Background and Objective: Epilepsy and depression are interlinked and lead to an increased risk of suicidal ideation and suicide. Although depression is a significant risk factor for suicidal ideation in epilepsy patients, epilepsy itself is independently associated with suicidal ideation. There are various other factors related to epilepsy that further increase this risk. Methods: We conducted a study of suicidal-ideation amongst epilepsy patients in our centre. Demographic data and clinical history were obtained while suicidal ideation was determined using the Columbia Suicide Severity Rating Scale (C-SSRS). Beck’s Depression Inventory–II (BDI-II) was used to identify presence of depression. Results: We recruited 80 patients with epilepsy and an equal number of controls. Epilepsy patients were more likely to be depressed with a mean BDI-II score of 9.09 ±6.48 compared to controls who has a mean score of 5.56 ±4.56. The proportion of epilepsy patients with suicidal ideation was 33.75% vs. 5.00% in the control group (p 3 anti-epileptic drugs or prior head surgery. Our findings suggest that assessment of suicidal ideation is pertinent in high-risk epilepsy patients and should be routinely carried out in the clinical setting.
INTRODUCTION: The aim of this study was to determine the association between sexual abuse, substance abuse and socio-demographic factors with suicidal ideation (SI), plans (SP) and deliberate self-harm (DSH) and propose steps to prevent youth suicidal behavior.
METHODS: This was a cross-sectional study of 6786 adolescents aged 17-18 years, selected randomly from all Malaysian adolescents to undergo compulsory youth camps located in Selangor, Malaysia (2008-2009). Participants were assessed using self-administered questionnaires developed to reflect the local cultural setting. However, only 4581 subjects were analyzed after excluding incomplete data.
RESULTS: The rates of SI, SP and DSH were 7.6%, 3.2% and 6.3%, respectively. The multivariable-adjusted odds ratio showed that sexual abuse was associated with SI 1.99 (95% CI: 1.56-2.55), SP 1.57 (95% CI: 1.09-2.27) and DSH 2.26 (95% CI: 1.75-2.94); illicit drug use was associated with SI 4.05 (95% CI: 2.14-7.67), SP 2.62 (95% CI: 1.05-6.53) and DSH 2.06, (95% CI: 1.05-4.04); for alcohol use DSH was 1.34 (95% CI: 1.00-1.79). Being female was associated with all suicidal behaviors: SI 2.51 (95% CI: 1.91-3.30), SP 2.07 (95% CI: 1.39-3.08) and DSH 1.59 (95% CI: 1.19-2.11).
DISCUSSION: Given the well-founded concern of increasing risk of suicidal behavior among youth, preventive efforts should adopt a more comprehensive approach in dealing with sexual abuse and substance abuse, and their sequelae, especially in girls.
KEYWORDS: adolescent; risks; sexual abuse; substance abuse; suicidal behavior
Suicide studies in Malaysia tend to be repetitive. Data from hospital studies, small scale community surveys and national epidemiological studies over nearly 50 years have consistently shown that there are real ethnic differences in terms of suicides and attempted suicides in this country, though some of these differences appear to be narrowing somewhat. Malays have shown significantly lower rates of suicidal ideas, attempts and completed suicides. Indians, on the other hand, figure prominently at the other end with high rates in all the above parameters. The reasons for these are also necessarily complex. Experience elsewhere from studies of the Indian diaspora have elucidated a number of explanations, which include the effects of poverty, acculturation, alcoholism, the lack of a strong religious protective factor as well as increased rates of mental ill-health. Efforts to contain this public health problem have been somewhat patchy. This has largely depended on efforts by non-government organizations such as the Befrienders whereas the public response
lags behind in providing the financial and other resources necessary for a comprehensive national program. This paper reviews the relevant literature and suggest new areas for research as well as steps to provide a fresh impetus to suicide prevention in Malaysia.
Standard psychiatric criteria for depression developed in the United States and United Kingdom are increasingly used worldwide to establish the prevalence of clinical disorders and to help develop services. However, these approaches are rarely sensitive to local and cultural expressions of symptoms or beliefs about treatment. Mismatch between diagnostic criteria and local understanding may result in underreporting of depression and underutilization of services. Little such research has been conducted in Malaysia, despite the acknowledged high rate of depression and low access to services. This study examines depression in Moslem Malay women living in Johor Bahru, Southern Peninsular Malaysia, to explore depression symptoms using the Structured Clinical Interview for DSM-IV. The 61 women interviewed were selected on the basis of high General Health Questionnaire scores from a large questionnaire survey of 1,002 mothers. The illustrative analysis looks at descriptions of depressed mood, self-depreciation and suicidal ideation, as well as attitudes toward service use. The women gave full and open descriptions of their emotional symptoms, easily recognizable by standard symptom categories, although somatic symptoms were commonly included, and the spiritual context to understanding depression was also prevalent. However, few women had knowledge about treatment or sought medical services, although some sought help from local spiritual healers. Attending to such views of depression can help develop services in Malaysia.
Self-injury is a significant predictor of future self-harm and suicide, and is associated with significant psychological morbidity. However, despite an
apparent increase in prevalence, very little research on this behaviour has been conducted within Malaysia. This paper reviews the definitional issues
pertinent to the study of self-injury including the need to adopt a consistent nomenclature for the behaviour, separate self-injury which occurs with and
without suicidal intent, and to address role of culture in defining self-injurious behaviour. A review and critique of research exploring the prevalence, function, aetiology, and correlates of self-injury across both clinical and community samples is provided. Finally, in light of the current international knowledge regarding self-injurious behaviour, recommendations to guide future research in Malaysia are proposed.
Objective: The smoking rate among patients with mental health problem is higher than in the general population. Effective pharmacotherapy to treat nicotine addiction is thus needed to reduce the morbidity and mortality associated with cigarette smoking among these patients. This article reviews the literature on the suitability of varenicline for smokers with mental health problems.
Methods: A search of the literature was conducted using PubMed from year 2001 to July 2009 using key words varenicline alone and varenicline and mental health. Articles chosen were narrowed to those published in English. The type of articles chosen included clinical trials, metaanalyses, case reports, and review articles.
Results: The search produced a total of 322 articles on varenicline and 14 articles on varenicline and mental health. Varenicline, a new drug for smoking cessation is an α4β2 partial agonist and partial antagonist at nicotinic acetylcholine receptor. As a partial agonist, varenicline relieves craving and withdrawal symptoms that occur during smoking abstinence and also reduce the rewarding effects of smoking in patients who relapse. However, at present, there is concern regarding the neuropsychiatric side effects such as aggressive behaviour, suicidal ideation, mania and depression associated with varenicline use in patients with mental health problems, but these reports did not show a causal-link or lack of link between these symptoms and varenicline.
Conclusion: Current available data support the effectiveness of varenicline to treat nicotine dependence. However its safety among smokers with mental health problems remains to be elucidated. At present, further safety assessment is needed in this patient population. Until new data is available regarding the safety of varenicline in these populations, psychiatrists and physicians prescribing this medication should be extra cautious and monitor for possible psychiatric side effects when prescribing this medication to patients with pre-existing psychiatric disorders or have vulnerability to psychoses.