Relationship Between the Feeling of Emptiness and Suicide Reattempt: Conclusions From Cross-Sectional and Longitudinal Analyses.

INTRODUCTION: The feeling of emptiness is a complex subjective experience considered relevant in the suicidal process, acting as a risk factor for suicide ideation, attempts and even reattempts. However, empirical studies are still scarce. OBJECTIVES: This study has three objectives: to compare emptiness levels in healthy people and those with suicide attempts; to compare the emptiness level between people with a single suicide attempt and multiple suicide attempts at baseline; and to study emptiness as a risk factor for the appearance of new suicidal attempts after an index one. METHODOLOGY: In the study, 382 healthy controls and 58 participants with a recent suicide attempt (in the past 15 days) participated. All completed the feeling of emptiness scale (FES). Information was also collected on sociodemographic characteristics and history of suicide attempts. First, the control sample scores were compared with those of the clinical sample. Later, the single attempt and reattempt groups (any amount greater than one attempt at baseline) were compared. Finally, the clinical sample was followed for 1 year and 3 months (through clinical records). Survival analysis was performed. RESULTS: The clinical group obtained higher scores across the FES subscales, even when controlling for other relevant variables (p < 0.01). When comparing people with one versus several attempts, differences were also observed in all subscales except one, the reattempt group getting higher scores (p < 0.05). Regarding the survival analysis, the feeling of emptiness was significantly associated with the risk of reattempt (HR = 1.04; p < 0.05). All people who reattempted during follow-up belonged to the reattempt group at baseline. CONCLUSIONS: People who have attempted suicide present higher emptiness scores. Furthermore, emptiness appears to significantly predict the occurrence of new attempts at follow-up. The feeling of emptiness may be associated with the lack of vital meaning and disconnection from others, fundamental aspects of the ideation-to-action suicide models. Including emptiness in suicide assessments could increase clinicians' predictive ability.

Neurocognitive profile associated with borderline personality disorder: building specific indices of executive function.

The objective of this work is the creation of specific indices of the different executive functions (EF).

Inflammatory profiles in women with eating disorder: Linking inflammatory biomarkers to clinical phenotypes.

INTRODUCTION: Eating disorders (ED) represent a group of very complex and serious diagnoses characterized by emotional dysregulation and impulsivity. New approaches are necessary to achieve effective diagnosis and treatments. Shifting biomarker research away from the constraints of diagnostic categories may effectively contribute to a dimensional differentiation across disorders according to neurobiology (e.g., inflammatory biomarkers). Thus, the aim of our study was to identify inflammatory profiles in patients with ED. METHODS: A sample of 100 women with an ED (23.4 ± 8.55 years) and 59 healthy controls (HC) (20.22 ± 4.18 years) was used. K-means cluster analysis was followed to identify inflammatory clusters considering seven blood biomarkers (iNOS, TNFα, COX2, p38, ERK, TBARS and PPARγ). Moreover, a wide assessment of clinical features was conducted. RESULTS: Two distinct clusters were identified. Cluster 1 patients were characterized by higher inflammatory levels of TNF-α, COX2, p38, and ERK, and had more restrictive anorexia diagnosis than cluster 2. Cluster 2 participants showed higher inflammatory levels of iNOS and were older than cluster 1 and controls and had lower BMI than HC. In addition, they had higher levels of bulimic symptoms than those from the cluster 1 and HC, and higher impulsivity than HC. All ED patients (regardless of cluster) showed higher ED symptoms and more trauma than HC. CONCLUSIONS: Our study revealed that inflammatory dysfunction may be linked with clinical endophenotypes in ED, one more restrictive (cluster 1) with an inflammation/oxidative endophenotype more cytokine and MAPK/ERK mediated, and the other more impulsive, with more bulimic symptoms (cluster 2) with NO free radical high output source iNOS. Trauma seems to be a vulnerability factor for both endophenotypes.

Psychiatric profiles in suicidal attempters: Relationships with suicide behaviour features.

