Suicidal Behaviours in Sickle Cell Patients at the Douala Sickle Cell Care Centre in Cameroon

Introduction: Sickle cell anaemia is a hereditary disease that combines physical and psychological manifestations, including suicidal tendencies. So far, to our knowledge, no study has been conducted on suicidal behaviours among people with sickle cell disease in Cameroon. This is what justifies our study on the prevalence and factors related to suicidal behaviors in our study population. Methods: We conducted a cross-sectional, analytical study of 171 sickle cell patients aged from 12 years upwards who came to the sickle cell disease care service of the Laquintinie Hospital in Douala, over a period of 6 months, that is, from 1 January to 31 June 2022. Data were collected using a structured questionnaire with questions on suicidal behaviours based on the “MINI” (Mini International Neuropsychiatric Interview). The data were processed using the SPSS 26.0 software. The related factors were studied in both a bivariate and multivariate analysis. Results: Female sickle cell patients accounted for 60.2% of the sample. The mean age was 23.36 ± 8.42 years. Suicidal ideation was prevalent in 56% of cases and 13% attempted suicide. The factors most associated with suicidal ideation were: primary level of education (OR = 0.08 (0.09 - 0.79);p = 0.03), feeling unworthy of life (OR = 0.40 (0.08 - 1.96);p = 0.02), not often being considered by those around them (OR = 2.97 (1.26 - 6.99);p = 0.01), lack of family support (OR = 0.34 (0.15 - 0.77);p = 0.01). Meanwhile, the factors associated with suicide attempts were: the fact of being rarely exposed to suicide-related media (OR = 4.17 (1.40 - 71.80);p = 0.03), and a constant feeling of sadness when returning home (OR = 18.02 (1.59 - 20.55);p = 0.01). Conclusion: More than half of sickle cell patients had had suicidal thoughts and 1/6 had made at least one suicide attempt, women and young adults being the most concerned. It is therefore necessary to ensure optimum psychological care for patients with sickle cell disease.

Risk factors for suicidal behaviour in late-life depression:A systematic review

BACKGROUND Suicide is a leading cause of preventable death worldwide,with its peak of maximum incidence in later life.Depression often puts an individual at higher risk for suicidal behaviour.In turn,depression deserves particular interest in old age due to its high prevalence and dramatic impact on health and wellbeing.AIM To gather integrated evidence on the potential risk factors for suicide behaviour development in depressive older adults,and to examine the effects of depression treatment to tackle suicide behaviour in this population.METHODS A systematic review of empirical studies,published from 2000 onwards,was conducted.Suicidal behaviour was addressed considering its varying forms(i.e.,wish to die,ideation,attempt,and completed suicide).RESULTS Thirty-five papers were selected for review,comprising both clinical and epidemiological studies.Most of studies focused on suicidal ideation(60%).The studies consistently pointed out that the risk was related to depressive episode severity,psychiatric comorbidity(anxiety or substance use disorders),poorer health status,and loss of functionality.Reduced social support and loneliness were also associated with suicide behaviour in depressive older adults.Finally,the intervention studies showed that suicidal behaviour was a robust predictor of depression treatment response.Reductions in suicidal ideation were moderated by reductions in risk factors for suicide symptoms.CONCLUSION To sum up,common and age-specific risk factors seem to be involved in suicide development in depressive older adults.A major effort should be made to tackle this serious public health concern so as to promote older people to age healthily and well.

Treatment priority for suicide ideation and behaviours at an Australian emergency department

AIM: To investigate the treatment priority given to selfharmers presenting to a hospital emergency department(ED) in Queensland, Australia, over the period 2005-2010. METHODS: The main outcome measure of this study was the treatment priority given to persons presenting with suicide ideation and communication(SIC) or self-harming behaviour. Treatment priority was measured using the Australasian Triage Scale, which ranks patients from 1(in need of immediate treatment) to 5(assessment and treatment to start within 120 min). Ordered logistic regression was used to assess the broad demographic and treatment-related factors associated with more urgent triage categories and to in-vestigate which methods of non-fatal suicidal behaviour(NFSB) were prioritised as most urgent.RESULTS: Most cases of NFSB were between 15 and 34 years. A larger proportion of persons presenting for SIC were aged 35 to 44 years. Over 50% of male presentations and 38% of female presentations were for SIC. Those cases prioritised as being more urgent had significantly greater odds of being older, presented after an act of self-harm rather than SIC, and had used multiple methods of NFSB. These individuals also had greater odds of being male and having made past presentations for SIC or NFSB. Among males, those presenting after ingestion of drugs had the greatest odds of receiving immediate attention compared to SIC. "Cutters" were considered as the least "urgent" subjects, and had a greatest risk of waiting 60 to 120 min for treatment compared to suicide ideators. Among females, those presenting with chemicals, poisons and gases had the greatest odds of receiving immediate attention compared to SIC. Females who presenting after cutting themselves had lower odds of receiving immediate treatment than those who presented with SIC. CONCLUSION: ED staff seems to judge the urgency of cases based on demographic factors such as age and gender, as well as method of NFSB.

