Indigenous Suicide in New Zealand

This article describes patterns of suicide and attempted suicide among the indigenous (Ma ̄ori) population of New Zealand using official data from the New Zealand Health Information Service (NZHIS). The majority of Ma ̄ori suicides (75%) occurr in young people aged \u3c35 years. Rates of suicide are higher among Ma ̄ori males and females aged \u3c25 than in their non-Ma ̄ori peers. Rates of hospitalization for attempted suicides are higher amongst Ma ̄ori males aged 15–24, compared to non-Ma ̄ori. In contrast, suicide is virtually unknown amongst older Ma ̄ori (60 years). This article reviews explanations for the observed rates of suicide in Ma ̄ori, and examines approaches to effective intervention to reduce rates of suicide in young Ma ̄ori

Cross-National Analysis of the Associations among Mental Disorders and Suicidal Behavior: Findings from the WHO World Mental Health Surveys

Using data from over 100,000 individuals in 21 countries participating in the WHO World Mental Health Surveys, Matthew Nock and colleagues investigate which mental health disorders increase the odds of experiencing suicidal thoughts and actual suicide attempts, and how these relationships differ across developed and developing countries

Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations

Despite strong indications of elevated risk of suicidal behavior in lesbian, gay, bisexual, and transgender people, limited attention has been given to research, interventions or suicide prevention programs targeting these populations. This article is a culmination of a three-year effort by an expert panel to address the need for better understanding of suicidal behavior and suicide risk in sexual minority populations, and stimulate the development of needed prevention strategies, interventions and policy changes. This article summarizes existing research findings, and makes recommendations for addressing knowledge gaps and applying current knowledge to relevant areas of suicide prevention practice

Serious suicide attempts in young people : a case control study

xvi, 280, 72, [41] leaves :ill. ; 30 cm. +2 booklets. Includes bibliographical references. "April, 1996"Risk factors for serious suicide attempts among young people were examined in a case control study in which a consecutive series of 129 young people aged 13 to 24 years who made serious suicide attempts was compared with 153 control subjects selected randomly from the community. Review of the literature suggested five domains of risk factors were likely to contribute to suicide attempt risk: social and demographic factors; family background and childhood experiences; personality traits; psychiatric disorder; environmental factors, including, particularly, life events. Case control analyses confirmed the contribution of these risk factor domains to suicide attempt risk and suggested that those at increased risk of serious suicide attempt included: 1. Individuals who lacked formal educational qualifications and were of low socio-economic status. 2. Young people who reported higher rates of childhood and family adversity including childhood sexual abuse, poor parental relationships during childhood and parental alcohol problems during childhood. 3. Individuals with significantly higher scores on measures of neuroticism and hopelessness. 4. Individuals characterised by the presence of psychiatric morbidity, including, in particular, affective disorders and substance use disorders, within the month prior to the suicide attempt. 5. Those characterised by higher rates of reported life events including, particularly, interpersonal or legal problems. These findings were established using data gathered from self reports and reports provided by a parallel informant (a significant other) thus reducing risks that results could be attributed to recall bias. In general, the findings of this study suggest a life course model of suicide attempt risk in which the aetiology of suicide attempts is multicausal and reflects an accumulation of adverse factors and influences including: social disadvantage; childhood and family adversity; personality difficulties; psychiatric disorders and exposure to adverse life events. Of those making suicide attempts, 65.9% had risk factors from four or more of the five risk factor domains and it was estimated that those reporting a total of five or more risk factors had odds of serious suicide attempt which were over 120 times higher than those with an absence of risk factors. The findings from statistical analysis of risk factor data were generally consistent with the themes evident from qualitative examination of case history material. The major contribution of this study is to provide an account of the ways in which multiple risk factors combine over an individual's life course to influence risks of serious suicide attempt. Parallel to these findings there are a number of possible opportunities for interventions to reduce suicide attempt risk in young people. These intervention opportunities include: macro-social approaches including reduction in social inequities, reduction of unemployment and restriction of access to methods of suicide; targeted early intervention and family support programmes aimed at improving the life circumstances of those at high risk of psychosocial disorders; school based programmes aimed at fostering good mental health among young people, and programmes to educate teachers to recognise and refer students at risk for suicide; improved recognition and treatment of adolescent mental health problems, particularly of affective disorders and substance use disorders

