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Maria A. Oquendo - One of the best experts on this subject based on the ideXlab platform.
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severity and variability of depression symptoms predicting Suicide Attempt in high risk individuals
JAMA Psychiatry, 2019Co-Authors: Nadine M Melhem, Maria A. Oquendo, Ainsley K Burke, Boris Birmaher, Barbara Stanley, John G Keilp, Giovanna Porta, Jamie Zelazny, Satish Iyengar, John J MannAbstract:Importance Predicting suicidal behavior continues to be among the most challenging tasks in psychiatry. Objectives To examine the trajectories of clinical predictors of Suicide Attempt (specifically, depression symptoms, hopelessness, impulsivity, aggression, impulsive aggression, and irritability) for their ability to predict Suicide Attempt and to compute a risk score for Suicide Attempts. Design, Setting, and Participants This is a longitudinal study of the offspring of parents (or probands) with mood disorders who were recruited from inpatient units at Western Psychiatric Institute and Clinic (Pittsburgh) and New York State Psychiatric Institute. Participants were recruited from July 15, 1997, to September 6, 2005, and were followed up through January 21, 2014. Probands and offspring (n = 663) were interviewed at baseline and at yearly follow-ups for 12 years. Lifetime and current psychiatric disorders were assessed, and self-reported questionnaires were administered. Model evaluation used 10-fold cross-validation, which split the entire data set into 10 equal parts, fit the model to 90% of the data (training set), and assessed it on the remaining 10% (test set) and repeated that process 10 times. Preliminary analyses were performed from July 20, 2015, to October 5, 2016. Additional analyses were conducted from July 26, 2017, to July 24, 2018. Main Outcomes and Measures The broad definition of Suicide Attempt included actual, interrupted, and aborted Attempts as well as suicidal ideation that prompted emergency referrals during the study. The narrow definition referred to actual Attempt only. Results The sample of offspring (n = 663) was almost equally distributed by sex (316 female [47.7%]) and had a mean (SD) age of 23.8 (8.5) years at the time of censored observations. Among the 663 offspring, 71 (10.7%) had Suicide Attempts over the course of the study. The trajectory of depression symptoms with the highest mean scores and variability over time was the only trajectory to predict Suicide Attempt (odds ratio [OR], 4.72; 95% CI, 1.47-15.21;P = .01). In addition, we identified the following predictors: younger age (OR, 0.82; 95% CI, 0.74-0.90;P Conclusions and Relevance The specific predictors of Suicide Attempt identified are those that clinicians already assess during routine psychiatric evaluations; monitoring and treating depression symptoms to reduce their severity and fluctuation may attenuate the risk for suicidal behavior.
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Childhood maltreatment and risk of Suicide Attempt: a nationally representative study.
The Journal of clinical psychiatry, 2015Co-Authors: Nicolas Hoertel, Melanie M. Wall, Silvia Franco, Maria A. Oquendo, Shuai Wang, Frédéric Limosin, Carlos BlancoAbstract:BACKGROUND: Previous research suggests that various types of childhood maltreatment frequently co-occur and confer risk for Attempting Suicide. However, it is unknown whether the effect of childhood maltreatment on this risk occurs through diverse, specific mechanisms or through a generalized liability, independently of psychopathology. Although these competing explanations have different implications for intervention, they have never been evaluated empirically. METHOD: Structural equation modeling was used to examine the effect of different types of childhood maltreatment (ie, sexual abuse, physical and emotional abuse and neglect) on Suicide Attempt risk, and on age at first Suicide Attempt and repeated Suicide Attempts among Attempters. Analyses controlled for demographic characteristics and DSM-IV Axis I and Axis II disorders. Data were drawn from a nationally representative survey of US adults, the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions (N = 34,653). RESULTS: Childhood maltreatment was associated with an increased risk for Attempting Suicide and an earlier age at first Suicide Attempt among Attempters, independently of psychopathology (P .05). CONCLUSIONS: The association between childhood maltreatment and Suicide Attempt operates mainly through a single broad liability, suggesting that the mechanisms underlying this dimension should be considered as an important therapeutic target for Suicide prevention. Language: en
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mental disorders and risk of Suicide Attempt a national prospective study
Molecular Psychiatry, 2015Co-Authors: Nicolas Hoertel, Melanie M. Wall, Silvia Franco, Maria A. Oquendo, Frédéric Limosin, Bradley T Kerridge, Carlos BlancoAbstract:Most mental disorders, when examined independently, are associated with an elevated risk for Suicide Attempt. However, mental disorders often co-occur, and that co-occurrence is well explained by models where specific mental disorders are understood as manifestations of latent dimensions of psychopathology. To date, it remains unclear whether the risk of Suicide Attempt is due to specific mental disorders, to specific dimensions of psychopathology (that is, internalizing and externalizing dimensions), to a general psychopathology factor or to a combination of these explanations. In a large nationally representative prospective survey, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we used structural equation modeling to examine the shared and specific effects of Axis I and Axis II disorders on the occurrence of Suicide Attempts in the general population and among individuals with a lifetime history of suicidal ideation. Effects of mental disorders on the risk of Suicide Attempt were exerted almost exclusively through a general psychopathology factor representing the shared effect across all mental disorders. Effects of remitted psychiatric disorders on the risk of Suicide Attempt were fully mediated by current mental disorders. Similar patterns of associations were found in individuals with suicidal ideation. These results held when using different approaches to modeling psychiatric comorbidity. Our findings underscore the importance of adopting dimensional approaches to comorbidity in the study of suicidal behavior. Because mental disorders increase the risk of Suicide Attempt through a general psychopathology liability, this dimension should be considered as an important therapeutic target to substantially advance Suicide prevention.
