History of previous suicide attempts is one of the most important risk factors for a subsequent completed suicide. Suicide reattempters (SR) has been long associated with demographic and clinical risk factors for suicide, such as unemployment and psychiatric disorders, however a recent review of the literature has not supported a specific age and gender profile of SR, but rather underscored that, as far as diagnosis is concerned, SR were more likely to have a personality disorder. According to literature, 16%–34% of the subjects repeat a suicide attempt within the first 2 years after the previous one.

The purpose of our study was evaluating clinical and socio-demographic characteristics and the outcome of psychiatric consultation among subjects referring to an emergency room for recommitting a suicide attempt.

We considered a sample of SR aged > 16 years. We extracted data from the database including all patients requiring psychiatric evaluation in the emergency room, and eventually compared the features of SR and patients with a single suicide attempt. For each patient, we gathered socio-demographic features, psychiatric history and current clinical issues, suicidal intent and suicidal behaviors.

Data collection and statistical analyses are still ongoing. Preliminary results show that, compared to patients with a single suicide attempt, SR were more frequent female, unmarried, employed, with a low level of instruction; they had a psychiatric disease (axis I – anxiety disorder, somatoform disorder; axis II – histrionic personality disorder); they are under the care of mental health services and under psychopharmacological treatment.

The authors have not supplied their declaration of competing interest.

Suicide attempts, defined as self-inflicted, potentially injurious behaviors with a nonfatal outcome, and with evidence of intent to die are extremely prevalent. Literature suggests that suicide is more common among males, while attempted suicide is more frequent among females. Depression, mental disorders, substance use disorders and history of suicidal behavior are important risk factors for suicide: the risk of suicide attempt is 3 to 12 times higher in psychiatric patients than in the general population.

The aim of our study was to compare severity of depressive symptoms in a sample of suicide attempters with a diagnosis of bipolar and related disorders or depressive disorders and in a sample of sex- and diagnosis-matched patients who do not commit a suicide attempt. The severity of attempted suicide and the suicidal risk in the hospital will be assessed as well.

We collected a sample of inpatients who committed a suicide attempt during 2015. For each attempter, we selected another sex- and diagnosis-matched patient with no history of attempted suicide. Socio-demographic and clinical characteristics of the sample were gathered. Assessment included: Montgomery-Asberg Depression Rating Scale (MADRS) for severity of depressive symptoms in both groups, Suicide Intent Scale (SIS) for the severity of attempted suicide and the suicidal risk with a nurse assessment for suicide.

Data collecting is still ongoing. We expected to find more severe symptoms in patients who attempted suicide. Clinical implication will be discussed.

The authors have not supplied their declaration of competing interest.

Death by suicide stuns with soul-crushing surprise, leaving family and friends not only grieving the unexpected death, but confused and lost by this haunting loss. The underlying structure of grief for survivors of suicide loss appears complicated.

The purpose of this study consists in reviewing literature data about survivors of suicide, especially exploring the few informations emerged by researches on the role of psychiatrist as “survivor”.

A PubMed search was conducted using combinations of the following keywords: survivors suicide or bereavement suicide or suicide psychiatrists and randomized.

The search was conducted through September 10, 2015, and no conference proceedings were included.

Bereavement following suicide is complicated by the psychological impact of the act on those close to the victim. It is further complicated by the societal perception that the act of suicide is a failure by the victim and the family to deal with some emotional issue and ultimately society affixes blame for the loss on the survivors. This individual or societal stigma introduces a unique stress on the bereavement process that in some cases requires clinical intervention.

Suicide bereavement seems to be different from natural loss. Clinicians may react to a patient's suicide both on a personal and professional level, with emotions such as loss of self-esteem or blame. This grief somehow nullifies the core of a helping relationship and may imply a more conservative management of future patients or even avoiding to accept suicidal patients for treatment. Support interventions have been proposed.

The authors have not supplied their declaration of competing interest.

The number of suicides rises in the Netherlands. In 2008, 1435 suicides were recorded; in 2012: 1753 (CBS). Adequate risk assessment with suicidal behaviour (SRA) is essential for prevention. The Health Inspectorate and Insurances seek to have a stronger grip on the way suicide risk is assessed and insist on using questionnaires. This runs counter to the multidisciplinary guidelines in the Netherlands for diagnosis and treatment of suicidal behaviour, which state that “questionnaires or observation instruments cannot replace clinical diagnostic examination.”

Do questionnaires rather than ‘care as usual’ (CAU) in SRA lead to different treatment policies?

