suicide among individuals diagnosed with psychotic disorders, risk factors for completed suicide remain largely unexamined in this population. Using a case-control design, this study aimed to investigate clinical and behavioural risk factors for suicide completion in schizophrenia and other chronic psychotic disorders. METHOD A total of 81 psychotic subjects were examined; of these, 45 died by suicide. Proxy-based interviews with, on average, 2 informants were conducted using the SCID I and II interviews and a series of personality trait assessments. RESULTS Psychotic individuals at risk for suicide are most readily identified by the presence of depressive disorders NOS, moderate to severe psychotic symptoms and a family history of suicidal behaviour. They also exhibited fewer negative symptoms, had more comorbid diagnoses and, contrary to findings in other populations, we found that cluster A and C personality trait symptoms seem to have protective effects against suicide in schizophrenics and other chronic psychotic suicides. CONCLUSIONS Our study suggests that behavioural mediators of suicide risk, such as impulsive-aggressive behaviours, do not play a role in schizophrenic and chronic psychotic suicide. This is contrary to findings in other diagnostic groups, thus implying heterogeneity in predisposing mechanisms involved in suicide.

Suicide and no axis I psychopathology

BackgroundIt is unclear why approximately 10% of suicide completers seem to be psychiatrically normal. To better understand this issue, we studied suicide completers without an axis I diagnosis and compared them, on measures of psychopathology other than axis I, to normal controls and suicide cases with axis I psychopathology.Methods168 suicide cases were examined by way of a psychological autopsy with the best possible informant. Sixteen cases did not meet criteria for an axis I diagnosis; each of these cases was then age and gender matched to 52 suicide completers with an axis I disorder and 110 normal controls.ResultsFourteen of sixteen suicide cases without an axis I diagnosis had detectable abnormalities that were more similar to the axis I diagnosed suicide group than to a living group. Both suicide groups were similar in the total number of past suicide attempts, the total number of individuals with an axis II disorder, and similar scores on measures of impulsive-aggressive behaviors.ConclusionsThese findings suggest that most of the individuals who committed suicide and appeared psychiatrically normal after a psychological autopsy may probably have an underlying psychiatric process that the psychological autopsy method, as commonly carried out, failed to detect.

TPH and suicidal behavior: a study in suicide completers.

An association between the gene that codes for tryptophan hydroxylase (TPH)—the rate-limiting enzyme in the synthesis of serotonin—and suicidal behavior has been investigated with some detail in samples of living subjects who attempted suicide. In this study, we investigated TPH and suicide completion, the most severe form of suicidal behavior. A relatively large sample of suicide completers (n = 101) was genotyped at three TPH loci (two polymorphisms in the promoter region, A-6526G and G-5806T, and one in intron 7, A218C) and compared to psychiatrically normal living controls (n = 129). Although no significant differences were found between groups for genetic variation at single loci, haplotype analysis revealed that one haplotype (-6526G -5806T 218C) was significantly more frequent among suicide cases than in normal controls (χ2 = 11.30, df = 2, P = 0.0008; OR = 2.0 CI: 1.30–3.6). Further analyses suggested that this haplotype is particularly more frequent among subjects who committed suicide using violent methods. Similar results were observed in recent haplotype analyses in suicide attempters, which found that the equivalent of haplotype -6526G -5806T 218C was more frequent in impulsive attempters (Rotondo et al, Mol Psychiatry 1999; 4: 360–368). Our results replicate in suicide completers previous data observed in suicide attempters. These and other results continue to point to the substantial role that the gene that codes for TPH may play in the neurobiology of suicidal behavior

Suicide and serotonin: study of variation at seven serotonin receptor genes in suicide completers.

Suicide is an important public health problem, accounting for a significant proportion of total mortality among young people, particularly males. There is growing and consistent evidence suggesting that genetic factors play an important role in the predisposition to suicide. Based on several lines of evidence supporting a reduced serotonergic neurotransmission in subjects who committed suicide, we investigated variation at genes that code for serotonin receptor 1B (5‐HTR1B), 1Dα (5‐HTR1Dα), 1E (5‐HTR1E), 1F (5‐HTR1F), 2C (5‐HTR2C), 5A (5‐HTR5A), and 6 (5‐HTR6) in a total sample of 106 suicide completers and 120 normal controls. No differences were observed in allelic or genotypic distributions between groups for any of the loci investigated. Moreover, further analysis according to suicide method or psychopathology also failed to reveal differences between groups. Our results do not support a substantial role of these serotonergic receptors in suicide completion.

Informant-Specific Correlates of Suicidal Behavior in a Community Survey of 12- to 14-Year-Olds

OBJECTIVES To arrive at a better estimation of informant-specific correlates of suicidal behavior in young adolescents and to see how agreements and discrepancies between child and parent informants can contribute to the development of research and interventions. METHOD The weighted sample from the Quebec Child Mental Health Survey conducted in 1992 included 825 adolescents, aged 12 to 14 years, and their parents. The adolescent and one parent were questioned by two different interviewers. The response rate was 80.3%. Three categories of independent variables were assessed: adolescent, family, and socioeconomic characteristics. Logistic regression models were based on the adolescent and parent informant reports. RESULTS Parents identified 6 of the 59 adolescents having reported suicidal ideation and 2 of the 36 adolescents having reported suicide attempts. Two informant-specific models of correlates of suicidal behavior were found. The adolescent model included internalizing and externalizing mental disorders, family stressful events, and parent-adolescent relationship difficulties, while the parent model included perceiving a need for help for the adolescent, parents depressive disorders, and parent-adolescent relationship difficulties. CONCLUSION The study shows the relevance of considering informant-specific correlates of suicidal behavior in the development of research and interventions targeting youths suicidal behavior.

