Table 1 - uploaded by Gregg Henriques
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Although several epidemiological studies have found increases in the percentages of people who have made a suicide attempt, few cohort comparisons have been conducted to determine changes within this population over time. The purpose of this investigation was to determine if there have been changes in the clinical profile of suicide attempters in r...
Citations
... Any discrepancies in data extraction were discussed and agreed by consensus. A number of papers reported on repeat self-harm in multiple cohorts or centres/time periods/countries (Bergen et al., 2010a; Eudier et al., 2006; Hawton et al., 1997; Henriques et al., 2004; Mehlum et al., 2010; Morgan and Coleman, 2000). When data were recorded separately for each centre, each estimate was recorded separately and included in subsequent analysis. ...
Background
Self-harm is a common reason for hospital presentation; however, evidence to guide clinical management of these patients to reduce their risk of repeat self-harm and suicide is lacking.
Methods
We undertook a systematic review to investigate whether between study differences in reported clinical management of self-harm patients were associated with the risk of repeat self-harm and suicide.
Results
Altogether 64 prospective studies were identified that described the clinical care of self-harm patients and the incidence of repeat self-harm and suicide. The proportion of a cohort psychosocially assessed was not associated with the recorded incidence of repeat self-harm or suicide; the incidence of repeat self-harm was 16.7% (95% CI 13.8–20.1) in studies in the lowest tertile of assessment levels and 19.0% (95% CI 15.7–23.0) in the highest tertile. There was no association of repeat self-harm with differing levels of hospital admission (n=47 studies) or receiving specialist follow-up (n=12 studies). In studies reporting on levels of hospital admission and suicide (n=5), cohorts where a higher proportion of patients were admitted to a hospital bed reported a lower incidence of subsequent suicide (0.6%, 95% CI 0.5–0.8) compared to cohorts with lower levels of admission (1.9%, 95% CI 1.1–3.2).
Limitations
In some analyses power was limited due to the small number of studies reporting the exposures of interest. Case mix and aspects of care are likely to vary between studies.
Discussion
There is little clear evidence to suggest routine aspects of self-harm patient care, including psychosocial assessment, reduce the risk of subsequent suicide and repeat self-harm.
... A recent systematic review by the first author of the current article showed that only community networking is effective in reducing the actual number of suicides, while training of gatekeepers and other 'educational-type' campaigns have little or no effect at all [21]. A substantial decline of suicide rates throughout Europe, the USA and Canada happened in the last 20-25 years [22]; however, with the global economic crisis, the future of these rates is unknown. The current paper suggests that there is a time lag in the increase of suicidality, and vulnerable populations (probably mentally ill persons) remain to be more precisely identified. ...
During the last few years, many countries in Europe suffered from a severe economic crisis which resulted in high unemployment rates. In this frame, the possible relationship between unemployment rate and suicidal rates at the level of the general population has been debated recently.
The official data concerning completed suicides and unemployment rates from the Hungarian Central Statistical Office for the years 2000-2011 were used. The percentage of changes from the previous year in the unemployment rate and the suicidal rates concerning both the general and the unemployed populations was calculated. Pearson correlation coefficient between the change in suicidal rates and change in unemployment rates was calculated both for the same year as well as after 1-6 years.
The correlations between the unemployment rate and suicide rates were strongly negative both for the general and for the unemployed populations (-0.65 and -0.55, respectively). The correlation of unemployment change with suicidality change after 1-6 years gave a peak strong positive correlation at 5 years for the general population (0.78). At 4 years after the index year, there is a peak correlation with a moderate value for the unemployed population (0.47) and a similar moderate value for the general population (0.46).
The current findings from Hungary suggest that unemployment might be associated with suicidality in the general population only after 3-5 years. It is possible that the distressing environment of the economic crisis increases suicidality in the general population rather than specifically in unemployed people.
... Very short duration interventions don't seem to have even this slight effect. During the past two decades a substantial decline of suicide rates took place throughout Europe, the US and Canada, suggesting that the overall intervention is so far at least partially effective (Henriques et al., 2004). Although relevant data are lacking, it is almost certain that both pharmacological and psychosocial treatments are inadequately administered. ...
Broad general community campaigns were developed to reduce suicide rates. The aim of the current paper was to review such studies in the literature. The MEDLINE search using a combination of the keywords 'suicide', 'education'/'psychoeducation' and 'community' updated through January 10th 2010, returned 424 references and relevant for the current review were 48 with 14 papers reporting results. Although suicide prevention programs through community education are widespread, the reporting of their efficacy is limited. It seems that only long term programs that utilize a commitment of the society at multiple levels and succeed in establishing a community support network that can effectively reduce suicidal rates. The success of most interventions in changing the attitudes and improving the knowledge of the public concerning suicide is restricted at the theoretical-intellectual level; when it comes to action there seems to be no change. Very short duration interventions don't seem to have even this slight effect.
