Last Suicide Attempt before Completed Suicide in Severe Depression: An Extended Suicidal Process May Be Found in Men Rather Than Women.

The objective of this study was to compare the time from last suicide attempt to suicide in men and women with major depressive disorder with melancholic and/or psychotic features. The case records of 100 suicide victims with severe depression were evaluated. All suicide attempts during the course of depression were noted. The time from last suicide attempt to suicide was compared as well as the occurrence of suicide attempt during the last depressive episode, by gender. Male suicide attempters made fewer suicide attempts than women during their last depressive episode before suicide (8% versus 37%). Men appeared to have a more extended suicidal process from suicide attempt to completed suicide, which ought to be considered in the after-care

Antidepressant Therapy in Severe Depression May Have Different Effects on Ego-Dystonic and Ego-Syntonic Suicidal Ideation

The objective of the present study was to investigate whether ego-dystonic and ego-syntonic suicidal ideation occurred at different frequencies during antidepressant therapy. A blind evaluation has been performed on records of 100 suicides with a primary severe depression and 100 matched controls, admitted to the Department of Psychiatry, Lund, Sweden. Ego-dystonic suicidal ideation was more commonly reported during adequate treatment as compared to ego-syntonic ideation (P = .004). Men who committed suicide during adequate antidepressant therapy more often reported ego-dystonic suicidal ideation earlier in their lives compared with those who were not treated (P = .0377). This may indicate that treatment failure for ego-dystonic ideation was a precursor of their suicides. Consequently, ego-dystonic ideation seems to show a poorer response to antidepressant therapy as compared to ego-syntonic ideation, which may be more directly related to depression. Ego-dystonic ideation is proposed to be related to depressive psychosis

Repetition of suicide attempts across episodes of severe depression Behavioural sensitisation found in suicide group but not in controls

<p>Abstract</p> <p>Background</p> <p>Those who die by suicide and suffer from depression are known to have made more suicide attempts during their life-span as compared to other people with depression. A behavioural sensitisation or kindling model has been proposed for suicidal behaviour, in accordance with a sensitisation model of depressive episodes. The aim of the present study was to test such a model by investigating the distribution of initial and repeated suicide attempts across the depressive episodes in suicides and controls with a unipolar severe depression.</p> <p>Method</p> <p>A blind record evaluation was performed of 80 suicide victims and controls admitted to the Department of Psychiatry between 1956 and 1969 and monitored to 2010. The occurrence of initial and repeated suicide attempts by order of the depressive episodes was compared for suicides and controls.</p> <p>Results</p> <p>The risk of a first suicide attempt decreased throughout the later episodes of depression in both the suicide group (p < .000) and control group (p < .000). The frequencies of repetition early in the course were actually <it>higher </it>in the control group (p < .007). After that, the risk decreased in the control group, while the frequencies remained proportional in the suicide group. At the same time, there was a significantly greater decreased risk of repeated attempts during later episodes in the control group as compared to the suicide group (p < .000). The differences were found despite a similar number of episodes in suicides and controls.</p> <p>Conclusion</p> <p>Repeated suicide attempts in the later episodes of depression appear to be a risk factor for suicide in severe depression. This finding is compatible with a behavioural sensitisation of attempts across the depressive episodes, which seemed to be independent of a corresponding kindling of depression.</p

Repetition and severity of suicide attempts across the life cycle: a comparison by age group between suicide victims and controls with severe depression

