Academic literature on the topic 'Depression; attempted suicide; short-term follow-up'

ObjectivesThe overall aim of this study is to gain greater knowledge about the risk of suicide among suicide attempters in a very long-term perspective. Specifically, to investigate possible differences in clinical risk factors at short (≤5 years) versus long term (>5 years), with the hypothesis that risk factors differ in the shorter and longer perspective.DesignProspective study with register-based follow-up for 21–32 years.SettingMedical emergency inpatient unit in the south of Sweden.Participants1044 individuals assessed by psychiatric consultation when admitted to medical inpatient care for attempted suicide during 1987–1998.Outcome measuresSuicide and all-cause mortality.ResultsAt follow-up, 37.6% of the participants had died, 7.2% by suicide and 53% of these within 5 years of the suicide attempt. A diagnosis of psychosis at baseline represented the risk factor with the highest HR at long-term follow-up, that is, >5 years, followed by major depression and a history of attempted suicide before the index attempt. The severity of a suicide attempt as measured by SIS (Suicide Intent Scale) showed a non-proportional association with the hazard for suicide over time and was a relevant risk factor for suicide only within the first 5 years after an attempted suicide.ConclusionsThe risk of suicide after a suicide attempt persists for up to 32 years after the index attempt. A baseline diagnosis of psychosis or major depression or earlier suicide attempts continued to be relevant risk factors in the very long term. The SIS score is a better predictor of suicide risk at short term, that is, within 5 years than at long term. This should be considered in the assessment of suicide risk and the implementation of care for these individuals.

AbstractObsessive compulsive disorder (OCD) is a severe, often long-term mental disorder. It may be independent from, or comorbid with other mental disorders, especially depression and anxiety disorders. Suicidal thoughts, ideations and ruminations are prevalent in subjects with OCD, but it is not yet clear if the incidences of attempted and completed suicides have increased in comparison with the general population and with other psychiatric disorders.MethodsWe conducted a systematic literature search on the incidence of suicide attempts and completed suicides in subjects with OCD. Search terms for Pubmed and Medline were OCD and suicide. We selected papers providing follow-up data on the incidence of attempted and completed suicide in OCD.Results404 papers were initially identified. Only 8 papers covering six studies provided prospective data on attempted or completed suicide over a defined period in subjects with OCD, four studies included control subjects. Two studies providing follow-up data were limited to high-risk samples and did not provide enough data on the incidence of suicide in comparison with the general population. The conclusion that there is an increased risk of attempted and completed suicides in OCD can only be based on one large Swedish National Registry sample with an up to 44 year follow up. Psychiatric comorbidity is the most relevant risk factor for suicide.ConclusionsEven though some studies report an increased incidence of attempted and completed suicides in OCD patients from selected high risk samples, the evidence from population based studies is mostly based on one large Swedish study. More long-term studies in the general population with a reduced risk of subject attrition are needed. Using a clear definition and assessment of suicidal behaviour and a common time-frame would improve the comparability of future studies.

BackgroundDespite the high suicide rate in the elderly, there is a relative lack of information on the longer-term outcome of elderly people who have attempted suicide, particularly their psychiatric and physical morbidity and mortality.MethodComprehensive demographic and psychiatric data were available on 100 consecutive referrals to a liaison psychiatric service of patients over 65 years of age who attempted suicide between 1989 and 1992. Detailed follow-up in 1994 included the interviewing of survivors using GMS–AGECAT.ResultsOf the 64 women and 36 men, with a mean age of 75.8 years, 42 subjects were dead at follow-up; 12 were suspected suicides, five having died as a delayed result of their index attempt. Twelve women made a further non-lethal suicide attempt. All five male repeat attempts proved fatal.ConclusionsElderly people who attempt suicide have a high mortality both from completed suicide and death from other causes. The completed suicide rate is at least 1.5% per year, and the repetition rate is 5.4% per year. Those at risk of further self-harm are likely to be in contact with psychiatric services and to be suffering from persistent depression.

