Completed suicide among adolescents with no diagnosable psychiatric disorder

The characteristics of male adolescent suicide victims with (n = 84) and without (n = 8) a diagnosable psychiatric disorder were compared. Using psychological autopsy methods--interviews with victims' family members and health care professionals, and review of records (e.g., medical, school, police)-data were collected on all adolescent suicides in Finland during a 12-month period. Compared with adolescents with a psychiatric disorder, those with no disorder tended to come from less disturbed families, had shown less antisocial behavior, and had less frequently utilized health care and social services. Adolescents with no disorder more often communicated suicidal thoughts for the first time just before the suicide, and difficulties with the law (discipline problems) were more common precipitants than among those with a disorder. It was concluded that the process leading to suicide seems to be relatively short among male adolescents with no diagnosable psychiatric disorder. Communication of suicidal intent and problems with discipline are among the few clinical warning signs.     

Categories of attempted suicide: a longitudinal study

A series of 151 index suicide attempts was categorized on the basis of situation and motivation: (a) 56 per cent occurred in a state of heightened emotionality due to a relatively limited stress;(b) 9 per cent were characterized by a life crisis which seriously challenged the patient' emotional homeostasis; and (c) 35 per cent attempted suicide in relation to the symptomatology of a pre-existing serious psychiatric disorder. At the time of first contact, usually in the general hospital emergency room, 69 per cent were sent home, the remainder being admitted for medical care (18 per cent) or transferred to a psychiatric hospital (13 per cent). In follow-up ambulatory care, successful referral correlated with the intensity of staff efforts during the early post-attempt contacts. The findings suggest that a brief hospitalization, perhaps two to three days, might be regularly utilized as a bridgehead for further ambulatory care, particularly for stress category patients with a high appointment failure rate. In a two-year follow-up, 16 of the 151 index cases re-attempted and two committed suicide. At the time of the index attempt, 24 (16 per cent) were in ongoing treatment. Among these 24 patients were many substance abusers and prior attempters as well as the two committed suicides of the follow-up period. Ongoing treatment should be weighed as a high risk factor suggesting particular caution in arranging the disposition for such patients.     

Suicidal ideation and behavior and noncompliance with the medical regimen among diabetic adolescents

OBJECTIVE: To examine (1) the 1-year and lifetime prevalence of suicidal thoughts and behavior among adolescents with insulin-dependent diabetes mellitus (IDDM), (2) the relationship between suicidal thoughts and serious noncompliance with the medical regimen, and (3) factors including psychiatric disorder, self-efficacy expectations, and hopelessness that might mediate the relationship between suicidal thoughts and noncompliance. METHOD: Semistructured and structured interview instruments and self-report questionnaires were used to determine history of suicidal thoughts and behavior, serious noncompliance with the medical regimen, current psychiatric disorder, hopelessness, and self-efficacy expectations among 91 adolescents attending outpatient clinic appointments. RESULTS: The rate of suicidal ideation among the diabetic adolescents was higher than expected, but the rate of suicide attempts was comparable with that reported for the general population. Suicidal thoughts were strongly associated with serious noncompliance with the medical regimen. Duration of IDDM and psychiatric diagnosis were related to both suicidal ideation within the previous year and lifetime suicidal ideation. Diagnosable psychiatric disorder and not living in a two-parent home were related to noncompliance with medical treatment. CONCLUSIONS: Suicidal thoughts and serious noncompliance with the medical regimen are strongly associated among diabetic teenagers, and psychiatric disorder is a common correlate of both.     

Test-retest characteristics of a group of attempted suicide patients.

15 male and 36 female patients who had been psychologically tested after having made a suicide attempt were retested in a postal follow-up to ascertain whether significant changes had occurred in their scores on the Neuroticism Scale Questionnaire (NSQ) and Symptom Sign Inventory. Men and women differed significantly in their response to postal retest. It is concluded that while women who responded to retest were representative of all women in the group, men who responded could not be so considered due to the disproportionate number of repeat-prone individuals in this group. These men showed no change in their test scores. Women, overall, did not change on any NSQ variables, although those who were retested quite soon after the original testing showed an increase in tendermindedness. They did show a significant reduction in psychiatric symptomatology, especially where the test-retest interval was longer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Association of childhood parental loss with attempted suicide and depression.

