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The European Psychiatric Association (EPA) guidance on suicide treatment and prevention

Part of: EPA Guidance Papers

Published online by Cambridge University Press:  15 April 2020

D. Wasserman ,
Z. Rihmer ,
D. Rujescu ,
M. Sarchiapone ,
M. Sokolowski ,
D. Titelman ,
G. Zalsman ,
Z. Zemishlany  and
V. Carli
D. Wasserman*
Affiliation:
The National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, S-171 77, Stockholm, Sweden
Z. Rihmer
Affiliation:
Department of Clinical and Theoretical Mental Health and Department of Psychiatry and Psychotherapy, Semmelweis University, Faculty of Medicine, Budapest, Hungary
D. Rujescu
Affiliation:
Ludwig Maximilians University, Munich, Germany
M. Sarchiapone
Affiliation:
Department of Health Sciences, University of Molise, Campobasso, Italy
M. Sokolowski
Affiliation:
The National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, S-171 77, Stockholm, Sweden
D. Titelman
Affiliation:
The National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, S-171 77, Stockholm, Sweden
G. Zalsman
Affiliation:
Geha Mental Health Centre, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Division of Molecular Imaging and Neuropathology, Psychiatry Department, Columbia University, New York, USA
Z. Zemishlany
Affiliation:
Geha Mental Health Centre, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
V. Carli
Affiliation:
The National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, S-171 77, Stockholm, Sweden
*
*Corresponding author. Tel.: +46 8 52 48 49 37; fax: +46 8 52 48 77 93. E-mail address:[email protected] (D. Wasserman).
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Abstract

Suicide is a major public health problem in the WHO European Region accounting for over 150,000 deaths per year.

Suicidal crisis:

Acute intervention should start immediately in order to keep the patient alive.

Diagnosis:

An underlying psychiatric disorder is present in up to 90% of people who completed suicide. Comorbidity with depression, anxiety, substance abuse and personality disorders is high. In order to achieve successful prevention of suicidality, adequate diagnostic procedures and appropriate treatment for the underlying disorder are essential.

Treatment:

Existing evidence supports the efficacy of pharmacological treatment and cognitive behavioural therapy (CBT) in preventing suicidal behaviour. Some other psychological treatments are promising, but the supporting evidence is currently insufficient. Studies show that antidepressant treatment decreases the risk for suicidality among depressed patients. However, the risk of suicidal behaviour in depressed patients treated with antidepressants exists during the first 10–14 days of treatment, which requires careful monitoring. Short-term supplementary medication with anxiolytics and hypnotics in the case of anxiety and insomnia is recommended. Treatment with antidepressants of children and adolescents should only be given under supervision of a specialist. Long-term treatment with lithium has been shown to be effective in preventing both suicide and attempted suicide in patients with unipolar and bipolar depression. Treatment with clozapine is effective in reducing suicidal behaviour in patients with schizophrenia. Other atypical antipsychotics are promising but more evidence is required.

Treatment team:

Multidisciplinary treatment teams including psychiatrist and other professionals such as psychologist, social worker, and occupational therapist are always preferable, as integration of pharmacological, psychological and social rehabilitation is recommended especially for patients with chronic suicidality.

Family:

The suicidal person independently of age should always be motivated to involve family in the treatment.

Social support:

Psychosocial treatment and support is recommended, as the majority of suicidal patients have problems with relationships, work, school and lack functioning social networks.

Safety:

A secure home, public and hospital environment, without access to suicidal means is a necessary strategy in suicide prevention. Each treatment option, prescription of medication and discharge of the patient from hospital should be carefully evaluated against the involved risks.

Training of personnel:

Training of general practitioners (GPs) is effective in the prevention of suicide. It improves treatment of depression and anxiety, quality of the provided care and attitudes towards suicide. Continuous training including discussions about ethical and legal issues is necessary for psychiatrists and other mental health professionals.

Keywords

SuicideDepressionPsychiatric diagnosisPreventionIdentificationTreatment
Type
Review
Information
European Psychiatry , Volume 27 , Issue 2 , February 2012 , pp. 129 - 141
Copyright
Copyright © Elsevier Masson SAS 2012

