Study finds that suicides are far more likely to occur after midnight
03 jun 2014--A new study provides novel evidence suggesting that suicides are far more likely to occur between midnight and 4 a.m. than during the daytime or evening.
Results show that the weighted, scaled mean suicide rate per hour was 10.27 percent after midnight, peaking at 16.27 percent between 2 a.m. and 2:59 a.m. In contrast, the mean suicide rate per hour was 2.13 percent between 6 a.m. and 11:59 p.m. When six-hour time blocks were examined, the observed frequency of suicide between midnight and 5:59 a.m. was 3.6 times higher than expected.
"This appears to be the first data to suggest that circadian factors may contribute to suicidality and help explain why insomnia is also a risk factor for suicidal ideation and behavior," said principal investigator Michael Perlis, PhD, associate professor in the Department of Psychiatry and Director of the Penn Behavioral Sleep Medicine Program at the University of Pennsylvania in Philadelphia. "These results suggest that not only are nightmares and insomnia significant risk factors for suicidal ideation and behavior, but just being awake at night may in and of itself be a risk factor for suicide," he said.
The research abstract was published recently in an online supplement of the journal Sleep and will be presented Tuesday, June 3, in Minneapolis, Minnesota, at SLEEP 2014, the 28th annual meeting of the Associated Professional Sleep Societies LLC.
According to the authors, previous research suggesting that more suicides occur during the day failed to account for the proportion of the population that is awake at each given hour. The current study involved archival analyses of both the National Violent Death Reporting System, which provided data for the estimated time of fatal injury, and the American Time Use Survey, which provided an hourly proportion of the American population that is awake. Time of fatal injury was categorized into one-hour bins, and the hourly distribution of these data were weighted by the proportion of people awake at each hour and scaled to 100 percent. A total of 35,332 suicides were included in the analysis.
According to Perlis, an important implication of the study is that the treatment of insomnia may be one way to reduce suicide risk. The American Academy of Sleep Medicine reports that about 10 percent of adults have a chronic insomnia disorder lasting at least three months.
Accounting for more than 38,000 deaths each year, suicide is the 10th leading cause of death in the U.S. according to the Centers for Disease Control and Prevention. In comparison, about 16,000 deaths occur each year due to homicide.
More information: "When Accounting for Wakefulness, Completed Suicides Exhibit an Increased Likelihood during Circadian Night," Sleep, 2014.
Provided by American Academy of Sleep Medicine
Showing posts with label Suicide Risk. Show all posts
Showing posts with label Suicide Risk. Show all posts
Tuesday, June 03, 2014
Friday, March 21, 2014
One million people commit suicide each year: WHO
One million people die by their own hand each year, accounting for more deaths than wars and murders put together, the World Health Organisation said Friday, calling for urgent action to address the problem.
22 mar 2014--"Data from the WHO indicate that approximately one million people worldwide die by suicide each year. This corresponds to one death by suicide every 40 seconds," the organisation said in a report launched ahead of the World Suicide Prevention Day on Monday.
And while the number of deaths by suicide is staggering, the number of attempts each year is 20 times higher, the WHO said, pointing out that five percent of people in the world try to kill themselves at least once during their lifetime.
And the problem is getting worse, the organisation said, insisting that "given the magnitude of the public health problem of suicidal behaviours", urgent action was needed.
"As suicide is largely preventable, it is imperative that governments, through their health, social and other relevant sectors, invest human and financial resources in suicide prevention," the report said.
According to Dr. Shekhar Saxena, who headed the team behind the report, suicide rates have risen sharply in some parts of the world in recent years, with some countries seeing their rates jump by as much as 60 percent.
"Although suicide continues to remain a serious problem in high income countries, it is the low and middle income countries that bear the larger part of the global suicide burden," the report said, adding: "It is also these countries that are relatively less equipped to prevent suicide".
The highest documented suicide rates can be found in Eastern European countries like Lithuania and Russia, while they are lowest in Latin America, WHO said.
The United States, Western European countries and Asia fell in the middle of the range, the report showed, but stressed that statistics are not available for many countries in Africa and South-East Asia.
Globally, suicide is meanwhile the second cause of death worldwide among 15-19 year-olds, with at least 100,000 adolescents killing themselves each year, according to the study.
Among adults, the suicide rate is highest among those aged 75 and older, the WHO said, pointing out that "elderly people are likely to have higher suicide intent and use more lethal methods than younger people, and they are less likely to survive the physical consequences of an attempt".
The report also showed that men were three times more likely to commit suicide, but that three times as many women as men attempted to kill themselves.
"The disparity in suicide rates has been partly explained by the use of more lethal means and the experience of more aggression and higher intent to die, when suicidal, in men than women," it explained.
Friday, June 05, 2009
Sedatives Increase Suicide Risk Among Elderly
Sedatives greatly increase the risk of suicide in the elderly, Swedish researchers say
05 june 2009--In their study, hypnotic medication also was linked with a greater likelihood of suicides in older people. "Sedative treatment was associated with an almost 14-fold increase of suicide risk in the crude analysis and remained an independent risk factor for suicide even after adjustment for the presence of mental disorders," wrote Anders Carlsten, of Gothenburg University. "Having a current prescription for a hypnotic was associated with a fourfold increase in suicide risk in the adjusted model."
The drugs may increase suicide risk in the elderly by triggering aggressive or impulsive behavior, or by providing the means to take an overdose, the researchers said. It's also possible that sedatives may merely be markers for other factors related to suicide, such as sleep disturbance, lack of a social network, interpersonal problems, alcohol abuse and physical disability.
"Persons with these problems might be more likely to seek health care and perhaps more likely to receive prescriptions for psychotropic drugs. However, given the extremely high prescription rates for these drugs, a careful evaluation of the suicide risk should always precede prescribing a sedative or hypnotic to an elderly individual," Carlsten said.
The study appears in the current issue of BMC Geriatrics.
More information
The U.S. National Institute of Mental Health has more about older adults and suicide.
Wednesday, August 13, 2008
Older Patients With Cancer at Heightened Suicide Risk
13 aug 2008-- Cancer patients are at increased risk for suicide, according to three new studies.
In the first study, researchers at the University of Washington analyzed U.S. data from 1973 to 2002 and found that the suicide rate among cancer patients was 31.4 per 100,000 person-years, compared to 16.7 per 100,000 person-years in the general population.
Higher suicide rates were associated being male, white and older at the time of cancer diagnosis. Patients with the highest suicide rates were those with lung, stomach, oral/pharyngeal and larynx cancers. Suicide risk was greatest within the first five years after diagnosis but remained elevated for up to 15 years after diagnosis.
The second study found that older Americans with cancer are more than twice as likely to commit suicide as those without cancer. The Harvard School of Public Health and Harvard Medical School study compared 128 New Jersey residents, age 65 and older, who committed suicide between 1994 and 2002 and 1,280 living people in the same age group.
The suicide risk was 2.3 times higher among cancer patients than among those who were cancer-free. This increased risk held true even after the researchers adjusted for age, sex, race, medical and psychiatric illnesses, and use of prescription medications.
The cancer patients in the study who committed suicide were more likely to have advanced metastatic disease, and two-thirds of them used a firearm to commit suicide. Most of the patients who committed suicide had seen a physician in the month before their death, and 25 percent had seen a doctor within a week before their suicide.
A third study by researchers at the University of Edinburgh in the United Kingdom found that cancer patients are at increased risk for suicidal thoughts. The survey of 2,924 cancer patients receiving outpatient care found that nearly 8 percent reported suicidal thoughts persisted for at least several days over the previous two weeks. A similar survey of the general population in Australia found that only 2.6 percent of respondents reported having similar thoughts.