BackgroundStrong links exist between juvenile and adult depression, but comorbid conduct disorder may be associated with worse adult social difficulties.AimsTo test the impact of comorbid conduct disorder on social adjustment and dysfunction, suicidality and criminality of adults who had had depression as youths.MethodSubjects (n=149) assessed at the Maudsley Hospital in 1970–1983 and meeting DSM–IV criteria for major depressive disorder with (CD–MDD; n=53) or without (MDD; n=96) conduct disorder were interviewed 20 years later. Data were collected on lifetime psychiatric disorders and adult social/personality functioning. Death certificates and criminal records were obtained.ResultsThe suicide risk was 2.45%, and 44.3% of the sample had attempted suicide once in their lives. Compared with the MDD group, the CD–MDD group had higher rates of suicidal behaviours and criminal offences, and exhibited more pervasive social dysfunction.ConclusionsAdolescent depression is associated with raised risks of adult suicidality and with persistent interpersonal difficulties. Youths with CD–MDD show more severe and pervasive social dysfunction.

According to contemporary suicidology, mental pain represents one of the main suicide risk factors, along with more traditional constructs such as depression, anxiety and hopelessness. This work aims to investigate the relationship between the levels of mental pain and the risk to carry out suicide or suicide attempt in the short term in order to understand if a measurement of mental pain can be used as a screening tool for prevention. For this purpose, 105 outpatients with psychiatric diagnosis were recruited at the university hospital of Varese during a check-up visit and were assessed by using psychometric scales of mental pain levels, hopelessness, anxiety and depression. Clinical and sociodemographic variables of the sample were also collected. A period of 18 months following the recruitment was observed to evaluate any suicides or attempted suicides. Subjects numbering 11 out of 105 committed an attempted suicide. From statistical analyses, high values of the Beck Depression Inventory (BDI-II), Mental Pain Questionnaire (OMMP) and Hamilton Rating Scale for Depression (HAM-D) scales showed a significant association with the risk of carrying out a suicide attempt and, among these, OMMP and BDI-II showed characteristics of good applicability and predictivity proving suitable to be used as potential tools for screening and primary prevention of suicidal behavior.

Summary: The cathartic effect of suicide is traditionally defined as the existence of a rapid, significant, and spontaneous decrease in the depressive symptoms of suicide attempters after the act. This study was designed to investigate short-term variations, following a suicide attempt by self-poisoning, of a number of other variables identified as suicidal risk factors: hopelessness, impulsivity, personality traits, and quality of life. Patients hospitalized less than 24 hours after a deliberate (moderate) overdose were presented with the Montgomery-Asberg Depression and Impulsivity Rating Scales, Hopelessness scale, MMPI and World Health Organization's Quality of Life questionnaire (abbreviated versions). They were also asked to complete the same scales and questionnaires 8 days after discharge. The study involved 39 patients, the average interval between initial and follow-up assessment being 13.5 days. All the scores improved significantly, with the exception of quality of life and three out of the eight personality traits. This finding emphasizes the fact that improvement is not limited to depressive symptoms and enables us to identify the relative importance of each studied variable as a risk factor for attempted suicide. The limitations of the study are discussed as well as in particular the nongeneralizability of the sample and setting.

SummaryThe prevalence of anxiety disorders and associated DSM-III-R diagnoses were measured in a sample of 80 female adolescents aged between 15 to 20 years consulting an outpatient psychiatric service for adolescents. The suicide attempt group (SA) included 40 patients evaluated within 24 h after attempted suicide. This is compared to 40 consecutive patients consulting the same center but without any history of suicide attempt (the no attempt group, NA).The global prevalence of anxiety disorders was similar in both groups (SA: 65% vs. NA: 60%, NS) as was the relative importance of the different disorders in each group, generalized anxiety being the most frequent specific anxiety disorder. The most striking difference between the two groups was in the prevalence of affective disorders in 90% (SA) vs. 32.5% (NA) (P < 0.001), leading to high rates of comorbidity on axis I in the SA group. Of the 24 patients with anxiety disorders who attempted suicide, 21 (95%) fulfilled criteria for associated major depression, compared to five out of 21 (24%) patients with anxiety disorders who had not attempted suicide.Adolescents with anxiety disorders developing major depression are at a high risk for suicide. The depression may be of short duration (less than two weeks) when compared to that of the anxiety disorder (greater than six months). To improve suicide prevention, our findings if confirmed should encourage clinicians to perform a close follow-up of adolescents with anxiety disorders for an early detection of sudden depressive breakdowns.

