Skip to main content
Top
Published in: BMC Psychiatry 1/2011

Open Access 01-12-2011 | Research article

Repetition of suicide attempts across episodes of severe depression Behavioural sensitisation found in suicide group but not in controls

Authors: Louise Brådvik, Mats Berglund

Published in: BMC Psychiatry | Issue 1/2011

Login to get access

Abstract

Background

Those who die by suicide and suffer from depression are known to have made more suicide attempts during their life-span as compared to other people with depression. A behavioural sensitisation or kindling model has been proposed for suicidal behaviour, in accordance with a sensitisation model of depressive episodes. The aim of the present study was to test such a model by investigating the distribution of initial and repeated suicide attempts across the depressive episodes in suicides and controls with a unipolar severe depression.

Method

A blind record evaluation was performed of 80 suicide victims and controls admitted to the Department of Psychiatry between 1956 and 1969 and monitored to 2010. The occurrence of initial and repeated suicide attempts by order of the depressive episodes was compared for suicides and controls.

Results

The risk of a first suicide attempt decreased throughout the later episodes of depression in both the suicide group (p < .000) and control group (p < .000). The frequencies of repetition early in the course were actually higher in the control group (p < .007). After that, the risk decreased in the control group, while the frequencies remained proportional in the suicide group. At the same time, there was a significantly greater decreased risk of repeated attempts during later episodes in the control group as compared to the suicide group (p < .000). The differences were found despite a similar number of episodes in suicides and controls.

