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Suicide prevention efforts have focused primarily on screening, education, and brief interventions rather than on treatment of underlying vulnerabilities. The Psychiatry High Risk Program (PHRP) is a specialized outpatient program for suicidal youths and young adults that facilitates transitions in care and provides comprehensive treatment aimed at healing and recovery. The authors evaluated the program's impact on inpatient utilization and suicide risk for patients (N=32) who were referred to the PHRP after psychiatric hospitalization for suicidality. Results indicate that program participants had large reductions in depression and suicidal ideation over 180 days postdischarge; they also had significantly fewer rehospitalizations than did a matched historical cohort, with an average savings of >6 hospital days per patient. These preliminary results suggest that a recovery-based suicide prevention program can be feasible and sustainable and may be cost-effective in a value-based system of care. [ABSTRACT FROM AUTHOR]

Objective: This observational study examined the effects of electroconvulsive therapy (ECT) on suicide and all-cause mortality risk in older psychiatric patients.Methods: Participants were Medicare-insured psychiatric inpatients age 65 or older. Patients receiving ECT were exact-matched to control subjects (in a 1:3 ratio) on age, gender, principal hospital diagnosis, past-year psychiatric hospitalizations, past-year suicide attempts, and Elixhauser comorbidity index. Cox proportional hazard models were risk-adjusted for race, year of hospitalization, rural-urban continuum code, year of index hospitalization, median income of zip code, and all matched covariates to estimate hazard ratios with 95% confidence intervals.Results: A total of 10,460 patients in the ECT group and 31,160 in the control group were included in the analyses (total N=41,620; 65.4% female; mean age, 74.7 years [SD=7.09]). Compared with the control group, patients receiving ECT had lower all-cause mortality for up to 1 year following hospital discharge (adjusted hazard ratio=0.61, 95% CI=0.56, 0.66). For death by suicide, 1-year survival analysis showed no group difference. A significant association was observed with suicide in the first months following ECT, but this pattern waned over time (1 month: hazard ratio=0.44, 95% CI=0.21, 0.91; 2 months: hazard ratio=0.52, 95% CI=0.29, 0.92; 3 months: hazard ratio=0.56, 95% CI=0.37, 0.92; 6 months: 0.87, 95% CI=0.59, 1.28; 12 months: 0.92, 95% CI=0.68, 1.25).Conclusions: In this observational study, ECT was associated with lower 1-year all-cause mortality and with short-lived protective effects on suicide risk. These findings support greater consideration of ECT for inpatients with mood disorders at short-term risk of suicide. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented in which the editor discusses various articles published within the issue on topics like the association of genes to suicidal behavior, parental transmission of suicide attempts, and depression.

Objective: The authors examined the association between alcohol use disorder (AUD) and risk of suicide, before and after accounting for psychiatric comorbidity, and assessed the extent to which the observed association is due to a potentially causal mechanism or genetic and familial environmental confounding factors that increase risk for both.Methods: Longitudinal population-wide Swedish medical, criminal, and pharmacy registries were used to evaluate the risk of death by suicide as a function of AUD history. Analyses employed prospective cohort and co-relative designs, including data on 2,229,880 native Swedes born between 1950 and 1970 and observed from age 15 until 2012.Results: The lifetime rate of suicide during the observation period was 3.54% for women and 3.94% for men with AUD, compared with 0.29% and 0.76% of women and men, respectively, without AUD. In adjusted analyses, AUD remained robustly associated with suicide: hazard ratios across observation periods ranged from 2.61 to 128.0 among women and from 2.44 to 28.0 among men. Co-relative analyses indicated that familial confounding accounted for some, but not all, of the observed association. A substantial and potentially causal relationship remained after accounting for a history of other psychiatric diagnoses.Conclusions: AUD is a potent risk factor for suicide, with a substantial association persisting after accounting for confounding factors. These findings underscore the impact of AUD on suicide risk, even in the context of other mental illness, and implicate the time frame shortly after a medical or criminal AUD registration as critical for efforts to reduce alcohol-related suicide. [ABSTRACT FROM AUTHOR]

