Posts tagged suicide
Articles and news from the latest research reports.
Association between sunshine and suicide examined in study
Lower rates of suicide are associated with more daily sunshine in the prior 14 to 60 days.
Light interacts with brain serotonin systems and possibly influences serotonin-related behaviors. Those behaviors, such as mood and impulsiveness, can play a role in suicide.
The authors examined the relationship between suicide and the duration of sunshine after mathematically removing seasonal variations in sunshine and suicide numbers. They analyzed data on 69,462 officially confirmed suicides in Austria between January 1970 and May 2010. Hours of sunshine per day were calculated from 86 representative meteorological stations.
There was a positive correlation between the number of suicides and hours of daily sunshine on the day of the suicide and up to 10 days before that seemed to facilitate suicide, while sunshine 14 to 60 days prior appeared to have a negative correlation and was associated with reduced suicides. The correlation between daily sunshine hours and suicide rates was seen largely among women, while negative correlations between the two were mainly found among men.
"Owing to the correlative nature of the data, it is impossible to directly attribute the increase in suicide to sunshine during the 10 days prior to the suicide event. … Further research is warranted to determine which patients with severe episodes of depression are more susceptible to the suicide-triggering effects of sunshine."
(Image: Shutterstock)
A blood test for suicide?
Johns Hopkins researchers say they have discovered a chemical alteration in a single human gene linked to stress reactions that, if confirmed in larger studies, could give doctors a simple blood test to reliably predict a person’s risk of attempting suicide.
The discovery, described online in The American Journal of Psychiatry, suggests that changes in a gene involved in the function of the brain’s response to stress hormones plays a significant role in turning what might otherwise be an unremarkable reaction to the strain of everyday life into suicidal thoughts and behaviors.
“Suicide is a major preventable public health problem, but we have been stymied in our prevention efforts because we have no consistent way to predict those who are at increased risk of killing themselves,” says study leader Zachary Kaminsky, Ph.D., an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. “With a test like ours, we may be able to stem suicide rates by identifying those people and intervening early enough to head off a catastrophe.”
For his series of experiments, Kaminsky and his colleagues focused on a genetic mutation in a gene known as SKA2. By looking at brain samples from mentally ill and healthy people, the researchers found that in samples from people who had died by suicide, levels of SKA2 were significantly reduced.
Within this common mutation, they then found in some subjects an epigenetic modification that altered the way the SKA2 gene functioned without changing the gene’s underlying DNA sequence. The modification added chemicals called methyl groups to the gene. Higher levels of methylation were then found in the same study subjects who had killed themselves. The higher levels of methylation among suicide decedents were then replicated in two independent brain cohorts.
In another part of the study, the researchers tested three different sets of blood samples, the largest one involving 325 participants in the Johns Hopkins Center for Prevention Research Study found similar methylation increases at SKA2 in individuals with suicidal thoughts or attempts. They then designed a model analysis that predicted which of the participants were experiencing suicidal thoughts or had attempted suicide with 80 percent certainty. Those with more severe risk of suicide were predicted with 90 percent accuracy. In the youngest data set, they were able to identify with 96 percent accuracy whether or not a participant had attempted suicide, based on blood test results.
The SKA2 gene is expressed in the prefrontal cortex of the brain, which is involved in inhibiting negative thoughts and controlling impulsive behavior. SKA2 is specifically responsible for chaperoning stress hormone receptors into cells’ nuclei so they can do their job. If there isn’t enough SKA2, or it is altered in some way, the stress hormone receptor is unable to suppress the release of cortisol throughout the brain. Previous research has shown that such cortisol release is abnormal in people who attempt or die by suicide.
Kaminsky says a test based on these findings might best be used to predict future suicide attempts in those who are ill, to restrict lethal means or methods among those a risk, or to make decisions regarding the intensity of intervention approaches.
He says that it might make sense for use in the military to test whether members have the gene mutation that makes them more vulnerable. Those at risk could be more closely monitored when they returned home after deployment. A test could also be useful in a psychiatric emergency room, he says, as part of a suicide risk assessment when doctors try to assess level of suicide risk.
The test could be used in all sorts of safety assessment decisions like the need for hospitalization and closeness of monitoring. Kaminsky says another possible use that needs more study could be to inform treatment decisions, such as whether or not to give certain medications that have been linked with suicidal thoughts.
“We have found a gene that we think could be really important for consistently identifying a range of behaviors from suicidal thoughts to attempts to completions,” Kaminsky says. “We need to study this in a larger sample but we believe that we might be able to monitor the blood to identify those at risk of suicide.”
