1. New biomarker is higher in suicide attempters and associated with stress response

    December 14, 2016 by Ashley

    From the Lund University media release:

    debt stressResearchers at Lund and Malmö universities in Sweden have measured a biomarker in cell-free blood plasma which can be linked to an overactive stress system in suicidal individuals. This biomarker can hopefully be used in future psychiatric studies.

    “We don’t expect the marker to be able to predict who will try to commit suicide, but it may serve as a biological marker indicating greater stress exposure in vulnerable people suffering from various psychiatric conditions such as anxiety and depression. We would like to test the marker in future psychiatric studies and see how it is affected by, for example, lifestyle interventions, psychotherapy and pharmacological treatment,” says Daniel Lindqvist, associate professor of experimental psychiatry at Lund University and psychiatry resident at Psykiatri Skåne.

    The researchers compared 37 patients who had been hospitalized at a psychiatric clinic after attempting suicide with an equal number of healthy control subjects. About 70 per cent of both groups were female, and the average age of the patients was approximately 40.

    Compared to the healthy control subjects, the suicidal patients had strikingly increased levels of mitochondrial DNA in their cell-free blood plasma.

    The researchers also found that the large amount of mitochondrial DNA in the plasma was linked to higher levels of cortisol in the blood. Cortisol is an important hormone in the body’s stress system and high levels of cortisol, which have been found in depressed and suicidal patients in previous studies, are a sign of an overactive stress system.

    Previous studies have shown that depressed individuals have an increased level of mitochondrial DNA in their immune cells and that this is linked to stressful life events. Furthermore, studies on animals have shown that increased stress and cortisol levels are linked to higher mitochondrial DNA, but this is the first study to be tested on psychiatric patients.

    “We believe the increased levels in suicidal patients are due to their exposure to severe stress for longer periods than the healthy subjects we compared them to. An increased level of cortisol can cause the body’s cells to malfunction, which in turn contributes to increased levels of cell-free mitochondrial DNA in the blood,” says Lars Ohlsson, senior lecturer at Malmö University.

    “The amount of mitochondrial DNA in cell-free plasma is a new and interesting marker of stress that can be used in future psychiatric studies, but the results have to be replicated in other groups of patients as well. A key question will be how the biomarker changes over time in connection with the patient’s symptoms improving or deteriorating,” says Åsa Westrin, associate professor of clinical psychiatry at Lund University and senior physician at Psykiatri Skåne.


  2. Victimized adolescents more at risk of thinking about suicide or attempting suicide at 15

    October 17, 2016 by Ashley

    From the Elsevier media release:

    school_bully

    A study to be published in the February 2016 issue of the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) reports that adolescents chronically victimized during at least two school years, are about five times more at risk of thinking about suicide and 6 times more at risk of attempting suicide at 15 years compared to those who were never victimized.

    This is the first study to show a predictive association between victimization, suicidal ideation and suicide attempt in mid-adolescence. It also takes into account a variety of factors, including previous suicidality, mental health problems (by the age of 12 years) such as depression, opposition/defiance and inattention/hyperactivity problems, as well as family adversity.

    Using data from the Quebec Longitudinal Study of Child Development, which followed a general population sample of 1168 children born in 1997-98 in Quebec (Canada) until they were 15 years old, a group of researchers led by Dr. Marie-Claude Geoffroy of the CIUSSS de l’Ouest-de-l’Île-de-Montréal (Douglas Mental Health University Institute, McGill Group for Suicide Studies) and the Sainte-Justine Hospital Research Centre examined the relationship between victimization by peers, suicidal ideation and suicide attempt. The authors hypothesized that children victimized by their peers would be at higher risks of suicidal ideation and suicide attempt compared to non-victims.

