Youth suicide attempts and the dose-response relationship to parental risk factors: a population-based study.

BACKGROUND: There is a lack of specific knowledge about the dose-response effect of multiple parental risk factors for suicide attempts among children and adolescents. The aim of this study was to determine the dose-response effect of multiple parental risk factors on an offspring's risk for suicide attempt. METHOD: We designed a population-based two-generation nested case-control study and used Danish register data. A population of 403 431 individuals born between 1983 and 1989 was sampled. Among these, 3465 (0.8%) were registered as having had a suicide attempt. Twenty controls were matched to each case and a link to the offspring's biological parents was established. RESULTS: There was a dose-response relationship between the number of exposures and the risk of suicide attempts, with the increased risk seeming to be a multiplicative effect. Parental suicide, suicide attempt, psychiatric illness and low level of income were all significant independent risk factors for offspring's suicide attempts. CONCLUSIONS: Knowledge of the effect of multiple risk factors on the likelihood of suicide attempts in children and adolescents is important for risk assessment. Dose-response effects of multiple parental risk factors are multiplicative, but it is rare for children and adolescents to be exposed to multiple parental risk factors simultaneously. Nevertheless, they should be considered along with the offspring's own multiple risk factors in determining the overall risk of a suicide attempt. Further research incorporating both parental and offspring's risk factors is indicated to determine the overall dose-response effect of multiple risk factors.

Cohort analysis of suicide rates in Australia.

Age-specific cohort analysis of Australian suicide rates confirmed recent Canadian and American reports of a substantial increase in suicide rate among young age groups. However, it was unable to replicate fully the previous findings that not only did successive birth cohorts have higher suicide rates, but that at each successive five-year period they had higher suicide rates than preceding cohorts had at that age. The major differences could be explained on the basis of the introduction of legislation that restricted the prescription of sedatives. This suggests that although there may be early and lasting effects on successive birth cohorts contributing to a general increase in cohort-specific suicide rates in the countries examined, such rates also can be influenced by changing environmental factors more immediately related to the suicide itself.

Safety of the combination of lithium and neuroleptic drugs.

A retrospective study of 60 manic patients treated with neuroleptic medications alone and 69 manic patients treated with a combination of neuroleptic drugs and lithium revealed no difference between groups in side effects and complications of treatment. Similarly, when comparisons were made between patients treated with haloperidol only and those treated with haloperidol and lithium, there were no differences in side effects and complications. The results counter sporadic clinical reports suggesting a toxic interaction between lithium and neuroleptic drugs.

Attempted suicide and death anxiety.

Young women who had attempted suicide (N = 103) had scores similar to those of a nonsuicidal group (N = 24) on a validated Death Anxiety Scale. Although the lethality of the suicide attempt was not significantly related to death anxiety, there was a weak but significant negative correlation between measures of suicidal intent and death anxiety, indicating stronger suicidal intent in subjects with less death anxiety. Because of the weakness of this correlation, it cannot be assumed that a patient who indicates that she is particularly afraid of death will not engage in a suicide attempt with high lethality.

Case report: manic depressive psychosis following infectious mononucleosis.

The onset of manic depressive psychosis following infectious mononucleosis is reported. The patient appeared to be predisposed to develop such an illness, and it is postulated that the initial hypomanic episode may have been precipitated by an alteration in cerebral biogenic amines due to the infectious mononucleosis.

Mental health literacy: an impediment to the optimum treatment of major depression in the community.

BACKGROUND: Mental health literacy refers to the knowledge and beliefs about mental disorders which aid their recognition, management and prevention. This study examined the mental health literacy and experience of depression in a random and representative community population. METHODS: The experience of depression and mental health literacy of 3010 subjects from a random and representative population were determined on the basis of responses to the mood module of the PRIME-MD and questions about a vignette of a person with features of major depression. RESULTS: Those with major depression had significantly more personal experience of depression than those with other depressions and those who were not depressed, but there were few significant differences between the groups in terms of mental health literacy. Of those with major depression, 40% considered anti-depressants helpful, but 40% also considered they were harmful. CONCLUSIONS: There is a considerable impediment to the recognition and management of major depression and a need for further community education programs.

Depression in young women who have attempted suicide. An international replication study.

In accord with a recent Australian study, a greater proportion of young women who attempted suicide in 4 centres in Australia, Canada and New Zealand were designated as manifesting a depressive syndrome by a depression questionnaire than would have been anticipated on the basis of previous clinical reports. Furthermore, on the basis of a decision-rule applied to the questionnaire responses, one-third of subjects in each centre were allocated to the "endogenous' category of depression.

Mental health status of the South Australian population.

OBJECTIVE: To determine, by the use of a telephone survey, the mental health status of SA adults (18+ years) using the GHQ-28, SF-12 and self-report as indicators of mental health, and to examine risk factors for mental health morbidity. SAMPLE: A random representative sample of South Australian adults selected from the Electronic White Pages. Overall, 2,501 interviews were conducted (74.0% response rate). RESULTS: Overall, 19.5% of respondents had a mental health problem as determined by the GHQ-28, 11.8% as determined by the mental health component summary score of the SF-12 and 11.9% self-reported a mental health condition. The percentage of people with a mental health problem who had used a psychologist or a psychiatrist in the previous 12 months was 9.6% for people diagnosed by the GHQ-28, 16.2% by SF-12 and 23.7% for self-report. The logistic regression analyses undertaken to describe people with a mental health problem as determined by the GHQ-28 and to describe people who visited a psychologist or psychiatrist produced different age categories, demographic and co-morbidity indicators. Variables found in both analyses included living in the metropolitan area, being economically inactive and being a high user of health services. CONCLUSIONS: One in five South Australian adults has a mental problem. Although the prevalence is higher for younger age groups, older adults are more likely to visit a psychologist or a psychiatrist. IMPLICATIONS: Telephone interviewing produces robust indicators of the prevalence of mental health problems and is a cost-effective way of identifying prevalence estimates or tracking changes over time.

