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Dr. Maria Oquendo of the New York State Psychiatric Institute and the College of Physicians and Surgeons at Columbia University in New York City, was interviewed by Medscape Medical News about her reseach into risk factors of familial suicide. Dr. Oquendo is studying families to clarify development of mood disorders and suicidal behavior, to find out what factors contribute to suicide other than the presence of depression.
Dr. Oquendo is looking at a variety of factors related to suicidal tendency, such as early trauma and early abuse, particularly sexual abuse. Breakup of a family is also an important factor, as are mood disorders and high levels of agreession and impulivity, and cultural differences.
But "we are just beginning to get an understanding of this and we are still gathering data," she said. In so doing the study has enrolled 136 families, but hopes to increase that to 500; "and from that group we will be able to feel more confident in our findings.
Another factor of suicidal tendency is religious beliefs. A religious affiliation of any kind "seems to be protective in terms of suicidal behavior, even in the context of a mood disorder."
Though she does not much about differences between male and female suicidal behavior, she does know that female offspring of a suicide attempter is more likely to attempt suicide. The study expects to learn more about this in the future. The study is also collecting genetic data but factors of genetics is difficult to assess without a very large study group.
According to The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), suicidal tendency is only listed under depression, but Dr. Oquendo knows that suicidal behavior also occurs in people with schizophrenia, PTSD, bipolar disorder, borderline personality disorder, and other personality disorders such as antisocial personality disorder and narcissistic personality disorder.
Dr. Oquendo has also investigated biological and behavioral factors of suicidal tendency which will help identify persons at risk, such as low serotonin levels in the brain's prefrontal cortex and a person's aggression/impulsivity tendencies or lack thereof.
Persons with high-lethality suicide attempts had "less activity in the ventral, medial and lateral PFC, compared to low-lethality suicide attempters" (1). In her study, persons who were more impulsive and made low-lethality suicide attempts showed higher activity in the PFC than less impulsive high-lethality attempters. The higher PFC activity was also associated with lower age.
Persons who are impulsive have a lower suicidal tendency, while persons who are not impulsive are more likely to die from a suicide attempt. Perhaps because the non-impulsive person takes more time to plan the suicide attempt. Her findings indicate that impulsivity decreases with age, resulting in more well planned attempts.
More on factors contributing to suicidal tendency can be found at Medscape
Source : "Familial Suicidal Behavior:" A Newsmaker Interview With Maria Oquendo, MD, by Robert Kennedy (Medscape Medical News, 2004)
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