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Danuta Wasserman

Publications and source records attributed to Danuta Wasserman.

At least 19 recordsLinked to original sources
PubMed2007

Do alcohol restrictions reduce suicide mortality?

AIM: Blood alcohol concentration (BAC) at the time of suicide was examined in relation to the marked falls in suicide rates and per capita alcohol consumption in Estonia during the major Soviet anti-alcohol campaign from 1 June 1985. DESIGN AND PARTICIPANTS: In all, 5054 suicide cases (76% males, 24% females) were examined with respect to the official autopsy reports of the Estonian Bureau of Forensic Medicine (autopsy rates: 95% of males, 88% of females) before (1981-84), during (1986-88) and after (1989-92) the campaign. Cases were divided by gender and BAC level (0.5-1.49, 1.5-2.49 and > 2.5 per thousand). FINDINGS: During the campaign, annual per capita alcohol consumption in Estonia fell from 10.9 to 6.6 l. Alcohol in blood was found in 47.9% before, 35.1% during and 40.9% after the campaign. During the intervention, BAC-positive, i.e. alcohol-positive, suicides decreased by 39.2% for males and 41.4% for females, with the largest fall occurring at the BAC 2.5 per thousand + level for both sexes. Changes in BAC-negative suicides were modest. When the campaign ended suicide rates started to rise. CONCLUSIONS: Investigation on an individual level showed that alcohol consumption was a common precursor to suicide and that rigorous alcohol restrictions were accompanied particularly by a decrease in BAC-positive suicide mortality among both sexes. However, the 'natural experiment' does not, in terms of study design, demonstrate convincingly that the fall in the suicide rate was due specifically to the decrease in alcohol use as such.

Adult↗
PubMed2006

Association of the serotonin transporter promotor polymorphism with suicide attempters with a high medical damage.

Serotonergic neurotransmission has been implicated in suicidal behavior, including inconsistent results concerning the serotonin transporter promoter polymorphism (5-HTTLPR). Here, we analyzed the 5-HTTLPR in suicide attempters (n=85). Comparing the presence of SS with SL+LL genotypes showed a significantly higher prevalence of the SS genotype in suicide attempters with high medical damage scores (chi2=9.054, df=1, p=0.0026). The results suggest that the S-allele may predispose for suicidal behavior characterized by high determination.

Adult↗
PubMed2006

The role of alcohol in suicide: a case-control psychological autopsy study.

BACKGROUND: The purpose of the study was to estimate the proportion of alcohol abuse and dependence (AAD) among suicides and controls, and to compare the incidence of AAD documented by clinicians with diagnoses derived from a research protocol. METHOD: AAD according to DSM-IV was diagnosed on the basis of interviews with relatives of people who committed suicide and with controls. A total of 427 people who committed suicide during one year were paired by region, gender, age and nationality with controls randomly selected from general practitioners' lists. RESULTS: Alcohol abuse was found in 10% and alcohol dependence in 51% of suicide cases. The corresponding figures for controls were 7% and 14% respectively. AAD was a statistically significant predictor of completed suicides, while abstinence was a significant predictor for female suicides and former use a significant predictor for older male suicides. AAD was diagnosed in 68% of male and 29% of female suicides. Middle-aged (35-59 years) males who committed suicide had the highest risk of alcohol dependence. Among suicide cases only 29% had received a lifetime diagnosis of AAD, against 23% of controls. CONCLUSIONS: AAD was significantly more prevalent among suicides than controls. Overall, the proportion of male suicides affected by alcohol was the same in the present psychological autopsy study as in our previous findings for Estonia on the aggregate level, while the share of female suicides with an AAD diagnosis was dramatically higher on the individual level. AAD is markedly underdiagnosed by general practitioners and clinicians.

Adult↗
PubMed2006

The serotonin 1A receptor C(-1019)G polymorphism in relation to suicide attempt.

BACKGROUND: Serotonergic neurotransmission has been implicated in suicidal behavior. Association between suicidal completers and a regulatory C(-1019)G polymorphism (rs6295) in the serotonin 1A receptor (HTR1A) gene was previously reported, whereas a following study showed no association in a sample of suicide attempters. METHODS: The involvement of the implicated G-allele of the 5-HTR1A C(-1019)G polymorphism (rs6295) was analyzed with the transmission disequilibrium test (TDT) in a sample of 272 suicide attempter families. RESULTS: No overtransmission of the G-allele was found in the entire sample of suicide attempters (p = 0.1460; n = 272 trios). However, a strong trend for overtransmission of the G-allele was observed in a sub-sample selected for a high level of previous traumatic and/or stressful life events prior to the suicide attempt (p = 0.0630, two-tail; n = 94 trios). CONCLUSION: The current results show that variation at the rs6295 polymorphism of the HTR1A gene is not associated with suicide attempts generally. However, the results indicate a possible role of the G-allele in suicidal behavior in connection with high exposure to traumatic and/or stressful life events, which is in need of future investigation.