    Overall, approximately 20% of the study participants report being exposed to victimization by their peers. Peer victimization includes actions such as being called names, spreading rumours, excluding someone from a group on purpose, attacking someone physically or cyberbullying. According to the authors, victims reported higher rates of suicidal ideation at age 13 and 15 (respectively 11.6% and 14.7%) compared to those who had not been victimized (2.7% at 13 and 4.1% at 15). The authors also observed higher rates of suicide attempt for the victimized adolescents at age 13 and 15 (5.4 % and 6.8%) compared to non-victims (1.6% at 13 and 1.9% at 15). In particular, the data showed that 13 years old adolescents who had been victimized by their peers have two times more risk of having suicidal ideation two years later and three times more at risks of suicide attempt.

    The authors point out that although victimization predicts suicidality it does not necessarily cause it, and this prediction does not apply to all individuals. Only a minority of victims will later develop suicidal ideation or make a suicide attempt. Why these adverse experiences affect individuals remains to be investigated.

    Adolescence is a crucial period for suicide prevention. As a result, the authors suggest that effective interventions may require a multidisciplinary effort involving parents, schoolteachers, principals, and mental health professionals. All adolescents, victimized or not, who think often and/or seriously about suicide should see a mental health professional such as a psychiatrist, a psychologist, or an accredited psychotherapist.


  3. Study supports do not sell voluntary waiting period for gun sales to reduce suicide

    October 11, 2016 by Ashley

    From the University of Alabama at Birmingham media release:

    Depressed seniorA new study suggests many patients at risk for suicide would voluntarily place their name on a Do Not Sell list, prohibiting gun shops from immediately selling them a firearm.

    The study, published in Suicide and Life-Threatening Behavior, says nearly half of the 200 people surveyed would willingly place their name on such a list.

    “There is evidence that suicide, in particular suicide-by-gun, is often impulsive — that once an individual decides to take their own life they are, in many cases, able to quickly obtain a firearm and use it,” said lead author Fredrick Vars, J.D., a professor in the School of Law at the University of Alabama. “The concept of a Do Not Sell list, similar to the national Do Not Call list, would be to eliminate such impulsive transactions. Restricting access to firearms, even temporarily, could save many lives.”

    The authors report that previous studies of survivors of firearm suicide attempts found a majority had suicidal thoughts for less than a day, while another found that, of nearly lethal suicide attempts among people 13-34 years of age, about one-fourth of attempters spent less than five minutes between the decision to attempt suicide and the actual attempt.

    Vars conducted the survey with investigators in the University of Alabama at Birmingham Department of Psychiatry in the School of Medicine.

    “People with mental illness are more likely to commit suicide,” said Richard Shelton, M.D., vice chair of Research for the UAB Department of Psychiatry and a study co-author. “Studies indicate the vast majority of suicide attempt survivors end up eventually dying of something other than suicide, so a means of preventing someone from making future gun purchases during a suicidal crisis might reduce suicide rates.”

    The researchers surveyed 200 patients at an inpatient psychiatric unit and two outpatient psychiatry clinics at UAB. The most commonly reported conditions of those surveyed were mood disorders, anxiety disorders, psychotic disorders or substance abuse.

    The survey presented two options to study participants. In the first, respondents would voluntarily place their name on the Do Not Sell list, which would feature a seven-day waiting period following a request for removal from the list to avoid an impulse buy. The second option would require a judicial hearing to remove a name from the list and allow a gun sale. A total of 46 percent of respondents indicated willingness to participate in one of the two methods, with a slight preference for the seven-day waiting period.

    “Nearly one-half of participants indicated they would like to be able to restrict their own future gun purchases,” Vars said. “This approach wouldn’t stop all suicides, but any dent we could make in the estimated 20,000 people who use a gun to commit suicide every year in the United States would be significant.

    “Waiting periods to purchase firearms have been shown to reduce gun suicide, most likely due to the impulsive nature of suicide attempts,” said Karen L. Cropsey, Psy.D., associate professor of psychiatry at UAB and a study co-author. “The Do Not Sell list is a new type of means restriction, and means restriction generally has been shown to be one of the most effective suicide prevention strategies.”

    Cropsey says a Do Not Sell list would be a natural extension of current counseling practice.

