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What Depressive Symptoms and Disorders Are Linked to Adolescent Suicide?

A study reported in the April 2008 issue of the Journal of Affective Disorders examines the role of depressive symptoms and disorders as potential predictors of suicidal behaviour in adolescents. The authors used a representative sample of 2464 Norwegian school students (average age 13.7 years) who were initally tested (T1).  These same subjects were followed up and reassessed a year later (T2). All subjects who scored significantly high on the depresson questionnaire at the one year mark (T2) were matched with low- or middle-scoring respondents according to age and gender.  A subset of 345 subjects were diagnostically assessed by face-to-face interviews (mean age=14.9 years) and then reassessed after five years (T3) using telephone interviews and questionnaires. There were 265 subjects tested with a participation rate of 76.9%. The results indicated that cognitive symptoms were predominant among suicide attempters, regardless of age. Among younger adolescents, suicidal thoughts and acts of self-harm without suicidal intent were associated with suicidal acts. Recurrent thoughts about death, hopelessness, disturbed concentration and middle insomnia were associated with suicidal acts among older adolescents. Perceived worthlessness by the age of 15 was a significant predictor of suicidal acts between 15 to 20 years.  Major depression was significantly associated with suicidal acts among younger adolescents, while dysthymia by the age of 15 years remained a significant predictor of suicidal acts between 15 to 20 years, even when controlling for depressive symptoms. The authors conclude that acts of self-harm without suicidal intent, middle insomnia, cognitive depressive symptoms and a formal psychiatric diagnosis of any depressive disorder should alert professionals in the risk assessment of suicidal adolescents.

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Indian Health Ministry Reports 16,000 Student Suicides In The Past Three Years

A representative of India’s Health Ministry has reported that over 16,000 school and college students in India have committed suicide in the last three years and announced plans to deal with the problem by reforming the national health care system.

According to the ministry, there were 5,857 student suicides in 2006, 5,138 in 2005 and 5,610 in 2004. While some private schools have started providing counselors to address the problem, government-run schools have been slow to follow suit.

Cherian Verghese, a specialist with the Indian branch of the World Health Organization, said: "The mental health system needs an overhaul. Our schools might be giving good education but we need education in life skills. From counseling to increasing the number of mental health workers, the strategy should be holistic.  Students are a vulnerable group. Age, competition and relations in the family are all contributing to the growing cases of suicide among school goers”.

"There is a gamut of problems; India lacks the required number of psychiatrists as well. The social taboo around mental health also fuels the problem. A country which houses a huge number of youngsters must not take mental health lightly," Verghese added.

Potential factors that have limited greater access to counseling include social stigma surrounding mental illness, the high doctor-patient ratio, and societal pressures. Despite India’s burgeoning population, there are only 3,500 psychiatrists for a population of more than a billion people.

The health ministry is planning to modernize psychiatric hospitals, expand community mental health services, and introduce counseling in schools.

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Casualties of War

The Winter issue of Perspectives in Biology and Medicine presents a thoughtful overview on war and its casualties. Throughout America's first 145 years of war, far more of the country's military personnel died from infectious diseases than from combat injuries. This only began to change in World War II due to better methods of disease prevention and treatment. The authors suggested that soldier deaths throughout U.S. history can be divided into a Disease Era (1775-1918), during which infectious diseases were the major killer of America's armed forces, and a Trauma Era (1941-present), in which combat-related injuries were the major cause of fatalities. Using the 3,400 U.S. military fatalities in Iraq as a comparison, suicide deaths have become more prevalent than deaths from infectious disease.  Given the rising rate of suicides in U.S. soldiers posted overseas, this trend is not expected to change.

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Bizarre Suicide by Psychiatrist Mimics Patient Death

It was on February 14 when staff members at Pavlov Mental Hospital in Kolkata, India discovered the body of Dr. Dipankar Choudhury in the hospital duty room. The 52-year old psychiatrist had apparently strangled himself by tying his muffler to the door handle. The circumstances under which the body was found was identical to a suicide that had been committed by one of his patients in early January. A colleague reported that Dr. Choudhury had been shaken by his patient's suicide but there is no indication that his own suicide was pre-planned.

While he had been visibly depressed in the weeks leading up to his suicide, it is not known if he was on medication at the time of his death. The body was discovered after his wife contacted to hospital to express her concern over a call that he had made to her that evening. An alert was sounded after the duty room was found locked from the inside.