To determine whether the use of questionnaires rather than CAU in SRA leads to different treatment policies.

Patients who were seen by staff at the department of Psychiatry at the ETS Hospital, either for in-house consultation or at the MPU, in connection with attempted suicide, auto-intoxication, or psychological distress with suicidal statements. Patients were examined by conducting a questionnaire, resulting in treatment policy (admission, discharge with an appointment with patient's own practitioner, discharge with referral to a practitioner, discharge without aftercare). Then, the same patient was again examined by another colleague in a free interview (CAU). The colleague was not informed about the outcome of the first assessment. Again, treatment policy was determined as a result. The two outcomes were then compared.

Data collection still continues.

There are signs that there are no differences in the determined treatment policies following SRA based on the use of questionnaires or CAU.

The authors have not supplied their declaration of competing interest.

Suicide is the deliberate act of take off life to itself. According to WHO, more than one million people commit suicide every year.

Compare data of suicide attempts between 1996 and 2014 in the University Hospital of Valladolid. Influence of the economic crisis on suicide data. Expose the risk factors. Provide prevention strategies.

We have performed a study of epidemiological surveillance collecting descriptive data of suicide attempts; using the same methodology as in 1996. The variables studied were: sex, age, day, month, residence, method, personal status, education, employment status, religious believes, family history of suicide, psychiatric history and family and personal psychiatric history.

Increase in the rate of suicide attempts 27%. Distribution by sex is similar, but in 2014, a higher proportion was observed in males. The percentage of women is significantly higher than that of men in the group of teenagers (10–19 years old) (20% women vs. 4.5% of men; P = 0.005); 83.5% have a psychiatric diagnosis (54.2% of them have a depressive disorder). Unemployment and economic problems stand out as environmental stressors in 2014. The main suicide method used in Valladolid is the hanging, and the second method used is the precipitation.

The primary, secondary and tertiary prevention strategies are very important. Suicide is the major cause of mortality in the young age group (15–24 years old). Mortality in the general population has been on a downward trend; but suicide rates per 100,000 population has remained stable over the last decade.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

There is emerging evidence that suicide and suicidal behavior frequently occur in people with autistic spectrum disorders (ASD), although this topic is largely understudied. We have little understanding of suicidal behavior among individuals with ASD and there are no empirical data to guide practitioners in the treatment of suicidality in persons with ASD. There is a need to investigate risk factors associated with suicidal behavior in persons with ASD, to improve prevention strategies and interventions.

To get an overview from literature of risk factors for suicidality in individuals with ASD.

Review of the literature using Cochrane Collaboration Centre, Embase, Medline, PsychINFO, PubMed, and Web of Science.

In the literature, we found that, among already known risk factors like comorbid depression, an underlying vulnerability in personality may be a risk factor for suicidal behavior. Several studies showed that a high score on the temperament factor ‘novelty seeking’ and ‘harm avoidance’ is associated with suicidality. In other studies, where suicidality was not an object of study, adults with ASD showed high scores on ‘harm avoidance’ and low scores on ‘novelty seeking’. This suggests that personality profiles may be of predictive value for suicidality in adults with ASD. A study proposal focused on this possible association be presented.

The authors have not supplied their declaration of competing interest.

Optimizing psychiatric assessments could help to standardize the use of structured instruments in clinical practice. In recent years, several research groups have applied Computerized Adaptive Tests (CATs) to simplify assessments in depression, anxiety and also suicidal behaviors. We aimed to construct a shortened test to classify suicide attempters using a decision tree methodology that allows the integration of relevant clinical information, namely the history of past suicide attempts, in the construction of the test.

The sample was composed of 902 adult participants in three subsamples: first-time suicide attempters, psychiatric inpatients that never attempted suicide and healthy controls. The performance of a decision tree built using the items of a previously developed scale for suicidal risk was examined. The history of past suicide attempts was used to separate patients in the decision tree. The data was randomly divided in a training set and a test set. The test set, that contained 25% of the data, was used to determine the accuracy of the decision tree. Twenty-five cross-validations of this set up were conducted.

The first four items of the decision tree classified correctly 81.4% of the patients.

As a result of a methodology based on decision trees that, contrary to CATs, can incorporate relevant information in building the test we were able to create a shortened test capable of separating suicidal and non-suicidal patients. Using all the information that is available improves the precision and utility of instruments adapted for psychiatric assessments.

The authors have not supplied their declaration of competing interest.