The University of Edinburgh team found that suicidal thoughts among cancer patients were associated with having substantial emotional distress or pain, but not with cancer severity. Better management of patients' emotional distress and pain may improve quality of life and reduce suicide risk, the researchers concluded.
The research was published online Monday in the Journal of Clinical Oncology.
More attention needs to be given to suicidal thoughts and attempts by cancer patients, Dr. Timothy Quill, a professor of medicine, psychiatry and medical humanities at the University of Rochester Medial Center, said in an accompanying editorial.
"It is important to ask about suicidal thoughts regularly, especially when disease is worsening, symptoms are increasing, or the patient is entering a more serious phase of illness ... Creating an environment where these issues can be openly explored without being judged is critical," Quill wrote.
13 aug 2008-- Cancer patients are at increased risk for suicide, according to three new studies.
In the first study, researchers at the University of Washington analyzed U.S. data from 1973 to 2002 and found that the suicide rate among cancer patients was 31.4 per 100,000 person-years, compared to 16.7 per 100,000 person-years in the general population.
Higher suicide rates were associated being male, white and older at the time of cancer diagnosis. Patients with the highest suicide rates were those with lung, stomach, oral/pharyngeal and larynx cancers. Suicide risk was greatest within the first five years after diagnosis but remained elevated for up to 15 years after diagnosis.
The second study found that older Americans with cancer are more than twice as likely to commit suicide as those without cancer. The Harvard School of Public Health and Harvard Medical School study compared 128 New Jersey residents, age 65 and older, who committed suicide between 1994 and 2002 and 1,280 living people in the same age group.
The suicide risk was 2.3 times higher among cancer patients than among those who were cancer-free. This increased risk held true even after the researchers adjusted for age, sex, race, medical and psychiatric illnesses, and use of prescription medications.
The cancer patients in the study who committed suicide were more likely to have advanced metastatic disease, and two-thirds of them used a firearm to commit suicide. Most of the patients who committed suicide had seen a physician in the month before their death, and 25 percent had seen a doctor within a week before their suicide.
A third study by researchers at the University of Edinburgh in the United Kingdom found that cancer patients are at increased risk for suicidal thoughts. The survey of 2,924 cancer patients receiving outpatient care found that nearly 8 percent reported suicidal thoughts persisted for at least several days over the previous two weeks. A similar survey of the general population in Australia found that only 2.6 percent of respondents reported having similar thoughts.
The University of Edinburgh team found that suicidal thoughts among cancer patients were associated with having substantial emotional distress or pain, but not with cancer severity. Better management of patients' emotional distress and pain may improve quality of life and reduce suicide risk, the researchers concluded.
The research was published online Monday in the Journal of Clinical Oncology.
More attention needs to be given to suicidal thoughts and attempts by cancer patients, Dr. Timothy Quill, a professor of medicine, psychiatry and medical humanities at the University of Rochester Medial Center, said in an accompanying editorial.
"It is important to ask about suicidal thoughts regularly, especially when disease is worsening, symptoms are increasing, or the patient is entering a more serious phase of illness ... Creating an environment where these issues can be openly explored without being judged is critical," Quill wrote.
Saturday, May 10, 2008
Medical know-how raises suicide risk for doctors
By LINDSEY TANNER
10 may 2008--There's a grim, rarely talked-about twist to all that medical know-how doctors learn to save lives: It makes them especially good at ending their own. An estimated 300 to 400 U.S. doctors kill themselves each year — a suicide rate thought to be higher than in the general population, although exact figures are hard to come by.
Some doctors believe the stigma of mental illness is magnified in a profession that prides itself on stoicism and bravado. Many fear admitting psychiatric problems could be fatal to their careers, so they suffer in silence.
And when the pain is too much, doctors have easy access to prescription drugs and a precise knowledge of both how the body works and the amount of a drug needed for an overdose to stop breathing and halt the heart.
"All physicians have access to neat, clean ways to commit suicide," said Dr. Robert Lehmberg, a Little Rock, Ark., surgeon who has battled depression and long considered suicide "an exit strategy if absolutely necessary."
The American Medical Association has called physician suicide "an endemic catastrophe," and pledged two years ago to work to prevent the problem.
But the suicides have persisted. So the American Foundation for Suicide Prevention has launched an educational campaign in hopes of making troubled doctors more willing to seek help.
The foundation, the American College of Psychiatrists and Wyeth Pharmaceuticals, a maker of antidepressant pills, paid for the program. It includes a documentary titled "Struggling in Silence" that begins airing on public television stations this week.
"It really has been swept under the carpet," said Dr. Paula Clayton, the suicide foundation's medical director.
The foundation says 300 to 400 doctors commit suicide each year, based on estimates from research, but that more studies are needed to get a more precise count.
Another estimate of 250 yearly comes from an online article by Dr. Louise Andrew and in American Medical News, an AMA publication. But a spokesman said the AMA doesn't track doctor suicides because accurate numbers aren't available.
Suicide figures in broader society are not completely reliable because suicide is often not given as the cause of death.
The overall U.S. suicide rate among men is four times higher than in women — about 23 per 100,000 versus about 6 per 100,000 in women, according to the most recent government data.
But among doctors, suicide rates are about equal for men and women.
A 28-state study from 1984-95 found women doctors were more than twice as likely as women in the general population to kill themselves. Men were more than 70 percent more likely inside the medical profession than overall to commit suicide.
One explanation is that most suicide attempts in the broader population are unsuccessful, while doctors know how to successfully commit suicide, said Dr. Erika Frank, who specializes in research on physician health.
Depression is often the problem.
Depressed doctors frequently decide to self-medicate but don't seek psychotherapy that could help them deal with underlying issues, said Dr. Glenn Siegel, who runs a suburban Chicago program that treats doctors with drug abuse, depression and other psychiatric problems.
"It's not a safe topic to be as open about in that profession because you're responsible for the well-being of others," Siegel said. "If you're admitting something like that, you're saying maybe you're not fit to do your job."
Adds Lehmberg, the Arkansas surgeon, who is featured in the documentary: "You just would rather take a risk with your health than your career. It's not like you get a second chance with it."
A psychiatrist in the New York area who asked to remain unidentified said he had suicidal thoughts every day for several years. But in medical school in the 1980s, he said he was so embarrassed about seeking help for depression that he went to a pay phone instead of his dorm to call a therapist.
Since then, some schools have begun teaching medical students about depression among doctors, but, he said in an interview, "so much more needs to be done."
Because the stigma persists, he said he didn't want his name used to avoid hurting his family and relationships with colleagues and patients.
Some studies have suggested depression is more common among doctors, especially women physicians, and that the high demands of a job dealing with life-and-death issues makes them prone.
But Frank questions that and said she worries that singling out physicians risks "pathologizing" a profession whose members generally "have it awfully good."
"I think the situation gets portrayed as far more grave than it really is for physicians compared to anyone else in the world," Frank said.
There could be reasons why the stigma would be worse for doctors, "but you can come up with just as many reasons why physicians would be better equipped to acknowledge" mental illness, she said.
"We've all done psychiatric training. We all know bad mental health outcomes happen to good people," she said.
A study in Denmark, published last year, found more suicides in doctors than among more than 20 other professions, including nurses, factory workers, elementary school teachers, corporate managers and architects.
But there are few comprehensive studies on suicides among U.S. doctors.
Some have been based on newspaper obituaries, which are "flawed at best" because suicide often isn't listed as a cause of death, said Dr. Morton Silverman, a University of Chicago suicide expert.
New Jersey physician Ron Brown suffered from depression and killed himself in 2002. His widow, Mumtaz Bari-Brown, said she believes the stigma kept her husband from getting help in time to save his life.
As a boy, Brown had been told his father died of a heart attack, not the real cause of suicide, the widow said.