Journal Article↗
PubMed2006

Life time suicidal thoughts in an urban community in Hanoi, Vietnam.

BACKGROUND: Suicidal thought is a risk factor and a stage in the suicidal process from planning to attempting and dying by suicide. To date, studies on suicidal thought in the general population, especially in Asian communities, have been limited. METHOD: The WHO SUPRE-MISS (the multisite intervention study on suicidal behaviours) community survey questionnaire was filled in for 2,280 randomly selected residents of the DongDa district of Hanoi, Vietnam by means of face-to-face interviews. This multi-factor questionnaire includes such variables as sociodemographic information, suicidal thought and history of suicide attempts, physical health, alcohol consumption and medication. RESULTS: Prevalence rates for life time suicidal thoughts, suicide plans and suicide attempts were 8.9%, 1.1% and 0.4% respectively. Suicidal thoughts are associated with multiple characteristics, such as female gender, single/widowed/separated/divorced marital status, low income, lifestyle (use of alcohol, sedatives and pain relief medication), but not with low education or employment status. Having no religion and being a Buddhist appear to be protective factors for suicidal thought. The ratio of suicidal thoughts, suicide plans and suicide attempts on a lifetime basis is 22.3:2.8:1. CONCLUSION: In Vietnam, as in Western and other Asian countries, suicidal thoughts are associated with similar negative psychosocial risk factors, lifestyle and emotional problems, which implies that suicide preventive measure developed elsewhere can be adjusted to Vietnamese condition. Understanding the unique and common risks in a culture may assist in prediction and control.

Adolescent↗
PubMed2006

Undergraduate student mental health at Makerere University, Uganda.

There is little information on the current mental health of University students in Uganda. The present study was carried out to determine the prevalence of depressed mood and suicidal ideation among students at Makerere University. Two student samples participated. Sample I comprised 253 fresh students admitted to all faculties at the University in the academic year 2000/2001, selected by a simple random sampling procedure. Sample II comprised 101 students admitted to the Faculty of Medicine during the academic year 2002/2003. The prevalence of depressed mood was measured using the 13-item Beck Depression Inventory (BDI). The prevalence of depressed mood (BDI score 10 or more) was significantly higher in sample I (16.2%) than sample II (4.0%). Sample I members were significantly more likely than those of sample II to report lifetime and past week suicide ideation. Thus, there is a high prevalence of mental health problems among the general population of new students entering Makerere University and this is significantly higher than for new students in the Faculty of Medicine.

Journal Article↗
PubMed2005

Suicide prevention strategies: a systematic review.

CONTEXT: In 2002, an estimated 877,000 lives were lost worldwide through suicide. Some developed nations have implemented national suicide prevention plans. Although these plans generally propose multiple interventions, their effectiveness is rarely evaluated. OBJECTIVES: To examine evidence for the effectiveness of specific suicide-preventive interventions and to make recommendations for future prevention programs and research. DATA SOURCES AND STUDY SELECTION: Relevant publications were identified via electronic searches of MEDLINE, the Cochrane Library, and PsychINFO databases using multiple search terms related to suicide prevention. Studies, published between 1966 and June 2005, included those that evaluated preventative interventions in major domains; education and awareness for the general public and for professionals; screening tools for at-risk individuals; treatment of psychiatric disorders; restricting access to lethal means; and responsible media reporting of suicide. DATA EXTRACTION: Data were extracted on primary outcomes of interest: suicidal behavior (completion, attempt, ideation), intermediary or secondary outcomes (treatment seeking, identification of at-risk individuals, antidepressant prescription/use rates, referrals), or both. Experts from 15 countries reviewed all studies. Included articles were those that reported on completed and attempted suicide and suicidal ideation; or, where applicable, intermediate outcomes, including help-seeking behavior, identification of at-risk individuals, entry into treatment, and antidepressant prescription rates. We included 3 major types of studies for which the research question was clearly defined: systematic reviews and meta-analyses (n = 10); quantitative studies, either randomized controlled trials (n = 18) or cohort studies (n = 24); and ecological, or population- based studies (n = 41). Heterogeneity of study populations and methodology did not permit formal meta-analysis; thus, a narrative synthesis is presented. DATA SYNTHESIS: Education of physicians and restricting access to lethal means were found to prevent suicide. Other methods including public education, screening programs, and media education need more testing. CONCLUSIONS: Physician education in depression recognition and treatment and restricting access to lethal methods reduce suicide rates. Other interventions need more evidence of efficacy. Ascertaining which components of suicide prevention programs are effective in reducing rates of suicide and suicide attempt is essential in order to optimize use of limited resources.

