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Medicina
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Preventing Suicide in Patients with Mental Disorders
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Preventing Suicide in Patients with Mental Disorders

A special issue of Medicina (ISSN 1648-9144).

Deadline for manuscript submissions: closed (31 August 2019) | Viewed by 112384

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Prof. Dr. Maurizio Pompili

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Guest Editor
Suicide Prevention Centre, Department of Neurosciences, Mental Health and Sensory Organs, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
Interests: suicide and suicide prevention; public health; well-being; youth mental health
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Andrea Fiorillo

E-Mail Website
Guest Editor
Department of Psychiatry, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
Interests: clinical psychiatry; epidemiology; social psychiatry; early intervention in mental health; promotion of mental health
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Suicide is a multi-factorial, highly prevalent clinical condition; it is estimated that every 30 seconds a person worldwide commits suicide. Moreover, it represents the second cause of death in adolescents, and it is becoming a major health problem, which requires the development and adoption of appropriate preventive strategies.

Suicide is a complex phenomenon that is now considered understood as a neurodevelopmental condition encompassing childhood experiences as well as proximal conditions such as mental disorders and adverse life events. Individuals in crisis may face overwhelming psychological pain, which in some cases may overcome the threshold of each unique individual for whom suicide is considered the best option to deal with such pain. However, many socio-demographic, personal, or temperamental variables have been investigated for their causal association with suicide risk, but to date no single factor has clearly demonstrated an association with suicide. The mental disorders most frequently associated with suicide risk include bipolar disorders and major unipolar depression, substance use disorders and schizophrenia. However, anxiety, personality, eating, and trauma-related disorders, as well as organic mental disorders, also contribute to suicidal risk. Moreover, in modern society, the presence of social uncertainty, the changes in family models, the development of social media, and the loss of face-to-face interaction can have an impact on suicide risk, particularly in the younger generation.

We are pleased to invite you and your co-workers to contribute to this Special Issue with original research reports, reviews, or meta-analyses on the topics of suicide and mental disorders, the social and personal burden of suicide, and the possible preventive strategies to be implemented for reducing suicidal risk for each mental disorder considered. All mental disorders as well as mental health problems associated with an increased risk of suicide can be considered for publication in this Special Issue.

Prof. Maurizio Pompili
Prof. Andrea Fiorillo
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Suicide
  • Non-suicidal self-injury
  • Suicidal behaviours
  • Mental disorders
  • Suicidality
  • Survivors
  • Hopelessness

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Published Papers (10 papers)

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Research

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12 pages, 333 KiB  
Article
Affective Temperaments and Clinical Course of Bipolar Disorder: An Exploratory Study of Differences among Patients with and without a History of Violent Suicide Attempts
by Giovanna Fico, Vito Caivano, Francesca Zinno, Marco Carfagno, Luca Steardo, Jr., Gaia Sampogna, Mario Luciano and Andrea Fiorillo
Medicina 2019, 55(7), 390; https://doi.org/10.3390/medicina55070390 - 19 Jul 2019
Cited by 22 | Viewed by 4629
Abstract
Background and Objectives: Suicide is the leading cause of death in patients with Bipolar Disorder (BD). In particular, the high mortality rate is due to violent suicide attempts. Several risk factors associated with suicide attempts in patients with BD have been identified. Affective [...] Read more.
Background and Objectives: Suicide is the leading cause of death in patients with Bipolar Disorder (BD). In particular, the high mortality rate is due to violent suicide attempts. Several risk factors associated with suicide attempts in patients with BD have been identified. Affective temperaments are associated with suicidal risk, but their predictive role is still understudied. The aim of this study is to assess the relationship between affective temperaments and personal history of violent suicide attempts. Materials and Methods: 74 patients with Bipolar Disorder type I (BD-I) or II (BD-II) were included. All patients filled in the short version of Munster Temperament Evaluation of the Memphis, Pisa, Paris and San Diego (short TEMPS-M) and the Temperament and Character Inventory, revised version (TCI-R). The sample was divided into two groups on the basis of a positive history for suicidal attempts and the suicidal group was further divided into two subgroups according to violent suicide attempts. Results: Violent suicide attempts were positively associated with the cyclothymic temperament and inversely to the hyperthymic one. BD-I patients and patients with a clinical history of rapid cycling were significantly more represented in the group of patients with a history of violent suicide attempts. Conclusions: Our study highlights that several clinical and temperamental characteristics are associated with violent suicide attempts, suggesting the importance of affective temperaments in the clinical management of patients with BPI. Full article
(This article belongs to the Special Issue Preventing Suicide in Patients with Mental Disorders)