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familial pathways to early onset Suicide Attempt a 5 6 year prospective study
JAMA Psychiatry, 2015Co-Authors: David A. Brent, Maria A. Oquendo, Nadine M Melhem, Ainsley K Burke, Boris Birmaher, Barbara Stanley, Candice Biernesser, John G Keilp, David J Kolko, Steve EllisAbstract:Importance Suicide Attempts are strong predictors of Suicide, a leading cause of adolescent mortality. Suicide Attempts are highly familial, although the mechanisms of familial transmission are not understood. Better delineation of these mechanisms could help frame potential targets for prevention. Objective To examine the mechanisms and pathways by which suicidal behavior is transmitted from parent to child. Design, Setting, and Participants In this prospective study conducted from July 15, 1997, through June 21, 2012, a total of 701 offspring aged 10 to 50 years (mean age, 17.7 years) of 334 clinically referred probands with mood disorders, 191 (57.2%) of whom had also made a Suicide Attempt, were followed up for a mean of 5.6 years. Main Outcomes and Measures The primary outcome was a Suicide Attempt. Variables were examined at baseline, intermediate time points, and the time point proximal to the Attempt. Participants were assessed by structured psychiatric assessments and self-report and by interview measures of domains hypothesized to be related to familial transmission (eg, mood disorder and impulsive aggression). Results Among the 701 offspring, 44 (6.3%) had made a Suicide Attempt before participating in the study, and 29 (4.1%) made an Attempt during study follow-up. Multivariate logistic regression revealed that proband Suicide Attempt was a predictor of offspring Suicide Attempt (odds ratio [OR], 4.79; 95% CI, 1.75-13.07), even controlling for other salient offspring variables: baseline history of mood disorder (OR, 4.20; 95% CI, 1.37-12.86), baseline history of Suicide Attempt (OR, 5.69; 95% CI, 1.94-16.74), and mood disorder at the time point before the Attempt (OR, 11.32; 95% CI, 2.29-56.00). Path analyses were consistent with these findings, revealing a direct effect of proband Attempt on offspring Suicide Attempt, a strong effect of offspring mood disorder at each time point, and impulsive aggression as a precursor of mood disorder. Conclusions and Relevance Parental history of a Suicide Attempt conveys a nearly 5-fold increased odds of Suicide Attempt in offspring at risk for mood disorder, even after adjusting for the familial transmission of mood disorder. Interventions that target mood disorder and impulsive aggression in high-risk offspring may attenuate the familial transmission of suicidal behavior.
