Search

Aim: Suicidal behavior is a serious public health problem and a major cause of death among adolescents. Three categories of major risk factors have been identified: psychological factors, stressful life events, and personality traits. Severe and objective stressful life events (SLEs), such as childhood mistreatment or abuse, have been clearly associated with higher rates of suicide risk. However, the relationship between suicide risk and adolescents' perceptions of the SLE impact is not as clear. This paper studies the relationship between SLE impact perception and suicide risk and the possible mediating role of perceived family functioning in this relationship. The need for longer-term or more intense psychological or psychiatric treatment in relation to SLE impact perception is also addressed. Method: One hundred forty-seven adolescents aged 11–17 were consecutively recruited from the Child and Adolescent Mental Health Outpatient Services Department of a general hospital in Madrid, Spain. Self-informed questionnaires were used to assess suicide risk, SLEs, and family functioning. In addition, the clinical records of the participants were consulted to collect information about their treatment histories, including the number of appointments and the duration of follow-up. Results: SLE impact perception correlates significantly with suicide risk, the number of clinical appointments, the duration of treatment, and the perceived level of family functioning. The mediation model of the family functioning perception variable in the relationship between SLE impact perception and suicide risk is significant. The linear regression model of SLE impact perception and family functioning perception on suicide risk is also significant, accounting for 25.7% of the variance. Conclusions: Beyond the clear and proven effect of serious and objective SLEs, the perceived impact of SLEs reported by adolescents is related to an increased risk of suicide and more intense psychological and/or psychiatric follow-up. This relationship is mediated by the perceived level of family functioning. Adolescents' perceptions of their life experiences and perceived family support may be key determinants of suicide risk prevention. [ABSTRACT FROM AUTHOR]

Analyses of healthcare expenditures and adequacy are needed to identify cost-effective policies and practices that improve mental healthcare quality. Data are from 2010 to 2012 electronic health records from three hospital psychiatry departments in Madrid (n = 29,944 person-years) and three in Boston (n = 14,109 person-years). Two-part multivariate generalized linear regression and logistic regression models were estimated to identify site differences in mental healthcare expenditures and quality of care. Annual total average treatment expenditures were $4442.14 in Boston and $2277.48 in Madrid. Boston patients used inpatient services more frequently and had higher 30-day re-admission rates (23.7 vs. 8.7%) despite higher rates of minimally adequate care (49.5 vs. 34.8%). Patients in Madrid were more likely to receive psychotropic medication, had fewer inpatient stays and readmissions, and had lower expenditures, but had lower rates of minimally adequate care. Differences in insurance and healthcare system policies and mental health professional roles may explain these dissimilarities. [ABSTRACT FROM AUTHOR]

The objective of this study was to test whether suicide attempters and suicide gesturers can be clinically differentiated. A total of 150 subjects who had attempted suicide at least once, had made a suicide gesture, had suicidal ideation, and/or had engaged in non-suicidal self-injury were recruited from the inpatient service of the Jiménez Díaz Foundation (Madrid, Spain). A multinomial regression analysis was conducted. Histrionic and antisocial personality disorders were risk factors specific to suicide gestures. Narcissistic personality disorder was specifically associated with suicide attempts. Borderline personality disorder was associated with both suicide gestures and attempts. A high level of impulsiveness was a risk factor specific to suicide attempts. Conclusion: Suicide attempters and suicide gesturers are two distinct, although partially overlapping, populations. [ABSTRACT FROM AUTHOR]

Explores the factors that psychiatrists consider in deciding hospitalization for a large sample of suicide attempters in the emergency department of a general hospital in Madrid, Spain, between 1996 and 1998. Use of the Beck's Suicidal Intent Scale in assessing patients with suicidal intent, patients held in psychiatric units, and persons discharged from the emergency department; Variables associated with increased odds of hospitalization; Tendency for psychiatrists to rely on patients' self-report.

The association of aggression and impulsivity with suicidal behavior (SB) in depression may vary across countries. This study aimed (i) to compare aggression and impulsivity levels, measured with the Brown-Goodwin Scale (BGS) and the Barratt Impulsivity Scale (BIS), respectively, between New York City (NYC) (US), Madrid (Spain) and Florence (Italy) (ANOVA); and (ii) to investigate between-site differences in the association of aggression and impulsivity with previous SB (binary logistic regression). Aggression scores were higher in NYC, followed by Florence and Madrid. Impulsivity levels were higher in Florence than in Madrid or NYC. Aggression and impulsivity scores were higher in suicide attempters than in non-attempters in NYC and in Madrid. SB was associated with aggression in NYC (OR 1.12, 95% CI 1.07–1.16; p < 0.001) and in Florence (OR 1.11, 95% CI 1.01–1.22; p = 0.032). Impulsivity was linked with SB in NYC (OR 1.01, 95% CI 1.00–1.02; p < 0.001) and in Madrid (OR 1.03, 95% CI 1.02–1.05; p < 0.001). The higher suicide rates in NYC, compared to Madrid or Florence, may be, in part, explained by these cross-cultural differences in the contribution of aggression-impulsivity to SB, which should be considered by future research on SB prevention. [ABSTRACT FROM AUTHOR]

Background. Suicide prevention is a primary goal of mental health care, and a past history of suicide attempts is considered a high-risk factor for subsequent attempts. This study aims to evaluate the effectiveness of an intensive suicide-reattempt-prevention program (ISRPP) in a health catchment area of 430.000 inhabitants. Methods. A 12-month follow-up study was conducted with all individuals who, between 1 January 2013 and 31 December 2015, had attempted suicide and sought mental health care in the area. Out of a total of 871 patients treated, 292 received treatment as part of ISRPP using short-term problem-solving therapy and a case management approach. Results were compared to those of 357 patients who received treatment as usual (TAU). Results. Attempted suicide was repeated by 9,0% in the ISRPP group, compared to 23,3% in the TAU (Fisher's exact test p<0,001). The number needed to treat (NNT) was=7; 95% CI 95% (5-11). A multivariate Cox regression analysis showed that the TAU group had a hazard ratio (HR)=2,68; 95% CI (1,65-4,35) compared to the ISRPP group. The advantage of ISRPP was maintained when controlling for the non-homogeneous characteristics of the groups. Conclusions. Applied after a suicide attempt, an intensive prevention programme based on brief cognitive behavioural therapy (CBT) and case management reduces and delays repeat suicide attempts at one-year follow-up. The clinical effort is remarkable (NNT=7). [ABSTRACT FROM AUTHOR]