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Background Suicide is strongly associated with mental disorders, particularly with depression. There is insufficient knowledge to what extent sociodemographic and behavioral characteristics contribute to suicide risk. Methods A population-based cohort study on three independent cross-sectional MONICA/KORA Augsburg surveys with 12,888 subjects (6456 men, 6432 women) was followed up on average for 12.0 years. Information on sociodemographic characteristics, chronic disease conditions, smoking habits, alcohol consumption, depressive symptoms, personality type, and other psychodiagnostic parameters was assessed by standardized interviews. Cox proportional hazards regression analyses were used to compute hazard ratios (HRs) as estimates of relative risks for suicide mortality. Additionally, population-attributable risks were calculated. Results Within the follow-up period, a total of 1449 persons had died, 38 of them by suicide. Although several variables were associated with increased risk in the basic analyses, only obesity (HR=2.73), smoking (HR=2.23), and living alone (HR=2.19) remained significantly associated with suicide additionally to male sex (HR=3.57) and depressed mood (HR=2.01) in a multivariate analysis. Limitations The generalization of our findings to countries with different social, economic or cultural conditions may be questioned. Conclusions Our findings extend the knowledge about sociodemographic and behavioral risk factors for suicide in the general population: Suicide prevention measures should not consider only subjects with mental disorders but also address other adverse conditions.

The railway suicide of Robert Enke, an internationally respected German football goal keeper, sent shockwaves throughout the world of football. We analyzed its impact on the frequency of subsequent railway suicide acts (RS).Two analytic approaches were performed applying German Railway Event database Safety (EDS) data: first, an inter-year approach comparing the incidence of RS during a predefined "index period" with identical time windows in 2006 to 2008; second, an intra-year approach comparing the number of RS 28 days before and after the incidence. To analyze a possible "compensatory deficit", the number of RS in the subsequent first quarter of 2010 was compared with the identical time windows in the preceding three years. Incidence ratios with 95% confidence intervals were estimated by Poisson regression. Findings were controlled for temperature.Compared to the preceding three years, the incidence ratio (IR) of the number of RS in the index period increased by 1.81 (1.48-2.21; p0.001), leading to an overall percentage change of 81% (48-121%; p0.001). Comparing the number of suicides 28 days before and after the incidence revealed an even more pronounced increase of IR (2.2; 1.6-3.0). No modifications of these associations were observed by daytime, by location of the suicide and fatality. No compensatory deficit occurred in the post-acute period.The substantial increase of RS in the aftermath of the footballer's suicide death brought about copycat behavior in an unforeseen amount, even though the media reporting was largely sensitive and preventive measures were taken.

Patients with an implantable cardioverter defibrillator (ICD) show clinically relevant depression and anxiety, but little is known about their levels of posttraumatic stress. We assessed chronic posttraumatic stress attributable to a traumatic cardiac event and its predictors in patients at two time points after ICD placement.We investigated 107 consecutively enrolled patients (57 ± 14 years, 62% men) on average 24 ± 21 months after ICD placement (baseline) and again 41 ± 18 months later (follow-up). All patients completed the Impact of Event Scale-Revised (IES-R) to self-rate the severity of posttraumatic stress (range 0-110). The 30% of patients with the highest IES-R scores (≥ 25) at baseline were defined as PTSD cases; the same threshold was applied to define PTSD caseness at follow-up.Posttraumatic stress increased from baseline to follow-up (19 ± 22 vs. 25 ± 19, p0.001); 19% of patients had PTSD at both assessments, 12% at baseline only, and 18% at follow-up only. Female gender as well as greater peritraumatic dissociation and depression predicted greater posttraumatic stress at baseline (p-values ≤ 0.041). Greater baseline posttraumatic stress, helplessness, alexithymia, and ≥ 5 shocks during follow-up all predicted greater posttraumatic stress at follow-up (p-values ≤ 0.029). Female gender, helplessness, and depression predicted PTSD at baseline (p-values ≤ 0.022); low education and posttraumatic stress at baseline predicted PTSD at follow-up (p-values ≤ 0.003).Between 2 and 5.5 years post-ICD placement chronic posttraumatic stress slightly increased and nearly one-fifth of patients had newly developed PTSD. The identified psychological predictors of long-term chronicity of posttraumatic stress might particularly inform behavioral interventions for ICD recipients.

