Epidemiological Trend, Risk Factors, Prevention and Treatment Strategies of Self-directed Violent Behavior: A Critical Appraisal of Relevant Literature

Main Article Content

Naseem Akhtar Qureshi
Rashid Abdullah Alduraihem
Sarah Mohammad Aldosari
Abdulhameed Abdullah Alhabeeb

Abstract

Background: Suicide is an intentional fatal act of self-destruction and largely preventable phenomenon. Early Identification of suicide risk factors, proactive preventive steps and therapeutic interventions tend to reduce robustly its epidemiological trends including associated high mortality around the world.

Objective: This review study aimed to critically describe the identified potential risk factors underlying suicide together with a specific focus on its relevant preventive and management strategies.

Methods: A selective e-searches of Google Scholar, PubMed/MEDLINE and Science Direct of relevant English literature (2000-2019) was conducted by using keywords and Boolean operators, and following exclusion and inclusion criteria included 115 most influential articles for this critical review.

Results: Suicide is a global preventable phenomenon determined by multiple interconnected risk factors and mechanisms embedded in several levels; population (indigenous people and social media), individual (distal predisposing factors), developmental (mediating factors) and proximal (precipitating factors). Evidently suicide needs multimodal intervention approach in terms of universal, selective and indicated prevention.

Conclusion: Suicide is a global heterogeneous phenomenon and needs continuing concerted efforts of multidisciplinary health team and multi-sector stakeholders because its risk pathways and protective factors dynamically changes overtime across the world.

Keywords:
Epidemiological trend, violent behavior, suicide, self-destruction.

Article Details

How to Cite
Akhtar Qureshi, N., Abdullah Alduraihem, R., Mohammad Aldosari, S., & Abdullah Alhabeeb, A. (2020). Epidemiological Trend, Risk Factors, Prevention and Treatment Strategies of Self-directed Violent Behavior: A Critical Appraisal of Relevant Literature. Journal of Advances in Medicine and Medical Research, 32(1), 51-70. https://doi.org/10.9734/jammr/2020/v32i130350
Section
Review Article

References

Bachmann S. Epidemiology of suicide and the psychiatric perspective. International Journal Environmental Research Public Health. 2018;15(7):1425.

Sinyor M, Tse R, Pirkis J. Global trends in suicide epidemiology. Current Opinion Psychiatry.2017;30(1):1-6.

Dumitru MM, Constantin BS. The effects of the last global economic crisis on the suicide rate in Europe. European Psychiatry. 2016;33:S112-113.

Arya V, Page A, Dandona R, Vijayakumar L, Mayer P, Armstrong G. The geographic heterogeneity of suicide rates in India by religion, caste, tribe, and other backward classes. Crisis. Advanced publication; 2019.

Lempert D. The logic of cultural suicide and application to contemporary global strategies: Drawing from models in psychology and biology. Globalistics and globalization studies: Global Evolution, Historical Globalistics Globalization Studies. 2017;72.

Jin Y, Sun LH, Yang W, Cui RJ, Xu SB. The Role of BDNF in the Neuroimmune axis regulation of mood disorders. Frontiers Neurology. Advanced Publication. 2019;10.

World Health Organization. Suicide Prevention: A global imperative. Geneva: WHO; 2014.

Erlangsen A, Nordentoft M, Conwell Y, Waern M, De Leo D, Lindner R, et al. International research group on suicide among elderly. Key Considerations for Preventing Suicide in Older Adults. Crisis. 2011;32(2):106-109.

Allen J, Mohatt GV, Beehler S, Rowe HL. People awakening: Collaborative research to develop cultural strategies for prevention in community intervention. American Journal Community Psychology. 2014;54: 100-111.

Caldwell TM, Jorm AF, Dear KB. Suicide and mental health in rural, remote and metropolitan areas in Australia. Medical Journal Australia. 2004;181:S10-14.

Blosnich JR, Brown GR, Shipherd JC, Kauth M, Piegari RI, Bossarte RM. Prevalence of gender identity disorder and suicide risk among transgender veterans utilizing Veterans Health Administration care. American Journal Public Health. 2013;103(10):e27-32.

