مختصرات وتعليقات وخلاصات لدراسات علمية

 Studies & Comments : Abstracts & Summaries

يسرنا أن ننشر في هذه الباب مختصرات وخلاصات وتعليقات لدراسات وأبحاث في ميادين العلوم النفسية ،  باللغة العربية أو الإنكليزية أو كليهما . ويمكنك إرسال ملخص عن دراسة أو بحث تخرج  لك منشور أو غير منشور ، أو تعليق علمي مفيد حول موضع معين أو دراسة ، أو دراسة لباحثين آخرين اطلعت عليها ، إذا وجدت أنها مفيدة للنشر هنا

 ونرحب دائماً بكل ماهو مفيد .. ونشجع على نشره

 مدير الموقع

director@hayatnafs.com

 

-1- Testosterone gel supplementation for men with refractory depression

 -2- Hyperhidrosis in social anxiety disorder.

-3- Occupation and the mind

 -4- نمط المراجعات النفسية في القطاع الخاص في الأردن

-5- Childhood Predictors of Completed and Severe Suicide Attempts

-1- Testosterone gel supplementation for men with refractory depression: a randomized, placebo-controlled trial.

Pope HG Jr, Cohane GH, Kanayama G, Siegel AJ, Hudson JI.

 
Am J Psychiatry 2003 Jan;160(1):105-11

OBJECTIVE: Testosterone supplementation may produce antidepressant effects in men, but until recently it has required cumbersome parenteral administration. In an 8-week randomized, placebo-controlled trial, the authors administered a testosterone transdermal gel to men aged 30-65 who had refractory depression and low or borderline testosterone levels. METHOD: Of 56 men screened, 24 (42.9%) displayed morning serum total testosterone levels of 350 ng/dl or less (normal range=270-1070). Of these men, 23 entered the study. One responded to an initial 1-week single-blind placebo period, and 22 were subsequently randomly assigned: 12 to 1% testosterone gel, 10 g/day, and 10 to identical-appearing placebo. Each subject continued his existing antidepressant regimen. Ten subjects receiving testosterone and nine receiving placebo completed the 8-week trial. RESULTS: The groups were closely matched on baseline demographic and psychiatric measures. Subjects receiving testosterone gel had significantly greater improvement in scores on the Hamilton Depression Rating Scale than subjects receiving placebo. These changes were noted on both the vegetative and affective subscales of the Hamilton Depression Rating Scale. A significant difference was also found on the Clinical Global Impression severity scale but not the Beck Depression Inventory. One subject assigned to testosterone reported increased difficulty with urination, suggesting an exacerbation of benign prostatic hyperplasia; no other subject reported adverse events apparently attributable to testosterone. CONCLUSIONS: These preliminary findings suggest that testosterone gel may produce antidepressant effects in the large and probably underrecognized population of depressed men with low testosterone levels.

      -2- Hyperhidrosis in social anxiety disorder.

Davidson JR, Foa EB, Connor KM, Churchill LE.

Duke University Medical Center, Trent Drive, 4th Floor, Yellow Zone, Room 4082B, Box 3812, Durham, NC 27710, USA.

Prog Neuropsychopharmacol Biol Psychiatry 2002 Dec;26(7-8):1327-31


PURPOSE: Excessive sweating (hyperhidrosis) is an overlooked and potentially disabling symptom, which is often seen in social anxiety disorder (SAD). We conducted a retrospective review of data acquired in patients with SAD who had participated in placebo-controlled clinical trials of fluoxetine, cognitive behavior therapy, clonazepam and gabapentin. Four specific topics were addressed: (1) overall levels of sweating; (2) characteristics of those with hyperhidrosis; (3) a comparison of active treatments relative to placebo on hyperhidrosis; and (4) an examination of baseline sweating severity as a predictor of treatment outcome. METHODS: Using the Brief Social Phobia Scale (BSPS) and Social Phobia Inventory (SPIN), we examined the above questions. RESULTS: Hyperhidrosis was found in 24.8-32.3% of 375 subjects assessed, depending upon the scale used. Hyperhidrosis was associated with higher levels of disability, fear, avoidance, and other physiologic symptoms. While treatment in general was associated with a reduction in the rate of hyperhidrosis from 23.7% to 9.7% (BSPS), and 34.0% to 15.5% (SPIN), only fluoxetine differed significantly from placebo in respect of change in sweating score from baseline to endpoint. In an ANCOVA, gabapentin differed from placebo on the SPIN. CONCLUSION: We conclude that hyperhidrosis is frequently seen in patients with SAD, and that its response to treatment is variable. Further attention should be paid to the possible importance of this symptom in social anxiety.

