Rational suicide and psychiatric disorders.
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Adult↗
Biomedical subjects
C L Rich
Publications and source records attributed to C L Rich.
Similarities in diagnostic comorbidity between suicide among young people in Sweden and the United States.
A significant difference in the prevalence of personality disorders was reported between similar studies of suicide among young people (under age 30) performed in San Diego, California (10% of 133 cases), and Göteborg, Sweden (34% of 58 cases). The difference was due entirely to the absence of borderline personality disorder (BPD) reported in the San Diego sample. In this study, we used preselected variables to reassess the suicides from the San Diego study for criteria consistent with BPD. We found that 41% met the criteria, which was now not significantly different from the Göteborg sample. Comparisons among a number of other demographic, social, and diagnostic variables revealed many similarities in the two samples, particularly Axis I comorbidity with depression and/or substance abuse and Axis II comorbidity with antisocial personality disorder. We conclude that the characteristics associated with BPD identify similar young persons who committed suicide in Sweden and the United States. Questions remain as to whether or not Axis I and II disorders are independent in relation to suicide. The comorbidity pattern described here must be considered seriously in the clinical setting for its fatal implications.
Adolescent↗
Secular trends in psychiatric diagnoses of suicide victims.
Post-mortem psychiatric diagnoses are compared in two cohorts of male suicides from St. Louis (1956-1957) (Robins, 1981) and San Diego (1981-1982) (Rich et al., 1986). Similar structured interviews and diagnostic criteria had been used in both assessments. Substance/alcohol abuse has remained the major diagnosis in suicides under age 60. Rates of depressive disorder alone have decreased overall, due mostly to decreased rates in the elderly. Thus, depression occurs more frequently in younger ages. Comorbid depression and substance/alcohol abuse has also increased in younger ages. Implications in terms of the so-called 'cohort effect' are discussed.
Adolescent↗
Suicide, stressors, and the life cycle.
OBJECTIVE: Relationships between stressors and suicide might be expected to vary with stages of the life cycle. The purpose of this study was to examine this possibility. METHOD: The authors examined the first 204 consecutive cases from the San Diego Suicide Study, a federally funded investigation of 283 suicides, for possible relationships between suicide and age and the frequency of specific stressors. Information was gathered from family members, spouses, acquaintances, employers, other witnesses, physicians, and other professionals by trained interviewers using a structured format. Hospital, physician, therapist, school, and police records were also included when available. DSM-III diagnoses were made by consensus of two investigators. Life events information was also reviewed independently by the investigators to determine stressors (if any) for each case. RESULTS: Of the 202 subjects for whom data were available, 195 (97%) had one or more stressors; 137 male subjects had a total of 272 stressors, and 58 female subjects had a total of 115 stressors. The authors found predictable patterns of the three most common stressor groups--conflict-separation-rejection, economic problems, and medical illness. The majority of the stressors among subjects 80 years old or older were illnesses. The only significant difference between the sexes was that more men than women had economic problems as a stressor. CONCLUSIONS: The variations in the patterns of stressors found in this study of suicides coincide with adult development theory. The lack of population comparison subjects and stressor scoring validation, however, limits the predictive value of these data in assessing suicidal persons.
Adolescent↗
Antidepressant treatment and the occurrence of mania in bipolar patients admitted for depression.
We examined the records of 33 patients who had 70 inpatient admissions with a diagnosis of bipolar affective disorder, depressed. During 14 of these admissions, a switch occurred from depression into mania. We compared the treatment patients were on at the time of their switch to treatment during the 56 admissions where there was no switch. We conclude that clinicians must be prepared for depressed bipolar patients to switch to mania regardless of treatment status.
Antidepressive Agents, Tricyclic↗
Accuracy of adults' reports of abuse in childhood.
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Adult↗
Guns and suicide: possible effects of some specific legislation.
The authors describe suicide rates in Toronto and Ontario and methods used for suicide in Toronto for 5 years before and after enactment of Canadian gun control legislation in 1978. They also present data from San Diego, Calif., where state laws attempt to limit access to guns by certain psychiatric patients. Both sets of data indicate that gun control legislation may have led to decreased use of guns by suicidal men, but the difference was apparently offset by an increase in suicide by leaping. In the case of men using guns for suicide, these data support a hypothesis of substitution of suicide method.
Adult↗
San Diego Suicide Study: the adolescents.
The San Diego Suicide Study involved psychological autopsy and toxicological examination of 283 suicides. Of the 133 consecutive cases under age 30, 14 were under age 20. In this paper, detailed data on the 14 adolescent cases are presented and the findings compared to other studies.
Adolescent↗
Verifying patients' reports of childhood abuse.
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Borderline Personality Disorder↗
San Diego Suicide Study. III. Relationships between diagnoses and stressors.
Few attempts have been made to look for potential correlations between psychiatric diagnoses and psychosocial stressors in suicides. In this study, we examine relationships between the most common psychiatric illnesses and the most common stressors in 283 suicides from San Diego County. We found that interpersonal loss/conflicts occurred more frequently near the time of death for substance abusers with and without depression than for persons with "pure" affective disorder. These findings are consistent with those of previous reports, suggesting a difference between the way suicidal persons with substance abuse and pure affective disorder respond to certain external stressors.
Adult↗
Platelet serotonin transport after a single ECT.