Objective: Pharmacotherapy to rapidly relieve suicidal ideation in depression may reduce suicide risk. Rapid reduction in suicidal thoughts after ketamine treatment has mostly been studied in patients with low levels of suicidal ideation. The authors tested the acute effect of adjunctive subanesthetic intravenous ketamine on clinically significant suicidal ideation in patients with major depressive disorder.Method: In a randomized clinical trial, adults (N=80) with current major depressive disorder and a score ≥4 on the Scale for Suicidal Ideation (SSI), of whom 54% (N=43) were taking antidepressant medication, were randomly assigned to receive ketamine or midazolam infusion. The primary outcome measure was SSI score 24 hours after infusion (at day 1).Results: The reduction in SSI score at day 1 was 4.96 points greater for the ketamine group compared with the midazolam group (95% CI=2.33, 7.59; Cohen's d=0.75). The proportion of responders (defined as having a reduction ≥50% in SSI score) at day 1 was 55% for the ketamine group and 30% for the midazolam group (odds ratio=2.85, 95% CI=1.14, 7.15; number needed to treat=4.0). Improvement in the Profile of Mood States depression subscale was greater at day 1 for the ketamine group compared with the midazolam group (estimate=7.65, 95% CI=1.36, 13.94), and this effect mediated 33.6% of ketamine's effect on SSI score. Side effects were short-lived, and clinical improvement was maintained for up to 6 weeks with additional optimized standard pharmacotherapy in an uncontrolled follow-up.Conclusions: Adjunctive ketamine demonstrated a greater reduction in clinically significant suicidal ideation in depressed patients within 24 hours compared with midazolam, partially independently of antidepressant effect. [ABSTRACT FROM AUTHOR]

Objective: The authors sought to identify risk factors for repeat self-harm and completed suicide over the following year among adults with deliberate self-harm.Method: A national cohort of Medicaid-financed adults clinically diagnosed with deliberate self-harm (N=61,297) was followed for up to 1 year. Repeat self-harm per 1,000 person-years and suicide rates per 100,000 person-years (based on cause of death information from the National Death Index) were determined. Hazard ratios of repeat self-harm and suicide were estimated by Cox proportional hazard models.Results: During the 12 months after nonfatal self-harm, the rate of repeat self-harm was 263.2 per 1,000 person-years and the rate of completed suicide was 439.1 per 100,000 person-years, or 37.2 times higher than in a matched general population cohort. The hazard of suicide was higher after initial self-harm events involving violent as compared with nonviolent methods (hazard ratio=7.5, 95% CI=5.5-10.1), especially firearms (hazard ratio=15.86, 95% CI=10.7-23.4; computed with poisoning as reference), and to a lesser extent after events of patients who had recently received outpatient mental health care (hazard ratio=1.6, 95% CI=1.2-2.0). Compared with self-harm patients using nonviolent methods, those who used violent methods were at significantly increased risk of suicide during the first 30 days after the initial event (hazard ratio=17.5, 95% CI=11.2-27.3), but not during the following 335 days.Conclusions: Adults treated for deliberate self-harm frequently repeat self-harm in the following year. Patients who use a violent method for their initial self-harm, especially firearms, have an exceptionally high risk of suicide, particularly right after the initial event, which highlights the importance of careful assessment and close follow-up of this group. [ABSTRACT FROM AUTHOR]