On the Nature of Suicide—Suicide as a Multipurpose Behaviour Nested in the Human Mind—An Alternative View!

Suicide is a universal human phenomenon and seems to be a multipurpose behaviour which occurs in a number of different situations that not necessarily have to do with mental distress/disorder. It might as well be a kind of defence of a threatened self-image or revenge or punishment or weapon in a struggle for something more important than the own life. Is there a suicidal virus or meme nested in the human mind? Maybe it is the mere idea of suicide as an alternative way of dealing with a number of human dilemmas that should be the focus of our suicide preventive efforts? Suicide ideas are common in most populations, but ideas are just ideas. It is when the ideas—the suicidal thoughts—are converted to actions that they become dangerous. The focus for our suicide preventive work should be to counteract a destructive use of suicidal ideation. So, the crucial question is thus: how do we do that?

成年抑郁症患者非自杀性自伤行为及其动机的影响因素

目的探讨成年抑郁症患者非自杀性自伤行为及其动机的影响因素。方法采用简单随机抽样法选择2023年1~6月本院收治成年抑郁症患者120例作为研究对象,收集患者临床信息,评估其孤独感、挫败感及自伤动机,统计分析患者非自杀性自伤(non-suicidal self-injury,NSSI)行为及动机的影响因素。结果年龄、ULS-8评分、DS评分、婚姻情况、就业情况均为导致成年抑郁症患者存在NSSI的影响因素(P<0.05)。ULS-8评分、DS评分、婚姻情况(丧偶/离异)、就业情况均为导致成年抑郁症患者存在NSSI的独立危险因素(P<0.05)。ULS-8评分是患者以“情绪调节”为NSSI动机的独立危险因素,年龄、DS评分、就业情况(无业)是患者以“人际界限”为NSSI动机的独立危险因素(P<0.05)。结论成年抑郁症患者存在NSSI及NSSI动机的影响因素众多,且不同NSSI动机的影响因素各不相同,临床应通过详细调查明确患者实施NSSI的主要动机及相关影响因素,以为患者拟定针对性的干预策略。

脑电技术在抑郁症非自杀性自伤行为和自杀意念中研究进展

非自杀性自伤行为和自杀意念是抑郁症患者自杀未遂的重要危险因素。目前研究发现,两者在脑电特征上存在明显差异。脑电静息态分析发现伴自杀意念抑郁症患者Gamma绝对功率在特定电极点明显升高,伴非自杀性自伤行为者的Beta和Gamma活性发生变化。脑电微状态研究表明,伴非自杀性自伤行为者、伴自杀意念者的微状态存在差异,其中微状态序列短片段具有一定潜力。事件相关电位研究中,两者在P3波、N2波等成分表现出特定特征,伴非自杀性自伤行为的抑郁症患者N2波幅值较低。虽然脑电技术的机器学习相关研究较少,但已显示出一定的应用前景。因此本文概述两者相关的脑电研究进展,旨在为抑郁症自杀的早期预测提供依据。

The Underlying Reasons of Suicide Attempts among Arab Population in the Holy-Land—Nazareth: View and Overview