Antipsychotic Agents↗
PubMed2005

Problem-solving ability and repetition of deliberate self-harm: a multicentre study.

BACKGROUND: While recent studies have found problem-solving impairments in individuals who engage in deliberate self-harm (DSH), few studies have examined repeaters and non-repeaters separately. The aim of the present study was to investigate whether specific types of problem-solving are associated with repeated DSH. METHOD: As part of the WHO/EURO Multicentre Study on Suicidal Behaviour, 836 medically treated DSH patients (59% repeaters) from 12 European regions were interviewed using the European Parasuicide Study Interview Schedule (EPSIS II) approximately 1 year after their index episode. The Utrecht Coping List (UCL) assessed habitual responses to problems. RESULTS: Factor analysis identified five dimensions--Active Handling, Passive-Avoidance, Problem Sharing, Palliative Reactions and Negative Expression. Passive-Avoidance--characterized by a pre-occupation with problems, feeling unable to do anything, worrying about the past and taking a gloomy view of the situation, a greater likelihood of giving in so as to avoid difficult situations, the tendency to resign oneself to the situation, and to try to avoid problems--was the problem-solving dimension most strongly associated with repetition, although this association was attenuated by self-esteem. CONCLUSIONS: The outcomes of the study indicate that treatments for DSH patients with repeated episodes should include problem-solving interventions. The observed passivity and avoidance of problems (coupled with low self-esteem) associated with repetition suggests that intensive therapeutic input and follow-up are required for those with repeated DSH.

Adaptation, Psychological↗
PubMed2005

Attempted suicide in Hanoi, Vietnam.

BACKGROUND: Attempted suicide is a key predictor of suicide, which is among the dominant causes of young people's deaths worldwide. Very little is known about the characteristics of suicide attempters in Asia, especially in Vietnam. METHODS: Medical records of 509 patients (515 attempted-suicide events) admitted to Bach Mai General Hospital in Hanoi, Vietnam from 1 January 1999 to 30 April 2001 were analysed according to the criteria of the WHO Multicentre Study of Attempted Suicide. RESULTS: The suicide attempters' mean age was 28.3+/-12.9 years. Nearly half (48.7%) were aged 15-24. The female-to-male ratio of patients living in urban areas (2.1:1) was higher than in rural areas (1.2:1). In urban areas, students (32 %) and homeworkers (28%) and, in rural areas, farmers (56 %) and students (17%) were the salient occupational categories. Acute life stressors were the main causes (73.8%) of suicide attempts. Only in some 6% of cases had a psychiatric illness been diagnosed before the suicide attempts. As a means of attempting suicide, intoxication with analgesics and antipyretics (e. g. paracetamol) with low medical lethality scores was a frequent method among the urban patients, the majority of whom (81%) consequently stayed in hospital less than 24 h. Pesticide and rat poison, more commonly (57.2%) used by attempters in rural areas, had higher medical lethality scores and also necessitated more prolonged hospital treatment. CONCLUSIONS: Some suicide-preventive strategies used in the West for young people may be applicable in Vietnam. Reducing access to pesticides and rat poison is comparable to western efforts to make paracetamol or firearms less freely available. Skills in resolving family and other conflicts can be taught in schools according to WHO's suicide-prevention resources for teachers.

Adolescent↗
PubMed2005

The prevalence of depression in two districts of Uganda.

BACKGROUND: Little information is available on the prevalence of depression in Uganda. Given the recent political history of Uganda, depression may be common. METHOD: The aim was to estimate the point prevalence of probable clinical depressive disorder among the general population in two contrasting districts of Uganda. Translated versions (in Madi and Lusoga) of the 13-item Beck Depression Inventory (BDI) were administered to a systematic sample of adult residents in the Adjumani and Bugiri districts of Uganda. RESULTS: The overall prevalence of probably clinically significant depression (BDI score of 20-39) was 17.4%. Significantly higher rates were found in women and in Adjumani District. CONCLUSION: Depression is common in Uganda and particularly in the more troubled and less socially cohesive district of Adjumani.

