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Biological and Psychological Suicide Risk Factors

Biological and Psychological Suicide Risk Factors. Frequently Used Statistics. Observed/expected (standardized mortality ratio) Risk ratio (RR) and odds ratio (OR) 1.0 - the groups are even 1.7 – the target group is at 70% greater risk 0.8 – the target group is at lower risk

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Biological and Psychological Suicide Risk Factors

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  1. Biological and Psychological Suicide Risk Factors

  2. Frequently Used Statistics • Observed/expected (standardized mortality ratio) • Risk ratio (RR) and odds ratio (OR) • 1.0 - the groups are even • 1.7 – the target group is at 70% greater risk • 0.8 – the target group is at lower risk • Population attributable risk

  3. Biological Predictors of Suicide • Baldessarini and Hennen (2004) • Examined genetics of suicide through several comparisons • Close relative attempted or died by suicide: OR = 5.01 • Weighting study sizes and variances: OR = 2.86 • MZ vs DZ twins concordance for suicide/attempts • MZ 401/1,704 = 23.5% • DZ 2/1,486 = 0.135% • 175 times greater risk (may be an over-estimate) • Weighting study sizes and variances: OR = 2.86 • Adoptive studies: RR =4.84 • Data from molecular genetic studies mixed

  4. The Brain and Suicide • First, caveat about imaging studies • Rely on correlations, like much of our research • Correlations can be very telling and informative, or sometimes can lead us astray. • Some fun examples from Buzzfeed: http://www.buzzfeed.com/kjh2110/the-10-most-bizarre-correlations

  5. Ice Cream Sales and Murder

  6. Pirate Shortage and Global Warming

  7. Organic Food and Autism

  8. Mexican Lemon Imports and Highway Deaths

  9. The Brain and Suicide • Van Heeringen, Gijttebier, & Godfrin, 2011 • Reviewed brain imaging studies examining suicide attempts • Orbitofrontal and dorsolateral prefrontal cortex • Decision-making and problem solving • Sensitivity to social disapproval • Choosing options with high immediate rewards • Reduced ability to generate positive future events

  10. Other Findings • White Matter Hyperintensities (WMH) • Associated with 2.5 – 3 times greater risk of depression or bipolar • Those who were depressed and had WMH were 18.6 times more likely to have had a prior suicide attempt (Ehrlich et al., 2004). • Serotonin and suicide • Lower tryptophan trapping (serotonin synthesis) in those with suicide intent • Less 5-HT2a receptor binding in prefrontal cortex (esp. dorsolateral prefrontal) in suicide attempters • Larger right amygdala volume

  11. Notable Illnesses • Stroke (Pompili et al., 2012) • Kidney Disease and Dialysis (Pompili, et al., 2013) • Cancer (2X greater risk than general population; Anguiano, et al., 2012) • Diabetes Type 1 (Pompili, et al., 2014) • Dementia (Data mixed; Haw et al., 2009)

  12. What is Psychiatric Illness

  13. Diagnostic Criteria • International Statistical Classification of Diseases and Related Health Problems (ICD-10) • Author: World Health Organization • Contains all health disorders • Often preferred by those outside the U.S, public health and epidemiological researchers • Diagnostic and Statistical Manual of Mental Disorders (DSM 5) • Author: American Psychiatric Association • Contains only mental health disorders • Often used by U.S. mental health providers

  14. Depression DSM Criteria • Two weeks or more of 5 or more of the following: • Depressed mood most of the day, nearly every day • Markedly diminished interest or pleasure in previously interesting or pleasurable things • Significant weight loss or gain without trying • Insomnia • Psychomotor retardation or agitation • Fatigue and loss of energy • Feelings of worthlessness • Inability to think or concentrate/indecisiveness • Recurrent thoughts of death or suicidal ideation

  15. Depression and Suicide • Increases the likelihood of suicidal behavior by more than 33 times (Beautrais, 1996) • The severity of depressive symptoms are positively correlated with suicide risk • Unipolar Depression vs. Bipolar

  16. Bipolar Disorder • Manic Episode • A period of abnormally elevated mood lasting at least 1 week with three or more of the following • inflated self-esteem or grandiousity • decreased need for sleep • more talkative than usual or pressure to keep talking • flight of ideas • distractability • increase in goal-directed activity or psychomotor agitation • excessive involvement in pleasurable activities that have a high potential for painful consequences

  17. Bipolar Disorder and Suicide Risk • Bipolar I and Suicide • 80% report suicidal ideation, and 51% report a suicide attempt (Valtonen, et al., 2005) • 15% - 19% die by suicide (de Abreu, et al., 2009) • Not all bad news: Lithium, a common treatment for bipolar disorder, is one of the few medications that has been shown to reduce suicide risk (Tondo, Hennen, & Baldessarini, 2001)

  18. Substance Use and Suicide • It has long been held that 40 – 60% of those who died by suicide were intoxicated at the time of death • Very recent review found that 73% of suicide decedents had BACs of 0.00% (Anestis, et al., In Press, Abnormal Psychology) • Research suggests that alcohol dependence puts individuals at between 6 and 25 times greater risk of suicide

  19. Psychotic Disorders • DSM Criteria: Schizophrenia • Two or more of the following, each present during a significant portion of a 1 month period • delusions • hallucinations • disorganized speech • grossly disorganized or catatonic behavior • negative symptoms (e.g. affective flattening)

  20. Schizoprenia • Associated with increased risk of suicide, especially for those with greater cognitive impairment due to the disease • Those with paranoid schizophrenia diagnoses are also at higher risk

  21. Anxiety Disorders and PTSD • Literature on anxiety disorder and panic disorder is mixed. Some evidence for a link in children, no recent review for adults. • PTSD has been shown to be associated with suicide • OR = 9.8 • OR controlling for other disorders and demographics = 5.3 (Gradus et al., 2010)

  22. Personality Disorders • Cluster A (odd or eccentric) • Paranoid, Schizoid, Schizotypal • Cluster B (dramatic and erratic) • Antisocial, Borderline, Histrionic, Narcissistic • Cluster C (anxious and fearful) • Avoidant, Dependent, Obsessive-Compulsive

  23. Borderline Personality Disorder and Suicide • Estimates are that as high as 80% of individuals who meet criteria for Borderline Personality Disorder demonstrate suicide related behaviors (Linehan, et al., 2006) • Between 4 – 9% die by suicide (Linehan, et al., 2006; Zanarini, et al., 2005)

  24. Nightmares • Examined insomnia symptoms, nightmares and a measure of suicide risk • Sample: • 165 suicide attempters in Sweden • Results: • Nightmares related with suicide risk (OR: 4.9) • Nightmares remain significantly associated with suicide risk (OR: 3.0) after controlling for depression, anxiety, PTSD, and substance abuse

  25. Nightmares • 2-year follow-up to see whether nightmares predict future suicide attempts • Hospital records used to detect suicide attempts • Results: • Nightmares predicted suicide attempts (OR = 5.2) • Nightmares were still predictive after controlling for depression, anxiety, PTSD, and substance abuse disorders (OR = 4.18)

  26. Comorbidity • Having two or more mental disorders increases one’s risk of death by suicide 169.6 times! • In a sample of medically-serious suicide attempters, Beautrais and colleagues (1996) found that 56.6% had more than one diagnosis • OR with one disorder: 17.4 • OR with two or more: 89.7

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