Objective: Conclusions regarding lithium's antisuicidal effect for bipolar disorder have been limited due to nonrepresentative subjects and potential confounding factors, including varying severity of illness. Findings regarding the effect of valproate, the most common alternative to lithium, are inconsistent for suicidal behavior. This study investigated the associations of these two drugs with the risk of suicide-related events, and possible differences between drugs, by using within-individual designs in a register-based longitudinal cohort.Method: Through linkage of multiple Swedish national registers, 51,535 individuals with bipolar disorder were followed from 2005 to 2013 for treatment with lithium and valproate. Stratified Cox regression was used to estimate the hazard ratios of suicide-related events during treated periods compared with untreated periods. For significant associations between medication and suicide-related events, the population attributable fraction was estimated to assess the public health impact for patients with bipolar disorder.Results: During follow-up, 10,648 suicide-related events occurred. The incidence rate was significantly decreased by 14% during lithium treatment (hazard ratio 0.86, 95% confidence interval [CI] 0.78-0.95) but not during valproate treatment (hazard ratio 1.02, 95% CI 0.89-1.15). The difference in hazard ratios of suicide-related events between lithium and valproate was statistically significant. Estimates of the population attributable fraction suggested that 12% (95% CI 4%-20%) of suicide-related events could have been avoided if patients had taken lithium during the entire follow-up.Conclusions: The results suggest that lithium should be considered for patients with bipolar disorder with suspected suicidal intentions, although risk for suicide is only one of the considerations when providing clinical care. [ABSTRACT FROM AUTHOR]

Objectives: International suicide prevention strategies recommend providing support to families bereaved by suicide. The study objectives were to measure the proportion of cases in which psychiatric professionals contact next of kin after a patient's suicide and to investigate whether specific, potentially stigmatizing patient characteristics influence whether the family is contacted.Methods: Annual survey data from England and Wales (2003-2012) were used to identify 11,572 suicide cases among psychiatric patients. Multivariate regression analysis was used to describe the association between specific covariates (chosen on the basis of clinical judgment and the published literature) and the probability that psychiatric staff would contact bereaved relatives of the deceased.Results: Relatives were not contacted after the death in 33% of cases. Contrary to the hypothesis, a violent method of suicide was independently associated with greater likelihood of contact with relatives (adjusted odds ratio=1.67). Four patient factors (forensic history, unemployment, and primary diagnosis of alcohol or drug dependence or misuse) were independently associated with less likelihood of contact with relatives. Patients' race-ethnicity and recent alcohol or drug misuse were not associated with contact with relatives.Conclusions: Four stigmatizing patient-related factors reduced the likelihood of contacting next of kin after patient suicide, suggesting inequitable access to support after a potentially traumatic bereavement. Given the association of suicide bereavement with suicide attempt, and the possibility of relatives' shared risk factors for suicide, British psychiatric services should provide more support to relatives after patient suicide. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this article was to determine whether longitudinal historical data, commonly available in electronic health record (EHR) systems, can be used to predict patients' future risk of suicidal behavior.Method: Bayesian models were developed using a retrospective cohort approach. EHR data from a large health care database spanning 15 years (1998-2012) of inpatient and outpatient visits were used to predict future documented suicidal behavior (i.e., suicide attempt or death). Patients with three or more visits (N=1,728,549) were included. ICD-9-based case definition for suicidal behavior was derived by expert clinician consensus review of 2,700 narrative EHR notes (from 520 patients), supplemented by state death certificates. Model performance was evaluated retrospectively using an independent testing set.Results: Among the study population, 1.2% (N=20,246) met the case definition for suicidal behavior. The model achieved sensitive (33%-45% sensitivity), specific (90%-95% specificity), and early (3-4 years in advance on average) prediction of patients' future suicidal behavior. The strongest predictors identified by the model included both well-known (e.g., substance abuse and psychiatric disorders) and less conventional (e.g., certain injuries and chronic conditions) risk factors, indicating that a data-driven approach can yield more comprehensive risk profiles.Conclusions: Longitudinal EHR data, commonly available in clinical settings, can be useful for predicting future risk of suicidal behavior. This modeling approach could serve as an early warning system to help clinicians identify high-risk patients for further screening. By analyzing the full phenotypic breadth of the EHR, computerized risk screening approaches may enhance prediction beyond what is feasible for individual clinicians. [ABSTRACT FROM AUTHOR]