Compared the parental loss of adult depressed inpatient suicide attempters, nonsuicidal depressed patients, and normal controls. Findings suggest that a childhood characterized by intentional parental separation from the child is associated with attempted suicide in adult life, whereas the loss of a parent through natural causes in unrelated to suicide. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attempted suicide among adolescents: A stepwise discriminant analysis.

A sample of 40 adolescents (aged 13–17 yrs), some of whom had attempted suicide (n?=?20) and some who had not (n?=?20), were compared on a number of life history and psychological variables (affective and cognitive). Stepwise discriminant analyses produced 1 discriminant function (the lack of emotional significant other) that differentiated between the groups. This single discriminant function accounted for 77% of the variance in the data. These results are interpreted within the context of the early loss hypothesis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prediction of suicide ideation and attempts among adolescents using a brief performance-based test.

Suicide is a leading cause of death that is difficult to predict because clinical assessment has relied almost exclusively on individuals' self-report of suicidal thoughts. This is problematic because there often is motivation to conceal such thoughts. The authors tested the ability of the Self-Injury Implicit Association Test (SI-IAT), a reaction-time measure of implicit associations between self-injury and oneself, to detect and predict suicide ideation and attempts. Participants were adolescents who were nonsuicidal (n = 38), suicide ideators (n = 37), or recent suicide attempters (n = 14). Analyses revealed large between-group differences on the SI-IAT, with nonsuicidal adolescents showing large negative associations between self-injury and themselves, suicide ideators showing small positive associations, and suicide attempters showing large positive associations on this performance-based test. The SI-IAT accurately predicted current suicide ideation and attempt status as well as future suicide ideation, and it incrementally improved prediction of these outcomes above and beyond the use of known risk factors. Future research is needed to refine this assessment method and to further develop and examine performance-based assessment of suicide risk in clinical settings (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictive and concurrent validity of the Suicidal Ideation Questionnaire among American Indian adolescents

Suicide is currently the second leading cause of death for ages 15-24 years; reports indicate that 6-8% of American teens have attempted suicide. Rates of suicide and suicide attempts are at least as high, if not higher, for American Indian adolescents and young adults. The Suicidal Ideation Questionnaire (Junior High School Version) (SIQ-JR) could be used to identify young people who may be at risk for attempting suicide, since this questionnaire focuses on suicidal ideation, a major risk factor for suicide attempt. However, little is known about the predictive validity of the SIQ-JR, particularly in American Indian adolescent populations. A suicide attempt cluster at an American Indian boarding school provided the unique opportunity to examine the performance of the SIQ-JR in a group of American Indian high school students who had taken the SIQ-JR approximately 2 months prior to the outbreak of attempts. The SIQ-JR proved to be an excellent predictor of future suicide attempts when compared to other measures of distress: anxiety, depression, and alcohol use. The SIQ-JR is an effective screener for suicide risk in this American Indian adolescent population.     

Agreement among teachers'' behavior ratings of adolescents with a childhood history of attention deficit hyperactivity disorder

The ability to continuously deliver osteoinductive proteins to a specific anatomic site would facilitate the treatment of fracture nonunions and other clinical problems associated with bone loss. We have developed a murine model of regional gene therapy. A bone-marrow stromal cell line infected with an adenovirus expressing recombinant bone morphogenetic protein-2 cDNA secreted biologically active bone morphogenetic protein-2. These bone morphogenetic protein-2-producing cells were able to induce abundant heterotopic bone formation when implanted into the quadriceps muscle of severe combined immune deficient mice and also successfully healed large segmental femoral defects in nude rats. These studies demonstrate that regional gene therapy with continuous delivery of osteoinductive factors to a specific anatomic site can enhance the formation and repair of bone.     