... It seems that better recognition of major depression as well as availability of treatment with antidepressants and mood stabilizers could be one of the major underlying factors. It is also possible that contemporary suicide attempters suffer from more severe forms of depression in comparison to attempters in the past, maybe suggesting that the overall intervention is so far at least partially effective (Henriques et al., 2004 ). What is impressive is the fact that in spite of frequent medical contact before the suicide event, only a small minority of depressive suicide victims had received appropriate antidepressant pharmacotherapy, and this observation is particularly strong concerning primary care. ...
25-50% of bipolar patients attempt suicide at least once in their lifetime and completed suicide in this population is about 1% annually, about 60 times the rate of the general population. Psychotherapy may be an effective adjunctive option in preventing suicide in bipolar patients. It has been suggested that interpersonal, cognitive and behavioural techniques may be effective in controlling mood shifts, increasing compliance with pharmacotherapy, and maintaining morale in the face of therapeutic adversity and incomplete response. The aim of our study was to systematically review the literature concerning the efficacy of psychosocial interventions in reducing the risk for attempting or committing suicide.
We searched MEDLINE with the combination of the key words 'psychotherapy' or 'psychoeducation' or 'cognitive therapy' or 'behavio(u)ral therapy', 'cognitive-behavio(u)ral' or 'family therapy' or 'social rhythm' or 'rhythm' with 'suicide' and 'bipolar', limited to English language papers published between 1990 and January 2008. Papers were selected based on the criterium that they provided definite data on the role of psychotherapy in suicide prevention, and specifically in bipolar disorder.
Our search returned 481 references, of which 17 were selected based on the above criteria. The selected papers were classified according to the area of suicide prevention they were dealing with as 1. Psychosocial and demographic factors, 2. Psychological profile and 3. Efficacy of psychotherapies.
Our paper summarizes specific features and correlates of suicide in bipolar patients and possible targets of psychosocial intervention in the prevention of suicide in bipolar patients. Although studies researching the effect of psychosocial interventions on suicidal behaviour are virtually non-existent, hard data concerning the effectiveness of psychosocial interventions in bipolar disorder are emerging, but still suffer from methodological drawbacks.
... To our knowledge, no study has assessed the accuracy of information on substance use recorded in the medical charts of subjects with suicidal behavior, obtained from self-report or from any other source of information. However, a growing body of evidence suggests that psychoactive substance use is a risk factor for suicide and suicide attempt (Hawton et al., 1993;Lesage et al., 1994;Hawton et al., 2002;Kim et al., 2003;Henriques et al., 2004). We have previously shown that substance use is frequent in subjects hospitalized for intentional drug overdose (IDO) (Tournier et al., 2005a,b). ...
Psychoactive substance use is a risk factor for suicidal behavior and current intoxication increases the likelihood of serious intentional drug overdose (IDO). The objective was to assess the accuracy of information on substance use recorded in medical charts using toxicological assays as a reference in subjects admitted for IDO to an emergency department. Patients (n=1190) consecutively admitted for IDO were included. Information on substance use was recorded in routine practice by the emergency staff and toxicological assays (cannabis, opiate, buprenorphine, amphetamine/ecstasy, cocaine, LSD) were carried out in urine samples collected as part of routine management. The information on substance use was recorded in medical charts for 24.4% of subjects. A third of subjects (27.5%) were positive for toxicological assays. Recorded substance use allowed correct classification of nearly 80% of subjects. However, specificity (88.6%) was better than sensitivity (54.2%). Compared with toxicological assays, medical records allowed identification of only half of the subjects with current substance use. The usefulness of systematic toxicological assays during hospitalization for IDO should be assessed in further studies exploring whether such information allows medical management to be modified and contributes to improving prognosis.
... The WHO/EURO Multicentre Study on Suicidal Behaviour found that 56% of patients medically treated for DSH had made previous attempts and that 29% made a further attempt within 12 months of their index act (Kerkhof & Arensman, 2004). Rates of repetition are increasing (Hawton et al. 1997) and those presenting to hospital with DSH are now more likely to have a history of DSH and to engage in further acts, than was previously observed (Henriques et al. 2004). Repetition is regarded as an important outcome following an episode of DSH (Owens et al. 1994 ;Kerkhof & Arensman, 2004) because it reflects ongoing or recurrent distress (Hawton & Fagg, 1995 ;Hawton et al. 1999) and is associated with increased risk of suicide (Zahl & Hawton, 2004). ...