Objective: Insomnia is associated with increased risk for suicide. The Food and Drug Administration (FDA) has mandated that warnings regarding suicide be included in the prescribing information for hypnotic medications. The authors conducted a review of the evidence for and against the claim that hypnotics increase the risk of suicide.Method: This review focused on modern, FDA-approved hypnotics, beginning with the introduction of benzodiazepines, limiting its findings to adults. PubMed and Web of Science were searched, crossing the terms "suicide" and "suicidal" with each of the modern FDA-approved hypnotics. The FDA web site was searched for postmarketing safety reviews, and the FDA was contacted with requests to provide detailed case reports for hypnotic-related suicide deaths reported through its Adverse Event Reporting System.Results: Epidemiological studies show that hypnotics are associated with an increased risk for suicide. However, none of these studies adequately controlled for depression or other psychiatric disorders that may be linked with insomnia. Suicide deaths have been reported from single-agent hypnotic overdoses. A separate concern is that benzodiazepine receptor agonist hypnotics can cause parasomnias, which in rare cases may lead to suicidal ideation or suicidal behavior in persons who were not known to be suicidal. On the other hand, ongoing research is testing whether treatment of insomnia may reduce suicidality in adults with depression.Conclusions: The review findings indicate that hypnotic medications are associated with suicidal ideation. Future studies should be designed to assess whether increases in suicidality result from CNS impairments from a given hypnotic medication or whether such medication decreases suicidality because of improvements in insomnia. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to compare assisted outpatient treatment (AOT) eligibility characteristics among participants receiving community treatment through AOT and non-AOT referrals.Methods: A total of 131 AOT and non-AOT charts were reviewed from three sites within one treatment agency in New York City. Intake information was coded for AOT eligibility information, suicide history, and risk of future violence according to the Historical Clinical Risk Management-20, version 3 (HCR-20V3), instrument.Results: No significant differences were found between groups for measurable AOT eligibility criteria. Compared with non-AOT participants, the participants referred through AOT scored significantly higher on HCR-20V3 for risk of future violence; however, most charts, including almost half of AOT participants, received low risk ratings.Conclusions: Study findings raise questions about why some individuals, and not others, are referred to AOT in New York City. [ABSTRACT FROM AUTHOR]

Objective: To inform suicide pre- vention efforts in mental health treatment, the study assessed asso- ciations between recent mental health treatment, personal charac- teristics, and circumstances of sui- cide among suicide decedents. Methods: Data from 18 states reporting to the National Violent Death Reporting System between 2005 and 2010 (N=57,877 suicides) were used to compare circum- stances among adult decedents re- ceiving any or no type of mental health treatment within two months before death. Results: Of suicide decedents, 28.5% received treat- ment before suicide. Several vari- ables were associated with higher odds of receiving treatment, in- eluding death by poisoning with commonly prescribed substances (adjusted odds ratio [AOR]=3.04, 95% confidence inter~'a1 [CI]= 2.84- 3.26), a history of suicide attempts (AOR 2.77, C12.64-2.90), de- pressed mood (AOR 1.69, CI~ 1.62-1.76), and nonalcoholic sub- stance abuse or dependence (AOR 1.13, CF 1.07-1.19). Conclusions: For nearly a third of all suicide dece- dents, better mental health care might have prevented death. Ef- forts to reduce access to lethal doses of prescription medications seem warranted to prevent over- dosing with commonly prescribed substances. (Psychiatric Services 65:387-390, 2014; doi: 10.1176/ appi.ps.201300124) [ABSTRACT FROM AUTHOR]

The authors reflect on the genome-wide association studies of DNA cytosine methylation which plays a critical role in the regulation of gene expression. The authors stress that the researchers examined the changes in DNA methylation in the neuronal and nonneuronal chromatin from postmortem hippocampus of several individuals who died by suicide. The authors conclude that suicide depression are disorders of the neuronal genome.