Suicide causes 1.4% of deaths worldwide. Twenty times more frequent, suicide attempts entail an important source of disability and of psychosocial and medical resources use.

To describe main socio-demographical and psychiatric risk factors of suicide attempters treated in a general hospital's emergency room basis.

To identify individual features potentially useful to improve both emergency treatments and resource investment.

A descriptive study including data from 2894 patients treated in a general hospital's emergency room after a suicidal attempt between years 2006 and 2014.

Sixty-nine percent of the population treated after an attempted suicide were women. Mean age was 38 years old. Sixty-six percent had familiar support; 48.5% had previously attempted a suicide (13% did not answer this point); 72.6% showed a personal history of psychiatric illness. Drug use was present in 38.3% of the patients (20.3% did not answer this question); 23.5% were admitted to an inpatient psychiatric unit. Medium cost of a psychiatric hospitalization was found to be 4900 euros.

This study results agree with previously reported data. Further observational studies are needed in order to bear out these findings, rule out potential confounders and thus infer and quantify causality related to each risk factor.

The authors have not supplied their declaration of competing interest.

Suicide behavior constitutes a public health problem worldwide. It deserves epidemiological investigation regarding “best clinical practices”, and it is fundamental since the patient's first observation at psychiatric emergencies services. These are the ideal practices to start suicide prevention, and prevent further suicidal behavior. The improvement of healthcare quality includes the adoption of clinical guidelines, which support medical care since the emergencies services. The lack of specific instruments to evaluate suicidal risk urges the scientific community to create them.

The authors aim to discuss the advantages and limitations of the application of these kinds of instruments, and the creation of models based in scientific evidence available.

From multiple available studies, the Modified Sad-Persons Scale (MSPS) seems to be one of the most scientifically used in literature, as well as in epidemiological studies of suicide attempts and their repetition, either by nonfatal or fatal attempts. However, even this scale has been questioned by experts, and the lack of specific and sensible tests towards suicide behavior and risk of suicide attempts raises the importance of the need of further investigation towards this area. This evidence would then help the clinician in his work at emergencies wards and provide better healthcare towards preventing new suicide attempts.

The authors have not supplied their declaration of competing interest.

There is limited information published on the specific financial costs of completed and/or attempted suicide in bipolar patients. In the last 15 years, only 6 studies were published. Their results vary considerably due to differences in methods used. Also, information on cost for pure manic versus mixed episodes is lacking. This is surprising, since studies have shown that suicidal behaviour is more common among patients with depressive symptoms than with pure mania, and this difference increases considerably when the mixed-features specifier is applied.

We conducted a registry study with the aim to expand the epidemiological information on suicidal behaviour by episode type in bipolar disorder, and its associated costs.

Health data were retrieved from the Swedish Patient Register. Data covered the period 1990–2014 and included the number of discharged patients with bipolar diagnosis, hospital re-admissions, and attempted and/or completed suicides. Moreover, we retrieved data on suicide and cause of death from the Swedish Cause of Death register. Analyses were done for the whole sample and stratified by subtypes (mania, depression and mixed forms).

First results will be presented at the EPA meeting.

This is a nation-wide Swedish study of completed and attempted suicide in bipolar patients. The hypothesis we will test is that there is a substantial variation between different bipolar disorder subtypes, and that most of the expenditures due to suicidal behaviour in bipolar disorder are linked to mixed forms, mania in combination with depression.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Suicide in the elderly is a growing problem in Western society, despite which there are no large studies examining this issue, nor specific protocols to address them.

To raise awareness of the importance of suicidal behavior in elderly both its prevalence and special features that presents need a different performance plan from other fractions old.

Comprehensive literature review of all published in the last two years, as well as the specific features.

Suicidal behavior in the elderly has very specific characteristics that we must know in order to develop therapeutic strategies adapted to the present conditions.

The authors have not supplied their declaration of competing interest.

Although it is increasingly an immigrant country, we can not forget that for years has been a world leader as a meeting place of many nationalities. It has carried out a review of the literature about the number of suicides that occur in the immigrant population of our country.

Cultural factors that influence suicidal behavior are religion, socio-demographic factors (inverse relationship between socioeconomic status and suicide attempts), conflicts, alcohol/drugs, and social and family support as emigration entails fostering emotional and cultural rootlessness isolation and increased risk. Stresses in young Filipinos (20%) and American Indians (19%) than for any other ethnic group. Among the immigrants, I returned to their country of origin, the Germans have a 30% rate of suicides. And if we consider the length of stay, a clear decrease in rates seen since the frequent change of residence results in an increased risk. In the comparison of nationality and gender, it shows that the rate for suicides is very high among Moroccan women aged between 10 and 24 years.