تم النشر في 3 / 1 / 2003

     -3- Occupation and the mind

Dr. Samah Jabr

د. سماح جبر

Psychiatrist,Occupied Palestine

The New Internationalist,May, 2007.( Republished here by Author permission )

 

Dr. Samah Jabr exposes the damage done to the emotional health of Palestinians by the Israeli occupation.

 

Ahmad, a 46-year-old man from Ramallah, was doing well, until his last detention. But this time he just could not tolerate the long incarceration in a tiny cell, with complete visual and auditory deprivation. First, he lost his orientation to time. Then he became over-attentive to the movement of his gut and started thinking that he was ‘artificial inside his body’.  Later, he developed paranoid thinking, started hearing voices and seeing people in his isolated cell. Today, Ahmad is out of his detention, but still imprisoned by the idea that everyone is spying on him.

Fatima spent several years doctor-shopping for a combination of severe headaches, stomach-aches, joint pain and various dermatological complaints. There was no evidence of any organic cause. Finally, Fatima showed up at our psychiatric clinic and spoke of how all her symptoms started after she saw the skull of her murdered son, open on the stairs of her house, during the Israeli invasion of her village of Beit Rima on 24 October 2001.

Such are is the cases I see in my clinic. The traumatic events of war have always been a major source of psychological damage. In Palestine the kind of war being waged needs to be understood in order to appreciate the psychological impact on this long-occupied population. The war is chronic and continuous, over the lifetime of at least two generations. It pits an ethnically, religiously and culturally foreign state against a stateless civilian population. In addition to daily oppression and exploitation, it involves periodic military operations of usually moderate intensity. These provoke occasional Palestinian fractional and individual responses. The vast majority of people are never consulted about such actions. While their opinion does not matter, it is they who must endure pre-emptive Israeli strikes or collective punishment in retaliation.

Displacement 

Demographic factors complicate the picture. Those living in the occupied territories make up just a third of Palestinians; the rest are scattered around the region in a Diaspora, many in refugee camps. Almost every Palestinian family has experiences of displacement or major painful separation. Even inside Palestine , people are refugees, expelled in 1948 to live in refugee camps. The massive displacement of 70 per cent of the people, and the destruction of over 400 of their villages, are referred to by Palestinians as the Nakba or Catastrophe. This remains a trans-generational psychological trauma, scarring Palestinian collective memory. Very often, you will encounter young Palestinians who introduce themselves as residents of towns and villages their grandparents were evacuated from. These places are frequently no longer on the map, either razed entirely, or now inhabited by Israelis.

Palestinians perceive Israel ’s war against them as a national genocide, and to resist it they give birth to many children. The fertility rate among Palestinians is 5.8 - the highest in the region. This leads to a very young population (53 per cent under the age of 17) – a vulnerable majority, at a crucial stage of physical and mental development. The geographical enclosure of Palestinians in very small neighbourhoods, with the separation wall and a system of checkpoints, encourages consanguineous marriages, increasing a genetic predisposition to mental illness. Walling off friends and neighbours from each other also has a debilitating effect on the cohesion of Palestinian society.

But it is the violent environment in which they live which most undermines the mental health of Palestinians. Population density, especially in Gaza - with 3,823 persons per square kilometre - is very high. Elevated levels of poverty and unemployment - 67 per cent and 40 per cent respectively - undermine hope and deform personality. The war has left us with a huge community of prisoners and ex-prisoners, estimated at 650,000, or some 20 per cent of the population. The handicapped and mutilated make up six per cent. Recent screenings found a disturbing level of anaemia and malnutrition, especially among youngsters and women. The intense emotional hostility provoked by our daily friction with the Israeli soldiers at our doorsteps is a constant stress factor. Many Palestinian kids have been living with daily violence since birth. For them, the noise of bombardment is more familiar than the singing of birds.