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References

Ahrens, B., Muller-Oerlinghausen, B.Does lithium exert an independent antisuicidal effect?. Pharmacopsychiatry. 2001; 34: 132–136CrossRefGoogle ScholarPubMed
Aish, A.M., Wasserman, D.Does Beck's Hopelessness Scale really measure several components?. Psychol Med. 2001; 31: 367–372CrossRefGoogle ScholarPubMed
Akiskal, H.S., Benazzi, F.Psychopathologic correlates of suicidal ideation in major depressive outpatients: is it all due to unrecognized (bipolar) depressive mixed states?. Psychopathology. 2005; 38: 273–280CrossRefGoogle ScholarPubMed
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Washington D.C.: American Psychiatric Press; 2000.Google Scholar
Améry, J.At the mind's limits: Contemplations by a survivor of Auschwitz and its realities. Indiana: Bloomington & Indianapolis; 1980Google Scholar
Andreasen, N.C., Endicott, J., Spitzer, R.L., Winokur, G.The family history method using diagnostic criteria. Reliability and validity. Arch Gen Psychiatry. 1977; 34: 1229–1235CrossRefGoogle ScholarPubMed
Andriessen, K.The role of volunteer organizations in suicide prevention. Wasserman, D.Wasserman, C.Oxford textbook of suicidology and suicide prevention: a global perspective. Oxford: Oxford University Press; 2009 745748Google Scholar
Angst, F., Stassen, H.H., Clayton, P.J., Angst, J.Mortality of patients with mood disorders: follow-up over 34-38 years. J Affect Disord. 2002; 68: 167–181CrossRefGoogle ScholarPubMed
Appleby, L., Shaw, J., Amos, T., et al.Suicide within 12 months of contact with mental health services: national clinical survey. BMJ.. 1999; 318: 1235–1239CrossRefGoogle ScholarPubMed
Balazs, J., Lecrubier, Y., Csiszer, N., Kosztak, J., Bitter, I.Prevalence and comorbidity of affective disorders in persons making suicide attempts in Hungary: importance of the first depressive episodes and of bipolar II diagnoses. J Affect Disord. 2003; 76: 113–119CrossRefGoogle ScholarPubMed
Baldessarini, R.J., Tondo, L., Davis, P., Pompili, M., Goodwin, F.K., Hennen, J.Decreased risk of suicides and attempts during long-term lithium treatment: a meta-analytic review. Bipolar Disord. 2006; 8: 625–639CrossRefGoogle ScholarPubMed
Barlow, K., Grenyer, B., Ilkiw-Lavalle, O.Prevalence and precipitants of aggression in psychiatric inpatient units. Aust N Z J Psychiatry. 2000; 34: 967–974CrossRefGoogle ScholarPubMed
Bech, P., Awata, S.Measurement of suicidal behaviour with psychometric scales. Wasserman, D.Wasserman, C.Oxford textbook of suicidology and suicide prevention: a global perspective. Oxford: Oxford University Press; 2009 305311Google Scholar
Beck, A.T.Cognitive therapy: past, present, and future. J Consult Clin Psychol. 1993; 61: 194–198CrossRefGoogle ScholarPubMed
Bertolote, J.M., Fleischmann, A., Butchart, A., Besbelli, N.Suicide, suicide attempts and pesticides: a major hidden public health problem. Bull World Health Org. 84 2006 260CrossRefGoogle Scholar
Bertolote, J.M., Fleischmann, A., De Leo, D., Wasserman, D.Suicide and mental disorders: do we know enough?. Br J Psychiatry.. 2003; 183: 382–383CrossRefGoogle Scholar
Bertolote, J.M., Fleischmann, A.A global perspective on the magnitude of suicide mortality. Wasserman, D.Wasserman, C.Oxford textbook of suicidology and suicide prevention: a global perspective. Oxford: Oxford University Press; 2009.9198Google Scholar
Beskow, J., Runeson, B., Asgard, U.Psychological autopsies: methods and ethics. Suicide Life Threat Behav. 1990; 20: 307–323Google ScholarPubMed
Bloch, Y., Levcovitch, Y., Bloch, A.M., Mendlovic, S., Ratzoni, G.Electroconvulsive therapy in adolescents: similarities to and differences from adults. J Am Acad Child Adolesc Psychiatry. 2001; 40: 1332–1336CrossRefGoogle ScholarPubMed
Boden, J.M., Fergusson, D.M., Horwood, L.J.Anxiety disorders and suicidal behaviours in adolescence and young adulthood: findings from a longitudinal study. Psychol Med. 2007; 37: 431–440CrossRefGoogle Scholar
Brent, D., Melhem, N., Turecki, G.Pharmacogenomics of suicidal events. Pharmacogenomics. 2010; 11: 793–807CrossRefGoogle ScholarPubMed
Brent, D.A., Mann, J.J.Family genetic studies, suicide, and suicidal behavior. Am J Med Genet C Semin Med Genet. 133C 2005 1324CrossRefGoogle ScholarPubMed
Brent, D.A., Melhem, N.Familial transmission of suicidal behavior. Psychiatr Clin North Am. 2008; 31: 157–177CrossRefGoogle ScholarPubMed
Bridge, J.A., Goldstein, T.R., Brent, D.A.Adolescent suicide and suicidal behavior. J Child Psychol Psychiatry. 2006; 47: 372–394CrossRefGoogle ScholarPubMed