Conclusion

Repeated suicide attempts in the later episodes of depression appear to be a risk factor for suicide in severe depression. This finding is compatible with a behavioural sensitisation of attempts across the depressive episodes, which seemed to be independent of a corresponding kindling of depression.
Appendix
Available only for authorised users
Literature
1.
go back to reference Lönnqvist JK: Psychiatric aspects of suicidal behaviour: depression. The International Handbook of Suicide and Attempted Suicide. Edited by: Hawton K., Van Heeringen K. 2000, John Wiley & Sons Ltd, Chichester, 107-120.CrossRef Lönnqvist JK: Psychiatric aspects of suicidal behaviour: depression. The International Handbook of Suicide and Attempted Suicide. Edited by: Hawton K., Van Heeringen K. 2000, John Wiley & Sons Ltd, Chichester, 107-120.CrossRef
2.
3.
go back to reference Bertolote JM, Fleischmann A, De Leo D, Wasserman D: Psychiatric diagnoses and suicide: revisiting the evidence. Crisis. 2004, 25: 147-55. ReviewCrossRefPubMed Bertolote JM, Fleischmann A, De Leo D, Wasserman D: Psychiatric diagnoses and suicide: revisiting the evidence. Crisis. 2004, 25: 147-55. ReviewCrossRefPubMed
4.
go back to reference Sainsbury P: Depression, suicide and suicide prevention. Suicide. Edited by: Roy A. 1986, William & Wilkins, Baltimore, 73-88. Sainsbury P: Depression, suicide and suicide prevention. Suicide. Edited by: Roy A. 1986, William & Wilkins, Baltimore, 73-88.
5.
go back to reference Goldstein RB, Black DW, Nasrallah A, Winokur G: The prediction of suicide. Sensitivity, specificity, and predictive value of a multivariate model applied to suicide among 1906 patients with affective disorders. Arch Gen Psychiatry. 1991, 48: 418-22.CrossRefPubMed Goldstein RB, Black DW, Nasrallah A, Winokur G: The prediction of suicide. Sensitivity, specificity, and predictive value of a multivariate model applied to suicide among 1906 patients with affective disorders. Arch Gen Psychiatry. 1991, 48: 418-22.CrossRefPubMed
6.
go back to reference Nordström P, Asberg M, Aberg-Wistedt A, Nordin C: Attempted suicide predicts suicide risk in mood disorders. Acta Psychiatr Scand. 1995, 92: 345-50.CrossRefPubMed Nordström P, Asberg M, Aberg-Wistedt A, Nordin C: Attempted suicide predicts suicide risk in mood disorders. Acta Psychiatr Scand. 1995, 92: 345-50.CrossRefPubMed
7.
go back to reference Brådvik L, Berglund M: Aspects of the suicidal career in severe depression. A comparison between attempts in suicides and controls. Arch Suicide Res. 2002, 6: 339-349.CrossRef Brådvik L, Berglund M: Aspects of the suicidal career in severe depression. A comparison between attempts in suicides and controls. Arch Suicide Res. 2002, 6: 339-349.CrossRef
8.
go back to reference Brådvik L, Berglund M: Repetition and severity of suicide attempts across the life cycle. A comparison by age-groups between suicide victims and controls with a severe depression. BMC Psychiatry. 2009, 9: 62-CrossRefPubMedPubMedCentral Brådvik L, Berglund M: Repetition and severity of suicide attempts across the life cycle. A comparison by age-groups between suicide victims and controls with a severe depression. BMC Psychiatry. 2009, 9: 62-CrossRefPubMedPubMedCentral
9.
go back to reference Ahrens B, Berghöfer A, Wolf T, Müller-Oerlinghausen B: Suicide attempts, age and duration of illness in recurrent affective disorders. J Affect Disord. 1995, 36: 43-49. 10.1016/0165-0327(95)00054-2.CrossRefPubMed Ahrens B, Berghöfer A, Wolf T, Müller-Oerlinghausen B: Suicide attempts, age and duration of illness in recurrent affective disorders. J Affect Disord. 1995, 36: 43-49. 10.1016/0165-0327(95)00054-2.CrossRefPubMed
10.
