İntiharda Risk Faktörleri ve İntiharın Önlenmesi
Özet
İntihar davranışı küresel ölçekte ciddi bir halk sağlığı problemi olup, önlenmesindeki en kritik adım risk faktörlerinin yüksek kesinlikle saptanmasıdır. Güncel teoriler intiharı çevresel, biyolojik, psikolojik ve kültürel etkileşimlerin bir yanıtı olarak ele almaktadır. Psikiyatrik bozukluklar, özellikle de majör depresyon, intihar riskini önemli ölçüde artırmaktadır. Ayrıca geçmiş intihar girişimleri, ileri yaş, kronik hastalıklar ile kanser tanısı, stigmatizasyon ve umutsuzluk da güçlü risk faktörleri arasında yer almaktadır. Son dönemde, intiharın tahmin edilmesinde geleneksel risk faktörlerinin yerine makine öğrenmesi temelli algoritmaların kullanımı ön plana çıkmaktadır. Önleme çalışmalarında ise geçerliliği tartışmalı olan "zarar vermeme sözleşmeleri" yerine, hastayla birlikte hazırlanan ve içsel/dışsal başa çıkma mekanizmalarını içeren kişiselleştirilmiş "güvenlik planları" ile "krize yanıt planlaması" çok daha etkili sonuçlar vermektedir. Farmakolojik alanda esketamin nazal sprey ve klozapin gibi ajanların yanı sıra, klinik uygulamalarda elektrokonvülsif tedavi (EKT) ve transkraniyal manyetik stimülasyon (rTMS) gibi nöromodülasyon yöntemleri dirençli olgularda intihar düşüncelerini hızla azaltabilmektedir.
Suicidal behavior is a serious global public health problem, and the most critical step in its prevention is the identification of risk factors with high accuracy. Current theories conceptualize suicide as a response to environmental, biological, psychological, and cultural interactions. Psychiatric disorders, particularly major depression, significantly increase the risk of suicide. Additionally, past suicide attempts, advanced age, chronic illnesses, cancer diagnosis, stigmatization, and hopelessness are among the prominent risk factors. Recently, the use of machine learning-based algorithms has come to the fore instead of traditional risk factors in predicting suicide. In prevention efforts, personalized "safety plans" and "crisis response planning," which are prepared collaboratively with the patient and include internal/external coping mechanisms, yield much more effective results than "no-harm contracts," whose validity is questioned. In the pharmacological field, agents such as esketamine nasal spray and clozapine, as well as neuromodulation methods like electroconvulsive therapy (ECT) and transcranial magnetic stimulation (rTMS) in clinical practice, can rapidly reduce suicidal ideation in treatment-resistant cases.
Referanslar
Naghavi, M., Global, regional, and national burden of suicide mortality 1990 to 2016: systematic analysis for the Global Burden of Disease Study 2016. Bmj, 2019. 364: p. l94.
Obegi, J.H., Rethinking Suicidal Behavior Disorder. Crisis, 2019. 40(3): p. 209-219.
Franklin, J.C., et al., Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychol Bull, 2017. 143(2): p. 187-232.
Belsher, B.E., et al., Prediction Models for Suicide Attempts and Deaths: A Systematic Review and Simulation. JAMA Psychiatry, 2019. 76(6): p. 642-651.
Naherniak, B., et al., Ambivalence About Living and the Risk for Future Suicide Attempts: A Longitudinal Analysis. Prim Care Companion CNS Disord, 2019. 21(2).
Gairin, I., A. House, and D. Owens, Attendance at the accident and emergency department in the year before suicide: retrospective study. Br J Psychiatry, 2003. 183: p. 28-33.
Stanley, I.H., et al., Anxiety sensitivity and suicidal ideation/suicide risk: A meta-analysis. J Consult Clin Psychol, 2018. 86(11): p. 946-960.
van Bergen, D., O. Eylem-Van Bergeijk, and A.H. Montesinos, Attempted suicide and suicide of young Turkish women in Europe and Turkey: A systematic literature review of characteristics and precipitating factors. PLoS One, 2021. 16(8): p. e0253274.
