Original Article

Exploration of the Association Between Physical Health and Suicidal Behavior in Psychiatric Outpatients in Rural America

Authors: Jessica M. Carbajal, MD, Nolan C. Kordsmeier, MS, Ricardo Cáceda, MD, PhD

Abstract

Objective: Evidence reveals a link between poor physical health and suicide. The physical health of rural, adult psychiatric outpatients with a history of suicide was examined.

Methods: The medical records of 192 patients seen at a tertiary-level academic medical center were examined for demographics, psychiatric and medical history, and self-reported measures of depression, anxiety, childhood trauma, and health status.

Results: The 48 subjects who endorsed a history of suicide attempts evidenced more medical conditions than those who had not made a suicide attempt (t = 2.91, P = 0.005).

Conclusions: The results support the hypothesis of increased health risks in patients with a history of suicide attempts and highlight the need for targeted health interventions.

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References

1. Hoyert DL, Xu J. Deaths: preliminary data for 2011. Natl Vital Stat Rep 2012;61:1-51.
 
2. Hirsch JK. A review of the literature on rural suicide: risk and protective factors, incidence, and prevention. Crisis 2006;27:189-199.
 
3. Koenig J, Rinnewitz L, Warth M, et al. Autonomic nervous system and hypothalamic-pituitary-adrenal axis response to experimentally induced cold pain in adolescent non-suicidal self-injury-study protocol. BMC Psychiatry 2015;15:150.
 
4. Goldman-Mellor SJ, Caspi A, Harrington H, et al. Suicide attempt in young people: a signal for long-term health care and social needs. JAMA Psychiatry 2014;71:119-127.
 
5. Benedek T. The functions of the sexual apparatus and their disturbances. In: Alexander F, Benedek T, eds. Psychosomatic Medicine, Its Principles and Applications. New York: Norton, 1950:216-240.
 
6. Claassen CA, Trivedi MH, Rush AJ, et al. Clinical differences among depressed patients with and without a history of suicide attempts: findings from the STAR*D trial. J Affect Disord 2007;97:77-84.
 
7. Xiang YT, Weng YZ, Leung CM, et al. Socio-demographic and clinical correlates of lifetime suicide attempts and their impact on quality of life in Chinese schizophrenia patients. J Psychiatr Res 2008;42:495-502.
 
8. Hawton K, Harriss L, Zahl D. Deaths from all causes in a long-term follow-up study of 11,583 deliberate self-harm patients. Psychol Med 2006;36:397-405.
 
9. Ponizovsky AM, Grinshpoon A, Levav I, et al. Life satisfaction and suicidal attempts among persons with schizophrenia. Compr Psychiatry 2003;44:442-447.
 
10. Karasouli E, Owens D, Abbott RL, et al. All-cause mortality after non-fatal self-poisoning: a cohort study. Soc Psychiatry Psychiatr Epidemiol 2011;46:455-462.
 
11. Bergen H, Hawton K, Waters K, et al. Premature death after self-harm: a multicentre cohort study. Lancet 2012;380:1568-1574.
 
12. Wahlbeck K, Westman J, Nordentoft M, et al. Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. Br J Psychiatry 2011;199:453-458.
 
13. Syme SL. Social and economic disparities in health: thoughts about intervention. Milbank Q 1998;76:493-505.
 
14. Cohen CI. Poverty, social problems, and serious mental illness. Psychiatr Serv 2002;53:899-900.
 
15. Whitley E, Gunnell D, Dorling D, et al. Ecological study of social fragmentation, poverty, and suicide. BMJ 1999;319:1034-1037.
 
16. Bergen H, Hawton K, Kapur N, et al. Shared characteristics of suicides and other unnatural deaths following non-fatal self-harm? A multicentre study of risk factors. Psychol Med 2012;42:727-741.
 
17. Diagnostic Criteria from DSM-IV-TR. Washington, DC:American Psychiatric Association , 2000.
 
18. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001;16:606-613.
 
19. Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006;166:1092-1097.
 
20. Bernstein DP, Fink L, Handelsman L, et al. Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry 1994;151:1132-1136.
 
