Showing papers on "Suicide attempt published in 1990"
TL;DR: The group practising problem solving improved significantly more than controls on ratings of depression, hopelessness, suicidal ideation and target problems at the end of treatment and at follow-up of up to one year, and there was evidence of an effect on the rates of repetition over the six months after treatment.
Abstract: In a controlled trial, 20 patients at high risk of repeated suicide attempts were randomly allocated to either cognitive-behavioural problem solving or a 'treatment-as-usual' control condition. The group practising problem solving improved significantly more than controls on ratings of depression, hopelessness, suicidal ideation and target problems at the end of treatment and at follow-up of up to one year, and there was evidence of an effect on the rates of repetition over the six months after treatment.
326 citations
TL;DR: Analysis of data from the Epidemiologic Catchment Area surveys in the United States found that educational achievement was inversely associated with risk of suicide attempt, and multivariable conditional logistic regression results were obtained by applying a conventional epidemiologic strategy with poststratification of subjects into homogeneous risk sets.
Abstract: This is a report of new research on suicide attempts, based on an analysis of data from the Epidemiologic Catchment Area surveys in the United States. Risk of making a suicide attempt during a 1-2 year observation interval in the early 1980s was estimated in relation to selected personal and behavioral attributes of 13,673 study participants who completed baseline and follow-up interviews for these surveys. Being an active case of Major Depression was associated with increased risk of suicide attempt (estimated relative odds, RO = 41; 95% CL = 6.46-262), as was active alcoholism (RO = 18; 95% CL = 2.75-118) and being separated or divorced (RO = 11; 95% CL = 1.64-77). Being a user of cocaine was associated with increased risk of making a suicide attempt (RO = 62; 95% CL = 2.51-1528), but illicit use of marijuana, sedative-hypnotics, or sympathomimetic stimulants was not (P greater than 0.30). Educational achievement was inversely associated with risk of suicide attempt at a marginal level of statistical significance (P = 0.068). These multivariable conditional logistic regression results were obtained by applying a conventional epidemiologic strategy with post-stratification of subjects into homogeneous risk sets. Limitations of the study data and the analytic strategy are discussed in relation to directions for future epidemiologic field surveys.
271 citations
TL;DR: There was little evidence that the programs were successful in influencing views consistent with the curricula at baseline, but there was some evidence that previous attempters were more upset by the programs than their nonattempter peers.
Abstract: As part of a controlled evaluation of three suicide-prevention curricula delivered to 1438 ninth- and 10th-grade students, 63 adolescents were identified as having made a suicide attempt. Their attitudes about suicide and help seeking were compared with those of 910 nonattempters drawn from the same population. Reaction to the prevention program was assessed by comparing the responses of the 35 attempters exposed to the programs with responses of 524 exposed nonattempters. The impact of the programs was assessed by comparing 35 exposed attempters with 28 attempters from a control group. Self-identified attempters were less likely to endorse views consistent with the curricula at baseline, but there was little evidence that the programs were successful in influencing these views. There was some evidence that previous attempters were more upset by the programs than their nonattempter peers. The prevalence of suicide attempts as defined in this study by self-report was higher than that reported in studies using interview techniques.
176 citations
TL;DR: Survival analytic techniques are discussed in which the time until a suicide attempt from a specific point, such as prior attempt or onset of illness, is also examined, and Cox's proportional hazards model is discussed, which estimates the significance of different risk factors.
Abstract: Studies of suicide risk factors generally examine suicidal behavior as a dichotomous outcome. Survival analytic techniques are discussed in which the time until a suicide attempt from a specific point, such as prior attempt or onset of illness, is also examined. These procedures can incorporate information on those lost to followup or “censored.” One survival analytic technique, Cox's proportional hazards model, is a particularly informative statistical technique for the study of suicidal risk factors because several covariates can be incorporated. Illustrative analyses estimate the significance of different risk factors, and demonstrate that there is a 32% increase in the relative risk of a suicide attempt associated with each prior attempt.
154 citations
TL;DR: Early identification and treatment of affectively ill youth that target the above-noted domains may prevent much of the associated morbidity and mortality due to suicidality.
