How lipids may affect risk for suicidal behavior

Suicide and nonfatal suicidal behaviors are major causes of mortality and morbidity worldwide. Variability in rates of suicide and suicidal behaviors within and between countries has been attributed to population and individual risk factors, including economic status and cultural differences, both of which can have suicide risk effects mediated through a variety of factors, of which perhaps the least understood is the role of diet. We therefore review the scientific literature concerning two major dietary lipid classes, cholesterol and polyunsaturated fatty acids (PUFAs), that have been associated with higher risk of suicide attempts and suicide. We consider potential mechanistic intermediates including serotonin transporters and receptors, toll-like receptors (TLRs), nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB), and peroxisome proliferator activated receptors (PPARs). Based on this review, we describe a theoretical model linking cholesterol and PUFA status to suicide risk, taking into account the effects of cholesterol-lowering interventions on PUFA balance, membrane lipid microdomains (rafts) as a nexus of interaction between cholesterol and omega-3 PUFAs, and downstream effects on serotonergic neurotransmission and specific inflammatory pathways.Fil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Mann, John. Columbia University. Department of Psychiatry. New York State Psychiatric Institute; Estados UnidosFil: Sublette, M. Elizabeth. Columbia University. Department of Psychiatry. New York State Psychiatric Institute; Estados Unido

Cambios en la conceptualización de la conducta suicida a lo largo de la historia: desde la antigüedad hasta el DSM-5

El suicidio es una conducta universal y específica del hombre que ha estado presente a lo largo de toda la historia de la humanidad. Sin embargo, a través de las épocas han variado las consideraciones sociales que se han tenido acerca del mismo: la aceptación o el castigo. Estos cambios dependieron fundamentalmente de la influencia de distintos factores culturales. En el presente artículo, se realiza una revisión sobre como los paradigmas imperantes en cada época produjeron cambios en la conceptualización del suicidio.</p

Patients hospitalized for suicidal ideation and suicide attempt in a mental health hospital: clinico-demographical features and 6-month follow-up

Introducción: El suicidio es un problema de alto impacto para la salud pública. En la Argentina son pocos los estudios publicados sobre suicidio e intento de suicidio. Objetivo: Determinar el porcentaje de internaciones motivadas por intento o ideación suicida en un Hospital de Salud Mental de la Ciudad de Buenos Aires, describir las características clínico-demográficas de estas pacientes y analizar la frecuencia de eventos desfavorables en el seguimiento a 6 meses. Métodos: En el presente estudio se emplean los datos basales y de seguimiento de un estudio analítico, observacional, de cohorte prospectivo. Resultados: Los datos basales muestran que de la totalidad de pacientes que ingresaron al Servicio de Guardia, el 27% lo hizo por ideación o intento de suicidio. Los diagnósticos más frecuentes fueron: trastorno límite de la personalidad (41%), trastorno depresivo mayor (38%), trastorno bipolar (20%) y esquizofrenia (16%). El método utilizado con más frecuencia en el intento de suicidio fue la sobreingesta medicamentosa. En la mitad de las pacientes, el proceso suicida se desarrolló en menos de 10 minutos. Los datos del seguimiento muestran que el 22% de las pacientes presentó un nuevo intento de suicidio y el 34% tuvo una reinternación a 6 meses. Conclusiones: En conjunto, estos resultados describen las características de las pacientes suicidas asistidas en un Hospital de Salud Mental, muestran la baja eficacia de las intervenciones y plantean la necesidad de diseñar nuevas estrategias para el manejo de las mismas.Background: Suicide is an issue of high public health impact. In Argentina there are few published studies on suicide and suicide attempt. Objective: To determine the percentage of hospitalizations caused by suicidal attempt or suicidal ideation in a Mental Health Hospital of the City of Buenos Aires, describe the clinical and demographic characteristics of these patients and to analyze the frequency of adverse events at a 6-month follow-up. Methods: In the present study, baseline and follow-up data of an analytical, observational, prospective cohort study are used. Results: Baseline data show that of all patients who entered the Emergency Department, 27% did so for ideation or suicide attempt. The most frequent diagnoses were: borderline personality disorder (41%), major depressive disorder (38%), bipolar disorder (20%) and schizophrenia (16%). The method most commonly used during the suicide attempt was drug poisoning. In half of the patients, the suicidal process was developed in less than 10 minutes. Monitoring data show that 22% of patients had a new attempted suicide and 34% had a readmission in a 6-month period. Conclusions: Together, these results describe the characteristics of suicide patients admitted to a Mental Health Hospital and show the low efficacy of interventions and the need to devise new strategies for the management of suicidal patients.Fil: Teti, Germán Leandro. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital “Dr. Braulio A. Moyano”; ArgentinaFil: Rebok, Federico. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital “Dr. Braulio A. Moyano”; ArgentinaFil: Grendas, Leandro Nicolás. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Dr. Teodoro Álvarez"; ArgentinaFil: Rodante, Demián. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital “Dr. Braulio A. Moyano”; ArgentinaFil: Fógola, Agustina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital “Dr. Braulio A. Moyano”; Argentin