    “We regularly have conversations with patients who are having or have had suicidal thoughts about removing access to firearms in the home,” she said. “Taking a gun out of the home or, as in this case, creating a delay period that removes the ability to impulsively purchase a firearm are good strategies for suicide prevention.”

    Vars, who has studied mental health and gun ownership for years, believes the concept of the Do Not Sell list is unique but could be implemented fairly easily.

    A waiting period — say seven, 10 or perhaps 15 days — would be fairly easy to establish and would involve primarily one-time set up costs rather than an ongoing expense,” Vars said. “The judicial review option would be more expensive. The largest hurdle would be in educating health care providers and the public that an option such as a Do Not Sell list exists.”

    Vars would like to see the survey administered in other regions of the country to see if the results are similar.

    “Alabama has a high rate of gun ownership and a strong consensus against gun regulation,” Vars said. “Sign-up rates could be different and possibly higher in regions with lower gun ownership rates.”


  4. Social connectedness can increase suicide risk

    September 13, 2016 by Ashley

    From the University of Chicago media release:

    teens friends punkCommunity characteristics play an important role in perpetuating teen suicide clusters and thwarting prevention efforts, according to a new study by sociologists at the University of Chicago and University of Memphis who examined clusters in a single town.

    The study, published in the American Sociological Review, illustrates how the homogeneous culture and high degree of social connectedness of a community can increase suicide risk, particularly among teenagers. Such conditions contribute to clusters in which a series of suicides happen around the same time and in close proximity.

    While news outlets have repeatedly documented the emergence of clusters, little is understood about why they happen and how to stop them. In the new study, Anna S. Mueller, an assistant professor in Comparative Human Development at UChicago, and Seth Abrutyn, an assistant professor at the University of Memphis, examined a suburban, upper-middle-class community that had experienced at least four clusters over the last 15 years.

    Researchers found intense pressure to succeed, coupled with narrowly defined ideals about what youths should be, namely academically and athletically exceptional. Fears of not living up to such ideals combined with the ease with which private information became public, due to social connectedness, left teens and their parents unwilling to seek help for mental health problems. Such conditions rendered youths who were already struggling particularly vulnerable to suicide, despite having social connections within the community.

    “Perhaps one of the most interesting findings of this study is that it highlights the downside to social connectedness, something that is usually touted as a key tool for suicide prevention,” Mueller said. “It also helps explain why some schools with intense academic pressure have problems with suicide while others do not. It’s not just the pressure: It’s the pressure combined with certain community factors that can make asking for help harder to do.”

    The findings provide new insight for suicide prevention, which has focused traditionally on the downsides of social isolation and the role of mental illness. The researchers demonstrate how community needs to be considered when assessing vulnerabilities, and why prevention organizations should no longer view social connectedness exclusively as a positive force in measuring suicide risk.

    In the study, Mueller and Abrutyn started with the seminal work Suicide by French sociologist Émile Durkheim, published in 1897. While his assertion that a socially isolated individual is more prone to suicide remains a cornerstone of prevention, much less attention has been given to his discussion of how high levels of integration in society also can create risk.

    Mueller and Abrutyn then turned their focus to a single community, in which 19 students or recent graduates of the local high school had committed suicide between 2000 and 2015. Their field research included interviews and focus groups involving a total of 110 people. The study does not name the town because of confidentiality agreements tied to the research.

    In their findings, Mueller and Abrutyn recommend the creation of programming to help students navigate perceived failure and academic stresses. Additionally, they caution that suicide prevention strategies should take into consideration that social connectedness is not always a good thing. The authors suggest more sociologists focus on suicide, seeing a growing role for the field to understand and prevent it.

    “Since Durkheim’s important work, sociology has contributed surprisingly little to understanding and preventing suicide, particularly compared to psychology and epidemiology,” Mueller said. “This is unfortunate since sociologists have the theoretical and empirical tools necessary to examine some fundamental unanswered questions about suicide, one of the most important being: ‘How do we stop suicide clusters from happening?’


