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Is lethality different between males and females? Clinical and gender differences in inpatients suicide attempters
- I. Berardelli, E. Rogante, S. Sarubbi, D. Erbuto, M. Cifrodelli, C. Concolato, M. Pasquini, D. Lester, M. Innamorati, M. Pompili
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S315-S316
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Introduction
According to the gender paradox,in suicidology an important sex difference has been reported with a preponderance of females in nonfatal suicidal behavior and a preponderance of males in completed suicide.The lethality of suicidal behavior in females is lower most likely because males choose more violent suicide methods.Furthermore,women more frequently present traditional risk factors for suicide than do men,including depression,childhood sexual abuse, and prior suicidal ideation and attempts.
ObjectivesThe purpose of this study was to explore possible clinical differences between male and female psychiatric inpatients who had recently attempted suicide.We hypothesized that clinical characteristics such as psychiatric diagnosis,the methods and lethality of the suicide attempt,the history of suicide attempts,age at onset of psychiatric illness,the presence of substance or alcohol use and the length of stay differ between male and female suicide attempters.
MethodsThe study included 177 adult inpatients at the University Psychiatric Clinic, Sant’Andrea Hospital, Sapienza University of Rome hospitalized following a suicide attempt, between January 2018 and May 2022.Clinical features assessed included psychiatric diagnosis, method and lethality of suicide attempts using the Risk-Rescue Rating Scale, the history of suicide attempts, age at onset of psychiatric illness, the presence of substance or alcohol use, and the length of stay.All statistical analyses were performed with the Statistical Package for Social Sciences(SPSS 27.0).
ResultsMales and females differed according to the method used for suicide attempt(x23=10.96,p<0.05),the scores for risk and rescue(t175=2.55,p<0.05;t146.6=-1.99,p<0.05,respectively),and the length of stay(U= 3084.5,p<0.05).Females were more likely to use drug/poisoning ingestion as method for suicide attempt than were males(72.8% vs.51.4%),whereas males were more likely to use hanging than were females(20.3% vs. 6.8%).The risk score was higher for males(3.76±0.68)than for females(3.49±0.72),and the rescue score was higher for females than for males(2.79±1.09 vs. 2.43±1.22).Finally,the length of stay was longer for males than for females(10.66±8.09 vs. 8.25±6.48).These results confirm the role of difference in suicide methods used by males and females for explaining the “gender paradox.”
ConclusionsThe present study illustrates the usefulness of the Risk-Rescue Rating Scale which is a descriptive and quantitative method of assessing the lethality of suicide attempts.Identifying sex related characteristics of suicide risk in patients is important for implementing specific suicide prevention strategies to reduce suicidal intent, psychological pain and rehospitalization in patients with psychiatric disorders.Men and women may need different strategies for the prevention of future suicidal behavior.
Disclosure of InterestNone Declared
Mental pain and depressive symptoms in the determination of suicidal ideation among psychiatric patients
- E. Rogante, S. Sarubbi, D. Erbuto, M. A. Trocchia, S. P. Iancau, F. Manfreda, F. Splendori, M. Tinè, A. V. Vallerga, L. Longhini, I. Berardelli, M. Innamorati, M. Pompili
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S500
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Introduction
Though the literature suggests a strong association between depressive symptoms and suicidal ideation, in clinical practice, it is often observed that many patients who show those symptoms, even the most severe, do not experience suicidal ideation. Thus, the association between depressive symptoms and suicidal ideation is insufficient to explain the complexity behind suicide. From Shneidman’s point of view, the common feature in patients with suicidal ideation and suicidal behavior seems to be mental pain, defined by the author as “psychache” and characterized by a distressed state of mind, in which the subject experiences extreme angst, hopelessness and in which pain is seen as unsolvable. Individuals with depressive symptoms are suicidal only when psychache is so unbearable that suicide is perceived as the only option.
ObjectivesOur study aimed to investigate the association among depressive symptoms, mental pain, and recent suicidal ideation, specifically whether mental pain could mediate the relationship between depressive symptoms and current suicidal ideation in a sample of psychiatric patients.
MethodsParticipants were 206 adult patients (49.5% females). Patients were assessed for psychiatric diagnoses according to DSM-5. For the study, the following instruments were administered: the Columbia-Suicide Severity Rating Scale (C-SSRS), the Beck Depression Inventory-2 (BDI-2), and the Orbach & Mikulincer Mental Pain Questionnaire (OMMP).
Results32.5% of the patients had bipolar disorder, 21.4% had MDD, 24.8% had schizophrenia or other psychotic disorders, and 15% had a personality disorder. About 34% of the patients reported recent suicidal ideation with at least some intent to act. Recent suicidal ideation was associated with both mental pain and depressive symptoms, but mental pain completely mediated the association between depression and suicidal ideation (β=.04, SE=.01, 95% CI (.01/.06).
ConclusionsOur study indicated that patients with more severe depressive symptoms are more likely to report suicidal ideation and that the presence of mental pain could explain this association thoroughly. Thus, in clinical practice, the identification of mental pain confirms its crucial role in the assessment of suicide risk and in the understanding of the individual’s unique pain.
Disclosure of InterestNone Declared
Are demoralization and insight involved in suicide risk? An observational study on psychiatric inpatients
- I. Berardelli, M. Innamorati, S. Sarubbi, E. Rogante, D. Erbuto, A. Costanza, A. Del Casale, M. Pasquini, D. Lester, M. Pompili
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S174
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Introduction
Although several authors have investigated the relationship between demoralization, insight, and suicide risk, the role of these factors in determining suicide risk in patients with psychiatric disorders is still unclear [Berardelli et al., 2019; Costanza et al., 2020].
ObjectivesThe main aim of this study was therefore to determine whether suicide risk was associated with better insight and worse demoralization in a sample of 100 adult psychiatric inpatients.
MethodsThe study was performed on 100 psychiatric hospitalized adult patients consecutively enrolled between January 2019 and April 2020 at psychiatric units of Sant’Andrea Medical Center, Sapienza University of Rome. The Columbia Suicide Severity Rating Scale (C-SSRS) was used to assess suicide risk, Demoralization was assessed using the Demoralization Scale (DS) [Kissane et al., 2004] and for the assessment of insight we used the The Insight Scale (IS).
ResultsOnly age was significantly associated with higher suicide risk (χ2=9.07, p<0.01). The variable mood disorder was significantly associated with higher suicide risk (χ22=7.50, p<0.05). Non-suicidal self-harm behaviors in the last 3 months (χ2=5.89, p<0.05) and lifetime suicide attempts (χ2=21.80, p<0.001) were significantly associated with higher suicide risk. Only the insight-high dimension (χ2=8.01, p<0.01) and lifetime suicide attempts (χ2=12.33, p<0.001) were significantly associated with higher suicide risk.
ConclusionsOur results don’t confirm the role of demoralization in suicide risk. In our sample of patients, only high insigth of illness and other psychological variables are involved in suicide risk.
DisclosureNo significant relationships.