Cognitive style and pleasant activities among female adolescent suicide attempters.

Cognitive style and pleasant activities of 77 suicide-attempting female minority adolescents were compared with those of 2 groups of non-suicide-attempting female minority adolescents, 39 who were psychiatrically disturbed and 23 who were nondisturbed. Suicide attempters differed from other groups, even when depression and IQ were statistically controlled. They reported significantly fewer alternatives for solving interpersonal problems, were significantly more focused on problems, and were more likely to report a wishful thinking style of coping in stressful situations than were members of the nondisturbed comparison group. Across groups, depression was associated with significantly more dysfunctional attributions. Interpersonal problem-solving ability and attributional style best distinguished the suicide attempters. Results suggest using different cognitive–behavioral interventions with depressed and nondepressed minority female adolescent suicide attempters. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impairment in risk-sensitive decision-making in older suicide attempters with depression.

Suicidal behavior is a potentially lethal complication of late-life depression. In younger adults, suicide has been linked to abnormal decision-making ability. Given that there are substantial age-related decreases in decision-making ability, and that older adults experience environmental stressors that require effective decision-making, we reasoned that impaired decision-making may be particularly relevant to suicidal behavior in the elderly. We thus compared performance on a probabilistic decision-making task that does not involve working memory (“Cambridge Gamble Task”) in four groups of older adults: (1) individuals with major depression and a history of suicide attempt (n = 25), (2) individuals with major depression with active suicidal ideation but no suicide attempt (n = 13), (3) individuals with major depression without suicidality (n = 35), and (4) nondepressed control subjects (n = 22). There was a significant effect of group on quality of decision-making, whereby the suicide attempters exhibited poorer ability to choose the likely outcome, compared with the nonsuicidal depressed and nondepressed comparison subjects. There were no group differences in betting behavior. The suicide attempters differed in several aspects of social problem-solving on a self-report scale. Quality of decision-making was negatively correlated with the score on the impulsive/careless problem-solving subscale. These data suggest that older suicide attempters have a deficit in risk-sensitive decision-making, extending observations in younger adults. More specifically, older suicide attempters seem to neglect outcome probability and make poor choices. These impairments may precipitate and perpetuate suicidal crisis in depressed elders. Identification of decision-making impairment in suicidal elders may help with designing effective interventions. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychiatric diagnoses of previous suicide attempters, first-time attempters, and repeat attempters on an adolescent inpatient psychiatry unit

OBJECTIVE: To compare psychiatric diagnoses of hospitalized adolescents who (a) have made previous but no recent suicide attempts, (b) have recently made their first suicide attempt, (c) have recently made a second or subsequent attempt, or (d) have never made an attempt. METHOD: Semistructured psychiatric diagnostic interviews were used to determine psychiatric diagnoses and history of recent and previous suicidal behavior of 269 consecutively admitted adolescents to an inpatient psychiatric facility. Forty-nine previously suicidal youths, 28 first-time attempters, and 33 repeat attempters were compared with 159 nonsuicidal youths in prevalence of Axis I psychiatric disorders and psychiatric comorbidity with affective disorder. RESULTS: Previous attempters and repeat attempters both reported more affective disorders, whereas first-time attempters reported more adjustment disorders than nonsuicidal youths. Previous attempters and nonsuicidal youths reported the most externalizing disorders. CONCLUSIONS: Previous attempters on an inpatient unit have multiple psychiatric problems. Like repeat attempters, they often are depressed, but like nonsuicidal youths, they also exhibit significant externalizing behaviors. Interventions with these adolescents should focus not only on immediate presenting problems, but also on ameliorating their long-term risk of posthospitalization suicidal behavior.     