Determinants of mental and physical health-related quality of life among patients hospitalized for suicidal behavior

The current study was interested in exploring the clinical factors related to mental and physical health-related quality of life among patients hospitalized for suicidal behavior. A multicenter cross-sectional study was designed to compare data obtained form 246 patients hospitalized for suicide behavior. Results suggest that mental health-related quality of life was negatively associated with hopelessness while physical health-related quality of life was negatively associated with age, medical disease and the number of previous suicide attempts and positively associated with employment. Findings are discussed in the context of theoretical evidence and clinical implications.Fil: Grendas, Leandro Nicolás. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital Dr. Braulio A. Moyano; Argentina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Rodante, Demián. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital Dr. Braulio A. Moyano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Rojas, Sasha. University of Arkansas for Medical Sciences; Estados UnidosFil: Puppo, Soledad. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Vidjen, Patricia. Gobierno de la Ciudad de Buenos Aires. Hospital Municipal ; ArgentinaFil: Lado, Gisela. Gobierno de la Ciudad de Buenos Aires. Hospital Municipal ; ArgentinaFil: Portela, Alicia. Gobierno de la Ciudad de Buenos Aires. Hospital Municipal ; ArgentinaFil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Association between religiosity and depression varies with age and sex among adults in South America: Evidence from the CESCAS I study

Prior studies have suggest that religiosity mitigates symptoms of depression. However, population-based data in South America are limited. This study determines the prevalence of religiosity and explores its association with depression in four cities of the Southern cone of Latin-America. In the CESCAS I study 7524 participants aged between 35 and 74 years old were recruited between 2011 and 2012 from randomly selected samples in 4 cities (Bariloche and Marcos Paz, Argentina; Temuco, Chile; and Pando-Barros Blancos, Uruguay). Religiosity was assessed with a questionnaire from the Hispanic Community Health Study/Study of Latinos. Two dimensions were used: 1) recognition as belonging to a religion; and 2) frequency of participation in religious activities. Depression was measured using the PHQ-9. Prevalence of religiosity was described by sociodemographic characteristics. Association between religiosity and depression was examined through logistic regression models controlling for sex, age and other potential confounders. Weekly religious activities were reported by 32.3% (95% CI: 30.1, 33.6) of participants. Prevalence of major depressive episode (MDE) was 14.6% (95% CI: 13.6, 15.6). After controlling for confounders, older women (≥65 years) who reported religious affiliation had 70% lower likelihood of having MDE (OR: 0.3; 95% CI, 0.1, 0.8). Moreover, in this group, women participating in religious activities more than once per week compared with "never" had 50% lower likelihood of having a MDE (OR: 0.5; 95% CI: 0.3, 0.9). No association between religious activities and depression was found in men. Religiosity is highly prevalent among adults in four cities of South America. Our study found an inverse association between religiosity and depression only in women, stronger in olders. Although longitudinal studies are necessary to determine the true nature of these relationships, religiosity may be a relevant factor that health care providers could take into account when exploring depression in their patients.Fil: Santero, Marilina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Daray, Federico Manuel. Universidad de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Prado, Carolina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Hernández Vásquez, Akram. Universidad San Ignacio de Loyola; PerúFil: Irazola, Vilma. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Predicción del reintento de suicidio: Random survival forest versus regresión de Cox

