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Objective: We wished to examine whether resilience might be a protective factor in relation to suicidal behavior., Method: To do this resilience was examined in relation to childhood trauma, a well established risk factor for suicidal behavior, in two samples. In a preliminary sample 20 abstinent substance abuse patients who had attempted suicide were matched for age and their score on the Childhood Trauma Questionnaire (CTQ) with 20 substance abuse patients who had never attempted suicide. The two age and CTQ matched attempter (N=20) and non-attempter (N=20) groups were then compared for their scores on the Connor-Davidson Resilience Scale (CD-RISC). In the second sample 166 prisoners who had attempted suicide were matched for age and their scores on the CTQ with 166 prisoners who had never attempted suicide. These two age and CTQ matched attempter (N=166)and non-attempter (N=166) groups were similarly compared for their CD-RISC resilience scores., Results: In the preliminary substance abuse sample, patients who had never attempted suicide (N=20) had significantly higher mean CD-RISC resilience scores than the age and CTQ matched patients who had attempted suicide (N=20). Similarly in the prisoner sample, those who had never attempted suicide (N=166) had significantly higher CD-RISC resilience scores than the age and CTQ matched prisoners who had attempted suicide (N=166)., Conclusions: The results from these two studies suggest that resilience may be a protective factor mitigating the risk of suicidal behavior associated with childhood trauma., (Published by Elsevier B.V.)

Background: To examine the relationship of childhood trauma to depressive symptoms in type 1 diabetes, a chronic disease in which the frequency of depression is increased., Method: One hundred fifty African American patients with type 1 diabetes seen between August 1993 and January 1998 completed the Beck Depression Inventory and Childhood Trauma Questionnaire. They were also genotyped for a functional serotonin transporter promoter polymorphism (5-HTTLPR) that modulates resiliency. Patients who had Beck Depression Inventory scores above and below 14 were compared., Results: Diabetic patients who had Beck Depression Inventory scores ≥ 14 had experienced significantly more different types of childhood trauma than those with Beck Depression Inventory scores < 14 (P < .001), independent of potential interaction with 5-HTTLPR genotype., Conclusions: Childhood trauma appears to be a determinant of depressive symptoms in type 1 diabetes, independently of genotype of a functional locus modulating resiliency., (© Copyright 2011 Physicians Postgraduate Press, Inc.)

Background: There is a need to try to identify patients at highest risk for suicidal behavior. A family history of suicidal behavior (FHS) and childhood trauma are two important risk factors for suicidal behavior. It was therefore decided to combine them and examine if the combination would identify patients at even increased risk for suicidal behavior., Methods: Two hundred and eighty one substance dependent patients with a FHS completed the Childhood Trauma Questionnaire (CTQ) and were interviewed about their lifetime history of suicidal behavior. Patients with the combination of a FHS and CTQ score above the mean were examined and compared with FHS patients with a CTQ score below the mean., Results: One hundred and two of the 129 (79.1%) FHS patients with a CTQ score above the mean had attempted suicide. Thirty five of the 40 female (87.5%) FHS patients with a CTQ score above the mean had attempted suicide .Patients with a CTQ score above the mean were found significantly more among FHS patients who had attempted suicide than among FHS patients who had never attempted. FHS attempters with a CTQ score above the mean had a significantly earlier age of first attempting and had made more attempts than FHS attempters with a CTQ score below the mean., Limitations: Childhood trauma data derived from self-report questionnaire. No consistent collateral information about FHS., Conclusion: The combination of a FHS and childhood trauma may represent a correlate of increased risk of attempting suicide, attempting earlier, and making more attempts., (Published by Elsevier B.V.)

Unlabelled: IntroductionSelf-harm is a direct, socially unacceptable,repetitive behavior that causes minor to moderate physical injury without suicidal intent. It is also a significant and growing concern among prison inmates, although it has been rarely studied. In the present study, we aimed to investigate demographic, psychosocial, and clinical variables associated to this critical bahaviour in a high risk sample of 1,555 male prisoners., Methods: Prisoners were interviewed about their history of self-mutilation, psychiatric history,and forensic history. The prisoners completed the Barratt Impulsivity Scale, Buss-Durkee Hostility Inventory, Eysenck Personality Questionnaire, and Childhood Trauma Questionnaire., Results: Eighteen percent of prisoners had a history of self-harm. They more frequently reported childhood traumas, were more likely to be unmarried, previously imprisoned, tested positive for substance abuse, had a history of suicide attempt, and more likely showed violent tendencies.DiscussionSelf-harm among prisoners is common, being found in almost 20% of the subjects in our sample. Self-mutilation among prisoners appears to be multi-factorial with developmental, socio-demographic, psychiatric, and personality determinants., Conclusion: Self-harm is associated with critical behaviors such as violence, substance abuse and suicide attempts, which represent major critical problems in contention environments.