BACKGROUND: Suicide constitutes a major health concern worldwide, being a significant contributor of death, globally. The diagnosis of a mental disorder has been extensively linked to the varying forms of suicidal ideation and behaviour. The aim of our study was to identify the varying diagnostic profiles in a sample of suicide attempters. METHODS: A sample of 683 adults (71.3% females, 40.10±15.74 years) admitted at a hospital emergency department due to a suicide attempt was recruited. Latent class analysis was used to identify diagnostic profiles and logistic regression to study the relationship between comorbidity profile membership and sociodemographic and clinical variables. RESULTS: Two comorbidity profiles were identified (Class I: low comorbidity class, 71.3% of attempters; Class II: high comorbidity class, 28.7% of attempters). Class I members were featured by the diagnosis of depression and general anxiety disorder, and low comorbidity; by contrast, the high comorbidity profile was characterized by a higher probability of presenting two or more coexisting psychiatric disorders. Class II included more females, younger, with more depressive symptoms and with higher impulsivity levels. Moreover, Class II members showed more severe suicidal ideation, higher number of suicide behaviours and a greater number of previous suicide attempts (p<.01, for all the outcomes), compared to Class I members. CONCLUSIONS: Psychiatric profiles may be considered for treatment provision and personalized psychiatric treatment in suicidal attempters as well as tackle suicide risk.

Anxious and depressive symptoms and health-related quality of life in a cohort of people who recently attempted suicide: A network analysis.

BACKGROUND: Suicide is an international health concern with immeasurable impact from the perspective of human and social suffering. Prior suicide attempts, anxious and depressive symptoms, and relatively lower health-related quality of life (HRQoL) are among the most replicated risk factors for suicide. Our goal was to visualize the distribution of these features and their interconnections with use of a network analysis approach in individuals who recently attempted suicide. METHODS: Individuals with a recent suicide attempt were recruited from nine University Hospitals across Spain as part of the SURVIVE cohort study. Anxious and depressive symptoms, and perceived HRQoL were included in the network analysis. Network structures were estimated with the EBICglasso model. Centrality measures and bridge symptoms connecting communities were explored. Subnetworks comparing younger and older individuals, and women and men were analyzed. RESULTS: A total of 1106 individuals with a recent suicide attempt were included. Depressed mood was the symptom with the greatest influence in the overall network, followed by anxiety symptoms such as feeling nervous, worrying, restless, and having difficulties to relax. Perceived general health was associated with increased suicidal ideation in the whole sample. Older people showed a specific connection between perceived general health and depressed mood. LIMITATIONS: The cross-sectional design does not allow determination of established causality. CONCLUSIONS: Depressed mood was the core network's symptom and, therefore, an important target in the management and prevention of suicide. HRQoL had more influence on the network of older populations, in which it should be a primary focus.

Clinical predictors and psychosocial risk factors of suicide attempt severity.

BACKGROUND: Suicide attempts are an important predictor of completed suicide and may differ in terms of severity of medical consequences or medical lethality. There is little evidence on serious suicide attempt (SSA) and very few studies have compared SSA with non-SSA. OBJECTIVE: The aim of this multisite, coordinated, cohort study was to analyze the role of clinical variables and the sociodemographic and psychological risk factors of SSA. METHOD: In this multisite, coordinated, cohort study, 684 participants (222 for the mild suicide attempt group, 371 for the moderate suicide attempt group and 91 for the SSA group) were included in the study. Ordinal regression models were performed to analyze the predictor variables of SSA. RESULTS: Early physical abuse (OR=1.231) and impulsivity (OR=1.036) were predictors of SSA, while depressive symptoms were associated with a lower risk of SSA. CONCLUSION: Environmental and psychological factors as physical abuse and impulsivity are related with severe suicide severity. These findings will help to develop strategies to prevent suicide and may be considered for the treatment and management of suicide.

Risk factors for suicidal behaviour in late-life depression: A systematic review.

