Suicide remains the most severe emergency in every psychiatric disorder.

After evaluating the frequency of suicide among patients followed from 1-1-2004 to 31-12-2005 by the Mental Health Service of Modena Centro, we statistically analyzed socio-demographic and clinical data of suicide patients (n=25).

Among psychiatric population followed by our psychiatric service in the observation period, suicide occurred in the 0.15% of all patients (25/16392) and represented the third cause of death, after cardiovascular disorders and neoplasia. The median age of suicide patients was 42 years for male and 50 years for women, with a ratio male/female of 1.8:1. “Depressive Disorders” followed by “Schizophrenia and other Psychotic Disorders” represented the prevalent psychiatric diagnosis with a statistically significant correlation to suicide death cause (p< 0.005; Chi square test). The suicide patients had being treated for more than one year by psychiatric service (685 days, median) and 10 % of them was hospitalized in a psychiatric ward during the observation period. Suicide occurred after 73 days (median) from last psychiatric discharge and 12 days (median) from last psychiatric consultation.

Our data confirmed the literature: suicide is more frequent in young male affected by Depressive Disorders or Schizophrenia and other Psychotic Disorders1. We have to conclude pessimistically about our preventive capacity since suicide occurred in patients already hospitalized and treated for a long period and after a short period from the last psychiatric intervention.

The aim of this study was to investigate the relationship between suicidal behavior and hypothalamic-pituitary thyroid (HPT) axis activity in depressed patients.

The serum levels of thyrotropin (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) were evaluated before and after 8 AM and 11 PM TRH challenges, on the same day, in 95 medicationfree DSM-IV euthyroid major depressed inpatients and 44 healthy hospitalized controls

Compared to controls:

1. 1) patients with a positive suicide history (PSH; n=53) showed lower basal FT4 (at 8AM: p< 0.005; at 11PM: p< 0.03), but normal FT3 levels, while patients with a negative suicide history (NSH; n=42) showed normal FT4 and FT3 levels;

2. 2) TSH responses to TRH (delta TSH) were blunted in NSHs (at 8 AM: p< 0.03; at 11PM: p< 0.00001), but not in PSHs.

Compared to NSHs, basal FT4 levels were reduced in PSHs (at 8AM: p< 0.002; at 11PM: p< 0.006). HPT parameters were not significantly different between recent suicide attempters (RSA; n=32) and past suicide attempters (PSA; n=21). However, compared to controls, RSAs showed lower 11PM-deltaTSH (p< 0.04) and lower basal FT4 values (at 8AM: p< 0.002; at 11PM: p< 0.008).

Our results indicate that various degrees of HPT axis dysregulation are associated with the history of suicide. In NSHs, one may hypothesize that hypersecretion of hypothalamic TRH (as reflected by decreased TRH receptor responsiveness) represents a compensatory mechanism to maintain normal thyroid hormone secretion. In PSHs this mechanism is ineffective.

Russia has one of the highest suicidal ratings in the world. Mental patients form the absolute majority both in suicidal attempts and consummated suicides.

448 cases of mental patients with suicidal attempts in the period 1991-2001, who received medical care in St. Petersburg district outpatient clinic were studied.

The amount of suicidal patients among all mental outpatients was 4.9%. Male/female ratio was 1 : 1,6. Suicidal patients were diagnosed as schizophrenia (F2 -55.6%) and delusional disorders (F22 - 4.5%), affective disorders (F3 - 16.5%), organic disorders (F07.8 - 18.8%), personality disorders (F60 - 4.5%). Mean age for males was significantly lower (31.4) compared to females (36.6). The tendency of decrease in suicide mean age (4.1 year) was obtained during the period of 1990-2001. The preponderate mode of suicide in females was self-poisoning (82,7%); in males preponderate modes were self-injuring (50,6%) and self-poisoning (45,9%). The duration of mental disorder in our study was higher (mean 10.3 years), compared to previous data. Maximum of suicidal attempts (20%) was registered in 1997-96. Less number of registered suicidal attempts after 1997 may be explained by the loss of officially registered mental patients including firstly registered in the outpatient service. The role of risk factors such as mental disorder heredity, suicidal attempts in relatives, loneliness, and alcohol abuse was elucidated.