ObjectiveTo determine the postoperative attempted and completed suicide rates after subthalamic nucleus deep brain stimulation (STN-DBS) in a single-center cohort and to determine factors associated with attempted and completed suicide.MethodsWe retrospectively included all patients with Parkinson disease (PD) who underwent bilateral STN-DBS surgery at the Grenoble University Hospital between 1993 and 2016. For each patient who committed or attempted suicide, 2 patients with PD with STN-DBS without any suicidal behaviors were matched for age (±1 year), sex, and year of surgery (±2 years). Clinical data were collected from medical records. Detailed preoperative and postoperative neuropsychological evaluations, including frontal and Beck Depression Inventory (BDI) scores, were gathered.ResultsA total of 534 patients with PD were included. Completed and attempted suicide percentages were 0.75% (4 of 534) and 4.11% (22 of 534), respectively. The observed suicide rate in the first postoperative year (187.20 of 100,000 per year, 1 of 534) was higher than the expected National Observatory on Suicide Risks rate adjusted for age and sex (standardized mortality ratio 8.1). This rate remained similar over the second and third postoperative years. In a comparison of the 26 patients completing/attempting suicide and the 52 controls, the first group showed more frequent history of suicidal ideation/suicide attempts and psychotic symptoms, higher percentage of family psychiatric history, higher psychiatric medication use, and higher preoperative frontal and BDI scores on neuropsychological evaluations.ConclusionsSuicide behaviors can occur after STN-DBS, especially during the first 3 years. A careful multidisciplinary assessment and long-term follow-up are recommended to recognize and treat this potentially preventable risk for mortality.

AbstractSuicide is a major public health problem in the WHO European Region accounting for over 150,000 deaths per year.Suicidal crisis:Acute intervention should start immediately in order to keep the patient alive.Diagnosis:An underlying psychiatric disorder is present in up to 90% of people who completed suicide. Comorbidity with depression, anxiety, substance abuse and personality disorders is high. In order to achieve successful prevention of suicidality, adequate diagnostic procedures and appropriate treatment for the underlying disorder are essential.Treatment:Existing evidence supports the efficacy of pharmacological treatment and cognitive behavioural therapy (CBT) in preventing suicidal behaviour. Some other psychological treatments are promising, but the supporting evidence is currently insufficient. Studies show that antidepressant treatment decreases the risk for suicidality among depressed patients. However, the risk of suicidal behaviour in depressed patients treated with antidepressants exists during the first 10–14 days of treatment, which requires careful monitoring. Short-term supplementary medication with anxiolytics and hypnotics in the case of anxiety and insomnia is recommended. Treatment with antidepressants of children and adolescents should only be given under supervision of a specialist. Long-term treatment with lithium has been shown to be effective in preventing both suicide and attempted suicide in patients with unipolar and bipolar depression. Treatment with clozapine is effective in reducing suicidal behaviour in patients with schizophrenia. Other atypical antipsychotics are promising but more evidence is required.Treatment team:Multidisciplinary treatment teams including psychiatrist and other professionals such as psychologist, social worker, and occupational therapist are always preferable, as integration of pharmacological, psychological and social rehabilitation is recommended especially for patients with chronic suicidality.Family:The suicidal person independently of age should always be motivated to involve family in the treatment.Social support:Psychosocial treatment and support is recommended, as the majority of suicidal patients have problems with relationships, work, school and lack functioning social networks.Safety:A secure home, public and hospital environment, without access to suicidal means is a necessary strategy in suicide prevention. Each treatment option, prescription of medication and discharge of the patient from hospital should be carefully evaluated against the involved risks.Training of personnel:Training of general practitioners (GPs) is effective in the prevention of suicide. It improves treatment of depression and anxiety, quality of the provided care and attitudes towards suicide. Continuous training including discussions about ethical and legal issues is necessary for psychiatrists and other mental health professionals.

