Lifetime Suicide Attempts in Otherwise Psychiatrically Healthy Individuals

Oquendo, M. A., et al. (2024).

JAMA psychiatry, e235672.

Advance online publication.

https://doi.org/10.1001/jamapsychiatry.2023.5672

Abstract

Importance: Not all people who die by suicide have a psychiatric diagnosis; yet, little is known about the percentage and demographics of individuals with lifetime suicide attempts who are apparently psychiatrically healthy. If such suicide attempts are common, there are implications for suicide risk screening, research, policy, and nosology.

Objective: To estimate the percentage of people with lifetime suicide attempts whose first attempt occurred prior to onset of any psychiatric disorder.

Design, setting, and participants: This cross-sectional study used data from the US National Epidemiologic Study of Addictions and Related Conditions III (NESARC-III), a cross-sectional face-to-face survey conducted with a nationally representative sample of the US civilian noninstitutionalized population, and included persons with lifetime suicide attempts who were aged 20 to 65 years at survey administration (April 2012 to June 2013). Data from the NESARC, Wave 2 survey from August 2004 to September 2005 were used for replication. Analyses were performed from April to August 2023.

Exposure: Lifetime suicide attempts.

Main outcomes and measures: The main outcome was presence or absence of a psychiatric disorder before the first lifetime suicide attempt. Among persons with lifetime suicide attempts, the percentage and 95% CI of those whose first suicide attempt occurred before the onset of any apparent psychiatric disorders was calculated, weighted by NESARC sampling and nonresponse weights. Separate analyses were performed for males, females, and 3 age groups (20 to <35, 35-50, and >50 to 65 years).

Conclusions and relevance: In this study, an estimated 19.6% of individuals who attempted suicide did so despite not meeting criteria for an antecedent psychiatric disorder. This finding challenges clinical notions of who is at risk for suicidal behavior and raises questions about the safety of limiting suicide risk screening to psychiatric populations.

Budding designer from Paramus left "suicide diary," according to newspaper report.

Englewood-Englewood Cliffs Patch
Originally posted February 7, 2013

A 22-year-old aspiring fashion designer originally from Paramus jumped off the George Washington Bridge Wednesday and left behind a list of five girls she did not want at her funeral, the New York Post reported.

Riders on a jitney bus saw Ashley A. Riggitano plunge from the New Jersey-bound lanes at around 4:40 p.m., the report said. She reportedly left a Louis Vuitton bag containing pages of notes in a "suicide diary" on the bridge walkway.

Riggitano was apparently bullied by friends in the fashion industry, according to the Post report. The girls banned from her funeral were reportedly from work and college.

“All my other ‘friends’ are in it for gossip,” she wrote in the letter, the Post reported. “Never there.”

Riggitano had attempted to commit suicide before, the newspaper reported.

The entire story is here.

Hanging Suicides Up in United States

By Steven Reinberg
HealthDay Reporter
Originally published November 20, 2012

A surge in hanging deaths among middle-aged adults appears to be responsible for the notable increase in U.S. suicides between 2000 and 2010, a new study finds.


Hangings accounted for 26 percent of suicides in 2010, up from 19 percent at the start of the decade. Among those aged 45 to 59, suicide by hanging increased 104 percent in that time period, according to the report documenting changing suicide patterns.

Overall, 16 percent more Americans took their own lives in 2010 than in 2000. That's equivalent to 12.1 suicides per 100,000 people compared to 10.4 per 100,000 previously.

"It is important that the huge increase in suicide by hanging be recognized," said lead researcher Susan Baker, founding director of the Johns Hopkins Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

The entire story is here.

The Jumper Squad

By WENDY RUDERMAN
The New York Times
Originally published October 5, 2012

ON a concrete ledge off the upper deck of the George Washington Bridge, more than 200 feet above the swift and leaden Hudson River that November night, the two detectives gingerly approached the despondent man as he contemplated jumping.


The plunge, at a speed of more than 60 miles per hour, would surely kill him.

Detectives Marc Nell and Everald Taylor, tethered to the bridge and to their rescue truck with nylon harnesses and heavy rope, knew to resist the urge to pull the man to safety. It was not time yet.

“Tell me your name,” Detective Nell said, tapping into the emotional and psychological arsenal that he had acquired in training. “Talk to me.” “Think of your family.”

Sometimes the detectives do most or all of the talking. It does not always matter. What the detectives are probing for is not necessarily conveyed in words. They are looking for an opening. A moment of doubt.

“Once you see that light, you see their facial expression change, their body posture change, and you think: ‘Oh, I got them. O.K., they are not going anywhere,’ ” Detective Nell said. “It’s like when a boxer gets that shot and he knows that the opponent is wobbly and he just keeps going at that same spot.”

In this case, Detectives Nell and Eddie Torres, a third officer who had joined the rescue, did what they refer to as the Grab. They seized the man, pulling him off the ledge and over a guardrail.

Each year, the Police Department receives hundreds of 911 calls for so-called jumper jobs, or reports of people on bridges and rooftops threatening to jump. So far this year, that number is on track to surpass last year’s total, 519.

The entire story is here.

Thanks to Ed Lundeen for this story.

Means restriction for suicide prevention

The Lancet, Volume 379, Issue 9834, Pages 2393 - 2399, 23 June 2012

doi:10.1016/S0140-6736(12)60521-2

By Yip, et. al

Summary

Limitation of access to lethal methods used for suicide—so-called means restriction—is an important population strategy for suicide prevention. Many empirical studies have shown that such means restriction is effective. Although some individuals might seek other methods, many do not; when they do, the means chosen are less lethal and are associated with fewer deaths than when more dangerous ones are available. We examine how the spread of information about suicide methods through formal and informal media potentially affects the choices that people make when attempting to kill themselves. We also discuss the challenges associated with implementation of means restriction and whether numbers of deaths by suicide are reduced.