"We have to stop the hiding and the ignorance and recognize it as a disease like high blood pressure or diabetes," said Bari-Brown, who also is featured in the new documentary.
Dr. G. Richard Smith, Lehmberg's doctor and director of the University of Arkansas for Medical Sciences' psychiatric research institute, said doctors need assurance they won't risk their jobs if they seek psychiatric help.
Smith succeeded in getting changes to questions on medical license applications in Arkansas that he believes will help. The old application asked doctors if they were being treated for mental illness or ever had been. A "yes" answer required a psychiatrist's note declaring they were fit to practice medicine. Now, they need only disclose mental health treatment that was advised or required by medical authorities.
The previous form didn't keep doctors with psychiatric problems from practicing, Smith said. But it did keep "doctors who needed treatment from getting the treatment that they needed."
By LINDSEY TANNER
10 may 2008--There's a grim, rarely talked-about twist to all that medical know-how doctors learn to save lives: It makes them especially good at ending their own. An estimated 300 to 400 U.S. doctors kill themselves each year — a suicide rate thought to be higher than in the general population, although exact figures are hard to come by.
Some doctors believe the stigma of mental illness is magnified in a profession that prides itself on stoicism and bravado. Many fear admitting psychiatric problems could be fatal to their careers, so they suffer in silence.
And when the pain is too much, doctors have easy access to prescription drugs and a precise knowledge of both how the body works and the amount of a drug needed for an overdose to stop breathing and halt the heart.
"All physicians have access to neat, clean ways to commit suicide," said Dr. Robert Lehmberg, a Little Rock, Ark., surgeon who has battled depression and long considered suicide "an exit strategy if absolutely necessary."
The American Medical Association has called physician suicide "an endemic catastrophe," and pledged two years ago to work to prevent the problem.
But the suicides have persisted. So the American Foundation for Suicide Prevention has launched an educational campaign in hopes of making troubled doctors more willing to seek help.
The foundation, the American College of Psychiatrists and Wyeth Pharmaceuticals, a maker of antidepressant pills, paid for the program. It includes a documentary titled "Struggling in Silence" that begins airing on public television stations this week.
"It really has been swept under the carpet," said Dr. Paula Clayton, the suicide foundation's medical director.
The foundation says 300 to 400 doctors commit suicide each year, based on estimates from research, but that more studies are needed to get a more precise count.
Another estimate of 250 yearly comes from an online article by Dr. Louise Andrew and in American Medical News, an AMA publication. But a spokesman said the AMA doesn't track doctor suicides because accurate numbers aren't available.
Suicide figures in broader society are not completely reliable because suicide is often not given as the cause of death.
The overall U.S. suicide rate among men is four times higher than in women — about 23 per 100,000 versus about 6 per 100,000 in women, according to the most recent government data.
But among doctors, suicide rates are about equal for men and women.
A 28-state study from 1984-95 found women doctors were more than twice as likely as women in the general population to kill themselves. Men were more than 70 percent more likely inside the medical profession than overall to commit suicide.
One explanation is that most suicide attempts in the broader population are unsuccessful, while doctors know how to successfully commit suicide, said Dr. Erika Frank, who specializes in research on physician health.
Depression is often the problem.
Depressed doctors frequently decide to self-medicate but don't seek psychotherapy that could help them deal with underlying issues, said Dr. Glenn Siegel, who runs a suburban Chicago program that treats doctors with drug abuse, depression and other psychiatric problems.
"It's not a safe topic to be as open about in that profession because you're responsible for the well-being of others," Siegel said. "If you're admitting something like that, you're saying maybe you're not fit to do your job."
Adds Lehmberg, the Arkansas surgeon, who is featured in the documentary: "You just would rather take a risk with your health than your career. It's not like you get a second chance with it."
A psychiatrist in the New York area who asked to remain unidentified said he had suicidal thoughts every day for several years. But in medical school in the 1980s, he said he was so embarrassed about seeking help for depression that he went to a pay phone instead of his dorm to call a therapist.
Since then, some schools have begun teaching medical students about depression among doctors, but, he said in an interview, "so much more needs to be done."
Because the stigma persists, he said he didn't want his name used to avoid hurting his family and relationships with colleagues and patients.
Some studies have suggested depression is more common among doctors, especially women physicians, and that the high demands of a job dealing with life-and-death issues makes them prone.
But Frank questions that and said she worries that singling out physicians risks "pathologizing" a profession whose members generally "have it awfully good."
"I think the situation gets portrayed as far more grave than it really is for physicians compared to anyone else in the world," Frank said.
There could be reasons why the stigma would be worse for doctors, "but you can come up with just as many reasons why physicians would be better equipped to acknowledge" mental illness, she said.
"We've all done psychiatric training. We all know bad mental health outcomes happen to good people," she said.
A study in Denmark, published last year, found more suicides in doctors than among more than 20 other professions, including nurses, factory workers, elementary school teachers, corporate managers and architects.
But there are few comprehensive studies on suicides among U.S. doctors.
Some have been based on newspaper obituaries, which are "flawed at best" because suicide often isn't listed as a cause of death, said Dr. Morton Silverman, a University of Chicago suicide expert.
New Jersey physician Ron Brown suffered from depression and killed himself in 2002. His widow, Mumtaz Bari-Brown, said she believes the stigma kept her husband from getting help in time to save his life.
As a boy, Brown had been told his father died of a heart attack, not the real cause of suicide, the widow said.
"We have to stop the hiding and the ignorance and recognize it as a disease like high blood pressure or diabetes," said Bari-Brown, who also is featured in the new documentary.
Dr. G. Richard Smith, Lehmberg's doctor and director of the University of Arkansas for Medical Sciences' psychiatric research institute, said doctors need assurance they won't risk their jobs if they seek psychiatric help.
Smith succeeded in getting changes to questions on medical license applications in Arkansas that he believes will help. The old application asked doctors if they were being treated for mental illness or ever had been. A "yes" answer required a psychiatrist's note declaring they were fit to practice medicine. Now, they need only disclose mental health treatment that was advised or required by medical authorities.
The previous form didn't keep doctors with psychiatric problems from practicing, Smith said. But it did keep "doctors who needed treatment from getting the treatment that they needed."
Wednesday, September 19, 2007
Elderly at highest risk for suicide
By SARAH SKIDMORE
Not long after 72-year-old Anne Beale Golsan had retired on disability from her job as a librarian, she put a stack of paid bills out for the mail, hung up a freshly pressed outfit and taped a note to the front of the house. "Don't come in by yourself. Get somebody to come with you. Sorry, Love Beale."
Her niece arrived at the house they shared in Baton Rouge, La., to find police already there. Golsan had killed herself with a gunshot to the head.
"Every single day it makes me feel like I wish I could have done something," Jane Golsan Ray said, recalling her aunt's death eight years ago. "I wish I could turn back the clock and prevent it. It doesn't get any better, it hurts every day."
The elderly are the highest risk population in the country for suicide. But few suicide-prevention programs target them — a result, advocates say, of scarce funding and lack of concern for older Americans.
And mental heath experts say the number of elderly suicides is likely to climb as baby boomers enter their twilight years.
The overall U.S. suicide rate is 11 per 100,000 people. But for those 65 and older, that figure rises to 14 per 100,000, according to the Centers for Disease Control and Prevention, which based its findings on 2004 data, the most recent available.
Older adults are less likely to seek help and are more lethal in their suicide attempts. So experts say special care is needed to reach out.
Dale Smith, 67, said he might not be alive if not for a suicide-prevention program in Spokane, Wash.
Two years ago, he attended a meeting at his retirement complex where everyone filled out a screening form for depression, a key risk factor for suicide.
Based on his answers, a caseworker and psychiatrist later visited Smith at his home, where they discussed what turned out to be a lifetime of depression. They developed a plan of medication and therapy that Smith says probably saved his life.