Antisuicidal programs in outpatient care should include introduction of suicide risk ratings together with mental patient compliance improvement.

Suicide is one of the most frequent causes of death. In 1993, Bleuler emphasized its importance in his “Suicidal behavior is the most serious symptom of schizophrenia”. Since then, various studies have confirmed importance of suicide in schizophrenia, and today it's clear that his research and knowledge is one of the great challenges of psychiatry.

1. - Establish clinical-socio-demographic profile and risk factors for psychotic people with autolytic behaviors.

2. - Determine frequency of suicides in psychotic disorders in our area of care.

Retrospective study(3 years evolution) that includes psychotic patients(diagnosed according DSM IV-TR) admitted to the HCU of Valladolid. With data provided by hospital medical records, analyzed socio-demographic variables and clinics. Study consists of two groups:group of cases(those patients who have suicidal behavior) and control group (those that haven't autolytic gesture during the study period). Statistical evaluation was performed with SPSS.

1. - The sample includes 191 patients:41(21%) have attempted suicide.

2. - Of them:73% are males;88% singles;51% have basic studies;61% we re unemployed;37% were 31-40 aged;54% started disease 21-30 aged and 63.5% are schizophrenic.

3. - Considering statistical study we find that suicidal patient profile is male(p = 0.039),diagnosed with schizophrenia(p = 0.033),with previous suicide attempts(p = 0.009)and lack of social support(p = 0.007).

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1. - 21% of hospitalized psychotic patients have presented some autolytic attempt.

2. - Profile of suicidal psychotic patient is a male, single, 21-40 aged, primary education, unemployed, with a primary diagnosis of schizophrenia, particularly paranoid, with ten years evolution,without acceptable social support, number of revenues higher than non-suicidal psychotic and a personal history of previous autolytic attempts.

Low serum cholesterol has been linked to suicide and violent behaviour. The same kind of associations has been reported regarding low levels of 5-hydroxyindolacetic acid (5-HIAA) in the cerebrospinal fluid (CSF) and suicidal behaviour. The hypothesis of the link between serum cholesterol and suicide incorporate serotonin. It proposes that low cholesterol is related to reduced serotonergic neurotransmission, which in turn, is linked to violent and suicidal behaviour. A correlation between CSF 5-HIAA and serum cholesterol has been shown in animal-studies, but has not been found in humans.

To study the interrelationship between serum cholesterol and CSF 5-HIAA in suicide attempters. Since both cholesterol and CSF 5-HIAA are associated with suicide and violent suicide-attempts, we also investigated the correlation with suicide, violent suicide attempt method, suicide intent, hopelessness and depression severity.

Serum total cholesterol and CSF 5-HIAA was measured in 42 medication free suicide attempters. Patients were assessed with Becks‘s Hopelessness scale (BHS), Suicide Intent Scale (SIS) and Montgomery-Åsberg depression rating scale (MADRS) and followed-up for causes of death.

Serum total cholesterol and CSF 5-HIAA showed a significant positive correlation adjusted for age, body mass index and substance abuse diagnosis. Cholesterol and CSF 5-HIAA levels did not differ between violent and non-violent suicide attempters or between suicide completers and survivors.

These findings indicate that the serotonergic system may be connected to serum cholesterol in patients with a recent suicide attempt.

Paracetamol is one of the most frequently used drugs in intentional overdoses. Countries that limit the quantity of paracetamol available in a single purchase generally report lower rates of paracetamol related morbidity and mortality.

To determine the socio-demographic characteristics of those who intentionally overdosed on paracetamol and associated psychiatric illness (identifying high-risk groups).

To improve mental health care delivery and propose a restriction of pack sizes of paracetamol in a single purchase.

This study was a retrospective, descriptive analysis study. Cases of parasuicide in the year 2008 were identified through our database and their case notes studied by completing questionnaires pertaining to details of the act.

