{"id":8037,"date":"2023-03-16T15:10:22","date_gmt":"2023-03-16T12:10:22","guid":{"rendered":"https:\/\/gfmg.ua\/new\/?p=8037"},"modified":"2023-03-23T16:14:32","modified_gmt":"2023-03-23T13:14:32","slug":"rizik-suicidu","status":"publish","type":"post","link":"https:\/\/gfmg.ua\/en\/rizik-suicidu\/","title":{"rendered":"The key to suicide risk assessment is a consistent approach"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"8037\" class=\"elementor elementor-8037\" data-elementor-post-type=\"post\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-51247ec elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"51247ec\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column 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elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"073f13f\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-c40d8aa\" data-id=\"c40d8aa\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-825b7e8 elementor-widget__width-auto elementor-widget elementor-widget-heading\" data-id=\"825b7e8\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">ARTICLE<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7cecbe0 elementor-widget elementor-widget-theme-post-title elementor-page-title elementor-widget-heading\" data-id=\"7cecbe0\" data-element_type=\"widget\" data-widget_type=\"theme-post-title.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\"><a href=\"\">The key to suicide risk assessment is a consistent approach<\/a><\/h1>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-1a31973 elementor-reverse-mobile elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"1a31973\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-cef0406\" data-id=\"cef0406\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e61a21e elementor-widget elementor-widget-heading\" data-id=\"e61a21e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Suicide remains a common cause of death, and a meta-analysis by Franklin and colleagues argued that physicians are still quite limited in their ability to predict the risk for suicide. Their study, which was published in the February 2017 issue of Psychological Bulletin, assessed 365 studies of risk factors for suicide.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f2147e4 elementor-widget elementor-widget-heading\" data-id=\"f2147e4\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">The main finding of the meta-analysis was that no prediction tool for suicide was highly sensitive and specific. Prediction with these instruments was only slightly better than that related to chance alone. Moreover, there was no trend toward improved performance of predictive abilities over time, and risk factors remained fairly stagnant over the 50 years of included research. Studies with longer periods of follow-up were not superior to shorter studies in terms of finding meaningful risk factors for suicide.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-77f5389\" data-id=\"77f5389\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2fd5832 elementor-widget elementor-widget-image\" data-id=\"2fd5832\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"560\" height=\"340\" src=\"https:\/\/gfmg.ua\/wp-content\/uploads\/2023\/03\/RizikSuicidu.jpg\" class=\"attachment-full size-full wp-image-8021\" alt=\"\" srcset=\"https:\/\/gfmg.ua\/wp-content\/uploads\/2023\/03\/RizikSuicidu.jpg 560w, https:\/\/gfmg.ua\/wp-content\/uploads\/2023\/03\/RizikSuicidu-64x39.jpg 64w, https:\/\/gfmg.ua\/wp-content\/uploads\/2023\/03\/RizikSuicidu-300x182.jpg 300w\" sizes=\"(max-width: 560px) 100vw, 560px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-65caf07 elementor-reverse-mobile elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"65caf07\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-f5e1a57\" data-id=\"f5e1a57\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-afcad8f elementor-widget elementor-widget-heading\" data-id=\"afcad8f\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">One limitation of previous research is that many studies assessed mental health at a single point in time. The current research by Melhem and colleagues assessed multiple clinical predictors of suicide attempt among young people over time, with an emphasis on how the trajectories of these variables affect the risk for suicide attempt.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bfee365 elementor-widget elementor-widget-heading\" data-id=\"bfee365\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Study Synopsis and Perspective\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-00ca2a9 elementor-widget elementor-widget-heading\" data-id=\"00ca2a9\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">A new assessment tool that detects severity and fluctuation of depressive symptoms accurately predicts the risk for suicidality in high-risk individuals, a new study suggests.