Canetto, S.S., Suicidal Behaviors Among Muslim Women. Patterns, Pathways, Meanings, and Prevention. Crisis, 2015. 36(6): p. 447-58.
Snorrason, I., et al., Body dysmorphic disorder and major depressive episode have comorbidity-independent associations with suicidality in an acute psychiatric setting. J Affect Disord, 2019. 259: p. 266-270.
Cáceda, R., W.S.T. Griffin, and P.L. Delgado, A probe in the connection between inflammation, cognition and suicide. J Psychopharmacol, 2018. 32(4): p. 482-488.
López-Goñi, J.J., et al., Suicidal attempts among patients with substance use disorders who present with suicidal ideation. Addict Behav, 2019. 89: p. 5-9.
Fernández-Montalvo, J., J.J. López-Goñi, and A. Arteaga, Psychological, physical, and sexual abuse in addicted patients who undergo treatment. J Interpers Violence, 2015. 30(8): p.1279-98.
Arribas-Ibar, E., et al., Suicidal behaviours in male and female users of illicit drugs recruited in drug treatment facilities. Gac Sanit, 2017. 31(4): p. 292-298.
Rodríguez-Cintas, L., et al., Factors associated with lifetime suicidal ideation and suicide attempts in outpatients with substance use disorders. Psychiatry Res, 2018. 262: p. 440-445.
Paris, J., Suicidality in Borderline Personality Disorder. Medicina (Kaunas), 2019. 55(6).
Oexle, N., et al., Mental illness stigma, secrecy and suicidal ideation. Epidemiol Psychiatr Sci,2017. 26(1): p. 53-60.
Rüsch, N., M.C. Angermeyer, and P.W. Corrigan, Mental illness stigma: concepts, consequences, and initiatives to reduce stigma. Eur Psychiatry, 2005. 20(8): p. 529-39.
Oexle, N., et al., Self-stigma and suicidality: a longitudinal study. Eur Arch Psychiatry Clin Neurosci, 2017. 267(4): p. 359-361.
Fawcett, J., et al., Time-related predictors of suicide in major affective disorder. Am J Psychiatry, 1990. 147(9): p. 1189-94.
Joiner, T.E., Jr., et al., Four studies on how past and current suicidality relate even when "everything but the kitchen sink" is covaried. J Abnorm Psychol, 2005. 114(2): p. 291-303.
Links, P., et al., Prospective study of risk factors for increased suicide ideation and behavior following recent discharge. Gen Hosp Psychiatry, 2012. 34(1): p. 88-97.
Miranda, R., et al., Cognitive inflexibility as a prospective predictor of suicidal ideation among young adults with a suicide attempt history. Depress Anxiety, 2012. 29(3): p. 180-6.
Borges, G., et al., Risk factors for the incidence and persistence of suicide-related outcomes: a 10-year follow-up study using the National Comorbidity Surveys. J Affect Disord, 2008.105(1-3): p. 25-33.
O'Connor, R.C., et al., Psychological processes and repeat suicidal behavior: a four-year prospective study. J Consult Clin Psychol, 2013. 81(6): p. 1137-43.
Suokas, J., et al., Long-term risk factors for suicide mortality after attempted suicide--findings of a 14-year follow-up study. Acta Psychiatr Scand, 2001. 104(2): p. 117-21.
Wenzel, A., et al., Predictors of suicide relative to other deaths in patients with suicide attempts and suicide ideation: a 30-year prospective study. J Affect Disord, 2011. 132(3): p. 375-82.
Tejedor, M.C., et al., Attempted suicide: repetition and survival--findings of a follow-up study.Acta Psychiatr Scand, 1999. 100(3): p. 205-11.
Brådvik, L. and M. Berglund, Repetition and severity of suicide attempts across the life cycle: a comparison by age group between suicide victims and controls with severe depression. BMC Psychiatry, 2009. 9: p. 62.
Ribeiro, J.D., et al., Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: a meta-analysis of longitudinal studies. Psychol Med, 2016. 46(2): p. 225-36.