Suicide is one of the leading causes of death in many western countries, but in eastern countries this phenomenon was until recently extremely rare. Our study, performed during 2005-2012 comes to shed lights on the prevalence and the underlying reasons of the notable increase of suicide attempts in the conservative and religious Arab community of Nazareth, Israel. Extensive interviews, sociodemographic information, suicide risk factors in addition to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnoses were used in current retrospective study of 772 suicide attempters in the emergency room at the Nazareth Hospital. Statistical analysis using SPSS version 17, Pearson χ2 analysis and percentage distribution were used for the statistical analysis. We considered the differences to be significant at the level of p < 0.05. Three fold frequency of suicide attempts were observed among females (77%) compared to males (23%), (P = 0.0001). During the year 2009 the suicide attempts prevalence was the highest 118 (15.3%) and during 2005 it was the lowest 77 (10%). 76.5% of the attempters arrived to the emergency room within 1 - 6 hours. A single suicide attempt was observed among 60% of males compared to 70.5% among females [OR = 0.846 (CI: 0.742 - 0.966)] additionally, more than one suicide attempt was notified among 40% of males whereas 29.5% among females [OR = 1.367 (CI: 1.099 - 1.701), (P = 0.007)]. Psychiatric patients (59.3%) performed more than one suicide attempt compared to normal subjects (21.5%), [OR = 2.76;CI: 2.276 - 3.354, P-value = 0.0001]. Drugs was preferred for suicide attempts in both genders (87.7%), especially among females compared to males (90.6% vs. 78.8% respectively), [OR = 0.869;CI: 0.801 - 0.942, P = 0.001]. 38 of males (21.3%) committed suicide attempts by causing accidents and self harm compared to 56 females (9.4%);[OR = 2.261;CI: 1.552 - 3.294, (P = 0.0001)]. 40 psychiatric patients (18.7%) chose this method compared to 54 non-psychiatric patients (9.7%), [OR = 1.925;CI: 1.32 - 2.806, P-value = 0.001]. The underlying causes of suicide were as follows: 50% social causes, 26% adjustment reactions and 24% psychiatric diseases. Conclusion: Being the first unique study to shed lights on the increasing phenomenon of suicide in the Arab community, our findings unveiled a tragic transition in the rate of suicide attempts in a supposedly conservative and religious community. Even though the rate of suicide attempts is lower than other communities it should not divert focus away from efforts to develop effective strategies to prevent suicide attempts, especially among females.

合肥市男男性行为者自杀行为与社会特征关系

目的了解男男性行为者(Men who have sex with men,MSM)自杀行为状况及其与社会特征的关系。方法采用应答驱动抽样(RDS)、关键知情人介绍、网上招募等方法在合肥市进行招募,运用自编的《健康状况调查表》,面对面调查了228名MSM。结果合肥市MSM曾有自杀未遂行为报告率为11.4%;近一个月自杀意念报告率为10.5%;自杀计划报告率为3.9%。认为同性恋伤害了家庭、家庭拒绝同性恋、因同性恋被人殴打、有性病史、伙伴数少于3个和近半年月收入少于500元的人与自杀意念有统计学关联;家庭拒绝同性恋、已婚、受教育程度为高中及以下,去同性恋公厕参加活动和聚会、伙伴数少于3个与自杀未遂有统计学关联。结论减少社会对男性同性恋的歧视,可降低MSM自杀行为的发生。

认知行为干预对抑郁症患者抑郁情绪和自杀态度影响的研究

目的探讨认知行为干预对抑郁症患者抑郁情绪和自杀态度的影响。方法选择2005年9月1日—2006年5月31日入院的抑郁症患者,共80例,随机分为两组。对照组采用精神科护理常规、支持性心理护理,干预组在此基础上实施针对性的认知行为干预。运用汉密顿抑郁量表(Hamilton depression rating scale for depression,HAMD)和自杀态度问卷(Questionnaire of suicide attitude,QSA)对干预效果进行评定。结果入院第3周末及第6周末干预组HAMD量表分值显著低于对照组,干预组HAMD的总平均减分值显著大于对照组的总平均减分值,入院第6周末干预组对自杀行为性质的认识和对自杀者、自杀者家属及安乐死的态度分值显著高于对照组。结论认知行为干预对改善抑郁症患者的抑郁情绪和自杀态度有着明显的影响。

