2.  Observed/expected (standardized mortality ratio)  Risk ratio (RR) and odds ratio (OR)  1.0 - the groups are even  1.7 – the target group is at 70% greater risk  0.8 – the target group is at lower risk  Population attributable risk

3.  Baldessarini and Hennen (2004)  Examined genetics of suicide through several comparisons  Close relative attempted or died by suicide: OR = 5.01  Weighting study sizes and variances: OR = 2.86  MZ vs DZ twins concordance for suicide/attempts  MZ 401/1,704 = 23.5%  DZ 2/1,486 = 0.135%  175 times greater risk (may be an over-estimate)  Weighting study sizes and variances: OR = 2.86  Adoptive studies: RR =4.84  Data from molecular genetic studies mixed

4.  First, caveat about imaging studies  Rely on correlations, like much of our research  Correlations can be very telling and informative, or sometimes can lead us astray.  Some fun examples from Buzzfeed: http://www.buzzfeed.com/kjh2110/the-10-most-bizarre- correlations

9.  Van Heeringen, Gijttebier, & Godfrin, 2011  Reviewed brain imaging studies examining suicide attempts  Orbitofrontal and dorsolateral prefrontal cortex  Decision-making and problem solving  Sensitivity to social disapproval  Choosing options with high immediate rewards  Reduced ability to generate positive future events

10.  White Matter Hyperintensities (WMH)  Associated with 2.5 – 3 times greater risk of depression or bipolar  Those who were depressed and had WMH were 18.6 times more likely to have had a prior suicide attempt (Ehrlich et al., 2004).  Serotonin and suicide  Lower tryptophan trapping (serotonin synthesis) in those with suicide intent  Less 5-HT2a receptor binding in prefrontal cortex (esp. dorsolateral prefrontal) in suicide attempters  Larger right amygdala volume

11.  Stroke (Pompili et al., 2012)  Kidney Disease and Dialysis (Pompili, et al., 2013)  Cancer (2X greater risk than general population; Anguiano, et al., 2012)  Diabetes Type 1 (Pompili, et al., 2014)  Dementia (Data mixed; Haw et al., 2009)

13.  International Statistical Classification of Diseases and Related Health Problems (ICD-10)  Author: World Health Organization  Contains all health disorders  Often preferred by those outside the U.S, public health and epidemiological researchers  Diagnostic and Statistical Manual of Mental Disorders (DSM 5)  Author: American Psychiatric Association  Contains only mental health disorders  Often used by U.S. mental health providers

14.  Two weeks or more of 5 or more of the following:  Depressed mood most of the day, nearly every day  Markedly diminished interest or pleasure in previously interesting or pleasurable things  Significant weight loss or gain without trying  Insomnia  Psychomotor retardation or agitation  Fatigue and loss of energy  Feelings of worthlessness  Inability to think or concentrate/indecisiveness  Recurrent thoughts of death or suicidal ideation

15.  Increases the likelihood of suicidal behavior by more than 33 times (Beautrais, 1996)  The severity of depressive symptoms are positively correlated with suicide risk  Unipolar Depression vs. Bipolar

16.  Manic Episode  A period of abnormally elevated mood lasting at least 1 week with three or more of the following  inflated self-esteem or grandiousity  decreased need for sleep  more talkative than usual or pressure to keep talking  flight of ideas  distractability  increase in goal-directed activity or psychomotor agitation  excessive involvement in pleasurable activities that have a high potential for painful consequences

17.  Bipolar I and Suicide  80% report suicidal ideation, and 51% report a suicide attempt (Valtonen, et al., 2005)  15% - 19% die by suicide (de Abreu, et al., 2009)  Not all bad news: Lithium, a common treatment for bipolar disorder, is one of the few medications that has been shown to reduce suicide risk (Tondo, Hennen, & Baldessarini, 2001)

18.  It has long been held that 40 – 60% of those who died by suicide were intoxicated at the time of death  Very recent review found that 73% of suicide decedents had BACs of 0.00% (Anestis, et al., In Press, Abnormal Psychology)  Research suggests that alcohol dependence puts individuals at between 6 and 25 times greater risk of suicide

19.  DSM Criteria: Schizophrenia  Two or more of the following, each present during a significant portion of a 1 month period  delusions  hallucinations  disorganized speech  grossly disorganized or catatonic behavior  negative symptoms (e.g. affective flattening)

20.  Associated with increased risk of suicide, especially for those with greater cognitive impairment due to the disease  Those with paranoid schizophrenia diagnoses are also at higher risk

21.  Literature on anxiety disorder and panic disorder is mixed. Some evidence for a link in children, no recent review for adults.  PTSD has been shown to be associated with suicide  OR = 9.8  OR controlling for other disorders and demographics = 5.3 (Gradus et al., 2010)

22.  Cluster A (odd or eccentric)  Paranoid, Schizoid, Schizotypal  Cluster B (dramatic and erratic)  Antisocial, Borderline, Histrionic, Narcissistic  Cluster C (anxious and fearful)  Avoidant, Dependent, Obsessive-Compulsive

23.  Estimates are that as high as 80% of individuals who meet criteria for Borderline Personality Disorder demonstrate suicide related behaviors (Linehan, et al., 2006)  Between 4 – 9% die by suicide (Linehan, et al., 2006; Zanarini, et al., 2005)

24.  Examined insomnia symptoms, nightmares and a measure of suicide risk  Sample:  165 suicide attempters in Sweden  Results:  Nightmares related with suicide risk (OR: 4.9)  Nightmares remain significantly associated with suicide risk (OR: 3.0) after controlling for depression, anxiety, PTSD, and substance abuse

25.  2-year follow-up to see whether nightmares predict future suicide attempts  Hospital records used to detect suicide attempts  Results:  Nightmares predicted suicide attempts (OR = 5.2)  Nightmares were still predictive after controlling for depression, anxiety, PTSD, and substance abuse disorders (OR = 4.18)

26.  Having two or more mental disorders increases one’s risk of death by suicide 169.6 times!  In a sample of medically-serious suicide attempters, Beautrais and colleagues (1996) found that 56.6% had more than one diagnosis  OR with one disorder: 17.4  OR with two or more: 89.7