Suicide attempt by jumping: a study of gonadal axis hormones in male suicide attempters versus men who fell by accident.

Low plasma total testosterone (T) levels may influence the sense of well-being and produce depressive symptomatology, increasing the risk of suicide. In a previous study, we reported reduced serum T levels in male psychiatric patients after a suicide attempt. The reduction was more pronounced in subjects who used violent attempt methods, and we discussed the possible influence of stress of hospitalization, serious medical condition and treatment. In order to minimize the influence of such factors, we compared in this study the levels of plasma sex hormones of 15 psychiatric patients (10 suffering from schizophrenia and 5 from depression) who had attempted suicide by jumping with those of a group of 18 male subjects who were hospitalized after accidentally falling from a high height. Compared with a healthy control group of 40 males, both accident and attempt groups had lower T levels. The attempt group showed a trend toward lower T levels compared with levels in the accident group. In the accident group, luteinizing hormone (LH) levels were elevated compared with levels in healthy controls, indicating a normal function of the hypothalamic-pituitary-gonadal (HPG) axis. This was not the case for the attempt group, where low T levels were not accompanied by increases in LH. Cortisol and prolactin were similarly elevated in both patient groups, but were not related to the low T levels. The results indicate that male psychiatric patients who attempt suicide by violent methods may have low total plasma T levels, possibly due to a dysfunction of the HPG axis at the hypothalamic-pituitary level. Monitoring HPG axis function in future studies could prove to be a predictor of suicide at least for male psychiatric attempters, and could lead to preventive strategies.

Changes in utilization of community mental health services in three boroughs of Athens (1979/1983-2000/2004)

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Background and Objectives: Several investigators reported that there is agap between prevalence of mental disorders and utilization of mental health services. The trends in help –seeking from two Community Mental Health Centers (CMHC) serving three boroughs in Athens and having identical organizational profile were examined. Method: Utilization rates were compared for the first four years of operation (1979-1983) of the first CMHC in Greece and the corresponding first years 2000-2004 of the most recent CMHC in the country. The sociodemographic characteristics of both catchment areas were almost identical. Results: In the years 2000-2003 the time of untreated mental disorders was found to belower than that of 1979-1983. Moreover only 4.6% of clients of the first CMHC were self referred contrasting the 51.7% of their counterparts of the second Center. More than 50%of persons, who have visited the second Center reported that this Center was the first psychiatric service in their life. Additionally between the years 2000-2004, the treated prevalence of depression was found to be much higher than that in the years 1979-1983.Conclusions: Apparently these findings are probably linked with opinion changes towards psychiatry and mental illness, ability of early recognition of psychopathological symptoms, as well as, the attitudinal change in the need for help-seeking (AU)

Gonadal axis hormones in psychiatric male patients after a suicide attempt.

Epidemiological and clinical studies support the view that aggressive acts like suicidal and violent behaviors share a common substrate. Certain aspects of violence in males have been related to high testosterone levels, but the relation of testosterone to attempted suicide has not been studied until now. We estimated plasma levels of testosterone (T), LH, and FSH in 80 male subjects after a suicide attempt and in whom a psychiatric assessment was done during their hospitalization. Suicide intent was evaluated in 72 subjects. A group of 56 healthy males in the same age range served as control. As a group, attempters showed significantly lower T levels, marginally higher LH, and normal FSH compared to controls. The attempters who used violent methods (26 subjects) had T levels even lower than the non-violent (drug overdose) subgroup. Comparisons of T levels of subgroups according to the (main) drug ingested (analgesics, benzodiazepines, antidepressants, neuroleptics, or other drugs) did not reveal any significant drug effect. In relation to diagnosis, the lowest T levels were found in the subgroup with schizophrenia (29 subjects). The T levels of this subgroup were also significantly lower compared to those of a group of 31 male schizophrenic patients, hospitalized and treated with neuroleptics. If the influence of post-attempt stress and medical condition on plasma T could be ruled out, low plasma T may prove to be a biological predictor of attempt, at least in male schizophrenic patients. Nevertheless, the findings differentiate suicidal behavior from other aggressive/violent behaviors and do not support the notion that suicidal and aggressive behaviors are manifestations of the same impulse.