"I'm not unique. I think there's a lot of individuals out there who do suffer from depression and they have no clue," he said. "They just know they're not happy. They are tired, they want to pull the covers over their heads and not look at the world, and they don't know what it is."
But many older Americans have fewer options for treatment than younger people.
"It's a not-so-subtle social-political assignment of resources," said Donna Cohen, a professor in the Department of Aging and Mental Health at the University of South Florida.
Ten states passed laws last year intended to curb suicide among children and young adults. But only two — New Jersey and New Mexico — passed laws addressing suicide among the elderly, according to Suicide Prevention Action Network USA, a national advocacy group based in Washington, D.C.
Depression is underdetected at all ages, mental health groups say. But much more funding is available for treating younger people, including $82 million in federal money approved in 2004.
The situation prompted Sen. Harry Reid of Nevada, who lost his father to suicide, to propose funding more suicide-prevention programs for the elderly and changing a Medicare coverage rule that forces seniors to pay more for outpatient mental health services than other medical care.
Some advocates and mental health workers say they also have to battle a prevailing notion that depression is a normal part of aging.
"It is not natural and should be treated at all times," said Dr. Paula Clayton, a psychiatrist and medical director for the American Foundation for Suicide Prevention.
Janice Hodge of Sandy, Ore. said she didn't realize until after her 91-year old father, Anthony Liberto, died that he had been depressed.
He was struggling to care for his 85-year-old wife, who suffered from Parkinson's disease. He did not work and he could no longer play golf, his favorite pastime. Friends and family still visited, but they say he spent much of his time lying on the couch and growing frustrated with suggestions that he place his wife of 62 years in a nursing home.
Eventually, he shot his wife and killed himself, leaving a note that read: "Sorry we had to leave this way, forgive me. Love, your Dad."
Experts say there need to be services tailored to the elderly because they handle depression differently than younger patients.
In Spokane, the program that helped Smith, called Elder Services, trains people who come in contact with the elderly — from bank tellers to postal carriers — to notice signs of trouble, such as mail piling up or bills going unpaid. Those people can then notify social workers.
In San Francisco, Patrick Arbore founded the Friendship Line in San Francisco in 1973 after seeing the lack of understanding some suicide hot line workers displayed for older people.
The line, which lets people call just to talk or get support, now handles more than 3,000 calls a month. About one-quarter of the callers have suicidal thoughts, a staffer said. But most just want a compassionate listener.
"It's about reminding people that they are still a part of their community," Arbore said. "Those connections bind us to life."
___
Associated Press Writer Sarah Skidmore reported from Portland, Ore.
___
On the Web:
National Institute for Mental Health on elderly suicide: http://www.nimh.nih.gov/publicat/elderlydepsuicide
Centers for Disease Control suicide information:
http://www.cdc.gov/ncipc/dvp/suicide/
By SARAH SKIDMORE
Not long after 72-year-old Anne Beale Golsan had retired on disability from her job as a librarian, she put a stack of paid bills out for the mail, hung up a freshly pressed outfit and taped a note to the front of the house. "Don't come in by yourself. Get somebody to come with you. Sorry, Love Beale."
Her niece arrived at the house they shared in Baton Rouge, La., to find police already there. Golsan had killed herself with a gunshot to the head.
"Every single day it makes me feel like I wish I could have done something," Jane Golsan Ray said, recalling her aunt's death eight years ago. "I wish I could turn back the clock and prevent it. It doesn't get any better, it hurts every day."
The elderly are the highest risk population in the country for suicide. But few suicide-prevention programs target them — a result, advocates say, of scarce funding and lack of concern for older Americans.
And mental heath experts say the number of elderly suicides is likely to climb as baby boomers enter their twilight years.
The overall U.S. suicide rate is 11 per 100,000 people. But for those 65 and older, that figure rises to 14 per 100,000, according to the Centers for Disease Control and Prevention, which based its findings on 2004 data, the most recent available.
Older adults are less likely to seek help and are more lethal in their suicide attempts. So experts say special care is needed to reach out.
Dale Smith, 67, said he might not be alive if not for a suicide-prevention program in Spokane, Wash.
Two years ago, he attended a meeting at his retirement complex where everyone filled out a screening form for depression, a key risk factor for suicide.
Based on his answers, a caseworker and psychiatrist later visited Smith at his home, where they discussed what turned out to be a lifetime of depression. They developed a plan of medication and therapy that Smith says probably saved his life.
"I'm not unique. I think there's a lot of individuals out there who do suffer from depression and they have no clue," he said. "They just know they're not happy. They are tired, they want to pull the covers over their heads and not look at the world, and they don't know what it is."
But many older Americans have fewer options for treatment than younger people.
"It's a not-so-subtle social-political assignment of resources," said Donna Cohen, a professor in the Department of Aging and Mental Health at the University of South Florida.
Ten states passed laws last year intended to curb suicide among children and young adults. But only two — New Jersey and New Mexico — passed laws addressing suicide among the elderly, according to Suicide Prevention Action Network USA, a national advocacy group based in Washington, D.C.
Depression is underdetected at all ages, mental health groups say. But much more funding is available for treating younger people, including $82 million in federal money approved in 2004.
The situation prompted Sen. Harry Reid of Nevada, who lost his father to suicide, to propose funding more suicide-prevention programs for the elderly and changing a Medicare coverage rule that forces seniors to pay more for outpatient mental health services than other medical care.
Some advocates and mental health workers say they also have to battle a prevailing notion that depression is a normal part of aging.
"It is not natural and should be treated at all times," said Dr. Paula Clayton, a psychiatrist and medical director for the American Foundation for Suicide Prevention.
Janice Hodge of Sandy, Ore. said she didn't realize until after her 91-year old father, Anthony Liberto, died that he had been depressed.
He was struggling to care for his 85-year-old wife, who suffered from Parkinson's disease. He did not work and he could no longer play golf, his favorite pastime. Friends and family still visited, but they say he spent much of his time lying on the couch and growing frustrated with suggestions that he place his wife of 62 years in a nursing home.
Eventually, he shot his wife and killed himself, leaving a note that read: "Sorry we had to leave this way, forgive me. Love, your Dad."
Experts say there need to be services tailored to the elderly because they handle depression differently than younger patients.
In Spokane, the program that helped Smith, called Elder Services, trains people who come in contact with the elderly — from bank tellers to postal carriers — to notice signs of trouble, such as mail piling up or bills going unpaid. Those people can then notify social workers.
In San Francisco, Patrick Arbore founded the Friendship Line in San Francisco in 1973 after seeing the lack of understanding some suicide hot line workers displayed for older people.
The line, which lets people call just to talk or get support, now handles more than 3,000 calls a month. About one-quarter of the callers have suicidal thoughts, a staffer said. But most just want a compassionate listener.
"It's about reminding people that they are still a part of their community," Arbore said. "Those connections bind us to life."
___
Associated Press Writer Sarah Skidmore reported from Portland, Ore.
___
On the Web:
National Institute for Mental Health on elderly suicide: http://www.nimh.nih.gov/publicat/elderlydepsuicide
Centers for Disease Control suicide information:
http://www.cdc.gov/ncipc/dvp/suicide/
Friday, August 17, 2007
Cosmetic Breast Implants Linked With Later Risk of Suicide in Swedish Study
Marlene Busko
August 16, 2007 — Swedish women who received cosmetic breast implants had suicide rates that were 3 times higher than other women; the risk appeared 10 years after surgery. Deaths due to drug and alcohol abuse also increased 3-fold in the women who received breast augmentation.
These findings are based on data from a cohort of Swedish women who received breast implants from 1965 to 1993 and were followed for an average of almost 19 years. This study, which has an 8-year longer follow-up than an earlier study of this cohort, is published in the August issue of the Annals of Plastic Surgery.