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attachment and social adjustment relationships to Suicide Attempt and major depressive episode in a prospective study
Journal of Affective Disorders, 2010Co-Authors: Michael F Grunebaum, Maria A. Oquendo, Ainsley K Burke, Hanga Galfalvy, Lindsey Y Mortenson, John J MannAbstract:Abstract Objective To study two aspects of interpersonal function – attachment security and social adjustment – in relation to Suicide Attempt and major depressive episode (MDE) during naturalistic follow-up of up to one year after presentation with MDE. Method 136 adults who presented with a DSM-IV MDE completed the Adult Attachment Scale and the Social Adjustment Scale-Self Report at study entry. Based on follow-up interviews at three months and one year, we used survival analysis to investigate the relationship of scores on these measures with time to a Suicide Attempt and time to recurrent MDE. Results Less secure/more avoidant attachment predicted increased risk of Suicide Attempt during the 1-year follow-up (Wald χ2 = 9.14, df = 1, p = 0.003, HR = 1.16, 95% CI = 1.05 to 1.27). Poorer social adjustment predicted increased risk of recurrent MDE (Wald χ2 = 6.95, df = 1, p = 0.008, HR = 2.36, 95% CI = 1.25 to 4.46), and that in turn increased the risk of a Suicide Attempt (z = 4.19, df = 1, p Conclusions Avoidant attachment in the setting of major depressive disorder is a potential therapeutic target to prevent suicidal behavior. Enhancing social adjustment may reduce relapse in major depressive disorder and thereby reduce risk of a Suicide Attempt. Study limitations include small sample size and use of a self-report attachment scale.
John J Mann - One of the best experts on this subject based on the ideXlab platform.
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severity and variability of depression symptoms predicting Suicide Attempt in high risk individuals
JAMA Psychiatry, 2019Co-Authors: Nadine M Melhem, Maria A. Oquendo, Ainsley K Burke, Boris Birmaher, Barbara Stanley, John G Keilp, Giovanna Porta, Jamie Zelazny, Satish Iyengar, John J MannAbstract:Importance Predicting suicidal behavior continues to be among the most challenging tasks in psychiatry. Objectives To examine the trajectories of clinical predictors of Suicide Attempt (specifically, depression symptoms, hopelessness, impulsivity, aggression, impulsive aggression, and irritability) for their ability to predict Suicide Attempt and to compute a risk score for Suicide Attempts. Design, Setting, and Participants This is a longitudinal study of the offspring of parents (or probands) with mood disorders who were recruited from inpatient units at Western Psychiatric Institute and Clinic (Pittsburgh) and New York State Psychiatric Institute. Participants were recruited from July 15, 1997, to September 6, 2005, and were followed up through January 21, 2014. Probands and offspring (n = 663) were interviewed at baseline and at yearly follow-ups for 12 years. Lifetime and current psychiatric disorders were assessed, and self-reported questionnaires were administered. Model evaluation used 10-fold cross-validation, which split the entire data set into 10 equal parts, fit the model to 90% of the data (training set), and assessed it on the remaining 10% (test set) and repeated that process 10 times. Preliminary analyses were performed from July 20, 2015, to October 5, 2016. Additional analyses were conducted from July 26, 2017, to July 24, 2018. Main Outcomes and Measures The broad definition of Suicide Attempt included actual, interrupted, and aborted Attempts as well as suicidal ideation that prompted emergency referrals during the study. The narrow definition referred to actual Attempt only. Results The sample of offspring (n = 663) was almost equally distributed by sex (316 female [47.7%]) and had a mean (SD) age of 23.8 (8.5) years at the time of censored observations. Among the 663 offspring, 71 (10.7%) had Suicide Attempts over the course of the study. The trajectory of depression symptoms with the highest mean scores and variability over time was the only trajectory to predict Suicide Attempt (odds ratio [OR], 4.72; 95% CI, 1.47-15.21;P = .01). In addition, we identified the following predictors: younger age (OR, 0.82; 95% CI, 0.74-0.90;P Conclusions and Relevance The specific predictors of Suicide Attempt identified are those that clinicians already assess during routine psychiatric evaluations; monitoring and treating depression symptoms to reduce their severity and fluctuation may attenuate the risk for suicidal behavior.
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attachment and social adjustment relationships to Suicide Attempt and major depressive episode in a prospective study
Journal of Affective Disorders, 2010Co-Authors: Michael F Grunebaum, Maria A. Oquendo, Ainsley K Burke, Hanga Galfalvy, Lindsey Y Mortenson, John J MannAbstract:Abstract Objective To study two aspects of interpersonal function – attachment security and social adjustment – in relation to Suicide Attempt and major depressive episode (MDE) during naturalistic follow-up of up to one year after presentation with MDE. Method 136 adults who presented with a DSM-IV MDE completed the Adult Attachment Scale and the Social Adjustment Scale-Self Report at study entry. Based on follow-up interviews at three months and one year, we used survival analysis to investigate the relationship of scores on these measures with time to a Suicide Attempt and time to recurrent MDE. Results Less secure/more avoidant attachment predicted increased risk of Suicide Attempt during the 1-year follow-up (Wald χ2 = 9.14, df = 1, p = 0.003, HR = 1.16, 95% CI = 1.05 to 1.27). Poorer social adjustment predicted increased risk of recurrent MDE (Wald χ2 = 6.95, df = 1, p = 0.008, HR = 2.36, 95% CI = 1.25 to 4.46), and that in turn increased the risk of a Suicide Attempt (z = 4.19, df = 1, p Conclusions Avoidant attachment in the setting of major depressive disorder is a potential therapeutic target to prevent suicidal behavior. Enhancing social adjustment may reduce relapse in major depressive disorder and thereby reduce risk of a Suicide Attempt. Study limitations include small sample size and use of a self-report attachment scale.