150例自杀未遂者流行病学研究

目的 了解山东省自杀未遂者流行病学特点 ,为自杀行为干预提供依据。方法 在山东省内随机选取四县三市的 7家综合医院急诊科或内科为调查点 ,收集 2 0 0 3年 1～ 9月同意被调查的自杀未遂者信息 ,共 15 0例 ,进行描述性和相关性分析。结果 自杀未遂较易发生在农村、年轻女性、文化程度低、农民、已婚、收入低、具有情感冲突者中。自杀时有人在场或附近者 ,占 5 6 0 % ;真正想自杀者占 4 2 0 %。男性自杀者较女性具有文化程度高、人均月收入高、精神障碍、对学习 /工作不满意及不易冲动 ;城市自杀者较农村具有较高的文化程度和较高的收入 ,对学习 /工作不满意 ,不需要家庭经济帮助、对将来生活寄予希望 ;抑郁性自杀与经济、精神、心理、社会支持因素均相关 ;冲动性自杀者较易发生在女性、内向、具有情感冲突、无精神障碍、对将来生活满意者中。结论 不同地区自杀未遂流行特征具有相似性 ,不同类型自杀未遂相关因素不同 。

住院精神分裂症与抑郁症患者自杀行为的临床特征比较

目的：比较精神分裂症与抑郁症住院病人自杀行为的发生比率，临床特征及自杀死亡率的差异。方法：采用病史询问、精神状态检查和定式评定的方法，确定精神分裂症有自杀行为者６４例，抑郁症３４例患者为研究对象，并在５年后追踪调查其自杀死亡的情况。结果：住院精神分裂症自杀行为的发生率为３３％，其中自杀未遂者为１２．９％；抑郁发作的自杀行为发生率为８９．５％，自杀未遂者为５７．９％。影响住院精神分裂症的自杀行为的主要因素为幻觉妄想；影响抑郁症自杀行为的影响因素除情绪障碍外，有８～１１％的病人伴有妄想症状。精神分裂症和抑郁症伴有自杀行为的追踪病例中病程在６年内自杀死亡的比率分别为２．９％和５．６％。结论：精神分裂症和抑郁症的自杀行为是精神科临床危机干预的重要内容，临床医师应当重视发病期精神症状对自杀行为的影响。

单相抑郁症自杀行为与父母育龄及胎次效应的研究

目的 探讨单相抑郁症自杀行为有否父母育龄及胎次效应。方法 采用严格的纳入标准 ,对 5 9例单相抑郁症患者的家系应用 Haldance和 Smith法进行研究。结果 单相抑郁症自杀行为与父母育龄及胎次的关系非常显著 ( x=2 .4>2 ,P<0 .0 5 ;6A>x6 A)。结论 单相抑郁症患者父母育龄越大和胎次越高者易发生自杀行为。

精神病人自杀行为的随访研究

目的 探讨精神病人自杀行为的危险因素。方法 对 73例有自杀行为的精神病人出院后进行 5年跟踪随访研究。结果 出院后 5年内有 6 1.6 %的病人再次出现自杀行为 ,其中 15 .1%的病人自杀身亡。再次出现自杀的因素有阳性家族史、社会支持状态较差等。结论 有精神病和自杀家族史且有自杀行为者再次发生自杀的机率较大 ,病人出院后的心理康复治疗和建立良好的社会环境是防止自杀的重要措施。

268例自杀未遂状况分析

目的 从社会、心理、生物医学因素角度评价人群的心理健康状况，分析自杀行为。方法调查２６８ 例病例及询问病史，从服药、饮酒动机、社会心理、家庭职业、学习情况及文化程度等进行分析。结果 资料说明人的心理是客观现实的反映，也就是说人生活在特定的社会生活条件下，人的文化素质，社会的物质文明和精神文明，以及个人所处的社会地位、经济基础都在调节和影响人的心理。结论 一旦导致人的心理失调，对于行为都会起着消极作用。当今医药卫生推向市场、推向个体，精神药物管理存在问题，尤其在边少穷的民族地区，精神药物管理问题依然存在混乱现象，加之人群贫穷落后、文化素质偏低、服安定等药物及大量饮酒解愁，致使自杀行为的人数在逐年增多，影响社会安定。

Integrative therapy for personality disorders: Experiences in developing integrative approaches for treatment-refractory personality-disordered clients

Personality Disordered (herein referred to as PD) clients are challenging to statutory mental healthcare programmes. They can be difficult to diagnose: their disorders can be obscured by second-order problems such as anxiety and depression, caused by PD cognitive processes. Treatment-as-usual (the predominant model of psychiatric intervention) for PD clients in crisis tends to focus on these second-order presentations, but provide no means of identifying underlying PD. The purpose of this paper is to describe how heuristic methods of diagnosis can be used to reframe the client’s distress in the context of personality disorders (according to DSM-IV criteria), and how subsequent application of integrative therapies can break their cycle of recidivism. Method: Two case studies of treatment-refractory individuals with cyclical patterns of crisis-point service engagement for self-harm or psychotic depression where heuristic/ integrative therapies were used. Results: The use of integrative therapies in the case studies presented resulted in a marked change in recidivism and quality of life for each client, as measured by a significant reduction in presentation of symptoms and hypervigilance. Discussion: By understanding the maladaptive cognitive-behavioural processes of PD clients, they can be modified to reduce the client’s self-defeating behavioural patterns, breaking the cycle of recidivism. However, a new diagnostic strategy must first be formulated that looks at the clients past use of mental health services to detect underlying PD.