"Women and doctors should be aware that there is a group of women [seeking cosmetic breast implants] who may be suffering from severe psychiatric illness, which may put them at risk later on for suicide or death from drug and alcohol abuse," lead author, Loren Lipworth, ScD, from Vanderbilt University, in Nashville, Tennessee, told Medscape.
The group concludes that "screening for preimplant psychiatric morbidity and postimplant monitoring among women seeking cosmetic breast implants may be warranted."
Five Studies Showed Suicide Risk
The researchers explain that 5 previous epidemiologic studies looked at mortality patterns among 5 cohorts of women in Sweden, Denmark, Finland, Canada, and the United States who received cosmetic breast implants. These studies all reported an approximately 2- to 3-fold higher rate of suicide in the women who received implants compared with other women.
The current study aimed to gain further insight into the relationship between implants and suicide by looking at a cohort of 3527 Swedish women who had previously been followed for a mean of 11.3 years, extending this follow-up to a mean of 18.7 years (range, 0.1 – 37.8 years).
The women, identified by a national registry of hospital discharges, had undergone cosmetic breast augmentation (mostly silicone gel implants) for the first time from 1965 to 1993. The women had a mean age of 32 at the time of surgery.
Overall, 175 women with implants died during follow-up, vs 133.4 expected deaths based on mortality rates of age-matched Swedish women. A total of 24 women with implants committed suicide, vs 8 expected deaths from suicide (standardized mortality ratio = 3; 95% CI, 1.9 – 4.5). The elevated rate of suicide was seen after 10 years. Suicides were higher in women who were aged 45 years and older at the time of breast augmentation.
An additional 14 women with implants died during follow-up from mental disorders or injuries and accidents related to alcohol and or drug dependence or abuse.
Compared with women in the general population, the women with implants had higher rates of death from lung cancer and chronic respiratory disease, largely related to smoking, but they did not have higher rates of breast cancer.
"The large excesses of suicide, as well as alcohol- and drug-dependence-related deaths, suggest that a nontrivial proportion of women undergoing cosmetic breast augmentation may bring with them — or develop later — serious long-term psychiatric morbidity and eventually mortality," the group writes, adding that this might warrant increased screening, counseling, and possibly postimplant monitoring of women seeking this procedure.
Dr. Lipworth explained there were more than 300,000 cosmetic breast implants in the United States in 2006, and it remains to be seen whether that number will increase now that the Food and Drug Administration has approved the sale of silicone breast implants after their removal from the market from 1992 to 2006.
The study was funded by the International Epidemiology Institute, in Rockville, Maryland, which in turn received funds from the Dow Corning Corporation. The Dow Corning Corporation was not involved in any aspect of the study design, data collection, data analysis, data interpretation, or writing of this manuscript. Corresponding study author Joseph K. McLaughlin, PhD, from the International Epidemiology Institute, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Annals of Plastic Surgery. 2007;59:119-123. Abstract
Marlene Busko
August 16, 2007 — Swedish women who received cosmetic breast implants had suicide rates that were 3 times higher than other women; the risk appeared 10 years after surgery. Deaths due to drug and alcohol abuse also increased 3-fold in the women who received breast augmentation.
These findings are based on data from a cohort of Swedish women who received breast implants from 1965 to 1993 and were followed for an average of almost 19 years. This study, which has an 8-year longer follow-up than an earlier study of this cohort, is published in the August issue of the Annals of Plastic Surgery.
"Women and doctors should be aware that there is a group of women [seeking cosmetic breast implants] who may be suffering from severe psychiatric illness, which may put them at risk later on for suicide or death from drug and alcohol abuse," lead author, Loren Lipworth, ScD, from Vanderbilt University, in Nashville, Tennessee, told Medscape.
The group concludes that "screening for preimplant psychiatric morbidity and postimplant monitoring among women seeking cosmetic breast implants may be warranted."
Five Studies Showed Suicide Risk
The researchers explain that 5 previous epidemiologic studies looked at mortality patterns among 5 cohorts of women in Sweden, Denmark, Finland, Canada, and the United States who received cosmetic breast implants. These studies all reported an approximately 2- to 3-fold higher rate of suicide in the women who received implants compared with other women.
The current study aimed to gain further insight into the relationship between implants and suicide by looking at a cohort of 3527 Swedish women who had previously been followed for a mean of 11.3 years, extending this follow-up to a mean of 18.7 years (range, 0.1 – 37.8 years).
The women, identified by a national registry of hospital discharges, had undergone cosmetic breast augmentation (mostly silicone gel implants) for the first time from 1965 to 1993. The women had a mean age of 32 at the time of surgery.
Overall, 175 women with implants died during follow-up, vs 133.4 expected deaths based on mortality rates of age-matched Swedish women. A total of 24 women with implants committed suicide, vs 8 expected deaths from suicide (standardized mortality ratio = 3; 95% CI, 1.9 – 4.5). The elevated rate of suicide was seen after 10 years. Suicides were higher in women who were aged 45 years and older at the time of breast augmentation.
An additional 14 women with implants died during follow-up from mental disorders or injuries and accidents related to alcohol and or drug dependence or abuse.
Compared with women in the general population, the women with implants had higher rates of death from lung cancer and chronic respiratory disease, largely related to smoking, but they did not have higher rates of breast cancer.
"The large excesses of suicide, as well as alcohol- and drug-dependence-related deaths, suggest that a nontrivial proportion of women undergoing cosmetic breast augmentation may bring with them — or develop later — serious long-term psychiatric morbidity and eventually mortality," the group writes, adding that this might warrant increased screening, counseling, and possibly postimplant monitoring of women seeking this procedure.
Dr. Lipworth explained there were more than 300,000 cosmetic breast implants in the United States in 2006, and it remains to be seen whether that number will increase now that the Food and Drug Administration has approved the sale of silicone breast implants after their removal from the market from 1992 to 2006.
The study was funded by the International Epidemiology Institute, in Rockville, Maryland, which in turn received funds from the Dow Corning Corporation. The Dow Corning Corporation was not involved in any aspect of the study design, data collection, data analysis, data interpretation, or writing of this manuscript. Corresponding study author Joseph K. McLaughlin, PhD, from the International Epidemiology Institute, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Annals of Plastic Surgery. 2007;59:119-123. Abstract
Friday, July 13, 2007
Antidepressant Use and Suicide: Reassuring Findings
Two studies in the American Journal of Psychiatry offer some reassurance about antidepressant therapy and suicide risk.
The first, done in a large prepaid health plan, examined insurance claims for antidepressants or psychotherapy for new episodes of depression. Claims were also examined for evidence of suicide attempts in the 90 days before and the 180 days after the start of therapy. Suicide attempts were highest in the month before therapy began, fell significantly during the first month of treatment, and declined steadily thereafter. This pattern held for treatment with antidepressants or psychotherapy. And although suicide attempt rates were higher in adolescents and young adults, the time patterns remained the same.
The second study examined Veterans Administration records of some 225,000 patients with new depression. Suicide attempt rates were lower among those treated with antidepressants, especially SSRIs or tricyclics, than among those who didn't receive drug therapy. Again, rates were higher before treatment than after.
An editorialist writes that while the studies do not prove that therapy reduces risk, they support the conclusion that "it is much more likely that suicidal behavior leads to treatment than that treatment leads to suicidal behavior."
Writing in Journal Watch Psychiatry, Joel Yager comments: "These association studies do not preclude the fact that a minority of younger patients may well experience an increase in suicidal ideation and perturbation when they start antidepressant medications and bear close follow-up during treatment initiation."
Two studies in the American Journal of Psychiatry offer some reassurance about antidepressant therapy and suicide risk.
