A chronological perspective on suicide--the last days of life.

A combined psychological autopsy and narrative approach was used to study the completed suicides of 67 Israeli soldiers. Three issues were addressed. First, the authors examined the typology of the life narratives of suicide completed during active army duty. Second, focusing on the last 3 weeks of the soldiers' lives, they sought to examine their triggers for suicide, emotional state of mind, army duty functioning, and communication of suicidal intent. Finally, they examined military responses to communication of intent, help provision, and help acceptance. Four types of narratives were identified: regressive, stable, tragic (progression and sudden collapse), and romantic (ups and downs). During the last days of life, suicide completers exhibited a split between an emotional state of mind (evidencing an emotional deterioration) and a behavioral military functioning, which was mostly stable. The analysis also revealed a resistance to receive help and a resistance to provide help, both of which impeded intervention. The gap between functioning and emotional distress in suicidal individuals and the incongruence between crisis and help are highlighted. The need to educate military personnel to look beyond duty functioning and the need to develop clear guideline about referrals to professional helps are discussed.

Serum cholesterol, suicidal tendencies, impulsivity, aggression, and depression in adolescent psychiatric inpatients.

BACKGROUND: This study was undertaken to examine the relationship between serum cholesterol levels and suicidal behaviors in adolescent psychiatric inpatients. Any association between serum cholesterol and measures of suicidal behavior, impulsivity, aggression, anxiety, and depression was also examined. METHODS: Consecutive admissions (n = 152) to an adolescent psychiatric inpatient unit were assessed using measures of suicidal behavior, violence, impulsivity, and depression. Serum cholesterol was compared between those admitted for reasons of suicidal tendencies and those for other reasons. Correlation between serum cholesterol and measures of suicidal behavior, violence, impulsivity, and depression were examined. RESULTS: Serum cholesterol levels were significantly higher in adolescent patients who were currently suicidal than in nonsuicidal adolescents. Within the suicidal group, but not in the total inpatient group, serum cholesterol correlated negatively with the degree of suicidal behavior. No correlation between serum cholesterol levels and depression, violence, and impulsivity were detected. No significant differences were found in serum cholesterol levels between diagnoses or between suicidal and nonsuicidal patients within each diagnostic group. CONCLUSIONS: The association between cholesterol and suicidal tendencies remains complex and may depend on several variables within the population studied. Its usefulness as a biologic risk factor in clinical samples remains to be determined.

Impulsivity as a correlate of suicidal behavior in adolescent psychiatric inpatients.

One hundred and eighteen inpatient adolescents in a psychiatric hospital were evaluated to determine the relationship of aggression, self injury, and suicidal behavior to impulsivity. It was hypothesized that all these variables would be significantly and positively correlated with one another. This hypothesis was in part based on the results of psychobiological research that found serotonin dysfunction to be the common denominator of these psychopathological dimensions. As predicted, a significant correlation was found between the measures of suicidal behavior, aggressive behavior, and impulsivity. This correlation between suicidal behavior and impulsivity remained after partialing out the factor of aggression. Furthermore, the correlations between impulsivity and suicidality appeared greater in males than in females. Since male suicide attempters are more likely to eventually commit suicide than female suicide attempters, these findings may have a bearing on suicide prediction.

Death concepts in suicidal adolescents.

OBJECTIVE: To investigate the relationship between components of death concept (preoccupation with death, death as a pleasant state, and death as final) and suicidal behavior in adolescents. METHOD: The death concepts of 51 suicidal inpatients, 102 nonsuicidal inpatients, 36 emergency room suicidal subjects, and 81 normal controls were compared using Pfeffer's Child Suicide Potential Scale. In addition, the IQ level as well as emotions that potentially influence the death concept were measured. RESULTS: Both groups of suicidal adolescents evaluated death as more pleasant than the nonsuicidal groups. All the study groups equally perceived death as a final state. Suicidal inpatients were more preoccupied with death than nonsuicidal inpatients, but surprisingly among all study groups, including normal controls, the emergency room suicidal subjects were the least preoccupied with death. Partialing out depression, anxiety, and aggression specifically augmented the association between preoccupation with death and suicidality. Thus the relationship between death concept and suicidality appears to be a direct one. No correlation was found between suicidality and intelligence level. CONCLUSIONS: Elements of death concept distinguish suicidal from nonsuicidal as well as between hospitalized versus nonhospitalized suicidal adolescents. Thus the death concept evaluation is potentially valuable in the assessment of adolescents with a high risk for suicide.

The child suicide potential scale: inter-rater reliability and validity in Israeli in-patient adolescents.

The objective of this study was to evaluate the psychometric properties of the Hebrew version of the Child Suicide Potential Scale for use with psychiatrically hospitalized adolescents. The criterion validity, the parallel validity, the internal consistency, the inter-rater reliability and the test-retest reliability were assessed. One hundred eighty-five adolescent in-patients, consecutive admissions to a locked adolescent unit, were interviewed by a single interviewer. The subjects filled out a series of self report questionnaires and were also rated on an observational measure by the ward staff. In addition, 30 adolescents were interviewed by two raters simultaneously, in order to check the inter-rater reliability of this semi-structured interview. Twenty-three of the interviewees were re-interviewed after 6-12 months in order to assess the test-retest reliability. The majority of the Pearson correlation coefficients between the Child Suicide Potential Scale and parallel self report measures were also statistically significant. The internal consistencies of sections in the scale were high. The scale was found to have good parallel validity, by differentiating between suicidal and non-suicidal patients. The Pearson Correlation Coefficients between the two raters were markedly significant. The test-retest reliability was low. These results indicate that the Child Suicide Potential Scale is a reliable and fairly valid tool for the assessment of suicidal behavior in adolescent in-patients in Israel.

City size, quality of life, and the urbanization deflator of the GNP: 1910-1984.

The authors attempt to determine the net effect of city size on quality of life by developing a welfare measure of urbanization. "The estimation procedure suggested in the theoretical part of the paper (section II) is implemented in the empirical part (section III) using 1980 census data from the [U.S.] PUMS (Public Use Micro Data Sample). The results indicate there is no single optimal city size, but rather a worst city size, and about 90 percent of the U.S. population reside in cities smaller than worst city size. If quality of life is related to the degree of urbanization, then long-term trends in the locational distribution of the population should be accounted for in any welfare-oriented measure of national income. One application of our results is, as indicated, the derivation of a GNP welfare deflator reflecting changes in the degree of urbanization (section IV). The findings suggest an urban deflator on the order of six to seven percentage points, which is steadily increasing at a rate of about half a percentage point per decade."