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comparison of clinical and research assessments of diagnosis Suicide Attempt history and suicidal ideation in major depression
Journal of Affective Disorders, 2009Co-Authors: Mary E Bongiovigarcia, Ainsley K Burke, Barbara Stanley, John J Mann, Jessica Merville, Goretti M Almeida, Steven P Ellis, Kelly Posner, Maria A. OquendoAbstract:A number of studies have compared clinical diagnostic and Suicide assessments to standardized schedules to determine the level of agreement. At best there is only moderate diagnostic agreement, but most often it is fair. There are only a few reports comparing clinical assessments for suicidal behavior with standardized schedules. We present the data from 201 inpatient admissions for major depression that had both clinical diagnostic and Suicide evaluations by PGYII resident physicians under supervision from an attending psychiatrist and research evaluations using standardized schedules for diagnosis and Suicide by at least masters' level clinicians. There was moderate agreement for diagnosis and Suicide Attempt history but only fair agreement for the presence of suicidal ideation using Cohen's kappa statistic. In regards to Suicide Attempt history a cross-tabulation demonstrated that 18.7% of those patients identified by a research schedule as having a past Suicide Attempt were not identified as such by the clinicians. A cross-tabulation demonstrated that 29.7% of those patients identified by structured interview as having suicidal ideation were not identified as such by the clinician. There was a statistically significant difference in the level of agreement for Suicide Attempt history between clinical and research assessments for Attempts within a year of admission and those beyond a year. These findings suggest the importance of adding a structured diagnostic and Suicide assessment to routine clinical care to improve the reliability and validity of clinical evaluations and to inform treatment planning to benefit our patients.
Philippe Courtet - One of the best experts on this subject based on the ideXlab platform.
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a combined high cyp2d6 cyp2c19 metabolic capacity is associated with the severity of Suicide Attempt as measured by objective circumstances
Pharmacogenomics Journal, 2015Co-Authors: E Penaslledo, M E G Naranjo, Hilario Blascofontecilla, Isabelle Jaussent, Sebastien Guillaume, Philippe Courtet, A DelgadoAbstract:A combined high CYP2D6-CYP2C19 metabolic capacity is associated with the severity of Suicide Attempt as measured by objective circumstances
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A combined high CYP2D6-CYP2C19 metabolic capacity is associated with the severity of Suicide Attempt as measured by objective circumstances
Pharmacogenomics Journal, 2015Co-Authors: E. Peñas-lledó, Philippe Courtet, A Delgado, I. Jaussent, S. Guillaume, M.e. Naranjo, H. Blasco-fontecilla, A. LlerenaAbstract:This study examined, for the first time, whether a high CYP2D6-CYP2C19 metabolic capacity combination increases the likelihood of suicidal intent severity in a large study cohort. Survivors of a Suicide Attempt (n=587; 86.8% women) were genotyped for CYP2C19 (*2, *17) and CYP2D6 (*3, *4, *4xN, *5, *6, *10, wtxN) genetic variation and evaluated with the Beck Suicide Intent Scale (SIS). Patients with a high CYP2D6-CYP2C19 metabolic capacity showed an increased risk for a severe Suicide Attempt (P
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ABCB1 gene polymorphisms and violent Suicide Attempt among survivors
Journal of Psychiatric Research, 2015Co-Authors: E. Peñas-lledó, A Delgado, I. Jaussent, S. Guillaume, M.e. Naranjo, A. Llerena, Philippe CourtetAbstract:INTRODUCTION: Those Suicide Attempters that choose violent methods dramatically diminish the possibility of survival. Completed Suicide using violent means, which is common among first-time Suicide Attempters, was recently found to be more likely among T allele carriers in the three most common ABCB1 SNPs, encoding for P-gp. Thus, this study examined, for the first time, whether these ABCB1 SNPs were associated with the use of violent means among survivors of a Suicide Attempt. MATERIAL AND METHODS: Suicide Attempters (n = 578, 87.4% women; of whom 16.6% committed a violent intent) were genotyped for exonic SNPs in the ABCB1 (C1236T, G2677T/A, C3435T). The relations of the three genotypes and of the TTT haplotype with the use of a violent Suicide method were evaluated separately. The impact of confounds on these variables was controlled. RESULTS: A higher frequency (p = 0.02) of Suicide Attempters using violent methods was found among those carrying the ABCB1 haplotype (1236TT-2677TT-3435TT). Since gender and number of previous Suicide Attempts were identified as confounds, the relation was tested in the subset of women who were first-time Attempters or second- and more-time Attempters. The ABCB1 haplotype increased the risk more than three times in those women Attempting a violent Suicide for the first time (OR = 3.6; CI95%: 1.08-12.09; p = 0.04). DISCUSSION: The ABCB1 haplotype (1236TT-2677TT-3435TT) was related to the use of a violent Suicide Attempt method. Genotyping for these three ABCB1 SNPs may be helpful to detect people at risk of first Suicide intents using violent methods.
