Risk factors for fatal and nonfatal repetition of suicide attempts: a literature review

Objectives: This review aimed to identify the evidence for predictors of repetition of suicide attempts, and more specifically for subsequent completed suicide. Methods: We conducted a literature search of PubMed and Embase between January 1, 1991 and December 31, 2009, and we excluded studies investigating only special populations (eg, male and female only, children and adolescents, elderly, a specific psychiatric disorder) and studies with sample size fewer than 50 patients. Results: The strongest predictor of a repeated attempt is a previous attempt, followed by being a victim of sexual abuse, poor global functioning, having a psychiatric disorder, being on psychiatric treatment, depression, anxiety, and alcohol abuse or dependence. For other variables examined (Caucasian ethnicity, having a criminal record, having any mood disorders, bad family environment, and impulsivity) there are indications for a putative correlation as well. For completed suicide, the strongest predictors are older age, suicide ideation, and history of suicide attempt. Living alone, male sex, and alcohol abuse are weakly predictive with a positive correlation (but sustained by very scarce data) for poor impulsivity and a somatic diagnosis. Conclusion: It is difficult to find predictors for repetition of nonfatal suicide attempts, and even more difficult to identify predictors of completed suicide. Suicide ideation and alcohol or substance abuse/dependence, which are, along with depression, the most consistent predictors for initial nonfatal attempt and suicide, are not consistently reported to be very strong predictors for nonfatal repetition

Relationship of antecedent stressful life events to childhood and family history of anxiety and the course of panic disorder

OBJETIVO: Os autores examinaram a freqüência de eventos vitais significativos (estressores) durante o ano que antecedeu o transtorno do pânico e sua relação com história de ansiedade na infância, história familiar de ansiedade, comorbidades e curso da doença. MATERIAIS E MÉTODOS: 223 pacientes foram acompanhados em um estudo naturalístico, longitudinal do transtorno do pânico. RESULTADOS: Apesar de 80% dos pacientes com transtorno do pânico referirem a presença de um fator estressor durante o ano anterior ao início da sua doença, sua freqüência é mais elevada em pacientes com história de ansiedade na infância e comorbidade com depressão na vida adulta. CONCLUSÕES: A presença de eventos vitais significativos não está associada com a presença de outros transtornos de ansiedade na vida adulta e nem com história familiar de ansiedade. Apesar de sua associação com história de ansiedade na infância e depressão, a presença de um fator estressor identificável não está associado a severidade ou ao curso do transtorno do pânico.OBJECTIVES: The authors examined the incidence of significant life events during the year prior to the onset of panic disorder and its relationship to childhood and family history of anxiety difficulties, comorbidity, and the course of illness. MATERIALS AND METHODS: 223 panic patients were followed in a naturalistic study of panic disorder. RESULTS: Similar to previous reports, antecedent negative life events occurred in the majority (80%) of patients. Patients with a childhood history of anxiety and comorbid adulthood major depression were more likely to report an antecedent, stressful life event. CONCLUSIONS: Antecedent events were not linked with comorbid adulthood anxiety disorders or a family history of anxiety difficulties. Despite its associations with childhood anxiety pathology and adulthood major depression, the presence of an identifiable antecedent at the onset of panic disorder was not associated with the subsequent severity or course of the disorder

Relação entre eventos vitais e história de ansiedade na infância, história familiar de ansiedade e curso do transtorno do pânico

OBJECTIVES: The authors examined the incidence of significant life events during the year prior to the onset of panic disorder and its relationship to childhood and family history of anxiety difficulties, comorbidity, and the course of illness.MATERIALS AND METHODS: 223 panic patients were followed in a naturalistic study of panic disorder.RESULTS: Similar to previous reports, antecedent negative life events occurred in the majority (80%) of patients. Patients with a childhood history of anxiety and comorbid adulthood major depression were more likely to report an antecedent, stressful life event.CONCLUSIONS: Antecedent events were not linked with comorbid adulthood anxiety disorders or a family history of anxiety difficulties. Despite its associations with childhoodnxiety pathology and adulthood major depression, the presence of an identifiable antecedent at the onset of panic disorder was not associated with the subsequent severity or course of the disorder.OBJETIVO: Os autores examinaram a freqüência de eventos vitais significativos (estressores) durante o ano que antecedeu o transtorno do pânico e sua relação com história de ansiedade na infância, história familiar de ansiedade, comorbidades e curso da doença.MATERIAIS E MÉTODOS: 223 pacientes foram acompanhados em um estudo naturalístico, longitudinal do transtorno do pânico.RESULTADOS: Apesar de 80% dos pacientes com transtorno do pânico referirem a presença de um fator estressor durante o ano anterior ao início da sua doença, sua freqüência é mais elevada em pacientes com história de ansiedade na infância e comorbidade com depressão na vida adulta.CONCLUSÕES: A presença de eventos vitais significativos não está associada com a presença de outros transtornos de ansiedade na vida adulta e nem com história familiar de ansiedade. Apesar de sua associação com história de ansiedade na infância e depressão, a presença de um fator estressor identificável não está associado a severidade ou ao curso do transtorno do pânico