En Psiquiatría, resulta de interés poder predecir un reintento de suicidio en pacientes asistidos por conducta suicida, de acuerdo a sus características sociodemográficas y clínicas. El objetivo de este trabajo es comparar la capacidad discriminante y predictiva de cuatro estrategias para el ajuste de los datos: regresión de Cox con todas las covariables (CoxComp), regresión de Cox mediante eliminación hacia atrás (CoxBack), Random Survival Forest (RSF) con todas las covariables (RSFComp) y RSF con eliminación de las variables cuya importancia en RSFComp resulta negativa (RSFElim). Los datos corresponden a una cohorte de pacientes con conducta suicida seguidos por dos años. Estos se dividieron en una base de entrenamiento y otra de prueba. Sobre la base de entrenamiento, se ajustaron los modelos propuestos y, con ellos, se estimó la probabilidad de supervivencia a dos años para los datos de prueba. Se midió la capacidad discriminante de los modelos en términos de sensibilidad, especificidad y precisión para predecir el reintento de suicidio y se calculó el área bajo la curva ROC (AUC) y el score integrado de Brier (IBS) a fin de evaluar el rendimiento de predicción general. Este proceso se repitió 500 veces, y los valores obtenidos en cada iteración se registraron para su análisis posterior. En cuanto a la predicción de reintento de suicidio a dos años, RSFElim presentó los mejores resultados respecto a AUC, especificidad y precisión, siendo CoxComp y CoxBack quienes presentaron mejores resultados para sensibilidad. RSFComp mostró los resultados más desfavorables en las medidas calculadas, salvo para especificidad. Respecto al IBS, RSFElim mostró los mejores resultados y CoxComp, los más desfavorables. Si bien RSFComp y CoxBack presentaron valores similares de la mediana de IBS, CoxBack mostró mayor variabilidad. De acuerdo a estos resultados, RSFElim fue considerado el método con mejor capacidad predictiva para este conjunto de datos.Fil: Chiapella, Luciana C.. Universidad Nacional de Rosario. Facultad de Ciencias Bioquímicas y Farmacéuticas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET); Argentina.Fil: Grendas, Leandro. Universidad Buenos Aires. Facultad de Medicina. Instituto de Farmacología; Argentina.Fil: Daray, Federico. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET); Argentina. Universidad Buenos Aires. Facultad de Medicina. Instituto de Farmacología; Argentina

Differential Impact of Child Sexual Abuse and Family History of Suicidal Behavior in High-Risk Suicidal Patients

The current study aimed to compare suicide-related variables as a function of 1) family history of suicidal behavior and 2) child sexual abuse among patients hospitalized for a suicide attempt or active suicidal ideation. Family history of suicidal behavior and child sexual abuse were examined independently and in combination as a diathesis for a high-risk suicidal phenotype. A multicenter cross-sectional study was designed to compare data obtained from 292 patients hospitalized for suicidal behavior. Demographic and clinical variables were compared among Group 1 (patients who reported both family history of suicidal behavior and child sexual abuse), Group 2 (patients who reported only family history of suicidal behavior), Group 3 (patients who reported only child sexual abuse), and Group 4 (patients who did not report family history of suicidal behavior or childhood sexual abuse). A multinomial logistic regression was used to examine suicide-related variables associated with each group and to compare differences between groups. Group 1 and 3 endorsed a higher number of previous suicide attempts and were more likely to be younger at the first suicide attempt compared to Group 4. Group differences remained after adjustment in a multinomial regression model. The current findings suggest that child sexual abuse may be more strongly related to suicide risk among high risk patients than family history of suicidal behavior.Fil: Grendas, Leandro. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Dr. Teodoro Álvarez"; ArgentinaFil: Rojas, Sasha M.. University of Arkansas for Medical Sciences; Estados UnidosFil: Rodante, Demián E.. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital Neuropsiquiatrico Braulio Aurelio Moyano.; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; ArgentinaFil: Puppo, Soledad. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Vidjen, Patricia. Gobierno de la Ciudad de Buenos Aires. Hospital Municipal "José Tiburcio Borda"; ArgentinaFil: Portela, Alicia. Gobierno de la Ciudad de Buenos Aires. Hospital Municipal "José Tiburcio Borda"; ArgentinaFil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; Argentina. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital Neuropsiquiatrico Braulio Aurelio Moyano.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentin

A randomized 3-month, parallel-group, controlled trial of CALMA m-health app as an adjunct to therapy to reduce suicidal and non-suicidal self-injurious behaviors in adolescents: study protocol