Abstract: Forty-two suicidal and 14 nonsuicidal affectively ill adolescent psychiatric inpatients were compared with respect to clinical phenomenology and measures of cognitive distortion, social skills, and familial-environmental stress. The suicidal group had an earlier onset and longer duration of affective illness and greater self-rated depression. The suicidal group also evinced greater cognitive distortion, less assertiveness, a greater likelihood of both a history and exposure to familial suicidality, and more life stressors within the 12 months prior to hospitalization. Among those suicidal patients who presented with a suicide attempt, suicidal intent was related to "double depression," comorbidity with substance abuse or conduct disorder, lack of assertiveness, family conflict, and family history of suicidal behavior. Early identification and treatment of affectively ill youth that target the above-noted domains may prevent much of the associated morbidity and mortality due to suicidality.
150 citations
TL;DR: Self-perceived chronic loneliness in childhood appears to be a singularly important initiator of adolescent drug use and subsequent suicide attempts among drug abusers.
Abstract: • Substance use has been identified as a significant risk factor in nonfatal and fatal suicides during adolescence. A • prehensive questionnaire on patterns of alcohol and other drug use, early childhood and nuclear family psychological and behavioral history, and previous suicidal attempts was completed by 298 (88%) of 340 outpatient adolescent substance abusers in three geographic regions east of the Mississippi River. An abbreviated Beck Depression Inventory was included to ascertain current symptoms of depressed mood. Adolescents admitting to a previous suicide attempt (30%) were compared with two age- and sex-matched samples. Substance abusers were three times as likely as a normative population of non—drug-using ageand sex-matched peers to make a suicide attempt. Thirty-three percent of attempts reported occurred prior to high school. Both the wish to hurt oneself and actual suicide attempts were found to increase significantly after the initiation of substance use. Forty percent used drugs within 8 hours before the suicide attempt, and 23% of attempters reported that their families continued to have a firearm with ammunition in the home following the suicide attempt. Adolescent substance abusers who had attempted suicide were significantly more likely than a matched group of nonattempters in the same drug treatment facility to: (1) complain of usually feeling "blue" or sad (depressed affect) during early childhood, (2) identify important childhood behavioral problems, (3) identify long-standing self-perceived impaired self-concept, and (4) identify serious parental problems, such as chronic depression or alcoholism. Self-perceived chronic loneliness in childhood appears to be a singularly important initiator of adolescent drug use and subsequent suicide attempts among drug abusers. ( AJDC. 1990;144:310-314)
88 citations
TL;DR: Aspects of problem solving were measured in nine male psychiatric patients, hospitalized after attempted suicide, interpreted as indicating a decreased ability of suicidal patients to generate new ideas, when no alternatives are provided.
Abstract: Aspects of problem solving were measured in nine male psychiatric patients, hospitalized after attempted suicide. Testing took place within 3 weeks (except for one patient) of the suicide attempt. Controls were patients with chronic idiopathic pain and healthy volunteers. Suicidal patients had significantly lower scores on general intellectual tests and in verbal and design fluency. No differences in problem solving (the Perceptual Maze Test and the Wisconsin Card-Sorting Test) and flexibility (the Uses of Objects Test and the Stroop Test) were found. The results are interpreted as indicating a decreased ability of suicidal patients to generate new ideas, when no alternatives are provided.
78 citations
TL;DR: In independent psychiatric interviews with 175 children and their mothers, either the mother or the child reported that 13 (7%) of the children had made a suicide attempt.
Abstract: In independent psychiatric interviews with 175 children and their mothers, either the mother or the child reported that 13 (7%) of the children had made a suicide attempt. Eight of the 13 children reported attempts that were not reported by their mothers.
58 citations
TL;DR: It is suggested that seclusion may meet specific needs for children and may not always be an indicator of inadequate institutional policies and programs.