Background. While recent studies have found problem-solving impairments in individuals who engage in deliberate self-harm (DSH), few studies have examined repeaters and non-repeaters separately. The aim of the present study was to investigate whether specific types of problem-solving are associated with repeated DSH.
Method. As part of the WHO/EURO Multicentre Study on Suicidal Behaviour, 836 medically treated DSH patients (59% repeaters) from 12 European regions were interviewed using the European Parasuicide Study Interview Schedule (EPSIS II) approximately 1 year after their index episode. The Utrecht Coping List (UCL) assessed habitual responses to problems.
Results. Factor analysis identified five dimensions – Active Handling, Passive-Avoidance, Problem Sharing, Palliative Reactions and Negative Expression. Passive-Avoidance – characterized by a pre-occupation with problems, feeling unable to do anything, worrying about the past and taking a gloomy view of the situation, a greater likelihood of giving in so as to avoid difficult situations, the tendency to resign oneself to the situation, and to try to avoid problems – was the problem-solving dimension most strongly associated with repetition, although this association was attenuated by self-esteem.
Conclusions. The outcomes of the study indicate that treatments for DSH patients with repeated episodes should include problem-solving interventions. The observed passivity and avoidance of problems (coupled with low self-esteem) associated with repetition suggests that intensive therapeutic input and follow-up are required for those with repeated DSH.
... There is clearly a need for more research on treatments for deliberate selfharm patients, especially in view of the growing extent of the problem of deliberate self-harm, evidence of increasing rates of repetition (Hawton et al. 2003b;Henriques et al. 2004), and the strong link to suicide (Hawton et al. 2003d). In our systematic review of treatments, we identified several methodological issues which need addressing in future studies (Arensman et al. 2001). ...
Chapter 12 considers the characteristics and needs of deliberate self-harm patients that should be addressed if treatments are to be effective. It then reviews the range of psychosocial interventions that have been evaluated in randomized controlled trials, and what conclusions can be reached to inform clinical practice. Finally, it outlines how treatments might be improved and what is required to develop a more informative evidence base in this field.
... Sin embargo, el BDI-II fue diseñado principalmente como " un instrumento de evaluación de la gravedad de la depresión en pacientes adultos y adolescentes con diagnóstico psiquiátrico " (Beck et al., 1996, p. 6). Por tanto, una parte fundamental de la adaptación de la versión española del BDI-II requiere el estudio de las propiedades psicométricas de dicho instrumento en relación con ese objetivo original, es decir, en muestras de pacientes con diagnóstico psicopatológico, propiedades que, en el caso de la versión original estadounidense ya han sido analizadas con amplitud y con resultados empíricos satisfactorios (Acton et al., 2001; Aharonovich et al., 2001; Ball y Steer, 2003; Cole et al., 2003; Beck, Steer y Brown, 1996; Beck, Steer, Ball et al., 1996; Buckley et al., 2001; Henriques et al., 2004; Sprinkle et al., 2002; Steer et al., 1997 Steer et al., , 1998 Steer et al., , 1999 Steer et al., , 2000 Steer et al., , 2001 Steer et al., , 2003 Trygstad et al., 2002). En consecuencia, el objetivo principal del presente estudio es obtener, en una muestra de pacientes ambulatorios con trastornos psicológicos, datos de fiabilidad y de validez de la versión española del BDI-II que permitan sustentar su utilización como instrumento para la cuantificación de la gravedad de los síntomas depresivos que presentan los pacientes psicopatológicos.tero, ...
... En este caso se toma la puntuación de la frase elegida de mayor gravedad. Varios estudios psicométricos avalan la fiabilidad y validez del BDI-II en muestras de pacientes con trastornos psicológicos diversos, tanto ambulatorios (Acton et al., 2001; Beck, Steer y Brown, 1996; Beck, Steer, Ball y Ranieri, 1996; Sprinkle et al., 2002; Steer, Ball, Ranieri y Beck, 1997; Steer, Clark, Beck y J. Sanz, M.ª P. García-Vera, R. Espinosa, M.ª Fortún, C Ranieri, 1998; Steer et al., 2003) como ingresados (Cole et al., 2003; Henriques et al., 2004 ), o en muestras de pacientes con trastornos específicos como, por ejemplo, pacientes ambulatorios con trastornos depresivos (Ball y Steer, 2003; Steer, Ball, Ranieri y Beck, 1999), pacientes con dependencia de sustancias (Aharonovich, Nguyen y Nunes, 2001; Buckley, Parker y Heggie, 2001 ), pacientes ingresados geriátricos con trastornos depresivos (Steer et al., 2000), pacientes ambulatorios con trastorno depresivo mayor (Steer et al., 2001) y pacientes ambulatorios con esquizofrenia (Trygstad et al., 2002). ...
