Background: Suicidal behaviour devastates families, communities, and societies, as well as the millions of individuals who survive suicide attempts. This thesis addresses an urgent need to develop new treatment and intervention strategies for millions of at-risk people by exploring potential metabolic risk factors of suicidal behaviour. Methods: A systematic review and meta-analysis was performed to assess the association between BMI and suicidal behaviour. We explored the association between attempted suicide and various metabolic factors and health behaviours using data from the Determinants of Suicide Conventional and Emergent Risk (DISCOVER) study. DISCOVER is an age and sex matched case-control study comparing adult psychiatric inpatients who had made a recent suicide attempt (n=84) to psychiatric inpatients (n=104) and community members (n=93) who have never attempted suicide. The following potential risk factors were assessed using logistic regression analyses: BMI, waist-circumference, serum total cholesterol, physical activity, tobacco use, and dietary food groups. Results: The systematic review included 38 studies. A meta-analysis established an inverse association between BMI and completed suicide, whereby being underweight is associated with the greatest risk of suicide and being obese or overweight is associated with a deceased risk of suicide relative to normal weight. Evidence for an association between BMI and attempted suicide remains equivocal. The review suggests no association between BMI and suicidal ideation. Analysis of DISCOVER data demonstrated that even a small amount of regular physical activity is significantly associated with decreased risk of attempted suicide. Tobacco use was associated with an increased risk of attempted suicide. Contrary to prior research, obesity, serum-total cholesterol, and diet were not found to be significant risk factors. Conclusion: BMI is inversely related to completed suicide. Obese individuals may be more likely to choose less lethal methods of suicide or may be less susceptible to fatal overdose or self-poisonings. Clinicians should monitor underweight patients for increased risk of suicide. Contrary to prior research, serum total cholesterol, BMI, and waist-circumference were not significantly associated with risk of attempted suicide. Increased physical activity was associated with a decreased risk of attempted suicide, and tobacco use was associated with an increased risk of attempted suicide. While people at risk of attempting suicide tend to use more tobacco products and exercise less than non-suicidal community members, so do non-suicidal psychiatric patients. For this reason, it remains unclear whether smoking habits represent a useful clinical predictor of suicide risk. / Thesis / Master of Science (MSc)

No description available.

Evidence is mixed regarding an independent association between anxiety and suicidality. Beyond associations with demographic factors and depression, do anxiety disorders increase risk for suicidality in youth? Given that not all anxiety-disordered youth experience suicidal ideation, potential predictors of risk also require investigation. The present study examined (a) the independent relationship between anxiety and suicidal ideation and (b) comorbid depressive disorders, emotion dysregulation, and distress intolerance as predictors of risk for suicidal ideation in a sample of anxiety-disordered youth aged 7-17 (N = 86, M = 11.5). Youth and parents reported on suicidality, comorbid depressive disorders, emotion dysregulation, and distress intolerance. Distress tolerance was further measured by a computerized behavioral task. Results supported an independent relationship between anxiety symptomatology and youth-reported suicidal ideation, controlling for depressive symptoms. Youth self-report of emotion dysregulation and distress intolerance predicted higher levels of suicidal ideation in univariate analyses. In a multivariate analysis including all significant predictors, only anxiety symptomatology uniquely predicted suicidal ideation. Results are discussed in terms of implications for assessment and treatment in anxiety-disordered youth. Suggestions for future research investigating the relationship between anxiety and suicidal ideation in youth are offered. / Psychology