Diagnostic utility of video EEG monitoring in paroxysmal events

A total of 89 suicide attempters were diagnosed according to the DSM-III-R, and categorized according to suicide method as 'violent' and 'non-violent' attempters, and also as those who had made previous suicide attempts ('repeaters') and those who had not ('non-repeaters'). All of the subjects completed the MNT questionnaire. Our hypothesis was that the temperament patterns would reflect specific clinical characteristics, such as psychiatric diagnoses and type of suicidal behaviour. The 'validity' (ranging from fatiguableness to a high level of psychic energy) showed a bimodal distribution, suggesting the existence of two subgroups. The subjects with adjustment disorders displayed a significantly higher mean validity than the other patients. The lowest validity scores were found in subjects with bipolar depression. Men showed significantly higher 'stability' (reflecting emotional distance from others) than women. Subjects with major depression and those who were 'violent' suicide attempters showed somewhat higher 'solidity' (unchangeability, non-impulsiveness) compared with the other groups. Female 'non-repeaters' displayed significantly lower solidity than males or other females. In general, no clear temperament patterns were detected in patients categorized according to type of suicidal behaviour. In contrast to the findings of studies of normal populations, the intercorrelations between the dimensions were considerable, especially among the men. This prompted us to perform a cluster analysis procedure in which the subjects were allocated to five clusters according to the MNT dimensions. No distinct clinical characteristics appeared in these clusters, except in the cluster with the highest validity and the lowest stability, as 54% (P = 0.014) of the patients in this cluster had an adjustment disorder diagnosis. These temperament results reflect the clinical heterogeneity of patients who attempt suicide.     

Toward a clinical model of suicidal behavior in psychiatric patients

OBJECTIVE: Risk factors for suicide attempts have rarely been studied comprehensively in more than one psychiatric disorder, preventing estimation of the relative importance and the generalizability of different putative risk factors across psychiatric diagnoses. The authors conducted a study of suicide attempts in patients with mood disorders, psychoses, and other diagnoses. Their goal was to determine the generalizability and relative importance of risk factors for suicidal acts across diagnostic boundaries and to develop a hypothetical, explanatory, and predictive model of suicidal behavior that can subsequently be tested in a prospective study. METHOD: Following admission to a university psychiatric hospital, 347 consecutive patients who were 14-72 years old (51% were male and 68% were Caucasian) were recruited for study. Structured clinical interviews generated axis I and axis II diagnoses. Lifetime suicidal acts, traits of aggression and impulsivity, objective and subjective severity of acute psychopathology, developmental and family history, and past substance abuse or alcoholism were assessed. RESULTS: Objective severity of current depression or psychosis did not distinguish the 184 patients who had attempted suicide from those who had never attempted suicide. However, higher scores on subjective depression, higher scores on suicidal ideation, and fewer reasons for living were reported by suicide attempters. Rates of lifetime aggression and impulsivity were also greater in attempters. Comorbid borderline personality disorder, smoking, past substance use disorder or alcoholism, family history of suicidal acts, head injury, and childhood abuse history were more frequent in suicide attempters. CONCLUSIONS: The authors propose a stress-diathesis model in which the risk for suicidal acts is determined not merely by a psychiatric illness (the stressor) but also by a diathesis. This diathesis may be reflected in tendencies to experience more suicidal ideation and to be more impulsive and, therefore, more likely to act on suicidal feelings. Prospective studies are proposed to test this model.     

Suicide attempts in a cohort of drug abusers: a 5-year follow-up study

A group of 125 drug abusers admitted consecutively for detoxification and short-term rehabilitation were followed up 5 years after discharge. They were asked about possible suicide attempts in a semi-structured face-to-face interview. Nearly half of the group (45%) reported having attempted suicide at some point in their life. The most common reasons given were the loss of a person whom they loved, and feelings of loneliness. Only three respondents reported using their drug of choice in the attempt(s). The suicide attempters were more often found to have been in child psychiatric treatment earlier, and to have experienced loss of significant others in childhood, than those who did not report attempting suicide. At follow-up the suicide attempters indicated that they experienced more depressive moods and more severe psychological problems than those who had never made a suicide attempt. The importance of assessing the risk of suicide attempts among drug addicts in order to be able to take measures to prevent future suicidal behaviour is emphasized.     

