Objective While suicide attempt history is considered to robustly predict completed suicide, previous studies have limited generalizability from using convenience samples of specific methods/treatment settings, disregarding previous attempts, or overlooking first-attempt deaths. Eliminating these biases should more accurately estimate suicide prevalence in attempters. Method This observational retrospective-prospective cohort study using the Rochester Epidemiology Project identified 1,490 (555 males/935 females) Olmsted County residents making index suicide attempts (first lifetime attempts reaching medical attention) between 01-01-1986 and 12-31-2007. The National Death Index identified suicides between enrollment and 12-31-2010 (follow-up 3-25 years). Medical records were queried for sex, age, method, and follow-up care for index attempt survivors. Coroner records yielded data on index attempt deaths. Results During the study period, 81/1490 enrollees (5.4%) died by suicide. Of the 81, 48 (59.3%) perished on index attempt; 27 of the surviving 33 index attempt survivors (81.8%) killed themselves within a year. Males were disproportionately represented: 62/81 (11.2% of men; 76.5% of suicides) vs 19/81 (2.0% of women, 23.5% of suicides). Of dead index attempters, 72.9% used guns, yielding an odds ratio for gunshot death vs all other methods of 140 [95%CI:60,325]. When adjusted for covariates, survivors given follow-up psychiatric appointments had significantly lower likelihood of subsequent suicide (OR=0.212[95%CI:0.089, 0.507]). Conclusions At 5.4%, completed suicide prevalence in this community cohort of suicide attempters was almost 59% higher than previously reported. An innovative aspect of this study explains the discrepancy: by including index attempt deaths—approximately 60% of total suicides—suicide prevalence more than doubled. We contend that counting both index and subsequent attempts deaths more accurately reflects prevalence. Our findings support suicide attempt as an even more lethal risk factor for completed suicide than previously thought. Research should focus on identifying risk factors for populations vulnerable to making first attempts and target risk reduction in those groups.

This paper demonstrates the ability to use capillary electrophoresis (CE) separation coupled with laser-induced fluorescence for analyzing the contents of single femtoliter-volume aqueous droplets. A single droplet was formed using a T-channel (3 microm wide by 3 microm tall) connected to microinjectors, and then the droplet was fluidically moved to an immiscible boundary that isolates the CE channel (50 microm wide by 50 microm tall) from the droplet generation region. Fusion of the aqueous droplet with the immiscible boundary effectively injects the droplet content into the separation channel. In addition to injecting the contents of droplets, we found aqueous samples can be introduced directly into the separation channel by reversibly penetrating and resealing the immiscible partition. Because droplet generation in channels requires hydrophobic surfaces, we have also investigated the advantages to using all hydrophobic channels versus channel systems with patterned hydrophobic and hydrophilic regions. To fabricate devices with patterned surface chemistry, we have developed a simple strategy based on differential wetting to deposit selectively a hydrophilic polymer (poly(styrenesulfonate)) onto desired regions of the microfluidic chip. Finally, we applied our device to the separation of a simple mixture of fluorescein-labeled amino acids contained within a approximately 10-fL droplet.

Not merely a drop in the ocean: The integration of capillary electrophoresis (CE) with droplet generation driven by electroosmotic flow enabled the compartimentalization of molecular components separated by CE in a series of droplets (see picture; the green bars represent the separated analytes). The droplet-confined bands can be docked and studied on a chip.

Objective: Although suicide is the second most frequent cause of death in American youth, suicide research has heretofore been confined to convenience samples (1) representing neither psychiatric nor general populations and (2) failing to include individuals dying on first attempts. We sought to address these limitations by assembling a youth cohort followed from first medically recorded attempt (index attempts=IA). We hypothesized this approach would more accurately represent prevalence of completed suicide after attempt and underscore lethality based on method. Method: This study draws from a previously reported retrospective-prospective all-age cohort identified through the Rochester Epidemiology Project. The original 1490 subject sample included 813 Olmsted County youth aged 10–24yrs (n=258 males, n=555 females; 54.6% of the total cohort) making IAs between 01-Jan-1986 and 31-Dec-2007 and followed until 31-Dec-2010. Results: 29/813 (3.6%) subjects killed themselves during the study period, with 28/29 dying before their 25th birthdays and 20/28 (71.4%) dying on first attempt. Comprising only 31.7% (258/813) of the cohort, males comprised the majority of suicides: 23/29 (79.3% of suicides; 8.9% of males) versus 6/29 females (20.7% of suicides; 1.1% of females). 85.0% of all IA deaths involved firearms. More than a third of youth—41.2%—lacked prior psychiatric history. Conclusion: Our data shows over half of IAs occurring in youth with approximately three-quarters of completed youth suicides happening on IAs. In parsing cause of death in the all-age-cohort, the contribution of firearms figured even more prominently in the subsample of youth (85.0%) than those 25 and older (64.3%). The high IA lethality suggests that prevention efforts commencing after IA are too late for most victims.

Suicide prevention efforts are increasing to enhance capabilities and better understand risk factors and etiologies. Postvention, or how clinicians manage the postsuicide aftermath, strengthens suicide prevention, destigmatizes the tragedy, operationalizes the confusing aftermath, and promotes caregiver recovery. However, studies regarding its efficacy are minimal. The Psychopathology Committee of the Group for the Advancement for Psychiatry surveyed a convenience sample of psychiatrists to better understand postvention activities. Ninety psychiatrists completed the survey; they were predominantly men (72%) with an average of 24.6 years of experience (SD, 16.7 years). Most had contact with the patient’s family within 6 months of the suicide, and most psychiatrists sought some form of support. Few psychiatrists used a suicide postvention procedure or toolkit (9%). No psychiatrists stopped clinical practice after a patient suicide, although 10% stopped accepting patients they deemed at risk of suicide. Postvention efforts, therefore, should be improved to better address survivor care.

Mehr als ein Tropfen im Meer: Die Kombination von Kapillarelektrophorese (CE) mit elektroosmotischer Tröpfchenerzeugung ermöglicht die Kompartimentalisierung von durch CE getrennten molekularen Komponenten in einzelnen Tröpfchen (siehe Bild; die grünen Balken repräsentieren die getrennten Analyte). Die tröpfchenweise separierten Banden können auf einem Chip untersucht oder isoliert und separat analysiert werden.magnified image

Electroosmotic‐flow‐driven droplet generation integrated with capillary electrophoresis (CE) allows the molecular components separated by CE to be compartmentalized into a stream of droplets, as reported by D. T. Chiu and co‐workers in their Communication on and illustrated on the cover picture. After separation and droplet compartmentalization, the droplet‐confined bands either can be docked and studied on‐chip or removed off‐chip for a second‐dimension separation and further analysis.

Elektroosmotische Tröpfchenerzeugung in Kombination mit Kapillarelektrophorese ermöglicht die Kompartimentalisierung molekularer Komponenten in einem Tröpfchenstrom, wie D. T. Chiu et al. in der Zuschrift auf S. 2757 ff. berichten und wie das Titelbild illustriert. Die tröpfchenweise separierten Banden können entweder auf einem Chip untersucht oder isoliert und einzeln analysiert werden.magnified image