The three-step theory of suicide (3ST) proposes that suicidal ideation (SI) and behavior develops in the context of unbearable pain and hopelessness (Step 1), low social connection (Step 2) and acquired capability (Step 3 - not assessed in this study; Klonsky et al., 2016). Distress disclosure is one way a person may utilize their social network to mitigate feelings of distress and can be a critical measure of social connectedness. Building on efforts to diversify measurement of social connectedness in the 3ST, a sample of 549 college students (mean age = 19.27, SD = 1.28; 56.6% reporting history of SI) completed measures of physical and psychological pain (Patient Health Questionnaire – Revised; Unbearable Psychache Scale-3), hopelessness (State Hopelessness Scale; Beck Hopelessness Scale-4), social connectedness (Interpersonal Needs Questionnaire; Social Connectedness Scale – Revised; Distress Disclosure Index), and suicidal ideation (Depression Severity Index; Suicide Cognitions Scale – Shortened). Structural equation modeling was used to evaluate steps one and two of the 3ST and the utility of incorporating distress disclosure into this framework. In line with the 3ST, the structural model including pain, hopelessness, and social connectedness was supported and the direct effects of these variables on SI was significant (p < .05). In contrast to the 3ST, the interaction between pain and hopelessness did not predict SI (p = .385), nor was the moderating role of social connectedness supported (p = .133). Although distress disclosure was a significant indicator of social connectedness (p = .001), this variable did not contribute additional variance over other measures of connectedness. The results provide partial support for core features of the 3ST, however further research is needed to verify the theoretical assumptions of Step 2. Additionally, although disclosure is associated with SI, it may not be a critical measure of social connectedness when considered alongside traditional measures.

Researchers have previously identified substance use and borderline personality disorder as factors that increase risk for suicidal thoughts and behaviors. This study explored the relationship between these factors in samples of students and individuals seeking outpatient treatment. Supplemental data collected via the internet (MTurk) also looked at experiential avoidance (EA) with the Avoidance and Fusion Questionnaire for Youth. The Structured Clinical Interview for the DSM-IV, Alcohol Use Disorders Identification Test, Scale for Suicide Ideation, and Personality Assessment Inventory- Borderline Features Scale elicited information regarding severity and/or frequency of substance use, suicidal thoughts, and borderline features respectively. Additionally, the Psychiatric Diagnostic Screening Questionnaire was administered to the UNT sample. The UNT sample analyses indicate substance use moderates, strengthening, the relationship between borderline features and current suicidal thoughts. However, severity of suicidal thoughts was lower for individuals high in both borderline features and substance use disorder symptoms compared to those low in borderline features and high in substance use symptoms. The MTurk sample analyses suggest substance use functions as a mediator. A robust relationship existed between substance use severity and EA, showing substance use as a behavioral marker for EA. In conclusion, concurrent treatment of substance use and borderline personality features would be beneficial in reducing risk for suicidal thoughts. Further investigation into the role and utility of addressing EA is warranted.

Thesis (M.A.)--University of the Witwatersrand, Faculty of Humanities, 1991. / This study examines factors associated with attempted suicide during adolescence. The sample consists of 10 Black adolescent girls who atempted suicide in the past year, and were admitted to Baragwanath Hospital. Each subject was questioned on demographic information and completed the Separation Anxiety Test (Hansburg, 1972) and Section 1 of the Inventory of Parent and Peer Attachment (Armsden and Greenberg, 1987), which assesses attachment to a parent. Subjects were also required to answer questions on their choice of responses. Common trends were found to exist among adolescent girls who attempt suicide. Adolescent girls who attempt suicide have disruptive home environments where parents experience marital problems. They show a low degree of attachment, high degree of hostility, stress avoidance during the stage of identity crisis, and they maintain a poor attachment-individuation balance. These findings suggest that the most common treatment strategy, ie. crisis intervention is not sufficient as it does not deal with underlying problems of adolescent suicide.