Adult↗
PubMed2005

Suicide attempts, plans, and ideation in culturally diverse sites: the WHO SUPRE-MISS community survey.

BACKGROUND: The objectives were to assess thoughts about suicide, plans to commit suicide and suicide attempts in the community, to investigate the use of health services following a suicide attempt, and to describe basic socio-cultural indices of the community. METHOD: The community survey was one component of the larger WHO multisite intervention study on suicidal behaviours (SUPRE-MISS). In each site, it aimed at randomly selecting and interviewing at least 500 subjects of the general population living in the catchment area of the emergency department where the intervention component of the study was conducted. Communities of eight SUPRE-MISS sites (in Brazil, China, Estonia, India, Iran, South Africa, Sri Lanka, and Viet Nam) participated plus two additional sites from Australia and Sweden conducting similar surveys. RESULTS: Suicide attempts (0.4-4.2%), plans (1.1-15.6%), and ideation (2.6-25.4%) varied by a factor of 10-14 across sites, but remained mostly within the ranges of previously published data. Depending on the site, the ratios between attempts, plans, and thoughts of suicide differed substantially. Medical attention following a suicide attempt varied between 22% and 88% of the attempts. CONCLUSIONS: The idea of the suicidal process as a continuous and smooth evolution from thoughts to plans and attempts of suicide needs to be further investigated as it seems to be dependent on the cultural setting. There are indications, that the burden of undetected attempted suicide is high in different cultures; an improved response from the health sector on how to identify and support these individuals is needed.

Adult↗
PubMed2005

Characteristics of attempted suicides seen in emergency-care settings of general hospitals in eight low- and middle-income countries.

BACKGROUND: The objective was to describe patients presenting themselves at emergency-care settings following a suicide attempt in eight culturally different sites [Campinas (Brazil), Chennai (India), Colombo (Sri Lanka), Durban (South Africa), Hanoi (Viet Nam), Karaj (Iran), Tallinn (Estonia), and Yuncheng, (China)]. METHOD: Subjects seen for suicide attempts, as identified by the medical staff in the emergency units of 18 collaborating hospitals were asked to participate in a 45-minute structured interview administered by trained health personnel after the patient was medically stable. RESULTS: Self-poisoning was the main method of attempting suicide in all eight sites. Self-poisoning by pesticides played a particularly important role in Yuncheng (71.6% females, 61.5% males), in Colombo (43.2% males, 19.6% females), and in Chennai (33.8% males, 23.8% females). The suicide attempt resulted in danger to life in the majority of patients in Yuncheng and in Chennai (over 65%). In four of the eight sites less than one-third of subjects received any type of referral for follow-up evaluation or care. CONCLUSIONS: Action for the prevention of suicide attempts can be started immediately in the sites investigated by addressing the one most important method of attempted suicide, namely self-poisoning. Regulations for the access to drugs, medicaments, pesticides, and other toxic substances need to be improved and revised regulations must be implemented by integrating the efforts of different sectors, such as health, agriculture, education, and justice. The care of patients who attempt suicide needs to include routine psychiatric and psychosocial assessment and systematic referral to professional services after discharge.

Adult↗
PubMed2005

Suicide in Thailand, 1977 to 2002.

The epidemiology of suicide in Thailand from 1977-2002 was presented. In the years 1977 and 2002, the suicide rates were 5.9 and 7.8 per 100,000 population. This is low compared to nearby Asian countries. The highest suicide rate was 8.6 per 100,000 in the year 1999, a time of economic crisis. The ratio of male to female suicide rate was 1.14:1 in the year 1977 and increased to 3.16:1 in the year 2002. The highest suicide rate was in young males, ages 25-29 and the trend shows an increase. Despite the increasing incidence, there has been little study to date; however, HIV/AIDS has been identified as a major risk factor.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Internet comments on media reporting of two adolescents' collective suicide attempt.

The presented study covered the analysis of 7 Internet media portrayals and 188 readers' spontaneous Internet comments about a case of two adolescents who survived a serious suicide attempt. Articles with photographs attracted the most responses (82%), irrespective of the length and content of the articles. More than half of the comments expressed readers' negative attitude (ironic 31% and angry 28%) while 21% of them remained neutral or indifferent. Twenty one percent of readers tried to initiate a serious discussion about the causes and prevention of suicide. An association was found between the style of media reporting and the number of readers' comments as well as certain aspects of the content of the comments. Inadequate reporting of suicidal behavior is associated with comments expressing oversimplified attitudes towards suicide. The influence of suicide reporting on the Internet on attitude formation in the general population should not be underestimated.