Background: Suicidal and non-suicidal self-injurious behaviors are among the leading causes of death and injury in adolescents and youth worldwide. Mobile app development could help people at risk and provide resources to deliver evidence-based interventions. There is no specific application for adolescents and young people available in Spanish. Our group developed CALMA, the first interactive mobile application with the user in Spanish, which provides tools based on Dialectical Behavioral Therapy to manage a crisis of suicidal or non-suicidal self-directed violence with the aim of preventing suicide in adolescents and youth. Methods: To test the effectiveness, safety and level of engagement of the CALMA app in people aged 10 to 19 who are treated in mental health services of two public hospitals, we will conduct a parallel-group, two-arm randomized controlled trial. Participants will be assessed face-to-face and via video call at four timepoints: day-0 (baseline), day-30, day-60, and day-90. A total of 29 participants per group will be included. Change in the frequency of suicidal and non-suicidal self-injurious behaviors will be compared between groups, as well as the level of emotional dysregulation, level of app engagement and time of psychiatric admission during the follow-up period. Discussion: This study is particularly relevant to young people given their widespread use of mobile technology, while there are currently no available smartphone app-based self-guided psychological strategies in Spanish that attempt to reduce suicidal behavior in adolescents who are assisted in the public health sector from low and middle-income countries in Latin America.Fil: Rodante, Demián. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; ArgentinaFil: Chiapella, Luciana Carla. Universidad Nacional de Rosario. Facultad de Ciencias Bioquímicas y Farmacéuticas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario; ArgentinaFil: Olivera Fedi, Ramiro. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; ArgentinaFil: Papavero, Eliana Belen. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; ArgentinaFil: Lavoie, Kim L.. Université du Québec a Montreal; CanadáFil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Differences between female suicidal patients with family history of suicide attempt and family history of completed suicide

Background: Family history of suicidal behavior and suicide are both risk factors for suicide. However, the effects of family history of suicide versus suicide attempts on patient suicidal behavior remain unclear. The aim of the present study was to understand if family history of suicide as compared to family history of suicide attempts or no family history of suicidal behavior evidences different associations with suicidal behavior among psychiatric patients. Method: Participants included 157 female patients between the ages of 18 and 65 years admitted at the Dr. Braulio A. Moyano Neuropsychiatric Women's Hospital. Results: Seventy-nine patients (50.3%) reported no family history of suicidal behavior (NFHSB), while 78 patients (49.7%) reported a family history of suicidal behavior. Specifically, 41 patients (26.1%) reported a family history of suicide attempt (FHSA) and 37 patients (23.6%) reported a family history of suicide (FHS). These groups showed significant differences between family history of psychopathology and number of previous suicide attempts. Patients with an FHSA were more likely to present with a greater number of previous suicide attempts as compared to patients with NFHSB and FHS. Conclusion: There is an association between the number of suicide attempts and family history of suicide attempts in female patients hospitalized for suicidal behavior.Fil: Rodante, Demián. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Rojas, S. M.. University of Arkansas; Estados UnidosFil: Feldner, M. T.. University of Arkansas; Estados Unidos. Laureate Institute for Brain Research; Estados UnidosFil: Dutton, C.. University of Arkansas; Estados UnidosFil: Rebok, Federico. Ciudad Autónoma de Buenos Aires. Hospital Neuropsiquiátrico “Dr. Braulio A. Moyano”; ArgentinaFil: Teti, Germán Leandro. Ciudad Autónoma de Buenos Aires. Hospital Neuropsiquiátrico “Dr. Braulio A. Moyano”; ArgentinaFil: Grendas, Leandro Nicolás. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Fógola, Agustina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Time Left for Intervention in the Suicidal Process in Borderline Personality Disorder

The objective of this study was to measure the duration of the suicidal process among patients diagnosed with Borderline Personality Disorder (BPD). The sample included 110 female patients who met DSM-IV-TR criteria for BPD and were consecutively admitted after suicide-related behavior. A total of 63 patients (58%) reported that their suicidal process lasted 10 minutes or less. After being adjusted, the β coefficient of impulsivity scales in women with a suicidal process ≤10 minutes was lower compared to those observed in women with >10 min (β = −0.03, 95% CI = −0.06 = −0.01, p < 0.01). Suicidal patients with BPD can be divided into two groups; patients who report a suicidal process less than 10 minutes show a higher degree of impulsivity.Fil: Daray, Federico Manuel. Universidad de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Teti, Germán Leandro. Gobierno de la Ciudad de Buenos Aires. Hospital Neuropsiquiátrico "Braulio A. Moyano"; ArgentinaFil: Rojas, Sasha M.. University Of Arkansas - Fayetteville; Estados UnidosFil: Fantini, Adrian Pablo. Gobierno de la Ciudad de Buenos Aires. Hospital Neuropsiquiátrico "Braulio A. Moyano"; ArgentinaFil: Cárdenas Delgado, Christian. Gobierno de la Ciudad de Buenos Aires. Hospital Neuropsiquiátrico "Braulio A. Moyano"; ArgentinaFil: Armesto, Arnaldo Raúl. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Derito, María N. C.. Gobierno de la Ciudad de Buenos Aires. Hospital Neuropsiquiátrico "Braulio A. Moyano"; ArgentinaFil: Rebok, Federico. Gobierno de la Ciudad de Buenos Aires. Hospital Neuropsiquiátrico "Braulio A. Moyano"; Argentin