A preliminary naturalistic study of low-dose ketamine for depression and suicide ideation in the emergency department

Abstract We examined the preliminary feasibility, tolerability and efficacy of single-dose, intravenous (i.v.) ketamine in depressed emergency department (ED) patients with suicide ideation (SI). Fourteen depressed ED patients with SI received a single i.v. bolus of ketamine (0.2 mg/kg) over 1-2 min. Patients were monitored for 4 h, then re-contacted daily for 10 d. Treatment response and time to remission were evaluated using the Montgomery-Asberg Depression Rating Scale (MADRS) and Kaplan-Meier survival analysis, respectively. Mean MADRS scores fell significantly from 40.4 (S.E.M.=1.8) at baseline to 11.5 (S.E.M.=2.2) at 240 min. Median time to MADRS score f10 was 80 min (interquartile range 0.67-24 h). SI scores (MADRS item 10) decreased significantly from 3.9 (S.E.M.=0.4) at baseline to 0.6 (S.E.M. =0.2) after 40 min post-administration ; SI improvements were sustained over 10 d. These data provide preliminary, open-label support for the feasibility and efficacy of ketamine as a rapid-onset antidepressant in the ED

Suicidal behaviour in adolescence and subsequent mental health outcomes in young adulthood

Background. The aim of this study was to examine the linkages between suicidal ideation and attempt in adolescence and subsequent suicidal behaviours and mental health in young adulthood. Method. Data were gathered during the course of a 25-year longitudinal study of a birth cohort of 1265 New Zealand children. The information collected included: (a) measures of suicidal thoughts and attempts in adolescence (< 18 years); (b) measures of suicidal ideation, suicide attempt, major depression, anxiety disorders, and substance use disorders in young adulthood (18-25 years); and (c) measures of childhood and family background, individual characteristics, and mental disorders in adolescence. Results. After statistical adjustment for confounding factors, suicide attempt in adolescence was associated with increased risks of subsequent suicidal ideation (OR 5.7) suicide attempt (OR 17.8) and major depression (OR 1.5). Those reporting suicidal ideation without suicide attempt showed moderate increases in risks of later suicidal ideation (OR 2.5), suicide attempt (OR 2.0) and major depression (OR 1.6). In addition, there was evidence of an interactive relationship in which suicidal behaviour in adolescence was associated with increased risks of later substance use disorders in females but not males. Conclusions. Young people reporting suicidal ideation or making a suicide attempt are an at-risk population for subsequent suicidal behaviour and depression. Further research is needed into the reasons for suicidal adolescent females being at greater risk of later substance use disorder

Sexual orientation and mental health in a birth cohort of young adults

Background. This paper sought to examine the relationship between sexual orientation and mental health in a New Zealand birth cohort studied to age 25 years. Method. The analysis is based on a sample of 967 participants (469 males; 498 females) in the Christchurch Health and Development Study. As part of this study information was gathered on: (a) measures of sexual orientation, same-sex behaviour and sexual attraction obtained at ages 21 and 25 years; (b) measures of mental disorders and suicidal behaviours over the interval 21-25 years; (c) measures of childhood and family background. Results. Latent class analysis was used to combine indicators of sexual orientation, same sex behaviour and attraction to form an empirically based classification of sexual orientation. The best-fitting model classified the sample into three groups: exclusively heterosexual orientation (87.6%); predominantly heterosexual but with same-sex inclinations or experience (9.6%); predominantly homosexual (2.8%). Proportionately more women than men were classified as predominantly heterosexual (14.2% v. 4.8% respectively) or predominantly homosexual (3.9% v. 1.5% respectively). Cohort members with a predominantly homosexual orientation had rates of mental disorder and suicidal behaviours that were between 1.5 and 12 times higher than for those with an exclusively heterosexual orientation. These associations persisted after adjustment for confounding. The associations between sexual orientation and mental health were more marked for males than females. Conclusions. The findings suggest a continuum of sexual preferences amongst young adults. Variations in sexual orientation were clearly associated with mental health. These associations tended to be stronger for males