Sudden blindness

During my medical school training in several Palestinian hospitals and clinics, I saw men complaining of non-specific chronic pains after they lost their jobs as labourers in Israeli areas; school children brought in for secondary bed-wetting after a horrifying night of bombardment. My memory of a woman, brought to the emergency room suffering from sudden blindness that started when she saw her child murdered as a bullet entered his eye and went out from the back of his head, remains all too vivid.

In Palestine , such cases are not registered as war injuries and are not treated properly. This realization provoked me to specialize in psychiatry. It is one of the most underdeveloped medical fields in Palestine . For a population of 3.8 millions, we have 15 psychiatrists and are understaffed with nurses, psychologists and social assistants. We have an estimated three per cent of the staff we need. We have two psychiatric hospitals, in Bethlehem and Gaza , but it is difficult to get to them, due to checkpoints. There are seven outpatient community mental-health clinics. In developing countries like occupied Palestine , psychiatry is the most stigmatized and the least financially rewarding medical profession. Psychiatrists work with desperately sick patients and, in the eyes of their communities, are far removed from the glory of other medical specialties. As a result, competent and talented doctors rarely specialize in psychiatry.

I find psychiatry a humanizing and dignifying profession – not least because it helps me personally to cope with all the violence and disappointments surrounding me. I move from Ramallah to Jericho to see psychiatric patients. In one working day I see between 40 and 60 patients; 10 times the number I used to see during my training in Parisian clinics.  I observe my patients’ disorganized behaviour, listen to their overwhelming stories and answer them with the few means I have: a bit of talking, to pull together their fragmented ideas; some pills that might help them to organize their thinking, stop their delusions and hallucinations, or allow them to sleep or calm down. But talks and pills can never return a killed child to his parents, an imprisoned father to his kids, or reconstruct a demolished home.

The ultimate solution for mental health in Palestine is in the hands of politicians, not psychiatrists. So, until they do their job, we in the health professions continue to offer symptomatic treatment and palliative therapy - and sensitize the world to what is taking place in Palestine .

Resistance

Nowadays, Palestinians are pressured to surrender once and for all, when they are asked to ‘recognize’ Israel . We are asked to accept, reconcile ourselves with and bless the Israeli violation of our life.  The fact that our homeland is occupied does not, by itself, mean that we are not free. We reject the occupation in our minds, as far as we can cope with it; and learn how to live in spite of it, rather being adjusted to it. But, if we recognize Israel , we are mentally occupied - and that, I claim, is incompatible with our wellbeing as individuals and a nation. Resistance to the occupation and national solidarity are very important for our psychological health. Their practice can be a protective exercise against depression and despair.

Israel has created awful facts on the ground. What remains for us of Palestine is a thought, an idea that becomes a conviction of our right to a free life and a homeland. When Palestinians are asked to ‘recognize’ Israel , we are asked to give up that thought, and to renounce everything we have and are. This will only sink us deeper into an eternal collective depression.

After several years in Paris I returned to a tired, starved Palestinian people, torn apart by fractional conflicts as well as by the separation wall. Palestinians are especially demoralized by the infighting taking place on the streets of Gaza , but orchestrated elsewhere in order to abort the results of last year’s democratic elections. Those who have stopped all money from going to Palestine are, in effect, sending us guns instead of bread. They encourage the psychologically and spiritually impoverished to kill their neighbours, cousins and ex-classmates. Even if the factions settle up, Palestinian society will be left with a serious problem of intra-family revenge.

We shall overcome

It is hard not to wonder whether Israel ’s targeting of Palestinians is deliberately designed to create a traumatized generation, passive, confused and incapable of resistance. I know enough about oppression to diagnose the non-bleeding wounds and recognize the warning signs of psychological deformity. I worry about a community forced to extract life from death and peace through war. I worry about youth who live all their lives in inhumane conditions; and about babies who open their eyes to a world of blood and guns. I am concerned about the inevitable numbness chronic exposure to violence brings. I fear also the revenge mentality – the instinctive desire to perpetuate on your oppressors the wrongs committed against yourself.