Bursztein Lipsicas, C., Makinen, I.H., Apter, A., et al.Attempted suicide among immigrants in European countries: an international perspective. Soc Psychiatry Psychiatr Epidemiol. 2011 Jan 1Google Scholar
Carter, T.D., Mundo, E., Parikh, S.V., Kennedy, J.L.Early age at onset as a risk factor for poor outcome of bipolar disorder. J Psychiatr Res. 2003; 37: 297–303CrossRefGoogle ScholarPubMed
Caspi, A., Sugden, K., Moffitt, T.E., et al.Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Science. 2003; 301: 386–389CrossRefGoogle ScholarPubMed
Cheng, A.T., Mann, A.H., Chan, K.A.Personality disorder and suicide. A case-control study. Br J Psychiatry. 1997; 170: 441–446CrossRefGoogle ScholarPubMed
Crow, S.J., Peterson, C.B., Swanson, S.A., et al.Increased mortality in bulimia nervosa and other eating disorders. Am J Psychiatry. 2009; 166: 1342–1346CrossRefGoogle ScholarPubMed
Cutler, A.J., Montgomery, S.A., Feifel, D., Lazarus, A., Astrom, M., Brecher, M.Extended release quetiapine fumarate monotherapy in major depressive disorder: a placebo- and duloxetine-controlled study. J Clin Psychiatry. 2009; 70: 526–539CrossRefGoogle ScholarPubMed
Duberstein, P.R., Conwell, Y., Seidlitz, L., Denning, D.G., Cox, C., Caine, E.D.Personality traits and suicidal behavior and ideation in depressed inpatients 50 years of age and older. J Gerontol B Psychol Sci Soc Sci. 55 2000 P18P26Google ScholarPubMed
Dunne, E.J.Family psychoeducation with suicide attempters. Wasserman, D.Wasserman, C.Oxford textbook of suicidology and suicide prevention: a global perspective. Oxford: Oxford University Press; 2009 439443Google Scholar
El-Mallakh, R.S., Ghaemi, S.N., Sagduyu, K., et al.Antidepressant-associated chronic irritable dysphoria (ACID) in STEP-BD patients. J Affect Disord. 2008; 111: 372–377CrossRefGoogle Scholar
Engel, Z., Mitrani, M., Zalsman, G.Prevention of suicide in an inpatient adolescent unit by environmental safety modification [letter]. Int J Adolesc Med Health. 1732005 309Google Scholar
Fawcett, J.The detection and consequences of anxiety in clinical depression. J Clin Psychiatry. 1997; 58(Suppl. 8): 35–40Google ScholarPubMed
Fawcett, J.The anxiety disorders, anxiety symptoms and suicide. Wasserman, D.Suicide: an unnecessary death. London: Martin Dunitz Ltd; 2001 5963CrossRefGoogle Scholar
Fedyszyn, I.E., Robinson, J., Matyas, T., Harris, M.G., Paxton, S.J.Temporal pattern of suicide risk in young individuals with early psychosis. Psychiatry Res. 2010; 175: 98–103CrossRefGoogle ScholarPubMed
Fergusson, D., Doucette, S., Glass, K.C., et al.Association between suicide attempts and selective serotonin reuptake inhibitors: systematic review of randomised controlled trials. BMJ. 330 2005 396CrossRefGoogle ScholarPubMed
Gearing, R.E., Lizardi, D.Religion and suicide. J Relig Health. 2009; 48: 332–341CrossRefGoogle ScholarPubMed
Ghaemi, S.N., Rosenquist, K.J., Ko, J.Y., Baldassano, C.F., Kontos, N.J., Baldessarini, R.J.Antidepressant treatment in bipolar versus unipolar depression. Am J Psychiatry. 2004; 161: 163–165CrossRefGoogle ScholarPubMed
Gibbons, R.D., Brown, C.H., Hur, K., Marcus, S.M., Bhaumik, D.K., Mann, J.J.Relationship between antidepressants and suicide attempts: an analysis of the Veterans Health Administration data sets. Am J Psychiatry. 2007; 164: 1044–1049CrossRefGoogle ScholarPubMed
Goodwin, F.K., Fireman, B., Simon, G.E., Hunkeler, E.M., Lee, J., Revicki, D.Suicide risk in bipolar disorder during treatment with lithium and divalproex. JAMA. 2003; 290: 1467–1473CrossRefGoogle ScholarPubMed
Gould, M.S., Wallenstein, S., Davidson, L.Suicide clusters: a critical review. Suicide Life Threat Behav. 1989; 19: 17–29CrossRefGoogle ScholarPubMed
Gould, M.S., Wallenstein, S., Kleinman, M.H., O’Carroll, P., Mercy, J.Suicide clusters: an examination of age-specific effects. Am J Public Health. 1990; 80: 211–212CrossRefGoogle ScholarPubMed
Grad, O.T.Therapists as survivors of suicide loss. Wasserman, D.Wasserman, C.Oxford textbook of suicidology and suicide prevention: a global perspective. Oxford: Oxford University Press; 2009 609613Google Scholar
Guthrie, E., Kapur, N., Mackway-Jones, K., et al.Randomised controlled trial of brief psychological intervention after deliberate self-poisoning. BMJ. 2001; 323: 135–138CrossRefGoogle ScholarPubMed
Guzzetta, F., Tondo, L., Centorrino, F., Baldessarini, R.J.Lithium treatment reduces suicide risk in recurrent major depressive disorder. J Clin Psychiatry. 2007; 68: 380–383CrossRefGoogle ScholarPubMed
Hamilton, M.A rating scale for depression. J Neurol Neurosurg Psychiatr. 1960; 23: 56–62CrossRefGoogle ScholarPubMed