The stability of attributional style and its relation to psychological distress.

A group of yound adults completed the Attributional Style Questionnaire and measures of depressive affect and hopelessness on two occasions separated by a time interval of three years. Attributional style was demonstrated to be relatively stable over this time period, and was correlated with the measures of psychological well-being. Specifically, those who scored highest on depressive affect and hopelessness attributed good outcomes more externally and less stably, and attributed bad outcomes to relatively more stable and global causes. In contrast to the hopelessness model of depression, however, multiple regression analyses showed that depressive attributions were not antecedent to increased psychological distress; nor were they a consequence. Furthermore, negative life-events did not contribute to the prediction. It was concluded that the data are most consonant with Brewin's (1985) symptom model, in which depressive attributions are a concomitant or symptom of depression but have no causal impact on the onset or course of the disorder.

Attempted suicide: an ethological perspective.

Attempted suicides are complex phenomena. Examination of the observed and described behavior permits an analogy to be drawn between them and the biological concept of "conservation withdrawal." This cognizance of innate of innate responses, individual differences and changing socio-cultural standards. Such a formulation more readily allows a non-judgemental approach to the patient, with acceptance of both the appeal and wish to die components. In addition, it offers a different view of the nosological debate, rendering the differences more apparent than real.

The media and suicide: a cautionary view.

There is now unequivocal statistical evidence of an association between some media portrayals of suicide and further subsequent suicide. However, it is a weak association, and it is probably of far less importance than our need to address basic principles of good mental health management. Rather than prescribe to the media how to report suicide, its potentially positive effects should be addressed.

The privilege and responsibility of suicide prevention.

Each year about a million people worldwide take their lives, and a further unknown number, but probably no less than 20 million, attempt suicide. In addition, for every person who engages in suicidal behavior, another five or six will be associated with them in some way, making a conservative total of 100 million people worldwide who are affected each year--and to whom we have some degree of responsibility. There is no one approach to suicide prevention, and probably more so than for any other human condition, we are privileged to be able to collaborate with many different disciplines in our endeavors. However, there is a considerable responsibility to ensure that whatever our own area of expertise and interest may be, we should apply universal principals of objective analysis to these diverse contributions. This is addressed by examining research from four broad areas. First, there are studies that irrevocably bring together the sociological and biological approaches to suicide. Second, there are reports that support the notion of the universality of suicide. Third, despite considerable attention paid to the media, its influence on suicide is very limited. And finally, although there have been pessimistic reviews, there are persuasive data from innovative research designs that have documented that we can prevent suicide.

Pre-Durkheim suicidology.

Durkheim is generally regarded as the founder of the scientific study of suicide. However, even a cursory review of 18th- and 19th-century literature reveals an increasingly sophisticated scientific approach to suicide, culminating in the encyclopedic research of Morselli in 1879 and the critical review of Tuke in 1892, works that lose nothing in comparison with Durkheim's Le Suicide of 1897. This review, while in no way drawing Durkheim's role as a founder of scientific sociology into question, indicates that his position in regard to the study of suicide does warrant reconsideration.

Grief reactions and recovery in a support group for people bereaved by suicide.

Recent controlled studies have demonstrated that there are few quantitative, but a number of qualitative differences between those bereaved by suicide and those bereaved in other ways. Observations from participants in a support group of those bereaved through suicide are presented here. Guidelines are offered concerning therapy for those who are so clearly distressed by this mode of death.

A support group for people bereaved through suicide.

Although much research has been performed in recent years on the prevention of suicide, less attention has been focused on helping the persons left behind. This article outlines the history of establishing a support group for people who have been bereaved through suicide in an Australian city. It describes the difficulties in establishing the group, its structure, management, and helping functions, and the experiences gained from the initial 7 years of operation. The article has been written in response to requests from medical, social, and lay agencies for information in establishing similar support groups.

Suicidal ideation in Sudanese women.

A literature review indicated that suicidal behavior in Sudan was very infrequent. However, an assessment of suicidal ideation in two Sudanese groups of women demonstrated high levels, particularly in women in a displaced-persons area. In addition, the recent establishment of a Befrienders International volunteer service allowed anecdotal evidence of substantial suicidal behavior to be collated. These findings highlight the need for further professional and volunteer assistance with continuing evaluation and research concerning programs for this vulnerable population.

Agoraphobia: the clinical problem.

The symptoms of agoraphobia can vary from those which a person may accept as being consistent with the everyday anxiety of living, to those which provide a barrier to the participation of an individual in any outside activities whatsoever. These symptoms, while classically presenting with the affective state of anxiety, may sometimes become manifest in such a way that cardiovascular, respiratory or other somatic pathology is suspected.