Effect of assertive case management intervention on suicide attempters with comorbid Axis I and II psychiatric diagnoses: secondary analysis of a randomised controlled trial.

BACKGROUND: Most suicide attempters suffer from psychiatric disorders, which are often comorbid with personality disorders. The effects of intervention on patients who have attempted suicide with comorbid Axis I and II diagnoses have not been fully elucidated. We evaluated whether assertive case management can reduce the repetition of suicidal behaviours in patients who had attempted suicide with comorbid Axis I and II diagnoses. METHODS: This study was a secondary analysis of a randomised controlled trial investigating whether assertive case management could reduce the repetition of suicide attempts, compared with enhanced usual care. Subjects were divided into those who had comorbid Axis I and II diagnoses (Axis I + II group), and those who had an Axis I diagnosis without Axis II comorbidity (Axis I group). Outcome measures were compared between patients receiving a case management intervention and patients receiving enhanced usual care, as allocated. The primary outcome measure was the incidence proportion of the first episode of recurrent suicidal behaviour at 6 months after randomisation. We calculated risk ratios (RR) with 95% confidence intervals (CI) at 6 months and 12 months after randomisation of patients in the Axis I and Axis I + II groups. RESULTS: Of 914 enrolled patients, 120 (13.1%) were in the Axis I + II group, and 794 (86.9%) were in the Axis I group. Assertive case management was significantly effective for the Axis I group on the primary outcome at 6 months (risk ratio [RR] 0.51, 95% confidence intervals [CI] 0.31 to 0.84). The RR of the Axis I + II group was 0.44 (95% CI 0.14 to 1.40). CONCLUSIONS: Assertive case management not only had an effect on patients who had attempted suicide with only Axis I disorders but may also have a similar effect on patients with comorbid Axis I and II disorders.

Usefulness of reminiscence therapy for community mental health.

Reminiscence therapy workshops for health-care professionals (total, n = 105: four trainees in their 20, seven in their 30s, 13 in their 40s, 30 in their 50s, 41 in their 60, five in their 70s, one in their 80s, and four of unknown age) were held, and group work with reminiscence therapy was provided to local residents (total, n = 151; mean age, 73.6 ± 10.6 years). Comparison of pre- and post-workshop questionnaires showed that rates of interest and understanding of trainees increased after the workshop. Concerning group work, 89.2% of the participants felt that reminiscence therapy would prove helpful in their life. Reminiscence therapy may be useful in improving mental health in local residents.

The impact of inpatient suicide on psychiatric nurses and their need for support.

BACKGROUND: The nurses working in psychiatric hospitals and wards are prone to encounter completed suicides. The research was conducted to examine post-suicide stress in nurses and the availability of suicide-related mental health care services and education. METHODS: Experiences with inpatient suicide were investigated using an anonymous, self-reported questionnaire, which was, along with the Impact of Event Scale-Revised, administered to 531 psychiatric nurses. RESULTS: The rate of nurses who had encountered patient suicide was 55.0%. The mean Impact of Event Scale-Revised (IES-R) score was 11.4. The proportion of respondents at a high risk (≥ 25 on the 88-point IES-R score) for post-traumatic stress disorder (PTSD) was 13.7%. However, only 15.8% of respondents indicated that they had access to post-suicide mental health care programmes. The survey also revealed a low rate of nurses who reported attending in-hospital seminars on suicide prevention or mental health care for nurses (26.4% and 12.8%, respectively). CONCLUSIONS: These results indicated that nurses exposed to inpatient suicide suffer significant mental distress. However, the low availability of systematic post-suicide mental health care programmes for such nurses and the lack of suicide-related education initiatives and mental health care for nurses are problematic. The situation is likely related to the fact that there are no formal systems in place for identifying and evaluating the psychological effects of patient suicide in nurses and to the pressures stemming from the public perception of nurses as suppliers rather than recipients of health care.

Study of the outcome of suicide attempts: characteristics of hospitalization in a psychiatric ward group, critical care center group, and non-hospitalized group.