Harris, E.C., Barraclough, B.Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry. 1997; 170: 205–228CrossRefGoogle ScholarPubMed
Hawton, K., Arensman, E., Townsend, E., et al.Deliberate self-harm: systematic review of efficacy of psychosocial and pharmacological treatments in preventing repetition. BMJ. 1998; 317: 441–447CrossRefGoogle ScholarPubMed
Hawton, K., Harriss, L., Hall, S., Simkin, S., Bale, E., Bond, A.Deliberate self-harm in Oxford, 1990–2000: a time of change in patient characteristics. Psychol Med. 2003; 33: 987–995CrossRefGoogle ScholarPubMed
Hawton, K., Houston, K., Haw, C., Townsend, E., Harriss, L.Comorbidity of axis I and axis II disorders in patients who attempted suicide. Am J Psychiatry. 2003; 160: 1494–1500CrossRefGoogle ScholarPubMed
Hawton, K., Simkin, S., Deeks, J., et al.UK legislation on analgesic packs: before and after study of long-term effect on poisonings. BMJ. 329 2004 1076CrossRefGoogle ScholarPubMed
Hawton, K., Sutton, L., Haw, C., Sinclair, J., Deeks, J.J.Schizophrenia and suicide: systematic review of risk factors. Br J Psychiatry. 2005; 187: 9–20CrossRefGoogle ScholarPubMed
Hegerl, U., Althaus, D., Schmidtke, A., Niklewski, G.The alliance against depression: 2-year evaluation of a community-based intervention to reduce suicidality. Psychol Med. 2006; 36: 1225–1233CrossRefGoogle ScholarPubMed
Heikkinen, M.E., Henriksson, M.M., Isometsa, E.T., Marttunen, M.J., Aro, H.M., Lonnqvist, J.K.Recent life events and suicide in personality disorders. J Nerv Ment Dis. 1997; 185: 373–381CrossRefGoogle ScholarPubMed
Heila, H., Haukka, J., Suvisaari, J., Lonnqvist, J.Mortality among patients with schizophrenia and reduced psychiatric hospital care. Psychol Med. 2005; 35: 725–732CrossRefGoogle ScholarPubMed
Hendin, H.Recognizing a suicide crisis in psychiatric patients. Wasserman, D.Wasserman, C.Oxford textbook of suicidology and suicide prevention: a global perspective. Oxford: Oxford University Press; 2009 327331Google Scholar
Hepp, U., Wittmann, L., Schnyder, U., Michel, K.Psychological and psychosocial interventions after attempted suicide: an overview of treatment studies. Crisis. 2004; 25: 108–117CrossRefGoogle ScholarPubMed
Herzog, D.B., Greenwood, D.N., Dorer, D.J., et al.Mortality in eating disorders: a descriptive study. Int J Eat Disord. 2000; 28: 20–263.0.CO;2-X>CrossRefGoogle ScholarPubMed
Horesh, N., Nachshoni, T., Wolmer, L., Toren, P.A comparison of life events in suicidal and nonsuicidal adolescents and young adults with major depression and borderline personality disorder. Compr Psychiatry. 2009; 50: 496–502CrossRefGoogle Scholar
Horesh, N., Sever, J., Apter, A.A comparison of life events between suicidal adolescents with major depression and borderline personality disorder. Compr Psychiatry. 2003; 44: 277–283CrossRefGoogle ScholarPubMed
Hunt, I.M., Kapur, N., Robinson, J., et al.Suicide within 12 months of mental health service contact in different age and diagnostic groups: National clinical survey. Br J Psychiatry. 2006; 188: 135–142CrossRefGoogle ScholarPubMed
Hunt, I.M., Windfuhr, K., Swinson, N., Shaw, J., Appleby, L., Kapur, N.Suicide amongst psychiatric in-patients who abscond from the ward: a national clinical survey. BMC Psychiatry. 10 2010 14CrossRefGoogle ScholarPubMed
Inamdar, S.C., Lewis, D.O., Siomopoulos, G., Shanok, S.S., Lamela, M.Violent and suicidal behavior in psychotic adolescents. Am J Psychiatry. 1982; 139: 932–935Google ScholarPubMed
Isacsson, G., Holmgren, P., Druid, H., Bergman, U.The utilization of antidepressants--a key issue in the prevention of suicide: an analysis of 5281 suicides in Sweden during the period 1992–1994. Acta Psychiatr Scand. 1997; 96: 94–100CrossRefGoogle ScholarPubMed
Isacsson, G., Holmgren, P., Wasserman, D., Bergman, U.Use of antidepressants among people committing suicide in Sweden. BMJ. 1994; 308: 506–509CrossRefGoogle ScholarPubMed
Jamison, K.R.Night falls fast: understanding suicide. New York: Random House; 1999Google Scholar
Jick, H., Kaye, J.A., Jick, S.S.Antidepressants and the risk of suicidal behaviors. JAMA. 2004; 292: 338–343CrossRefGoogle ScholarPubMed
Karg, K., Burmeister, M., Shedden, K., Sen, S.The serotonin transporter promoter variant (5-HTTLPR), stress, and depression meta-analysis revisited: evidence of genetic moderation. Arch Gen Psychiatry. 2011; 68: 444–454CrossRefGoogle ScholarPubMed
Kasckow, J., Montross, L., Golshan, S., et al.Suicidality in middle aged and older patients with schizophrenia and depressive symptoms: relationship to functioning and Quality of Life. Int J Geriatr Psychiatry. 2007; 22: 1223–1228CrossRefGoogle ScholarPubMed