Michael T. Compton - One of the best experts on this subject based on the ideXlab platform.
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Social environment factors associated with Suicide Attempt among low-income African Americans: The protective role of family relationships and social support
Social Psychiatry and Psychiatric Epidemiology, 2005Co-Authors: Michael T. Compton, Nancy J. Thompson, Nadine J. KaslowAbstract:Background Suicide and Suicide Attempts are important public health concerns, and recent decades have witnessed a rising rate of Suicide among African Americans. A history of prior Attempts is a leading risk factor for completed Suicide. Further research is needed into the social environment risk factors for Suicide Attempt among African Americans. This study focused on two important dimensions of the social environment, family relationships and social support, as well as an important person-level risk factor—depressive symptoms. Method Data were obtained from a case-control study of 200 African American men and women aged 18–64 years, who sought services at a large, urban, public hospital. Odds ratios adjusted for significant sociodemographic differences between groups (aORs) were calculated for environment risk factors for Suicide Attempt among the cases and controls. The role of depressive symptoms was also studied. Results Lower levels of family adaptability and family cohesion increased the relative rate of Suicide Attempt in the sample. The aOR associated with the lowest quartile of family adaptability was 3.90, and the aORs associated with the first and second quartiles of family cohesion were 8.91 and 5.51, respectively. Lower levels of social embeddedness and social support increased the relative rate of Suicide Attempt in our sample. The aOR associated with the first and second quartiles of social embeddedness were 5.67 and 4.93, respectively, and the aOR associated with the lowest quartile of social support was 6.29. A mediating role of depression was discovered when depressive symptoms were entered into the logistic regression models. Conclusions Our findings indicate that social environment factors including deficits in family functioning and social support are associated strongly with Suicide Attempts among low-income African American men and women seeking treatment in a large, urban hospital. Thus, better family functioning and social supports can be considered protective factors in this population. The presence of depressive symptoms, a well-known risk factor for Suicide Attempts and Suicide, appears to mediate the association between social environment factors and Suicide Attempt.
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social environment factors associated with Suicide Attempt among low income african americans the protective role of family relationships and social support
Social Psychiatry and Psychiatric Epidemiology, 2005Co-Authors: Michael T. Compton, Nancy J. Thompson, Nadine J. KaslowAbstract:Suicide and Suicide Attempts are important public health concerns, and recent decades have witnessed a rising rate of Suicide among African Americans. A history of prior Attempts is a leading risk factor for completed Suicide. Further research is needed into the social environment risk factors for Suicide Attempt among African Americans. This study focused on two important dimensions of the social environment, family relationships and social support, as well as an important person-level risk factor—depressive symptoms. Data were obtained from a case-control study of 200 African American men and women aged 18–64 years, who sought services at a large, urban, public hospital. Odds ratios adjusted for significant sociodemographic differences between groups (aORs) were calculated for environment risk factors for Suicide Attempt among the cases and controls. The role of depressive symptoms was also studied. Lower levels of family adaptability and family cohesion increased the relative rate of Suicide Attempt in the sample. The aOR associated with the lowest quartile of family adaptability was 3.90, and the aORs associated with the first and second quartiles of family cohesion were 8.91 and 5.51, respectively. Lower levels of social embeddedness and social support increased the relative rate of Suicide Attempt in our sample. The aOR associated with the first and second quartiles of social embeddedness were 5.67 and 4.93, respectively, and the aOR associated with the lowest quartile of social support was 6.29. A mediating role of depression was discovered when depressive symptoms were entered into the logistic regression models. Our findings indicate that social environment factors including deficits in family functioning and social support are associated strongly with Suicide Attempts among low-income African American men and women seeking treatment in a large, urban hospital. Thus, better family functioning and social supports can be considered protective factors in this population. The presence of depressive symptoms, a well-known risk factor for Suicide Attempts and Suicide, appears to mediate the association between social environment factors and Suicide Attempt.