Introdução: Ideação suicida e tentativas de suicídio são geralmente complicações dos transtornos psiquiátricos. O estudo da freqüência e fatores associados podem contribuir para uma abordagem mais adequada por profissionais de saúde mental. Objetivos: Estimar a prevalência de tentativas e pensamentos suicidas, em pessoas com transtornos mentais graves (TMG) e as associações com características sócio-demograficas, diagnóstico, ajustamento social, sintomas psiquiátricos, uso de substâncias psicoativas, envolvimento familiar e tratamentos realizados. Método: Foram entrevistados e avaliados 192 pessoas que apresentavam TMG, com idade entre 18 e 65 anos e que tiveram contato com os serviços de saúde mental de três regiões definidas do município de São Paulo em período determinado. Utilizou-se anamneses estruturadas com questionários padronizados e escalas psicométricas. As entrevistas foram realizadas no domicílio do paciente. Realizou-se análise descritiva, análise univariada e análise multivariada. Resultados: Da amostra estudada predominaram as pessoas do sexo masculino (53,1%), solteiras (57,3%), com diagnóstico de esquizofrenia (58,3%). Poucas pessoas apresentavam abuso ou dependência de álcool (7,3%) e apenas três pessoas (1,6%) não utilizaram medicações psiquiátricas no período de um ano anterior à entrevista. Cento e nove (57,7%) entrevistados apresentaram pensamentos suicidas ao longo da vida e nos 12 meses anteriores a entrevista, trinta e oito (20,1%) tiveram tais pensamentos. Cinqüenta e nove (30,9%) pessoas já haviam tentado suicídio durante a vida e oito (4,2%) apresentaram tentativas nos 12 meses anteriores à entrevista. Para todas as variáveis de desfecho, apresentaram associação estatística, a presença de sentimentos de culpa e sintomas depressivos. Na análise multivariada, o uso de neurolépticos apresentou associação com pensamentos e tentativas de suicídio ao longo da vida. Conclusão: Ideação e tentativas de suicídio foram bastante prevalentes na população estudada devendo sempre ser investigadas pelos profissionais de saúde mental, para que se possa tomar as devidas condutas, como o manejo dos sentimentos de culpa e depressão, além do ajuste correto da medicação para o transtorno mental. / Introduction: Suicidal ideation and suicidal attempts are usually complications of psychiatric disorders. The study of the frequency and associated factors may contribute for the mental health professionals to have a more appropriate approach. Aims: Estimate the prevalence of attempts and suicidal thoughts, in people who have serious mental disorder (SMD) and the association with social-demographic characteristics, diagnosis, social adjustment, psychiatric symptoms, use of psychoactive substances, family involvement and treatments they have gone though. Method: One hundred ninety two subjects, age 18 - 65, showing SMD and having been in touch with mental health services in three defined zones in the city of Sao Paulo, in the determined period, were evaluated and interviewed. The researchers used structured anamnesis with standardized questionnaires and psychometric scales, the subjects were interviewed at home and a descriptive analysis, a univariate analysis and a multivariate analysis were used. Results: From the sample we studied we’ve found a predominance of men (53,1%), single people (57,3%), having a diagnose of schizophrenia (58,3%). Few people presented abuse or dependence of alcohol (7,3%) and only three people (1,6%) hadn’t used psychiatric medications within one year before the interview. One hundred nine (57,7%) people who where interviewed showed suicidal thoughts during their lives and during 12 months prior to the research, thirty eight (20,1%) had that kind of thoughts. Fifty nine (30,9%) people had tried to commit suicide during their lives and eight (4,2%) showed attempts to it within 12 months before the interview. The presence of guilt feelings and depressive symptoms showed statistics association to all dependant variables. The multivariate analyses showed statistics association to attempts and suicidal thoughts during the patients’ lives to the occasional use of neuroleptics. Conclusion: The presence of suicidal ideation and attempts to suicide were prevalent in the studied population and they should always be investigated by the health mental professionals in order for them manage the prosper procedures, such as the handling of guilt feelings and depression and be able to stablish the proper medication, for the mental disorder.

The diploma thesis "Risks of suicidal behavior among adolescents: Diagnostic, intervention and preventive options" deals with suicidality and suicidal behavior among adolescents in the Czech Republic. The theoretical part of the thesis describes the basic terms of this topic, various approaches and understanding of this issue in the past and in the present. This work also deals with the forms, methods and motives of suicidal behavior. Furthermore it describes the age of adolescence as an independent evolutionary period in the life of man and analyses the risks of this life era. The theoretical part also contains a description of the epidemiology of this phenomenon and possible diagnostic, therapeutic and preventive approaches to suicidal behavior. The empirical part of this thesis describes the research in which the goal was to determine the connection of the increase of suicidal risk and the basic dimension of the personality (using the Freiburg's Personality Inventory), social support (by the Perceived Social Support Scale) and life engagement (through the Life Engagement Test). The research sample contained 99 respondents from the last years of one of Prague's grammar school and two of Prague's vocational schools. The results of this research confirmed the connection between a lowered suicidal...