Keel, P.K., Dorer, D.J., Eddy, K.T., Franko, D., Charatan, D.L., Herzog, D.B.Predictors of mortality in eating disorders. Arch Eur Psychiatry. 2003; 60: 179–183CrossRefGoogle ScholarPubMed
Kendler, K.S.Genetic and environmental pathways to suicidal behavior: reflections of a genetic epidemiologist. Eur Psychiatry. 2010; 25: 300–303CrossRefGoogle ScholarPubMed
Kennedy, S.H., Milev, R., Giacobbe, P., et al.Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. IV. Neurostimulation therapies. J Affect Disord. 2009; 117(Suppl. 1): S44–S53CrossRefGoogle ScholarPubMed
Kernberg, O.F.The suicidal risk in severe personality disorders: differential diagnosis and treatment. J Pers Disord. 2001; 15: 195–208[discussion 209-15]CrossRefGoogle ScholarPubMed
Kisely, S., Smith, M., Lawrence, D., Maaten, S.Mortality in individuals who have had psychiatric treatment: population-based study in Nova Scotia. Br J Psychiatry. 2005; 187: 552–558CrossRefGoogle ScholarPubMed
Klomek, A.B., Krispin, O., Apter, A.Suicidal behaviour in children and adolescents in different clinical settings. Wasserman, D.Wasserman, C.Oxford textbook of suicidology and suicide prevention: a global perspective. Oxford: Oxford University Press; 2009 629632Google Scholar
Kovacsics, C.E., Gottesman, I.I., Gould, T.D.Lithium's antisuicidal efficacy: elucidation of neurobiological targets using endophenotype strategies. Annu Rev Pharmacol Toxicol. 2009; 49: 175–198CrossRefGoogle ScholarPubMed
Lieberman, D.Z., Resnik, H.L., Holder-Perkins, V.Environmental risk factors in hospital suicide. Suicide Life Threat Behav. 2004; 34: 448–453CrossRefGoogle ScholarPubMed
Linehan, M.M., Comtois, K.A., Murray, A.M., et al.Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry. 63 2006 757CrossRefGoogle ScholarPubMed
Linehan, M.M., Goodstein, J.L., Nielsen, S.L., Chiles, J.A.Reasons for staying alive when you are thinking of killing yourself: the reasons for living inventory. J Consult Clin Psychol. 1983; 51: 276–286CrossRefGoogle ScholarPubMed
Litman, R.E.Mental disorders and suicidal intention. Suicide Life Threat Behav. 1987; 17: 85–92CrossRefGoogle ScholarPubMed
Lonnqvist, J.Major psychiatric disorders in suicide and suicide attempters. Wasserman, D.Wasserman, C.Oxford textbook of suicidology and suicide prevention: a global perspective. Oxford: Oxford University Press; 2009 275286Google Scholar
MacLeod, A.K., Tata, P., Tyrer, P., Schmidt, U., Davidson, K., Thompson, S.Personality disorder and future-directed thinking in parasuicide. J Pers Disord. 2004; 18: 459–466CrossRefGoogle ScholarPubMed
Maltsberger, J.T.The descent into suicide. Int J Psychoanal. 2004; 85: 653–667CrossRefGoogle ScholarPubMed
Maltsberger, J.T., Buie, D.H.Countertransference hate in the treatment of suicidal patients. Arch Gen Psychiatry. 1974; 30: 625–633CrossRefGoogle ScholarPubMed
Mann, J.J., Apter, A., Bertolote, J., et al.Suicide prevention strategies: a systematic review. JAMA. 2005; 294: 2064–2074CrossRefGoogle ScholarPubMed
Mann, J.J., Arango, V.A., Avenevoli, S., et al.Candidate endophenotypes for genetic studies of suicidal behavior. Biol Psychiatry. 2009; 65: 556–563CrossRefGoogle ScholarPubMed
Mann, J.J., Currier, D.M.Stress, genetics and epigenetic effects on the neurobiology of suicidal behavior and depression. Eur Psychiatry. 2010; 25: 268–271CrossRefGoogle ScholarPubMed
Marttunen, M.J., Aro, H.M., Henriksson, M.M., Lonnqvist, J.K.Antisocial behaviour in adolescent suicide. Acta Psychiatr Scand. 1994; 89: 167–173CrossRefGoogle ScholarPubMed
Meltzer, H.Y., Baldessarini, R.J.Reducing the risk for suicide in schizophrenia and affective disorders. J Clin Psychiatry. 2003; 64: 1122–1129Google ScholarPubMed
Mittendorfer-Rutz, E., Rasmussen, F., Wasserman, D.Familial clustering of suicidal behaviour and psychopathology in young suicide attempters. A register-based nested case control study. Soc Psychiatry Psychiatr Epidemiol. 2008; 43: 28–36CrossRefGoogle ScholarPubMed
Moller, H.J.Evidence for beneficial effects of antidepressants on suicidality in depressive patients: a systematic review. Eur Arch Psychiatry Clin Neurosci. 2006; 256: 329–343CrossRefGoogle ScholarPubMed
Moller, H.J.Pharmacological and other biological treatments of suicidal individuals. Wasserman, D.Wasserman, C.Oxford textbook of suicidology and suicide prevention: a global perspective. Oxford: Oxford University Press; 2009 395405Google Scholar
Molnar, B.E., Berkman, L.F., Buka, S.L.Psychopathology, childhood sexual abuse and other childhood adversities: relative links to subsequent suicidal behaviour in the US. Psychol Med. 2001; 31: 965–977CrossRefGoogle ScholarPubMed
