The Gender-Specific Associations Between Religion/Spirituality and Suicide Risk in a Sample of Austrian Psychiatric Inpatients.

Most studies have found religion/spirituality to be protective against suicide risk, with a stronger effect among women. To understand this effect, theories of suicide and clinical samples are needed, but related studies are lacking. We applied two established suicide models in 753 psychiatric inpatients. Religion/spirituality correlated protectively with components of the suicide models, with stronger associations among women. The protective effect emerged especially for the capability aspect of suicide among men and for the motivational aspect among women, suggesting very different causal mechanisms, but this has to be replicated with longitudinal studies.

Explaining the suicide risk of sexual minority individuals by contrasting the minority stress model with suicide models.

Many studies have found elevated levels of suicide ideation and attempts among sexual minority (homosexual and bisexual) individuals as compared to heterosexual individuals. The suicide risk difference has mainly been explained by minority stress models (MSTM), but the application of established suicidological models and testing their interrelations with the MSTM has been lacking so far. Therefore, we have contrasted two established models explaining suicide risk, the Interpersonal Psychological Theory (IPT) (Joiner, 2005) and the Clinical Model (CM) (Mann et al., 1999), with the MSTM (Meyer, 2003) in a Bavarian online-sample of 255 adult sexual minority participants and 183 heterosexual participants. The results suggested that the CM and the IPT model can well explain suicide ideation among sexual minorities according to the factors depression, hopelessness, perceived burdensomeness, and failed belongingness. The CM and the IPT were intertwined with the MSTM via internalized homophobia, social support, and early age of coming out. Early coming out was associated with an increased suicide attempt risk, perhaps through violent experiences that enhanced the capability for suicide; however, coming out likely changed to a protective factor for suicide ideation by enhanced social support and reduced internalized homophobia. These results give more insight into the development of suicide risk among sexual minority individuals and may be helpful to tailor minority-specific suicide prevention strategies.

Religion and suicide risk in lesbian, gay and bisexual Austrians.

Religion is known to be a protective factor against suicide. However, religiously affiliated sexual minority individuals often report a conflict between religion and sexual identity. Therefore, the protective role of religion against suicide in sexual minority people is unclear. We investigated the effect of religion on suicide risk in a sample of 358 lesbian, gay and bisexual Austrians. Religion was associated with higher scores of internalized homophobia, but with fewer suicide attempts. Our data indicate that religion might be both a risk and a protective factor against suicidality in religiously affiliated sexual minority individuals.

Hiking in suicidal patients: neutral effects on markers of suicidality.

BACKGROUND: Regular physical activity promotes physical and mental health. Psychiatric patients are prone to a sedentary lifestyle, and accumulating evidence has identified physical activity as a supplemental treatment option. METHODS: This prospective, randomized, crossover study evaluated the effects of hiking in high-risk suicidal patients (n = 20) who performed 9 weeks of hiking (2-3 hikes/week, 2-2.5 hours each) and a 9-week control period. RESULTS: All patients participated in the required 2 hikes per week and thus showed a compliance of 100%. Regular hiking led to significant improvement in maximal exercise capacity (hiking period Δ: +18.82 ± 0.99 watt, P < .001; control period: P = .134) and in aerobic capability at 70% of the individual heart rate reserve (hiking period Δ: +8.47 ± 2.22 watt; P = .010; control period: P = .183). Cytokines, associated previously with suicidality (tumor necrosis factor-α, interleukin-6, S100), remained essentially unchanged. CONCLUSIONS: Hiking is an effective and safe form of exercise training even in high-risk suicidal patients. It leads to a significant improvement in maximal exercise capacity and aerobic capability without concomitant deterioration of markers of suicidality. Offering this popular mode of exercise to these patients might help them to adopt a physically more active lifestyle.

Suicide risk and sexual orientation: a critical review.

Many studies have reported higher rates of suicide attempts among sexual minority individuals compared with their heterosexual counterparts. For suicides, however, it has been argued that there is no sexual orientation risk difference, based on the results of psychological autopsy studies. The purpose of this article was to clarify the reasons for the seemingly discrepant findings for suicide attempts and suicides. First, we reviewed studies that investigated if the increased suicide attempt risk of sexual minorities resulted from biased self-reports or less rigorous assessments of suicide attempts. Second, we reanalyzed the only two available case-control autopsy studies and challenge their original "no difference" conclusion by pointing out problems with the interpretation of significance tests and by applying Bayesian statistics and meta-analytical procedures. Third, we reviewed register based and clinical studies on the association of suicides and sexual orientation. We conclude that studies of both suicide attempts and suicides do, in fact, point to an increased suicide risk among sexual minorities, thus solving the discrepancy. We also discuss methodological challenges inherent in research on sexual minorities and potential ethical issues. The arguments in this article are necessary to judge the weight of the evidence and how the evidence might be translated into practice.

Nonlinear dynamics: theoretical perspectives and application to suicidology.

Despite decades of research, the prediction of suicidal behavior remains limited. As a result, searching for more specific risk factors and testing their predictive power are central in suicidology. This strategy may be of limited value because it assumes linearity to the suicidal process that is most likely nonlinear by nature and which can be more adequately described and analyzed with nonlinear dynamics. The goal of moving nonlinear dynamics from theory to practice and to real-world phenomena can now be realized with Internet-based monitoring systems such as the Synergetic Navigation System.

A closer look at self-reported suicide attempts: false positives and false negatives.