... Por ejemplo, los estudios llevados a cabo por Beck y sus colaboradores (Beck, Steer y Brown, 1996; Beck, Steer, Ball y Ranieri, 1996 ) administrando simultáneamente el BDI-II y el BDI-IA a muestras de pacientes con trastornos psicológicos corroboran que la puntuación media del BDI-II es 2-3 puntos mayor que la del BDI-IA, y que la diferencia es estadísticamente significativa. Igualmente, al comparar la versión española del BDI-II y la del BDI-IA en muestras de estudiantes universitarios (Sanz, Navarro y Vázquez, 2003) o en muestras de la población general (Sanz, Perdigón y Vázquez, 2003), vuelve a emerger una diferencia de 2-4 puntos en favor del BDI-II., 1988 ), mientras que el coeficiente alfa medio ponderado de los siete estudios con pacientes ambulatorios con trastornos psicológicos que aparecen recogidos en la Tabla 2 es de 0,92, coeficiente que no varía mucho si en su cálculo también se tienen en cuenta los estudios previos con pacientes psicopatológicos ingresados (Cole et al., 2003; Henriques et al., 2004; Steer et al., 2000) o con pacientes con tras-tornos específicos (Aharonovich et al., 2001; Ball y Steer, 2003; Buckley et al., 2001; Steer et al., 2001; Trygstad et al., 2002). En este caso, el coeficiente alfa medio ponderado del BDI-II teniendo en cuenta los 15 estudios previos con pacientes psicopatológicos es de 0,91. ...
Se presentan datos sobre la fiabilidad y validez de la adaptación española del Inventario para la Depresión de Beck-II (BDI-II; Beck, Steer y Brown, 1996), obtenidos con una muestra de 305 pacientes ambulatorios con diversos diagnósticos psicopatológicos según el DSM-IV. El coeficiente alfa de fiabilidad fue alto (alfa = 0,89). Las correlaciones con otras medidas autoaplicadas y heteroaplicadas de depresión fueron elevadas y significativamente mayores que la correlación con una medida de ansiedad, lo que avala la validez convergente y discriminante del BDI-II, respectivamente. Respecto a la validez de criterio, los resultados demostraron que los pacientes diagnosticados con un trastorno depresivo mayor tenían niveles de depresión más elevados, medidos con el BDI-II, que los pacientes de otros grupos diagnósticos, aunque no hubo diferencias con los pacientes con trastornos de personalidad. Finalmente, la validación factorial del BDI-II proporcionó una solución bifactorial (factor somático- motivacional y factor cognitivo) que coincide con la hallada en estudios previos. Se concluye que el BDI es un instrumento válido de detección y cuantificación de síntomas depresivos en pacientes, si bien su utilidad como herramienta para el diagnóstico diferencial de la depresión es una cuestión pendiente de investigación.
... My sense that there were serious problems with the ecology in which these folks lived and with the health system that was providing treatment was greatly reinforced when I discovered that the degree of psychopathology exhibited by the population of suicide attempters 2 in Philadelphia had markedly increased over the past 30 years (Henriques, Brown, Berk, & Beck, 2004). In the early 1970s, Beck and his colleagues had evaluated hundreds of suicide attempters with the same basic instruments we were using in our outcome trial. ...
Psychology has failed to reach its full potential as either a science or a profession. The inability of psychologists to generate a shared, general understanding of their subject matter and fundamental differences between scientific and nonscientific views of human behavior in society at large interact to render psychology's contributions to the world's most pressing problems much less potent than might otherwise be the case. The Tree of Knowledge (ToK) System affords new opportunities both to define the discipline of psychology and to examine the epistemological interrelations between the institution of science and other societal institutions, such as law, governance, health care, the arts, and religion. In this article I articulate how the foundation can be laid for the development of a useful mass movement that could transform the discipline of psychology in a manner that unleashes its constructive potential, while at the same time it attempts to address many of the concerns about the proposal raised by the contributors to these two special issues.
Suicide rates continue to increase globally. The volume of research in this field has also expanded rapidly. In A Concise Guide to Understanding Suicide, leading researchers and clinicians provide a concise review of recent literature, report solutions achieved and give practical guidance for patient care to aid understanding and help prevent suicide. Each chapter is highly focused to provide pertinent information covering all major aspects of the field, from epidemiology and theories of causation through to treatment and prevention. This text will educate practising clinicians (psychologists, psychiatrists, nurses, counsellors, and emergency room personnel) and other health care workers and researchers, as well as providing a pathway for undergraduate and graduate students interested in furthering their understanding of the complexities surrounding suicide. Further, mental health professionals and those in the social sciences will be extremely interested in this monograph, as will the University community, armed forces and interested lay public.