Abstract: Characteristics of 102 children admitted to a child psychiatry unit were analyzed to determine predictability of seclusion use. A subgroup of 36 children was rated using the Zeitlin Coping Inventory. Results showed that frequently secluded children were significantly more likely to have a history of physical abuse, neurological impairment, relatively weaker verbal ability, assaultive behavior, and a suicide attempt in the 6 months prior to admission. They shared a profile of coping behavior, such as more need for environment structure, less ability to successfully meet needs, and more activity and rigidity in their unsuccessful attempts. Three items on the Coping Inventory related to frustration tolerance, response to external controls, and knowledge of what is expected in situations were highly predictive of seclusion use. Results suggest that seclusion may meet specific needs for children and may not always be an indicator of inadequate institutional policies and programs.
58 citations
Journal Article•
TL;DR: In this article, the authors examined the relationship among depression, social skills, and suicidal behavior in a sample of 41 adolescents hospitalized in a general medical setting following a suicide attempt, compared to 40 nonsuicidal psychiatrically hospitalized adolescents.
Abstract: The relationship among depression, social skills, and suicidal behavior was examined in a sample of 41 adolescents hospitalized in a general medical setting following a suicide attempt. These subjects were compared to 40 nonsuicidal psychiatrically hospitalized adolescents. Level of depression, assessed using the Children's Depression Inventory (CDI), and social skills, assessed via the Matson Evaluation of Social Skills with Youngsters (MESSY), were evaluated for all subjects. The suicide attempters and psychiatrically hospitalized patients were not found to differ on either the CDI or MESSY. However, multiple regression analyses revealed the factor scores of the MESSY to be related to depression in both patient groups. The data provide support for the relationship between social skills and depression. Results are also discussed in terms of the similarities between adolescent suicide attempters and nonsuicidal psychiatrically disturbed adolescents.
58 citations
TL;DR: Results support the concept that feeling expendable is a characteristic of suicidal adolescents and implications for prevention and treatment of adolescent suicidality are discussed.
Abstract: Assessed the concept of the "expendable child" syndrome proposed by Sabbath (1969) as a contributing factor in adolescent suicide attempts. It was hypothesized that suicidal adolescents would be rated higher on a measure of "expendability" than would a psychiatric control group of adolescents with no known history of suicide attempts or ideation. Forty adolescents, ages 13-24, who had been seen in psychotherapy at a teen-age health clinic, were rated by their psychotherapists on suicidality and a 12-item scale of expendability (a sense of being unwanted and/or a burden on the family). As predicted, suicidal adolescents received significantly higher ratings on the expendability measure than non-suicidal adolescents. Results support the concept that feeling expendable is a characteristic of suicidal adolescents. Implications for prevention and treatment of adolescent suicidality are discussed. Language: en
TL;DR: The findings suggest that primary medical care settings serving the poor and homeless may present an excellent opportunity for delivering mental health services and that psychiatrists should expand their involvement in such settings.
Abstract: Data were collected on indicators of mental health status and substance abuse among 214 homeless and 250 domiciled but impoverished patients who sought care in a community medical clinic in a california beach community. Although both groups had a high prevalence of problems, homeless patients were significantly more likely to have been hospitalized for alcohol or mental problems, to have been arrested because of drinking, and to have experienced delirium tremens. Homeless persons were also more likely to have made a suicide attempt, to have experienced recent psychotic symptoms, and to be dissatisfied with life. The findings suggest that primary medical care settings serving the poor and homeless may present an excellent opportunity for delivering mental health services and that psychiatrists should expand their involvement in such settings.
TL;DR: Risk for suicidal ideation and suicide attempt among solvent users appeared to covary with presence of antisocial personality disorder, alcoholism, and secondary depression rather than being specifically associated with solvent use.
Abstract: From a family study of 286 alcoholics, 157 felons, 60 control subjects, and 1640 of their relatives, 130 solvent users were retrospectively identified. Risk for diagnosis of antisocial personality disorder was significantly elevated for all solvent users. Relatives, though not probands, were more likely to receive diagnoses of alcoholism and secondary depression, but this relationship appeared to be mediated by the presence of antisocial personality disorder. Solvent users were not at increased risk for primary depression or other psychiatric illnesses. Subjects reporting any solvent use also had significantly increased risk of suicidal ideation and suicide attempt compared to non-users, with half of the solvent users reporting suicidal ideation and 30% reporting a history of suicide attempt. However, risk for suicidal ideation and suicide attempt among solvent users appeared to covary with presence of antisocial personality disorder, alcoholism, and secondary depression rather than being specifically associated with solvent use.