Migration can alter the development and adaptation of people and sometimes increase the risk of suicide especially when migration occurs alone. Attempted suicide is an exceptional crisis that requires special attention. Progress in research will deepen the psychological effects of migration in adults and in children migrated.

The author has not supplied his declaration of competing interest.

The recent crash of Germanwings Flight 4U9525 appears to be the latest act of aircraft-assisted murder-suicide. The psychiatric preventive aspects of the murder-suicide need to be discussed, and effective measures for recognition and prevention of this murder-suicide are needed. Aircrew health is biased towards the physical ailments, and evaluation manuals have not discussed the mental health aspects, especially preventive strategies. These strategies involve multifactorial interventions, their applicability and usefulness are not globally validated.

Thanatology has since long, focused on early detection of mental distress and elucidating behavioural and psychological factors that predispose towards attempts at self-harm. Aircrew forms a different group from the general population. The recognition and preventive strategies in this special group, must, therefore, be tailored to this group with its special characteristics.

Data sources, study selection and data synthesis publications were identified via electronic searches using multiple search terms related to suicide prevention. The available effective preventive measures were juxtaposed on the current concepts in aerospace psychiatry.

Murder-suicide by aircrew is an event that is the culmination of undetected, ignored or even condoned discrete events that gradually progress and insidiously escalate. The importance of psychological factors in this catastrophic event needs to be disseminated amongst psychiatrists, and aircrew medical examiners. Ascertaining which components of suicide prevention programmes are effective in early recognition of aircrew who may attempt or complete the murder-suicide and putting into practice these to optimize the use of limited resources, is therefore essential and necessary.

The authors have not supplied their declaration of competing interest.

Previous suicide attempts are a consistent risk factor for suicide. Repetition has been associated with higher future morbidity and suicidality.

To examine the relationship between psychological variables at pregnancy and previous repetition of suicidal attempts, first attempts and absence of attempts.

The sample comprise 568 third trimester pregnant women, mean aged 29.82 years (SD = 4.55; variance = 17–44). Previous suicidal behaviors were assessed with diagnostic interview for genetic studies, depression with PDSS and BDI-II, and affect with POMS. Current suicidal thoughts were assessed with PDSS dimension; hopelessness and helplessness by summing the scores of the POMS items hopeless/gloomy; and lonely/helpless, respectively.

Repeaters (R; n = 11, 1.9%) scored higher than non-repeaters (NR; n = 20, 3.5%) in most of the clinical variables, but only significantly in sleeping/eating disturbances (PDSS).

R and NR when compared to women who never attempted suicide (NA; n = 535, 94.5%) both revealed significant higher levels of depressive/hostility affect (POMS), BDI-II total score, suicide ideation, guilt/shame (PDSS) and anxiety/insecurity or anxiety/somatic (PSDD or BDI-II).

In comparison with NA, R also revealed significant higher levels of negative affect (POMS), PDSS total score, loss of self, mental confusion (PDSS), cognitive and affective symptoms, fatigue (BDI-II), hopelessness and helplessness. NR also differs from NA in their higher emotional liability (PDSS).

Women with previous suicide attempts are at elevated risk for high depressive symptoms, negative affect and suicide ideation at pregnancy. Compared to never attempters, repeaters revealed high morbidity than first attempters. The intervention in pregnancy must carefully assess previous history of suicide attempts.

The authors have not supplied their declaration of competing interest.

Concerns over suicide among military veterans has been as issue of major public and policy concern, particularly by the Veterans Health Administration (VHA), which is the largest integrated health care system in the United States.

The reasons for suicide risk and means to reduce risk in this population have been under active investigation and implementation. The aim of this presentation is to review recent trends in suicide risk assessment and suicide prevention interventions within the VHA in the United States.

A literature review consisting of an electronic database search of PubMed, “gray literature” search, and manual search for articles related to suicide in military personnel and veterans was conducted.

In recent years, annual VHA rates of completed suicide have ranged from approximately 34 to 40 suicides per 100,000 person-years, rates significantly higher than the general US population. Risk assessment methods examined in military veteran populations have primarily included self-report instruments, scales, and checklists. Recently, “big data” approaches to analysis of electronic medical records have shown promise in stratifying veterans into high- and low-risk groups. VHA suicide prevention initiatives have included extensive staff hiring, development of research centers and data-sharing agreements focused on suicide, a national telephone crisis line, routine suicide risk assessment and screening, and suicide safety plans.