Nadine J. Kaslow - One of the best experts on this subject based on the ideXlab platform.
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Social environment factors associated with Suicide Attempt among low-income African Americans: The protective role of family relationships and social support
Social Psychiatry and Psychiatric Epidemiology, 2005Co-Authors: Michael T. Compton, Nancy J. Thompson, Nadine J. KaslowAbstract:Background Suicide and Suicide Attempts are important public health concerns, and recent decades have witnessed a rising rate of Suicide among African Americans. A history of prior Attempts is a leading risk factor for completed Suicide. Further research is needed into the social environment risk factors for Suicide Attempt among African Americans. This study focused on two important dimensions of the social environment, family relationships and social support, as well as an important person-level risk factor—depressive symptoms. Method Data were obtained from a case-control study of 200 African American men and women aged 18–64 years, who sought services at a large, urban, public hospital. Odds ratios adjusted for significant sociodemographic differences between groups (aORs) were calculated for environment risk factors for Suicide Attempt among the cases and controls. The role of depressive symptoms was also studied. Results Lower levels of family adaptability and family cohesion increased the relative rate of Suicide Attempt in the sample. The aOR associated with the lowest quartile of family adaptability was 3.90, and the aORs associated with the first and second quartiles of family cohesion were 8.91 and 5.51, respectively. Lower levels of social embeddedness and social support increased the relative rate of Suicide Attempt in our sample. The aOR associated with the first and second quartiles of social embeddedness were 5.67 and 4.93, respectively, and the aOR associated with the lowest quartile of social support was 6.29. A mediating role of depression was discovered when depressive symptoms were entered into the logistic regression models. Conclusions Our findings indicate that social environment factors including deficits in family functioning and social support are associated strongly with Suicide Attempts among low-income African American men and women seeking treatment in a large, urban hospital. Thus, better family functioning and social supports can be considered protective factors in this population. The presence of depressive symptoms, a well-known risk factor for Suicide Attempts and Suicide, appears to mediate the association between social environment factors and Suicide Attempt.
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social environment factors associated with Suicide Attempt among low income african americans the protective role of family relationships and social support
Social Psychiatry and Psychiatric Epidemiology, 2005Co-Authors: Michael T. Compton, Nancy J. Thompson, Nadine J. KaslowAbstract:Suicide and Suicide Attempts are important public health concerns, and recent decades have witnessed a rising rate of Suicide among African Americans. A history of prior Attempts is a leading risk factor for completed Suicide. Further research is needed into the social environment risk factors for Suicide Attempt among African Americans. This study focused on two important dimensions of the social environment, family relationships and social support, as well as an important person-level risk factor—depressive symptoms. Data were obtained from a case-control study of 200 African American men and women aged 18–64 years, who sought services at a large, urban, public hospital. Odds ratios adjusted for significant sociodemographic differences between groups (aORs) were calculated for environment risk factors for Suicide Attempt among the cases and controls. The role of depressive symptoms was also studied. Lower levels of family adaptability and family cohesion increased the relative rate of Suicide Attempt in the sample. The aOR associated with the lowest quartile of family adaptability was 3.90, and the aORs associated with the first and second quartiles of family cohesion were 8.91 and 5.51, respectively. Lower levels of social embeddedness and social support increased the relative rate of Suicide Attempt in our sample. The aOR associated with the first and second quartiles of social embeddedness were 5.67 and 4.93, respectively, and the aOR associated with the lowest quartile of social support was 6.29. A mediating role of depression was discovered when depressive symptoms were entered into the logistic regression models. Our findings indicate that social environment factors including deficits in family functioning and social support are associated strongly with Suicide Attempts among low-income African American men and women seeking treatment in a large, urban hospital. Thus, better family functioning and social supports can be considered protective factors in this population. The presence of depressive symptoms, a well-known risk factor for Suicide Attempts and Suicide, appears to mediate the association between social environment factors and Suicide Attempt.