Objective: This study evaluated the national trends in prescribing pharmacologic treatments for pediatric depression before and after a 2003 U.S. Food and Drug Administration advisory linking an increased risk of suicidality with antidepressants among pediatric patients with major depressive disorder.Methods: National estimates on outpatient visits between 1998 and 2007 with a diagnosis of depression, a prescription for an antidepressant, or both among children ages 5 to 17 and adults were obtained from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey.Results: Among children, depression visits increased from 1998-1999 to 2002-2003 (3.2 and 4.3 million, respectively) but decreased to 3.2 million in 2006-2007. Antidepressant visits increased from 1998-1999 to 2002-2003 (3.4 and 7.6 million, respectively) but dropped to 6.7 million in 2006-2007. Depression visits with an antidepressant prescribed rose from 1998-1999 to 2002-2003 (1.7 and 2.8 million, respectively) but dropped in 2004-2005 and 2006-2007 (2.4 and 2.1 million, respectively). Nevertheless, the proportion of depression visits with an antidepressant prescribed, having risen from 54% in 1998-1999 to 66% in 2002-2003, remained stable in 2004-2005 (65%) and in 2006-2007 (64%), the result, seemingly, of more prescribing of antidepressants for major depressive disorder and less for other depression. Utilization patterns among adults were not interrupted.Conclusions: Children's depression visits and visits with an antidepressant prescribed dropped after the advisory, but children with major depressive disorder appeared no less likely to be prescribed antidepressants. [ABSTRACT FROM AUTHOR]

Objective: Mortality risk is relatively high in young people with asthma, and the risk may include causes of death other than those directly linked to respiratory disease. The authors investigated the association between asthma and suicide mortality in a large population-based cohort of young people. Method: A total of 162,766 high school students 11 to 16 years of age living in a catchment area in Taiwan from October 1995 to June 1996 were enrolled in a study of asthma and allergy. Each student and his or her parents completed structured questionnaires. Participants were classified into three groups at baseline: current asthma (symptoms present in the past year), previous asthma (history of asthma but no symptoms in the past year), and no asthma. Participants were followed to December 2007 by record linkage to the national Death Certification System. Cox proportional hazards models were used to study the association between asthma and cause of death. Results: The incidence rate of suicide mortality in participants with current asthma at baseline was more than twice that of those without asthma (11.0 compared with 4.3 per 100,000 person-years), but there was no significant difference in the incidence of natural deaths. The adjusted hazard ratio for suicide was 2.26 (95% CI=1 .43-3.58) in the current asthma group and 1.76 (95% CI=0.90-3.43) in the previous asthma group. Having a greater number of asthma symptoms at baseline was associated with a higher risk of subsequent suicide. The population attributable fraction was 7.0%. Conclusions: These results highlight evidence of excess suicide mortality in young people with asthma. There is a need to improve mental health care for young people, particularly those with more severe and persistent asthma symptoms. [ABSTRACT FROM AUTHOR]

Objective: The mental health of U.S. college students is a growing public health concern. Particularly alarming is the prevalence of depression and risk of suicide in this cohort. Methods: A literature review of PsycINFO, MEDLINE, and CINAHL databases was conducted in order to identify and evaluate depression and treatment outcomes among U.S. college students since 1990. Results: Four studies documenting depression and treatment outcomes among U.S. college students were identified and reviewed. Conclusions: Although research on the depression and treatment outcomes among U.S. college students exists, it is scarce and inconsistent, with verifying inclusion and exclusion criteria and measurement of depression severity and its treatment. Future work needs to focus on the development of reasonable benchmarks of depression and treatment outcomes in the college population and the integration of such outcome data into college mental health practice. [ABSTRACT FROM AUTHOR]