The validity of self-reported suicide attempt information is undermined by false positives (e.g., incidences without intent to die), or by unreported suicide attempts, referred to as false negatives. In a sample of 1,385 Austrian adults, we explored the occurrence of false positives and false negatives with detailed, probing questions. Removing false positives decreased the rate of suicide attempters from 4.3% to 2.7%. Probing questions also revealed 0.8% false negatives. We recommend using probing questions with both those who report a suicide attempt and those who do not report a suicide attempt to increase the validity of self-reported suicide-related information.

The relation between sexual orientation and suicide attempts in Austria.

Previous studies indicate that homosexual or bisexual individuals are at a higher risk of attempting suicide compared to heterosexuals. To overcome biases in these studies, more rigorous definitions of "suicide attempts" and the assessment of multiple dimensions of sexual orientation are needed. In addition, studies from the German speaking region are sparse, especially those not recruiting participants from the gay or lesbian communities. We solicited self-reported suicide attempts among 1,382 Austrian adults recruited through structured snowball sampling from students' social networks. Suicide attempts were more frequently reported by those participants with homosexual or bisexual fantasies, partner preference, behavior, and self-identification, compared to their heterosexually classified counterparts. This was true for any dimension of sexual orientation and for suicide attempts with intent to die or suicide attempts that required medical treatment. Our Austrian study confirmed existing evidence that homosexual and bisexual individuals are at an increased risk for attempting suicide. This should be considered in suicide preventive efforts.

[Are near-death experiences following attempted suicide important for suicide risk assessment? A case report]. / Sind Nahtoderlebnisse nach Suizidversuchen bedeutsam für die weitere Suizidrisikoeinschätzung? Ein Fallbericht.

We describe a 59-year old patient who reported a near-death experience following attempted suicide. The near-death experience induced reduction of suicidality. Previous studies suggested a high prevalence of near-death experiences following attempted suicide and that near-death experiences may decrease rather than increase subsequent suicide risk. Implications for suicide risk assessment are discussed.

[Child and adolescent bipolar disorder]. / Bipolar Affektive Störungen im Kindes- und Jugendalter.

The onset of bipolar disorders before the age of 10 is rare. First manifestation occurs most frequently between the age of 15 to 30. Children of a parent with bipolar disorder are at a fivefold risk for developing a bipolar disorder. Therefore, an elaborate family-history is essential for the assessment of potentially manic or depressive symptoms in children and adolescents. Basically, for all age groups the same diagnostic criteria according to ICD 10 are applied. Due to the differing symptoms for children and adolescents the finding of a diagnosis is considerably harder than for adults. Manic episodes before the age of 10 are characterized by increased activity, more risk taking behaviour and elevated emotional instability. In adolescents, however, behavioural disturbance with antisocial behaviour and drug-abuse are more common. Thus, typical misdiagnosis as ADHD or conduct disorders for children and adolescents are frequent. Aggravating the complexity, in up to 90 % both differential-diagnosis may occur as comorbid disorders. Furthermore, psychotic symptoms are more common than in adults and dysphoria is more likely than euphoric or depressive mood. Asymptomatic intervals rarely exist, whereas "ups" and "downs" in rapid succession are prevailing (rapid cycling). An early diagnosis, leading specific treatment, is essential for the prognosis of bipolar disorders. Additionally, structural (CCT or MRI) and laboratory examination are essential to expel endocrine or brain-organic diseases. Besides psychotherapeutic and psychoeducative methods, always including parents and attached persons, the psychopharmacological treatment is a major part of a multimodal treatment. The available substances partly have been in use for years and are appropriate for youngsters. These include mood stabilizers like lithium, divalproex and carbamazepine, which provide besides their acute antimanic effects also relapse-prophylactic properties. In addition atypical antipsychotics like risperidone, olanzapine and quetiapine have gained more and more importance in the treatment of manic states in children and adolescents during the last years. However the use of antidepressants in children and adolescents should be considered with great caution due to arguable efficacy and potentially severe adverse effects, i.e. amplification of suicidal ideation.

Loss of self-understanding: a behavior-oriented model of depression.

BACKGROUND: A new model of depression is proposed which is biological and explanatory on the behavioral level. It is hypothesized that a patient suffering from a depressive disorder loses the ability to produce one or more modes of behavior at a given time and simultaneously has the urge to produce one or more other modes of behavior constantly. The patient is also unable to interpret his behavioral disorder ("loss of self-understanding"). MATERIAL/METHODS: The authors developed the Salzburg Subjective Behavioral Analysis (SSBA) self-assessment questionnaire asking subjects to elaborate on changes in 35 modes of behavior and to interpret the behavioral disorder, if possible. The study was conducted using this questionnaire and the Hamilton Depression Scale on 30 inpatients with depressive disorders and this questionnaire on 30 healthy controls. RESULTS: Extreme positions in the SSBA were found in all 30 patients, compared with 2 in the 30 healthy controls. Significant correlation between the occurrence of extreme positions and the Hamilton scores was found (r=0.44, p=0.02) and correlation between the Hamilton scores and the inability of the patients to interpret the behavioral disorder was nearly significant (r=-0.35, p=0.06). CONCLUSIONS: The occurrence of extreme positions in the SSBA increased with depressive mood. In addition, the likelihood that subjects could explain their extreme positions in behavior decreased with increasing depression. The SSBA questionnaire assesses the self-evaluation of modes of behavior. As a diagnostic instrument, DSM-IV does not have criteria for modes of behavior. Thus, behavioral analysis should be considered in diagnosing depression.