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National suicide prevention programmes that have been successful in reducing rates or keeping them low have been intentional, with collective alignment of local, regional and national priorities. Prevention efforts must begin well before individuals become suicidal, complementing readily available clinical services that address the needs of acutely distressed persons. These efforts, which focus on the antecedent risks and vulnerabilities of key populations, have the potential to diminish premature mortality from multiple causes, even as reducing suicide is the outcome of primary interest. In this commentary, I consider four key challenges that must be confronted in order to develop effective, broadly reaching systemic strategies that, at once, can be adapted locally while being implemented nationally – challenges that are framed in a social–ecological context. They involve defining the scope of the problem, meeting essential data needs, developing and modelling measurable implementation strategies and building prevention efforts based on shared culture and values.
Ternary variations of the II-VI zincblende semiconductors have received little attention for thermoelectric applications. Here we present the first systematic doping study on Cu3SbSe4, a zincblende-like ternary semiconductor with a unit cell four times larger than the parent II-VI compounds. The large unit cell of Cu3SbSe4 results in a low room temperature thermal conductivity (~3.0 W/m*K) and its large hole effective mass produces a Seebeck coefficient approaching 500 μV/K in the undoped compound. Our results show that Ge is an effective p-type dopant in Cu3SbSe4, and the power factor reaches nearly 16 μW/cm*K2 at 630K when 3% Ge is added, rivaling that of state-of-the-art thermoelectric materials at this temperature.
Clinical samples have identified a number of psychosocial risk factors
for suicidal acts but it is unclear if these findings relate to the
To describe the prevalence of and psychosocial risk factors for suicidal
acts in a general adult population.
Data were obtained from a Canadian epidemiological survey of 36 984
respondents aged 15 years and older (weighted sample
n=23 662 430).
Of these respondents, 0.6% (weighted n=130 143) endorsed
a 12-month suicidal act. Female gender (OR=4.27, 95% CI 4.05–4.50), being
separated (OR=37.88, 95% CI 33.92–42.31) or divorced (OR=7.79, 95% CI
7.22–8.41), being unemployed (OR=1.70, 95% CI 1.50–1.80), experiencing a
chronic physical health condition (OR=1.70, 95% CI 1.67–1.86) and
experiencing a major depressive episode in the same 12-month period as
the act (OR=9.10, 95% CI 8.65–9.59) were significantly associated with a
The psychosocial correlates of suicidal acts in this sample are
consistent with those previously reported in clinical and general
population samples. These findings reinforce the importance of the
determination of suicide risk and its prevention not only of psychiatric
illness but of physical and psychosocial factors as well.
Although people with schizophrenia display impaired abilities for consent, it is not known how much impairment constitutes incapacity.
To assess a method for determining the categorical capacity status of potential participants in schizophrenia research.
Expert-judgement validation of capacity thresholds on the sub-scales of the MacArthur Competence Assessment Tool – Clinical Research (MacCAT–CR) was evaluated using receiver operating characteristic (ROC) analysis in 91 people with severe mental illness and 40 controls.
The ROC areas under the curve for the understanding, appreciation and reasoning sub-scales of the MacCAT–CR were 0.94 (95% CI 0.88–0.99), 0.85 (95% CI 0.76–0.94) and 0.80 (95% CI 0.70–0.90). These findings yielded negative and positive predictive values of incapacity that can guide the practice of investigators and research ethics committees.
By performing such validation studies for a few categories of research with varying risks and benefits, it might be possible to create evidence-based capacity determination guidelines for most schizophrenia research.
Long-term mortality and the risk factors for premature death among
patients with schizophrenia living in rural communities are unknown.
To explore the 10-year mortality and its risk factors among patients with
We used data from a 10-year prospective follow-up study (1994–2004) of
mortality among people with schizophrenia, and death registration data
for Xinjin County, Chengdu, China.
The mortality rate was 2228 per 100 000 person-years during follow-up.