Insomnia has been associated with suicidality. Prisoners have an increased risk of both insomnia and suicidal behaviour. Therefore, it was decided to examine for a relationship between insomnia and suicidal behaviour in a large group of 1420 prisoners. Prisoners had a semi-structured psychiatric interview, which included the Hamilton Depression Rating Scale (HDRS), and completed the Childhood Trauma Questionnaire, Eysenck Personality Questionnaire, Spielberg Anger Expression Inventory and Connor-Davidson Resilience Scale. It was found that 568 (61.2%) of the prisoners scored in the insomnia cluster of the HDRS and that 183 (12.8%) had attempted suicide. Regression analyses showed that insomnia was significantly and independently associated with a lifetime history of attempting suicide. Insomnia was also significantly related to actual suicidality. After controlling for confounders, axis 1 psychiatric disorder, childhood trauma, neuroticism, low resilience, and anger were significantly associated with insomnia in male prisoners. These data suggest the possibility of a relationship between insomnia and suicidality in prisoners. Assessing insomnia may be helpful when evaluating the risk of suicidality in prisoners., (Copyright © 2009 Elsevier Ltd. All rights reserved.)

Objective. To determine risk factors for the development of hypertension among African-Americans living with type 1 diabetes. Methods. African-Americans with type 1 diabetes (n = 483) participated in a 6-year followup. At both baseline and followup blood pressure was measured twice in both sitting and standing positions using a standard protocol. Patients had a structured clinical interview, ocular examination, retinal photographs, and blood and urine assays and completed the Hostility and Direction of Hostility Questionnaire (HDHQ) and the Beck Depression Inventory (BDI). Results. Of the 280 diabetic patients with no hypertension at baseline, 82 (29.3%) subsequently developed hypertension over the 6-year followup. Baseline older age, longer duration of diabetes, family history of hypertension, greater mean arterial blood pressure, overt proteinuria, increasing retinopathy severity, peripheral neuropathy, smoking, and higher hostility scores were significantly associated with the development of hypertension. Multivariate analyses showed that higher hostility scores and overt proteinuria were significantly and independently associated with the development of hypertension in this population. Conclusions. The development of hypertension in African-Americans living with type 1 diabetes appears to be multifactorial and includes both medical (overt proteinuria) as well as psychological (high hostility) risk factors.

Objective: To examine the relationship between childhood trauma and prevalence of cardiovascular disease (CVD) (either coronary disease or stroke) in Type 1 diabetes (DM)., Methods: From an original cohort of 725 African Americana with Type 1 DM, 444 (61.2%) were reexamined as part of a 6-year follow-up. In both examinations, patients underwent a structured clinical interview to determine their medical history and a detailed ocular examination. At follow-up, patients completed the Childhood Trauma Questionnaire, Hostility and Direction of Hostility Questionnaire, and Beck Depression Inventory. Diabetic patients who had CVD and those had not developed CVD at the 6-year follow-up were compared for their experience of childhood trauma at the same time controlling for the presence of known risk factors for CVD., Results: Of the 393 patients at risk, 60 (15.3%) had developed any CVD, 52 (12.9%) had coronary disease, and 16 (3.8%) had a stroke at the 6-year follow-up. On univariate analysis, childhood trauma was significantly associated with 6-year incidence of any CVD (p < .01), coronary disease (p < .05), and stroke (p < .01). Childhood trauma scores were also significantly associated with depression (p < .001) and hostility (p < .001) scores, age (p < .05), and renal disease (p < .05). In primary multivariate analyses, childhood trauma predicted CVD independent of age, body mass index, blood pressure, and proteinuria. Secondary analyses suggested that association between the 6-year incidence of CVD and childhood trauma was also independent of depression ratings., Conclusion: Childhood seems to be an independent risk factor for the incidence of CVD in Type 1 DM.

In order to examine suicidality and its correlates in type 1 diabetics 412 African-American type 1 diabetics and 404 African-American controls underwent a semi-structured interview that asked if they had ever attempted suicide. Patients completed the Childhood Trauma Questionnaire (CTQ), Hostility and Direction of Hostility Questionnaire (HDHQ), and Beck Depression Inventory (BDI). Diabetics and controls were compared for their rate of suicide attempt. Diabetic patients who had or had never attempted suicide were compared on socio-demographic and clinical data. It was found that diabetics were 3 to 4 times more likely to attempt suicide than controls (13.3% vs 3.5%, respectively, P<0.001). Diabetic attempters were significantly more likely to be female, depressed and hostile, and to report a history of childhood trauma, smoking, alcohol abuse, and drug abuse than diabetic non-attempters. Multivariate analyses showed that female sex, severity of childhood abuse, history of alcohol abuse, and depression were significantly and independently associated with having attempted suicide. These results suggest that African-Americans with type 1 diabetes have a raised risk of attempting suicide. Suicide risk in diabetics appears to be multifactorial and includes gender, developmental, personality, psychiatric, and substance abuse determinants.

In order to examine risk factors for attempting suicide in heroin dependent patients, a group of 527 abstinent opiate dependent patients had a psychiatric interview and completed the Childhood Trauma Questionnaire. Patients who had or had never attempted suicide were compared on putative suicide risk factors. It was found that 207 of the 527 heroin abusers (39.3%) had attempted suicide. Attempters were younger; more were female, reported childhood trauma, a family history of suicidal behavior, a history of aggression, treatment with antidepressant medication, and alcohol and cocaine dependence. Logistic regression revealed that a family history of suicidal behavior, alcohol dependence, cocaine dependence, and treatment with antidepressant medication were significant predictors of attempting suicide. These results suggest that attempting suicide is common among opiate dependent patients and that both distal and proximal risk factors may play a role.