  5. Assisted dying for psychiatric disorders: Serious public health impact

    June 22, 2016 by Ashley

    From the Canadian Medical Association Journal media release:

    hospital stayOffering medical assistance in dying to people in Canada on the basis of psychiatric illnesses could put vulnerable people at risk, argues a commentary in CMAJ (Canadian Medical Association Journal).

    There is a serious gap between the idealized basis upon which assisted dying for patients with psychiatric conditions is advocated and the reality of its practice, as reflected in evidence from Belgium and the Netherlands. A policy for access to assisted dying by nonterminally ill patients with psychiatric conditions will put many vulnerable and stigmatized people at risk,” writes Dr. Scott Kim, a physician and bioethicist at the National Institutes of Health (NIH), Bethesda, Maryland, United States, with Dr. Trudo Lemmens, a professor at the University of Toronto Faculty of Law & the Dalla Lana School of Public Health.

    Canada has been grappling recently with conflicting recommendations over legalizing assisted dying. The Supreme Court of Canada ruled that competent adults suffering from a “grievous and irremediable medical condition” should be able to access assisted dying. It invited Parliament to develop a strict regulatory regime to enable this. A Special Joint Parliamentary Committee recommended that people with psychiatric illness should be eligible. Bill C14, now adopted by both the House of Commons and the Senate, restricts assisted dying to persons near the end of their natural lives (whether or not they have psychiatric disorders). This would generally rule out assisted dying for psychiatric conditions. But the government will be studying this issue further in the coming years.

    The authors argue that there are substantial challenges to deciding who would be eligible for assisted dying for psychiatric patients.

    Evidence from Belgium and the Netherlands indicates that doctors disagree when applying criteria for who is eligible for assisted dying for psychiatric disorders. As well, although most of the discussion has focused on persons with difficult-to-treat depression, legalizing assisted dying for psychiatric disorders would mean that persons with schizophrenia, autism, eating disorders, PTSD, personality disorders, and even prolonged grief would be eligible to receive assisted dying.

    “Perhaps those who advocate for extending access to people with psychiatric disorders may be willing to tolerate a number of potentially avoidable premature deaths as acceptable because access to assisted dying is felt to be so important in principle. However, that argument must be made explicit and debated publicly,” the authors conclude.


  6. Drug-overdose deaths hold steady in some high drug trafficking areas

    April 25, 2016 by Ashley

    From the University of Pittsburgh Schools of the Health Sciences media release:

    addiction_drugsAreas in the U.S. with the highest drug-overdose death rates are not always places with high drug trafficking, according to a new University of Pittsburgh Graduate School of Public Health analysis published in the journal Preventive Medicine.

    Drug-overdose mortality rates have increased an average of 6.7 percent per year since 1979 but held relatively steady in most U.S. border counties, indicating that drugs appear to pass through these counties without affecting the death rates of their residents.

    “Our research reveals several potential new drug overdose problem regions that warrant careful attention as they may not correspond to areas covered by federal resources to combat drug trafficking,” said lead author Jeanine Buchanich, Ph.D., deputy director of Pitt Public Health’s Center for Occupational Biostatistics and Epidemiology. “Western Pennsylvania is one such area that is not considered to have high drug trafficking, but yet has one of the fastest growing drug overdose rates nationwide.

    Using the Mortality and Population Data System, a unique repository and retrieval system for detailed death data from the National Center for Health Statistics, housed at Pitt Public Health, Dr. Buchanich and her team examined overdose deaths in the U.S. from 1979 to 2014. The team started with 1979 because changes in reporting cause of death make it impossible to make comparisons with previous years. 2014 is the most recent year for which data are available.

    The counties with the largest increases in overdose death rates were clustered in southern Michigan; eastern Ohio and western Pennsylvania; eastern Pennsylvania, New Jersey and much of southeastern New York; and coastal New England.

    Counties in the Midwest, California and Texas have seen little to no increase in overdose death rates.

    The mortality data was cross-referenced with counties in the High Intensity Drug Trafficking Areas program, which was created by Congress in 1988 to provide 31 high drug-trafficking areas of the U.S. with coordinated law enforcement resources dedicated to reducing trafficking and production.