Morgan, H.G., Jones, E.M., Owen, J.H.Secondary prevention of non-fatal deliberate self-harm. The green card study. Br J Psychiatr. 163 1993 111CrossRefGoogle ScholarPubMed
Nelson, E.C., Heath, A.C., Madden, P.A., et al.Association between self-reported childhood sexual abuse and adverse psychosocial outcomes: results from a twin study. Arch Gen Psychiatry. 2002; 59: 139–145CrossRefGoogle ScholarPubMed
Nock, M.K., Borges, G., Bromet, E.J., et al.Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry. 2008; 192: 98–105CrossRefGoogle ScholarPubMed
Nordentoft, M., Mortensen, P.B., Pedersen, C.B.Absolute risk of suicide after first hospital contact in mental disorder. Arch Gen Psychiatry. 2011; 68: 1058–1064CrossRefGoogle ScholarPubMed
O’Carroll, P.W., Mercy, J.A., Steward, J.A.CDC recommendations for a community plan for the prevention and containment of suicide clusters. MMWR Morb Mortal Wkly Rep. 1988; 37(Suppl. 6): 1–12Google ScholarPubMed
Oquendo, M.A., Baca-Garcia, E., Mann, J.J., Giner, J.Issues for DSM-V: suicidal behavior as a separate diagnosis on a separate axis. Am J Psychiatry. 2008; 165: 1383–1384CrossRefGoogle ScholarPubMed
Palmer, B.A., Pankratz, V.S., Bostwick, J.M.The lifetime risk of suicide in schizophrenia: a reexamination. Arch Gen Psychiatry. 2005; 62: 247–253CrossRefGoogle ScholarPubMed
Panagioti, M., Gooding, P., Tarrier, N.Post-traumatic stress disorder and suicidal behavior: a narrative review. Clin Psychol Rev. 2009; 29: 471–482CrossRefGoogle ScholarPubMed
Patorno, E., Bohn, R.L., Wahl, P.M., et al.Anticonvulsant medications and the risk of suicide, attempted suicide, or violent death. JAMA. 303 2010 1401CrossRefGoogle ScholarPubMed
Patterson, W.M., Dohn, H.H., Bird, J., Patterson, G.A.Evaluation of suicidal patients: the SAD PERSONS scale. Psychosomatics. 1983; 24: 343–345[348–9]CrossRefGoogle ScholarPubMed
Paykel, E.S.Life stress, depression and attempted suicide. J Human Stress. 1976; 2: 3–12CrossRefGoogle ScholarPubMed
Pirkola, S.P., Isometsa, E.T., Heikkinen, M.E., Lonnqvist, J.K.Suicides of alcohol misusers and non-misusers in a nationwide population. Alcohol Alcohol. 2000; 35: 70–75CrossRefGoogle Scholar
Posner, K., Oquendo, M.A., Gould, M., Stanley, B., Davies, M.Columbia Classification Algorithm of Suicide Assessment (C-CASA): classification of suicidal events in the FDA's pediatric suicidal risk analysis of antidepressants. Am J Psychiatry. 2007; 164: 1035–1043CrossRefGoogle ScholarPubMed
Pouliot, L., De Leo, D.Critical issues in psychological autopsy studies. Suicide Life Threat Behav. 2006; 36: 491–510CrossRefGoogle ScholarPubMed
Ramberg, I.L., Wasserman, D.Prevalence of reported suicidal behaviour in the general population and mental health-care staff. Psychol Med. 2000; 30: 1189–1196CrossRefGoogle ScholarPubMed
Ramberg, I.L., Wasserman, D.Benefits of implementing an academic training of trainers program to promote knowledge and clarity in work with psychiatric suicidal patients. Arch Suicide Res. 2004; 8: 331–343CrossRefGoogle ScholarPubMed
Reutfors, J., Osby, U., Ekbom, A., Nordstrom, P., Jokinen, J., Papadopoulos, F.C.Seasonality of suicide in Sweden: relationship with psychiatric disorder. J Affect Disord. 2009; 119: 59–65CrossRefGoogle ScholarPubMed
Rey, J.M., Walter, G.Half a century of ECT use in young people. Am J Psychiatry. 1997; 154: 595–602Google ScholarPubMed
Rihmer, Z.Suicide risk in mood disorders. Curr Opin Psychiatry. 2007; 20: 17–22CrossRefGoogle ScholarPubMed
Rihmer, Z., Akiskal, H.Do antidepressants t(h)reat(en) depressives? Toward a clinically judicious formulation of the antidepressant-suicidality FDA advisory in light of declining national suicide statistics from many countries. J Affect Disord. 2006; 94: 3–13CrossRefGoogle Scholar
Robinson, J., Harris, M.G., Harrigan, S.M., et al.Suicide attempt in first-episode psychosis: a 7.4-year follow-up study. Schizophr Res. 2010; 116: 1–8CrossRefGoogle ScholarPubMed
Robinson, J., Hetrick, S.E., Martin, C.Preventing suicide in young people: systematic review. Aust N Z J Psychiatry. 2011; 45: 3–26CrossRefGoogle ScholarPubMed
Roskar, S., Podlesek, A., Zorko, M., et al.Effects of training program on recognition and management of depression and suicide risk evaluation for Slovenian primary-care physicians: follow-up study. Croat Med J. 2010; 51: 237–242CrossRefGoogle ScholarPubMed
Roy, A., Janal, M.Family history of suicide, female sex, and childhood trauma: separate or interacting risk factors for attempts at suicide?. Acta Psychiatr Scand. 2005; 112: 367–371CrossRefGoogle ScholarPubMed