go back to reference Sokero TP, Melartin TK, Rytsälä HJ, Leskelä US, Lestelä-Mielonen PS, Isometsä ET: Prospective study of risk factors for attempted suicide among patients with DSM-IV major depressive disorder. Br J Psychiatry. 2005, 186: 314-8. 10.1192/bjp.186.4.314.CrossRefPubMed Sokero TP, Melartin TK, Rytsälä HJ, Leskelä US, Lestelä-Mielonen PS, Isometsä ET: Prospective study of risk factors for attempted suicide among patients with DSM-IV major depressive disorder. Br J Psychiatry. 2005, 186: 314-8. 10.1192/bjp.186.4.314.CrossRefPubMed
11.
go back to reference van Praag HM, Plutchik R: Increased suicidality in depression: group or subgroup characteristic?. Psychiatry Res. 1988, 26: 273-278. 10.1016/0165-1781(88)90121-7.CrossRefPubMed van Praag HM, Plutchik R: Increased suicidality in depression: group or subgroup characteristic?. Psychiatry Res. 1988, 26: 273-278. 10.1016/0165-1781(88)90121-7.CrossRefPubMed
12.
go back to reference Kessing LV, Andersen EW, Andersen PK: Predictors of recurrence in affective disorder - analyses accounting for individual heterogeneity. J Affect Disord. 2000, 57: 139-45. 10.1016/S0165-0327(99)00080-4.CrossRefPubMed Kessing LV, Andersen EW, Andersen PK: Predictors of recurrence in affective disorder - analyses accounting for individual heterogeneity. J Affect Disord. 2000, 57: 139-45. 10.1016/S0165-0327(99)00080-4.CrossRefPubMed
13.
go back to reference Kessing LV, Hansen MG, Andersen PK, Angst J: The predictive effect of episodes on the risk of recurrence in depressive and bipolar disorders - a life-long perspective. Acta Psychiatr Scand. 2004, 109: 339-44. 10.1046/j.1600-0447.2003.00266.x.CrossRefPubMed Kessing LV, Hansen MG, Andersen PK, Angst J: The predictive effect of episodes on the risk of recurrence in depressive and bipolar disorders - a life-long perspective. Acta Psychiatr Scand. 2004, 109: 339-44. 10.1046/j.1600-0447.2003.00266.x.CrossRefPubMed
14.
go back to reference Post RM, Rubinow DR, Ballenger JC: Conditioning and sensitisation in the longitudinal course of affective illness. Br J Psychiatry. 1986, 149: 191-201. 10.1192/bjp.149.2.191.CrossRefPubMed Post RM, Rubinow DR, Ballenger JC: Conditioning and sensitisation in the longitudinal course of affective illness. Br J Psychiatry. 1986, 149: 191-201. 10.1192/bjp.149.2.191.CrossRefPubMed
15.
go back to reference Kendler KS, Thornton LM, Gardner CO: Stressful life events and previous episodes in the etiology of major depression in women: an evaluation of the "kindling" hypothesis. Am J Psychiatry. 2000, 157: 1243-51. 10.1176/appi.ajp.157.8.1243.CrossRefPubMed Kendler KS, Thornton LM, Gardner CO: Stressful life events and previous episodes in the etiology of major depression in women: an evaluation of the "kindling" hypothesis. Am J Psychiatry. 2000, 157: 1243-51. 10.1176/appi.ajp.157.8.1243.CrossRefPubMed
16.
go back to reference Kessing LV: Severity of depressive episodes during the course of depressive disorder. Br J Psychiatry. 2008, 192: 290-3. 10.1192/bjp.bp.107.038935.CrossRefPubMed Kessing LV: Severity of depressive episodes during the course of depressive disorder. Br J Psychiatry. 2008, 192: 290-3. 10.1192/bjp.bp.107.038935.CrossRefPubMed
17.
go back to reference Teasdale JD: Negative thinking in depression: Cause, effect, or reciprocal relationship?. Adv Behav Res Ther. 1983, 5: 3-25. 10.1016/0146-6402(83)90013-9.CrossRef Teasdale JD: Negative thinking in depression: Cause, effect, or reciprocal relationship?. Adv Behav Res Ther. 1983, 5: 3-25. 10.1016/0146-6402(83)90013-9.CrossRef
18.
go back to reference Teasdale JD: Cognitive vulnerability to persistent depression. Cogn Emot. 1988, 2: 247-74. 10.1080/02699938808410927.CrossRef Teasdale JD: Cognitive vulnerability to persistent depression. Cogn Emot. 1988, 2: 247-74. 10.1080/02699938808410927.CrossRef
19.
