Lethality-Associated Factors in Deliberate Self-Poisoning.

OBJECTIVES: Deliberate self-poisoning (DSP) is the most common suicide method and can be life-threatening. The purpose of this study was to investigate the factors related to the lethality of DSP and the characteristics of the adolescent group. METHODS: A retrospective study was conducted on patients who had visited an academic hospital's regional emergency medical center between 2015 and 2018. The data reviewed through their medical records included sociodemographic factors, clinical variables, and psychiatric treatment. Four groups (Q1-Q4) were categorized by descriptive analysis using the risk-rescue rating scale. RESULTS: A total of 491 patients were enrolled in this study. This study showed that high lethality had statistically significant associa-tions with male sex, older age, admitting suicidal intentions, and the use of herbicides for suicide. Logistic regression analyses showed a significant association between high-lethality and female [odds ratio (OR)=0.50, 95% confidence interval (CI)=0.30-0.81, p=0.01], non-psychiatric drugs (over-the-counter drug: OR=2.49, 95% CI=1.08-5.74, p=0.03; herbicide: OR=8.65, 95% CI=3.91-19.13, p<0.01), and denial of suicide intent (OR=0.28, 95% CI=0.15-0.55, p<0.01). CONCLUSION: This study showed the clinical factors associated with the high lethality of DSP and suggested that efforts were needed to care for and thoroughly examine patients with DSP.

Risk Factors for Serious Suicide Attempts: Difference Between Older and Younger Attempters in the Emergency Department.

Objective: Suicide attempts of the older adults are known to be more serious than that of the younger adults. Despite its major social impact in South Korea, the behavioral mechanism of serious suicide attempt (SSA) in old people remains to be elucidated. Thus, we investigated the risk factors for SSA in older and younger suicide attempters in the emergency department. Methods: Demographic data, clinical information, and the level of seriousness of suicide with Risk Rescue Rating Scale were compared between older (age ≥65) and younger (age <65) adults who visited the emergency department for a suicide attempt. Regression analyses were performed to identify the risk factors for SSA in these two groups. Results: Among 370 patients, 37 were older adults (10%; aged 74.41 ± 6.78), more likely to have another medical disease (p < 0.001), and a higher suicide completion rate (16.2 vs. 5.4%, p = 0.023). In the younger group, old age (B = 0.090, p < 0.001), male sex (B = -0.038, p = 0.019), and impression of schizophrenia (B = 0.074, p = 0.027) were associated with a higher risk-rescue ratio and interpersonal stress condition was associated with a lower risk-rescue ratio (B = -0.045, p = 0.006). In the older group, however, no variables were included significant in the regression model for the Risk Rescue Rating Scale. Conclusions: Demographic and clinical factors such as old age, male sex, interpersonal stress, and impression of schizophrenia were associated with lethality in the younger suicide attempters. However, no factors were associated with SSA in the older adult group. Different mechanisms may underly the lethality in old age suicide.

Gender Differences in the Effect of Alcohol Use on Intent and Lethality of Suicidal Attempts / 정신신체의학

OBJECTIVES: The aim of this study was to clarify the role of alcohol use disorders and acute alcohol consumption in suicide attempts by gender. METHODS: Data of 1,152 suicide attempters(487 males and 742 females) who had visited an emergency center was gathered. Suicide attempts were categorized into three groups according to alcohol use: an alcohol use disorder group(AUD), an acute alcohol use group(AAU), and a no-alcohol use group(NAU). The intent and lethality of suicide attempts were evaluated by Suicidal Intents Scale and Risk-Rescue Rating Scale. RESULTS: For Suicidal Intents Scale score, the male AUD group revealed a significantly lower mean score than the male AAU one. However, there were no statistically significant differences for female subjects across subgroups. With regard to the Risk-Rescue Rating Scale score, there were no significant differences for males, while the AUD group showed both the lowest highest rescue scores and lowest risk-rescue scores within female groups. CONCLUSIONS: AUD in females was more likely regarding impulsive suicide attempts with high rescue chances. Consuming alcohol might have different effect on suicide attempts by gender and our study shows that alcohol use is an important risk factor according to gender, particularly with regard to female suicide attempts.