Background: Self-harm and suicide in children and adolescents are of serious consequence and increase during the adolescent years. Consequently, there is need for interventions that prevent such behaviour. The objective of this paper: to evaluate the effects of interventions preventing self-harm and suicide in children and adolescents in an overview of systematic reviews. Methods: We conducted a review of systematic reviews (OoO). We included reviews evaluating any preventive or therapeutic intervention. The quality of the included reviews was assessed independently, and data was extracted by two reviewers. We report the review findings descriptively. The certainty of the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Moderate certainty evidence suggests that school-based interventions prevent suicidal ideation and attempts short term, and possibly with long term effects on suicide attempts. The effects of community-based interventions following suicide clusters and local suicide plans are uncertain, as are the benefits and harms of screening young people for suicide risk. The effects of most interventions targeting children and adolescents with known self-harm are uncertain. However, low certainty evidence suggests that dialectical behavioural therapy and developmental group therapy are equally as effective on repetition of self-harm as enhanced treatment as usual. Conclusions: Research on several recommended practices, such as local suicide plans, prevention of suicide clusters and approaches to risk assessment, is lacking. When implemented, these interventions should be closely evaluated. There also is need for more research on treatment for repeated self-harm, including long term follow-up, and in general: possible harmful effects. Policy makers and health providers should consider evidence from population-based studies and adults in preventing self-harm and suicide in children and adolescents. Also, approaches showing promise in treatment of conditions associated with self-harm and/or suicidality, such as depression and psychosis, should be considered. PROSPERO registration: CRD42019117942 08/02/19.