Isolation and characterization of microsatellite markers in the nuclear genome of the brown alga Laminaria digitata (Phaeophyceae)

OBJECTIVE: The authors' goal was to investigate the treatment received by suicide attempters with major depression before and after the index attempt. METHOD: Forty-three patients with current unipolar DSM-III-R major depression were identified in a diagnostic study from a systematic sample of suicide attempters in Helsinki. All were comprehensively interviewed and investigated after the attempt, and their treatment was ascertained from psychiatric and other health care records and follow-up interviews. RESULTS: During the month just before the suicide attempt, seven (16%) of the patients had received antidepressants in adequate doses, seven had received weekly psychotherapy, and none had received ECT. Although almost all of the patients complied with the recommended aftercare following the suicide attempt, after 1 month only seven (17%) were receiving antidepressants in adequate doses, nine (22%) were receiving weekly psychotherapy, and none had been given ECT. CONCLUSIONS: It seems that few suicide attempters with major depression receive adequate treatment for depression before the suicide attempt and that, despite their well-known high risk for suicide, the treatment situation is not necessarily any better after the attempt. These findings suggest that the recognition of depression and the quality of treatment received for major depression among suicide attempters should be investigated and improved to prevent suicide.     

Adolescent psychopathology: II. Psychosocial risk factors for depression.

In a prospective study of adolescent depression, adolescents (N?=?1,508) were assessed at Time 1 and after 1 yr (Time 2) on psychosocial variables hypothesized to be associated with depression. Most psychosocial variables were associated with current (n?=?45) depression. Formerly depressed adolescents (n?=?217) continued to differ from never depressed controls on many of the psychosocial variables. Many of the depression-related measures also acted as risk factors for future depression (n?=?112), especially past depression, current other mental disorders, past suicide attempt, internalizing behavior problems, and physical symptoms. Young women were more likely to be, to become, and to have been depressed. Controlling for the psychosocial variables eliminated the gender difference for current and future but not for past depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hopelessness, impulsiveness and intent among suicide attempters with major depression, alcohol dependence, or both

The present study examined differences in hopelessness, impulsiveness and suicide intent between suicide attempters with either major depression or alcohol dependence, comorbid major depression and alcohol dependence, and those without these disorders. A sample of 114 patients from consecutive cases of attempted suicide referred to a general hospital in Helsinki was interviewed and diagnosed according to DSM-III-R. Suicide intent was measured by the Beck Suicide Intent Scale (SIS) and hopelessness was assessed by the Beck Hopelessness Scale (HS). Impulsiveness of the suicide attempt was measured by two items of the SIS. Suicide attempters with major depression without comorbid alcohol dependence had higher suicide intent and lower impulsiveness than attempters with non-depressive alcohol dependence. Suicide attempts may differ between subjects with major depression, alcoholism or both disorders in terms of impulsiveness and suicide intent.     

The measurement of pessimism: The Hopelessness Scale.

Administered a scale designed to quantify hopelessness to 294 hospitalized suicide attempters, 23 general medical outpatients, 62 additional hospitalized suicide attempters, and 59 depressed psychiatric patients. The scale had a Kuder-Richardson-20 internal consistency coefficient of .93 and correlated well with the Stuart Future Test (SFT) and the pessimism item of the Beck Depression Inventory (BDI; .60 and .63, respectively). The scale was also sensitive to changes in the patient's state of depression over time, as evidenced by a correlation of .49 with change scores on the SFT and .49 with the change scores on the BDI. Findings also indicate that depressed patients have an unrealistically negative attitude toward the future and that seriousness of suicidal intent is more highly correlated with negative expectancies than with depression. A principal-components factor analysis revealed 3 factors which tapped affective, motivational, and cognitive aspects of hopelessness. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lipid effects of an intrauterine levonorgestrel device or oral vs. vaginal natural progesterone in post-menopausal women treated with percutaneous estradiol

The clinical characteristics of 191 adolescent inpatients were examined in relation to frequency of previous suicide attempts, predictors of suicide attempts prior to hospitalization, and lifetime suicide attempts. Overall, more than 50% of the adolescent inpatients had attempted suicide during their lifetime, and of these more than half (58%) had made more than one attempt. Approximately half of the suicide attempters had made a serious attempt prior to hospitalization. Girls reported higher levels of depressive symptoms and suicidal ideation than boys, in addition to having attempted suicide prior to hospitalization (33%) or during lifetime (37%) more often than the boys (13% and 26%, respectively). Although about two thirds of the adolescent inpatients reported that they had received some help after a suicide attempt, approximately half of the repeaters had not received any help. The results of multivariate analyses showed that suicide attempts made prior to hospitalization were predicted by depressive symptom levels and a clinical diagnosis of depressive disorder, whereas frequency of lifetime suicide attempts was predicted by suicidal ideation levels and having a family member or a friend who had attempted (or committed) suicide. The high prevalence of lifetime and repeated suicide attempts among the psychiatric inpatients underscores the importance of identifying risk factors in the clinical evaluation of adolescent suicide attempters.     

