Relationship of depersonalization and suicidality in depressed patients

Suzana  Tošić Golubović; Olivera Žikić; Violeta  Slavković; Gordana Nikolić; Maja Simonović

doi:10.2298/VSP161201023T

Suzana Tošić Golubović University of Niš, Faculty of Medicine, Niš, Serbia; Clinical Centre Niš, Clinic for Mental Health Protection, Niš, Serbia
Olivera Žikić University of Niš, Faculty of Medicine, Niš, Serbia; Clinical Centre Niš, Clinic for Mental Health Protection, Niš, Serbia
Violeta Slavković Clinical Centre Niš, Clinic for Psychiatry, Niš, Serbia
Gordana Nikolić University of Niš, Faculty of Medicine, Niš, Serbia
Maja Simonović University of Niš, Faculty of Medicine, Niš, Serbia

DOI: https://doi.org/10.2298/VSP161201023T

Keywords: depression;, depersonalization;, suicide;, risk factors;, mental disorders;, behaviour;, suicide, attempted.

Abstract

Background/Aim. Depersonalization is considered to be the third leading symptom in psychiatric morbidity. The aim of this study was to investigate the correlation of depersonalization and different patterns of suicidal behaviour in patients suffering from depresssive disorder. Methods. The study included 119 depressed patients divided into two groups: the first group consisted of depressed patients with clinically manifested depersonalization according to the Cambridge Depresonalisation Scale presented score ≥ 70, and the second group consisted of the patients whithout clinically manifested depersonalization symptomatology, or, it was on the subsyndromal level. Subsequently, these two groups were compared regarding the suicidality indicators. Results. According to the Scale for Suicide Ideation of Beck, the depressed patients with depersonalization had statistically significantly higher scores regarding suicidal ideation, both active and passive, more often manifested suicidal desire, suicidal planning and overall suicidality (p < 0.000). Positive ideation, as a protective factor, was reduced in this group (p < 0.000). These patients had more previous suicide attempts (p < 0.001) and family history of suicides (p = 0.004). The depressed patients with depersonalization had 8 times more often active suicidal desire, 11 times more often passive suicidal desire and 5 times more often suicidal planning compared to patients without depersonalization. Conclusion. Suicidal potential, manifested in various patterns of suicidal behaviour among the patients suffering from depressive disorder with clinically manifested depersonalization is prominent. It is necessary to pay particular attention to depersonalization level during diagnostic and treatment procedure of the depressed patients having in mind that it may be associated with high suicidal potential.

Author Biography

Suzana Tošić Golubović, University of Niš, Faculty of Medicine, Niš, Serbia; Clinical Centre Niš, Clinic for Mental Health Protection, Niš, Serbia

docent medicinskog fakulteta u Nisu katedra za psihijatriju

References

Kutcher S, Chehil S. Suicide Risk Management: A Manual for Health Professionals. Oxford: Lundbeck Institute, Bleckwell Publishing; 2007.

Cheng AT. Mental illness and suicide. A case-control study in east Taiwan. Arch Gen Psychiatry 1995; 52(7): 594–603.

Cheng AT, Mann AH, Chan KA. Personality disorder and sui-cide. A case-control study. Br J Psychiatry 1997; 170(5): 441–6.

Cheng AT, Chen TH, Chen CC, Jenkins R. Psychosocial and psy¬chiatric risk factors for suicide: Case-control psychological autopsy study. Br J Psychiatry 2000; 177: 360–5.

Simeon D. Depersonalisation disorder: a contemporary over-view. CNS Drugs 2004; 18(6): 343–54.

Sedman G. Depersonalization in a Group of Normal Subjects. Br J Psychiatry 1966; 112(490): 907–12.

Simeon D, Gross S, Guralnik O, Stein DJ, Schmeidler J, Hollander E. Feeling unreal: 30 cases of DSM-III-R depersonalization dis¬order. Am J Psychiatry 1997; 154(8): 1107–13.

Baker D, Hunter E, Lawrence E, Medford N, Patel M, Senior C, et al. Depersonalisation disorder: clinical features of 204 cases. Br J Psychiatry 2003; 182: 428–33.

Strickland PL, Deakin JF, Percival C, Dixon J, Gater RA, Gold-berg DP. Bio-social origins of depression in the community. In-ter¬actions between social adversity, cortisol and serotonin neuro¬transmission. Br J Psychiatry 2002; 180: 168–73.

Sedman G, Reed GF. Depersonalization phenomena in obses-sional personalities and in depression. Br J Psychiatry 1963; 109: 376–9.

Noyes R, Kletti R. Depersonalization in response to life-threaten¬ing danger. Compr Psychiatry 1977; 18(4): 375–84.

Eckhardt A, Hoffmann SO. Depersonalization and self-injury. Z Psychosom Med Psychoanal 1993; 39(3): 284–306. (German)

Michal M, Wiltink J, Till Y, Wild PS, Münzel T, Blankenberg S, Beu¬tel ME. Type-D personality and depersonalization are asso-ciated with suicidal ideation in the German general population aged 35-74: results from the Gutenberg Heart Study.J Affect Disord 2010; 125(1-3): 227–33.

Shanafelt TD, Balch CM, Dyrbye L, Bechamps G, Russell T, Satele D, et al. Special report: suicidal ideation among American sur-geons. Arch Surg 2011; 146(1): 54–62.

Sierra M, Berrios GE. The Cambridge Depersonalization Scale: a new instrument for the measurement of depersonalization. Psychiatry Res 2000; 93(2): 153–64.

Beck AT, Kovacs M, Weissman A. Assessment of suicidal inten-tion: The Scale for Suicide Ideation. J Consult Clin Psychol 1979; 47(2): 343–52.

Osman A, Barrios FX, Gutierrez PM, Wrangham JJ, Kopper BA, Truelove RS, et al. The Positive and Negative Suicide Ideation (PANSI) inventory: psychometric evaluation with adolescent psychiatric inpatient samples. J Pers Assess 2002; 79(3): 512–30.

Vannoy SD, Unutzer J. Detection of suicide risk in patients with depression. WPA Bull Dep 2005; 10(3): 6–8.

Yoshimasu K, Sugahara H, Tokunaga S, Akamine M, Kondo T, Fu-ji¬sawa K, et al. Gender differences in psychiatric symptoms re-lated to suicidal ideation in Japanese patients with depression. Psychiatry Clin Neurosci 2006; 60(5): 563–9.

Zikić O, Cirić S, Mitković M. Depressive phenomenology in re-gard to depersonalization level. Psychiatr Danub 2009; 21(3): 320–6.

Beghi M, Rosenbaum JF. Risk factors for fatal and nonfatal rep-eti¬tion of suicide attempt: A critical appraisal. Curr Opin Psy-chiatry 2010; 23(4): 349–55.

Gonda X, Fountoulakis KN, Kaprinis G, Rihmer Z. Prediction and prevention of suicide in patients with unipolar depression and anxiety. Ann Gen Psychiatry 2007; 6: 23.

Qin P, Agerbo E, Mortensen PB. Suicide risk in relation to family history of completed suicide and psychiatric disorders: A nest-ed case-control study based on longitudinal registers. Lan¬cet 2002; 360(9340): 1126–30.

Mann JJ, Waternaux C, Haas GL, Malone KM. Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psy-chiatry 1999; 156(2): 181–9.