There has yet to be a comprehensive epidemiological study of the psychological disorders in Palestine . And, despite all that is published on Palestinian war-related psychopathology, my impression is that mental illness is still the exception in Palestine . Resilience and coping are still the norm among our people. In spite of all the home demolitions and extreme poverty, it is not in Palestine you find people sleeping in the streets or eating from trash cans. This resilience is based on family foundations, social steadfastness and spiritual and ideological conviction.

Still, we do have a mental-health emergency. Services are urgently needed for people who have suffered and endured crises so that they can restore their recuperative powers and coping capacities. This is crucial if they are not to crack when peace finally comes, as so often occurs in a post-war period. It is not just at a small number of sick individuals but an entire wounded society that needs care. Our trauma has been chronic and severe, but by recognizing our suffering and treating it with faith and compassion, we shall overcome.

Dr. Samah Jabr works as a psychiatrist in occupied Palestine .

 

Pullout

Many Palestinian kids have been living with daily violence since birth. For them, the noise of bombardment is more familiar than the singing of birds

The ultimate solution for mental health in Palestine is in the hands of politicians, not psychiatrists

I worry about a community forced to extract life from death and peace through war

تم النشر في 22/5/2007

 

   -4- نمط المراجعات النفسية في القطاع الخاص في الأردن

الدكتور جمال الخطيب

  اختصاصي الطب النفسي  

مدير قسم الطب النفسي والأورام في مركز الحسين الطبي / المدير الفني لمشفى الرشيد سابقاً / عمّان / الأردن

 

jabeer82@gmail.com

 

تشمل هذه الدراسة عينة عشوائية تتمثل في 500 مريض من مراجعي عيادتي الخاصة  حيث تمت دراسة وتقييم معظم المعطيات الواردة في ملف المريض .

الهدف من الدراسة هو فهم طبيعة مراجعي العيادة النفسية في الأردن من حيث طبيعة الشكوى والمرض وعلاقته بمختلف ظروف الحياة وذلك لتحسين الخدمات المقدمة في هذا المجال .

النتائج:

1-    المرضى من حيث الجنس

                    ذكور          54 % 

                    نساء           46%

مع أن نسبة إصابة النساء بكثير من الاضطرابات النفسية تتجاوز نسبة الرجال وتحديدا فيما يتعلق بالقلق والكآبة حيث تصل إلى الضعف , فإن مراجعة الرجال تساوي أو تتجاوز نسبة النساء وهذا يعكس الطبيعة الذكورية للمجتمع .

كما قد يفسر ذلك على انه بسبب الظلم اللاحق بالمرأة قي المجتمع  , فالمرأة عرضة لضغوط الحياة مضاف إليها ضغوط الرجل  واللافت  في بلادنا أن مراجعات النساء المصابات للعيادات اقل من مراجعات الرجال ولعل هذا يعكس حالة الظلم الواقعة على المرأة فهي الأكثر إصابة والأقل رعاية  .

2-الحالة الاجتماعية

                   أعزب         48%

                   متزوج        47%

                   مطلق       2 %

                   ارمل         2%

علاقة الأمراض النفسية بالحالة الاجتماعية وتحديدا الزواج والطلاق متشابكة  فقد يكون المرض سببا للطلاق وقد يكون نتيجة له.

بعض الأمراض تصيب الناس في مقتبل العمر وربما يؤدي استفحالها إلى عزوف الشخص عن الزواج بينما تصيب أمراض أخرى الناس في منتصف العمر بعد أن يكونوا قد تزوجوا .

وعموما وقي كثير من الأحيان يعتبر الزواج عنصرا إيجابيا   ويسهم في تحسين مسار العديد من الأمراض فقد دللت  الدراسات مثلا على أن مصير مرض الفصام يكون افضل لدى المتزوجين كما دللت دراسات أخرى أن العزلة والوحدة تفاقم حالات الاكتئاب.

3-العمر

                    0-10         5%

                   10-20       11%

                   20-40       60%

                   40-60       24%

يلاحظ هنا تماشي معدل الأعمار مع التشخيصات حيث أن الفترة العمرية من 20-40 -60 هي الأكثر شيوعا وفيها تزداد معدلات القلق والكآبة 38%+26% .

