Project plan for studies on suicide, attempted suicide, and suicide prevention

Completed and attempted suicide are major public health problems in most western countries. The importance of suicidal behavior as a health problem, particularly among adolescents and young adults, has been emphasized by the European Union, the WHO (Europe), as well as the Finnish authorities. Due to the exceptionally high suicide mortality, suicide prevention has been one of the main targets of Finnish health policy since the late 1980s. However, to develop feasible strategies for suicide prevention, better knowledge of the phenomenon of self-destruction is necessary. The Department of Mental Health of the National Public Health Institute has been actively involved in suicide research and the development of suicide strategies both in Finland and western Europe since 1986. The success is based on a long tradition of suicide research in Finland, the representative and reliable suicide data, a highly motivated research group, and also the necessary economic support by both the National Public Health Institute and the Finnish Academy. This article outlines our groups research plan for the next few years.     

Dimensions of perfectionism in unipolar depression.

We tested the hypothesis that self-oriented perfectionism, other-oriented perfectionism, and socially prescribed perfectionism are related differentially to unipolar depression. The Multidimensional Perfectionism Scale was administered along with measures of depression and anxiety to 22 depressed patients, 22 matched normal control Ss, and 13 anxiety patients. It was found that the depressed patients had higher levels of self-oriented perfectionism than did either the psychiatric or normal control Ss. In addition, depressed patients and anxious patients reported higher levels of socially prescribed perfectionism than did the normal control Ss. The results suggest that various dimensions of perfectionism may play an important role in clinical depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug-induced depression and attempted suicide

Sixty-eight patients who had attempted suicide were matched with non-suicidal patients with similar diagnoses to assess the extent to which excessive drug ingestion by the suicidal group might have contributed to their behaviour. It was found that the suicidal patients were consuming more drugs, particularly those of a potentially depressing kind. The implications of this finding are discussed.     

Problem-solving appraisal, hopelessness, and suicide ideation: Evidence for a mediational model.

Extended the research on D. E. Schotte and G. Clum's (see PA, Vols 69:1287 and 74:15906, respectively) theory of suicidal behavior using structural equation modeling involving latent variables to evaluate whether the construct of hopelessness mediates between the constructs of problem-solving appraisal and suicide ideation (SI). Participants in the study were 217 individuals in an intensive outpatient program targeting suicidal behavior in young adults. Results indicated a significant direct effect for hopelessness in predicting suicide ideation. Consistent with the mediational hypothesis, the results also indicated a significant indirect effect for problem-solving appraisal (through its impact on hopelessness) in predicting SI. Results not only replicate but also extend previous research by testing theory and increase the field's conceptualization of SI and behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Categories of attempted suicide: a longitudinal study

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

Association between epilepsy and attempted suicide

In a two-year study of patients admitted to hospital after deliberate self-poisoning or self-injury, a fivefold excess of patients with epilepsy was found compared with general population prevalence rates. Males with epilepsy were particularly over-represented. Patients with epilepsy were prone to make repeat attempts. Anticonvulsants, particularly barbiturates, were used in most cases of self poisoning.     

Predicting hopelessness and psychological distress: The role of perfectionism and coping.

This study investigated an integrative model involving the relationship between perfectionism (P. L. Hewitt & G. L. Flett, 1991) and coping (C. S. Carver, A F. Scheier. & J. K. Weintraub, 1989) to predict changes in hopelessness and general psychological distress among college students. Results indicated that changes in psychological well-being (4-5 weeks later) were predicted by socially prescribed perfectionism, and, as theorized, avoidance coping moderated the link between perfectionism and psychological well-being beyond initial levels of distress. Support was also found for the adaptive effects of cognitive reconstruction coping and other-oriented perfectionism, whereas, under certain conditions, self-oriented perfectionism was shown to be maladaptive. These findings offer support for the proposed model. Implications for intervention and suggestions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived problem-solving ability as a predictor of depression, hopelessness, and suicide ideation in a college population.

A longitudinal design with a mild, naturalistic stressor (poor grade on a midterm exam) tested whether perceived problem-solving ability predicted adjustment in a sample of 303 college students. Participants completed assessments before (Time 1) and after (Time 2) the stressor. Individuals who appraised their problem-solving ability as lower at Time 1 were found to be more vulnerable to the stress of a low grade and experienced higher levels of depression and hopelessness, though not of suicide ideation, at Time 2. These results were obtained independent of pretest scores on these adjustment measures. The results support the model of Perceived Problem-Solving?×?Stress as a predictor of adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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

