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

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

Revisión sistemática de los factores de riesgo de suicidio e intento de suicidio entre los pacientes psiquiátricos de América Latina y el Caribe

OBJETIVO: Analizar los datos probatorios publicados de la región de América Latina y el Caribe (ALC) que fueran pertinentes a los factores de riesgo de suicidio consumado e intentos de suicidio entre las poblaciones psiquiátricas. MÉTODOS: Se seleccionaron los posibles estudios mediante búsquedas electrónicas sistemáticas en MEDLINE y LILACS. Se incluyeron estudios cuyos diseños de investigación fueran de cohortes, de casos y controles, o transversales de muestras psiquiátricas, y en los que el suicidio o un intento de suicidio se notificaran como un resultado, y se evaluaran mediante alguna medida de la repercusión (razón de posibilidades, razón de riesgos o razón de riesgos instantáneos). Se evaluó la calidad metodológica mediante el uso de las recomendaciones de la iniciativa de Fortalecimiento de la Notificación de los Estudios Observacionales en Epidemiología (STROBE, por sus siglas en inglés). RESULTADOS: Se analizaron 17 de los 2 987 estudios seleccionados con objeto de determinar los posibles factores de riesgo de suicidio. Once estudios usaron un diseño de casos y controles, cinco usaron un diseño transversal, y un único estudio usó un diseño de cohortes prospectivo. Los principales factores de riesgo de intento de suicidio en ALC fueron el trastorno depresivo mayor (TDM), la disfunción familiar y el intento de suicidio previo, mientras que los principales factores de riesgo de suicidio consumado fueron el sexo masculino y el TDM. La mayor parte de los estudios mostraron una mala calidad metodológica. CONCLUSIONES: Esta revisión aporta datos probatorios de que la mayor parte de los factores de riesgo pertinentes al suicidio y los intentos de suicidio en la región de ALC son similares a los observados en las sociedades occidentales pero diferentes a los notificados en las sociedades orientales. Se necesitan estudios regionales de mayor calidad metodológica para apoyar estos resultados.-To analyze published evidence from the Latin America and Caribbean (LAC) region pertaining to risk factors for completed suicide and suicide attempts among psychiatric populations. METHODS- Potential studies were identified through systematic electronic searches in MEDLINE and LILACS. Included studies were cohort, case-control, and cross-sectional designed investigations of psychiatric samples in which suicide or a suicide attempt was reported as an outcome and evaluated with some measure of impact (odds ratio, risk ratio, or hazard ratio). Methodological quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations. RESULTS- Of the 2 987 identified studies, a total of 17 studies were reviewed to determine potential suicidal risk factors. Eleven studies used a case-control design, five used a cross-sectional design, and only one study used a prospective-cohort design. The main risk factors for suicide attempts in LAC included major depressive disorder (MDD), family dysfunction, and prior suicide attempt, while the main risk factors for completed suicide were male gender and MDD. The methodological quality of most of the studies was low. CONCLUSIONS- This review provides evidence that the majority of relevant risk factors for suicide and suicide attempts in the LAC region are similar to those observed in Western societies but different from those reported in Eastern societies. Studies of higher methodological quality from the region are needed to support these results-Fil: Teti, Germán. Hospital "Braulio A. Moyano"; ArgentinaFil: Rebok, Federico. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; ArgentinaFil: Rojas, Sasha M.. University Of Arkansas For Medical Sciences; Estados UnidosFil: Grendas, Leandro. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; ArgentinaFil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Systematic review of risk factors for suicide and suicide attempt among psychiatric patients in Latin America and Caribbean

OBJECTIVE: To analyze published evidence from the Latin America and Caribbean (LAC) region pertaining to risk factors for completed suicide and suicide attempts among psychiatric populations. METHODS: Potential studies were identified through systematic electronic searches in MEDLINE and LILACS. Included studies were cohort, case-control, and cross-sectional designed investigations of psychiatric samples in which suicide or a suicide attempt was reported as an outcome and evaluated with some measure of impact (odds ratio, risk ratio, or hazard ratio). Methodological quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations. RESULTS: Of the 2 987 identified studies, a total of 17 studies were reviewed to determine potential suicidal risk factors. Eleven studies used a case-control design, five used a cross-sectional design, and only one study used a prospective-cohort design. The main risk factors for suicide attempts in LAC included major depressive disorder (MDD), family dysfunction, and prior suicide attempt, while the main risk factors for completed suicide were male gender and MDD. The methodological quality of most of the studies was low. CONCLUSIONS: This review provides evidence that the majority of relevant risk factors for suicide and suicide attempts in the LAC region are similar to those observed in Western societies but different from those reported in Eastern societies. Studies of higher methodological quality from the region are needed to support these results