01 Jan 1990
TL;DR: Depression, by itself and in combination with other disorders, is arguably the most common problem seen in clinical practice (Seligman, 1975).
Abstract: A discussion of the treatment of depression has a special place in any book on Cognitive Therapy. Depression was, after all, the first problem area to which Beck (1967, 1976) applied Cognitive Therapy. It is also the clinical problem that has been most extensively studied in terms of the efficacy of Cognitive Therapy (Simon & Fleming, 1985). Finally, depression, by itself and in combination with other disorders, is arguably the most common problem seen in clinical practice (Seligman, 1975).
TL;DR: Tasks for the psychiatric consultant include dealing with reactions of hospital staff, instituting appropriate suicide precautions, determining future suicidality and psychiatric disposition, and helping patients cope with family reactions to the suicide attempt and with the psychological effects of disfiguring injuries.
TL;DR: Ego function ratings showed that violent attempters were more paranoid than both other groups and less able to cope with conflict situations, to handle dysphoric affect and to differentiate between reality and imagination.
Abstract: Rorschach records from 20 patients who had made active, violent suicide attempts were compared with records from 20 patients who had taken drug overdoses and 20 psychiatric control patients who had not made a suicide attempt. Ego function ratings showed that violent attempters were more paranoid than both other groups and less able to cope with conflict situations, to handle dysphoric affect and to differentiate between reality and imagination. Violent attempters had lower level of cognitive maturity than controls and tended to produce fabulized combination responses, suggesting cognitive slippage, and distorted human content responses, indicating pathological object relationships. Nonviolent attempters did not differ from controls. Six patients, all from the violent attempt group, completed suicide within a follow-up period of 4 years. Compared with the survivors, they were less tolerant of dysphoric affect and showed more pronounced decline of developmental level within cards. Completers could be identified on the Rorschach at 55% sensitivity and 93% specificity.
TL;DR: A case of a serious adolescent couple suicide attempt assessed and treated by the authors is reported here and the dynamics of this case are compared to the findings, the studies and case reports on adult suicide pacts.
Abstract: A suicide pact is a mutual arrangement between two people to kill themselves at the same time, usually in the same place. A summary of the highlights from a literature survey on suicide pacts with a major focus on high risk factors is presented in this paper. The victims of suicide pacts are usually the spouses over age 50. The instigator is usually a depressed male with a history of self-destructive behaviour. In many cases the presence of an overdependent relationship, and a threat to the maintenance of closeness are strongly associated with the attempt. Since there were no adolescent couple suicide pacts in the literature, a case of a serious adolescent couple suicide attempt assessed and treated by the authors is reported here. The dynamics of this case are compared to the findings, the studies and case reports on adult suicide pacts. Language: en
TL;DR: In this paper, a study of prior suicidal behavior in a nonclinical population indicated that impulsivity was associated only with a history of threatening suicide or considering suicide, not with any history of considering suicide or attempting suicide.
01 Jan 1990
TL;DR: In this paper, the suicidal client presents the therapist with a life and death crisis that demands an immediate response and in which the possible consequences of ineffective interventions are obvious, and the therapist has the conflicting goal of keeping the client alive.
Abstract: Cognitive Therapy with a suicidal client is quite different from therapy with a depressed client who is not suicidal. Even the most experienced therapist reacts with a surge of emotion when it becomes clear that a client is seriously considering taking his or her own life. The suicidal client presents the therapist with a life and death crisis that demands an immediate response and in which the possible consequences of ineffective interventions are obvious. At the same time, Cognitive Therapy’s collaborative approach can be difficult to implement when the client is seriously considering suicide and the therapist has the conflicting goal of keeping the client alive. Finally, it can be difficult to use a guided discovery approach when the client’s motivation for therapy is questionable and the therapist feels realistic pressure to intervene quickly.
TL;DR: A national underutilization of psychiatric consultation services in general hospitals in Kuwait is suggested, and the most common reason for referral was for assessment of a suicide attempt in the inpatient group and the absence of organic cause for patients' physical symptoms in the outpatient group.