(Source: hopkinsmedicine.org)
Study shows increasing rates of premature death and violent crime in people with schizophrenia since 1970s
New research, published in The Lancet Psychiatry journal, shows that rates of adverse outcomes, including premature death and violent crime, in people with schizophrenia are increasing, compared to the general population.
The results come from a unique study, led by Dr Seena Fazel, at Oxford University, UK, which analyses long-term adverse outcomes – including conviction for a violent crime (such as homicide or bodily harm) premature death (before the age of 56), and death by suicide – between 1972 and 2009 in nearly 25,000 people in Sweden diagnosed with schizophrenia or related disorders.
For the first time, the researchers compared adverse outcomes in people with a diagnosis of schizophrenia to both the general population and to unaffected siblings, allowing them to account for risk factors within families (such as parental criminality or violence) which might be expected to affect the risk of suicide or violent behaviour in siblings.
Overall, the results show that within five years of diagnosis, around 1 in 50 men and women with schizophrenia (2.3% of men and 1.7% of women) died by suicide; around one in 10 (10.7%) of men and around one in 37 (2.7%) of women with schizophrenia were convicted of a violent offence within five years of diagnosis. Overall, men and women with schizophrenia were eight times more likely to die prematurely than the general population.
Analysing the changing rate of adverse outcomes across the study period (1972 – 2009), the researchers found that the risk of premature death, suicide, and conviction for a violent offence has increased for men and women with schizophrenia in the last 38 years, compared with both the general population, and their unaffected siblings.
By tracking the number of nights spent in hospital by people with schizophrenia during the study period, the study shows that these increased rates of adverse outcomes appear to be associated with decreasing levels of inpatient care for these patients, although the study does not provide any evidence for a causal connection between decreasing inpatient care and adverse outcomes.
The researchers also analysed risk factors for adverse outcomes in both people with schizophrenia, the general population, and unaffected siblings. Across all three groups, the risk factors for violence and premature death were broadly similar, and included drug use disorders, criminality, and self-harm, all before diagnosis – suggesting that improved strategies to address these risk factors have the potential to reduce violence and premature deaths across the population, and not just in those with schizophrenia.
According to Dr Fazel, “In recent years, there has been a lot of focus on primary prevention of schizophrenia – preventing people from getting ill. While primary prevention is clearly essential and may be some decades away, our study highlights the crucial importance of secondary prevention – treating and managing the risks of adverse outcomes, such as self-harm or violent behaviour, in patients. Risks of these adverse outcomes relative to others in society appear to be increasing in recent decades, suggesting that there is still much work to be done in developing new treatments and mitigating risks of adverse outcomes in people with schizophrenia.”*
Dr Eric Elbogen and Sally Johnson, at the University of North Carolina-Chapel Hill School of Medicine, USA, write in a linked Comment that, “One of the unique aspects of this study—that violence and suicide were analysed simultaneously—has an important implication for how we as a society perceive people with mental illness. News coverage of schizophrenia and other psychiatric disorders often focuses on violence and crime. Much less attention is paid to suicide and self-harm in people with severe mental illnesses.”
However, they add that, “Importantly, we should remember that, when reporting about the intricate links between schizophrenia and these adverse outcomes, most people with schizophrenia and related disorders are neither violent nor suicidal. Despite the need to ensure people with schizophrenia are provided help to reduce their risks of suicide, violence, or premature death, researchers reporting findings also bear the burden of ensuring that most people with schizophrenia and related disorders, who are not violent, are not left to contend with stigma and discrimination. Policy makers, researchers, and clinicians need to remember the importance of appropriately weighing up the issue of schizophrenia relative to the myriad of other factors that contribute to increased risk of violence and suicide.”
(Source: alphagalileo.org)
Depression twice as likely in migraine sufferers
The prevalence of depression among those with migraine is approximately twice as high as for those without the disease (men: 8.4% vs. 3.4%; women 12.4% vs. 5.7%), according to a new study published by University of Toronto researchers.
In a paper published online this week in the journal Depression Research and Treatment, investigators reported that younger migraine sufferers were particularly at risk for depression. Women with migraines who were younger than 30 had six times the odds of depression in comparison to sufferers who were aged 65 and over, said lead author, Professor Esme Fuller-Thomson, Sandra Rotman Endowed Chair at the University of Toronto’s Factor-Inwentash Faculty of Social Work. Unmarried individuals and migraine sufferers who had difficulties with daily activities also had high odds of depression.