The first, done in a large prepaid health plan, examined insurance claims for antidepressants or psychotherapy for new episodes of depression. Claims were also examined for evidence of suicide attempts in the 90 days before and the 180 days after the start of therapy. Suicide attempts were highest in the month before therapy began, fell significantly during the first month of treatment, and declined steadily thereafter. This pattern held for treatment with antidepressants or psychotherapy. And although suicide attempt rates were higher in adolescents and young adults, the time patterns remained the same.
The second study examined Veterans Administration records of some 225,000 patients with new depression. Suicide attempt rates were lower among those treated with antidepressants, especially SSRIs or tricyclics, than among those who didn't receive drug therapy. Again, rates were higher before treatment than after.
An editorialist writes that while the studies do not prove that therapy reduces risk, they support the conclusion that "it is much more likely that suicidal behavior leads to treatment than that treatment leads to suicidal behavior."
Writing in Journal Watch Psychiatry, Joel Yager comments: "These association studies do not preclude the fact that a minority of younger patients may well experience an increase in suicidal ideation and perturbation when they start antidepressant medications and bear close follow-up during treatment initiation."
Wednesday, July 11, 2007
Suicide Attempt Pattern Is the Same Regardless of Initial Treatment of Depression
July 10, 2007 — According to the results of a large observational study, the same pattern of suicide attempts occurs in patients who start depression treatment with initial psychotherapy or with antidepressant drugs prescribed by family physicians or by psychiatrists. The risk of making a suicide attempt is highest in the month prior to starting treatment and then declines steadily during the next 6 months.
The study is published in the July issue of the American Journal of Psychiatry.
Author Gregory E. Simon, MD, MPH, at the Center for Group Health Studies in Seattle, Washington, told Medscape, "We conclude that the risk pattern [for suicide attempts] has probably more to do with the natural process of what happens to people in their treatment, rather than anything specific about the treatment. People enter treatment when they are in a crisis. When they start treatment, whatever the treatment is, they feel better."
He explained that there has been a lot of recent controversy about suicide risk early in antidepressant treatment. In 2003, the US Food and Drug Administration required a "black box" warning be placed on antidepressant medications, based on their review of pediatric clinical trials that suicidal behavior may emerge soon after people younger than 25 years start taking selective serotonin reuptake inhibitors (SSRIs). Dr. Simon clarified that this warning did not advise that people should not take these drugs, but rather that a closer follow-up was necessary. However, as an unintended result, rates of treatment went down, and as described in an accompanying editorial by David Brent, MD, from the University of Pittsburgh School of Medicine, in Pittsburgh, Pennsylvania, rates of adolescent suicide rose in 2004 after a decade of decline.
Dr. Simon and co-author James Savarino, PhD, aimed to compare the time patterns in suicide attempts among outpatients starting depression therapy with medication or psychotherapy.
More Than 100,000 Cases of New Treatment of Depression
Simon and Savarino examined computerized claims records from the Group Health Cooperative health plan and identified 109,256 individuals who started treatment of depression from 1996 to 2005. They divided the patients into 3 groups depending on their initial therapy for depression: antidepressant drugs from a primary care clinician, antidepressant drugs from a psychiatrist, or initial psychotherapy.
The investigators looked at the incidence of suicide attempts or possible suicide attempts in the 90 days before or the 180 days after the initial antidepressant prescription or psychotherapy visit.
The incidence of suicide attempt was highest among patients receiving antidepressant medications from a psychiatrist, which was expected, Dr. Simon explained, because people who are more severely ill see psychiatrists rather than their family clinicians.
The time pattern of suicide attempt was identical in the 3 treatment groups. The highest incidence occurred in the month prior to the start of treatment, followed by a high incidence in initial month of treatment and a subsequent steady decline.
The results were the same after an analysis that excluded patients receiving both psychotherapy and medication.
Among young adults younger than 25 years, suicide attempts were about twice as common as in the total group, but the time pattern for suicide attempts for patients receiving any of the 3 treatments was the same as for the total group.
"The practical message is that this is not a reason to avoid treatment, but a recommendation that people should be followed more closely," said Dr. Simon.
Dr. Simon has disclosed receiving research grants from Eli Lilly, Pfizer, and Wyeth Pharmaceuticals and consulting fees from Wyeth Pharmaceuticals. Dr. Savarino has disclosed no relevant financial relationships.
"Suicidal Behavior Leads to Treatment" Not the Reverse
In an accompanying editorial, Dr. Brent writes that this "elegant" observational study, "while not proving that antidepressants and psychotherapy reduce suicide risk, [does] strongly support the converse conclusion: it is much more likely that suicidal behavior leads to treatment than that treatment leads to suicidal behavior."
We need to conduct clinical trials that include rather than exclude these high-risk patients, he adds, cautioning that, "In the meantime, the disturbing increase in the suicide rate in adolescents at a time when antidepressant treatment is becoming less frequent in this population should serve as a warning that the consequences of not receiving treatment for depression may be fatal."
Am J Psychiatry. 2007;164:989-991, 1029-1034.
July 10, 2007 — According to the results of a large observational study, the same pattern of suicide attempts occurs in patients who start depression treatment with initial psychotherapy or with antidepressant drugs prescribed by family physicians or by psychiatrists. The risk of making a suicide attempt is highest in the month prior to starting treatment and then declines steadily during the next 6 months.
The study is published in the July issue of the American Journal of Psychiatry.
Author Gregory E. Simon, MD, MPH, at the Center for Group Health Studies in Seattle, Washington, told Medscape, "We conclude that the risk pattern [for suicide attempts] has probably more to do with the natural process of what happens to people in their treatment, rather than anything specific about the treatment. People enter treatment when they are in a crisis. When they start treatment, whatever the treatment is, they feel better."
He explained that there has been a lot of recent controversy about suicide risk early in antidepressant treatment. In 2003, the US Food and Drug Administration required a "black box" warning be placed on antidepressant medications, based on their review of pediatric clinical trials that suicidal behavior may emerge soon after people younger than 25 years start taking selective serotonin reuptake inhibitors (SSRIs). Dr. Simon clarified that this warning did not advise that people should not take these drugs, but rather that a closer follow-up was necessary. However, as an unintended result, rates of treatment went down, and as described in an accompanying editorial by David Brent, MD, from the University of Pittsburgh School of Medicine, in Pittsburgh, Pennsylvania, rates of adolescent suicide rose in 2004 after a decade of decline.
Dr. Simon and co-author James Savarino, PhD, aimed to compare the time patterns in suicide attempts among outpatients starting depression therapy with medication or psychotherapy.
More Than 100,000 Cases of New Treatment of Depression
Simon and Savarino examined computerized claims records from the Group Health Cooperative health plan and identified 109,256 individuals who started treatment of depression from 1996 to 2005. They divided the patients into 3 groups depending on their initial therapy for depression: antidepressant drugs from a primary care clinician, antidepressant drugs from a psychiatrist, or initial psychotherapy.
The investigators looked at the incidence of suicide attempts or possible suicide attempts in the 90 days before or the 180 days after the initial antidepressant prescription or psychotherapy visit.
The incidence of suicide attempt was highest among patients receiving antidepressant medications from a psychiatrist, which was expected, Dr. Simon explained, because people who are more severely ill see psychiatrists rather than their family clinicians.
The time pattern of suicide attempt was identical in the 3 treatment groups. The highest incidence occurred in the month prior to the start of treatment, followed by a high incidence in initial month of treatment and a subsequent steady decline.
The results were the same after an analysis that excluded patients receiving both psychotherapy and medication.
Among young adults younger than 25 years, suicide attempts were about twice as common as in the total group, but the time pattern for suicide attempts for patients receiving any of the 3 treatments was the same as for the total group.
