Suicide ideation, plans, and attempts among general practice patients with chronic health conditions in Puerto Rico

Abstract

Background:Little is known about suicidal ideation among general practice patients in Puerto Rico. In this study we examined the rates, severity, and correlates of suicidal ideation, plans, and attempts among general practice patients with chronic illnesses. This is important in targeting appropriate interventions and management approaches to minimize and prevent suicide.Methods:We screened patients with chronic physical conditions at general practices. Suicidal ideation was assessed with the suicidality module of the Mini International Neuropsychiatric Interview. Major depression was assessed with the Patient Health Questionnaire depression module. The relationship between sociodemographic factors, depression and suicidal ideation was examined with multiple logistic regression analysis. Among the subgroup that acknowledged suicidal ideation, we used multinomial logistic regression analysis to estimate simultaneously the multivariate associations of depression and sociodemographic factors with suicidality risk levels.Results:Of the 2068 patients screened, 15.4% acknowledged recent suicidal ideation. Among this group, 8.6% reported passive ideation, 3.7% active ideation without a plan, and 3.1% active ideation with a plan or attempt. According to multivariate logistic regression, suicidal ideation was higher among patients with moderately severe depression and severe depression than for those with milder symptoms. Patients aged 64 years or younger were over one and a half times more likely to acknowledge suicidal ideation than those aged 65 years and older. Compared with patients having a college degree, those with lower education had a twofold higher risk of suicidal ideation. Multinomial logistic regression analysis indicated that severe depression was associated with a higher likelihood of having a suicide plan or attempt.Conclusion:The findings of this study suggest that public health strategies focusing on the systematic identification of patients with increased depression severity and the implementation of evidence-based depression treatments are relevant for minimizing and preventing suicidal behavior among general practice patients with chronic health conditions.

Gender-Specific Factors Associated with Suicide Attempts among the Community-Dwelling General Population with Suicidal Ideation: the 2013 Korean Community Health Survey

“…However, previous findings regarding the association between gender and suicide attempts have been inconsistent; some studies found that females have a greater risk for lifetime suicide attempts compared with males (5,6,8,10), while others found that gender was not associated with suicide attempts (7,(11)(12)(13)15). Until now, the association between gender and suicide attempts had not been determined in Korea, although gender was not significantly associated with suicide attempts in this study (data not shown).…”

“…However, other studies have found that marital status is not associated with suicide attempts (7,11,15). In the present study, males who were widowed, divorced, or separated participants had a higher risk for suicide attempts than that of male participants who were married, whereas the risk was lower risk for females.…”

“…The suicide mortality per 100,000 persons in Korea increases with age from 4.5 deaths in those between the ages of 10 and 19 years to 78.6 deaths among those 80 years and over (1). Although a few studies have found no association between age and suicide attempts (8,11), many studies have reported that suicide attempts are predicted by a younger age (5,6,12,15). In this study, we found that suicide attempts were predicted by a younger age in both males and females, suggesting that younger age is a potent predictor of suicide attempts in both genders.…”

“…A majority of studies have shown that education level is not independently associated with suicide attempts (7,8,(10)(11)(12)(13)15), while only one study reported a significant association (6). Lower levels of education are significantly associated with higher suicide rates in Korea (9), possibly because educational status has a more significant impact on social variables, such as occupation and income, in Korea than in other countries.…”

“…Although many risk factors for suicide attempts have been identified (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), more effective intervention strategies for mental health and suicide prevention can be developed when the gender-specific underlying risk factors for suicide attempts are better understood (16). To our knowledge, however, few studies have examined gender-specific risk factors for suicide attempts in a large general population.…”