Observed/expected (standardized mortality ratio)

Risk ratio (RR) and odds ratio (OR) 1.0 - the groups are even 1.7 – the target group is at 70% greater risk 0.8 – the target group is at lower risk

Population attributable risk

Baldessarini and Hennen (2004) Examined genetics of suicide through several

comparisons Close relative attempted or died by suicide: OR =

5.01 Weighting study sizes and variances: OR = 2.86

MZ vs DZ twins concordance for suicide/attempts MZ 401/1,704 = 23.5% DZ 2/1,486 = 0.135% 175 times greater risk (may be an over-estimate) Weighting study sizes and variances: OR = 2.86

Adoptive studies: RR =4.84 Data from molecular genetic studies mixed

First, caveat about imaging studies Rely on correlations, like much of our research

Correlations can be very telling and informative, or sometimes can lead us astray. Some fun examples from Buzzfeed:

http://www.buzzfeed.com/kjh2110/the-10-most-bizarre-correlations

Van Heeringen, Gijttebier, & Godfrin, 2011 Reviewed brain imaging studies examining

suicide attempts Orbitofrontal and dorsolateral prefrontal

cortex Decision-making and problem solving

Sensitivity to social disapproval Choosing options with high immediate rewards Reduced ability to generate positive future events

White Matter Hyperintensities (WMH) Associated with 2.5 – 3 times greater risk of

depression or bipolar Those who were depressed and had WMH were

18.6 times more likely to have had a prior suicide attempt (Ehrlich et al., 2004).

Serotonin and suicide Lower tryptophan trapping (serotonin synthesis)

in those with suicide intent Less 5-HT2a receptor binding in prefrontal cortex

(esp. dorsolateral prefrontal) in suicide attempters

Larger right amygdala volume

Stroke (Pompili et al., 2012) Kidney Disease and Dialysis (Pompili, et

al., 2013) Cancer (2X greater risk than general

population; Anguiano, et al., 2012) Diabetes Type 1 (Pompili, et al., 2014) Dementia (Data mixed; Haw et al., 2009)

International Statistical Classification of Diseases and Related Health Problems (ICD-10) Author: World Health Organization Contains all health disorders Often preferred by those outside the U.S,public health and epidemiological researchers

Diagnostic and Statistical Manual of Mental Disorders (DSM 5) Author: American Psychiatric Association Contains only mental health disorders Often used by U.S. mental health providers

Two weeks or more of 5 or more of the following: Depressed mood most of the day, nearly every

day Markedly diminished interest or pleasure in

previously interesting or pleasurable things Significant weight loss or gain without trying Insomnia Psychomotor retardation or agitation Fatigue and loss of energy Feelings of worthlessness Inability to think or concentrate/indecisiveness Recurrent thoughts of death or suicidal ideation

Increases the likelihood of suicidal behavior by more than 33 times (Beautrais, 1996)

The severity of depressive symptoms are positively correlated with suicide risk

Unipolar Depression vs. Bipolar

Manic Episode A period of abnormally elevated mood lasting at

least 1 week with three or more of the following inflated self-esteem or grandiousity decreased need for sleep more talkative than usual or pressure to keep talking flight of ideas distractability increase in goal-directed activity or psychomotor

agitation excessive involvement in pleasurable activities that

have a high potential for painful consequences

Bipolar I and Suicide 80% report suicidal ideation, and 51% report a

suicide attempt (Valtonen, et al., 2005) 15% - 19% die by suicide (de Abreu, et al.,

2009)

Not all bad news: Lithium, a common treatment for bipolar disorder, is one of the few medications that has been shown to reduce suicide risk (Tondo, Hennen, & Baldessarini, 2001)

It has long been held that 40 – 60% of those who died by suicide were intoxicated at the time of death Very recent review found that 73% of suicide

decedents had BACs of 0.00% (Anestis, et al., In Press, Abnormal Psychology)

Research suggests that alcohol dependence puts individuals at between 6 and 25 times greater risk of suicide

DSM Criteria: Schizophrenia Two or more of the following, each present

during a significant portion of a 1 month period delusions hallucinations disorganized speech grossly disorganized or catatonic behavior negative symptoms (e.g. affective flattening)

Associated with increased risk of suicide, especially for those with greater cognitive impairment due to the disease

Those with paranoid schizophrenia diagnoses are also at higher risk

Literature on anxiety disorder and panic disorder is mixed. Some evidence for a link in children, no recent review for adults.

PTSD has been shown to be associated with suicide OR = 9.8 OR controlling for other disorders and

demographics = 5.3 (Gradus et al., 2010)

Cluster A (odd or eccentric) Paranoid, Schizoid, Schizotypal

Cluster B (dramatic and erratic) Antisocial, Borderline, Histrionic, Narcissistic

Cluster C (anxious and fearful) Avoidant, Dependent, Obsessive-Compulsive

Estimates are that as high as 80% of individuals who meet criteria for Borderline Personality Disorder demonstrate suicide related behaviors (Linehan, et al., 2006)

Between 4 – 9% die by suicide (Linehan, et al., 2006; Zanarini, et al., 2005)

Examined insomnia symptoms, nightmares and a measure of suicide risk

Sample: 165 suicide attempters in Sweden

Results: Nightmares related with suicide risk (OR: 4.9) Nightmares remain significantly associated

with suicide risk (OR: 3.0) after controlling for depression, anxiety, PTSD, and substance abuse

2-year follow-up to see whether nightmares predict future suicide attempts

Hospital records used to detect suicide attempts

Results: Nightmares predicted suicide attempts (OR =

5.2) Nightmares were still predictive after

controlling for depression, anxiety, PTSD, and substance abuse disorders (OR = 4.18)

Having two or more mental disorders increases one’s risk of death by suicide 169.6 times!

In a sample of medically-serious suicide attempters, Beautrais and colleagues (1996) found that 56.6% had more than one diagnosis OR with one disorder: 17.4 OR with two or more: 89.7