Childhood trauma is associated with hypothalamic-pituitary-adrenal (HPA) axis dysregulation and is a known risk factor for suicidal behavior. In this study we sought to determine whether the impact of childhood trauma on suicide risk might be modified by FKBP5, an HPA-axis regulating gene. Sixteen FKBP5 haplotype-tagging single nucleotide polymorphisms (SNPs) were genotyped in a sample of African Americans: 398 treatment-seeking patients with substance dependence (90% men; 120 suicide attempters) and 432 nonsubstance-dependent individuals (40% men; 21 suicide attempters). In all, 474 participants (112 suicide attempters) also completed the Childhood Trauma Questionnaire (CTQ). Primary haplotype analyses were conducted with the four SNPs implicated in earlier studies: rs3800373, rs9296158, rs1360780, and rs9470080. We found that childhood trauma was associated with suicide attempt (P<0.0001). Although there was no main effect of the two major yin yang haplotypes in the four SNP haplotype blocks, there was a haplotype influence on suicide risk (p=0.006) only in individuals exposed to high levels of childhood trauma. In this group, 51% with two copies of the risk haplotype, 36% with one copy, and 20% with no copies had attempted suicide. The total logistic regression model accounted for 13% of the variance in attempted suicide. Analyses of the 16 SNPs showed significant main effects on suicide attempt of rs3777747, rs4713902, and rs9470080 and interactive effects of rs3800373, rs9296158, and rs1360780 with CTQ score on suicide attempt. These data suggest that childhood trauma and variants of the FKBP5 gene may interact to increase the risk for attempting suicide.

Context: Brain-derived neurotrophic factor (BDNF) plays a pivotal role in the pathophysiology of suicidal behavior and BDNF levels are decreased in the brain and plasma of suicide subjects. So far, the mechanisms leading to downregulation of BDNF expression are poorly understood., Objectives: To test the hypothesis that alterations of DNA methylation could be involved in the dysregulation of BDNF gene expression in the brain of suicide subjects., Design: Three independent quantitative methylation techniques were performed on postmortem samples of brain tissue. BDNF messenger RNA levels were determined by quantitative real-time polymerase chain reaction., Setting: Academic medical center., Patients or Other Participants: Forty-four suicide completers and 33 nonsuicide control subjects of white ethnicity., Main Outcome Measures: The DNA methylation degree at BDNF promoter IV and the genome-wide DNA methylation levels in the brain's Wernicke area., Results: Postmortem brain samples from suicide subjects showed a statistically significant increase of DNA methylation at specific CpG sites in BDNF promoter/exon IV compared with nonsuicide control subjects (P < .001). Most of the CpG sites lying in the -300/+500 region, on both strands, had low or no methylation, with the exception of a few sites located near the transcriptional start site that had differential methylation, while genome-wide methylation levels were comparable among the subjects. The mean methylation degree at the 4 CpG sites analyzed by pyrosequencing was always less than 12.9% in the 33 nonsuicide control subjects, while in 13 of 44 suicide victims (30%), the mean methylation degree ranged between 13.1% and 34.2%. Higher methylation degree corresponded to lower BDNF messenger RNA levels., Conclusions: BDNF promoter/exon IV is frequently hypermethylated in the Wernicke area of the postmortem brain of suicide subjects irrespective of genome-wide methylation levels, indicating that a gene-specific increase in DNA methylation could cause or contribute to the downregulation of BDNF expression in suicide subjects. The reported data reveal a novel link between epigenetic alteration in the brain and suicidal behavior.

Background: The GABRA2 gene has been implicated in addiction. Early life stress has been shown to alter GABRA2 expression in adult rodents. We hypothesized that childhood trauma, GABRA2 variation, and their interaction would influence addiction vulnerability., Methods: African-American men were recruited for this study: 577 patients with lifetime DSM-IV single and comorbid diagnoses of alcohol, cocaine, and heroin dependence, and 255 control subjects. The Childhood Trauma Questionnaire (CTQ) was administered. Ten GABRA2 haplotype-tagging single-nucleotide polymorphisms (SNPs) were genotyped., Results: We found that exposure to childhood trauma predicted substance dependence (p < .0001). Polysubstance dependence was associated with the highest CTQ scores (p < .0001). The African Americans had four common haplotypes (frequency: .11-.30) within the distal haplotype block: two that correspond to the Caucasian and Asian yin-yang haplotypes, and two not found in other ethnic groups. One of the unique haplotypes predicted heroin addiction, whereas the other haplotype was more common in control subjects and seemed to confer resilience to addiction after exposure to severe childhood trauma. The yin-yang haplotypes had no effects. Moreover, the intron 2 SNP rs11503014, not located in any haplotype block and potentially implicated in exon splicing, was independently associated with addiction, specifically heroin addiction (p < .005). Childhood trauma interacted with rs11503014 variation to influence addiction vulnerability, particularly to cocaine (p < .005)., Conclusions: Our results suggest that at least in African-American men, childhood trauma, GABRA2 variation, and their interaction play a role in risk-resilience for substance dependence.