Fernandez-Rodrigues, V., et al., Risk factors for suicidal behaviour in late-life depression: A systematic review. World J Psychiatry, 2022. 12(1): p. 187-203.
Karbeyaz, K., et al., Elderly suicide in Eskisehir, Turkey. J Forensic Leg Med, 2017. 52: p.12-15.
van Heeringen, K., Frontiers in Neuroscience Stress–Diathesis Model of Suicidal Behavior, inThe Neurobiological Basis of Suicide, Y. Dwivedi, Editor. 2012, CRC Press/Taylor & Francis© 2012 by Taylor & Francis Group, LLC.: Boca Raton (FL).
Klonsky, E.D., B.Y. Saffer, and C.J. Bryan, Ideation-to-action theories of suicide: a conceptual and empirical update. Curr Opin Psychol, 2018. 22: p. 38-43.
Klonsky, E.D., et al., The three-step theory of suicide: Description, evidence, and some useful points of clarification. Prev Med, 2021. 152(Pt 1): p. 106549.
Harmer, B., et al., Suicidal Ideation, in StatPearls. 2022, StatPearls Publishing Copyright © 2022, StatPearls Publishing LLC.: Treasure Island (FL).
Zaorsky, N.G., et al., Suicide among cancer patients. Nat Commun, 2019. 10(1): p. 207.
Henson, K.E., et al., Risk of Suicide After Cancer Diagnosis in England. JAMA Psychiatry, 2019. 76(1): p. 51-60.
Swannell, S., G. Martin, and A. Page, Suicidal ideation, suicide attempts and non-suicidal self- injury among lesbian, gay, bisexual and heterosexual adults: Findings from an Australian national study. Aust N Z J Psychiatry, 2016. 50(2): p. 145-53.
Chen, R., et al., Suicidal ideation and attempted suicide amongst Chinese transgender persons: National population study. J Affect Disord, 2019. 245: p. 1126-1134.
Bokor, J., et al., Inflamed Mind: Multiple Genetic Variants of IL6 Influence Suicide Risk Phenotypes in Interaction With Early and Recent Adversities in a Linkage Disequilibrium- Based Clumping Analysis. Front Psychiatry, 2021. 12: p. 746206.
Bernert, R.A., M.A. Hom, and L.W. Roberts, A review of multidisciplinary clinical practice guidelines in suicide prevention: toward an emerging standard in suicide risk assessment and management, training and practice. Acad Psychiatry, 2014. 38(5): p. 585-92.
Green, J.D., et al., Evaluating the Effectiveness of Safety Plans for Military Veterans: Do Safety Plans Tailored to Veteran Characteristics Decrease Suicide Risk? Behav Ther, 2018. 49(6): p. 931-938.
Bryan, C.J., et al., Effect of crisis response planning vs. contracts for safety on suicide risk in U.S. Army Soldiers: A randomized clinical trial. J Affect Disord, 2017. 212: p. 64-72.
Ionescu, D.F., et al., Esketamine Nasal Spray for Rapid Reduction of Depressive Symptoms in Patients With Major Depressive Disorder Who Have Active Suicide Ideation With Intent: Results of a Phase 3, Double-Blind, Randomized Study (ASPIRE II). Int J Neuropsychopharmacol, 2021. 24(1): p. 22-31.
Canuso, C.M., et al., Esketamine Nasal Spray for the Rapid Reduction of Depressive Symptoms in Major Depressive Disorder With Acute Suicidal Ideation or Behavior. J Clin Psychopharmacol, 2021. 41(5): p. 516-524.
Zalsman, G., et al., Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry, 2016. 3(7): p. 646-59.
Guloksuz, S., et al., The impact of electroconvulsive therapy on the tryptophan-kynurenine metabolic pathway. Brain Behav Immun, 2015. 48: p. 48-52.
Mehta, S., et al., Effect of high frequency versus theta-burst repetitive transcranial magnetic stimulation on suicidality in patients with treatment-resistant depression. Acta Psychiatr Scand, 2022. 145(5): p. 529-538.
Gascon, B., et al., Suicide Risk Screening and Suicide Prevention in Patients With Cancer. JNCI Cancer Spectr, 2021. 5(4).