Review

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8 pages, 606 KiB  
Review
Cytomegalovirus Seropositivity and Suicidal Behavior: A Mini-Review
by Marco Paolini, David Lester, Michael Hawkins, Ameth Hawkins-Villarreal, Denise Erbuto, Andrea Fiorillo and Maurizio Pompili
Medicina 2019, 55(12), 782; https://doi.org/10.3390/medicina55120782 - 12 Dec 2019
Cited by 1 | Viewed by 2668
Abstract
Background and objectives: In recent years, a growing body of research has focused on identifying possible biological markers for suicidal behavior, including infective and immunological markers. In this paper, our aim was to review available evidence concerning the association between cytomegalovirus (CMV) [...] Read more.
Background and objectives: In recent years, a growing body of research has focused on identifying possible biological markers for suicidal behavior, including infective and immunological markers. In this paper, our aim was to review available evidence concerning the association between cytomegalovirus (CMV) infection and suicide. Materials and Methods: A systematic search according to the PRISMA statement was performed on Pubmed. After the screening procedure, we identified five relevant papers. Results: We found inconsistent evidence linking CMV infection and suicide, with some papers reporting an association between CMV seropositivity and suicidal behavior, and others not finding the association. Conclusions: With the evidence available presently, it is not possible to infer whether there is a correlation between suicide and CMV infection. Full article
(This article belongs to the Special Issue Preventing Suicide in Patients with Mental Disorders)
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23 pages, 571 KiB  
Review
Rational Suicide in Late Life: A Systematic Review of the Literature
by Carla Gramaglia, Raffaella Calati and Patrizia Zeppegno
Medicina 2019, 55(10), 656; https://doi.org/10.3390/medicina55100656 - 29 Sep 2019
Cited by 19 | Viewed by 6218
Abstract
Background and Objectives: The complex concept of rational suicide, defined as a well-thought-out decision to die by an individual who is mentally competent, is even more controversial in the case of older adults. Materials and Methods: With the aim of better [...] Read more.
Background and Objectives: The complex concept of rational suicide, defined as a well-thought-out decision to die by an individual who is mentally competent, is even more controversial in the case of older adults. Materials and Methods: With the aim of better understanding the concept of rational suicide in older adults, we performed a systematic review of the literature, searching PubMed and Scopus databases and eventually including 23 published studies. Results: The main related topics emerging from the papers were: depression, self-determination, mental competence; physicians’ and population’s perspectives; approach to rational suicide; ageism; slippery slope. Conclusions: Despite contrasting positions and inconsistencies of the studies, the need to carefully investigate and address the expression of suicidal thoughts in older adults, as well as behaviours suggesting “silent” suicidal attitudes, clearly emerges, even in those situations where there is no diagnosable mental disorder. While premature conclusions about the “rationality” of patients’ decision to die should be avoided, the possibility of rational suicide cannot be precluded. Full article
(This article belongs to the Special Issue Preventing Suicide in Patients with Mental Disorders)
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18 pages, 528 KiB  
Review
The Meaning in Life in Suicidal Patients: The Presence and the Search for Constructs. A Systematic Review
by Alessandra Costanza, Massimo Prelati and Maurizio Pompili
Medicina 2019, 55(8), 465; https://doi.org/10.3390/medicina55080465 - 11 Aug 2019
Cited by 54 | Viewed by 5913
Abstract
Background and Objectives: Research on suicidal behavior (SB) has frequently focused more on risk factors than protective factors. Since the historic works of Viktor E. Frankl, who inquired how some Nazi concentration camps prisoners maintained their will to live though confronted with pervasive [...] Read more.
Background and Objectives: Research on suicidal behavior (SB) has frequently focused more on risk factors than protective factors. Since the historic works of Viktor E. Frankl, who inquired how some Nazi concentration camps prisoners maintained their will to live though confronted with pervasive absurdity, Meaning in Life (MiL) has been interpreted as a potent resiliency factor. MiL then declined along a multitude of theoretical perspectives and was associated with various functioning domains of the individual. Surprising, few studies investigated the role of MiL on SB. We aimed to review and synthetize current literature on possible associations between MiL and SB, which included suicidal ideation (SI), suicidal attempts (SA), and completed suicide, focusing on two MiL constructs (the presence of MiL and search for MiL) from the Michael F. Steger’s recent conceptualization. Material and Methods: A systematic strategy following PRISMA guidelines was used to search for relevant articles in Pubmed/MEDLINE, Scopus, PsycINFO, and ScienceDirect (January 1980–February 2019) and yielded 172 articles, 37 of which met our inclusion criteria. Results: MiL emerged as a protective factor against SI, SA, and completed suicides, directly or through mediation/moderation models with other SB-related variables. When distinguishing the presence of MiL and the search for MiL, a consensual protective impact was described for the former. Data for the latter were less consistent but rather oriented towards a non-protective impact Conclusions: These findings could have clinical repercussions for SB prevention, in both suicide risk assessment refinement and psychotherapeutic interventions. Further research is needed to examine the dynamic interplay of the two constructs. Full article