كما أن معدلات إصابة الأطفال متمشية مع النسب العالمية.

و يلاحظ أيضا تناسب الفئة العمرية الشبابية مع  معدلات ونوعيات الإصابة في هذه المرحلة ,فصام ,إدمان.

وبشكل عام تعكس النسب معدلات انتشار الأمراض اكثر مما تعكس الفئات العمرية في المجتمع ,إذ نلاحظ انه رغم أن غالبية سكان الأردن هم من الفئة العمرية تحت العشرين , إلا أن الغالب في العينة هو سن ما فوق العشرين.

4-العمل

                    يعمل         40%

                   لا يعمل       40 %

                   طالب         20%

تتساوى هنا نسبة العاملين والعاطلين عن العمل مع أن المنطق أن نسبة الإصابة تكون اكثر في العاطلين واعتقد أن أغلبية العاطلين عن العمل يفضلون مراجعة العيادات الحكومية وليس القطاع الخاص وذلك لاسباب مادية.

وفيما يتعلق بالطلاب فان نسبتهم تتماشى مع تكرار فئتهم العمرية.

5-مصدر التحويل

                   طبيب         25%

                   نفسه         54%

                   الأهل         23%

على الأغلب فان المرضى المحولين من أطباء هم ذوو الأعراض المتشابكة والجسمية في ظاهرها مثل اضطرابات الفزع , الدوخة, الصداع, قلة النوم , الشهية,الضعف الجنسي وغالبا ما يكون الأطباء العامين وبقية التخصصات قد أدوا دورا ممتازا لجهة التوصل إلى تشخيص دقيق واستبعاد المرض العضوي ويلاحظ ذلك من المستوى الرفيع للتحويلات وجودة العمل المبذول قبل وصول المريض إلى الطبيب النفسي .

إلا أنه في كثير من الأحيان يتأخر وصول المريض بسبب الخوف من الوصمة او الاعتقاد الخاطئ بان التحويل لطبيب نفسي يعني أن الأعراض التي يشكو منها المريض ليست حقيقية وأنها نتاج الوهم أو ربما التمثيل وهنا لا بد من التنويه أن كون الأعراض ذات منشا نفسي لا يعني إنها وهمية فالمريض يشعر بها تماما كأي صداع أو دوخة أو ضيق نفس إنما يكون منشأها نفسيا لا عضويا.

المرضى المحولون من قبل الأهل هم في الغالب المرضى فاقدي البصيرة أو الحالات المتقدمة حيث يشكل المريض مشكلة للآخرين اكثر من شعوره الذاتي بها أو وعيه لها  ومنهم مرضى الفصام والذهان واضطرابات الطعام وكذلك مرضى الخرف والهذيان.

أما المرضى الذين يأتون من تلقاء أنفسهم فهم على الأغلب من أصحاب البصيرة الواضحة تجاه المرض,المقصود بالبصيرة هو معرفة الشخص أن ما يشعر به ناجم عن المرض وانه بحاجة للمساعدة ,كما أن أعراضهم يغلب عليها الطابع الشعوري أو الذهني أو السلوكي كما إنها تكون من الدرجة البسيطة إلى المعتدلة

6-الجنسية

                   أردني         79%

                   غير           21%

ربع المرضى هم من غير الأردنيين وهذه نسبة عالية  و يعكس ذلك تحول الأردن  إلى  نقطة استقطاب علاجية لأهالي دول المنطقة العربية.

7-التعليم  

                   بلا            17%       

                  ابتدائي        5% 

                  إعدادي        7%

                  ثانوي         23%

                  كلية           8%

                  جامعة       40 % 

لا تعكس هذه النسب  مستويات  انتشار التعليم الحقيقية  في المجتمع  كما أنها ليست مؤشرا على انتشار المرض في فئات معينة اكثر من غيرها ,   إنما قد تعكس هذه  درجة الوعي الطبي والبصيرة  تجاه المرض النفسي عند  مختلف الفئات.