Of the 437 cases of parasuicide, 195 cases overdosed on paracetamol (44.6%). Indians made up 41.0% of cases, followed by Malays (31.8%) and Chinese (20.5%). Of the Malays, 63.3% overdosed on paracetamol, compared with other means of parasuicide. 72.8% of those who overdosed with paracetamol were female, 54.4% were single and 69.7% purchased paracetamol over the counter. With increasing age, the incidence of paracetamol overdose declines, being highest (55.2%) in the age group 16-25. Of those who overdosed on paracetamol, 46.2% had a diagnosis of adjustment disorder, 26.2% of acute stress reaction and 21.0% of depression. 42.1% of them had a history of paracetamol overdose.

Paracetamol continues to be commonly used in parasuicides. Legislation restricting pack sizes of paracetamol in a single purchase is the most pragmatic means of reducing paracetamol related parasuicides and suicides.

Suicide is a serious phenomenon associated with psychiatric disorders.

In the present study, we investigated factors that can predict follow-up at the psychiatric clinic after medical care at the emergency room (ER).

Medical records of the 145 patients treated at the ER following suicide attempt from Jan 1, 2009 to July 31, 2009 were reviewed. Age, sex, past psychiatric history, impulsiveness and medical severity of suicide attempt, risk-rescue rating scores, reasons for suicide attempt and methods of suicide were examined. Psychiatric diagnoses were made by psychiatrists at the initial interview with patients at ER.

The mean age of the patients was 42.9 ± 15.7 years, and 68.3 % were women and 31.7% were men. Among the suicide methods, psychotropics were the most common (69%), and ingestion of pesticides was the second (19.3%). Interpersonal problems were the most common precipitating event (57.9%), and depression was the most common (89%). About a half had previous psychiatric disorders and about one third had previous suicide attempt. Fifteen patients (10.3%) attempted planned suicide and 124 patients (85.5%) attempted impulsively. Mean risk and rescue rating scores was 8.6 ±1.6 and 12.3 ± 2.2. About one third had a follow-up psychiatric visit. The most important predictor of psychiatric follow-up was risk rating scores.

This study suggests that women with interpersonal problems and depression should be carefully monitored to reduce suicide attempt. Patients commit less risky suicide attempts tend to more loss to psychiatric follow-up, thus, need more attention to prevent suicide re-attempts.

To examine associations between current diagnostic profile, suicidal intent, functional impairment and history of deliberate self harm (DSH) and life events among patients admitted to a general hospital after an act of attempted suicide.

Participants (n = 86) were patients consecutively admitted to a general hospital emergency care unit over the inclusion period of 26 months after an act of attempted suicide. They were interviewed within 2 days using the EPSIS protocol, the MINI and SCID-II interviews and a range of scales measuring life events (Brugha's scale), depression (MADRS), alcohol abuse (AUDIT), substance abuse (DAST), suicidal intent (SIS) and functioning levels (GAF). Simple regression analyses (linear and logistic) and t-tests were used in data analyses.

Men [4.9(2.6)] reported significantly more life events than women [3.6(2.0)], t(47.7) = 2.2, p < .05. Functional impairment was inversely associated with the number of life events among men, explaining more than 25% of the variance, F = 10.2(1, 28), p < .01. Number of life events was not associated with any diagnostic group, mean scores of depression severity, alcohol abuse, substance abuse, suicidal intent or with a history of an act of DSH.

Not only did men report more life events, their functioning was also affected by number of life events, indicating vulnerability to psychosocial aspects beyond psychological or psychiatric aspects in men admitted to a general hospital after attempted suicide.

Depression is among the most prevalent psychiatric conditions in general population. Previous reports established a link between suicidal attempts and major depressive disorder (MDD). There is a large number of risk factors which can participate in suicidal behavior. Many studies showed the role of personality dimensions such as borderline personality dimensions risk factors of suicidal behavior. The aim of this study was to assess dimensions of personality in inpatients who were hospitalized after suicidal attempt.

The sample consisted of sixty inpatients with MDD diagnosed with ICD X. There were thirty patients with suicidal attempt and thirty with no history of suicidal attempts. The assessment of personality dimensions was carried out by the Millon Clinical Multiaxial Inventory III (MCMI III).

Our findings have shown that borderline and masochistic dimensions were more frequently present in the group of patients with suicidal attempts. Compulsive dimensions were more present in the group of patients with no history of suicidal attempt.