Roy, A., Segal, N.L.Suicidal behavior in twins: a replication. J Affect Disord. 2001; 66: 71–74CrossRefGoogle ScholarPubMed
Roy, A., Segal, N.L., Centerwall, B.S., Robinette, C.D.Suicide in twins. Arch Gen Psychiatry. 1991; 48: 29–32CrossRefGoogle ScholarPubMed
Rudd, M.D., Williams, B., Trotter, D.The psychological and behavioural treatment of suicidal behaviour: what are the common elements of treatment that work?. Wasserman, D.Wasserman, C.Oxford textbook of suicidology and suicide prevention: a global perspective. Oxford: Oxford University Press; 2009 427437Google Scholar
Rutz, W., Walinder, J., Eberhard, G., et al.An educational program on depressive disorders for general practitioners on Gotland: background and evaluation. Acta Psychiatr Scand. 1989; 79: 19–26CrossRefGoogle ScholarPubMed
Santa Mina, E.E., Gallop, R.M.Childhood sexual and physical abuse and adult self-harm and suicidal behaviour: a literature review. Can J Psychiatry. 1998; 43: 793–800CrossRefGoogle ScholarPubMed
Sarchiapone, M., Carli, V., Cuomo, C., Roy, A.Childhood trauma and suicide attempts in patients with unipolar depression. Depress Anxiety. 2007; 24: 268–272CrossRefGoogle ScholarPubMed
Sarchiapone, M., Jaussent, I., Roy, A., et al.Childhood trauma as a correlative factor of suicidal behavior - via aggression traits. Similar results in an Italian and in a French sample. Eur Psychiatry. 2009; 24: 57–62CrossRefGoogle Scholar
Schneider, B., Maurer, K., Sargk, D., et al.Concordance of DSM-IV Axis I and II diagnoses by personal and informant's interview. Psychiatry Res. 2004; 127: 121–136CrossRefGoogle ScholarPubMed
Shea, S.C.Psychiatric interviewing. The art of understanding. Philadelphia: Saunders; 1988Google Scholar
Silfverhielm H. Sjalvmord 2006–2008 anmalda enligt lex Maria. Socialstyrelsen; 2010.Google Scholar
Silverman, M.M., Berman, A.L., Sanddal, N.D., O’Carroll, P.W., Joiner, T.E.Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 1: Background, rationale, and methodology. Suicide Life Threat Behav. 2007; 37: 248–263CrossRefGoogle Scholar
Silverman, M.M., Berman, A.L., Sanddal, N.D., O’Carroll, P.W., Joiner, T.E.Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 2: Suicide-related ideations, communications, and behaviors. Suicide Life Threat Behav. 2007; 37: 264–277CrossRefGoogle Scholar
Simon, G.E., Savarino, J., Operskalski, B., Wang, P.S.Suicide risk during antidepressant treatment. Am J Psychiatry. 2006; 163: 41–47CrossRefGoogle ScholarPubMed
Soloff, P.H., Lynch, K.G., Kelly, T.M.Childhood abuse as a risk factor for suicidal behavior in borderline personality disorder. J Pers Disord. 2002; 16: 201–214CrossRefGoogle ScholarPubMed
Stanley, B., Brodsky, B., Nelson, J.D., Dulit, R.Brief dialectical behavior therapy (DBT-B) for suicidal behavior and non-suicidal self injury. Arch Suicide Res. 2007; 11: 337–341CrossRefGoogle ScholarPubMed
Stanley, B., Brodsky, B.S.Dialectical behavioural therapy for suicidal individual. Wasserman, D., Wasserman, C.Oxford textbook of suicidology and suicide prevention: a global perspective. Oxford: Oxford University Press; 2009 421425Google Scholar
Stanley, B., Brown, G., Brent, D.A., et al.Cognitive-behavioral therapy for suicide prevention (CBT-SP): treatment model, feasibility, and acceptability. J Am Acad Child Adolesc Psychiatry. 2009; 48: 1005–1013CrossRefGoogle ScholarPubMed
Stanley, B., Jones, J.Risk for suicidal behaviour in personality disorders. Wasserman, D.Wasserman, C.Oxford textbook of suicidology and suicide prevention: a global perspective. Oxford: Oxford University Press; 2009 287292Google Scholar
Stenager, E., Stenager, E.Somatic diseases and suicidal behaviour. Wasserman, D.Wasserman, C.Oxford textbook of suicidology and suicide prevention: a global perspective. Oxford: Oxford University Press; 2009 293299Google Scholar
Stone, M., Laughren, T., Jones, M.L., et al.Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to US Food and Drug Administration. BMJ. 339 2009 b2880CrossRefGoogle ScholarPubMed
Suominen, K., Henriksson, M., Suokas, J., Isometsa, E., Ostamo, A., Lonnqvist, J.Mental disorders and comorbidity in attempted suicide. Acta Psychiatr Scand. 1996; 94: 234–240CrossRefGoogle ScholarPubMed
Szanto, K., Kalmar, S., Hendin, H., Rihmer, Z., Mann, J.J.A suicide prevention program in a region with a very high suicide rate. Arch Gen Psychiatry. 2007; 64: 914–920CrossRefGoogle Scholar
Taiminen, T.J., Kallio-Soukainen, K., Nokso-Koivisto, H., Kaljonen, A., Helenius, H.Contagion of deliberate self-harm among adolescent inpatients. J Am Acad Child Adolesc Psychiatry. 1998; 37: 211–217CrossRefGoogle ScholarPubMed