(This article belongs to the Special Issue Preventing Suicide in Patients with Mental Disorders)
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14 pages, 2114 KiB  
Review
Can Anhedonia Be Considered a Suicide Risk Factor? A Review of the Literature
by Luca Bonanni, Flavia Gualtieri, David Lester, Giulia Falcone, Adele Nardella, Andrea Fiorillo and Maurizio Pompili
Medicina 2019, 55(8), 458; https://doi.org/10.3390/medicina55080458 - 9 Aug 2019
Cited by 40 | Viewed by 6028
Abstract
Background and Objectives: At present, data collected from the literature about suicide and anhedonia are controversial. Some studies have shown that low levels of anhedonia are associated with serious suicide attempts and death by suicide, while other studies have shown that high [...] Read more.
Background and Objectives: At present, data collected from the literature about suicide and anhedonia are controversial. Some studies have shown that low levels of anhedonia are associated with serious suicide attempts and death by suicide, while other studies have shown that high levels of anhedonia are associated with suicide. Materials and Methods: For this review, we searched PubMed, Medline, and ScienceDirect for clinical studies published from 1 January 1990 to 31 December 2018 with the following search terms used in the title or in the abstract: “anhedonia AND suicid*.” We obtained a total of 155 articles; 133 items were excluded using specific exclusion criteria, the remaining 22 articles included were divided into six groups based on the psychiatric diagnosis: mood disorders, schizophrenia spectrum disorders, post-traumatic stress disorder (PTSD), other diagnoses, attempted suicides, and others (healthy subjects). Results: The results of this review reveal inconsistencies. Some studies reported that high anhedonia scores were associated with suicidal behavior (regardless of the diagnosis), while other studies found that low anhedonia scores were associated with suicidal behavior, and a few studies reported no association. The most consistent association between anhedonia and suicidal behavior was found for affective disorders (7 of 7 studies reported a significant positive association) and for PTSD (3 of 3 studies reported a positive association). In the two studies of patients with schizophrenia, one found no association, and one found a negative association. For patients who attempted suicide (undiagnosed), one study found a positive association, one a positive association only for depressed attempters, and one a negative association. Conclusions: We found the most consistent positive association for patients with affective disorders and PTSD, indicating that the assessment of anhedonia may be useful in the evaluation of suicidal risk. Full article
(This article belongs to the Special Issue Preventing Suicide in Patients with Mental Disorders)
8 pages, 296 KiB  
Review
Suicide Risk in Bipolar Disorder: A Brief Review
by Peter Dome, Zoltan Rihmer and Xenia Gonda
Medicina 2019, 55(8), 403; https://doi.org/10.3390/medicina55080403 - 24 Jul 2019
Cited by 149 | Viewed by 18871
Abstract
Bipolar disorders (BDs) are prevalent mental health illnesses that affect about 1–5% of the total population, have a chronic course and are associated with a markedly elevated premature mortality. One of the contributors for the decreased life expectancy in BD is suicide. Accordingly, [...] Read more.
Bipolar disorders (BDs) are prevalent mental health illnesses that affect about 1–5% of the total population, have a chronic course and are associated with a markedly elevated premature mortality. One of the contributors for the decreased life expectancy in BD is suicide. Accordingly, the rate of suicide among BD patients is approximately 10–30 times higher than the corresponding rate in the general population. Extant research found that up to 20% of (mostly untreated) BD subjects end their life by suicide, and 20–60% of them attempt suicide at least one in their lifetime. In our paper we briefly recapitulate the current knowledge on the epidemiological aspects of suicide in BD as well as factors associated with suicidal risk in BD. Furthermore, we also discuss concisely the possible means of suicide prevention in BD. Full article
(This article belongs to the Special Issue Preventing Suicide in Patients with Mental Disorders)
11 pages, 345 KiB  
Review
Suicide in Schizophrenia: An Educational Overview
by Leo Sher and René S. Kahn
Medicina 2019, 55(7), 361; https://doi.org/10.3390/medicina55070361 - 10 Jul 2019
Cited by 140 | Viewed by 20469
Abstract