Psychological and social indicators of suicide ideation and suicide attempts in Zuni adolescents.

Suicide behavior is a significant problem for many American Indian populations, often more so than in the general population, but little tribal-specific data is available. In this study, baseline data on the correlates of suicide ideation and the social and psychological differences between suicide attempters and nonattempters were collected on a sample of 84 Zuni adolescents. Results show significant correlations between a measure of suicide ideation and past suicide attempt behavior, drug use, depression, hopelessness, stress, psychological symptomatology, social support, liking for school, and interpersonal communication. Significant differences between the 30% of the students who reported having previously attempted suicide and the nonattempters were also found on these measures. Areas for education and prevention efforts are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social problem solving in suicidal adolescents.

Whether adolescent suicide attempters would have deficits in interpersonal problem solving and the relation between social problem solving, suicide intent, and medical lethality were evaluated. Compared with psychiatric and normal controls, adolescents who attempted suicide exhibited poorer social problem-solving abilities, particularly in terms of problem orientation. Specifically, suicide attempters brought more maladaptive cognitive-emotional-behavioral response sets to problematic situations than did psychiatric and normal controls. Both suicide attempters and psychiatric controls had similar deficits in problem-solving skills (e.g., generation of alternatives, decision making, and solution implementation) compared with nonhospitalized peers. Social problem solving was not found to be correlated with suicide lethality or intent. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Microanalysis of adolescent suicide attempters and ideators during the acute suicidal episode

OBJECTIVE: To compare psychological and event-related contingencies that characterize and differentiate adolescent suicidal ideation and attempts. METHOD: Thirty-five ideators and 32 attempters (aged 12 to 17 years) consecutively referred to the suicide disorders clinic were evaluated with a semistructured interview about current and past emotional, cognitive, and behavioral states. RESULTS: Before the precipitant stressor (baseline), attempters reported significantly more hopelessness than ideators (odds ratio [OR] = 4.2, p < .05). During the suicidal episode, attempters, relative to ideators, spent more time ideating (OR = 4.3, p < .05), were more likely to isolate themselves (OR = 5.8, p < .01), and were less likely to tell anyone what they were thinking (OR = 4.5, p < .05). In contrast, ideators reported significantly more residual anger after the episode than did attempters (OR = 4.0, p < .05). All the episodes of ideation and attempts were preceded by a stress event. No differences were found between the groups on Beck Depression inventory scores. CONCLUSIONS: Preexisting hopelessness, a tendency toward isolation, not talking about ideation, and longer length of time ideating during suicidal episodes discriminated suicide attempters from suicide ideators. Knowledge of these factors may be helpful in preventive and treatment efforts with suicidal adolescents.     

Clinical comparison of Black and White suicide attempters.

Compared clinical characteristics of Black and White suicide attempters. The sample consisted of virtually all (N?=?275) attempters aged 16 yrs and older brought to the Emergency Unit of the Yale-New Haven Hospital over a 1-yr period (1971–1972). Clinical ratings were made by on-duty resident psychiatrists using 42 variables dealing with mood, motivation, etc. Statistical analysis revealed few differences in Black and White profiles, a result contrary to theories asserting that Black psychology requires different principles from that of White psychology. A related incidental finding was that the frequency of suicide attempts appeared to be about the same among Blacks and Whites, which discredits the widely held belief that suicide is not an important psychiatric problem among Blacks. Rating areas in which the 2 groups did differ somewhat included extent of motivation to influence others, feelings of depression (hopelessness), and deliberateness of planning the attempt. In each of these areas, White attempters had higher scores. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric history and symptom differences in black and white depressed patients.