Fleischmann A, Arensman E, Berman A, Carli V, De Leo D, Hadlaczky G, et al. Overview evidence on interventions for population suicide with an eye to identifying best-supported strategies for LMICs. Global Mental Health. 2016;3:e5.

Sankaranarayanan A, Al-Amin H, Ghuloum S. Correlates of near-fatal deliberate self-harm in Qatar: A retrospective study of psychiatric admissions for suicidal behaviors. Crisis: Journal Crisis Intervention Suicide Prevention. Advance publication; 2019.

Carleton TA. Crop-damaging temperatures increase suicide rates in India. Proceedings National Academy Sciences. 2017;114(33):8746-8751.

Pirkis J, San Too L, Spittal MJ, Krysinska K, Robinson J, Cheung YT. Interventions to reduce suicides at suicide hotspots: A systematic review and meta-analysis. The Lancet Psychiatry. 2015;2(11):994-1001.

Shaughnessy MF, Johnson A. Depression and suicide: The need for awareness of signs of suicidal cognitions and lethality. Journal Advances Medicine Medical Research. 2019;1-8.

Wuebbolt J, Dick G. Effectiveness of suicide prevention programs in schools among adolescents. Undergraduate Scholarly Showcase Program (Spring); 2019.

Andersen K, Hawgood J, Klieve H, Kolves K, De Leo D. Suicide in selected occupations in Queensland: evidence from the state suicide register. Australian New Zealand Journal Psychiatry. 2010;44:243-249.

Zalsman G, Hawton K, Wasserman D, van Heeringen K, Arensman E, Sarchiapone M, et al. Suicide prevention strategies revisited: 10-year systematic review. The Lancet Psychiatry. 2016;3(7):646-59.

Breux P, Boccio DE, Brodsky BS. Creating Suicide Safety in Schools: A public health suicide prevention program in New York State. Suicidology. 2017;22(2).

Barzilay S, Apter A, Snir A, Carli V, Hoven CW, Sarchiapone M, et al. A longitudinal examination of the interpersonal theory of suicide and effects of school-based suicide prevention interventions in a multinational study of adolescents. Journal Child Psychology Psychiatry. 2019;60(10):1104-1111.

Brodsky BS, Spruch-Feiner A, Stanley B. The zero suicide model: Applying evidence-based suicide prevention practices to clinical care. Frontiers Pychiatry. 2018;9:33.

Sakashita T, Oyama H. Developing a hypothetical model for suicide progression in older adults with universal, selective, and indicated prevention strategies. Frontiers Psychiatry. 2019;10:161.

Sequeira L, Strudwick G, Bailey SM, De Luca V, Wiljer D, Strauss J. Factors influencing suicide risk assessment clinical practice: protocol for a scoping review. BMJ Open. 2019;9(2):e026566.

Maina G, Quarato F, Bramante S. Risk factors for suicide in bipolar disorder. Further Exploration Suicidal Behavior. 2019;25:149-154.

McGarry A, McDermott MP, Kieburtz K, Fung WL, McCusker E, Peng J, de Blieck EA, Cudkowicz M. Risk factors for suicidality in Huntington disease: An analysis of the 2CARE clinical trial. Neurology. 2019;92(14):e1643-51.

Pham TT, Talukder AM, Walsh NJ, Lawson AG, Jones AJ, Bishop JL, Kruse EJ. Clinical and epidemiological factors associated with suicide in colorectal cancer. Supportive Care Cancer. 2019;27 (2):617-621.

Clapham E, Bodén R, Brandt L, Jönsson EG, Bahmanyar S, Ekbom A, et al. Suicide ideation and behavior as risk factors for subsequent suicide in Schizophrenia: A nested case–control study. Suicide Life-Threatening Behavior. 2019;49(4):996-1005.

Fazel S, Wolf A, Larsson H, Mallett S, Fanshawe TR. The prediction of suicide in severe mental illness: Development and validation of a clinical prediction rule (OxMIS). Translational Psychiatry. 2019;9 (1):98.

Czyz EK, Horwitz AG, Eisenberg D, Kramer A, King CA. Self-reported barriers to professional help seeking among college students at elevated risk for suicide. Journal American College Health. 2013;61(7):398-406.