01 Jan 1990
TL;DR: In order to be more effective in a preventive role, physicians must understand the distribution and determinants of suicide and be able to apply that knowledge in prevention strategies.
Abstract: Physicians have an excellent opportunity to assist in the reduction of suicide, especially since they often see persons while they are in the process of considering the act. In a study of 60 persons who had committed suicide, Murphy found that 82% were known to have seen a physician within six months, and among 53 the visit occurred within one month or less of their death.1 They had seen a total of 71 physicians. Over two thirds of the patients had histories of suicide attempts, but only 40 of the physicians were aware of the histories. In some cases, the physician had provided the means of suicide by prescribing lethal amounts of medication to the patient.2 The relatively high rate of suicide within the medical profession is another reason for physicians to be personally concerned.3 In order to be more effective in a preventive role, physicians must understand the distribution and determinants of suicide and be able to apply that knowledge in prevention strategies. This chapter reviews important risk factors for suicide and assesses the effectiveness of various modes of intervention.
TL;DR: The MMPI results suggest it may be possible to identify a suicide attempt group in substance abusers but not when contrasted with a suicidal ideation group.
Abstract: Compared to drug addicts without histories of suicidal attempt (n = 50), drug addicts who have attempted suicide (n = 50) were characterized by higher levels of maladjustment--particularly in the areas of depression, feelings of alienation, and use of projection and externalization--and were more emotionally withdrawn. Certain Minnesota Multiphasic Personality Inventory (MMPI) codetypes appeared in the attempt group that were not present in the no history group. Drug addicts with suicidal ideation but no history of attempt (n = 13) were not significantly different from the other two groups, and their inclusion as a comparison group masked the real differences between the other two groups. The MMPI results suggest it may be possible to identify a suicide attempt group in substance abusers but not when contrasted with a suicidal ideation group. Treatment implications are considered.
01 Jan 1990
TL;DR: The Hemlock Society is based on the firm conviction that individuals are entitled to choose the time and method of their own death as discussed by the authors, however, the idea of rational suicide is hotly debated even for adults.
Abstract: Albert Camus (1955) has stated that suicide is the only important philosophical issue. For adults, one could argue that there are times when suicide may be a reasonable alternative to increasingly debilitated health or impaired functioning. Groups such as the Hemlock Society are based on the firm conviction that individuals are entitled to choose the time and method of their own death. However, the idea of “rational suicide” is hotly debated even for adults. Adolescent suicide is difficult to think of other than as a horrifying and tragic event that cuts short all promise and potential in a young life.
TL;DR: While the results indicate very few differences between the MCMI-II profiles of these two groups of patients, suicide attemptors scored significantly higher on Scale Y (Desirability), which suggests greater tendencies toward denial of problem areas.
Abstract: The MCMI-II profiles of 40 psychiatric inpatients admitted for suicidal ideation and 40 patients admitted for a suicide attempt were compared. Subjects in each group were matched on sex, history of previous attempts, and other demographic variables. While the results indicate very few differences between the MCMI-II profiles of these two groups of patients, suicide attemptors scored significantly higher on Scale Y (Desirability), which suggests greater tendencies toward denial of problem areas. Patients with suicidal ideation yielded a mean profile with elevations on Scale 2 (Avoidant), 8A (Passive-Aggressive), 8B (Self-Defeating), C (Borderline), D (Dysthymia), and Z (Debasement). These results are discussed in terms of a stress-vulnerability model of suicidal behavior with suggestions made for expanding on the findings in future studies. Language: en
Journal Article•
TL;DR: A pilot instrument to examine the differences between adolescents who have attempted suicide and other teenagers is developed, creating a streamlined instrument for assessing suicide risk that can be administered in 20 minutes.