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

Suicidal thinking among adolescents with a history of attempted suicide

OBJECTIVE: To examine the risk of suicidal plans and ideation, depression, and other factors (low self-esteem, loneliness, fatalism, pessimism) among adolescents with a lifetime history of attempted suicide. METHOD: A self-administered questionnaire was used in a school-based survey of five middle schools (grades 6 through 8) enrolling 6,400 students. Usable questionnaires were obtained from 5,423 (85.3%). Data were obtained on a wide range of constructs including recent and lifetime suicide attempts, recent and lifetime suicide plans, recent ideation, symptoms of DSM-IV major depression, self-esteem, pessimism, loneliness, and fatalism. RESULTS: Data on crude prevalence showed thoughts about death, wishing to be dead, thoughts of suicide, and suicide plans were all significantly higher among youths with a history of attempts. Suicidal thinking was related to being more lonely, more fatalistic, and more pessimistic, and to less self-esteem, in addition to depression and a history of attempts. Multivariate analyses revealed the strongest factors associated with current suicidal thinking were history of attempts (odds ratio [OR] = 3.50), depression (OR = 5.34), and recent life stress (OR = 2.64). Compared with youths with none of the factors examined, those with six or more were at extreme risk (OR = 67.87). CONCLUSIONS: The strong association between history of suicide attempts, current ideation, and depression indicates that past suicide attempts occur in the context of other signs of psychosocial dysfunction. Given the paucity of epidemiological data on the natural history of suicidal behaviors among youths, more epidemiological studies of the antecedents and consequences of the range of suicidal behaviors among children and adolescents are needed. Given the high risk of subsequent suicidal behaviors by youths who have attempted but not completed suicide, this constitutes a high-risk population on which future research should focus.     

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

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

Epidemiology of attempted suicide by drug overdose in Vienna

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

Accident-proneness in attempted suicide and in automobile accident victims.

The Rosenzweig Picture-Frustration Study was administered to 58 consecutively admitted Ss who had attempted suicide and to 30 consecutively admitted automobile accident victims matched with Ss without histories of accidents. The expectation that similar and deviant modes of handling aggression and frustration might be revealed in the suicide and accident Ss responses to the P-F Study was not supported. (15 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationships among suicide ideators, attempters, and multiple attempters in a young-adult sample

The relationships among suicide ideators, attempters, and multiple attempters were explored in 332 psychiatric patients referred specifically for suicidal ideation or behavior. Previous researchers have subsumed multiple attempters under the general category of attempters. However, comparisons across a range of variables, including Axis I diagnoses from the revised 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987) depressive and anxiety symptoms, suicidal ideation, hopelessness, problem solving, and a range of personality features revealed that multiple attempters presented a more severe clinical picture and, accordingly, elevated suicide risk compared with attempters and ideators. Observed differences between groups were maintained when attempters with "questionable intent" (i.e., those making equivocal attempts) were excluded from the analyses.     

Use of different sources of stress to predict hopelessness and suicide ideation in a college population.

This investigation expands on past research by (1) evaluating differing sources of stress (negative life events and hassles) as predictors of both hopelessness and suicide ideation and (2) testing for the mediating role of hopelessness. In Study 1, 143 introductory psychology students completed measures of negative life events, hassles, and hopelessness. Hassles accounted for a unique increment in hopelessness scores after negative life events were controlled for statistically. In Study 2, 250 introductory psychology students completed measures of negative life events, hassles, hopelessness, and suicide ideation. Results of Study 2 replicate and extend those of Study 1; hassles accounted for unique increments in both hopelessness and suicide ideation scores after negative life events were controlled for statistically. In addition, the results of Study 2 suggest that hopelessness mediates the relation between stress and suicidal thoughts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prediction of eventual suicide in psychiatric inpatients by clinical ratings of hopelessness.

A 9-point clinical rating scale was used to assess the severity of hopelessness in 141 patients hospitalized with suicidal ideation. The patients were followed from 5 to 10 years, and 10 (7.1%) eventually committed suicide. The mean hopelessness rating for the patients committing suicide was significantly higher than that for the patients not committing suicide. A cutoff score of 6 or above successfully predicted 9 (90.0%) of those committing suicide. The results supported previous findings in which self-reported hopelessness on the Beck Hopelessness Scale was reported to predict suicide in both psychiatric outpatients and inpatients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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

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

Dimensions of perfectionism, daily stress, and depression: A test of the specific vulnerability hypothesis.

Tested whether perfectionism dimensions interact with specific stressors to predict depression. A depressed patient sample (N?=?51) and a general psychiatric sample (N?=?94) completed measures of perfectionism, hassles, and depression. Ss in Sample 2 also completed other personality measures to assess the amount of unique variance in depression. Partial support was obtained: In both samples, self-oriented perfectionism interacted only with achievement stressors to predict depression. Socially prescribed perfectionism interacted with interpersonal stress in Sample 1 and with achievement stress in Sample 2 to predict depression. Several personality variables, including socially prescribed perfectionism, accounted for unique variance in depression. The results suggest that perfectionism dimensions are associated with depression and may constitute specific vulnerability factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)