Suicide in obstructive lung, cardiovascular and oncological disease.

Healthcare institutions face increasing demands stemming from the burden of noncommunicable diseases. The personal, social, financial and societal impact of these diseases are well-documented. However, the mental health concerns and trajectories of patients afflicted by chronic medical diseases have been under-recognized and are under-resourced. Despite that chronic diseases are associated with substantially increased risk of suicide, the medical world has largely failed to properly address suicide in the medically ill. Considering their high prevalence and mortality rate, this review article will highlight the mental health burden and suicide risk in obstructive lung, cardiovascular (including stroke) and oncological disease, in light of relevant data and conceptual models of suicide. Finally, general evidence-based suicide intervention strategies and potential selective adaptation of these strategies to the chronic medically ill patient populations and medical settings will be reviewed.

Suicidal Ideation and Insomnia in Bipolar Disorders: Idéation suicidaire et insomnie dans les troubles bipolaires.

OBJECTIVE: Bipolar disorder (BD) confers elevated suicide risk and associates with misaligned circadian rhythm. Real-time monitoring of objectively measured sleep is a novel approach to detect and prevent suicidal behavior. We aimed at understanding associations between subjective insomnia and actigraphy data with severity of suicidal ideation in BDs. METHODS: This prospective cohort study comprised 76 outpatients with a BD aged 18 to 65 inclusively. Main measures included 10 consecutive days of wrist actigraphy; the Athens Insomnia Scale (AIS); the Montgomery-Åsberg Depression Rating Scale (MADRS); the Quick Inventory of Depressive Symptoms-16, self-rating (QIDS-SR-16); and the Columbia Suicide Severity Rating Scale. Diagnoses, medications, and suicide attempts were obtained from chart review. RESULTS: Suicidal ideation correlated moderately with subjective insomnia (AIS with QIDS-SR-16 item 12 ρ =0.26, P = 0.03; MADRS item 10 ρ = 0.33, P = 0.003). Graphical sleep patterns showed that suicidal patients were enriched among the most fragmented sleep patterns, and this was confirmed by correlations of suicidal ideation with actigraphy data at 2 visits. Patients with lifetime suicide attempts (n = 8) had more varied objective sleep (a higher standard deviation of center of daily inactivity [0.64 vs. 0.26, P = 0.01], consolidation of daily inactivity [0.18 vs. 0.10, P = <0.001], sleep offset [3.02 hours vs. 1.90 hours, P = <0.001], and total sleep [105 vs. 69 minutes, P = 0.02], and a lower consolidation of daily inactivity [0.65 vs. 0.79, P = 0.03]). CONCLUSIONS: Subjective insomnia, a nonstigmatized symptom, can complement suicidality screens. Longer follow-ups and larger samples are warranted to understand whether real-time sleep monitoring predicts suicidal ideation in patient subgroups or individually.

Dissociative symptoms as measured by the Cambridge Depersonalization Scale in patients with a bipolar disorder.

BACKGROUND: The Cambridge Depersonalization Scale (CDS) characterizes the quality, frequency, and duration of dissociative symptoms. While the psychometric properties of the CDS have been evaluated in primary dissociative disorder, this has been insufficiently addressed among other psychiatric patient groups such as patients with a bipolar disorder (BD). METHODS: Outpatients with variable mood (n = 73) responded to a survey that assessed dissociative symptoms and other characteristics. We used factor analysis and McDonald's omega to evaluate psychometric properties of the CDS, and correlations with other characteristics. RESULTS: Previously suggested multifactorial models of the CDS were not supported, but the single-dimensional model fit both dichotomized (p = 0.31, CFI = 0.99, RMSEA = 0.02, ECV 70%) and trichotomized CDS responses (p = 0.06, CFI = 0.96, RMSEA = 0.04, ECV 47%). The CDS showed high internal consistency (ω = 0.96). CDS factor scores correlated with symptom severity on the Quick Inventory for Depressive Symptoms (QIDS-SR-16) (ρ = 0.59), the Social Phobia Inventory (ρ = 0.52), the American Association of Psychiatry Severity measure for Panic Disorders (ρ = 0.46), the Childhood Trauma Questionnaire (ρ = 0.44), and the Trauma Screening Questionnaire (ρ = 0.53). Two abbreviated versions of the CDS, retaining the best 14 or 7 items were proposed. LIMITATIONS: The sample size remained moderate. CONCLUSIONS: The CDS is a psychometrically sound, unidimensional measure with clinical impact to detect and characterize dissociative symptoms in BD patients. Establishing the reliability and validity of the abbreviated scales for screening necessitates further study.

Prevalence and Risk Factors of Suicidal Ideation among Patients with Head and Neck Cancer: Longitudinal Study.

OBJECTIVES: (1) Determine 1-year period prevalence of suicidal ideation, suicide attempt, and completed suicide among patients newly diagnosed with a first occurrence of head and neck cancer (HNC). (2) Characterize stability and trajectory of suicidal ideation over the year following cancer diagnosis. (3) Identify patients at risk of suicidal ideation. STUDY DESIGN: Prospective longitudinal study with 1-year follow-up. SETTING: Three university-affiliated outpatient departments of otolaryngology-head and neck surgery. SUBJECTS AND METHODS: The study comprised a representative sample of 223 consecutive patients who were newly diagnosed (<2 weeks) with a first occurrence of primary HNC, were ≥18 years old and able to consent, and had a Karnofsky Performance Scale score ≥60. Patients completed the Beck Scale for Suicidal Ideation and Structured Clinical Interview for DSM-IV-TR Axis I Disorders. RESULTS: Sixteen percent (15.7%) of patients with HNC were suicidal <1 year from diagnosis, with point prevalences of 8.1% <2 weeks, 14.8% at 3 months, 9.4% at 6 months, and 10.4% at 12 months; 0.4% committed suicide within 3 months, and 0.9% attempted suicide. An a priori comprehensive conceptual model revealed 2 predictors of 1-year period prevalence of suicidal ideation in HNC: psychiatric history ( P = .017, ß = 2.1, 95% CI = 0.4-3.8) and coping with the diagnosis by using substances (alcohol/drugs; P = .008, ß = 0.61, 95% CI = 0.16-1.06). All other predictors, including medical predictors, were nonsignificant. A clinical suicide risk assessment revealed low risk among 71.4% and medium to high risk among 28.6%. CONCLUSION: Suicide prevention strategies are clearly needed as part of routine clinical care in head and neck oncology, as well as their integration into clinical practice guidelines for HNC.