Data drawn from a representative sample of more than 67,000 Canadians, the 2005 Canadian Community Health Survey, were used to examine gender-specific associations between migraine and depression. More than 6,000 respondents reported that they had been diagnosed by a health professional with migraines. Consistent with prior research, the prevalence of migraines was much higher in women than men, with one in every seven women, compared to one in every 16 men, reporting that they had migraines.
The study also investigated the relationship between migraine and suicidal ideation. For both men and women, those with migraines were much more likely to have “ever seriously considered suicide or taking (their) own life” than were those without migraines (men: 15.6% versus 7.9%; women: 17.6% versus 9.1%). Migraineurs under age 30 had four times the odds of lifetime suicidal ideation in comparison to migraineurs aged 65 and over. Other factors associated with suicidal ideation among those with migraines included unmarried status, lower household income and greater activity limitations.
Co-author and former graduate student Meghan Schrumm commented “We are not sure why younger migraineurs have such a high likelihood of depression and suicidal ideation. It may be that younger people with migraines have not yet managed to find adequate treatment or develop coping mechanisms to minimize pain and the impact of this chronic illness on the rest of their lives. The much lower prevalence of depression and suicidal ideation among older migraineurs suggests a promising area for future research.”
Dr. Fuller-Thomson adds that this study “draws further attention to the need for routine screening and targeted interventions for depression and suicidality, particularly among the most vulnerable migraineurs: Individuals who are young, unmarried and those with activity limitations.”
(Image: Shutterstock)
Repeat Brain Injury Raises Soldiers’ Suicide Risk
People in the military who suffer more than one mild traumatic brain injury face a significantly higher risk of suicide, according to research by the National Center for Veterans Studies at the University of Utah.
A survey of 161 military personnel who were stationed in Iraq and evaluated for a possible traumatic brain injury – also known as TBI – showed that the risk for suicidal thoughts or behaviors increased not only in the short term, as measured during the past 12 months, but during the individual’s lifetime.
The risk of suicidal thoughts increased significantly with the number of TBIs, even when controlling for other psychological factors, the researchers say in a paper published online Wednesday, May 15 in JAMA Psychiatry, a specialty journal of the American Medical Association.
“Up to now, no one has been able to say if multiple TBIs, which are common among combat veterans, are associated with higher suicide risk or not,” says the study’s lead author, Craig J. Bryan, assistant professor of psychology at the University of Utah and associate director of the National Center for Veterans Studies. “This study suggests they are, and it provides valuable information for professionals treating wounded combat servicemen and women to help manage the risk of suicide.”
Results showed that one in five patients (21.7 percent) who had ever sustained more than one TBI reported suicidal ideation – thoughts about or preoccupation with suicide – at any time in the past. For patients who had received one TBI, 6.9 percent reported having suicidal thoughts, and zero percent for those with no TBIs. In evaluating the lifetime risk, patients were asked if they had ever experienced suicidal thoughts and behaviors up to the point they were assessed.
The increases were similar for suicidal thoughts during the previous year rather than at any time: 12 percent of those with multiple TBIs had entertained suicidal ideas during the past year, compared with 3.4 percent with one TBI and zero percent for no TBIs.
In this study, suicidal ideation was used as the indicator of suicide risk because too few patients reported a history of suicide plan or had made a suicide attempt for statistically valid conclusions to be made.
Researchers found that multiple TBIs also were associated with a significant increase in other psychological symptoms already tied to single traumatic head injuries, including depression, post-traumatic stress disorder or PTSD, and the severity of the concussive symptoms. However, only the increase in depression severity predicted an increased suicide risk.
“That head injury and resulting psychological effects increase the risk of suicide is not new,” says Bryan. “But knowing that repetitive TBIs may make patients even more vulnerable provides new insight for attending to military personnel over the long-term, particularly when they are experiencing added emotional distress in their lives.”
How the Study was Conducted
During a six-month period in 2009, 161 patients who received a suspected brain injury while on duty in Iraq were referred to an outpatient TBI clinic at a combat support hospital there. Patients were predominantly male, average age of 27, with 6.5 years of military service.
Diagnosis of traumatic brain injury was made by a clinical psychologist specifically trained in the assessment, diagnosis and management of the condition. Only patients with mild or no TBI completed all assessments; patients with moderate to severe TBI were immediately evacuated from Iraq.
TBI was confirmed if at least one clinical event was newly presented or worsened following the injury: loss of consciousness or memory, alteration of mental state, some neurological decline or brain damage.