Depression, no matter how it is categorized, is the most common psychiatric disorder in patients who attempt suicide. However, there are conflicting views about the nature, extent and significance of depression in this group. Further-more, there is minimal information available concerning the short term course of depression following attempted suicide and therefore the optimal clinical management of depressed suicidal patients. These patients carry a high risk for repeated attempted suicide or suicide. The study aimed to provide a detailed analysis of several conceptualizations of depression in adults who have attempted suicide and to examine short-term changes in mood state following the suicide attempt. It further aimed to identify predictors of depression one week following attempted suicide, with a view to assisting clinicians in the initial identification of patients who could be at risk for ongoing suicidal behaviour. To achieve these aims a three year multi-phasic study was designed, utilizing a range of measures of depression. Initially, the extent of the problem of attempted suicide at the Royal Adelaide Hospital was established and then, according to self-report measures of depression, the frequency and type of depression in the patients who had attempted suicide was defined. Having identified a cohort of suicidal patients with a depressive disorder, aspects of depression were characterized in depth, using self-report and observer rating scales and a structured clinical interview, which enabled quantification of depression severity, category, diagnosis and symptoms. A sub-group of this cohort was followed up at one week, with a detailed examination of all measures of depression. As well, socio-demographic, clinical history and mental state variables that predicted the presence of depression at one week were identified in this group. Depression screening of 437 patients demonstrated a high rate of depression in this group, independent of age and sex. A substantial number had features of an endogenous type depressive disorder, and only a small percentage was classified as not depressed. The detailed study of 201 subjects revealed a significant level of psychopathology, with more than half categorized as endogenous type depression and just less than half with a DSM-III Affective Disorder. Over one week, in 128 subjects, there was a significant reduction in all measures of depression. This was however less evident in the group categorized with an endogenous type depression. This finding was independent of age but some sex differences were identified. Significant changes were observed in all DSM-III categories and all depressive symptoms. The observed reductions in depression over one week adds support to the notion of attempted suicide having a cathartic therapeutic effect in a number of suicidal individuals. A logistic regression analysis enabled identification of a number of socio-demographic and clinical variables at initial assessment that predicted persistent depression at one week. These included female sex, being single/widowed/divorced, a history of previous depression, absence of acute psycho-social stressors, use of prescribed medication, a non-overdose method of suicide attempt, high level of hopelessness, the presence of personality disorder, recurrent thoughts of suicide, decreased appetite, the presence of excessive / inappropriate guilt, presence of early morning wakening and decrease in sexual drive. The findings of this large study make a substantial contribution to our understanding of the phenomenology of depression in suicidal patients and the short-term course of depression following the suicidal crisis. Furthermore, the unique study design enabled identification of predictors of persistent depression in this vulnerable group, which could provide valuable assistance to clinicians engaged in the initial assessment of suicidal patients in emergency departments. Clinicians should be alert to the presence of these high-risk characteristics when assessing all suicidal patients, and make every effort to ensure that such patients receive immediate and adequate psychiatric follow-up. A replication of findings and extension of this study could result in the development of a useful clinical protocol that could assist clinicians with the immediate assessment and short-term management of the vast number of suicidal patients presenting to hospitals in Australia. Several elements of this study of the association between depression and attempted suicide contributed to its uniqueness. The study was multi-phasic, moving from a broad to narrow focus on depression; it utilized multiple measures to define depression; and it incorporated a measure of “endogenicity”, that proved to be useful in identifying a sub-group of patients with characteristic biological features and a relatively stable mood state. The focus on short-term changes in depression was central to the study, as was the attempt to identify the pre- and post-suicidal mood condition of subjects. As far as I have determined from the literature review, the identification of predictors of persistent depression has not been reported by other researchers. Furthermore, the follow-up cohort of 128 patients was large when compared with all of the follow-up studies published to date. One of the greatest challenges for clinicians in assessing attempted suicide patients is the identification of patients at risk of further suicidal behaviour, either a repeat suicide attempt or suicide. The study findings could assist with the development and formulation of early intervention strategies, aimed at reducing the morbidity and mortality of this vulnerable group of patients.
Thesis (M.D.) -- University of Adelaide, School of Medicine, 2012

Increased risk of harm to self and others occurs in sev­eral mental disorders, and the prediction and assess­ment of risk has become an important component of psychiatric practice. Fatal self- harm— or suicide— is the most important risk to assess. At least a brief assessment of suicidal risk should be included in all psychiatric assessments. However, harm to others— both homicide and non- fatal harm— is increased in some mental disorders, and a thorough assessment of the nature, severity, and likeli­hood of such risks will often form an important part of a psychiatric assessment. When assessing risk, it is useful to consider static and dynamic risk factors. Static risk factors cannot be changed, whereas dynamic risk fac­tors change over time and include mental disorder. Generally, the assessment of risk should include: … ● the nature of the risk; ● the probability of the risk in the short and longer term; ● whether there are any factors that increase the risk; ● whether there are any factors that decrease the risk; ● whether there are any interventions that may reduce the risk. … A risk management plan will aim to: … ● reduce the risk; ● review the risk. … Often, the most appropriate intervention to reduce risk will be to ensure that the patient is offered the most effective treatment for their specific condition. For example, a depressed person with suicidal idea­tion may be offered a low- toxicity antidepressant and regular follow- up. On the other hand, the management of a new mother with a postpartum psychotic depres­sive disorder who has thoughts of harming her new child may involve specific intervention to reduce the risk of harm to her baby as well as effective therapy for the depressive disorder. Many patients deliberately take drug overdoses or harm themselves in other ways. Some die (suicide, completed suicide); others survive (attempted suicide, parasuicide, or deliberate self- harm). The characteris­tics of those who kill themselves and those who harm themselves are rather different, although they overlap.