8- الأمراض والشكوى

                   اضطرابات القلق               38%

                   اضطراب الكآبة                 26%

                   الإدمان                            7%

                  الفصام                            14%

                  الذهان                             4%

                اضطرابات الشخصية              8%

                الزهو ( الهوس )                   4%

                أخرى                               20%

هنا يلاحظ أن مجموع النسب يتجاوز أل 100%  ومرد ذلك إلى ترافق اكثر من مرض , فقد يترافق الاكتئاب مع القلق أو الفصام مع الإدمان  وما إلى ذلك مما يجعل نسبة الأمراض إلى عدد الأشخاص  اكثر من 1:1.

اضطرابات القلق(38%) تشمل مجموعة من الأمراض  مثل القلق العام , نوبات الفزع , حالات الرهاب الاجتماعي , الوسواس القهري , عقبى الكرب وهي الأمراض الأكثر شيوعا على المستوى العالمي ويبدو أن الوضع في الأردن يتماثل مع ذلك.

اضطراب الكآبة (26%) وهي ثاني الاضطرابات شيوعا قد تكون الثالثة انتشارا على الصعيد العالمي بعد القلق والإدمان إلا أنها هنا الثانية أي أنها تسبق الإدمان في حجم المراجعات  . وفيما يتعلق بحالات الزهو فإنها في الأغلب مستقبلا ستضاف إلى نسب الاكتئاب حيث أن الزهو في الغالب هو جزء من الاضطراب ثنائي القطب زهو-اكتئاب حيث يصاب الشخص بدورات متتالية من الهوس والكآبة.

الفصام يحتل المركز الثالث بنسبة 7% وهنا يلاحظ أن نسبة تمثيل مرضى الفصام في مراجعي العيادات عالية وذلك نظرا لصعوبة أعراض الفصام وخطورتها "هلاوس أوهام شكوك,..." مما يدفع الأهل للمراجعة الفورية وعدم الانتظار. الذهان بأشكاله المختلفة وتحديدا الزوري.. أي الشك المرضي ممثل أيضا.وهنا لابد من التأكيد أن هذه النسبة تعكس حجم مرضى الفصام  إلى مراجعي العيادات وليس نسبة مرض الفصام في المجتمع وهي حوالي 1%.

الإدمان 7% واضطرابات الشخصية 8%  على الأغلب هذان التشخيصان مترافقان وبالذات لجهة اضطراب الشخصية الحدودية  والضد اجتماعية حيث يكون إساءة استعمال المواد سلوكا نمطيا وملازما .

تدني مرتبة الإدمان وقلة تمثيله في المرضى يعود لسببين رئيسيين أولهما قلة هذه المشكلة نسبيا في الأردن وثانيهما قلة التبليغ عن هذه المشكلة بدافع الخجل والخوف من الوصمة.

أخرى 20% هذه النسبة تشمل

حالات الأطفال  حوالي  10% والغالب عليها حالات فرط الحركة ونقص الانتباه , اضطراب السلوك , ضعف قدرات التعلم ,التوحد, سلس التبول .

كبار السن وتشمل حالات الخرف سواء الزهيمر أو غيرها .

حالات خاصة مثل الاضطرابات المتعلقة بالدورة الشهرية والحمل والولادة" اكتئاب وذهان النفاس" وكذلك حالات مرتبطة بالاياس.

هناك أيضا , اضطرابات الأكل  مثل السمنة والريجيم المرضي , وكذلك بعض حالات الاضطراب الجنسي.

كما انه هناك نسبة لا بأس بها ممن يعانون من مشاكل زوجية وعائلية ويأتون للاستشارة.

ما يجب التنبه إليه دوما عند تفسير هذه الأرقام هو أنها تعكس نمط مراجعي العيادة الخاصة وليست قياسا إحصائيا لمعدل انتشار الأمراض في المجتمع.

 تعليق :

سبق هذه الدراسة دراسة قام بها الدكتور وليد سرحان والدكتور بهجت عبد الرحيم أستاذا الطب النفسي وقد شملت دراستهما التي قدمت لمؤتمر الطب النفسي العربي الحادي عشر 1994 ألف مريض .

