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Background: Stressful life events (SLEs), impulsivity, aggression, and hostility are known risk factors for suicide. The existence of an "I-A-H Triad" (composed of impulsiveness, aggressiveness and hostility) is proposed as a mediating factor between SLEs and suicide., Method: Data on 399 deceased people (274 from suicide, 125 from other causes) were collected through psychological autopsy. The Paul Ramsey Life Experience Scale (to collect SLE history), the Barrat Impulsivity Scale (BIS-11) and the Buss-Durkee Hostility Inventory (BDHI) were applied, using versions adapted for psychological autopsy., Results: Comparative analysis of the two groups showed significant differences in the variables of interest (SLE: t = 7.280; BDHI: = 4.201; BIS-11: t = 3.812; I-A-H Triad: t = 4.84). Mediation analysis confirmed the role of the I-A-H Triad in mediation of the presence of SLEs and the type of death., Conclusions: High levels of impulsivity, aggression, and hostility increase the risk of suicide when a person is faced with SLEs.

Objective: Patients with bipolar disorder are prone to suicidal behavior, yet possible protective mechanisms are rarely studied. We investigated a possible protective role for moral or religious objections to suicide against suicidal ideation and attempts in depressed bipolar patients., Method: A retrospective case control study of 149 depressed bipolar patients (DSM-III-R criteria) in a tertiary care university research clinic was conducted. Patients who reported religious affiliation were compared with 51 patients without religious affiliation in terms of sociodemographic and clinical characteristics and history of suicidal behavior. The primary outcome measure was the moral or religious objections to suicide subscale of the Reasons for Living Inventory (RFLI)., Results: Religiously affiliated patients had more children and more family-oriented social networks than nonaffiliated patients. As for clinical variables, religiously affiliated patients had fewer past suicide attempts, had fewer suicides in first-degree relatives, and were older at the time of first suicide attempt than unaffiliated patients. Furthermore, patients with religious affiliation had comparatively higher scores on the moral or religious objections to suicide subscale of the RFLI, lower lifetime aggression, and less comorbid alcohol and substance abuse and childhood abuse experience. After controlling for confounders, higher aggression scores (P = .001) and lower score on the moral or religious objections to suicide subscale of the RFLI (P < .001) were significantly associated with suicidal behavior in depressed bipolar patients. Moral or religious objections to suicide mediated the effects of religious affiliation on suicidal behavior in this sample., Conclusions: Higher score on the moral or religious objections to suicide subscale of the RFLI is associated with fewer suicidal acts in depressed bipolar patients. The strength of this association was comparable to that of aggression scores and suicidal behavior, and had an independent effect. A possible protective role of moral or religious objections to suicide deserves consideration in the assessment and treatment of suicidality in bipolar disorder., (© Copyright 2011 Physicians Postgraduate Press, Inc.)

Unlabelled: Adolescent suicide is a major social and medical problem. Alcohol use disorders with comorbid major depression represent an especially high-risk profile for suicidal behavior, repeated suicidal behavior and completed suicide. We compared demographic and clinical characteristics, prevalence of interpersonal triggers and the number of triggers for suicidal behavior in depressed late adolescents and young adults with or without comorbid alcohol use disorders., Methods: 18-26-year-old subjects were recruited through advertising and referrals and participated in mood disorders research in a university hospital. Thirty-eight depressed suicide attempters without a history of any alcohol or substance abuse/dependence and 29 depressed suicide attempters with comorbid alcohol abuse or dependence participated in the study. Demographic and clinical parameters including parameters related to suicidal behavior were examined and recorded., Results: There was no difference with regard to demographic parameters between the two groups. Depressed suicide attempters with comorbid alcohol use disorders had higher aggression and impulsivity scale scores and were more likely to be tobacco smokers compared to their counterparts without alcohol use disorders. Additionally, there was a trend towards higher lethality of suicide attempts in subjects with alcohol use disorders compared to the other group. We found no difference in the prevalence of interpersonal triggers or in the number of triggers for suicidal behavior between the two groups., Conclusion: It appears that among 18-26-year-old depressed suicide attempters, individuals with comorbid alcohol use disorders are more impaired with regard to aggressiveness and impulsivity compared to persons without comorbid alcohol abuse/dependence.