<p>Abstract</p> <p>Background</p> <p>Suicide attempts have been shown to be less common in older age groups, with repeated attempts generally being more common in younger age groups and severe attempts in older age groups. Consistently, most studies have shown an increased suicide risk after attempts in older age. However, little is known about the predictive value of age on repeated and severe suicide attempts for accomplished suicide. The aim of the present study was to investigate the reduced incidence for initial, repeated, or severe suicide attempts with age in suicide victims and controls by gender.</p> <p>Methods</p> <p>The records of 100 suicide victims and matched controls with severe depression admitted to the Department of Psychiatry, Lund University Hospital, Sweden between 1956 and 1969, were evaluated and the subjects were monitored up to 2006. The occurrence of suicide attempts (first, repeated, or severe, by age group) was analysed for suicide victims and controls, with gender taken into consideration.</p> <p>Results</p> <p>There was a reduced risk for an initial suicide attempt by older age in females (suicide victims and controls) and male controls (but not suicide victims). The risk for repeated suicide attempts appeared to be reduced in the older age groups in female controls as compared to female suicide victims. The risk for severe suicide attempts seemed reduced in the older age groups in female suicide victims. This risk was also reduced in male controls and in male controls compared to male suicide victims.</p> <p>Conclusion</p> <p>In the older age groups repeated attempts appeared to be predictive for suicide in women and severe attempts predictive in men.</p

Number of addictive substances used related to increased risk of unnatural death: A combined medico-legal and case-record study

<p>Abstract</p> <p>Background</p> <p>Substance use disorders have repeatedly been found to lead to premature death, i.e. drug-related death by disease, fatal intoxications, or trauma (accidents, suicide, undetermined suicide, and homicide). The present study examined the relationship between multi-drug substance use and natural and unnatural death.</p> <p>Methods</p> <p>All consecutive, autopsied patients who had been in contact with the Addiction Centre in Malmö University Hospital from 1993 to 1997 inclusive were investigated. Drug abuse was investigated blindly in the case records and related to the cause of death in 387 subjects.</p> <p>Results</p> <p>Every substance apart from alcohol used previously in life added to the risk of unnatural death in a linear way. There were independent increased risks of fatal heroin overdoses or undetermined suicide. Death by suicide and violent death were unrelated to additional abuse.</p> <p>Conclusion</p> <p>The number of drugs used was related to an increased risk of unnatural death by undetermined suicide (mainly fatal intoxications) and heroin overdose.</p

Multiaxala skattningar av patienter på den psykiatriska kliniken i Lund - Individer med alkoholdiagnos

Between 1949 and 1969, a multiaxial diagnostic schedule was used to rate all inpatients at the Department of Psychiatry, University Hospital Lund, Sweden. The ratings were made at discharge of the patients and were performed by senior psychiatrists with at least three years of training. The rating schedule was developed by Professor Erik Essen-Möller and consisted of one symptomatic or syndromatic part and one aetologic part. The interview consisted of questions about social situation, occupation, physical illness, current medication, course of depression, cause of onset and cause of recovery/remission, treatment, suicide attempts, childhood, alcohol, and so forth. Approximately 7000 individuals were rated with a follow-up on individuals with alcohol problems (n=1312) or the diagnosis severe depression/melancholia (n=1206). The follow-up included data from the patient-records and sometimes personal contact. Purpose: To rate all inpatients at the Department of Psychiatry in Lund according to a multiaxial rating schedule with a symptomatic, a syndromatic and an aetiological part.Under åren 1949-1969 skattades alla patienter på den psykiatriska kliniken i Lund enligt ett multiaxialt skattningsschema. Skattningen utfördes vid utskrivningen av patienterna och gjordes av en psykolog med minst tre års utbildning. Skattningsschemat skapades av professor Erik Essen-Möller och bestod av en symtomatisk, en syndromatisk och en etiologisk del. Intervjun bestod av frågor rörande t.ex. social situation, yrke, fysisk sjukdom, nuvarande medicinering, depression, orsaken till varför depressionen startade eller orsak till återhämtning/återfall, behandling, självmordsförsök, barndom samt alkoholvanor. Cirka 7000 personer blev skattade och man har gjort en uppföljning av individer med alkoholdiagnos (1312) eller diagnosen djup depression/melankoli (1206). Uppföljningen innebar journalskattningar och i vissa fall personliga efterundersökningar. Syfte: Att skatta alla patienter på den psykiatriska kliniken i Lund enligt ett multiaxialt skattningsschema med en symtomatisk, en syndromatisk och en etiologisk del