عند مراجعتي لدراسة الأساتذة سرحان وعبد الرحيم  لا حظت أن  نتيجة دراستي قريبة جدا من نتيجة دراستهما  أو حتى مطابقة وهذا التكرار يكسب الدراستين درجة من المصداقية  .

أما الفروق ذات المغزى فقد كانت في موضوعين

الأول زيادة في حجم المرضى المحولين من أطباء

12%  إلى    25%     وهذا يعكس تزايد الوعي تجاه الاختصاص الطبي.

الثاني  زيادة في نسبة المرضى غير الأردنيين

12%  إلى  21% وهو مؤشر على المكانة المتزايدة التي يحتلها الطب في الأردن على مستوى المنطقة.

تم النشر في 9/9/2007

 

5- Childhood Predictors of Completed and Severe Suicide Attempts

Findings From the Finnish 1981 Birth Cohort Study

Andre Sourander, MD; Anat Brunstein Klomek, PhD; Solja Niemelä, MD; Antti Haavisto, MD; David Gyllenberg, MD; Hans Helenius, MSc; Lauri Sillanmäki, BA; Terja Ristkari, RN, MNSc; Kirsti Kumpulainen, MD; Tuula Tamminen, MD; Irma Moilanen, MD; Jorma Piha, MD; Fredrik Almqvist, MD; Madelyn S. Gould, PhD

Arch Gen Psychiatry. 2009;66(4):398-406.

Context  To our knowledge, no prospective, population-based study in existence examines predictive associations between early or middle childhood psychopathologic disorders and later completed suicides.

Objective  To study predictive associations between childhood psychopathologic disorders at the age of 8 years and later completed suicides and severe suicide attempts.

Design  Birth cohort study of individuals 8 to 24 years old.

Setting  Finland.

Participants  The sample includes 5302 Finnish people born in 1981 who were examined at the age of 8 years to gather information about psychopathologic conditions, school performance, and family demographics from parents, teachers, and children.

Main Outcome Measures  National register-based lifetime information about completed suicides and suicide attempts that prompted hospital admission.

Results  Of all 24 deaths among males between 8 and 24 years of age, 13 were suicides, whereas of 16 deaths among females, only 2 were suicides. Fifty-four males and females (1%) had either completed suicide or made a serious suicide attempt, defined as a suicide attempt that prompted hospital admission. Of 27 males with completed or serious suicide attempts, 78% screened positive on parent or teacher Rutter scales at the age of 8 years, whereas of 27 females only 11% screened positive. Among males, completed or serious suicide attempt outcome was predicted at the age of 8 years by living in a nonintact family; psychological problems as reported by the primary teacher; or conduct, hyperkinetic, and emotional problems. However, self-reports of depressive symptoms at the age of 8 years did not predict suicide outcome. No predictive associations between the study variables measured at the age of 8 years and suicide outcome were found among females. Male suicide outcome was predicted most strongly by comorbid conduct and internalizing problems.

Conclusions  Most males who completed suicide and/or made serious suicide attempts in adolescence or early adulthood had psychiatric problems by the age of 8 years, indicating a trajectory that persists throughout their lives. However, female severe suicidality is not predicted by psychopathologic disorders at the age of 8 years. The results give additional support to the importance of early detection and treatment of psychiatric problems in males.


Author Affiliations: Departments of Child Psychiatry (Drs Sourander and Haavisto and Ms Ristkari), Psychiatry (Drs Niemelä and Piha), and Biostatistics (Mr Helenius and Ms Sillanmäki), Turku University Hospital, Turku, Finland; Institute of Clinical Medicine, Tromsø University, Tromsø, Norway (Dr Sourander); Departments of Child and Adolescent Psychiatry (Drs Klomek and Gould) and Epidemiology (Dr Gould), Columbia University, New York, New York; Department of Child Psychiatry, Helsinki University, Helsinski, Finland (Drs Gyllenberg and Almqvist); Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland (Dr Kumpulainen); Department of Child Psychiatry, Tampere University Hospital, Tampere, Finland (Dr Tamminen); and Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland (Dr Moilanen).

                                                                           

عودة إلى : للاختصاصيين                        عودة إلى الصفحة الرئيسية