Suicide is an important public health problem. The most frequent psychiatric illnesses associated with suicide or severe suicide attempt are mood and psychotic disorders. The purpose of this paper is to provide an educational overview of suicidal behavior in individuals with schizophrenia. A [...] Read more.
Suicide is an important public health problem. The most frequent psychiatric illnesses associated with suicide or severe suicide attempt are mood and psychotic disorders. The purpose of this paper is to provide an educational overview of suicidal behavior in individuals with schizophrenia. A lifetime suicide rate in individuals with schizophrenia is approximately 10%. Suicide is the largest contributor to the decreased life expectancy in individuals with schizophrenia. Demographic and psychosocial factors that increase a risk of suicide in individuals with schizophrenia include younger age, being male, being unmarried, living alone, being unemployed, being intelligent, being well-educated, good premorbid adjustment or functioning, having high personal expectations and hopes, having an understanding that life’s expectations and hopes are not likely to be met, having had recent (i.e., within past 3 months) life events, having poor work functioning, and having access to lethal means, such as firearms. Throughout the first decade of their disorder, patients with schizophrenia are at substantially elevated suicide risk, although they continue to be at elevated suicide risk during their lives with times of worsening or improvement. Having awareness of symptoms, especially, awareness of delusions, anhedonia, asociality, and blunted affect, having a negative feeling about, or non-adherence with, treatment are associated with greater suicide risk in patients with schizophrenia. Comorbid depression and a history of suicidal behavior are important contributors to suicide risk in patients with schizophrenia. The only reliable protective factor for suicide in patients with schizophrenia is provision of and compliance with comprehensive treatment. Prevention of suicidal behavior in schizophrenia should include recognizing patients at risk, delivering the best possible therapy for psychotic symptoms, and managing comorbid depression and substance misuse. Full article
(This article belongs to the Special Issue Preventing Suicide in Patients with Mental Disorders)
6 pages, 267 KiB  
Review
Suicidality in Borderline Personality Disorder
by Joel Paris
Medicina 2019, 55(6), 223; https://doi.org/10.3390/medicina55060223 - 28 May 2019
Cited by 136 | Viewed by 32691
Abstract
Borderline personality disorder (BPD) is associated with suicidal behaviors and self-harm. Up to 10% of BPD patients will die by suicide. However, no research data support the effectiveness of suicide prevention in this disorder, and hospitalization has not been shown to be useful. [...] Read more.
Borderline personality disorder (BPD) is associated with suicidal behaviors and self-harm. Up to 10% of BPD patients will die by suicide. However, no research data support the effectiveness of suicide prevention in this disorder, and hospitalization has not been shown to be useful. The most evidence-based treatment methods for BPD are specifically designed psychotherapies. Full article
(This article belongs to the Special Issue Preventing Suicide in Patients with Mental Disorders)
18 pages, 539 KiB  
Review
The Role of Demoralization and Hopelessness in Suicide Risk in Schizophrenia: A Review of the Literature
by Isabella Berardelli, Salvatore Sarubbi, Elena Rogante, Michael Hawkins, Gabriele Cocco, Denise Erbuto, David Lester and Maurizio Pompili
Medicina 2019, 55(5), 200; https://doi.org/10.3390/medicina55050200 - 23 May 2019
Cited by 38 | Viewed by 5771
Abstract
Background and Objectives: Demoralization has been defined by hopelessness and helplessness attributable to a loss of purpose and meaning in life. Demoralization is a meaningful mental health concern, frequently associated with suicide risk in medical and psychiatric patients. The aim of this systematic [...] Read more.
Background and Objectives: Demoralization has been defined by hopelessness and helplessness attributable to a loss of purpose and meaning in life. Demoralization is a meaningful mental health concern, frequently associated with suicide risk in medical and psychiatric patients. The aim of this systematic review was to synthesize the recent empirical evidence on demoralization in patients with schizophrenia and to better understand the relationship between demoralization and suicide risk in patients with schizophrenia. Methods: A comprehensive literature search using key words and subject headings was performed following PRISMA guidelines with several bibliographic databases, resulting in the identification of 27 studies. Results: The findings suggested that demoralization is prevalent in patients with schizophrenia and supported the hypothesis that the association between depression and suicide is moderated by hopelessness. In clinical practice, it is important to recognize symptoms of demoralization using appropriate psychological tools to better understand the suffering of patients with schizophrenia and to implement suicide prevention programs. Full article
(This article belongs to the Special Issue Preventing Suicide in Patients with Mental Disorders)
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Other