Epidemiology of attempted suicide by drug overdose in Vienna

We studied 361 Viennese patients (m = 111, f = 250) admitted to our observation ward after attempted suicide by drug ingestion over a two-year period. Age and sex distribution, social status, time of attempt, motives, and drugs used were documented, as well as the therapeutic management of the cases. The patients were divided into 4 age groups: 57 juveniles, 179 young adults, 80 middle-aged adults and 45 geriatric patients. These groups were compared with each other in manifold respects. Our analysis showed that the geriatric patients who had attempted suicide by drug ingestion differed from those of other groups insofar as there was a lack of exogenous influence with regard to motives and methods. They may represent a separate entity more akin to suicide than to attempted suicide. Vienna data on attempted suicide by drug ingestion did not differ markedly from international data.     

Suicidal hanging or simulated suicide? Once again a case of Kobue: a spectacular case in the history of Japanese legal medicine

Oculocutaneous albinism (OCA) is a heterogeneous groups of autosomal-recessive genetic disorders. The molecular pathogenesis of several types of OCA have been clarified in the ten years since our first report in 1989 on a pathologic mutation of the tyrosinase gene. In this article, a new classification of OCA based on genetic evidence is briefly reviewed, and our study on Japanese patients with tyrosinase-negative OCA is summarized.     

Classification of attempted suicide: a review of empirical studies, 1963-1993

A review was carried out on empirical studies on the classification of attempted suicide over the period 1963-1993. Our aim was to investigate whether there is research evidence for a valid classification of homogeneous subgroups of suicide attempters. After assessment of the research quality, 32 studies were selected for comparison. Although there is lack of consistency among the studies, indications were found for two clearly distinguished subgroups characterized by mild and severe suicide attempts, which constitute the opposite poles of a one-dimensional concept of severity.     

Dimensions of perfectionism, hopelessness, and attempted suicide in a sample of alcoholics

The question is addressed as to whether cognitive-behavior treatment delivered as a routine service in a specialist clinic is effective in the long term. Of 124 consecutive patients completing treatment for panic disorder or social phobia, 93 were assessed an average of 2 years following treatment. The treatment produced significant improvement in measures of symptoms, avoidance, and disablement during treatment and further significant improvement during the follow-up. A quarter of participants no longer met diagnostic criteria, had not sought further treatment, and their anxiety had not troubled them since treatment. These findings, although not showing the large treatment effects reported from controlled outcome research, support the effectiveness of cognitive-behavioral interventions in routine care.     

Personality differences in attempted suicide versus suicide in adults 50 years of age or older.

The authors tested hypotheses concerning personality differences in treatment-seeking suicide attempters (AT; n = 60) and a community sample of suicides (SU; n = 43) over age 50. On the basis of prior research, the authors hypothesized that SU would be lower in Neuroticism and Openness and higher in Conscientiousness. A 2-group (AT vs. SU) multivariate analysis of covariance with NEO Personality Inventory--Revised (Informant Version) domain scores as dependent variables revealed that SU were lower in Neuroticism and higher in Conscientiousness. The authors conclude that AT and SU in this age group can be distinguished on the basis of informant ratings of personality traits. These differences can inform risk detection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Suicidal desire and the capability for suicide: Tests of the interpersonal-psychological theory of suicidal behavior among adults.

The interpersonal-psychological theory of suicidal behavior (T. E. Joiner, 2005) proposes that an individual will not die by suicide unless he or she has both the desire to die by suicide and the ability to do so. Three studies test the theory's hypotheses. In Study 1, the interaction of thwarted belongingness and perceived burdensomeness predicted current suicidal ideation. In Study 2, greater levels of acquired capability were found among individuals with greater numbers of past attempts. Results also indicated that painful and provocative experiences significantly predicted acquired capability scores. In Study 3, the interaction of acquired capability and perceived burdensomeness predicted clinician-rated risk for suicidal behavior. Implications for the etiology, assessment, and treatment of suicidal behavior are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)