Suicidal attempts and ideations among adolescents and young adults: the contribution of the father's and mother's care and of parental separation

SummaryParental care was analyzed separately with the PBI for both father and mother or their surrogate to assess its association with suicidal behavior (attempt or serious ideation). The study was conducted on two French-speaking samples from Montreal: the first included 2,327 high school students and the second 701 young adults (18 to 24) reached by phone. Results showed poor care of father to be highly associated with suicidal behavior in the highschool group. Poor care of the mother and parental divorce obtained a lower association. In the second sample, only poor care of the father was significantly associated with suicidal behavior. The conclusion is that more attention should be focused on the father and that parental divorce may have a short-term effect but not a lasting influence when poor care is absent.

Prevalence of psychological distress and mental disorders, and use of mental health services in the epidemiological catchment area of Montreal South-West

BackgroundThis report presents the initial results of the first Epidemiological Catchment Area Study in mental health in Canada. Five neighbourhoods in the South-West sector of Montreal, with a population of 258,000, were under study. The objectives of the research program were: 1) to assess the prevalence and incidence of psychological distress, mental disorders, substance abuse, parasuicide, risky behaviour and quality of life; 2) to examine the links and interactions between individual determinants, neighbourhood ecology and mental health in each neighbourhood; 3) to identify the conditions facilitating the integration of individuals with mental health problems; 4) to analyse the impact of the social, economic and physical aspects of the neighbourhoods using a geographic information system. 5) to verify the adequacy of mental health services.MethodA longitudinal study in the form of a community survey was used, complemented by focused qualitative sub-studies. The longitudinal study included a randomly selected sample of 2,433 individuals between the ages of 15 and 65 in the first wave of data collection, and three other waves are projected. An overview of the methods is presented.ResultsThe prevalence of psychological distress, mental disorders and use of mental health services and their correlates are described for the first wave of data collection.ConclusionSeveral vulnerable groups and risk factors related to socio-demographic variables have been identified such as: gender, age, marital status, income, immigration and language. These results can be used to improve treatment services, prevention of mental disorders, and mental health promotion.

Sex biases in mental health scales: do women tend to report less serious symptoms and confide more than men?

Women report more symptoms than men in mental health surveys. The evidence shows that psychometric biases cannot explain this significant difference. This study attempts to explore other factors that could bias the results--for example, that women are likely to report less serious symptoms than men or are less apprehensive in reporting symptoms because they have a higher tendency to report symptoms than men. A random sample of 213 women and 222 men, all married and between the age of 25 and 40, were interviewed at home in two districts of Montreal (Canada) and given the Health Opinion Survey (HOS). As has been usually found, women scored higher than men on the HOS. A variety of scales assessed the seriousness of the symptoms and the results did not indicate any sex difference in this regard. Moreover, there was no correlation between the mental health and the Jourard Self-Confidence Scale. Finally, women did not confide more about their symptoms than men, contrary to the prevalent opinion according to which they are more likely to do so. Sex differences on mental health scales do not, therefore, appear to be related to the type of bias assessed in this survey.

Pena in the Ecuadorian Sierra: a psychoanthropological analysis of sadness.

In highland Ecuador, pena refers to a state of mind characterized by a mixture of sadness and anxiety as well as to an illness state resembling depression. This paper attempts to illustrate, through an analysis of the discourse on pena, how the ideology in which it is embedded serves to interpret a bodily problem at the same time as it reflects a more global attitude toward life. In essence, the folk theory states that the physical complaints caused by suffering are the result of a disturbance of the heart, the central organ of man, and of the emotional life which it controls. Because this suffering is often attributed to the immediate family group of the victim, the community at large often formulates accusations against one of its members. Though the therapy is limited to a cure of the symptoms through herbal remedies, a formal request can be made to a perceived wrongdoer to amend his behavior. The pena is also a state which can lead to colerin, a dangerous and sometimes lethal illness which is characterized by a sudden explosion of anger or madness and which will follow an unattended state of pena.

Suicide and gambling: psychopathology and treatment-seeking.

The aim of this study was to evaluate suicides with a history of problem gambling (PG) and others with no such history (NPG) and to compare the two on mental health problems and service utilization. Data on a sample of 49 PG suicides and 73 NPG suicides were obtained from informants and hospital records. Psychopathology was prevalent in both groups, but problem gamblers were twice as likely to have a personality disorder. Moreover, PG suicides were less in contact with mental health services in their last month, their last year, and their lifetime. NPG suicides consulted specialized services from 3 (last month and last year) to 13 times (lifetime) as often as their PG counterparts. Lower service utilization associated with PG suicides argues in favor of stepping up detection, engagement in care and treatment with respect to problem gambling, especially when comorbidity is present.