    High Intensity Drug Trafficking Areas with high overdose death rates were mostly concentrated in Appalachia and the Southwest U.S., whereas such areas with lower death rates were near the borders in California, Texas and southern Florida.

    “While resources are justifiably being targeted to the High Intensity Drug Trafficking Areas, they must also be allocated to counties outside those areas with rapidly increasing and currently high drug overdose rates,” said Dr. Buchanich, also a research assistant professor in Pitt Public Health’s Department of Biostatistics.

    Pitt Public Health’s Mortality and Population Data System also unveiled several demographic insights that could be used to guide prevention and drug intervention efforts, including that:

    • Since 1979, death rates increased for all age groups, with the smallest rate of growth in those older than 65 and the largest in 45 to 54 year olds.
    • In 1979, overdose deaths occurred most frequently among 25 to 34 year olds and blacks; in 2014, rates were highest among 45 to 54 year olds and whites.
    • Mortality rates were slightly higher in urban counties than rural counties.
    • Deaths due to overdose in women began increasing in the mid-1990s and increased dramatically in 2002; for men, the rates began climbing in the mid-1980s with a more rapid increase also beginning in 2002.

    Dr. Buchanich will continue to build on her drug overdose research with funding from the Pitt Public Health opioid pilot grant program. These one-year pilot grant projects explore different areas of the opioid overdose epidemic with the goal of providing research-based information to guide public health interventions.


  7. New mothers with postpartum psychiatric disorders face increased risk of suicide, study shows

    March 8, 2016 by Ashley

    From the Aarhus University media release:

    pregnancy coupleOver a period spanning four decades, a total of eight Danish women committed suicide within a year of being diagnosed with a birth-related psychiatric disorder, including severe episodes of postpartum depression or psychosis.

    Despite the modest number, statistical evidence of a causal link between postpartum disorder and suicide is extremely strong, highlighting the need for medical staff to be aware of the risk, according to the researchers who carried out the study.

    The findings have been published in the paper “All-Cause Mortality in Women With Severe Postpartum Psychiatric Disorders” in the American Journal of Psychiatry and are the result of an ambitious research project carried out by a team of epidemiologists at Aarhus BSS, Denmark, in cooperation with colleagues in the Netherlands and the United States.

    The study demonstrates that overall, mothers with postpartum psychological disorders have a four times higher risk of death from natural or unnatural causes during the follow-up period, than mothers without postpartum disorders. At the same time, mothers with postpartum disorders face roughly the same mortality rates as mothers with psychological disorders unrelated to childbirth.

    Crucially, however, even compared with that group, mothers with postpartum disorders are more likely to commit suicide during the first 12 months after giving birth. The high suicide risk among women with postpartum psychiatric disorders has been described before, but this study is the first to carry out a comprehensive comparison with other categories of women, enabling the researchers to focus on the exact causal link between birth and suicide risk.

    The suicide cases are very rare, but when they do happen, they are of course extremely tragic. And it’s not what people expect. The general belief is that a new mother doesn’t take her own life, and that she ought to be enjoying motherhood, but the reality isn’t always like that. We think it’s important that women with postpartum psychiatric disorders are properly diagnosed and get the treatment they need, which possibly can prevent that they commit suicide,” said Trine Munk-Olsen, a senior researcher at the Department of Economics at Aarhus BSS and one of the lead authors of the paper.

    The researchers employed the data of a total of 1,545,857 Danish women, covering all or most of the period between 1970 and 2011. This could not have been possible without the existence of rich data sets maintained by various government agencies in Denmark. Only a small number of countries have data this deep and detailed, providing social scientists with a goldmine of information to test their hypotheses.

    “The data give us the option of following the mothers over the very long term, almost 40 years, which is extremely helpful in putting the statistics into perspective. We’ve been able to track all the women over the years, the only exception being if they emigrated. Denmark is in a group of countries, especially in the Nordic region, that maintain detailed population registers. In addition, Denmark is unique in having psychiatric data reaching back so many years in time,” said Munk-Olsen.