White matter abnormalities:Insights into the pathophysiology of major affective disorders

The presence of white matter hyperintensities(WMHs) has been commonly associated with poor outcome in subjects with major affective disorders. Unfortunately, WMHs may be frequently confounded by the use of psychoactive medications and duration of illness. Al-though findings from the current literature are quite conflicting, we proposed that subjects with WMHs may be at higher suicidal risk when compared to other sub-groups without. Based on the Fazekas modified scale, the severity of WMHs may serve as a trait marker of disease. Interestingly, the presence of WMHs may rep-resent a neurobiological marker between the underlying vulnerability and clinical presentation of major affective disorders.

有自杀意念的男同性爱者／双性爱者艾滋病高危行为研究

目的探讨男同性爱者（gay）与双性爱者（Bi）中有自杀意念者的艾滋病高危行为特征，并分析其与自杀意念相关的危险因素。方法采用定向抽样法对gay／Bi人群进行横断面调查。从有效问卷中获取有自杀意念者，并依照自杀意念组的年龄隋况在无此意念者中选取比较组进行比较。结果调查的gay／Bi中有自杀意念者占20．2％。自杀意念组性向为同性、婚姻状况为未婚者多于比较组（P〈0．05）。自杀意念组在曾经向同性买性、近一年性交时曾出过血、曾去外地与陌生同性性交、16岁前曾遭受成年同性性虐待、有性施虐与受虐行为、有过主动或被动吻肛行为、有过主动或被动指交行为、每周饮酒至少一次或更多、曾因性向和／或同性性活动受到gay伤害、曾因性向和／或同性性活动受到异性爱者伤害等方面的比例显著高于对照组（P〈0．05）。多因素logistic回归模型提示曾因性向和／或同性性活动受到gay（WaldX^2=6．637，P=0．010）及异性爱者（IValdX^2=5．835，P=0．016）伤害是导致自杀意念产生的危险因素。结论有自杀意念的gay／Bi与艾滋病相关的高危性行为显著多于无此意念者。减少社会对gay与Bi人群的歧视及伤害可能对遏制艾滋病的流行有一定作用。

双相情感障碍抑郁发作患者自杀行为危险因素分析

目的自杀是双相情感障碍抑郁发作患者高死亡率的关键因素之一,本研究探讨双相情感障碍抑郁发作患者自杀行为的危险因素,以期减少该类患者自杀行为的发生。方法采用横截面研究的方法,纳入2018年1月—2021年12月在杭州市第七人民医院住院治疗的182例双相情感障碍抑郁发作患者,根据有无自杀行为分为伴自杀行为组(80例)和不伴自杀行为组(102例),分别比较2组患者人口学特征、临床特征及甲状腺功能指标,将差异有统计学意义的因素纳入二分类logistic回归模型,分析双相情感障碍抑郁发作患者自杀行为的危险因素。结果与不伴自杀行为组比较,伴自杀行为组年龄、首次发病年龄更低,既往自杀未遂次数、既往非自杀性自伤次数更高,既往有自杀未遂行为、既往有非自杀性自伤行为的比例更高,外周血游离三碘甲状腺原氨酸(FT3)、总三碘甲状腺原氨酸(TT3)水平更低(均P<0.05);Logistic回归分析显示,既往存在自杀未遂行为(OR=3.399)、既往存在非自杀性自伤行为(OR=4.190)是双相情感障碍重度抑郁发作患者自杀行为的危险因素;较大的首发年龄(OR=0.874)、较高的FT3(OR=0.153)是该类患者自杀行为的保护因素(均P<0.05)。结论既往自杀未遂行为、既往非自杀性自伤行为是双相抑郁患者自杀行为的风险因子,较大的首发年龄、较高的FT3为保护因子,在临床需加以关注。