Cleary A. Help-seeking patterns and attitudes to treatment amongst men who attempted suicide. Journal Mental Health. 2017;26(3):220-224.

Schomerus G, Evans-Lacko S, Rüsch N, Mojtabai R, Angermeyer MC, Thornicroft G. Collective levels of stigma and national suicide rates in 25 European countries. Epidemiology Psychiatric Sciences. 2015; 24(2):166-171.

Leavey G, Mallon S, Rondon-Sulbaran J, Galway K, Rosato M, Hughes L. The failure of suicide prevention in primary care: Family and GP perspectives–a qualitative study. BMC Psychiatry. 2017;17 (1):369.

Malakouti SK, Nojomi M, Ahmadkhaniha HR, Hosseini M, Fallah MY, Khoshalani MM. Integration of suicide prevention program into primary health care network: a field clinical trial in Iran. Medical Journal Islamic RepublicIran. 2015;29:208.

Coppens E, Van Audenhove C, Iddi S, Arensman E, Gottlebe K, Koburger N, et al. Effectiveness of community facilitator training in improving knowledge, attitudes, and confidence in relation to depression and suicidal behavior. Results of the OSPI-Europe intervention in four European countries. Journal Affective Disorder. 2014; 165:142-150.

Robertson M. Books reconsidered: Emile Durkheim, Le Suicide. Australasian Psychiatry. 2006;14(4):365-368.
Available:https://doi.org/10.1080/j. 14401 665.2006.02305.x

Durkheim E. Suicide: A study in sociology. Routledge; 2005.

Johnson BD. Durkheim's one cause of suicide. American Sociological Review. 1965;30(6):875-886.

Hanzlick R, Hunsaker JC, Davis GJ. Guide for manner of death classification. National Association of Medical Examiners.
Available:http://www.charlydmiller.com/LIB03/2002NAMEmannerofdeath.pdf

Posner K, Oquendo MA, Gould M, Stanley B, Davies M. Columbia classification algorithm of suicide assessment (C-CASA): Classification of suicidal events in the FDA’s pediatric suicidal risk analysis of antidepressants. American Journal Psychiatry. 2007;164:1035-1043.
Available:http://cssrs.columbia.edu/

Al-Habeeb AA, Sherra KS, Al Sharqi AM, Qureshi NA. Assessment of suicidal and self-injurious behaviours among patients with depression. Eastern Mediterranean Health Journal. 2013;19(3):248-254.

Al-Sharqi AM, Sherra KS, Al-Habeeb AA, Qureshi NA. Suicidal and self-injurious behavior among patients with alcohol and drug abuse. Substance Abuse Rehabilitation. 2012;3:91-99.

Turecki G, Brent DA. Suicide and suicidal behaviour. Lancet. 2016;387(10024):1227-1239.

Goodfellow B, Kõlves K, De Leo D. Contemporary definitions of suicidal behavior: A systematic literature review. Suicide Life-Threatening Behavior. 2019; 49(2):488-504.

Crosby AE, Ortega L, Melanson C. Self-directed violence surveillance: Uniform definitions and recommended data elements, version 1.0. Atlanta (GA): Centers Disease Control and Prevention. National Center for Injury Prevention and Control; 2011.

Goldsmith SK, Pellmar TC, Kleinman AM, Bunney WE, eds. Reducing Suicide: A national imperative. Washington, DC: National Academy Press; 2002.

O’Connor RC, Nock MK. The psychology of suicidal behaviour. Lancet Psychiatry. 2014;1(1):73-85.

Hawton K, van Heeringen K. Suicide. Lancet. 2009;373(9672):1372-1381.

Suicide Rate by Country Population; 2019.
(Retrieved 2019-10-04)
Available:http://worldpopulationreview.com/countries/ suicide-rate-by-country/

World Health Organization. Practice manual for establishing and maintaining suicide attempts and self-harm surveillance systems. WHO, Geneva; 2016.
Available:http://www.who.int/mental_health/suicideprevention/attempts_surveillance_ systems/en/

King M, Smith A, Gracey M. Indigenous health part 2: The underlying causes of the health gap. Lancet. 2009;374(9683):76-85.