Psychometric properties of the Patient Health Questionnaire nine-item version (PHQ-9) for use among hospitalized non-psychiatric medical patients

Background: Depression comorbid with non-psychiatric illness is widely prevalent, and the source of considerable burden. Reliable rating tools to detect depression in the general medical setting are therefore needed across different regions, including Argentina. The present study aimed to compare the psychometric characteristics of the Patient Health Questionnaire 9 (PHQ-9), Beck Depression Inventory-II (BDI-II) and Hospital Anxiety and Depression Scale (HADS) against each other, using independent criterion for the diagnosis of a major depressive episode (MDE).Methods: A multicenter, cross-sectional study was conducted over six months, screening 257 hospitalized general medical patients across three hospitals. After admission, participants were interviewed by a trained psychiatrist using the Mini International Neuropsychiatric Interview (MINI), and then each participant went through the administration of PHQ-9, BDI-II, and HADS.Results: For the diagnosis of a MDE according to the MINI, the best cut-off scores were 10 for the PHQ-9, 16 for the BDI-II, and 15 for the HADS. Owing to clinical interpretability issues, a two-factor solution was preferred using exploratory factor analysis (component 1 ?somatic/neurovegetative?, and component 2 ?psychological/cognitive? of depression). The local version of the PHQ-9 had high internal consistency (Cronbach's alpha=.87). Conclusions: The Argentine version of the PHQ-9 questionnaire showed acceptable validity and reliability for the screening of depressive symptoms.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: Hunter, F.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Ramos Mejía"; ArgentinaFil: Anastasia, A.. National Institue for Social Security; ItaliaFil: Fornaro, M.. Università degli Studi di Napoli Federico II; Itali

Interaction between prospective risk factors in the prediction of suicide risk

Background: To meet the goal of preventing suicide the most important thing is to know the risk factors of suicidal behavior and understand their interaction. Aims: The current study aims to evaluate prospective predictors and the interaction between factors for suicide and suicide re-attempts in high-risk, suicidal patients during a 24 month prospective follow-up period. Methods: A multicenter prospective cohort study was designed to compare data obtained from 324 patients admitted to the emergency department for current suicidal ideation or a recent suicide attempt. Participants were clinically evaluated at baseline and follow-up every 6 months to assess any unfavorable events (suicide or a suicide attempt). To estimate the rate of unfavorable events, the Kaplan–Meier method was used and Cox Proportional Hazards Regression Model was employed to examine predictors of suicide and suicide reattempt. Results: The incidence of a new suicide attempt was 26,000 events/100,000 persons-years. The incidence of death by suicide was 1110 events/100,000 person-year. The most reliable predictors of unfavorable events were being women, previous suicide attempts, younger age, and childhood sexual abuse. Findings revealed an interaction between childhood sexual abuse and low psychosocial functioning that increased the risk of an unfavorable event. Conclusion: The risk of suicide re-attempts and suicide in the current 2-year follow-up was high. There was an interaction between low psychosocial functioning and childhood sexual abuse. This evidence should be taken into account for the evaluation and planning of preventive strategies.Fil: Grendas, Leandro. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacología; 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: 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 Andrea. Gobierno de la Ciudad de Buenos Aires. Hospital Municipal "José Tiburcio Borda"; ArgentinaFil: Chiapella, Luciana Carla. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario; Argentina. Universidad Nacional de Rosario. Facultad de Ciencias Bioquímicas y Farmacéuticas; ArgentinaFil: Rodante, Demián. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacología; Argentina. Gobierno de la Ciudad Autónoma de Buenos Aires. Hospital Neuropsiquiátrico Braulio Aurelio Moyano; ArgentinaFil: Daray, Federico Manuel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacología; Argentin