Suicidal behavior remains a major source of morbidity and mortality among schizophrenics. The National Institute of Mental Health Longitudinal Study of Chronic Schizophrenia found that over a mean of 6 years, 38% of the patients had at least one suicide attempt and 57% admitted to substantial suicidal ideation. Suicide is also a major issue among inpatients, with serious implications for clinical practice and patient-doctor relationships. The management of schizophrenic patients with suicide risk remains a difficult area for clinicians despite attempts to better understand it by gathering experts in the field. This article discusses the frequency of suicidal behavior in schizophrenia, offers a model for understanding it, and discusses various aspects of the management of the at-risk schizophrenic patient.

Objective: Genetic variation influences differential vulnerability to addiction within populations. However, it remains unclear whether differences in frequencies of vulnerability alleles contribute to disparities between populations and to what extent ancestry correlates with differential exposure to environmental risk factors, including poverty and trauma., Method: The authors used 186 ancestry-informative markers to measure African ancestry in 407 addicts and 457 comparison subjects self-identified as African Americans. The reference group was 1,051 individuals from the Human Genome Diversity Cell Line Panel, which includes 51 diverse populations representing most worldwide genetic diversity., Results: African Americans varied in degrees of African, European, Middle Eastern, and Central Asian genetic heritage. The overall level of African ancestry was actually smaller among cocaine, opiate, and alcohol addicts (proportion=0.76-0.78) than nonaddicted African American comparison subjects (proportion=0.81). African ancestry was associated with living in impoverished neighborhoods, a factor previously associated with risk. There was no association between African ancestry and exposure to childhood abuse or neglect, a factor that strongly predicted all types of addictions., Conclusions: These results suggest that African genetic heritage does not increase the likelihood of genetic risk for addictions. They highlight the complex interrelation between genetic ancestry and social, economic, and environmental conditions and the strong relation of those factors to addiction. Studies of epidemiological samples characterized for genetic ancestry and social, psychological, demographic, economic, cultural, and historical factors are needed to better disentangle the effects of genetic and environmental factors underlying interpopulation differences in vulnerability to addiction and other health disparities.

Studies have increasingly shown that gene-environment interactions are important in psychiatry. Suicidal behavior is a major public health problem. Suicide is generally considered to be a multi-determined act involving various areas of proximal and distal risk. Genetic risk factors are estimated to account for approximately 30% to 40% of the variance in suicidal behavior. In this article, the authors review relevant studies concerning the interaction between the serotonin transporter gene and environmental variables as a model of gene-environment interactions that may have an impact on suicidal behavior. The findings reviewed here suggest that there may be meaningful interactions between distal and proximal suicide risk factors that may amplify the risk of suicidal behavior. Future studies of suicidal behavior should examine both genetic and environmental variables and examine for gene-environment interactions.

There have been few studies examining risk factors for attempting suicide among cocaine dependent patients. Therefore, a large group of 406 abstinent cocaine dependent patients had a psychiatric interview and completed the Childhood Trauma Questionnaire. Patients who had or had never attempted suicide were compared on putative suicide risk factors. The results showed that 43.5% of the patients had attempted suicide. Attempters were younger; more were female; more reported childhood trauma, a family history of suicidal behavior, a history of aggression, treatment with antidepressant medication, and comorbidity with alcohol and opiate dependence. Logistic regression revealed that childhood physical abuse, childhood emotional negelect, comorbidity with alcohol dependence, and treatment with antidepressant medication were significant predictors of attempting suicide. Thus these results suggest that attempting suicide is common among cocaine dependent patients and that both distal and proximal risk factors may play a role.

The objective of this study was to analyze the impact of family history of suicidal behaviour on psychopathlogical features of inmates. A sample of 1,179 prisoners had a psychiatric interview including the Brown-Goodwin Assessment for Lifetime History of Aggression (BGLHA). Prisoners completed the Barratt Impulsivity Scale (BIS), Buss-Durkee Hostility Inventory (BDHI), and Eysenck Personality Questionnaire (EPQ). Prisoners with a family history of suicide were compared with prisoners without a family history of suicide on clinical and personality variables. Seventy of the 1,179 prisoners (5.9%) had a family history of suicide. Significantly more FHS positive prisoners had attempted suicide compared with FHS negative prisoners (36% vs. 12%, P < 0.0001). Significantly more FHS positive prisoners had a previous history of convictions, a history of juvenile convictions, and had exhibited aggressive behavior in jail. FHS positive prisoners had significantly higher aggression scores on the BGLHA, higher hostility scores on the BDHI, higher impulsivity scores on the BIS, and higher neuroticism scores on the EPQ. A family history of suicide may be a useful clinical indicator that a prisoner is at increased risk for suicidal behaviour and may have problems with impulsive-aggression.

Introduction: Recent post-mortem studies of suicide victims have implicated brain-derived neurotrophic factor (BDNF) in suicide. Therefore, it was decided to examine the possible role of a gene in the regulation of BDNF activity in relation to suicidal behaviour among depressed patients., Method: A series of 170 depressed patients were evaluated for their history of suicide attempts and genotyped for the BDNF Val66Met polymorphism (SNP ID: rs6265). Depressed patients who had (n = 97) or had not (n = 73) attempted suicide were compared., Results: Depressed patients who carried the BDNF Val66Met polymorphism variant (GA + AA) appeared to show a significantly increased risk of suicidal behaviour. The risk of a suicide attempt was also significantly higher among those reporting higher levels of childhood emotional, physical and sexual abuse. Secondary analyses suggested that depression severity was a significant risk factor only in the wild-type BDNF genotype, and that the risk of suicide attempts was more predictable within the wild-type group., Conclusion: These preliminary data suggest that BDNF may play a role in the suicidal behaviour of depressed patients., (Copyright 2008 S. Karger AG, Basel.)

Although the serotonin transporter promoter polymorphism (5-HTTLPR) contributes to depression and suicidality in a fashion modulated by environmental stress, 5-HTTLPR has been little examined in relation to suicidal behavior in substance dependence. Recently, a third functional allele of 5-HTTLPR was discovered enabling more of the interindividual variation in serotonin transporter expression to be predicted by genotype. We examined whether the 5-HTTLPR gene alone, or interacting with childhood trauma, was predictive of suicidal behavior in substance-dependent patients, a clinical population that is at high risk of suicide, as well as childhood trauma and other stress. We interviewed 306 abstinent male African-American substance-dependent patients about whether they had ever attempted suicide and administered the 34-item Childhood Trauma Questionnaire (CTQ). Patients and 132 male African-American controls were genotyped to determine the S, L(G), and L(A) 5-HTTLPR alleles; some analyses grouped the S and L(G) alleles on the basis of equivalent function. The distribution of 5-HTTLPR genotypes did not differ between patients and controls, nor between suicide attempters and non-attempters. However, patients with low expression 5-HTTLPR genotypes and above-median CTQ scores were more likely to have attempted suicide. Logistic regression showed increasing risk of a suicide attempt with increasing reports of childhood trauma scores; in addition, this increase was exaggerated among those with low expression forms of the 5-HTTLPR genotype. Childhood trauma interacts with low expressing 5-HTTLPR genotypes to increase the risk of suicidal behavior among patients with substance dependence.

Objective: A high percentage of suicide victims have seen a primary care physician in the months before committing suicide. Thus, primary care physicians may play an important role in suicide prevention., Method: The authors mailed a survey to directors of training programs in family practice, internal medicine, and pediatrics, and 50.5% responded. Data obtained were analyzed with WebStat., Results: Training directors reported deficiencies in training in suicide and depression. Notably, less than half of the internal medicine and pediatrics training directors who replied reported that teaching about suicide was adequate. The majority of them indicated a need for standardized curricular materials on suicide and depression., Conclusions: Experts could provide standardized curricula to primary care residencies in the recognition and management of suicide and depression. More robust training about these vital mental health concerns in primary care could reduce morbidity and mortality.

Objective: To examine longitudinal data about depression in relationship to glycemic control and as a risk factor for diabetic retinopathy (DR). Depression is a common psychiatric disorder among diabetic persons and has been shown in cross-sectional studies to be associated with the vascular complications of diabetes., Methods: A total of 483 African-American patients with Type 1 diabetes had a baseline examination and 6-year follow-up examination. Evaluations at both visits included administering the Beck Depression Inventory (BDI), a detailed ophthalmologic examination, retinal photographs, and measurement of glycosylated hemoglobin as an index of glycemic control. Six-year progression of DR between baseline and follow-up visits was evaluated from the change in retinopathy severity using the Early Treatment of Diabetic Retinopathy Study grading scale., Results: Patients with high BDI scores at both baseline and 6-year follow-up visits had significantly higher baseline glycosylated hemoglobin values (p = .01), and were more likely to show progression of DR (odds ratio (OR) = 2.44; 95% confidence interval (CI): 1.01-5.88; p = .049) and progression to proliferative diabetic retinopathy (PDR) (OR = 3.19; 95% CI: 1.30-7.87; p = .01) than patients with low BDI scores at both visits. This was independent of baseline medical risk factors for DR., Conclusion: Six-year longitudinal data indicate that depression is significantly associated with both poor glycemic control and higher 6-year progression to PDR in African-Americans with Type 1 diabetes.

Suicidal behavior is a common and important problem among alcohol dependent patients. The study was designed to examine risk factors for attempting suicide in 499 alcohol dependent patients. Those who had attempted suicide (N = 198) were more likely to be female, report a family history of suicidal behavior, report more childhood trauma, report greater levels of aggressive behavior, began heavy drinking earlier, and were more likely to have received antidepressant medication. Logistic regression analysis showed that gender, family history, and childhood sexual abuse history made significant and independent contributions to the risk of a suicide attempt. Thus, developmental, personality, family history, social, and comorbidity risk factors may differentiate alcohol dependent patients who have attempted suicide from those who have not.

Resilience is an important personality feature that is thought to be protective against the development of psychiatric disorder. However, it appears not to have been previously examined directly in relation to suicidal behavior. Therefore, with the recent development of a resilience scale, the purpose of this preliminary study was to examine resilience in relation to attempting suicide. In order to do this 100 abstinent substance dependent patients were interviewed about whether or not they had ever attempted suicide and completed the Connor-Davidson Resilience Scale. The results showed that patients who had attempted suicide (N=41) had significantly lower resilience scale scores than patients who had never attempted suicide (N=59). This suggests the possibility that low resilience may be a risk factor for suicidal behavior. Longitudinal studies among suicide attempters, including measures of depression, may further evaluate the possible relevance of resilience to suicidal behavior.

Two competing explanations for higher rates of attempted suicide in women than men were compared. Because childhood sexual abuse is more prevalent in girls than boys, one explanation of higher rates of suicide attempts in women is that it is a direct result of the higher incidence of sexual abuse in girls. Alternatively, higher rates of suicide attempts might result from gender differences in the impact of childhood sexual abuse on suicidal behavior. To compare these theories, data from 1,889 abstinent, substance-dependent patients who completed the Childhood Trauma Questionnaire (CTQ) and who were interviewed about suicide attempts was examined. Scores on each scale of the CTQ were examined as a function of gender and attempter status. Results showed higher rates of suicide attempts in women than in men, higher CTQ scores in women than men, and a higher CTQ score in attempters than nonattempters. However, logistic regression indicated that gender and abuse did not interact to determine attempter status. Thus, the data support the first hypothesis that the greater frequency of suicide attempts in women may be partly attributed to the higher prevalence of childhood sexual abuse in girls. The generalizability of these results to the general population and to other diagnostic groups requires further study.

Low serum cholesterol has been associated with suicidal behavior. Depression has been postulated to be a mediating factor between low serum cholesterol and suicidal behavior. Therefore, this possibility was examined in a large group of 459 diabetic patients that had blood drawn for serum cholesterol levels on the same day that they completed the Beck Depression Inventory. The results failed to show any significant relationship between serum cholesterol levels and either total Beck Depression Inventory (BDI) scores or BDI scores on the item measuring current suicidal ideation. The limitations of the study are discussed.

A family history of suicide indicates a raised risk for suicidal behavior; this liability might be familially transmitted as an impulsive-aggression trait. To examine the impulsivity factor, data from 258 abstinent drug dependent patients who were interviewed about their family history of suicidal behavior and who completed the Barratt Impulsivity Scale (BIS) were examined. The results showed that patients with a family history of suicidal behavior had significantly higher BIS scores for risk taking than patients without a family history of suicidal behavior. Also, patients with a family history of suicidal behavior who had themselves attempted suicide had significantly higher BIS scores for both impulsivity and risk taking than patients with a family history of suicidal behavior who had never attempted suicide.

Childhood traumas are associated with suicidal behavior but this aspect has not been examined in relation to schizophrenia. In this study, 50 chronic schizophrenic patients who had attempted suicide were compared with 50 chronic schizophrenic patients who had never attempted suicide for their scores on the 34-item Childhood Trauma Questionnaire (CTQ). It was found that schizophrenics who had attempted suicide reported significantly higher CTQ scores for emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect than schizophrenics who had never attempted suicide. Therefore, childhood trauma may be a risk factor predisposing schizophrenic patients to attempt suicide.

Context: Tryptophan hydroxylase 2 (TPH2) encodes the rate-limiting enzyme for brain serotonin biosynthesis. It was recently reported that the TPH2 haplotype was linked to depression in humans., Objective: To determine the association of TPH2 with suicide attempt, major depression, and a neurochemical intermediate phenotype, cerebrospinal fluid 5-hydroxyindoleacetic acid., Design: We resequenced TPH2 coding, 5' promoter, 3'-untranslated region, and splice junction regions in 190 individuals selected for ethnic and clinical diversity, determined haplotype structure using 15 single nucleotide polymorphisms spanning 106 kilobases (kb), and performed linkage analysis in 1798 cases and controls representing 4 populations (657 African Americans, including 104 suicide attempters and 135 with major depression; 513 Finnish whites, including 150 suicide attempters; 146 US whites, including 81 with depression, anxiety disorder, or both; and 482 southwestern American Indians, including 123 suicide attempters and 191 with depression, anxiety disorder, or both) and in 94 Finnish whites for cerebrospinal fluid 5-hydroxyindoleacetic acid levels., Results: Sixteen single nucleotide polymorphisms, including Pro206Ser, were detected. The 15-locus panel defined and maximized information content from 2 haplotype blocks in whites, 3 haplotype blocks in African Americans, and the single haplotype block spanning TPH2 in southwestern American Indians. Among common Block1b haplotypes were 2 in yin and yang (opposite) configuration, indicating ancient origin. The yin haplotype, 212121, was increased in frequency in suicide attempters in both populations tested (Finnish whites and African Americans). It was associated with major depression and anxiety disorders in US whites and with major depression in African Americans. The yin haplotype was moderately predictive of lower cerebrospinal fluid 5-hydroxyindoleacetic acid concentrations in controls but not in cases., Conclusion: Haplotype linkage of TPH2 to suicide attempt and major depression and to a mediating phenotype, cerebrospinal fluid 5-hydroxyindoleacetic acid, provides preliminary evidence of a functional locus potentially within a haplotype block at least 52 kb in size.

