biological and psychological suicide risk factors
Post on 03-Jan-2016
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Observed/expected (standardized mortality ratio)
Risk ratio (RR) and odds ratio (OR) 1.0 - the groups are even 1.7 – the target group is at 70% greater risk 0.8 – the target group is at lower risk
Population attributable risk
Baldessarini and Hennen (2004) Examined genetics of suicide through several
comparisons Close relative attempted or died by suicide: OR =
5.01 Weighting study sizes and variances: OR = 2.86
MZ vs DZ twins concordance for suicide/attempts MZ 401/1,704 = 23.5% DZ 2/1,486 = 0.135% 175 times greater risk (may be an over-estimate) Weighting study sizes and variances: OR = 2.86
Adoptive studies: RR =4.84 Data from molecular genetic studies mixed
First, caveat about imaging studies Rely on correlations, like much of our research
Correlations can be very telling and informative, or sometimes can lead us astray. Some fun examples from Buzzfeed:
http://www.buzzfeed.com/kjh2110/the-10-most-bizarre-correlations
Van Heeringen, Gijttebier, & Godfrin, 2011 Reviewed brain imaging studies examining
suicide attempts Orbitofrontal and dorsolateral prefrontal
cortex Decision-making and problem solving
Sensitivity to social disapproval Choosing options with high immediate rewards Reduced ability to generate positive future events
White Matter Hyperintensities (WMH) Associated with 2.5 – 3 times greater risk of
depression or bipolar Those who were depressed and had WMH were
18.6 times more likely to have had a prior suicide attempt (Ehrlich et al., 2004).
Serotonin and suicide Lower tryptophan trapping (serotonin synthesis)
in those with suicide intent Less 5-HT2a receptor binding in prefrontal cortex
(esp. dorsolateral prefrontal) in suicide attempters
Larger right amygdala volume
Stroke (Pompili et al., 2012) Kidney Disease and Dialysis (Pompili, et
al., 2013) Cancer (2X greater risk than general
population; Anguiano, et al., 2012) Diabetes Type 1 (Pompili, et al., 2014) Dementia (Data mixed; Haw et al., 2009)
International Statistical Classification of Diseases and Related Health Problems (ICD-10) Author: World Health Organization Contains all health disorders Often preferred by those outside the U.S,public health and epidemiological researchers
Diagnostic and Statistical Manual of Mental Disorders (DSM 5) Author: American Psychiatric Association Contains only mental health disorders Often used by U.S. mental health providers
Two weeks or more of 5 or more of the following: Depressed mood most of the day, nearly every
day Markedly diminished interest or pleasure in
previously interesting or pleasurable things Significant weight loss or gain without trying Insomnia Psychomotor retardation or agitation Fatigue and loss of energy Feelings of worthlessness Inability to think or concentrate/indecisiveness Recurrent thoughts of death or suicidal ideation
Increases the likelihood of suicidal behavior by more than 33 times (Beautrais, 1996)
The severity of depressive symptoms are positively correlated with suicide risk
Unipolar Depression vs. Bipolar
Manic Episode A period of abnormally elevated mood lasting at
least 1 week with three or more of the following inflated self-esteem or grandiousity decreased need for sleep more talkative than usual or pressure to keep talking flight of ideas distractability increase in goal-directed activity or psychomotor
agitation excessive involvement in pleasurable activities that
have a high potential for painful consequences
Bipolar I and Suicide 80% report suicidal ideation, and 51% report a
suicide attempt (Valtonen, et al., 2005) 15% - 19% die by suicide (de Abreu, et al.,
2009)
Not all bad news: Lithium, a common treatment for bipolar disorder, is one of the few medications that has been shown to reduce suicide risk (Tondo, Hennen, & Baldessarini, 2001)
It has long been held that 40 – 60% of those who died by suicide were intoxicated at the time of death Very recent review found that 73% of suicide
decedents had BACs of 0.00% (Anestis, et al., In Press, Abnormal Psychology)
Research suggests that alcohol dependence puts individuals at between 6 and 25 times greater risk of suicide
DSM Criteria: Schizophrenia Two or more of the following, each present
during a significant portion of a 1 month period delusions hallucinations disorganized speech grossly disorganized or catatonic behavior negative symptoms (e.g. affective flattening)
Associated with increased risk of suicide, especially for those with greater cognitive impairment due to the disease
Those with paranoid schizophrenia diagnoses are also at higher risk
Literature on anxiety disorder and panic disorder is mixed. Some evidence for a link in children, no recent review for adults.
PTSD has been shown to be associated with suicide OR = 9.8 OR controlling for other disorders and
demographics = 5.3 (Gradus et al., 2010)
Cluster A (odd or eccentric) Paranoid, Schizoid, Schizotypal
Cluster B (dramatic and erratic) Antisocial, Borderline, Histrionic, Narcissistic
Cluster C (anxious and fearful) Avoidant, Dependent, Obsessive-Compulsive
Estimates are that as high as 80% of individuals who meet criteria for Borderline Personality Disorder demonstrate suicide related behaviors (Linehan, et al., 2006)
Between 4 – 9% die by suicide (Linehan, et al., 2006; Zanarini, et al., 2005)
Examined insomnia symptoms, nightmares and a measure of suicide risk
Sample: 165 suicide attempters in Sweden
Results: Nightmares related with suicide risk (OR: 4.9) Nightmares remain significantly associated
with suicide risk (OR: 3.0) after controlling for depression, anxiety, PTSD, and substance abuse
2-year follow-up to see whether nightmares predict future suicide attempts
Hospital records used to detect suicide attempts
Results: Nightmares predicted suicide attempts (OR =
5.2) Nightmares were still predictive after
controlling for depression, anxiety, PTSD, and substance abuse disorders (OR = 4.18)
Having two or more mental disorders increases one’s risk of death by suicide 169.6 times!
In a sample of medically-serious suicide attempters, Beautrais and colleagues (1996) found that 56.6% had more than one diagnosis OR with one disorder: 17.4 OR with two or more: 89.7
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