Tidemalm, D., Langstrom, N., Lichtenstein, P., Runeson, B.Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long-term follow-up. BMJ. 337 2008 a2205CrossRefGoogle ScholarPubMed
Titelman, D.Primo Levi's loneliness: psychoanalytic perspectives on suicide-nearness. Psychoanal Q. 2006; 75: 835–858CrossRefGoogle ScholarPubMed
Titelman, D., Nilsson, A., Estari, J., Wasserman, D.Depression, anxiety, and psychological defense in attempted suicide: a pilot study using PORT. Arch Suicide Res. 2004; 8: 239–249CrossRefGoogle ScholarPubMed
Tollefson, G.D., Sanger, T.M., Lu, Y., Thieme, M.E.Depressive signs and symptoms in schizophrenia: a prospective blinded trial of olanzapine and haloperidol. Arch Gen Psychiatry. 1998; 55: 250–258CrossRefGoogle ScholarPubMed
Uher, R.Genes, environment, and individual differences in responding to treatment for depression. Harv Rev Psychiatry. 2011; 19: 109–124CrossRefGoogle ScholarPubMed
Wasserman, D.Depression: the facts. Oxford: Oxford University Press; 2011Google Scholar
Wasserman, D.A stress-vulnerability model and the development of the suicidal process. Wasserman, D.Suicide: an unnecessary death. London: Martin Dunitz Ltd; 2001 1327CrossRefGoogle Scholar
Wasserman, D.Negative life events (losses, changes, traumas and narcissistic injury) and suicide. Wasserman, D.Suicide: an unnecessary death. London: Martin Dunitz Ltd; 2001 111117CrossRefGoogle Scholar
Wasserman, D.Suicidal people's experiences of negative life events. Wasserman, D.Suicide: an unnecessary death. London: Martin Dunitz Ltd; 2001 119124CrossRefGoogle Scholar
Wasserman, D., Geijer, T., Sokolowski, M., Rozanov, V., Wasserman, J.Nature and nurture in suicidal behavior, the role of genetics: some novel findings concerning personality traits and neural conduction. Physiol Behav. 2007; 92: 245–249CrossRefGoogle ScholarPubMed
Wasserman, D., Sokolowski, M., Wasserman, J., Rujescu, D.Neurobiology and the genetics of suicide. Wasserman, D.Wasserman, C.Oxford textbook of suicidology and suicide prevention: a global perspective. Oxford: Oxford University Press; 2009 165182CrossRefGoogle Scholar
Wasserman, D., Terenius, L., Wasserman, J., Sokolowski, M.The 2009 Nobel conference on the role of genetics in promoting suicide prevention and the mental health of the population. Mol Psychiatry. 2010; 15: 12–17CrossRefGoogle ScholarPubMed
Wasserman, D., Wasserman, C.Oxford textbook of suicidology and suicide prevention: a global perspective. Oxford: Oxford University Press; 2009CrossRefGoogle Scholar
Weissman, M.M., Bland, R.C., Canino, G.J., et al.Prevalence of suicide ideation and suicide attempts in nine countries. Psychol Med 1999; 29: 9–17CrossRefGoogle ScholarPubMed
Wolk-Wasserman, D.Suicidal communication of persons attempting suicide and responses of significant others. Acta Psychiatr Scand 1986; 73: 481–499CrossRefGoogle ScholarPubMed
Wolk-Wasserman, D.Some problems connected with the treatment of suicide attempt patients: transference and countertransference aspects. Crisis 1987; 8: 69–82Google ScholarPubMed
Wood, A., Trainor, G., Rothwell, J., Moore, A., Harrington, R.Randomized trial of group therapy for repeated deliberate self-harm in adolescents. J Am Acad Child Adolesc Psychiatry 2001; 40: 1246–1253CrossRefGoogle ScholarPubMed
World Health Organization. WHO mortality database. http://www.whoint/healthinfo/morttables/en/.Google Scholar
World Health Organization. The ICD-10 classification of mental and behavioural disorders. WHO; 1992.Google Scholar
Yatham, L.N., Kennedy, S.H., Schaffer, A., et al.Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009. Bipolar Disord 2009; 11: 225–255CrossRefGoogle ScholarPubMed
Yen, S., Pagano, M.E., Shea, M.T., et al.Recent life events preceding suicide attempts in a personality disorder sample: findings from the collaborative longitudinal personality disorders study. J Consult Clin Psychol 2005; 73: 99–105CrossRefGoogle Scholar
Yerevanian, B.I., Koek, R.J., Feusner, J.D., Hwang, S., Mintz, J.Antidepressants and suicidal behaviour in unipolar depression. Acta Psychiatr Scand 2004; 110: 452–458CrossRefGoogle ScholarPubMed
Zalsman, G.Timing is critical: gene, environment and timing interactions in genetics of suicide in children and adolescents. Eur Psychiatry 2010; 25: 284–286CrossRefGoogle ScholarPubMed
Zalsman, G., Shoval, G.The link between physical disabilities and suicidality in children and adolescents.Wasserman, D.Wasserman, C.Oxford textbook of suicidology and suicide prevention: a global perspective 2009 Oxford University Press Oxford661665Google Scholar
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