"The practical message is that this is not a reason to avoid treatment, but a recommendation that people should be followed more closely," said Dr. Simon.
Dr. Simon has disclosed receiving research grants from Eli Lilly, Pfizer, and Wyeth Pharmaceuticals and consulting fees from Wyeth Pharmaceuticals. Dr. Savarino has disclosed no relevant financial relationships.
"Suicidal Behavior Leads to Treatment" Not the Reverse
In an accompanying editorial, Dr. Brent writes that this "elegant" observational study, "while not proving that antidepressants and psychotherapy reduce suicide risk, [does] strongly support the converse conclusion: it is much more likely that suicidal behavior leads to treatment than that treatment leads to suicidal behavior."
We need to conduct clinical trials that include rather than exclude these high-risk patients, he adds, cautioning that, "In the meantime, the disturbing increase in the suicide rate in adolescents at a time when antidepressant treatment is becoming less frequent in this population should serve as a warning that the consequences of not receiving treatment for depression may be fatal."
Am J Psychiatry. 2007;164:989-991, 1029-1034.
Tuesday, July 10, 2007
Suicide Findings Question Link to Antidepressants
By NICHOLAS BAKALAR
Two large new studies in The American Journal of Psychiatry suggest that treatment of depression, either with psychotherapy or drugs, reduces the risk of suicide attempts in all age groups, especially during the first months of treatment. The findings raise further questions about possible links between antidepressant drugs and suicide.
In 2005, the Food and Drug Administration, faced with evidence from controlled studies, mandated a “black box” notification on all antidepressant drugs, warning that their use in children and adolescents could increase the risk of suicide. In May, after reviewing controlled data from all age groups, the F.D.A. required an updated version to include a warning about suicide risk in young adults 18 to 24.
The studies the F.D.A. analyzed, in which patients were followed closely and matched to controls, are considered the most direct way to analyze results. The two new studies were based on retrospective reviews of medical records.
In one, researchers led by Dr. Gregory E. Simon, a psychiatrist with the Center for Health Studies in Seattle, reviewed the records of 109,356 people being treated for depression in a large prepaid health plan serving 500,000 people in Washington State and northern Idaho. They found that suicide attempts were most common in the month before treatment began, declined sharply in the month after it began, and tapered off in the following six months. All treatments — psychotherapy, medication or both — showed the same pattern, suggesting that treating depression reduced suicide risk regardless of technique.
The authors acknowledged that they had no way to assess the severity of illness either before or after starting treatment, and that about a third of patients dropped out of treatment within a few weeks, two factors that may have influenced the results. Dr. Simon has received research grants and consulting fees from pharmaceutical companies.
Dr. David Shaffer, a professor of pediatrics and psychiatry at Columbia who was not involved in the study, said the results should prove reassuring to people taking antidepressants. “The study provided no evidence that starting an antidepressant increases the likelihood of a suicide attempt,” he said. “Starting treatment, regardless of which kind, seems to reduce suicide attempts.”
The second study was led by Robert D. Gibbons, director of the Center for Health Statistics at the University of Illinois at Chicago. Using medical data from the Veterans Health Administration, researchers found that among 226,866 adults with depression, the overall rate of suicide attempts after beginning treatment with a selective serotonin reuptake inhibitor, or S.S.R.I., was about one-third the rate of those who received no antidepressant at all. This was true for men 18 to 25 as well as for older adults.
“The V.A. has a very good electronic medical record system, so this is likely to be reliable data,” said Dr. Nada Stotland, a professor of psychiatry at Rush Medical College in Chicago. “That makes these results even more powerful.” Dr. Stotland had no part in the study.
The risk of suicide attempt was significantly higher before S.S.R.I. treatment than immediately after starting it, a finding that coincides with that of the Simon study. The scientists acknowledged that their patients were almost all men, and that they did not include any suicide attempts that did not result in contact with the Veterans Health Administration medical records system. One of the six authors has been a paid adviser to pharmaceutical companies.
The authors of both papers worried that extending the boxed warning to young adults might discourage people from seeking effective treatment. “The F.D.A. didn’t say anything wrong in the warning,” Dr. Simon said. “I am 100 percent in support of the message that we need better follow-up care. But my concern is that the warning may scare people away from treatment.”
Dr. Gibbons expressed similar concerns. “These two studies clearly show that the greatest risk for suicide is depression,” he said. “Failure to treat depression, either using pharmacotherapy or psychotherapy, will lead to dramatic increases in the rate of serious suicide attempts and completions in the U.S. and in the world.”
By NICHOLAS BAKALAR
Two large new studies in The American Journal of Psychiatry suggest that treatment of depression, either with psychotherapy or drugs, reduces the risk of suicide attempts in all age groups, especially during the first months of treatment. The findings raise further questions about possible links between antidepressant drugs and suicide.
In 2005, the Food and Drug Administration, faced with evidence from controlled studies, mandated a “black box” notification on all antidepressant drugs, warning that their use in children and adolescents could increase the risk of suicide. In May, after reviewing controlled data from all age groups, the F.D.A. required an updated version to include a warning about suicide risk in young adults 18 to 24.
The studies the F.D.A. analyzed, in which patients were followed closely and matched to controls, are considered the most direct way to analyze results. The two new studies were based on retrospective reviews of medical records.
In one, researchers led by Dr. Gregory E. Simon, a psychiatrist with the Center for Health Studies in Seattle, reviewed the records of 109,356 people being treated for depression in a large prepaid health plan serving 500,000 people in Washington State and northern Idaho. They found that suicide attempts were most common in the month before treatment began, declined sharply in the month after it began, and tapered off in the following six months. All treatments — psychotherapy, medication or both — showed the same pattern, suggesting that treating depression reduced suicide risk regardless of technique.
The authors acknowledged that they had no way to assess the severity of illness either before or after starting treatment, and that about a third of patients dropped out of treatment within a few weeks, two factors that may have influenced the results. Dr. Simon has received research grants and consulting fees from pharmaceutical companies.
Dr. David Shaffer, a professor of pediatrics and psychiatry at Columbia who was not involved in the study, said the results should prove reassuring to people taking antidepressants. “The study provided no evidence that starting an antidepressant increases the likelihood of a suicide attempt,” he said. “Starting treatment, regardless of which kind, seems to reduce suicide attempts.”
The second study was led by Robert D. Gibbons, director of the Center for Health Statistics at the University of Illinois at Chicago. Using medical data from the Veterans Health Administration, researchers found that among 226,866 adults with depression, the overall rate of suicide attempts after beginning treatment with a selective serotonin reuptake inhibitor, or S.S.R.I., was about one-third the rate of those who received no antidepressant at all. This was true for men 18 to 25 as well as for older adults.
“The V.A. has a very good electronic medical record system, so this is likely to be reliable data,” said Dr. Nada Stotland, a professor of psychiatry at Rush Medical College in Chicago. “That makes these results even more powerful.” Dr. Stotland had no part in the study.
The risk of suicide attempt was significantly higher before S.S.R.I. treatment than immediately after starting it, a finding that coincides with that of the Simon study. The scientists acknowledged that their patients were almost all men, and that they did not include any suicide attempts that did not result in contact with the Veterans Health Administration medical records system. One of the six authors has been a paid adviser to pharmaceutical companies.
The authors of both papers worried that extending the boxed warning to young adults might discourage people from seeking effective treatment. “The F.D.A. didn’t say anything wrong in the warning,” Dr. Simon said. “I am 100 percent in support of the message that we need better follow-up care. But my concern is that the warning may scare people away from treatment.”
Dr. Gibbons expressed similar concerns. “These two studies clearly show that the greatest risk for suicide is depression,” he said. “Failure to treat depression, either using pharmacotherapy or psychotherapy, will lead to dramatic increases in the rate of serious suicide attempts and completions in the U.S. and in the world.”