go back to reference Lau MA, Segal ZV, Williams JM: Teasdale's differential activation hypothesis: implications for mechanisms of depressive relapse and suicidal behaviour. Behav Res Ther. 2004, 42: 1001-17. 10.1016/j.brat.2004.03.003.CrossRefPubMed Lau MA, Segal ZV, Williams JM: Teasdale's differential activation hypothesis: implications for mechanisms of depressive relapse and suicidal behaviour. Behav Res Ther. 2004, 42: 1001-17. 10.1016/j.brat.2004.03.003.CrossRefPubMed
20.
go back to reference Joiner TE, Rudd MD: Intensity and duration of suicidal crises vary as a function of previous suicide attempts and negative life events. J Consult Clin Psychol. 2000, 68: 909-16. 10.1037/0022-006X.68.5.909.CrossRefPubMed Joiner TE, Rudd MD: Intensity and duration of suicidal crises vary as a function of previous suicide attempts and negative life events. J Consult Clin Psychol. 2000, 68: 909-16. 10.1037/0022-006X.68.5.909.CrossRefPubMed
21.
go back to reference Joiner TE: Why people die by suicide?. 2005, Harvard University Press, Cambridge, MA Joiner TE: Why people die by suicide?. 2005, Harvard University Press, Cambridge, MA
22.
go back to reference Van Orden KA, Witte TK, Gordon KH, Bender TW, Joiner TE: Suicidal desire and the capability for suicide: tests of the interpersonal-psychological theory of suicidal behavior among adults. J Consult Clin Psychol. 2008, 76: 72-83. 10.1037/0022-006X.76.1.72.CrossRefPubMed Van Orden KA, Witte TK, Gordon KH, Bender TW, Joiner TE: Suicidal desire and the capability for suicide: tests of the interpersonal-psychological theory of suicidal behavior among adults. J Consult Clin Psychol. 2008, 76: 72-83. 10.1037/0022-006X.76.1.72.CrossRefPubMed
23.
go back to reference Pettit JW, Joiner TE, Rudd MD: Kindling and behavioral sensitization: are they relevant to recurrent suicide attempts?. J Affect Disord. 2004, 83: 249-52. 10.1016/j.jad.2004.08.010.CrossRefPubMed Pettit JW, Joiner TE, Rudd MD: Kindling and behavioral sensitization: are they relevant to recurrent suicide attempts?. J Affect Disord. 2004, 83: 249-52. 10.1016/j.jad.2004.08.010.CrossRefPubMed
24.
go back to reference Solomon RL: The opponent-process theory of acquired motivation: the costs of pleasure and the benefits of pain. Am Psychol. 1980, 35: 691-712. 10.1037/0003-066X.35.8.691.CrossRefPubMed Solomon RL: The opponent-process theory of acquired motivation: the costs of pleasure and the benefits of pain. Am Psychol. 1980, 35: 691-712. 10.1037/0003-066X.35.8.691.CrossRefPubMed
25.
go back to reference Joiner TE: The trajectory of suicidal behavior over time. Suicide Life Threat Behav. 2002, 32: 33-41. 10.1521/suli.32.1.33.22187. ReviewCrossRefPubMed Joiner TE: The trajectory of suicidal behavior over time. Suicide Life Threat Behav. 2002, 32: 33-41. 10.1521/suli.32.1.33.22187. ReviewCrossRefPubMed
26.
go back to reference Witte TK, Merrill KA, Stellrecht NE, Bernert RA, Hollar DL, Schatschneider C, Joiner TE: "Impulsive" youth suicide attempters are not necessarily all that impulsive. J Affect Disord. 2008, 107: 107-16. 10.1016/j.jad.2007.08.010.CrossRefPubMed Witte TK, Merrill KA, Stellrecht NE, Bernert RA, Hollar DL, Schatschneider C, Joiner TE: "Impulsive" youth suicide attempters are not necessarily all that impulsive. J Affect Disord. 2008, 107: 107-16. 10.1016/j.jad.2007.08.010.CrossRefPubMed
27.
go back to reference Brådvik L, Berglund M: Long-term Treatment and Suicidal Behaviour in Severe Depression. ECT and Antidepressant Pharmacotherapy May Have Different Effects on the Occurrence and Seriousness of Suicide Attempts. Depress Anxiety. 2006, 23: 34-41.CrossRefPubMed Brådvik L, Berglund M: Long-term Treatment and Suicidal Behaviour in Severe Depression. ECT and Antidepressant Pharmacotherapy May Have Different Effects on the Occurrence and Seriousness of Suicide Attempts. Depress Anxiety. 2006, 23: 34-41.CrossRefPubMed
28.