He is survived by his wife and three children and had been working at Pavlov Mental Hospital for three years.

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Chronic Pain in Elderly Patients

In the November 2007 issue of the International Journal of Geriatric Psychiatry, an article presents the result of a study examining chronic pain in depressed geriatric inpatients.  By examining the medical charts of patients who were admitted to a geriatric psychiatric unit over a two year period, 148 patients with a depressive disorder were identified. Of these depressed patients, 62% of patients were found to reports problems with chronic pain. Further analysis found that depressed older adults with chronic pain were more likely to report suicidal ideation, be diagnosed with personality disorder, have chronic care needs, and experience less total sleep time compared to depressed older adults without chronic pain. The results match those of previous studies identifying chronic pain as a possible suicide risk factor in the elderly, particularly when depression is involved.  : Chronic pain-common in depressed older adults-may influence clinical features of depression and should be assessed as a possible suicide risk factor. Prospective studies should examine causal relationships and determine the effects of adequate pain treatment on depression course and suicide risk in older adults.

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Does Childhood Suicidal Thinking Predict Later Suicide?

An article in the November 2007 issue of the Journal of the American Academy of Child and Adolescent Psychiatry presents the results of a longitudinal study examining whether childhood suicidal thinking is related to mental health problems in adulthood. The study sample was made up of 1,022 Dutch children who were 11 years or younger in 1983 and who were followed over 10 to 14 years into adulthood. The study participants were assessed with a structured psychiatric interview to identify potential adult mental health problems including substance abuse, mental illness, and suicidal behaviour. Childhood suicidal thing was identified using using parental reports of suicidal thinking. The results indicated that childhood suicidal thinking was highly predictive of suicide ideation in adulthood and lifetime history of suicide attempts. Childhood suicidal thinking was also associated with an increased likelihood of mood disorder and anxiety disorder in adulthood as well as externalizing disorders such as ADHD, conduct disorder and behavioural syndromes. The authors conclude that suicidal thinking in childhood may be remain stable over time with worrying consequences in adulthood. Children with parent-reported suicide ideation at a young age may require additional resources, age-appropriate intervention, and careful monitoring into adulthood.

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Does Tamiflu Cause Suicide?

Chugai Pharmaceutical Company the Japanese manufacturer and distributer of the antiviral drug, Tamiflu, has announced that it will curb supply of the drug following a warning by the Japanese government that Tamiflu use should be avoided in teenagers. Tamiflu was first developed by Gilead Sciences under the name Oseltamivir and is currently marketed by Hoffman-LaRoche. It is a prescription-only agent used in the prevention and treatment of influenzaviruses A and B and governments around the world have been stockpiling it due to pandemic fears. An estimated 50 million people have been treated around the world with the majority of cases being in Japan. The Japanese government issued the warning following reports that adolescents treated with Tamiflu have been experiencing delirium, seizures and self-harm attempts.

While concern has focused primarily on teenagers, patients in other age groups have reported problems as well. According to Japan's Health Ministry, between 2004 and 2007, fifteen people aged 10 to 19 have been injured or killed in apparent suicide attempts following Tamiflu use. Since 2001, approximately 128 patients reported abnormal behaviour after being treated with Tamiflu. While Hoffman-LaRoche denied a causal link, the U.S. Food and Drug Administration amended the warning label for Tamiflu to include possible delirium and psychiatric symptoms. Research is ongoing although Tamiflu is still viewed as part of a comprehensive front-line defense against future pandemics.

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Schizophrenia and Suicide

The July 2007 issue of the Journal of Forensic Sciences presents the results of a retrospective study examining Medical Examiner cases of suicide in the state of Kentucky over a 10-year period (1993-2002).  Previous research examining incidence of suicide in schizophrenics determined that an estimated 10-13 percent of schizophrenics commit suicide.  Based on study results, the majority of cases were male (62.1 percent) and the average age at time of death was 41.6 years.  Firearm injury was the leading cause of death for both males and females (48.3 percent) followed by overdose (20.7 percent) and hanging (13.8%).  The researchers discuss their findings in terms of biopsychosocial factors that lead to suicide and the need for careful psychological autopsies to examine ways to prevent suicide in high-risk populations. 

Click here for the abstract.  The full journal article is also available for subscribers.