Mental disorders and comorbidity in suicide

Henriksson, Markus; Aro, Hillevi; Marttunen, Mauri; Heikkinen, Martti; Isometsä, Erkki; Kuoppasalmi, Kimmo; Lönnqvist, Jouko

doi:10.1176/ajp.150.6.935

Cited by 692 publications

(96 citation statements)

References 32 publications

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“…Apart from adjustment disorder, more than half of the patients in the present study had a depressive disorder. In fact, mental illness, especially depressive disorder, has long been associated with suicide [37]. In addition, an increase in suicide rates was found to parallel an increase in mental illness over the past 20 years in Taiwan [38].…”

Section: Discussionmentioning

confidence: 99%

Psychiatric Comorbidity and Its Impact on Mortality in Patients Who Attempted Suicide by Paraquat Poisoning during 2000–2010

et al. 2014

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BackgroundParaquat poisoning is a lethal method of suicide used around the world. Although restricting its accessibility had been widely discussed, the underlying psychopathological mechanism of paraquat self-poisoning and its association with mortality have not yet been explicitly evaluated.MethodsWe included all patients admitted to a tertiary general hospital in Taiwan between 2000 and 2010 following a suicide attempt by paraquat self-administration. Diagnoses were made upon psychiatric consultation based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. The risk of mortality was calculated by logistic regression with various psychiatric or medical covariates.ResultsThe consultation-liaison psychiatry team assessed 157 patients who attempted suicide by paraquat poisoning. Mood disorders (54.0%), including dysthymic (26.7%) and major depressive disorders (24.7%), were the most common psychiatric diagnoses among the self-poisoning patients. Among those who attempted suicide, 87 patients (58.0%) died and dysthymic disorder (OR = 5.58, 95% CI: 1.13–27.69; p<0.05) significantly increased the mortality risk after adjustment for relevant medical variables, including age, gender, severity index of paraquat poisoning (SIPP), and risk for respiratory failure.ConclusionsAwareness of comorbid psychiatric illnesses, especially dysthymic disorder, is vital in the prevention and treatment of suicide by paraquat poisoning.

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Section: Discussionmentioning

confidence: 99%

Psychiatric Comorbidity and Its Impact on Mortality in Patients Who Attempted Suicide by Paraquat Poisoning during 2000–2010

et al. 2014

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“…In 1986, the Finnish National Board of Health set up the National Suicide Prevention Project to deal with this significant public health problem [41]. As a part of this project, using a psychological autopsy method, all suicide victims in Finland during 1 year were evaluated and the majority of them were found to suffer from comorbid mental disorders [42]. The results remained unchanged also in somatically ill patients [43].…”

Section: Discussionmentioning

confidence: 99%

Suicidal Ideas in Stroke Patients 3 and 15 Months after Stroke

et al. 2001

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Patients with stroke may have an increased risk of suicide. We sought to examine the frequency and clinical correlates of suicidal ideas 3 and 15 months after stroke. The study group comprised 286 of 486 consecutive patients aged 55–85 years who at 3 and 15 months after ischemic stroke completed a detailed medical, neurological and radiological stroke evaluation, structured measures of cognition (Mini Mental State Examination), emotion (Beck Depression Inventory, BDI), disability (Rankin scale), and assessment of dependent living. Suicidal ideas were present in 9.8% (n = 28) at 3 months’ follow-up and in 14.0% (n = 40) at 15 months’ follow-up. The patients with suicidal ideas were more depressed measured by BDI both at 3 (17.0 vs. 7.9, p < 0.001) and 15 months (20.5 vs. 8.5, p < 0.001) after stroke compared to the patients without suicidal ideas. Patients with suicidal ideas had more often a history of a stroke already before the index stroke (35 vs. 18.3%, p = 0.0154), right-sided stroke (60.0 vs. 41.9%, p = 0.0323), they were more disabled according to the Rankin scale (2.4 vs. 1.9; p = 0.0035) and more dependent in living (45.0 vs. 27.2%, p = 0.023) 15 months after stroke. An independent correlate of suicidal ideas 15 months after stroke was history of prior stroke (OR 2.4; 95% CI 1.14–4.97) in logistic regression analysis. The frequency of suicidal ideas increased with the time elapsed from stroke. Recurrent strokes, depressive symptoms, more disabling stroke and right-sided stroke correlated to suicidal ideas at 15 months after stroke. Early identification of these risk factors may lead to effective therapeutic intervention.

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“…Treatment of suicidal patients has typically focused on reducing depressive symptoms believed to be the principal determinant underlying suicidal behavior (Henriksson et al, 1993). Evidence that treatment-related improvements in neurocognitive functioning are partially independent from improvement in the clinical symptoms of MDD (Herrera-Guzman et al, 2009), though, suggests that neurocognitive difficulties should be considered a distinct and essential target of treatment.…”

Section: Introductionmentioning

confidence: 99%

Treatment-related improvement in neuropsychological functioning in suicidal depressed patients: Paroxetine vs. bupropion

Gorlyn¹,

Keilp²,

Burke³

et al. 2015

Psychiatry Research

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Neuropsychological dysfunction is associated with risk for suicidal behavior, but it is unknown if antidepressant medication treatment is effective in reducing this dysfunction, or if specific medications might be more beneficial. A comprehensive neuropsychological battery was administered at baseline and after eight weeks of treatment within a randomized, double-blind clinical trial comparing paroxetine and bupropion in study of patients with DSM-IV major depressive disorder and either past suicide attempt or current suicidal thoughts. Change in neurocognitive performance was compared between assessments and between medication groups. Treatment effects on Hamilton Depression Rating Scale and Scale for Suicidal Ideation were compared with neurocognitive improvement. Neurocognitive functioning improved after treatment in all patients, without clear advantage for either medication. Improvement in memory performance was associated with a reduction in suicidal ideation independent of the improvement of depression severity. Overall, antidepressant medication improved neurocognitive performance in patients with major depression and suicide risk. Reduced suicidal ideation was best predicted by a combination of the independent improvements in both depression symptomatology and verbal memory. Targeted treatment of neurocognitive dysfunction in these patients may augment standard medication treatment for reducing suicidal behavior risk.

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Mental disorders and comorbidity in suicide

Abstract: The majority of suicide victims suffered from comorbid mental disorders. Comorbidity needs to be taken into account when analyzing the relationship between suicide and mental disorders and in planning treatment strategies for suicide prevention in clinical practice.

Cited by 692 publications

References 32 publications

Psychiatric Comorbidity and Its Impact on Mortality in Patients Who Attempted Suicide by Paraquat Poisoning during 2000–2010

Psychiatric Comorbidity and Its Impact on Mortality in Patients Who Attempted Suicide by Paraquat Poisoning during 2000–2010

Suicidal Ideas in Stroke Patients 3 and 15 Months after Stroke

Treatment-related improvement in neuropsychological functioning in suicidal depressed patients: Paroxetine vs. bupropion

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