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14 pages, 314 KiB  
Opinion
Psychotherapy with Suicidal Patients: The Integrative Psychodynamic Approach of the Boston Suicide Study Group
by Mark Schechter, Elsa Ronningstam, Benjamin Herbstman and Mark J. Goldblatt
Medicina 2019, 55(6), 303; https://doi.org/10.3390/medicina55060303 - 24 Jun 2019
Cited by 18 | Viewed by 7710
Abstract
Psychotherapy with suicidal patients is inherently challenging. Psychodynamic psychotherapy focuses attention on the patient’s internal experience through the creation of a therapeutic space for an open-ended exploration of thoughts, fears, and fantasies as they emerge through interactive dialogue with an empathic therapist. The [...] Read more.
Psychotherapy with suicidal patients is inherently challenging. Psychodynamic psychotherapy focuses attention on the patient’s internal experience through the creation of a therapeutic space for an open-ended exploration of thoughts, fears, and fantasies as they emerge through interactive dialogue with an empathic therapist. The Boston Suicide Study Group (M.S., M.J.G., E.R., B.H.), has developed an integrative psychodynamic approach to psychotherapy with suicidal patients based on the authors’ extensive clinical work with suicidal patients (over 100 years combined). It is fundamentally psychodynamic in nature, with an emphasis on the therapeutic alliance, unconscious and implicit relational processes, and the power of the therapeutic relationship to facilitate change in a long-term exploratory treatment. It is also integrative, however, drawing extensively on ideas and techniques described in Dialectical Behavioral Therapy (DBT), Mentalization Based Treatment (MBT), Cognitive-Behavioral Therapy (CBT), as well on developmental and social psychology research. This is not meant to be a comprehensive review of psychodynamic treatment of suicidal patients, but rather a description of an integrative approach that synthesizes clinical experience and relevant theoretical contributions from the literature that support the authors’ reasoning. There are ten key aspects of this integrative psychodynamic treatment: 1. Approach to the patient in crisis; 2, instilling hope; 3. a focus on the patient’s internal affective experience; 4. attention to conscious and unconscious beliefs and fantasies; 5. improving affect tolerance; 6. development of narrative identity and modification of "relational scripts"; 7. facilitation of the emergence of the patient’s genuine capacities; 8. improving a sense of continuity and coherence; 9 attention to the therapeutic alliance; 10. attention to countertransference. The elements of treatment are overlapping and not meant to be sequential, but each is discussed separately as an essential aspect of the psychotherapeutic work. This integrative psychodynamic approach is a useful method for suicide prevention as it helps to instill hope, provides relational contact and engages the suicidal patient in a process that leads to positive internal change. The benefits of the psychotherapy go beyond crisis intervention, and include the potential for improved affect tolerance, more fulfilling relational experiences, emergence of previously warded off experience of genuine capacities, and a positive change in narrative identity. Full article
(This article belongs to the Special Issue Preventing Suicide in Patients with Mental Disorders)
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