Tuesday, July 03, 2007
Epilepsy Doubles Suicide Risk
Epilepsy doubles the risk for suicide, according to a large case-control study published early online in Lancet Neurology.
Danish researchers identified some 450,000 people with data in five national health and socioeconomic registries. Even after differences in psychiatric history and socioeconomic status were taken into account, the risk for suicide among patients with epilepsy was twice that of people without epilepsy.
Overall, suicide risk was highest among those with both epilepsy and a history of psychiatric disease, particularly affective disorders. In addition, suicide risk was highest in the first 6 months after epilepsy diagnosis and decreased with increasing age, both among those with and those without psychiatric comorbidities.
The authors conclude that patients with newly diagnosed epilepsy "require special attention" to identify and treat those at risk for suicide.
[Editor's note: Although Lancet Neurology has released this article from embargo, it has not posted the article on its website. Rather than delay coverage while awaiting that posting, we have provided a link to the Lancet's early-release page, where the article will eventually appear.]
Danish researchers identified some 450,000 people with data in five national health and socioeconomic registries. Even after differences in psychiatric history and socioeconomic status were taken into account, the risk for suicide among patients with epilepsy was twice that of people without epilepsy.
Overall, suicide risk was highest among those with both epilepsy and a history of psychiatric disease, particularly affective disorders. In addition, suicide risk was highest in the first 6 months after epilepsy diagnosis and decreased with increasing age, both among those with and those without psychiatric comorbidities.
The authors conclude that patients with newly diagnosed epilepsy "require special attention" to identify and treat those at risk for suicide.
[Editor's note: Although Lancet Neurology has released this article from embargo, it has not posted the article on its website. Rather than delay coverage while awaiting that posting, we have provided a link to the Lancet's early-release page, where the article will eventually appear.]
Friday, June 15, 2007
Elderly Sleep Woes Linked to Increased Suicide Risk
By Janice BillingsleyHealthDay ReporterThu Jun 14, 7:02 PM ET
THURSDAY, June 14 (HealthDay News) - Chronically troubled sleep may be a marker for an increased risk for suicide in the elderly, a new report suggests.
"The association exists even after you control for depression," said lead researcher Rebecca Bernert, a clinical psychology doctoral student at Florida State University. "This finding is important, because sleep disturbances are amenable to treatment, unlike other risk factors, such as past suicide attempts. Sleep problems can be undone," she said.
Bernert was scheduled to present the findings Thursday at the annual meeting of the Associated Professional Sleep Societies, in Minneapolis.
In the study, Bernert reviewed health data on almost 14,500 elderly people aged 67 to 90 years old, tracked over a 10-year period.
During this period, 21 individuals committed suicide. When each suicide was matched to 20 randomly-selected controls, the researchers found that sleep disturbances, independent of depression, predicted an increased risk for eventual death by suicide.
Gregg Jacobs, an insomnia specialist with the University of Massachusetts Memorial Medical Center in Worcester, urged caution in attributing the existence of sleep problems, by itself, to an increase in suicide risk.
"The relationship between sleep problems and mortality is a complex one," he said. "Stress, for instance, is co-founded with insomnia, and it is really the stress causing the increased risk ... not just not sleeping well," Jacobs noted.
Studies also show that regular use of sleeping pills -- strongly linked to insomnia, of course -- also increases the risk for suicide. Those having trouble sleeping also sometimes use alcohol and drugs to self-medicate, and these abuses can raise the risk of mortality, Jacobs said.
Bernert and her colleagues assessed five types of self-reported sleep complaints in their report: non-restorative sleep, which meant that people may have had a full night's sleep but did not feel rested upon awakening; difficulty falling asleep; difficulty staying asleep; early-morning awakenings, and feelings of restless during the day.
When people reported suffering from non-restorative sleep, for instance, Bernert said, "They were almost twice as likely to complete suicide compared to those without this particular sleep complaint. This relationship existed even after controlling for depression."
However, she added, because the number of suicide victims in this study was small, the finding should be interpreted with caution, and more research is needed to investigate specific sleep complaints in the prediction of suicide.
How might sleep problems impact suicide risk?
"It's pure speculation, but sleep may play an important role in regulating moods," Bernert said. Having insufficient sleep can adversely affect someone's mood, she said.
Insomnia, the most common sleep complaint, affects approximately 48 percent of older adults, according to the National Sleep Foundation.
Older adults should get seven or eight hours of sleep a night, Bernert said, but many report that they have trouble falling asleep and so get less sleep than they need. Some problems associated with sleeplessness include memory and attention problems, depressed moods, excessive daytime drowsiness, more nighttime falls and reliance on over-the-counter or prescription sleep aids.
If an older person is having sleep problems, they shouldn't assume it's just an inevitable part of aging, Bernert added.
"It's important for each individual to see a sleep specialist," she said, because treatment is available and effective.
THURSDAY, June 14 (HealthDay News) - Chronically troubled sleep may be a marker for an increased risk for suicide in the elderly, a new report suggests.
"The association exists even after you control for depression," said lead researcher Rebecca Bernert, a clinical psychology doctoral student at Florida State University. "This finding is important, because sleep disturbances are amenable to treatment, unlike other risk factors, such as past suicide attempts. Sleep problems can be undone," she said.
Bernert was scheduled to present the findings Thursday at the annual meeting of the Associated Professional Sleep Societies, in Minneapolis.
In the study, Bernert reviewed health data on almost 14,500 elderly people aged 67 to 90 years old, tracked over a 10-year period.
During this period, 21 individuals committed suicide. When each suicide was matched to 20 randomly-selected controls, the researchers found that sleep disturbances, independent of depression, predicted an increased risk for eventual death by suicide.
Gregg Jacobs, an insomnia specialist with the University of Massachusetts Memorial Medical Center in Worcester, urged caution in attributing the existence of sleep problems, by itself, to an increase in suicide risk.
"The relationship between sleep problems and mortality is a complex one," he said. "Stress, for instance, is co-founded with insomnia, and it is really the stress causing the increased risk ... not just not sleeping well," Jacobs noted.
Studies also show that regular use of sleeping pills -- strongly linked to insomnia, of course -- also increases the risk for suicide. Those having trouble sleeping also sometimes use alcohol and drugs to self-medicate, and these abuses can raise the risk of mortality, Jacobs said.
Bernert and her colleagues assessed five types of self-reported sleep complaints in their report: non-restorative sleep, which meant that people may have had a full night's sleep but did not feel rested upon awakening; difficulty falling asleep; difficulty staying asleep; early-morning awakenings, and feelings of restless during the day.
When people reported suffering from non-restorative sleep, for instance, Bernert said, "They were almost twice as likely to complete suicide compared to those without this particular sleep complaint. This relationship existed even after controlling for depression."
However, she added, because the number of suicide victims in this study was small, the finding should be interpreted with caution, and more research is needed to investigate specific sleep complaints in the prediction of suicide.
How might sleep problems impact suicide risk?
"It's pure speculation, but sleep may play an important role in regulating moods," Bernert said. Having insufficient sleep can adversely affect someone's mood, she said.
Insomnia, the most common sleep complaint, affects approximately 48 percent of older adults, according to the National Sleep Foundation.
Older adults should get seven or eight hours of sleep a night, Bernert said, but many report that they have trouble falling asleep and so get less sleep than they need. Some problems associated with sleeplessness include memory and attention problems, depressed moods, excessive daytime drowsiness, more nighttime falls and reliance on over-the-counter or prescription sleep aids.
If an older person is having sleep problems, they shouldn't assume it's just an inevitable part of aging, Bernert added.
"It's important for each individual to see a sleep specialist," she said, because treatment is available and effective.
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