BACKGROUND: Suicide is a leading cause of preventable death worldwide, with its peak of maximum incidence in later life. Depression often puts an individual at higher risk for suicidal behaviour. In turn, depression deserves particular interest in old age due to its high prevalence and dramatic impact on health and wellbeing. AIM: To gather integrated evidence on the potential risk factors for suicide behaviour development in depressive older adults, and to examine the effects of depression treatment to tackle suicide behaviour in this population. METHODS: A systematic review of empirical studies, published from 2000 onwards, was conducted. Suicidal behaviour was addressed considering its varying forms (i.e., wish to die, ideation, attempt, and completed suicide). RESULTS: Thirty-five papers were selected for review, comprising both clinical and epidemiological studies. Most of studies focused on suicidal ideation (60%). The studies consistently pointed out that the risk was related to depressive episode severity, psychiatric comorbidity (anxiety or substance use disorders), poorer health status, and loss of functionality. Reduced social support and loneliness were also associated with suicide behaviour in depressive older adults. Finally, the intervention studies showed that suicidal behaviour was a robust predictor of depression treatment response. Reductions in suicidal ideation were moderated by reductions in risk factors for suicide symptoms. CONCLUSION: To sum up, common and age-specific risk factors seem to be involved in suicide development in depressive older adults. A major effort should be made to tackle this serious public health concern so as to promote older people to age healthily and well.

Perfil neurocognitivo asociado al trastorno límite de personalidad: creación de índices específicos de función ejecutiva / Neurocognitive profile associated with borderline personality disorder: building specific indices of executive function

Introducción. El objetivo de este trabajo es la creación de índices específicos de las distintas funciones ejecutivas (FE), que permitan comprender de forma más completa y no mediante pruebas aisladas el rendimiento ejecutivo asociado al trastorno límite de la personalidad (TLP). Metodología. 118 pacientes con TLP y 81 controles fueron evaluados con una batería neuropsicológica. Se crearon tres índices de atención, memoria y FE. Las pruebas que forman el índice ejecutivo se agruparon en cuatro índices ejecutivos diferentes: flexibilidad cognitiva, planificación, memoria de trabajo e inhibición de respuesta. Las puntuaciones para cada dominio se obtuvieron a través de las puntuaciones estandarizadas de las pruebas que los componían. Resultados. Los resultados mostraron diferencias significativas en los índices de memoria, atención y FE, así como en los diferentes índices ejecutivos de flexibilidad cognitiva, planificación, memoria de trabajo e inhibición de respuesta, entre los pacientes con TLP y los controles. Conclusiones. Este estudio ha permitido la creación de cuatro índices ejecutivos, siendo el primero hasta la fecha en hacerlo. Estos resultados establecen un perfil neurocognitivo del TLP caracterizado por un deterioro ejecutivo específico de la flexibilidad cognitiva, la planificación, la memoria de trabajo y la inhibición de la respuesta. Estos hallazgos avalan que los pacientes con TLP podrían beneficiarse de la aplicación de programas neuropsicológicos, especialmente enfocados en mejorar determinadas FE, y sientan las bases para la investigación de la relación entre estos déficits ejecutivos específicos y ciertas características clínicas del TLP, como diferentes tipos de comportamiento impulsivo y diferentes errores de mentalización. (AU)

Introduction. The objective of this work is the creation of specific indices of the different executive functions (EF), which allow a more complete understanding of the executive performance associated with borderline personality disorder (BPD) and not through isolated tests. Methodology. 118 patients with BPD and 81 controls were evaluated with a neuropsychological battery. Three indices of attention, memory and FE were created. The tests that make up the executive domain were grouped into four different executive indices: cognitive flexibility, planning, working memory, and response inhibition. The batteries for each domain were compared through the standardized batteries of the tests that comprised them. Results. The results showed differences in the memory, attention, and EF indices, as well as in the different executive indices of cognitive flexibility, planning, working memory, and response inhibition, between BPD patients and controls. Conclusions. This study has allowed the creation of four executive indexes, being the first to do so. These results established a neurocognitive profile of BPD characterized by executive-specific impairment of cognitive flexibility, planning, working memory, and response inhibition. These findings support that patients with BPD will benefit from the application of neuropsychological programs, especially focused on improving a certain EF, and lay the foundations for the investigation of the relationship between these specific executive deficits and certain clinical characteristics of BPD, such as different types of Impulsive behavior and different mentalization errors. (AU)