The Pathophysiological Role of Cytokines in Suicide Attempters with Major Depressive Disorder / 신경정신의학

OBJECTIVES: Cytokines are known to play an important role in the pathogenesis and the pathophysiology of major depressive disorders. However, the role of cytokines in suicide in major depression has not been explored thoroughly. The purpose of this study is to identify the roles of cytokine interaction of Th1, Th2, Th3 cytokines in suicidal depressive patients. METHODS: 110 major depressive patients (29 depressive patients without suicidal ideation, 32 depressive patients with suicidal ideation, and 49 depressive patients with suicide attempts) diagnosed by DSM-IV criteria were included in this study. The severity of suicide ideations and attempts was measured by Lethality of Suicide Attempt Rating Scale (LSARS) and Risk-Rescue Rating (RRR) system. Cytokine productions (TNF-alpha, IFN-gamma, IL-2, IL-4, and IL-6) upon mitogen stimulation were measured by ELISA in a whole blood assay. TGF-beta1 were measured in plasma by ELISA. RESULTS: There were no significant differences in age, sex and BMI among the three groups. IL-2 and IL-6 levels were significantly lower in the suicide attempt group than other two groups while TNF-alpha, IFN-gamma, IL-4 and TGF-beta1 did not differ among the groups. Significant positive correlations between TNF-alpha/IL-4, IL-6/IL-4, IFN-gamma/IL-4 and IL-6/TGF-beta1 ratio and LSARS scores in suicidal patients were found. In addition, there were significant correlations between TNF-alpha/IL-4 or IL-6/IL-4 and RRR scores in suicidal patients. CONCLUSION: These results indicate that decrease in Th1 cytokines may be associated with suicidal behavior in major depression. These findings suggest that cytokines may play a role in the pathogenesis of suicidal depression.

Decreased Concentration of Plasma Brain-Derived Neurotrophic Factor in Suicide Attempters

OBJECTS: Some studies have suggested that brain-derived neurotrophic factor(BDNF), one of the most important neurotrophins, is involved in pathophysiology of depression and suicide. This study was performed to determine whether there is an abnormality in plasma BDNF concentration in suicidal attempters. METHODS: The subjects were 71 suicidal attempters who visited emergency rooms in multi-medical centers. All subjects had been interviewed by using Structured Clinical Interview for DSM-IV(SCID), Hamilton Depression Rating Scale(HDRS), Young Mania Rating Scale(YMRS), and Positive And Negative Syndrome Scale(PANSS). The severity of the suicidal behavior was measured by Lethality of Suicide Attempt Rating Scale(LSARS) and Risk-Rescue Rating(RRR) system. Seventy-one age, sex, and diagnosis matched non-suicidal psychiatric patients who were consecutively admitted to a psychiatric ward during the same period recruited as psychiatric controls. They were drug-naive or drug-free at least more than 2 months. In addition, 80 healthy controls were randomly selected as normal controls. Plasma BDNF level was measured by the enzyme linked immunosorbent assay(ELISA) methods. RESULTS: In overall F-test, differences of the plasma BDNF levels among the groups were statistically significant(F=20.226, p<0.001). In the multiple comparisons(Scheffe), while mean levels of plasma BDNF between normal controls and non-suicidal psychiatric patients were similar(p=0.984), the BDNF levels of suicidal attempters were lower than those of other two groups(p<0.001). LSARS and RRR did not reveal any significant correlations with BDNF levels in suicidal attempters. CONCLUSION: These results suggest that reduction of plasma BDNF level is related to suicidal behavior and BDNF level may be a biological marker of suicidal behavior.

The Relationship between Serum Lipid Levels and Suicidality in Suicidal Attempters / 신경정신의학

OBJECTIVES: Many studies have demonstrated that suicide is related to low serum cholesterol level, whereas conflicting results have also reported. The aims of the present study are to determine whether suicidal attempters have low lipid concentration and to identify the relationship between suicidal attempt severity and serum lipid levels. METHODS: Subjects were 50 suicidal attempters who visited the emergency room in Korea University Medical Center between July 1998 and June 1999. All subjects had been interviewed by psychiatrist and evaluated with Risk-rescue rating, HDRS and BPRS. They were diagnosed as major depressive disorder (n=29), personality disorder (n=19), and schizophrenia (n=2). Serum lipid levels in 50 suicidal attempters were compared with those in 50 nonsuicidal psychiatric inpatients corresponding to the age, sex and diagnosis of the suicidal attempters. We also examined the Spearman's rank correl-ations between the serum lipid levels and risk-rescue score. RESULTS: The serum total cholesterol level (t=-3.29, p=.001), total lipid level (t=-2.62, p=.01), and LDL level (t=-2.64, p=.011) in suicidal attempters were significantly lower compared with non-suicidal controls. In major depressive patients, total cholesterol level, total lipid level, and LDL level in suicidal attempters were significantly lower than those of nonsuicidal controls. In personality disorder patients, however, only serum total cholesterol level was significantly lower. Risk-rescue rating score was negatively correlated with serum total cholesterol level (t=.-293, p=.039), and positively corre-lated with BPRS (t=.544, p< 001), and HDRS (t=.488, p=.001). CONCLUSION: The lipid levels in suicidal attempter were significantly lower. Suicidal attempt severity was also significantly correlated with serum total cholesterol level. These findings suggest that low serum cholesterol should be related with severe violent suicidal attempt.