Military veterans in the US receiving care in the VHA have a variety of risk factors for suicide and continue to be at elevated risk despite implementation of numerous suicide prevention initiatives.

The author has not supplied his declaration of competing interest.

Objectively validated models of the depressed suicide are lacking. Early observations that electrodermal hyporeactivity was strongly related to suicide in depression required an untraditional statistical approach that was applied on materials from published materials with between themselves totally confirming results.

A plausible explanation model of the relationship had to be developed.

The aims were to investigate the nature of electrodermal hyporeactivity and its possible causes and connections to other suicide relevant factors and to formulate a coherent model of the depressed suicide.

Published materials with in- and outpatients (in total > 900 patients) comprising follow-up of suicide and tests of habituation of the electrodermal response were analysed. Symptomatology, gender, age and other variables were considered and so were knowledge and theories from other scientists.

The apparent loss of or considerably reduced specific electrodermal orienting (curiosity) responses in future depressed suicide victims showed clear relationships to and clear independence of considered important suicidal factors.

Loss of specific orienting responses indicates loss of hippocampal CA3 plasticity. CA3 areas are early and centrally positioned in the information processing of neocortical sensory input supporting the hypothesis of a particular neuropsychological dysfunction disabling normal cognitive and emotional curiosity reactions to everyday events. It is proposed that this dysfunction may make the depressed person ready to leave the everyday life and fearless of imminent pain – a loss of two important barriers against suicide.

It seems righteous to propose this basically objectively validated model as a plausible explanation of the depressed suicide.

The author has not supplied his declaration of competing interest.

Suicidal behaviour represents a global public health issues; personal suicidal history is the most common predictor of the persistence and recurrence of suicidal ideation and behaviour in general.

This paper proposes to elaborate a synthesis of the scientific literature, concerning the main predictive factors of the persistence and recurrence of suicidal behaviour, considering that the current diagnostic criteria available fail to make a distinction and to specify clearly the differences between all psychiatric disorders without self-harming behaviour and the same nosological entity accompanied by suicidal behaviour.

I conducted a literature review, by analyzing the data concerning the predictors of the persistence and recurrence of self-harming behaviour, obtained from articles published between January 2013 and January 2015. I browsed the PubMed website, by keywords such as suicide, suicidal risk, suicide predictor, persistent suicidal ideation, and suicidal behaviour recurrence.

The scientific literature underscores that that entrapment and defeat are two elements often neglected; however, they should be a priority criterion, alongside traditional predictive factors, such as the following: gender, age, history of suicide attempts, socio-familial status, etc. All of these factors must be considered within the complex endeavour of assessing suicidal risk. However, there is still only scarce validated data concerning the mechanism that leads to entrapment and the one that determines its relation with self-harming behaviour.

This paper proposes to synthesize the current data concerning suicide predictors, in order to obtain new research assumptions. The final purpose is to develop proper preventive and therapeutic approaches.

The authors have not supplied their declaration of competing interest.

Studies conducted on Italian samples suggested that 70% of self-harms referred to the emergency room (ER) were suicide attempts. Suicide attempts are associated with societal, relationship and individual risk factors, which vary with age and gender, occur in combination, and may change over time. We conducted a previous study on a sample of psychiatric consultations in ER from 2008 to 2011. We observed that female gender, a permanent job and being in the warmer months of the year were risk factors for suicide attempts.

To update knowledge about risk factors for attempted suicide analyzing a larger sample of ER psychiatric consultations.

Determinants of emergency room visits for psychiatric reasons were studied prospectively in a period of 8 years, from 2008 to 2015 at the “Maggiore della Carità” Hospital in Novara. The psychiatric assessment of patients was performed by experienced psychiatrists with a clinical interview. For each patient, a data sheet was filled in order to gather demographic and clinical features. Comparison of qualitative data was performed by means of the Chi2 test while differences between groups for continuous variables were assessed through a t-test. Statistical significance was set at P ≤ 0.05. A multivariate analysis was performed using logistic regression in order to assess the potential predictors of attempted suicide. Results are expressed as odds ratio (OR) with 95% confidence intervals (95% CI).

We have collected data from more than 500 psychiatric consultations for attempted suicide. Data collection and statistical analyses are still ongoing. Implications will be discussed.

The authors have not supplied their declaration of competing interest.