Suicide risk and mental disorders

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Multiaxala skattningar av patienter på den psykiatriska kliniken i Lund - Individer med diagnosen djup depression/melankoli

Between 1949 and 1969, a multiaxial diagnostic schedule was used to rate all inpatients at the Department of Psychiatry, University Hospital Lund, Sweden. The ratings were made at discharge of the patients and were performed by senior psychiatrists with at least three years of training. The rating schedule was developed by Professor Erik Essen-Möller and consisted of one symptomatic or syndromatic part and one aetologic part. The interview consisted of questions about social situation, occupation, physical illness, current medication, course of depression, cause of onset and cause of recovery/remission, treatment, suicide attempts, childhood, alcohol, and so forth. Approximately 7000 individuals were rated with a follow-up on individuals with alcohol problems (n=1312) or the diagnosis severe depression/melancholia (n=1206). The follow-up included data from the patient-records and sometimes personal contact. Purpose: To rate all inpatients at the Department of Psychiatry in Lund according to a multiaxial rating schedule with a symptomatic, a syndromatic and an aetiological part.Under åren 1949-1969 skattades alla patienter på den psykiatriska kliniken i Lund enligt ett multiaxialt skattningsschema. Skattningen utfördes vid utskrivningen av patienterna och gjordes av en psykolog med minst tre års utbildning. Skattningsschemat skapades av professor Erik Essen-Möller och bestod av en symtomatisk, en syndromatisk och en etiologisk del. Intervjun bestod av frågor rörande t.ex. social situation, yrke, fysisk sjukdom, nuvarande medicinering, depression, orsaken till varför depressionen startade eller orsak till återhämtning/återfall, behandling, självmordsförsök, barndom samt alkoholvanor. Cirka 7000 personer blev skattade och man har gjort en uppföljning av individer med alkoholdiagnos (1312) eller diagnosen djup depression/melankoli (1206). Uppföljningen innebar journalskattningar och i vissa fall personliga efterundersökningar. Syfte: Att skatta alla patienter på den psykiatriska kliniken i Lund enligt ett multiaxialt skattningsschema med en symtomatisk, en syndromatisk och en etiologisk del

Suicide in Severe Depression: A Longitudinal Case-Control Study

Suicide in Severe Depression. A Longitudinal Case-Control Study. The present thesis is based on a case-control study of suicide victims with a severe depression/ melancholia. All patients admitted to the Department of Psychiatry 1956-1969 who received this diagnosis on a multiaxial schedule (1206 patients) were followed up in two sessions to 1984 and to 1998 concerning suicide and general mortality. A blind record evaluation of suicide victims with a primary depression at first follow up was performed on altogether 89 patients and 89 matched controls. Characteristics of depression did not differentiate between suicides and controls. 1. Initial ratings of heredity for psychosis or brittle/sensitive personality were related to suicide in the male group. There was a negative correlation with disharmony during childhood and physical illness in the female group. These findings indicate a vulnerability in the suicide group. 2. Suicidal ideation according to an established rating scale, the Beck’s SSI, was not related to suicide. 3. A suicide attempt was associated with an increased suicide risk in unipolar men and bipolar women. Characteristics of attempts, such as severity, method, and repetition did not discriminate between suicides and controls. However, female suicides more often started with a serious attempt, while controls showed an increase in severity. Life events were of minor importance in suicides as compared to controls. 4. Late in the course of depression (between 1984 and 1998) a sex difference appears with a higher rate in men, not seen at first follow up. 5. Controls more often received continuation treatment with antidepressants after ECT. In conclusion there was an evidence for a high degree of vulnerability in the suicide group, and a suicidal process with increasingly severe attempts could not be confirmed