Unlabelled: Alcohol abusers seem to be prone to both suicide attempts and completions. The relationship between alcohol abuse and suicide in adolescence is complex., Objectives: To examine the role of alcohol abuse and dependence in adolescent suicide in psychological autopsy studies., Method: A search in the National Library of Medicine (NLM) PubMed database using "adolescents" and "all child: 0-18 years" as the search terms for age and "psychological autopsy" as the search term for title or abstract., Results: Forty articles met the selection criteria and each one is described. There was a high prevalence of alcohol abuse detected in the studies (range 21.42% to 43.47% in samples aged under 20 years). Alcohol misuse was present in suicides in the form of chronic abuse, acute abuse and dependence., Conclusions: Alcohol abuse and dependence is highly prevalent among adolescent suicides. In many studies, alcohol consumption is analyzed in combination with drug abuse. Further studies are necessary to clarify the prevalence of chronic and acute alcohol abuse in order to identify specific high-risk population groups and design antisuicidal interventions for them. Both acute and chronic alcohol use should be evaluated when assessing suicide risk in adolescents.

Objective: To compare the clinical and demographic characteristics of older adolescents and young adults with and without alcohol misuse in a primary care setting., Methods: This study is a case-control study. Eighty-one 18-30 year old adolescents and young adults attending a primary care center were assessed with the CAGE questionnaire, the PRIME-MD instrument and the IPDE screening questionnaire. Sub-samples of positive screen for alcohol misuse (n = 21) and a negative age- and gender matched group (n = 21) were compared., Results: Of those with alcohol misuse, 71.9% had a comorbid psychiatric diagnosis. Depressive and anxiety disorders appeared to be more prevalent among the subjects with alcohol misuse than among controls. Among those patients with depressive or anxiety disorders and alcohol misuse, 22.2% reported suicidal ideation as compared to none among the controls suffering from depressive or anxiety disorders. 69.1% of subjects with alcohol misuse had a comorbid personality disorder. Significantly more adolescents and young adults with alcohol misuse exhibited borderline personality traits (p = 0.03) and there was also a trend towards a greater proportion exhibiting histrionic traits (p = 0.07) than among those without alcohol misuse., Conclusions: Adolescents and young adults with alcohol misuse in a primary care center have a high prevalence of psychiatric comorbidity. Cluster B personality disorders may be more prevalent in the population with alcohol misuse. Adolescents and young adults with alcohol misuse may be more likely to report suicidal ideation while suffering from depressive or anxiety disorders. Further studies that evaluate the clinical and demographic characteristics of adolescents and young adults with alcohol misuse attended in a primary care center are needed.

Objective: This study determined the clinical predictors of suicidal behavior during a 2-year follow-up of patients with bipolar disorder presenting with a major depressive episode (MDE)., Method: Sixty four patients with DSM-III-R bipolar disorder were assessed at presentation for treatment of an MDE. Correlates of past suicidal behavior were determined by comparing patients with and without a history of suicide attempts using a t-test, Wilcoxon test or chi-squared test of independence on individual explanatory variables. Putative predictors of attempts during the follow-up period were tested separately using Cox proportional hazards regression analysis., Results: Twelve of 64 patients had at least one suicide attempt in the follow-up period, five of them attempted in the first 2 months and seven around or shortly after the 1-year follow-up visit. All attempters had a history of past suicide attempts. Most predictors of future suicidal behavior were correlates of past suicidal behavior. Family history of suicide acts and comorbid borderline personality disorder predicted early attempts, while younger age, high hostility scores, number of past attempts, subjective pessimism as reflected in depression and suicidal ideation, and few reported reasons for living predicted suicidal acts during the whole period., Conclusion: In this data set of bipolar patients we noted an intriguing picture of two clusters of suicide attempts. Hostility was the strongest risk factor. These findings may have implications in both the identification of at-risk patients and the timing of clinical interventions including aggressive pharmacotherapeutic prophylaxis to prevent relapse or recurrence of depressive symptomatology.

Aims: The interpersonal theory of suicide (ITPS) provides a theoretical model for suicidal behaviour. It includes two interpersonal variables, thwarted belongingness (TB) and perceived burdensomeness (PB). This study tested the relationship between ITPS interpersonal variables and suicide risk (presence/absence of suicidal ideation and suicide attempts throughout life) in a clinical sample of Spanish adolescents. We also assessed the potential mediation effect of these variables in the well‐established relationship between stressful life events (SLE) and suicide risk. Methods: We recruited 147 adolescents aged 11–17 from the Child and Adolescent Mental Health Outpatient Services of the Jiménez Díaz Foundation (Madrid, Spain). Different questionnaires were administered to assess suicidal behaviour and SLE (SITBI, The Stressful Life Events Scale) and to calculate proxy measures for ITPS interpersonal factors (SDQ, STAXI‐NA, CDI). Results: TB and PB significantly correlated with suicide risk. PB played a mediating role in the relationship between SLE and suicide risk: adolescents reporting SLE were more likely to enact suicide behaviours when they experienced higher PB. Patients scoring higher PB were more likely to receive more intense treatment but tended to abandon intervention promptly. Conclusions: ITPS seems useful for predicting suicide risk in an adolescent clinical sample. The results suggest an important role for PB in the SLE‐suicide risk relationship and may impact the treatment process. Our exploratory findings should be addressed in future studies. [ABSTRACT FROM AUTHOR]

Abstract: Bipolar disorder (BD) is associated with high rates of suicide attempt and completion. Substance use disorders (SUD) have been identified as potent risk factors for suicidal behavior in BD. However, little is known concerning differences between BD subtypes with regard to SUD as a risk factor for suicidal behavior. We studied previous suicidal behavior in adults with a major depressive episode in context of BD type I (BD-I; N =96) or BD type II (BD-II; N =42), with and without history of SUD. Logistic regressions assessed the association between SUD and suicide attempt history by BD type, and exploratory analyses examined the effects of other clinical characteristics on these relationships. SUD were associated with suicide attempt in BD-I but not BD-II, an effect not attributable to sample size differences. The higher suicide attempt rate associated with alcoholism in BD-I was mostly explained by higher aggression scores, and earlier age of BD onset increased the likelihood that alcohol use disorder would be associated with suicide attempt(s). The higher suicide attempt rate associated with other drug use disorders in BD-I was collectively explained by higher impulsivity, hostility, and aggression scores. The presence of both alcohol and drug use disorders increased odds of a history of suicide attempt in a multiplicative fashion: 97% of BD-I who had both co-morbid drug and alcohol use disorders had made a suicide attempt. A critical next question is how to target SUD and aggressive traits for prevention of suicidal behavior in BD-I. [Copyright &y& Elsevier]

Abstract: Background: Bipolar disorder (BD) is associated with a high prevalence of suicide attempt and completion. Family history of suicidal behavior and personal history of childhood abuse are reported risk factors for suicide among BD subjects. Methods: BD individuals with family history of suicidal behavior and personal history of childhood abuse (BD-BOTH), BD individuals with family history of suicidal behavior or personal history of childhood abuse (BD-ONE), and BD individuals with neither of these two risk factors (BD-NONE) were compared with regard to demographic variables and clinical measures. Results: Almost 70% of the sample had a history of a previous suicide attempt. There were significantly higher rates of previous suicide attempts in the BD-BOTH and BD-ONE relative to the BD-NONE group. BD-BOTH were significantly younger at the time of their first suicide attempt and had higher number of suicide attempts compared with BD-NONE. BD-BOTH were significantly younger at the time of their first episode of mood disorder and first psychiatric hospitalization and had significantly higher rates of substance use and borderline personality disorders compared to BD-NONE. Limitations: Retrospective study. Use of semi-structured interview for the assessment of risk factors. Conclusions: BD individuals with a familial liability for suicidal behavior and exposed to physical and/or sexual abuse during childhood are at a greater risk to have a more impaired course of bipolar illness and greater suicidality compared to those subjects with either only one or none of these risk factors. Prospective studies are needed to confirm these findings. [Copyright &y& Elsevier]

Objectives: Bipolar disorder is a severe illness that is associated with suicidal behavior. A biological predictor of highly lethal suicide attempts in patients with bipolar disorder would be valuable. We hypothesized that cerebrospinal fluid (CSF) monoamine metabolite levels are related to lethality of suicide attempts in bipolar patients and examined the relation between CSF 5-hydroxyindolacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG) levels and maximum lethality of suicide attempts at baseline and during a 2-year follow up. Methods: Twenty-seven bipolar depressed patients participated in the study. Demographic and clinical parameters were examined and recorded. Lumbar punctures were performed and CSF 5-HIAA, HVA, and MHPG were assayed by high-performance liquid chromatography with electrochemical detection. Following discharge, patients were evaluated after 3 months, 1 year, and 2 years. Each follow-up interview included an in-depth assessment of suicidal behavior during the intervening time period. Results: Six subjects made suicide attempts during the 2-year follow-up. Bipolar patients who attempted suicide during the follow-up period had higher aggression and hostility scale scores compared to bipolar subjects who did not make a suicide attempt during the follow-up period. CSF 5-HIAA, HVA, and MHPG levels were negatively correlated with the maximum lethality of suicide attempts during the 2-year follow-up period. Conclusions: Our finding is the first observation that CSF monoamine metabolite levels may be predictors of lethality of suicide attempts in patients with bipolar disorder. Further studies are necessary to answer the question whether CSF monoamine metabolite levels are clinically useful biochemical predictors of highly lethal suicide attempts or completed suicides. [ABSTRACT FROM AUTHOR]

The article offers information on the prevention of suicide among depressed patients in primary care practice. It states that suicide prevention is an essential task in primary care practice. It is also observed that most suicide victims contact a primary care physician within a month prior to their death, and that 1% to 10% of primary care patients report suicidal ideation. Moreover, studies have illustrated that most suicide ideators, attempters, and completers suffer from one or more psychiatric illness.