Adolescent↗
PubMed2005

The response inventory for stressful life events (RISLE) I. refinement of the 100-item version.

BACKGROUND: No indigenous screening instruments are available for the detection of depression and suicide risk relevant to the context of patients in Uganda. The Response Inventory for Stressful Life Events (RISLE) may be an appropriate tool, but requires validation. OBJECTIVE: The paper reports on the development of the RISLE and the refinement of the 100-item RISLE into a shorter version for use in large samples. METHODS: Two samples were used in the validation exercise: a general population sample from Adjumani and Bugiri districts and a student sample from Makerere University in Kampala district. The RISLE responses were subjected to Principal Components Analysis and Discriminant Function Analysis. The 100-item RISLE and resulting shorter version were compared and their concurrent validity assessed by comparing test results to the individuals' responses to the Beck Depression Inventory (BDI) and the Beck Scale for Suicide ideation (BSS). RESULTS: Nine hundred thirty nine questionnaires were available for the population sample, 101 for the student sample. The 100-item RISLE was reduced to 36-items without loss of face validity. Both the 100- and 36-item versions had high internal consistency, were highly correlated with each other and with the BDI and BSS. CONCLUSION: The 36-item RISLE appears to be an advance on the 100-item version, retaining its internal consistency and concurrent validity.

Adolescent↗
PubMed2005

The response inventory for stressful life events (RISLE) II: validation of the 36-item version.

BACKGROUND: A 36-item version of the Response Inventory for Stressful Life Events (RISLE) was derived from the longer 100 item version. The 36-item version may be more appropriate for use in larger population sample. OBJECTIVE: To compare the responses of the 36-item RISLE to interview derived psychiatric diagnoses and suicidal ideation in a sub-sample of the general population and student samples reported in the accompanying paper. METHODS: Clinical interviews using the Mini International Neuropsychiatric Interview (MINI) were carried out on 67 members of the general population and 58 members of the student samples. Receiver Operating Characteristic (ROC) curves were constructed for the RISLE responses using current depressive disorder, any current psychiatric disorder, and past month suicidality variables. Sensitivities, specificities, predictive values and likelihood ratios were determined based on various cut-off points based on ROC curves. Kappa statistic was determined to evaluate the level of agreement between the result of questionnaire surveys and research clinical interviews at different cut-off points on the RISLE. RESULTS: The probability of correct detection of current depression was 79%, any current psychiatric disorder 83% and past month suicidality 83%. The optimal cut-offs for the general population was 10 and for the students 6. High scores on the 36-item RISLE were associated with a past history of suicide attempt and recent and past suicide ideation. CONCLUSION: The 36-item RISLE appears to have good concurrent validity and may be a reasonable screening instrument for psychological distress in the Ugandan population. The results suggest that the RISLE alone is capable of screening for both depressive mood and suicidal ideation effectively at different cut-off points. Thus the RISLE is capable of achieving what normally takes two scales such as the BDI and BSS to do separately. However, further validation work is required using larger population samples in clinical interviews in prospective studies.

Depressive Disorder↗
PubMed2005

Global suicide rates among young people aged 15-19.

Global suicide rates among adolescents in the 15-19 age group, according to the latest World Health Organization (WHO) Mortality Database, were examined. Data for this age group were available from 90 countries (in some cases areas) out of the 130 WHO member states. The mean suicide rate for this age group, based on data available for the latest year, was 7.4/100,000. Suicide rates were higher in males (10.5) than in females (4.1). This applies in almost all countries. The exceptions are China, Cuba, Ecuador, El Salvador and Sri Lanka, where the female suicide rate was higher than the male. In the 90 countries (areas) studied, suicide was the fourth leading cause of death among young males and the third for young females. Of the 132,423 deaths of young people in the 90 countries, suicide accounted for 9.1%. The trend of suicide rates from 26 countries (areas) with data available during the period 1965-1999 was also studied. A rising trend of suicide in young males was observed. This was particularly marked in the years before 1980 and in countries outside Europe. The WHO database is the largest of its kind and, indeed, the only information source that can currently be used for analysis of global mortality due to suicide. Methodological limitations are discussed.

Journal Article↗