Borderline personality dimensions with underlying impulsivity and low level of self-confidence might be potential risk factor for suicidal behavior, while the patients with a rigid system of organization and conscientiousness are less prone to suicidal behavior. Assessing personality dimensions is recommended in the process of psychodiagnostics and might be useful in preventive interventions.

To investigate the prevalence of non-fatal suicide behaviors (NFSBs) among patients admitted to an acute psychiatric ward in Bologna, Northern Italy.

30 attempters (mean age 45.10±16.12 years) consecutively hospitalized (May-July 2009) were compared to 117 controls randomly selected among patients admitted in the same ward for other reasons than NFSBs. Socio-demographical and clinical information were collected through the retrospective consultation of case-histories. Attempters were clinically interviewed and the Suicide Intent Scale (SIS) was administered. Clinical diagnoses were achieved using the International Classification of Disease-10th Revision (ICD-10) criteria. Associations between non-fatal suicide behaviors and covariates were evaluated by logistic regression analyses, estimating Odds Ratios (ORs) and 95% confidence intervals (95%CI).

Cases were more often women (63.3%), Italians (83.3%), unemployed (63.3%) and had a lower education (70.8%) than controls. Among attempters, most frequent diagnoses were personality disorders (56.7%) and mood disorders (50%); the 56.7% of cases was affected by concomitant organic disease (OR compared to controls:2.58; 95%CI=1.13-5.85). Stressful life-events were three-fold more frequent in cases than in controls; incongruous drugs assumption was the most common suicidal behaviours. A previous NFSB was highly prevalent in cases (46.7% p< 0.001) with a significantly association (OR:9.01; 95%CI=3.42-23.71) independent from socio-demographic features and diagnoses. SIS mean score was 11.6 ± 7.3 (low intention=53.3%, moderate intention=40%, high intention=6.7%. Increasing intention was associated with a longer duration of hospitalisation (p=0.005).

NFSBs are associated with distinct socio-demographic and clinical profiles. Routine assessment of intentionality might help to identify subjects at higher risk of relapse.

A monitoring project within the framework of EU supported MONSUE multicentre study on suicidal behaviour has been performed in Pecs catchment area.

To register and statistically analyze all suicide attempts, thus to explore current trends and consequences.

Detailed and complete data registration (epidemiologic, socio-demographic, socio-economic, previous attempts, methods, psychiatric diagnoses) of all suicide attempts was carried out in the region for two years from 2007 to 2009. Statistical analysis was performed by SPSS 17.0 to compare our results both with those of the previous study in 1999 and with the national data.

According to the Hungarian National Statistic Office 2500 suicides occurred in 2008, the population rate is 24.7/100000 inhabitants (40.1/100000 males, 10.7/100.000 females). The most common method for suicide was strangulation in both genders (male: 69.2%, female: 41%). The rate of self-poisoning was higher in females. Regarding suicide attempts we registered 993 cases during the two-year period (males: 41.7%, mean age 38.43 years; females: 58.3%, mean age 42.02 years), which corresponds to former rates. Female attempters were more likely repeaters (60% vs. 40%). The most often used method for suicide attempt was self-poisoning (females 81.9%, males 63.4%) and scarification (females 8.6%, males 21.1%).

These results suggest that the rates of completed suicides decreased significantly to three quarter compared to the rates in the ‘90s, but in contrary suicide attempts show an increasing tendency. The potential explanations are discussed, including restriction of lethal methods, health care changes and the role of prevention strategies.

Suicide has become a leading cause of mortality and morbidity in adolescents and young adults worldwide and has been identified as one of the key mental health problems affecting students. The aim of our study was to determine the prevalence of depressive symptoms and suicidal ideation among nursing students in Greece.

A total of 142 nursing students of the Department of Nursing of the Technological Educational Institute of Thessaloniki agreed to participate in the study. The Beck Depression Inventory II (BDI-II) was administered. Question 9 of the scale was evaluated to examine suicidal tendency.