Many Suicidal Teens Make First Try Before High School

By Molly McElroy

News and Information

University of Washington

Thoughts about killing oneself and engaging in suicidal behavior may begin much younger than previously thought. While about one of nine youths attempt suicide by the time they graduate from high school, new findings reveal that a significant proportion make their first suicide attempt in elementary or middle school.

In a study published in the November issue of the Journal of Adolescent Health, nearly 40 percent of young adults who said they had tried suicide said that they made their first attempt before entering high school.

The researchers also found that suicide attempts during childhood and adolescence were linked to higher scores of depression at the time of the attempts, validating for the first time that young adults can reliably recall when they first attempted suicide.

“Young adults who end up having chronic mental health problems show their struggles early,” said James Mazza, lead author and professor of educational psychology at the University of Washington. “This study suggests that implementation of mental health programs may need to start in elementary and middle schools, and that youth in these grades are fairly good reporters of their own mental health.”

Adolescence can often be a struggle for some youth with ongoing pressures of drugs, alcohol, sexual relationships and sexual orientation. At the same time, they’re becoming more autonomous.

The entire press release is here.

Survey: 1 in 4 Teens Bullied at School

By Salynn Bolyes

WebMD Health News

One in four high school students in a recent survey said they were victims of school bullying, and nearly 16% said they were victims of cyberbullying.

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Among the major findings from the survey:

• 33% of gay, lesbian, and other non-heterosexually identified teens reported being victims of cyberbullying, compared to just under 15% of teens who identified themselves as heterosexual.
• 47% of teens who reported being victims of both forms of bullying also reported having symptoms of depression, compared to 34% of those who reported being victims of cyberbullying only and 27% of those reporting being bullied only at school.
• Victims of both forms of bullying were also most likely to report having attempted suicide, with 15% saying that they had tried to kill themselves, compared to 9%, 4%, and 2%, respectively, of teens who reported being cyberbully victims, school bully victims, or those who were not victims of bullying.

Cyberbullying victims also reported poorer school performance than students who were not victims, and less attachment to the school they attended.

The story can be found here.

The entire research article can be found here.

Here is a portion of the conclusion:

Another important reason for schools to address cyberbullying is the link between victimization and school attachment and self-reported school performance. This is true even for the 6% of students who were victimized only through cyberbullying. Although this cross-sectional survey cannot make attributions of causality, cyberbullying may be a contributing factor to negative school  experiences, suggesting the need for schools to incorporate cyberbullying into their antibullying programs and policies. Efforts to increase student engagement in school, connectedness to peers and teachers, and academic success may also promote a climate in which school and cyberbullying are less likely to occur.

Bullying and Suicide: Detection and Intervention

By Anat Brunstein Klomek, PhD, Andre Sourander, MD and 
Madelyn S. Gould, PhD, MPH

Psychiatric Times

Bullying is recognized as a major public health problem in the Western world, and it appears to have devastating consequences. Cyberbullying has become an increasing public concern in light of recent cases associated with youth suicides that have been reported in the mass media.

Most of the studies that have examined the association between bullying and suicidality have been cross-sectional. Those studies show that bullying behavior in youth is associated with depression, suicidal ideation, and suicide attempts. These associations have been found in elementary school, middle school, and high school students. Moreover, victims of bullying consistently exhibit more depressive symptoms than nonvictims; they have high levels of suicidal ideation and are more likely to attempt suicide than nonvictims.

The results pertaining to bullies are less consistent. Some studies show an association with depression, while others do not. The prevalence of suicidal ideation is higher in bullies than in persons not involved in bullying behavior. Studies among middle school and high school students show an increased risk of suicidal behavior among bullies and victims. Both perpetrators and victims are at the highest risk for suicidal ideation and behavior.

Suicide risk by sex

Cross-sectional studies of the differential impact of school bullying by sex on the risk of depression and suicidal ideation have shown significant associations, but the results are not consistent. Some researchers have found stronger associations among girls.

Kim and colleagues¹ reported that girls who were involved with school bullying (as either victim or perpetrator) were at significantly greater risk for suicidal ideation. Roland² found that girls who were bullies had more suicidal thoughts. Van der Wal and colleagues³ found a strong association between being bullied and depression and suicidal ideation in girls, and Luukkonen and colleagues⁴ found that being bullied and bullying others are both potential risk factors for suicidal behavior in girls.

On the other hand, Rigby and Slee⁵ found that the association between being a bully and suicidal ideation applied only to boys. McMahon and colleagues6 recently reported that boys who had been bullied at school were more depressed and had a higher risk of thoughts about harming themselves and self-harming behavior than boys who had not been bullied. Kaltiala-Heino and colleagues⁷ reported that among girls, severe suicidal ideation was associated with frequently being bullied or being a bully and for boys it was associated with being a bully. No association was found between boys and girls for depressive symptoms.⁸

Our earlier work tried to explain the differences in the risks of depression and suicidality between girls and boys; we suggested that there is a difference in the threshold for depression and suicide between the sexes.⁹ Girls who bullied others were at risk for depression, suicidal ideation, and suicide attempts even when the bullying was infrequent. However, only frequent bullying was associated with depression, suicidal ideation, and suicide attempts among boys.

There may be a different sex threshold in victimization as well. Among girls, victimization at any frequency increased the risk of depression, suicidal ideation, and suicide attempts. On the other hand, only frequent victimization increased the risk of depression and suicidal ideation in boys, although infrequent victimization was associated with an increased risk of suicide attempts.

The rest of the article can be found here.  The reader can sign up for Psychiatric Times (free) or google the title of this blog for the entire story.