Abstract: Dramatic increases in the adolescent suicide rate over the past three decades have underscored the need for risk-assessment tools. The tools that do exist are oriented to older populations and their application to adolescents is questionable. A project was initiated at the University of Utah's Health Education Department to develop a pilot instrument to examine the differences between adolescents who have attempted suicide and other teenagers. Eighty-two subjects between the ages of 14 and 19 participated in the test of this instrument. Twenty-five subjects were identified by a physician or psychologist as having failed in a sincere suicide attempt within the previous 18 months. Fifty-seven nonsuicide attempters with similar demographic profiles served as a comparison group. An 86-item questionnaire was administered to both groups. Questions were generated from a review of the literature of the past three decades for problems associated with suicide in this population. Questions were sorted into three domains (family environment, social environment, and self-perceptions), with each domain having several subdomains. Statistical analysis revealed significant differences for each of the three domains and on 55 of 86 questions. The results were used to create a streamlined instrument for assessing suicide risk that can be administered in 20 minutes. Language: en
01 Jan 1990
TL;DR: In this article, the lifetime prevalence of suicidal ideation or suicide attempts in 100 consecutive referrals for treatment of panic disorder was estimated and the season of onset of panic attack was found to be very skewed distribution of first panic in late spring or summer.
Abstract: In a study of the general population, Weissman et al (1989), found that panic disorder is associated with an increased risk of suicide attempt. We estimated the lifetime prevalence of suicidal ideations or suicide attempts in 100 consecutive referrals for treatment of panic disorder. Sixty per cent of these patients had had suicidal ideation and 42% had attempted suicide during their lifetime. With regard to the season of onset of panic attack, we found a very skewed distribution of first panic in late spring or summer. Furthermore, patients who had their first attack in spring or summer had a higher rate of suicidal ideation and an increased risk of suicide attempt.
Journal Article•
TL;DR: The authors report the case of a 22 years old woman without psychiatric antecedent who started a prophylaxis with mefloquine for a journey in a chloroquino resistant area and induced an acute psychiatric syndrome which lasted five days and a suicide attempt by drowning.
Abstract: The authors report the case of a 22 years old woman without psychiatric antecedent who started a prophylaxis with mefloquine for a journey in a chloroquino resistant area. The first tablet induced an acute psychiatric syndrome which lasted five days; the second tablet induced the recidive of the psychiatric data and a suicide attempt by drowning.
01 Jan 1990
TL;DR: Suicide is one of the leading causes of death among young people in Canada as mentioned in this paper, and suicide ranks second among males aged 15 to 19 years and third among females in the same age group.
Abstract: Suicide in Canada,1 the Report of the National Task Force on Suicide in Canada, defines suicide as “intentional self-inflicted death” (p. 3). Suicide today is one of the leading causes of death among young people in Canada. It ranks second among males aged 15 to 19 years and third among females in the same age group.2,3 A nonfatal outcome of “intentional self-inflicted death” is described as attempted suicide or parasuicide and covers a variety of self-destructive behavior ranging from serious life-threatening acts to relatively minor gestures primarily aimed at attracting attention.4
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TL;DR: A sound approach to these issues does not always preclude a suicidal outcome, but it can help to minimize preventable deaths, which constitute a tragic human loss and a source of severe stress to therapists and to vulnerable survivors.
Abstract: Suicidal patients occupy a special place in any clinician’s practice, largely because of the social, legal, and ethical implications of self-destructive behavior in our culture. As suicide is the most visible cause of mortality in persons with emotional disorders, intense family concern and a sense of professional vulnerability bring a certain urgency to the issues involved. A sound approach to these issues does not always preclude a suicidal outcome, but it can help to minimize preventable deaths, which constitute a tragic human loss and a source of severe stress to therapists and to vulnerable survivors.
Journal Article•
TL;DR: Among the persons repeating suicide attempts affective illnesses, brain damage and personality disturbances were more often diagnosed; mental disturbances of their parents and/or disruption of their families in their childhood in the cases of these patients were more frequent.
Abstract: It has been found out that 45% of the Toxicology Clinic patients hospitalized by their suicide attempt had previous suicide attempts. Calculations have shown that there were 76 previous suicide attempts in all and that 48 (63%) among these were not followed by any psychological and/or psychiatric help. The most frequent reason of this was keeping the attempt secret from further environment. Among the persons repeating suicide attempts affective illnesses, brain damage and personality disturbances were more often diagnosed; mental disturbances of their parents and/or disruption of their families in their childhood in the cases of these patients were also more frequent. Collapse or loss of significant interpersonal relations was a more frequent motive for trying to take one's life with persons repeating suicide attempts. Language: pl