There has been an epidemic rate of increase in youth suicide since 1960. Professionals, teachers, counselors and parents want to identify youth at risk of suicide and intervene prior to an attempt or a suicide. The premise of this study is that youth who display similar risk factors as past attempters and completers may be at risk of attempting themselves and can be identified by these risk factors. This is a quantitative and descriptive study of youth suicide attempters and completers in the state of Oregon in 1989 and 1990 in an effort to further identify risk factors of youth suicide attempters and completers. The researcher petitioned the Oregon Center for Health Statistics and obtained databases of 1150 youth attempters and 40 suicide completers. The attempter database was compiled from a legislatively mandated informational form filled out in public and private hospital emergency rooms for anyone under 18 sustaining injuries due to a suicide attempt. The second database is compiled from death certificates for youth under 18, specifying suicide as the cause of death. Data, both in the number of cases, and in the depth of the material is sparse on suicide completers. The first question employed both databases to examine the demographic similarities and differences between youth suicide attempters and completers in Oregon in 1989 and 1990. The second and third research questions are answered using the attempter data base. The second question is an in depth examination of 18 social, psychological and behavioral factors taken from the attempter database, resulting in a description of the youth who have previously attempted in Oregon in 1989 and 1990. The third research question again studies the same 18 social psychological and behavioral factors of the attempter population, dividing it into subgroups of sex, race, and age. Through crosstabulation and the chi-square tests of statistical significance, each group was specifically described. A fourth research question called for a qualitative focus group of professional suicidologists who confirmed the findings by comparing them to their own practical experience.

Varje år genomför cirka 1100 personer i Sverige ett suicid. Varje suicid föregås av i genomsnitt 10 suicidförsök. Detta orsakar förutom kostnader i form av oerhörda summor pengar för samhället också otroligt mycket lidande för anhöriga. Ambulanssjuksköterskan är många gånger den första resursen i vårdkedjan som den suicidnära kommer i kontakt med. Detta ställer stora krav på bemötandet av patienten men också krav på kunskap om medicinska åtgärder för att rädda personen till livet. Detta arbete avser att studera ambulanssjuksköterskans bemötande och egna upplevelser av mötet med den suicidnära patienten genom att intervjua ambulanssjuksköterskor i Uppsala. Studien visar att få ambulanssjuksköterskor upplever sig ha tillräcklig kompetens för att bemöta den här typen av patienter. Vidare framgår att ambulanssjuksköterskan i mycket stor utsträckning känner en misstro till den vård som patienten erhåller från psykiatrin och att det förekommer stora skillnader i hur ambulanssjuksköterskan resonerar kring sin egen säkerhet i mötet med patienten. Studien visar också att de flesta av ambulanssjuksköterskorna bemöter patienterna enligt POSP-riktlinjerna (Prehospitalt Omhändertagande av Suicidnära Patienter). Patienten skriker ofta efter hjälp i samband med ett suicidförsök och vågar man identifiera syftet med handlingen så möts man ofta med tacksamhet. / Annually around 1100 individuals in Sweden end their lives by committing suicide. Prior to every completed suicide estimate shows that 10 attempts have been made. This results in both high costs for the society and unmeasurable suffering for their relatives. The nurses that are working in the Swedish ambulance system are often the first medical resources with whom the suicidal patient has contact. This means high demands are placed on the nurse both regarding the meeting itself with the patient but also with the medical knowledge that could prove to be lifesaving in an acute situation. This paper seeks to study the professional interaction and the strategies that the nurse uses to help the suicidal patients and their own experiences of the meeting by interviewing nurses working in the Uppsala ambulance service. This study shows that the nursing staff experiences a lack of knowledge in the meeting with the patients and a clear disbelief in the care that the patients receive at the psychiatric ward. Furthermore the study shows that most nurses in the study interact with the patients in accordance with the POSP-guidelines. The patient is often crying for help in connection to a suicide attempt and if the nurse has the courage to identify the purpose with the action one is most often met with gratitude.