go back to reference Brådvik L, Berglund M: Depressive episodes with suicide attempts in severe depression. Suicides and controls differ only in the later episodes of unipolar depression. Arch Suicide Res. 2010, 14: 363-367.CrossRefPubMed Brådvik L, Berglund M: Depressive episodes with suicide attempts in severe depression. Suicides and controls differ only in the later episodes of unipolar depression. Arch Suicide Res. 2010, 14: 363-367.CrossRefPubMed
29.
go back to reference Essen-Möller E, Wohlfahrt S: Suggestions for the amendment of the official Swedish classification of mental disorder. Acta Psychiatr Scand Suppl. 1947, 47: 551-555.CrossRef Essen-Möller E, Wohlfahrt S: Suggestions for the amendment of the official Swedish classification of mental disorder. Acta Psychiatr Scand Suppl. 1947, 47: 551-555.CrossRef
30.
go back to reference Brådvik L, Berglund M: Risk factors for suicide in melancholia. A case record evaluation of 89 suicides and their controls. Acta Psychiatr Scand. 1993, 87: 306-311.CrossRefPubMed Brådvik L, Berglund M: Risk factors for suicide in melancholia. A case record evaluation of 89 suicides and their controls. Acta Psychiatr Scand. 1993, 87: 306-311.CrossRefPubMed
31.
go back to reference Spitzer R, Endicott J, Robins E: Research diagnostic criteria. Arch Gen Psychiatry. 1978, 35: 773-82.CrossRefPubMed Spitzer R, Endicott J, Robins E: Research diagnostic criteria. Arch Gen Psychiatry. 1978, 35: 773-82.CrossRefPubMed
32.
go back to reference Berglund M: Mortality in alcoholics related to clinical state at first admission. A study of 537 deaths. Acta Psychiatr Scand. 1984, 70: 407-16. 10.1111/j.1600-0447.1984.tb01228.x.CrossRefPubMed Berglund M: Mortality in alcoholics related to clinical state at first admission. A study of 537 deaths. Acta Psychiatr Scand. 1984, 70: 407-16. 10.1111/j.1600-0447.1984.tb01228.x.CrossRefPubMed
33.
go back to reference Wilcox HC, Conner KR, Caine ED: Association of alcohol and drug use disorders and completed suicide: an empirical review of cohort studies. Drug Alcohol Depend. 2004, 76 (Suppl): S11-9. 10.1016/j.drugalcdep.2004.08.003. ReviewCrossRefPubMed Wilcox HC, Conner KR, Caine ED: Association of alcohol and drug use disorders and completed suicide: an empirical review of cohort studies. Drug Alcohol Depend. 2004, 76 (Suppl): S11-9. 10.1016/j.drugalcdep.2004.08.003. ReviewCrossRefPubMed
34.
35.
go back to reference Brådvik L, Mattisson C, Bogren M, Nettelbladt P: Mental disorders in suicide and undetermined death in the Lundby study. The contribution of severe depression and alcohol dependence. Arch Suicide Res. 2010, 14: 266-275.CrossRefPubMed Brådvik L, Mattisson C, Bogren M, Nettelbladt P: Mental disorders in suicide and undetermined death in the Lundby study. The contribution of severe depression and alcohol dependence. Arch Suicide Res. 2010, 14: 266-275.CrossRefPubMed
36.
go back to reference American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, DSM-IV. 1994, American Psychiatric Association, Washington, DC, Fourth American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, DSM-IV. 1994, American Psychiatric Association, Washington, DC, Fourth
37.
38.
go back to reference Weisman AD, Worden JW: Risk-rescue rating in suicide attempt. Arch Gen Psychiatry. 1972, 26: 553-61.CrossRefPubMed Weisman AD, Worden JW: Risk-rescue rating in suicide attempt. Arch Gen Psychiatry. 1972, 26: 553-61.CrossRefPubMed
39.
go back to reference Silverman MM, Berman AL, Sanddal ND, O'Carroll PW, Joiner TE: 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: 264-77. 10.1521/suli.2007.37.3.264.CrossRefPubMed Silverman MM, Berman AL, Sanddal ND, O'Carroll PW, Joiner TE: 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: 264-77. 10.1521/suli.2007.37.3.264.CrossRefPubMed
40.
