Background: Information is scarce concerning the perceived needs and the amount of health-care utilization of persons with suicidal ideation (SI) compared to those without SI. Aims: To describe the needs and health care use of persons with and without SI and to investigate whether these differences are associated with the severity of the axis-I symptomatology. Method: Data were obtained from 1,699 respondents with a depressive and/or anxiety disorder who participated in the Netherlands Study of Depression and Anxiety. Persons with and without SI were distinguished. Outcome variables were perceived needs and health-care utilization. We used multivariate regression in two models: (1) adjusted only for sociodemographic variables and (2) adjusted additionally for severity of axis-I symptomatology. Results: Persons with SI had higher odds for both unmet and met needs in almost all domains and made more intensive use of mental-health care. Differences in needs and health-care utilization of persons with and without SI were strongly associated with severity of axis I symptomatology. Conclusions: Our results validate previous findings about perceived needs and health-care use of persons with SI. The results also suggest that suicidal persons are more seriously ill, and that they need more professional care, dedication, and specialized expertise than anxious and depressed persons without SI, especially in the domains of information and referral.
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Psychiatrisch verpleegkundigen hebben in hun werk regelmatig te maken met mensen die ernstig lijden. Voor een aantal van deze mensen is dit lijden dusdanig ondraaglijk dat zij overwegen om hun leven te beëindigen, een aantal mensen doet dit ook daadwerkelijk. Gemiddeld plegen in Nederland 1600 mensen per jaar suïcide (CBS). Het aantal mensen dat een suïcidepoging doet is rond 94.000 per jaar en 410.000 mensen in de Nederlandse bevolking hebben weleens suïcidegedachten (Ten Have et al. 2006). Hoewel suïcide niet voorbehouden is aan mensen met een psychiatrische diagnose, blijkt uit onderzoek dat bij 47% tot 74% van alle mensen de suïcide is toe te schrijven aan psychiatrische problematiek (Cavanagh et al. 2003). Het uitvragen en bespreken van suïcidaal gedrag is een belangrijk aandachtspunt in elke psychiatrische behandeling. In aansluiting op de internationale term 'suicidal behavior' wordt suïcidaal gedrag gedefinieerd als het geheel aan gedachten, voorbereidingshandelingen en pogingen die een zekere intentie uitdrukken om zichzelf te doden (Hemert et al. 2012). Verpleegkundigen hebben een belangrijke functie in het signaleren, monitoren en behandelen van suïcidaal gedrag.
Let op het is Open Access maar met speciale Elsevier user rights, zie https://www.elsevier.com/about/policies/open-access-licenses/elsevier-user-license Background The presence of a comorbid borderline personality disorder (BPD) may be associated with an increase of suicidal behaviors in patients with depressive and anxiety disorders. The aim of this study is to examine the role of borderline personality traits on recurrent suicide attempts. Methods The Netherlands Study on Depression and Anxiety included 1838 respondents with lifetime depressive and/or anxiety disorders, of whom 309 reported at least one previous suicide attempt. A univariable negative binomial regression analysis was performed to examine the association between comorbid borderline personality traits and suicide attempts. Univariable and multivariable negative binomial regression analyses were performed to identify risk factors for the number of recurrent suicide attempts in four clusters (type and severity of axis-I disorders, BPD traits, determinants of suicide attempts and socio-demographics). Results In the total sample the suicide attempt rate ratio increased with 33% for every unit increase in BPD traits. A lifetime diagnosis of dysthymia and comorbid BPD traits, especially the symptoms anger and fights, were independently and significantly associated with recurrent suicide attempts in the final model (n=309). Limitations The screening of personality disorders was added to the NESDA assessments at the 4-year follow-up for the first time. Therefore we were not able to examine the influence of comorbid BPD traits on suicide attempts over time. Conclusions Persons with a lifetime diagnosis of dysthymia combined with borderline personality traits especially difficulties in coping with anger seemed to be at high risk for recurrent suicide attempts. For clinical practice, it is recommended to screen for comorbid borderline personality traits and to strengthen the patient's coping skills with regard to anger.