Patients were divided into three groups based the total number of TBIs during their entire lives – zero, single TBI and two or more – the most recent of which was typically within the days immediately preceding their evaluation and inclusion in the study.
Each individual was also given surveys as part of his or her evaluation and treatment. Using standard evaluation tools, patients were surveyed about their symptoms of depression, PTSD and concussions, and their suicidal thoughts and behaviors.
“An important feature of the study is that by being on the ground in Iraq, we were able to compile a unique data set on active military personnel and head injury,” Bryan says. “We collected data on a large number of service members within two days of impact.”
At the same time, because the results of this study are based on a single clinical sample –active military in a war zone within days of the injury – the researchers note that caution is advised before assuming that the results from this particular group will apply to every other group. Studies with larger sample sizes and conducted over longer periods of time will be needed.
Why TBI is of Concern for Military Personnel
As defined by the Centers for Disease Control and Prevention, a traumatic brain injury is caused by a bump, blow or jolt to the head, or a penetrating head injury that disrupts the normal function of the brain. Effects can be mild to severe. The majority of TBIs that occur each year are concussions or other mild forms.
TBI is considered a “signature injury” of the Iraq and Afghanistan conflicts and is of particular concern because of the frequency of concussive injuries from explosions and other combat-related incidents. Estimated prevalence of TBI for those deployed in these two countries ranges from 8 percent to 20 percent, according to a 2008 study.
In addition, according to studies by the RAND Corp., suicide is the second-leading cause of death among U.S. military personnel, and the rate has risen steadily since the conflicts began in Iraq and Afghanistan. Prevalence of PTSD, depression and substance abuse have risen as well, especially among those in combat, and each has been shown to increase risk for suicidal behaviors.
“Being aware of the number of a patient’s head injuries and the interrelation with depression and other psychological symptoms may help us better understand, and thus moderate, the risk of suicide over time,” Bryan says. “Ultimately, we would like to know why people do not kill themselves. Despite facing similar issues and circumstances, some people recover. Understanding that is the real goal.”
N.C. Coal Plant Emissions Might Play Role in State Suicide Numbers
New research from Wake Forest Baptist Medical Center finds that suicide, while strongly associated with psychiatric conditions, also correlates with environmental pollution.
Lead researcher John G. Spangler, M.D., M.P.H., a professor of family medicine at Wake Forest Baptist, looked specifically at the relationship between air pollution and emissions from coal-fired electricity plants.
"This study raises interesting questions about suicide rates in counties where coal-fired electrical plants operate and suggests that the quality of air can affect people suffering from different mood disorders," Spangler said.
For this ecological study, Spangler evaluated air level contaminates in 20 North Carolina counties where coal-fired electricity plants existed, using data from the 2000 U.S. Census, 2001-2005 mortality rates from the N.C. State Center for Health Statistics and the U.S. Environmental Protection Agency.
County-level suicide rates were higher overall in North Carolina (12.4 per 100,000 population) compared to the U.S. population (10.8 per 100,000). The study found that for each additional coal-fired electricity plant per N.C. county, there were about two additional suicides per 100,000 population annually per county. As there were 20 coal-fired electricity plants in North Carolina when this study was carried out, that means there were about 40 suicides a year per 100,000 population related to the plants. When applied to the state’s year 2,000 population of 8,049,313, this equals about 3,220 suicides a year associated with coal-fired electricity plants.
The study is published in the most recent online edition of the Journal of Mood Disorders.
"The presence of a coal-fired electricity plant correlated with airborne levels of nickel, mercury, lead, chromium, cadmium, beryllium and arsenic," Spangler said.
While prior research has evaluated the association between environmental contamination and mood disorders and suicide, coal emissions have not been looked at in this fashion, Spangler said. “This is the first study to show that the existence of coal-fired electricity plants is related to population-level suicide rates. Because suicide might be associated with environmental pollution, this study may help inform regulations not only of air pollutants, but also of coal-fired electrical power plant emissions.”
Spangler has conducted previous ecological research into environmental heavy metals, looking at their correlation to diabetes mortality, chronic liver disease death, cancer mortality and infant mortality. Spangler said the study was subject to a number of limitations because it only looked at county-level characteristics and could not control for factors in individual residents.
"Still, it raises the interesting question of whether suicide in a given population is related to the presence or absence of coal-fired electricity plants and the air quality," he said. "Further research is needed to understand what factors related to coal burning actually are at play and suggest that tighter regulation of coal-fired power plant emissions might cut down on county suicide rates in North Carolina."
(Image: David Freund)