Platelet 5-HT uptake was examined in six depressed patients before and after a single electroconvulsive treatment and compared with six age- and sex-matched controls. The depressed patients had a significantly (P less than 0.05) lower Vmax of platelet 5-HT uptake prior to ECT (22.9 +/- 7.6 pm/2 x 10 platelets) than did control subjects (37.5 +/- 9.1 SEM). After a single ECT treatment, the Vmax significantly (P less than 0.05) increased to levels (34.6 +/- 10.1)no longer significantly different from control. The results are compared with recent data from depressed patients indicating that low baseline levels of platelet imipramine binding increase after ECT treatment.
Adult↗
Suicide by psychotics.
The authors studied 31 cases with psychotic diagnoses from a consecutive series of 204 suicides in San Diego. They were compared to 25 similar cases from 134 suicides gathered in the city of St. Louis and St. Louis county 25 years earlier. The proportion of psychotic subjects (less than 20%) in the two samples was similar. The San Diego psychotics were younger on the average than those from St. Louis and had more polysubstance abuse than alcoholism. Only rarely did psychotics in either sample commit suicide by particularly "crazy" methods. In the San Diego suicides, the psychotics without a depressive syndrome had as many depressive symptoms as those with a depressive syndrome. Schizophrenics in the San Diego sample made suicidal communications just as often as the other psychotics and the nonpsychotics. Fewer schizophrenics than other psychotics or nonpsychotics had stressors identified at the time of death, but over half of all the subjects did have them.
Adult↗
Effects of trazodone on aggressive behavior in seven patients with organic mental disorders.
Seven patients with organic mental disorders and physically aggressive behavior were treated with trazodone. Three ceased demonstrating aggressive behavior within 4-6 weeks after starting trazodone treatment. Three had no discernible reduction in aggressiveness. One was unable to complete the trial.
Aged↗
Some differences between men and women who commit suicide.
Men have persistently had a several-fold higher suicide rate than women. In this study of 204 consecutive suicides, the authors examined three areas in which the men differed from the women. Men used more violent, immediately lethal methods of suicide, were almost three times more likely to be substance abusers, and were more likely to have economic problems as stressors. The authors conclude that while the difference in suicide rate between men and women is complexly determined, the weight of the evidence suggests that more men than women intend to commit suicide.
Adult↗
San Diego suicide study. I. Young vs old subjects.
The suicide rate among people under 30 years of age has nearly tripled in the past several decades. We compared 133 suicides under the age of 30 years with 150 aged 30 years and over. After gathering and reviewing extensive clinical information and postmortem toxicologic data, we assigned diagnoses using DSM-III criteria. A major diagnostic finding was the occurrence of more drug abuse than had been previously reported, significantly more often in the young people. Few other differences were found either between our total sample and previous studies or between our younger and older groups. We conclude that a closer look at the young group is necessary to see what other differences might occur between the drug abusers and other young suicides.
Adolescent↗
San Diego Suicide Study. II. Substance abuse in young cases.
Fifty-three percent of 133 consecutive young suicides had a principal psychiatric diagnosis of substance abuse. Twenty-four percent had an additional principal diagnosis of atypical depression, atypical psychosis, or adjustment disorder with depression. The relationship of the substance abuse to the additional diagnosis was usually obscure, though this subgroup was similar to the group with only substance abuse on a number of factors. Typically, substance abuse was a chronic condition present for nine years. Multiple substance abuse was the norm in these cases, and marijuana, alcohol, and cocaine were the most frequently abused substances. Substance abusers without other principal diagnoses received psychiatric care less frequently than those with additional principal diagnoses.
Adjustment Disorders↗
Endocrinology and suicide.
The data accumulated so far suggest several tentative conclusions. First, thyroid and adrenal gland disease unquestionably can produce severe mental disturbances. Most of these are "organic" in nature, but depressive symptoms are common as well. A connection between these diseases and suicide has not been established, however. Research cannot really address this possibility adequately, since these studies are difficult, if not impossible, to do in the postmortem state at this time. Ways should continue to be sought to overcome this problem. Clinically, it seems advisable to treat all depressed, suicidal persons with the same caution, whether they have diseases of these endocrine systems or not. The differences in responsiveness of the thyroid and adrenocortical systems among depressed and perhaps truly suicidal persons are of greater theoretical as well as practical clinical interest. The TRH-TSH test and the DST may not be as specific as once thought. Nonetheless, the abnormalities do occur with regularity in specific subgroups of depressed patients. It is far too early to stop research on the DST or the TRH-TSH test. Clinically, however, it is premature to make important management decisions about suicidal patients based on these test results. At this time, we really have no means of pinpointing the persons who will eventually suicide. The hope that they may someday provide valid data for assessing real suicide potential is there, and clinicians should stay informed in this arena. Until that day comes, though, we must continue to exercise caution regarding our clinical judgments and to live with their uncertainties.
17-Hydroxycorticosteroids↗
San Diego suicide study: comparison of gay to straight males.
Previous large studies of completed suicides have not considered sexual orientation in their data analyses. In this study, data from the known homosexual subpopulation (13 males, aged 21-42) in a series of 283 suicides were examined. They were compared with all other aged male suicides 21-42 (n = 106). Both groups showed considerable substance abuse plus a variety of other psychiatric diagnoses. Both also had a high frequency of relationship difficulties near the time of death. Gays who committed suicide did not have a history of more police trouble and were no more likely to be living alone than the comparison group. They did not have more prior suicide attempts or previous psychiatric treatment. We conclude that, among the factors examined here, there appears to be little difference between gay and heterosexual male suicides.
Adult↗