43.9% of the students experienced depressive symptoms. The mean scores on the BDI were higher in year 1 and 3, while the lowest score was observed in year 2. The evaluation of suicidal ideation per year of studies indicated that the percentage of students who thought of suicide but wouldn’t commit it were mainly in the first or in the last (graduate) years. 88% of our total sample reported never having thoughts of suicide. Significant differences on the basis of gender were observed concerning suicidal thoughts, without actually carrying it out (males>females).

The stressors in nursing education have been consistently acknowledged in the literature. In our sample can be assumed that 2nd year students are more adjusted to the demands of their studies and appear more confident about their choice. Higher levels observed in the last study years are maybe the result of student worries about their professional future.

The aims of the two pieces of work are to study wheter any differences exist in the rates and characteristics of suicide by ethnicity, sex and alcohol abuse in South Tyrol, Italy.

Psychological autopsy interviews were conducted for suicides who died between March 1997 and July 2006.

332 individuals belonging to the three major South Tyrolean ethnic groups (Germans, Italians and Ladins, who speak a Rhaeto-Romance language) died by suicide.

Germans were 1,37 times more at risk to commit suicide than Italians (95% CI 1.04/1.80; z=2.26, p< .05). 69% of the suicides had attended school for less than 8 years, and Germans (OR 4,62; 955 CI:2.52/8.47; p< .001) were more likely to have lower education than Italians. A further comparison of 267 male victims with and without alcohol abuse in their history evidenced that alcohol abusers were 3,5 times more likely to have low educational attainment, 4,22 times more likely to have been unemployed or have employment instability and 2.29 times more likely to have job security than male suicides without alcohol use disorders.

The study indicates that suicide, an alarming health problem in South Tyrol, may require different preventive interventions for men and women, for those of different ethnicities and for people with and without alcohol use disorder.

High suicide and homicide rates in Russia and its profound fluctuation over the past decades have attracted considerable interest. There is growing evidence that binge drinking pattern increasing the propensity for the alcohol-related suicide and lethal violence. In line with this evidence we assume that higher level of vodka consumption in conjunction with binge drinking pattern results in close aggregate-level association between vodka sale and suicide/homicide in Russia.

To test this hypothesis trends in beverage-specific alcohol sale per capita and suicide/homicide rates from 1970 to 2005 in Russia were analyzed employing ARIMA time series analysis.

The rate of suicide and homicide tend to be more responsive to changes in distilled spirits consumption per capita than to the total level of alcohol consumption. The results of time series analysis suggest that a 1 litre increase in vodka sale is expected to increase suicide rate by 9.3% for men and by 6% for women and homicide rate by 15.2% for men and by 13.4% for women.

Assuming that drinking spirits is usually associated with intoxication episodes, these findings provide additional evidence that drinking pattern is important determinant in the alcohol-suicide and alcohol-homicide relationship. The outcomes of this study also provide support for the hypothesis that suicide and alcohol are closely connected in culture were intoxication-oriented drinking pattern prevails and adds to the growing body of evidence that alcohol plaid a crucial role in the fluctuation in suicide mortality rate in Russia during the last decades.

Suicide is one of the leading external causes of death worldwide. The alarming increase in the occurrence of suicide in Belarus in recent years has resulted in the country having one of the highest suicide rates in the world. It is well recognized that both acute and chronic alcohol use are among the major behaviorally modifiable factors that are associated with suicidal behavior. Several studies have reported relatively high proportion of suicide cases positive for blood alcohol concentration (BAC).

The present study was designed to collect data on BAC-positive suicides in Belarus.

This study was based on the official autopsy reports of the Bureau of Forensic Medicine. The sample consisted of 1135 male subjects (76.3%) and 356 female subjects (23.7%).

In the present study 61% of males and 30.6% of females were BAC-positive at the time of death. It should be noted that the proportion of BAC-positive suicide in Belarus is among the highest in the world. Positive blood alcohol cases were found more frequently in men age 30-59 (66%) and women age 19-39 (48%). The average BAC was 2.2 ± 0.004 g/dL for males and 2.1 ± 0.005 for females.

In this study, substantial percentages of suicide victims tested positive for alcohol. These results are consistent with previous studies suggesting that acute alcohol intoxication may function as an important effect modifier to the act of suicide. The outcome of this study also suggests that alcohol-related suicide is mainly a male phenomenon.