  8. Two in five individuals with schizophrenia have attempted suicide

    February 25, 2016 by Ashley

    From the University of Toronto media release:

    addiction pillsA new study by the University of Toronto (U of T), released today, found that those with schizophrenia who’d been physically abused during childhood were five times more likely to have attempted suicide.

    The lifetime prevalence of suicide attempts among individuals with schizophrenia was 39.2 per cent compared to 2.8 per cent of those without the disorder, according to the study.

    “Even after taking into account most of the known risk factors for suicide attempts, those with schizophrenia had six times the odds of having attempted suicide in comparison to those without schizophrenia,” reported lead author Professor Esme Fuller-Thomson, Sandra Rotman Endowed Chair at the University of Toronto’s Factor-Inwentash Faculty of Social Work and Institute for Life Course and Aging.

    The study examined a representative sample of 21,744 community-dwelling Canadians, of whom 101 reported they had been diagnosed with schizophrenia. Data were drawn from the 2012 Canadian Community Health Survey-Mental Health.

    “When we focused only on the 101 individuals with schizophrenia, we found that women and those with a history of drug or alcohol abuse and/or major depressive disorder were much more likely to have attempted suicide,” said co-author Bailey Hollister, a recent U of T social work graduate.

    Of particular concern, individuals with schizophrenia who reported that they had been physically abused during their childhood were five times more likely to have attempted suicide and early adversities explained 24 per cent of the variability in suicide attempts, said the authors.

    “Clearly those with schizophrenia are an extremely vulnerable population. Knowledge of the added risk of suicide attempts associated with childhood abuse and substance abuse could help clinicians improve targeting and outreach to this population,” said Fuller-Thomson


  9. Is suicide a tragic variant of an evolutionarily adaptive set of behaviors?

    January 20, 2016 by Ashley

    From the American Psychological Association media release:

    Depressed seniorWhat do snapping shrimp, naked mole rats, ants, honeybees, and humans all have in common?

    They all share a similar colony-like organizational system that biologists have termed eusociality. Eusocial species have been remarkably successful in both surviving and thriving through the use of colony-level cooperation.

    One cooperative behavior used by all eusocial species is the self-sacrifice of individuals to defend the colony. For example, a eusocial bee may sting a predator to stop an attack but die in the process. This same self-sacrificial tendency is seen among humans across cultures and time periods, including among military recruits, first responders, and parents.

    In an article recently published in Psychological Review, Joiner et al. (Online first) draw from this scientific knowledge and argue that a tendency towards self-sacrifice among humans is adaptive in some situations — for instance, a firefighter willingly risking his or her life to save someone from a burning building. However, when individuals mistakenly view their own deaths as being worth more than their lives, results can be needlessly lethal. Specifically, Joiner et al. propose a framework in which suicide is viewed as a tragic variant of what typically serves as an adaptive tendency towards self-sacrifice among humans.

    Evidence for this framework can be seen in the numerous striking parallels between eusocial self-sacrificial behaviors among non-humans and death by suicide in humans. As one example, insects often become highly agitated prior to sacrificing themselves to defend their colony. Similarly, extreme overarousal and sleep problems are typically seen immediately prior to death by suicide among humans. Joiner and colleagues explain that these parallels in behavior point to the possibility that suicide is one unfortunate step away from adaptive sacrificial behaviors.

    So when do individuals take this tragic step? According to Joiner et al., when individuals believe that others or society as a whole will be better off without them, they miscalculate the worth of their lives and conclude that their deaths will be more valuable. This misperception, in conjunction with a tendency toward self-sacrifice, may then result in the individual’s death by suicide. This represents a devastating variant of what otherwise is an adaptive tendency.

    Although research is needed to test this novel framework, these ideas are an important step towards demystifying the phenomenon of suicide and furthering suicide prevention efforts. This framework may ultimately inform our ability to identify individuals at acute risk for suicide and aid in the development of new clinical interventions.