go back to reference Hawton K, Fagg GJ, Simkin S, Bale E, Bond A: Trends in deliberate self-harm in Oxford, 1985-1995. Implications for clinical services and the prevention of suicide. Br J Psychiatry. 1997, 171: 556-60. 10.1192/bjp.171.6.556.CrossRefPubMed Hawton K, Fagg GJ, Simkin S, Bale E, Bond A: Trends in deliberate self-harm in Oxford, 1985-1995. Implications for clinical services and the prevention of suicide. Br J Psychiatry. 1997, 171: 556-60. 10.1192/bjp.171.6.556.CrossRefPubMed
41.
go back to reference 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: 987-95. 10.1017/S0033291703007943.CrossRefPubMed 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: 987-95. 10.1017/S0033291703007943.CrossRefPubMed
42.
go back to reference Marzuk PM, Tardiff K, Leon AC, Portera L, Weiner C: The prevalence of aborted suicide attempts among psychiatric in-patients. Acta Psychiatr Scand. 1997, 96: 492-496. 10.1111/j.1600-0447.1997.tb09952.x.CrossRefPubMed Marzuk PM, Tardiff K, Leon AC, Portera L, Weiner C: The prevalence of aborted suicide attempts among psychiatric in-patients. Acta Psychiatr Scand. 1997, 96: 492-496. 10.1111/j.1600-0447.1997.tb09952.x.CrossRefPubMed
43.
go back to reference Barber ME, Marzuk PM, Leon AC, Portera L: Aborted suicide attempts: a new classification of suicidal behavior. Am J Psychiatry. 1998, 155: 385-89.CrossRefPubMed Barber ME, Marzuk PM, Leon AC, Portera L: Aborted suicide attempts: a new classification of suicidal behavior. Am J Psychiatry. 1998, 155: 385-89.CrossRefPubMed
44.
go back to reference Fleiss JL, Levin B, Paik MC: Statistical Methods for Rates and Proportions. 2003, New York: John Wiley & Sons, 3CrossRef Fleiss JL, Levin B, Paik MC: Statistical Methods for Rates and Proportions. 2003, New York: John Wiley & Sons, 3CrossRef
45.
go back to reference Ferguson GA: Statistical Analysis in Psychology and Education. 1966, McGrawhill, London, 2 Ferguson GA: Statistical Analysis in Psychology and Education. 1966, McGrawhill, London, 2
46.
go back to reference Zisook S, Lesser I, Stewart JW, Wisniewski SR, Balasubramani GK, Fava M, Gilmer WS, Dresselhaus TR, Thase ME, Nierenberg AA, Trivedi MH, Rush AJ: Effect of age at onset on the course of major depressive disorder. Am J Psychiatry. 2007, 164: 1539-46. 10.1176/appi.ajp.2007.06101757.CrossRefPubMed Zisook S, Lesser I, Stewart JW, Wisniewski SR, Balasubramani GK, Fava M, Gilmer WS, Dresselhaus TR, Thase ME, Nierenberg AA, Trivedi MH, Rush AJ: Effect of age at onset on the course of major depressive disorder. Am J Psychiatry. 2007, 164: 1539-46. 10.1176/appi.ajp.2007.06101757.CrossRefPubMed
47.
go back to reference Brådvik L, Mattisson C, Bogren M, Nettelbladt P: Long-term Suicide Risk in Depression in the Lundby cohort 1947-1997 - severity and gender. Acta Psychiatr Scand. 2008, 117: 185-191.CrossRefPubMed Brådvik L, Mattisson C, Bogren M, Nettelbladt P: Long-term Suicide Risk in Depression in the Lundby cohort 1947-1997 - severity and gender. Acta Psychiatr Scand. 2008, 117: 185-191.CrossRefPubMed
48.
go back to reference O'Carroll PW, Berman AL, Maris RW, Moscicki EK, Tanney BL, Silverman MM: Beyond the Tower of Babel: a nomenclature for suicidology. Suicide Life Threat Behav. 1996, 26: 237-52.PubMed O'Carroll PW, Berman AL, Maris RW, Moscicki EK, Tanney BL, Silverman MM: Beyond the Tower of Babel: a nomenclature for suicidology. Suicide Life Threat Behav. 1996, 26: 237-52.PubMed
Metadata
Title
Repetition of suicide attempts across episodes of severe depression Behavioural sensitisation found in suicide group but not in controls
Authors
Louise Brådvik
Mats Berglund
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2011
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/1471-244X-11-5

Other articles of this Issue 1/2011

BMC Psychiatry 1/2011 Go to the issue