Objective: The authors sought to determine 1) whether the risk for familial transmission of suicidal behavior is greater with increased family loading for suicide attempts, and 2) whether the transmission of suicidal behavior is mediated by impulsive aggression. Method: A reanalysis of a high-risk study compared the offspring of three mood disorder proband groups: suicide attempters with a sibling who also attempted suicide (N=19), suicide attempters whose siblings never made a suicide attempt (N=73), and non-suicidal probands whose siblings also never engaged in suicidal behavior (N=73). Probands and offspring were assessed with respect to psychopathology, suicide attempt history, impulsive aggression, and exposure to familial adversity. Results: Offspring of suicide attempters with siblings concordant for suicidal behavior showed a higher risk of suicide attempt than did offspring of non-suicidal probands and had an earlier age at onset of suicidal behavior than offspring of suicide attempters with siblings discordant for suicidal behavior. Probands from sibling pairs concordant for suicidal behavior and their offspring reported greater lifetime impulsive aggression compared with each of the other two proband/offspring groups. In the offspring, impulsive aggression was the most powerful predictor of early age at first suicide attempt. Conclusions: Familial loading for suicide attempts may affect rates of transmission as well as age at onset of suicidal behavior, and its effect may be mediated by the familial transmission of impulsive aggression. [ABSTRACT FROM AUTHOR]

Discusses results of a study evaluating the impact of clozapine on the rate of death due to suicide among schizophrenic elderly subjects. Patient demographics; Postdischarge mortality rates among hospitalized patients for treatment of schizophrenia who had short-term, long-term or no exposure to clozapine; Study limitations.

Discusses the results of a study on whether the psychiatric diagnoses of suicide victims vary with age. Psychological autopsy of suicide victims between 21 to 92 years old; Substance abuse and primary psychoses among young victims; Major depression among the elderly; Risk of suicide as a function of age.

Investigates the relation between various mental disorders and comorbidity with suicide among young men. Application of the psychological autopsy technique and a case-control design; Completion of suicide; Demographic aspects; Implications on suicide prevention services.

Analyzes the suicides of people with bipolar depression in aspects relevant to suicide prevention. Age and gender differences; Significance of treatment frequency and quality; Relevance of marital satisfaction; Comparison of the victims with suicide victims with unipolar major depression; Communication of suicide intent; Suicide methods.

Investigates the prevalence and comorbidity of current mental disorders defined by DSM-III-R among a random sample of suicide victims from a nationwide (Finland) suicide population. Psychological autopsy method; Depressive disorders; Alcohol dependence; Planning treatment strategies.

Presents a validation of an initial finding of heightened risk of suicidal ideation or behavior among individuals in a random community sample who met diagnostic criteria for panic disorder or attacks. Suicide Probability Scale; Conclusion.

The author reflects on the study by O. Keiser and colleagues which examines whether there is a decline in the suicide rate among HIV-positive persons in the antiretroviral therapy (ART) era. The author emphasizes that stress and coping theory offers a framework to understand how psychological responses to stressful life events increases suicide risk. The author suggests that further research is needed to examine the dynamic interplay among social, psychological, and biological factors.

The article discusses aspect of suicide as primary cause of death in U.S. Topics discussed include the author's knowledge regarding the biological root of ferocious suicidal impulse as psychiatrist, the author's view regarding the biological awareness of suicide in the community, and according to the author the crucial condition suicide reporting and discussion.

The article discusses the efforts to prevent suicide in the U.S. It states the Vision Zero program of Henry Ford Health System in Michigan succeeded in homing annual suicide rate to 5.77 per 100, 000. It mentions the crisis intervention strategy that aims to provide support to survivors who are attempting to cope with suicide death and reduce possibility of suicide contagion.

A letter to the editor about preoccupation with suicide in patients treated with fluoxetine is presented.

A letter to the editor is presented about the benefit of the psychiatrist's attending the funeral of a patient who commits suicide.

A letter to the editor is presented which concludes that fluoxetine is an effective and safe medication in mental illness.

A letter to the editor which examines the implication of anabolic androgenic steroids abuse on athletes is presented.