Both all-cause mortality and suicide rates were significantly greater in
male than in female patients. Age at illness onset (>45 years),
duration of illness (⩾10 years), age greater than 50 years, physical
illness, inability to work, male gender, and never having received
treatment were identified as independent predictors of increased
Higher mortality rates in male patients may contribute to the higher
prevalence of schizophrenia in women compared with men in China. The
findings of risk factors for mortality should be taken into account when
developing interventions to improve outcomes among people with
In traditional medical use, a categorical diagnosis conveys essential (although stereotypic) information about the signs and symptoms of a disease, its treatment, and its prognosis. Its utility derives from its generalizability. However, many of the shortcomings of categorical classification also reflect these same qualities. Diagnoses too often fail to capture important qualities of a disorder or do not sufficiently characterize a patient's particular symptoms. Recent editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which have emphasized highly specific entry criteria to establish psychiatric conditions in a more homogeneous fashion, have sometimes resulted in enhanced reliability at the cost of diminished validity. The variability of psychiatric disorders often defies attempts to create strictly defined clusters amenable to syndrome classifications.
Age of onset of depressive episodes may serve as a useful marker of pathogenetic heterogeneity in late-life depression. Medical illness may play an important role in the pathogenesis of depression in the elderly, but its relationship to age of onset has not been carefully examined. We prospectively studied 110 older inpatients with DSM-III-R major depression. Using multiple regression techniques, we found that medical illness was not independently associated with age of onset. Independent predictors of older age of onset were age, male sex, absence of substance abuse history, and absence of melancholia. Our discussion reconsiders the usefulness of age of onset as a primary research variable for elucidating heterogeneity of late-life depression.
The authors report preliminary data from a psychological autopsy study of completed suicide in late life. Sixteen of 18 victims had diagnosable psychopathology, most commonly major depression of late onset. Symptoms manifest prior to death are described and directions for future investigation discussed. The psychological autopsy is shown to be a viable method for studying suicide in the elderly.
There is an accumulating body of research suggesting that suicidal behavior may be associated with abnormalities of the central serotonin system. Other monoaminergic, peptidergic, and neuroendocrine systems have been implicated as well. A review of studies that examine neurobiological variables in postmortem tissue of suicide victims and controls reveals that investigators in most instances have viewed age as a confound to be controlled rather than considering it as a variable of interest. However, the close associations between aging and increased suicide rates, and the knowledge that the functional integrity of many of these same systems changes with normal and abnormal aging processes, raise the possibility that biological aging contributes to suicide risk, and that the underlying neurobiology of suicide in the elderly differs from that of younger people. The few available studies that did examine the association of age with neurobiological measures indicate directions for future research into the role that aging may play in determining the biological bases of suicide risk.
Establishing a medical diagnosis serves two utilitarian purposes: providing information necessary to initiate treatment and communicating information regarding prognosis. A nosology or diagnostic nomenclature (i.e., a classification of diagnoses) provides further utility by establishing a foundation for clinical research. In his book, Wulff outlined four types of diagnoses: (1) symptomatic or pseudoanatomic diagnoses (e.g., chronic headache, persistent diarrhea, or irritable bowel); (2) syndromes; (3) anatomic diagnoses; and (4) causal diagnoses. By definition, syndromes have no means of being validated by measures external to the constructs themselves. Often, specific syndromes reflect diverse origins, and conversely, specific etiologies may cause multiple syndromes (e.g., syphilis, human immunodeficiency virus, and diabetes).
Suicide is an action that calls for explanation. Many who kill themselves leave written words behind, attempting to explain, but many others do not. For those outside the experience, there remains a need to understand. Self-inflicted death may make sense occasionally, however painful it may be to those left behind. Most often, it is called a tragedy, death before one's time.
We compared the verbal learning and memory performance
of 57 inpatients with unipolar major depression and 30
nondepressed control participants using the California
Verbal Learning Test. The effect of age within this elderly
sample was also examined, controlling for sex, educational
attainment, and estimated level of intelligence. Except
for verbal retention, the depressives had deficits in most
aspects of performance, including cued and uncued recall
and delayed recognition memory. As well, there were interactions
between depression effects and age effects on some measures
such that depressives' performance declined more rapidly
with age than did the performance of controls. The results
are discussed in the context of recent contradictory reports
about the integrity of learning and memory functions in
late-life depression. We conclude that there is consistent
evidence, from this and other studies, that elderly depressed
inpatients have significant deficits in a range of explicit
verbal learning functions. (JINS, 1998, 4,
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