21. Ware J, Jr Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996;34:220-233.
 
22. Prins A, Ouimette P, Kimerling R, et al. The primary care PTSD screen (PC-PTSD): development and operating characteristics. Primary Care Psychiatry 2003;9:9-14.
 
23. de Abreu LN, Nery FG, Harkavy-Friedman JM, et al. Suicide attempts are associated with worse quality of life in patients with bipolar disorder type I. Compr Psychiatry 2012;53:125-129.
 
24. Koivumaa-Honkanen H, Honkanen R, Viinamaki H, et al. Life satisfaction and suicide: a 20-year follow-up study. Am J Psychiatry 2001;158:433-439.
 
25. Scott KM, Hwang I, Chiu WT, et al. Chronic physical conditions and their association with first onset of suicidal behavior in the world mental health surveys. Psychosom Med 2010;72:712-719.
 
26. Goldney RD, Fisher LJ, Wilson DH, et al. Suicidal ideation and health-related quality of life in the community. Med J Aust 2001;175:546-549.
 
27. Thompson JM, Zamorski MA, Sweet J, et al. Roles of physical and mental health in suicidal ideation in Canadian Armed Forces Regular Force veterans. Can J Public Health 2014;105:e109-e115.
 
28. Fanning JR, Pietrzak RH. Suicidality among older male veterans in the United States: results from the National Health and Resilience in Veterans Study. J Psychiatr Res 2013;47:1766-1775.
 
29. Berlim MT, Mattevi BS, Pavanello DP, et al. Suicidal ideation and quality of life among adult Brazilian outpatients with depressive disorders. J Nerv Ment Dis 2003;191:193-197.
 
30. Hooley JM, Franklin JC, Nock MK. Chronic pain and suicide: understanding the association. Curr Pain Headache Rep 2014;18:435.
 
31. Jollant F, Bellivier F, Leboyer M, et al. Impaired decision making in suicide attempters. Am J Psychiatry 2005;162:304-310.
 
32. Richard-Devantoy S, Berlim MT, Jollant F. A meta-analysis of neuropsychological markers of vulnerability to suicidal behavior in mood disorders. Psychol Med 2014;44:1663-1673.
 
33. Caceda R, Durand D, Cortes E, et al. Impulsive choice and psychological pain in acutely suicidal depressed patients. Psychosom Med 2014;76:445-451.
 
34. Burton CZ, Vella L, Weller JA, et al. Differential effects of executive functioning on suicide attempts. J Neuropsychiatry Clin Neurosci 2011;23:173-179.
 
35. Ghahramanlou-Holloway M, Bhar SS, Brown GK, et al. Changes in problem-solving appraisal after cognitive therapy for the prevention of suicide. Psychol Med 2012;42:1185-1193.
 
36. Caceda R, Moskovciak T, Prendes-Alvarez S, et al. Gender-specific effects of depression and suicidal ideation in prosocial behaviors. PLoS One 2014;9:e108733.
 
37. Pawelec G, Goldeck D, Derhovanessian E. Inflammation, ageing and chronic disease. Curr Opin Immunol 2014;29:23-28.
 
38. Gibbs HM, Davis L, Han X, et al. Association between C-reactive protein and suicidal behavior in an adult inpatient population. J Psychiatr Res 2016;79:28-33.
 
39. Janelidze S, Mattei D, Westrin A, et al. Cytokine levels in the blood may distinguish suicide attempters from depressed patients. Brain Behav Immun 2011;25:335-339.
 
40. Sublette ME, Galfalvy HC, Fuchs D, et al. Plasma kynurenine levels are elevated in suicide attempters with major depressive disorder. Brain Behav Immun 2011;25:1272-1278.
 
41. Coryell W, Schlesser M. The dexamethasone suppression test and suicide prediction. Am J Psychiatry 2001;158:748-753.
 
42. Wright BJ, Oɻ S, Hazi A, et al. Increased systolic blood pressure reactivity to acute stress is related with better self-reported health. Sci Rep 2014;4:6882.
 
43. Kupper N, Denollet J, Widdershoven J, et al. Cardiovascular reactivity to mental stress and mortality in patients with heart failure. JACC Heart Fail 2015;3:373-382.
 
44. Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62:617-627.