Weekly Mind Reader: Parsing the Disparities in Suicides Tied To Depression

This week features an exploration of suicides linked to depression, how a low-dose ketamine treatment can restore hope in the hopeless, and new research that proves a connection between poverty and mental illness.

Study Confirms Not All Depression-Linked Suicides Are the Same

Affective disorders – unipolar and bipolar depression in particular– present the highest risk of suicide.

Tragically, established research has shown that up to 70 percent of suicide victims contacted healthcare services within the month before their deaths. However, retrospective studies also reveal that healthcare providers often fail to diagnose depression in many people who later die by suicide, despite their recent visits. They also rarely administer antidepressant treatments.

Suicide risk factors remain diverse and include individual and environmental elements. Complex interactions among age, gender, social circumstances, and mental disorders also play a role. The stress-diathesis model suggests that preexisting factors make some individuals more vulnerable to stressful events, leading to suicidality. Others propose that perceived oppressiveness and an acute lack of belonging  increase vulnerability to negative events and suicidal behavior.

Specific models, such as those for borderline personality disorder (BPD), show differences in suicidal behavior related to comorbidities. These can include circumstances such as antisocial personality disorder and early life adversity. Models also link inflammation to suicide, with findings like increased inflammatory cytokines and immune alterations due to early-life adversities.

Depression, the focus of the most recent research appearing in the Journal of Clinical Psychiatry, includes multiple suicide risk factors, including substance use, previous attempts, and serious illness.

The relationship between antidepressant use and suicide remains murky. Some studies suggest a link between antidepressants and lower suicide rates in individuals over 25. The trend appears to be less clear in younger people, despite increased antidepressant use.

To understand the profiles of those who die by suicide, this study combines psychological autopsy and toxicological analysis. Researchers examined previous diagnoses, postmortem reports, prescribed treatments, and substances found in the blood. Conducted in Seville, Spain, the study included 313 people who died by suicide. The researchers examined both psychological autopsy data and toxicological tests.

Results show significant differences between those with and without major depressive episodes (MDE) at the time of death. MDE suicides were more likely to have had healthcare contact, be prescribed antidepressants, and have more severe symptoms. Despite frequent healthcare visits, few received a depression diagnosis or antidepressants. Benzodiazepines and alcohol were commonly found substances in toxicological analyses.

These findings highlight the need for better diagnosis and treatment adherence if we want to mitigate suicide risk.

IN OTHER PSYCHIATRY AND NEUROLOGY NEWS

• The Primary Care Companion for CNS Disorders published a case study this week that details a case of clozapine-related cecal volvulus that illustrates the need for a high index of suspicion for potentially life-threatening surgical emergencies in clozapine-treated patients.
• Original research in JCP reveals how a single infusion of low-dose ketamine resulted in a brief yet significant reduction in hopelessness.
• In a letter to the editor of PCC, Drs. Chamberlain and Grant discuss the history of suicide attempts among treatment-seeking individuals with gambling disorders who had participated in clinical trials.
• New research confirms that poverty and mental illness are causally linked, with each exerting influence on the other.
• Finally, another PCC case report explores the roles of psychiatry and clinical ethics consultants in withdrawing life-sustaining hemodialysis from a young patient.