Social factors are thought to contribute to impulsivity. As childhood traumas predispose to suicidal behavior it was decided to examine whether they may be a determinant of impulsivity, a personality dimension often associated with suicidal behavior. Thus 268 abstinent drug dependent patients completed both the Childhood Trauma Questionnaire (CTQ) and the Barratt Impulsivity Scale (BIS). The results showed that there were significant relationships, albeit small, between CTQ scores and BIS impulsivity scores. These results suggest that childhood trauma may be one determinant of impulsivity as an adult.

The study examined whether having a family history of suicidal behavior is associated with an earlier age of first attempting suicide. Interviews were conducted with 545 patients who had attempted suicide about their family history of suicidal behavior and about their age of first suicide attempt. The results showed that attempters with a family history of suicidal behavior, particularly attempters with two or more such family members, had first attempted suicide at an earlier age than attempters who did not have a family history of suicidal behavior. These results suggest that a family history of suicide, which is known to increase the risk of suicidal behavior, may also be associated with an earlier age of first attempting suicide.

Impulsivity is a personality dimension often implicated in suicidal behavior. However, it has been little studied in drug dependent patients who attempt suicide. Therefore, 292 recently abstinent opiate or cocaine dependent patients were asked to complete the Barratt Impulsivity Scale (BIS). Those who had attempted suicide were compared with those who had never attempted suicide for their scores on the BIS. The results showed that there was no significant difference between the drug dependent patients who had attempted suicide (N = 91) and those who had never attempted suicide (N = 201) on BIS scores. The possible clinical implication may be that the high impulsivity associated with drug dependent patients may mitigate the utility of impulsivity in the suicide risk assessment of such patients.

The aim of the study was to compare African American and Caucasian substance dependent suicide attempters for risk factors for suicidal behavior. One hundred and fifty-eight African American and 95 Caucasian substance dependent patients who had attempted suicide were interviewed and their family history of suicidal behavior recorded. Patients completed the Childhood Trauma Questionnaire, the Eysenck Personality Questionnaire, and the Foulds Hostility and Direction of Hostility Questionnaire. The results revealed that there were no significant differences between the African American and Caucasian suicide attempters for marital status, age, childhood abuse, or for personality scores for neuroticism, extraversion, psychoticism, or hostility. However, the African American attempters had significantly lower childhood emotional neglect scores. Also, significantly more of the Caucasian attempters had a family history of suicide and current legal problems. Further studies seem warranted examining for differences between African Americans and Caucasians for risk factors for suicidal behavior.

Background: To examine distal risk factors for suicidal behavior in alcoholics., Methods: Two-hundred and eighty alcoholics were interviewed and completed the Childhood Trauma (CTQ) and Eysenck Personality Questionnaires (EPQ)., Results: One-hundred and twenty-one of the two-hundred and eighty alcoholics had attempted suicide (42.9%). Significantly more of the attempters were female and had a family history of suicidal behavior. Alcoholics who had attempted were significantly younger and had significantly higher CTQ scores for emotional abuse, physical abuse, sexual abuse, emotional neglect and physical neglect. Attempters were significantly more introverted and neurotic on the EPQ. Significantly more alcoholics who had attempted suicide had received antidepressant medication., Limitation: Other possible distal and proximal suicide risk factors were not examined., Conclusion: These results suggest that the suicide risk factor model may be applicable to suicidal behavior in alcoholics. Distal risk factors like childhood trauma, family history of suicide, and introversion may increase an alcoholics suicide risk when they experience a proximal or trigger factor like depression.

The aim of the study was to further describe the characteristics of drug-dependent patients who attempt suicide. Thus, 449 drug-dependent patients were interviewed about whether or not they had ever attempted suicide and about their family history of suicidal behavior. Patients completed the Childhood Trauma Questionnaire and the Eysenck Personality Questionnaire, and were interviewed with the Addiction Severity Index (ASI). It was found that patients who had attempted suicide (N=175) were significantly younger than patients who had never attempted suicide (N=274). Significantly more of the patients who had attempted suicide were female; had a family history of suicide; and had a lifetime history of major depression, of having received antidepressant medication, and of alcoholism. Also, patients who had attempted suicide had significantly higher scores for childhood trauma, psychoticism, neuroticism and introversion, as well as higher ASI psychiatric composite scores. These results suggest that social, personality, family, developmental and psychiatric risk factors may predispose to suicidal behavior in drug-dependent individuals.