Compared 159 black psychiatric patients with 555 white patients on a battery of social, personality, and psychiatric history variables, as well as presenting symptoms. In making these comparisons, race differences in age, social class status, and sex were controlled. Both black and white depressed patients were remarkably similar on presenting symptoms, especially the core symptoms of depression, when the groups were equated or controlled for age and social class differences. However, some differences did emerge on a number of hostility variables. There was a greater tendency toward negativism and the introjection of anger in blacks than in whites. In addition, depressed black males indicated that they were more likely than their white counterparts to strike back, either verbally or physically, when they felt their rights were being violated. There was also a very high incidence of suicide threats or attempts among the black males. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stable trait components of hopelessness: Baseline and sensitivity to depression.

Hopelessness ( H ) plays an important theoretical and practical role in depression. The authors hypothesized that a patient's H is comprised of (a) a baseline level of H when not depressed and (b) an increment in H related to the severity of depression at the time and the person's rate of increase in H as a function of severity of depression (sensitivity). Baseline and sensitivity are explanatory stable traits; H and depression are observed, time-varying states. The corresponding statistical model described well the longitudinal data of 316 participants. Baseline and sensitivity were uncorrelated and correlated with different clinical and demographic variables. Baseline predicted a future suicide attempt; sensitivity and H when depressed did not. It may be useful to ask "How hopeless is this person when not depressed and how much more hopeless is he or she when depressed?", rather than simply "How hopeless is this depressed person?" (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Metaphor: the language of nursing researchers

BACKGROUND: The present study determines the association of obesity, gender, age and occupation in patients with carpal tunnel syndrome (CTS) in a New Zealand population. METHODS: Analysis of questionnaires and clinical review of patients who had undergone surgical decompression of the median nerve in the carpal tunnel. RESULTS: The age and gender distribution of 655 hands (512 patients) that had undergone carpal tunnel release (CTR) were compared with the age and gender distribution of the New Zealand population. The results indicate that the 3-year-period prevalence of CTS in females is more than double that in males. Proportionally there were more patients over age 55 than in the general population. The findings also indicate that, proportionally, six times the number of females who worked in moderate manual work underwent CTR compared with the general female population and proportionally twice the number of males who worked in heavy office/clerical work underwent CTR compared with the general male population. It was also found that CTR patients are twice as likely to be overweight (body mass index [BMI] > 25) than the general population and female patients are twice as likely to be obese (BMI > 30) than the general population. CONCLUSIONS: Carpal tunnel syndrome is more than twice as common in females as it is in males, and patients aged more than 55 years are more likely to suffer from CTS. Females with CTS are more likely to work in moderate manual work and males with CTS are more likely to work in heavy office/clerical work. Obesity and CTS are related statistically.     

Effects of KT-362, a sarcolemmal and intracellular calcium antagonist, on calcium transients of cultured neonatal rat ventricular cells: a comparison with gallopamil and ryanodine

During the years 1990-92 in the Regional Poisons Control Center in Sosnowiec 42 epileptics (20 females and 22 males) were hospitalized because of suicide attempt. It amounted to 9% of all attempters, treated there in this period. The majority of patients were males of age range from 21 to 62 years. In 23 patients the suicide attempts were performed for the first time. the main reason for suicide was the family conflicted situation. Additionally, in 14 patients the poisoning attempts have been done during alcohol abuse. In the suicide attempts the antiepileptic drugs were most frequently used, mainly carbamazepine (23 cases).     

Cognitive characteristics of suicide attempters.

Contrasted cognitive characteristics of rigidity, impulsivity, and field dependence in a group of 49 19–59 yr old suicide attempters and a group of 48 19–64 yr old nonsuicidal psychiatric controls. All Ss were administered the same test battery consisting of the Embedded Figures Test, the Alternate Uses Test, and the Matching Familiar Figures Test. The suicide attempt group was characterized by greater rigidity in a divergent thinking task while controlling for age and diagnosis using multivariate analysis. Field dependence was more characteristic of the suicide attempters, but only in the 19–34 age group. Impulsivity did not differentiate the 2 groups. The results are interpreted as supporting a hypothesis of a cognitive predisposition to attempting suicide. (1 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)