BACKGROUND: The allocation of outcome of suicide attempters is extremely important in emergency situations. Following categorization of suicidal attempters who visited the emergency room by outcome, we aimed to identify the characteristics and potential needs of each group. METHODS: The outcomes of 1348 individuals who attempted suicide and visited the critical care center or the psychiatry emergency department of the hospital were categorized into 3 groups, "hospitalization in the critical care center (HICCC)", "hospitalization in the psychiatry ward (HIPW)", or "non-hospitalization (NH)", and the physical, mental, and social characteristics of these groups were compared. In addition, multiple logistic analysis was used to extract factors related to outcome. RESULTS: The male-to-female ratio was 1:2. The hospitalized groups, particularly the HICCC group, were found to have biopsychosocially serious findings with regard to disturbance of consciousness (JCS), general health performance (GAS), psychiatric symptoms (BPRS), and life events (LCU), while most subjects in the NH group were women who tended to repeat suicide-related behaviors induced by relatively light stress. The HIPW group had the highest number of cases, and their symptoms were psychologically serious but physically mild. On multiple logistic analysis, outcome was found to be closely correlated with physical severity, risk factor of suicide, assessment of emergent medical intervention, and overall care. CONCLUSION: There are different potential needs for each group. The HICCC group needs psychiatrists on a full-time basis and also social workers and clinical psychotherapists to immediately initiate comprehensive care by a medical team composed of multiple professionals. The HIPW group needs psychological education to prevent repetition of suicide attempts, and high-quality physical treatment and management skill of the staff in the psychiatric ward. The NH group subjects need a support system to convince them of the risks of attempting suicide and to take a problem-solving approach to specific issues.

Knowledge of and attitudes toward suicide and depression among Japanese in municipalities with high suicide rates.

BACKGROUND: Knowledge of and attitudes toward suicide and depression have not been fully investigated in Japan. METHODS: Study areas comprised municipalities in northern Japan where standardized mortality ratios (SMRs) from suicide compared with a Japanese standard ranged from 1.62 to 3.72 in men and from 1.43 to 3.49 in women. We conducted a questionnaire survey on a random sample of 7,136 participants aged 20 to 79 years, and analyzed data of 5,547 (77.7%) subjects. We categorized seven municipalities, from which the subjects were drawn, into three groups according to the SMR from suicide. Self-Rating Depression Scale (SDS) score was used for evaluation of depressive states. RESULTS: The SDS score was significantly higher in the high SMR group in women, but no significant difference among the three SMR groups was observed in men. The percentage of subjects with nine years or less of education was significantly higher in the high SMR group both in men and in women. The percentage of men who drank alcohol once a week or more was significantly higher in the high SMR group. The percentages of subjects unaware that depressive states are treatable by medication were not significantly different among the three SMR groups both in men and in women, while the percentage of men unwilling to see a psychiatrist when depressed was the lowest in the high SMR group. CONCLUSION: Although a significant difference in SDS score was observed in women, most of the psychosocial factors or knowledge of and attitudes toward suicide and depression were not adversely associated with SMR group.

Factor analysis of Zung Scale scores in a Japanese general population.

The purpose of the present paper was to investigate the distribution of Zung Self-rating Depression Scale (SDS) scores in a general population and its factor structure. Questionnaires on SDS items were sent to 7136 randomly selected residents aged 20-79 years who lived in districts in Japan with high rates of suicide. Valid responses were received from 5547 residents (response rate: 77.7%). Factor analysis of the SDS scores was conducted. The SDS scores of the male subjects were significantly lower than those of the female subjects in all age groups. A reverse-J-shaped relationship was found between age groups and mean SDS scores for the male and female subjects. The highest mean score was in the age group of 20-39 years, and the lowest mean score was in the age group of 60-69 years for the male and female subjects. In factor analysis, two factors consisting of 12 items were extracted, and 10 of those 12 items covered six Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) criteria describing psychological disturbances of depression. The distribution of SDS scores differed depending on the age group. Major components of SDS in the subjects covered the DSM-IV criteria for psychological disturbances of depression.

[A case of mixed poisoning by organophosphate and methanol].

We encountered a case of mixed poisoning by organophosphate and methanol. Each poisoning was comparatively frequent but we reviewed no cases of mixed poisoning of them. A 49-year-old woman was transferred to our hospital because of oral ingestion of organophosphorous compound (about 14 g of fenitrothion) and glass cleaner (about 40 g of methanol) for suicidal purpose. She underwent general antioverdose treatment including gastric lavage, activated charcoal and cathartics. For fenitrothion poisoning, she received atropine and pralidoxime. For methanol poisoning, she was treated with hemodialysis. Three days later, she moved to psychiatric ward from emergency ward without aftereffects and was given a diagnosis of depression.