Alterations in stress responsivity may be important in the vulnerability to become cocaine dependent. Thus, an index of hypothalamic-pituitary-adrenal (HPA) axis function was examined in abstinent cocaine-dependent patients. Cerebrospinal fluid (CSF) concentrations of corticotropin releasing factor (CRH) were determined in 29 abstinent cocaine-dependent patients and 66 normal controls. The results showed that there was no significant difference between the abstinent cocaine-dependent patients and normal controls for CSF CRH. Also, CSF CRH concentrations were not related to cocaine-craving scores in a cue-elicited cocaine-craving procedure. Thus, these data suggest that after protracted abstinence from cocaine there is no marked dysregulation of CRH systems as measured by CSF CRH concentrations.

The objective of the study was to examine the relationship between an index of central dopamine function and electroretinographic (ERG) blue cone amplitudes in cocaine-dependent patients. Thus, 17 recently abstinent cocaine-dependent patients had an ERG performed. They also had a lumbar puncture for determination of cerebrospinal (CSF) concentrations of the dopamine metabolite homovanillic acid (HVA). It was found that patients who had reduced ERG blue cone b-wave amplitudes (<0.5 microV) had significantly lower concentrations of CSF HVA than patients who had ERG blue cone b-wave amplitudes greater than 0.5 microV. There was also a significant positive correlation between ERG blue cone amplitudes and CSF HVA concentrations. These results suggest the possibility that ERG blue cone amplitudes may be a neurobiologic marker related to central dopamine function in cocaine-dependent patients., (Copyright 2002 Elsevier Science Ireland Ltd.)

Background: Neuroticism is an important personality dimension associated with depressive and anxiety disorders. Both genetic and social factors are thought to contribute to neuroticism. This study aims to examine whether early childhood adversity may be a determinant of neuroticism., Method: Five hundred and thirty-two abstinent substance dependent patients completed both the Childhood Trauma Questionnaire (CTQ) and the Eysenck Personality Questionnaire (EPQ)., Results: There was a significant relationship between total childhood trauma scores on the CTQ and neuroticism scores on the EPQ. There were also significant relationships between neuroticism and CTQ subscores for emotional abuse, physical abuse, sexual abuse, emotional neglect and physical neglect., Conclusions: Childhood trauma may be a determinant of neuroticism. This may be one way in which childhood trauma plays a role in the development of psychiatric disorders. General population studies are needed.

Non-human primate studies suggest that early environmental influences may have an enduring effect on central serotonin function. Therefore, it was decided to examine in humans whether childhood trauma might be related to cerebrospinal fluid (CSF) concentrations of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) as an adult. A total of 29 withdrawn cocaine-dependent patients completed the Childhood Trauma Questionnaire. They also had a lumbar puncture for determination of CSF concentrations of 5-HIAA. CSF concentrations of the dopamine metabolite homovanillic acid (HVA) were also determined. Childhood emotional neglect scores showed significant negative correlations with CSF levels of 5-HIAA and HVA, and patients with emotional neglect scores above the median had significantly lower CSF 5-HIAA and HVA levels than patients with emotional neglect scores at or below the median. These findings suggest the possibility that childhood trauma may have an effect on central monoamine function as an adult.

Whether a family history of suicide (FHS) might increase the risk for suicidal behavior through an effect on personality was examined. Patients with a first or second-degree relative who had committed suicide were compared with matched patients with a negative FHS for their scores on the Eysenck Personality Questionnaire (EPQ). The trend for a difference on EPQ neuroticism scores between the total groups became significant when subgroups of FHS positive and negative patients, who had no personal history of attempting suicide, were compared. Further studies of the relationship of a family history of suicide to personality are needed in other populations and incorporating biologic measures.

Objective: To examine whether childhood trauma may have a relationship to hypothalamic-pituitary-adrenal (HPA) axis function as an adult., Methods: Forty-six withdrawn cocaine dependent patients participated in 24-h urine collections for determination of urinary-free cortisol (UFC) and completed the Childhood Trauma Questionnaire (CTQ)., Results: Patients with a mean UFC output below the median had significantly higher CTQ scores for childhood sexual abuse than patients with UFC outputs above the median. Multiple regression analysis showed that both childhood emotional neglect and sexual abuse were independently associated with UFC outputs., Conclusion: These cross sectional data, in a sample of middle-aged cocaine dependent patients, suggest the possibility that childhood trauma may have an effect on HPA axis function and thus predispose to psychiatric disorders. Further studies are needed in different samples.

Objective: To describe the characteristics of opiate dependent patients who attempt suicide., Method: Opiate dependent patients (DSM-IV criteria) who had (N = 105) or had not (N = 141) attempted suicide were compared for family history of suicide, childhood trauma, personality traits, and experience of comorbidity with cocaine and/or alcohol dependence, major depressive disorder. and physical disorder., Results: Significantly more opiate dependent patients who had attempted suicide were female (p < .0001) and unemployed (p < .0006). Patients who had attempted suicide reported significantly more family history of suicide and more childhood trauma; scored significantly higher for introversion, hostility, and neuroticism; and had experienced significantly more comorbidity with lifetime cocaine and alcohol dependence, major depressive disorder, and current physical disorder (p < .05 for all)., Conclusion: Suicidal behavior in opiate dependent patients may involve risk factors from the family, childhood, personality, psychiatric, and physical domains.