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4f7827e elementor-widget elementor-widget-heading\" data-id=\"4f7827e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Investigators followed more than 600 young adults with a mean age of 23.8\u00b18.5 years who were at elevated risk for suicidal behavior because their parents had been diagnosed with mood disorders.\n\nParents and children were followed over a 12-year period and periodically evaluated through standard assessments.\n\nThe most accurate predictor of suicidal behavior was having severe depressive symptoms that fluctuated over time.\n\nThe investigators combined this finding with other relevant factors, such as younger age, mood disorders, childhood abuse, and personal and family history of suicide attempts to create a Prediction Risk Score (PRS).<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5edb892 elementor-widget elementor-widget-heading\" data-id=\"5edb892\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">They found that having a score of \u22653 of these risk factors indicated a higher risk for suicidal behavior, with 87% sensitivity, which is far superior to currently available models.\n\n\"We recommend that clinicians pay particular attention in their assessment of depression to the severity of both current and past depression and the variability in these symptoms,\" lead author Nadine M. Melhem, PhD, associate professor of psychiatry, University of Pittsburgh School of Medicine, told Medscape Medical News.\n\n\"Our PRS is a valuable addition to predict suicide attempt in high-risk individuals and uses variables that are already collected as part of the medical history assessment in clinical settings,\" she said.<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b9f6022 elementor-widget elementor-widget-heading\" data-id=\"b9f6022\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Lack of Predictability \"Unacceptable\"\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-967d18c elementor-widget elementor-widget-heading\" data-id=\"967d18c\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">\"The prediction of suicidal behavior continues to be among the most challenging tasks in psychiatry,\" Dr Melhem observed.\n\n\"A recent meta-analysis of the past 50 years of research showed that the prediction of suicidal ideation, attempt, and suicide deaths was only slightly better than chance, which is unacceptable for a life-threatening outcome like suicidal behavior,\" she said.\n\n\"Here, we focused on symptoms and their variability over time because, while psychiatric diagnoses are important predictors of suicidal behavior, diagnoses and stable or trait-like predictors are of limited value because the risk of suicidal behavior varies during the course of psychiatric illness,\" she reported.\n\nThe researchers \"examined the trajectories of impulsivity, aggression, impulsive aggression, depression symptoms, irritability, and hopelessness in a longitudinal study of offspring of parents with mood disorders.\"<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c9054ad elementor-widget elementor-widget-heading\" data-id=\"c9054ad\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">They examined whether changes in these measures over time could predict suicidal attempts and time to onset of the attempt, above and beyond any psychiatric diagnoses and other predictors.\n\nIn addition, they computed a risk score according to their models and assessed its performance.\n\nThe study included 663 offspring of 318 parents (referred to as probands) with a lifetime history of mood disorders; more than half had a lifetime history of an actual suicide attempt.\n\nRecruitment of participants took place between July 15, 1997 and September 6, 2005, and participants were followed through January 21, 2014.\n\n\"Suicide attempt\" in offspring was defined in both \"broad\" and \"narrow\" terms.<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4a3dc2d elementor-widget elementor-widget-heading\" data-id=\"4a3dc2d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">\"Broad\" included an actual attempt or a suicide-related behaviour whereas \"narrow\" included only actual attempts.\n\nA 10-fold cross-validation model was used for statistical analysis; machine-learning regression techniques were used to determine a subset of predictors with the strongest effects.\n\nProbands and offspring were interviewed at baseline, and then at annual follow-ups for a 12-year period using a variety of established scales.<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cf1103a elementor-widget elementor-widget-heading\" data-id=\"cf1103a\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Monitor Severity, Variability\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bd0b48c elementor-widget elementor-widget-heading\" data-id=\"bd0b48c\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">The number of male and female offspring were approximately even (47.7% female), with a mean age of 23.8\u00b18.5 years; most participants (70.3%) were white.\n\nParticipants were followed for a median (range) of 8.1 (95% CI: 1, 15.4) years.\n\nAmong the offspring, 71 (10.7%) had suicide attempts over the course of the study. Of these, 51 were first-time attempts (incidence rate=8.4%).\n\nAmong individuals who attempted suicide, the mean number of suicide attempts and actual attempts were 1.2\u00b10.6 and 1.3\u00b10.7, respectively.<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2afd358 elementor-widget elementor-widget-heading\" data-id=\"2afd358\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">The mean lethality (for actual attempts only) was 1.7\u00b12, \"which corresponded to physical damage for which medical attention was needed,\" the investigators wrote.\n\nThe median time from the last assessment point to suicide attempt was 45 (95% CI: 1, 126) weeks and 30 (95% CI: 4, 126) weeks for actual attempt.\n\nThe researchers identified a 2-class model for each of the factors they identified and found that class 2 consistently showed higher mean scores and variability vs class 1 in measures of hopelessness, impulsivity, aggression, and irritability.\n\nFor depression, they identified a 3-class model, in which class 3 showed the highest mean scores and variability (2.08\u00b10.75 vs 0.59\u00b10.42 vs \u22120.44\u00b10.28 [class 1]; F2644=1216.7; P\u2009&lt;.001; Cohen d class 3 vs 2=2.97; Cohen d class 3 vs 1=7.31; Cohen d class 2 vs 1=3.17).<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a191c50 elementor-widget elementor-widget-heading\" data-id=\"a191c50\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Participants with suicide attempt were more likely than participants without attempt to belong to class 3 depression symptoms, with higher mean and variability (16 [22.9%] vs 27 [4.7%]; P\u2009&lt;.001; Cohen d =0.72), the authors reported.\n\nThey were also more likely to belong to class 2 for impulsivity, aggression, impulsive aggression, and irritability.\n\nThe only statistically significant trajectory that predicted increased risk for suicide attempt in the offspring turned out to be class 3 depression symptoms with higher mean and variability (model 1 odds ratio [OR]=6.53 [95% CI: 2.53,16.87]; t =3.88; P<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3250c1d elementor-widget elementor-widget-heading\" data-id=\"3250c1d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Class 3 depression symptoms remained associated with an almost 8-fold increased risk for suicide attempt (OR=7.69 [95% CI: 2.37, 24.90]; t\u2009=3.40; P =.001) when the researchers included the trajectories for all measures, even after controlling for demographics and proband history of actual attempt.\n\nIn fact, class 3 depression symptoms were the only statistically significant trajectory to predict suicide attempt and remained so, even after the researchers controlled for additional clinical characteristics (OR=4.72 [95% CI: 1.47, 15.21]; t\u2009=2.60; P =.01).\n\n\"We recommend that clinicians monitor and treat depression symptoms over time to reduce their severity and fluctuation in high-risk young adults to reduce their risk for suicide attempt,\" Dr Melhem said.<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ccf34ea elementor-widget elementor-widget-heading\" data-id=\"ccf34ea\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">New Tool in the Toolbox\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-765b9c2 elementor-widget elementor-widget-heading\" data-id=\"765b9c2\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">In addition to class 3 depression symptoms, the only ones that remained statistically significant in predicting the narrow and index attempt were:\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-21b8240 elementor-widget elementor-widget-html\" data-id=\"21b8240\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t\t<div>\n    <ul class=\"circle_mark-list list\">\n        <li>Younger age (\u226430 years) (OR=0.82 [95% CI: 0.74, 0.9])<\/li>\n        <li>Lifetime history of unipolar and bipolar disorder (OR=4.71 [95% CI: 1.63, 13.58] and OR=3.4 [95% CI: 0.96, 12.04], respectively)<\/li>\n        <li>History of childhood abuse (OR=2.98 [95% CI: 1.4, 6.38])<\/li>\n        <li>Proband actual attempt (OR=2.24 [95% CI: 1.06, 4.75])<\/li>\n    <\/ul>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-603140b elementor-widget elementor-widget-heading\" data-id=\"603140b\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">The researchers computed a risk score using these statistically significant predictors.\n\nA risk score of \u22653 resulted in the highest sensitivity (87.3%) and moderate specificity (63%; area under the curve=0.80) for suicide attempt.\n\nAlthough the positive predictive value was low, it increased as the prevalence of attempts increased.<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-25ce69e elementor-widget elementor-widget-heading\" data-id=\"25ce69e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">\"The PRS is not only a valuable addition to the physician's toolkit in predicting suicide risk, but it can also be done at little cost since the information is already being collected as part of standard evaluations,\" Dr Melhem commented.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2bd84a1 elementor-widget elementor-widget-heading\" data-id=\"2bd84a1\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Greater Predictive Accuracy\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f4d1c40 elementor-widget elementor-widget-heading\" data-id=\"f4d1c40\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Commenting on the study for Medscape Medical News, Beth Salcedo, MD, board president of the Anxiety and Depression Association of America, said that it \"underscores the need for more and better treatments for depression,\" since we need to be \"confident that the treatments we have cannot only get people better but also keep people better and control symptoms over time.\"\n\nDr Salcedo, who is also the medical director of the Ross Center, a large outpatient practice with offices in Washington, DC and New York, New York, noted that it \"has been long known that depression is a predictor of suicidal ideation and attempts, and the more severe the symptoms, the more concern one should have about that risk.\"<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d02577b elementor-widget elementor-widget-heading\" data-id=\"d02577b\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">\"It would be great if this new data could lead to a more accurate way of assessing an individual's risk, as this is something we are not at all able to do in current clinical practice,\" said Dr Salcedo, who was not associated with the current study.\n\nDr Melhem agreed, stating, \"We are working on further improving the accuracy of this prediction model by adding objective biological markers.\"<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-980e53a elementor-widget elementor-widget-heading\" data-id=\"980e53a\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">The study was funded by the National Institute of Mental Health. Melhem reports receiving research support from the National Institute of Mental Health, Brain and Behavior Research Foundation, and the American Foundation for Suicide Prevention. The other authors' disclosures are listed on the original paper. Salcedo has disclosed no relevant financial relationships.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0eb909d elementor-widget elementor-widget-heading\" data-id=\"0eb909d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Study Highlights\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b419090 elementor-widget elementor-widget-html\" data-id=\"b419090\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t\t<div>\n    <ul class=\"circle_mark-list list\">\n        <li>Researchers enrolled 663 offspring of 318 parents diagnosed with mood disorders treated in inpatient units in New York and Pennsylvania. More than half of parents had a history of suicide attempt. Offspring were recruited between 1997 and 2005 and followed into 2014. They were screened annually with a battery of psychiatric tests, including measurements of suicidality.<\/li>\n        <li>Suicide attempt was defined broadly as a true attempt or aborted effort or suicidal ideation that prompted emergency referral. Researchers also performed an analysis limited to participants with a true suicide attempt.<\/li>\n        <li>The main study analysis focused on longitudinal clinical features that might influence the risk for suicide attempt. Researchers also evaluated other variables traditionally associated with the risk for suicide.<\/li>\n        <li>47.7% of the 663 participants were female, and the mean age of participants at the time of censored observations was 23.8\u00b18.5 years; 70.3% of the cohort was white.<\/li>\n        <li>The median follow-up time was 8.1 years, and 10.7% had a suicide attempt during this time. The mean number of suicide attempts per participant who had attempted suicide was 1.2\u00b10.6.<\/li>\n        <li>More severe and variable symptoms of depression were the only clinical characteristics significantly associated with the risk for suicide attempt over time. Compared with participants without depression, the OR for suicide attempt among participants with severe depression was 4.72 (95% CI: 1.47, 15.21). This risk was similar for both the broad and narrow definitions of suicide attempt.<\/li>\n        <li>The finding of severe depression was associated with a sensitivity of 87.3% and specificity of 63% for suicide attempt.<\/li>\n        <li>Impulsivity, impulsive aggression, and irritability over time were not significantly linked with the risk for suicide attempt.<\/li>\n        <li>Age \u226430 years was predictive against suicide attempt (OR=0.82 [95% CI: 0.74, 0.90]). Lifetime histories of unipolar and bipolar disorders were associated with ORs for suicide attempt of 4.71 (95% CI: 1.63, 13.58) and 3.4 (95% CI: 0.96, 12.04).<\/li>\n        <li>A history of child abuse was associated with an OR for suicide attempt of 2.98 (95% CI: 1.4, 6.38), and the respective OR for suicide attempt by a parent was 2.24 (95% CI: 1.06, 4.75).<\/li>\n    <\/ul>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-03686e5 elementor-widget elementor-widget-heading\" data-id=\"03686e5\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Clinical Implications\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-56d1ddd elementor-reverse-mobile elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"56d1ddd\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-6b61d52\" data-id=\"6b61d52\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-b51f703 elementor-widget elementor-widget-html\" data-id=\"b51f703\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t\t<div>\n    <ul class=\"circle_mark-list list\">\n        <li>The principal finding of a previous meta-analysis by Franklin and colleagues was that no prediction tool for suicide was highly sensitive and specific. Moreover, there was no trend toward improved performance of predictive abilities over time, and risk factors for suicide remained fairly stagnant over the 50 years of included research. Studies with longer periods of follow-up were not superior to shorter studies in terms of finding meaningful risk factors for suicide.<\/li>\n        <li>In the current study by Melhem and colleagues, more severe and variable symptoms of depression were the only clinical characteristic significantly associated with the risk for suicide attempt over time.<\/li>\n        <li>Implications for the Healthcare Team: The healthcare team should closely track symptoms of depression among young people. More severe symptoms may be a sign of suicidality.<\/li>\n    <\/ul>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-5aaba8b\" data-id=\"5aaba8b\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-596897a elementor-widget elementor-widget-image\" data-id=\"596897a\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"400\" height=\"294\" src=\"https:\/\/gfmg.ua\/wp-content\/uploads\/2023\/03\/RizikSuicidu1.jpg\" class=\"attachment-large size-large wp-image-8018\" alt=\"\" srcset=\"https:\/\/gfmg.ua\/wp-content\/uploads\/2023\/03\/RizikSuicidu1.jpg 400w, https:\/\/gfmg.ua\/wp-content\/uploads\/2023\/03\/RizikSuicidu1-64x47.jpg 64w, https:\/\/gfmg.ua\/wp-content\/uploads\/2023\/03\/RizikSuicidu1-300x221.jpg 300w\" sizes=\"(max-width: 400px) 100vw, 400px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-eef79a6 elementor-reverse-mobile elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"eef79a6\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-29e6347\" data-id=\"29e6347\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-238131e elementor-align-right btn_ico elementor-widget elementor-widget-button\" data-id=\"238131e\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-md\" href=\"https:\/\/www.medscape.org\/viewarticle\/911815\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"38\" height=\"8\" viewBox=\"0 0 38 8\" fill=\"none\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M37.028 4.20659C37.413 4.02711 37.413 3.47974 37.028 3.30026L30.053 0.0482401C29.6553 -0.137218 29.2286 0.243158 29.3674 0.65952L29.9487 2.40332C29.9655 2.45363 29.9782 2.50511 29.9867 2.55727L0 2.55727L0 4.55728L29.9895 4.55728C29.9827 4.60402 29.9726 4.65028 29.9592 4.6957L29.3133 6.88686C29.1915 7.29984 29.6139 7.66334 30.0042 7.4814L37.028 4.20659Z\" fill=\"white\"><\/path><\/svg>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Reposted from Medscape<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<div class=\"elementor-element elementor-element-6f3b960 elementor-post-navigation-borders-yes elementor-widget elementor-widget-post-navigation\" data-id=\"6f3b960\" data-element_type=\"widget\" data-widget_type=\"post-navigation.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-post-navigation\">\n\t\t\t<div class=\"elementor-post-navigation__prev elementor-post-navigation__link\">\n\t\t\t\t<a href=\"https:\/\/gfmg.ua\/en\/zvyazok-agt-ta-demencii\/\" rel=\"prev\"><span class=\"post-navigation__arrow-wrapper post-navigation__arrow-prev\"><i class=\"fa fa-caret-left\" aria-hidden=\"true\"><\/i><span class=\"elementor-screen-only\">Prev<\/span><\/span><span class=\"elementor-post-navigation__link__prev\"><span 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