BACKGROUND: The aim of the present study was to examine the reliability and validity of the Impact of Event Scale-Revised (IES-R) with special emphasis on the evaluation of the hyperarousal subscale against a standardized psychophysiological measurement. METHODS: A total of 129 survivors of a life-threatening cardiac event underwent a psychodiagnostic evaluation and a psychophysiological acoustic startle reflex (ASR) paradigm. The ASR assessed the magnitude and habituation of electromyogram (EMG) and skin conductance responses (SCR) in response to the delivery of 15 acoustic startle trials. Pearson correlation and factor analysis was used to measure reliability and construct validity. The hyperarousal subscale was validated against the ASR in terms of sensitivity and specificity mainly using receiver operating characteristic (ROC) curve analysis. RESULTS: A high reliability was found for the intrusion and avoidance subscale (alpha>0.8); however, the hyperarousal subscale showed a weaker reliability (alpha=0.66). No avoidance item, one intrusion item but four hyperarousal items revealed higher correlations to another than its assigned subscale. The hyperarousal subscale was not able to discriminate sufficiently between patients with and without exaggerated startle reactions as indicated by ROC curves running near the diagonal line. LIMITATIONS: The scores in all three subscales are lower compared to subjects traumatized by non-cardiac events. CONCLUSIONS: Reliability and construct validity for the intrusion and avoidance subscale proved to be high but was only sufficient for the hyperarousal subscale. Moreover, the criterion validity of the hyperarousal subscale regarding psychophysiological measurements is arguable and indicates further investigations in this area.

Objective To examine sex-specific time patterns of suicidal behaviour on railway tracks as basis of suicide preventive strategies. Method Cases were derived from the National Central Registry of all person accidents on the German railway net (STABAG) between 1997 and 2002 satisfying the operational definition of suicidal behaviour and included sex, age, date, clock time and outcome of the incidence. Results Over the 6-year observation period, 4003 fatal and non-fatal suicidal incidences were documented. Male to female ratio was 2.70:1 (p

The aim of the present study was to examine the reliability and validity of the Impact of Event Scale-Revised (IES-R) with special emphasis on the evaluation of the hyperarousal subscale against a standardized psychophysiological measurement.A total of 129 survivors of a life-threatening cardiac event underwent a psychodiagnostic evaluation and a psychophysiological acoustic startle reflex (ASR) paradigm. The ASR assessed the magnitude and habituation of electromyogram (EMG) and skin conductance responses (SCR) in response to the delivery of 15 acoustic startle trials. Pearson correlation and factor analysis was used to measure reliability and construct validity. The hyperarousal subscale was validated against the ASR in terms of sensitivity and specificity mainly using receiver operating characteristic (ROC) curve analysis.A high reliability was found for the intrusion and avoidance subscale (alpha0.8); however, the hyperarousal subscale showed a weaker reliability (alpha=0.66). No avoidance item, one intrusion item but four hyperarousal items revealed higher correlations to another than its assigned subscale. The hyperarousal subscale was not able to discriminate sufficiently between patients with and without exaggerated startle reactions as indicated by ROC curves running near the diagonal line.The scores in all three subscales are lower compared to subjects traumatized by non-cardiac events.Reliability and construct validity for the intrusion and avoidance subscale proved to be high but was only sufficient for the hyperarousal subscale. Moreover, the criterion validity of the hyperarousal subscale regarding psychophysiological measurements is arguable and indicates further investigations in this area.