Determinants and geographical variation in the distribution of depression in the Southern cone of Latin America: A population-based survey in four cities in Argentina, Chile and Uruguay

Background Depression is one of the major contributors to the global burden of diseases; however, population-based data in South America are limited. Methods We conducted a population-based cross sectional study with 7524 participants, aged 35–74 years old, recruited between February 2010 and December 2011 from randomly selected samples in 4 cities (Bariloche and Marcos Paz, Argentina; Temuco, Chile; and Pando-Barros Blancos, Uruguay). Major Depressive Episode (MDE) was assessed using the Patient Health Questionnaire (PHQ) – 9. Results The overall prevalence of MDE was 14.6% (95% CI: 13.6, 15.6). However, there was a geographical variability of up to 3.7 folds between different cities being 5.6% (95% CI: 4.6, 6.7) in Marcos Paz, Argentina; 9.5% (95% CI: 8.2, 10.9) in Bariloche, Argentina; 18.1% (95% CI: 16.3, 20.0) in Temuco, Chile, and 18.2 (95% CI: 16.3, 20.2) in Pando-Barros Blancos, Uruguay. The multivariate model showed that, adjusted by location, being female, being between 35 and 44 years old, having experienced at least one stressful life event, currently smoking, and having a history of chronic medical diseases were independently associated with an increased risk of MDE, while having higher education and being married or living with a partner reduced the risk of MDE. Limitations These results are representative of the selected cities included in the study. As such extrapolation to the general populations of Argentina, Chile, and Uruguay should be done with caution Conclusions This study showed a high prevalence and variability of MDE in the Southern Cone of Latin America.Fil: Daray, Federico Manuel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Odontología; ArgentinaFil: Rubinstein, Adolfo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Gutierrez, L.. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Lanas, F.. Universidad de La Frontera; ChileFil: Mores, N.. Provincia de Buenos Aires. Municipalidad de Marcos Paz; ArgentinaFil: Calandrelli, M.. Sanatorio San Carlos; ArgentinaFil: Poggio, Rosana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Ponzo, J.. Universidad de la República; UruguayFil: Irazola, Vilma. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Lethality of Previous Suicidal Behavior among Patients Hospitalized for Suicide Risk Predicts Lethality of Future Suicide Attempts

Objective: A suicide attempt is an established risk factor for subsequent suicide attempts and suicide. Nonetheless, the prediction of future suicidal behavior is poor. The lethality of previous suicidal behavior may be informative to better understand future suicide risk among patients hospitalized for suicidal thoughts and behavior. The current study examined whether the lethality of patients' index (most recent suicidal episode at hospitalization), first, and worst suicidal episode predicts the lethality of one's most lethal suicide attempt during a 2-year follow-up period. Method: A total of 98 patients hospitalized at an emergency department for high suicide risk (i.e., acute suicidal ideation or a suicide attempt) were included in the study. Results: Results indicated that the lethality of the index suicidal episode predicted the lethality of the worst suicide attempt during a 2-year follow-up period. Conclusions: These findings extend a growing literature examining risk factors that influence the progression toward high lethality suicidal behavior.Fil: Rojas, Sasha M.. University of Arkansas for Medical Sciences; Estados UnidosFil: Skinner, Kayla D.. University of Arkansas for Medical Sciences; Estados UnidosFil: Feldner, Matthew T.. Laureate Institute for Brain Research; Estados Unidos. University of Arkansas for Medical Sciences; Estados UnidosFil: Rodante, Demian E.. Hospital Neuropsiquiátrico "Moyano, Braulio A."; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Farmacología; ArgentinaFil: Puppo, Soledad. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Farmacología; ArgentinaFil: Vidjen, Patricia. Gobierno de la Ciudad de Buenos Aires. Hospital Municipal "José Tiburcio Borda"; ArgentinaFil: Portela, Alicia Andrea. Gobierno de la Ciudad de Buenos Aires. Hospital Municipal "José Tiburcio Borda"; ArgentinaFil: Grendas, Leandro. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Farmacología; ArgentinaFil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Farmacología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin