Co-existing illnesses, high cholesterol add to suicide risk

March 27, 2000

Washington, D.C. -- Major depressive episodes, borderline personality, and high levels of serum cholesterol increase the risk of suicide and the severity of the suicide attempt according to two studies published in the April issue of the American Journal of Psychiatry.

Individuals with both major depression and borderline personality disorder (BPD) are at greater risk of suicide, according to a new study from Western Psychiatric Institute and Clinic and the University of Pittsburgh. The investigators found no significant differences in suicide attempts between patients with one or the other illness.

BPD is the only personality disorder defined, in part, by recurrent suicidal behaviors. However, they found that patients with both disorders had more serious symptoms, including impulsive-aggression, hopelessness, and depression, and were more serious in suicide attempts, with greater medical consequences. (1.)

"Comorbidity of BPD with major depressive episodes increases the number and seriousness of suicide attempts," concludes lead researcher Paul Soloff, M.D.

A second study found that the risk of violent suicide‹hanging, shooting, cutting, or jumping‹doubled among individuals with high serum cholesterol. After reviewing five independent population surveys in Finland, researchers at the Kuopio University Hospital and the National Public Health Institute, Helsinki, found no association between high cholesterol and nonviolent suicide, such as drug overdose, poisoning with gases, or drowning.

"The mechanism that may link cholesterol with violent suicide is unclear, but one possibility involves plasma polyunsaturated fatty acids (PUFAs)," said study participant Antti Tanskasnen, M.D. "These are inversely related to serum cholesterol, and depletion of certain PUFAs has been linked to an increased risk of depression‹one of the strongest risk factors of suicide." (2.)

Editor's Note: A new suicide prevention Public Service Announcement (PSA) is now available from the American Psychiatric Association (APA). The PSA, "Father," was conceived and produced by Industrial Light & Magic. Call: Rick Ottinger, 202-682-6119,

Also in the April issue of the American Journal of Psychiatry:

Mental health evaluation important safeguard to "assisted" suicide

A critical safeguard for patients requesting physician assisted suicide is an extensive psychiatric evaluation to ensure that patients with depression or other treatable disorders are capable of making an informed decision. A study from the Oregon Health Sciences University reports the results of a national survey of 456 forensic psychiatrists about the process and standards they believe mental health professionals should use in assessing a patient's capacity to consent to assisted suicide. All respondents recommended an extensive psychiatric evaluation: 73 percent recommended evaluation by more than one psychiatrist and 44 percent recommended judicial review.

"The evaluation recommended by experts would assure that patients are competent to make the decision about assisted suicide," said Linda Ganzini, M.D., lead researcher on the study. "But the process might burden terminally ill patients."

Although the study reveals a majority of forensic psychiatrists support legalization of assisted suicide, survey respondents regard it as a rare and extraordinary procedure. Those respondents that objected to legalized physician-assisted suicide believed suicide itself was unacceptable, while others objected to physician involvement. The study suggests that the ethical views of physicians have the potential to influence their clinical-legal opinions about assisted suicide. (3.)

Editors Note: To date, the APA has not adopted a formal position on Physician-Assisted Suicide. In July 1999, the APA Board of Trustees requested its Committee on End-of-Life Issues gather member comments on draft statements and to refer those comments and the statement to its Ethics Committee. Recommendations for an APA position will be based on these member and ethics reviews.

Finances and family play role in avoiding treatment for social anxiety

Despite the availability of effective treatments for social anxiety disorder, 47 percent of the 203 adults participating in a new study from the New York State Psychiatric Institute and Freedom From Fear Foundation were not receiving treatment. Researchers found that treatment costs, uncertainty over where to go for help, and a fear of what others might think prevent individuals with clinically significant social anxiety from seeking treatment. The study evaluated concerns by adults with social anxiety disorder who participated in the 1996 National Depression Screening Day.

"Expanding third-party mental health coverage, increasing public awareness of local services, and protecting patient privacy may reduce these barriers to treatment," said study director Mark Olfson, M.D. (4.)

Editor's Note: National Anxiety Disorders Screening Day is Wednesday, May 3. Call 1-718-239-0071 for a local screening site.

Delusions do not create violence

People with delusions are not more likely to be violent according to a MacArthur Foundation Study from the University of Massachusetts Medical School and the University of Virginia School of Law. This study followed more than 1,100 psychiatric patients for a year after their release from the hospital. Researchers suspect that earlier studies identified people who were suspicious and irritable, but not truly delusional. The study suggests that the mere presence of delusions does not mean a patient is dangerous.

"Media portrayals of violent acts by persons with mental illness have linked delusions and violence in the popular mind," said Paul S. Appelbaum, M.D., principal researcher of the study. "Our data, however, suggest that people with delusions are not more likely to be dangerous after hospital discharge." (5.)

Editor's Note: The APA has a Fact Sheet available on "Violence and Mental Illness." Call 1-888-357-7924, and request document number 6109, or, click on Public Information, then APA Fast Fax Series, then "Violence and Mental Illness."

Briefly noted:

New studies show posttraumatic stress risk factors can vary in cultures and severity

Three new studies point to high risk for posttraumatic stress disorder (PTSD) in the following groups: Hispanic males, persons with mild traumatic brain injuries, and those with acute traumatic head injuries. The first study from Yale University and the VA-Connecticut Healthcare System found that Hispanic male veterans have a higher risk for PTSD and experience more severe PTSD symptoms than non-Hispanic white male veterans. A study from the University of New South Wales assesses the ability of acute stress disorder as a predictor of PTSD, and the third study reports on PTSD after severe traumatic injury to the brain. (6, 7, 8.)

1. ["Characteristics of Suicide Attempts of Patients with Major Depressive Episode and Borderline Personality Disorder: A Comparative Study," by Paul H. Soloff, et. al., p. 601] APAfastFAX#6919

2. ["High Serum Cholesterol and Risk of Suicide, by Antti Tanskanen, et. al., p. 648] APAfastFAX#6920

3. ["Evaluation of Competence to Consent to Assisted Suicide: Views of Forensic Psychiatrists," by Linda Ganzini, et. al., p. 595] APAfastFAX#6921

4. ["Barriers to the Treatment of Social Anxiety," by Mark Olfson, et. al., p. 521] APAfastFAX#6922

5. ["Violence and Delusions: Data From the MacArthur Violence Risk Assessment Study," by Paul S. Appelbaum, et. al., p. 566] APAfastFAX#6923

6. ["Posttraumatic Stress Disorder Among Hispanic Vietnam Veterans," by Alexander N. Ortega, et. al., p. 615] APAfastFAX#6924

7. ["Two Year Prospective Evaluation of the Relationship Between Acute Stress Disorder and Posttraumatic Stress Disorder Following Mild Traumatic Brain Injury," by Allison G. Harvey and Richard A. Bryant, p. 626] APAfastFAX#6925

8. ["Posttraumatic Stress Disorder After Severe Traumatic Brain Injury," by Richard A. Bryant, et. al., p. 629] APAfastFAX#6926

Copies of these articles are available in their entirety by calling APAfastFAX at 888-357-7924.
The American Psychiatric Association is a national medical specialty society, founded in 1844, whose 40,000 physician members specialize in the diagnosis and treatment of mental and emotional illnesses and substance use disorders.

American Psychiatric Association

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