Borges G, Nock MK, Haro Abad JM, Hwang I, Sampson NA, Alonso J, et al. Twelve-month prevalence of and risk factors for suicide attempts in the World Health Organization World Mental Health Surveys. Journal Clinical Psychiatry. 2010; 71(12):1617-1628.

Nock MK, Green JG, Hwang I, McLaughlin KA, Sampson NA, Zaslavsky AM, et al. Prevalence, correlates and treatment of lifetime suicidal behavior among adolescents: Results from the National Co-Morbidity Survey Replication Adolescent Supplement. JAMA Psychiatry. 2013;70 (3):300-310.

Spallek J, Reeske A, Norredam M, Nielsen SS, Lehnhardt J, Razum O. Suicide among immigrants in Europe-a systematic literature review. European Journal Public Health. 2014;25(1):63-71.

Park S, Jang H. Correlations between suicide rates and the prevalence of suicide risk factors among Korean adolescents. Psychiatry Research. 2018;261:143-147.

Khan MM, Syed EU. Suicide in Asia: Epidemiology, risk factors and prevention. In R. C. O'Connor S. Platt, J. Gordon (Eds.), International Handbook of Suicide Prevention: Research, policy and practice. Wiley-Blackwell. 2011;487-506.
Available:http://dx.doi.org/10.1002/9781119998556.ch28

Brezo J, Paris J, Barker ED, et al. Natural history of suicidal behaviors in a population-based sample of young adults. Psychological Medicine. 2007;37(11): 1563-1574.

Conwell Y, Van Orden K, Caine ED. Suicide in older adults. Psychiatric Clinics North America. 2011;34(2):451-68.

McKinnon B, Gariépy G, Sentenac M, Elgar FJ. Adolescent suicidal behaviours in 32 low-and middle-income countries. Bulletin World Health Organization. 2016; 94(5):340-350F.

Eskin M, Albuhairan F, Rezaeian M, Abdel-Khalek AM, Harlak H, El-Nayal M, et al. Suicidal thoughts, attempts and motives among university students in 12 Muslim-majority countries. Psychiatric Quarterly. 2019;90(1):229-248.

Dell’ Osso B, Benatti B, Arici C, Palazzo C, Altamura AC, Hollander E, Fineberg N, Stein DJ, Nicolini H, Lanzagorta N, Marazziti D. Prevalence of suicide attempt and clinical characteristics of suicide attempters with obsessive-compulsive disorder: A report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS). CNS Spectrums. 2018;23(1):59-66.

Crestani C, Masotti V, Corradi N, Schirripa ML, Cecchiet R. Suicide in the elderly: A 37-years retrospective study. Acta Biomedica. 2019;90(1):68-76.

Kutcher S, Wei Y, Costa S, Gusmão R, Skokauskas N, Sourander A. Enhancing mental health literacy in young people. European Child Adolescents Psychiatry. 2016;25(6):567-569.

Gunnell D, Bennewith O, Hawton K, Simkin S, Kapur N. The epidemiology and prevention of suicide by hanging: A systematic review. International Journal Epidemiology. 2005;34(2):433-442.

World Health Organization. WHO Mental Health Action Plan 2013–2020. WHO: Geneva; 2013. ‏

Jollant F, Malafosse A, Docto R, Macdonald C. A pocket of very high suicide rates in a non-violent, egalitarian and cooperative population of South-East Asia. Psychological Medicine. 2014:1-7.

Fountoulakis KN, Kawohl W, Theodorakis PN, et al. Relationship of suicide rates to economic variables in Europe: 2000–2011. British Journal Psychiatry. 2014;205(6): 486-496.

Reeves A, McKee M, Stuckler D. Economic suicides in the great recession in Europe and North America. British Journal Psychiatry. 2014;205(3):246-247.

Gould MS. Suicide and the media. Annals New York Academy Sciences. 2001;932 (1):200-24.

Haas AP, Eliason M, Mays VM, et al. Suicide and suicide risk in lesbian, gay, bisexual and transgender populations: Review and recommendations. Journal Homosexuality. 2011;58(1):10-51.

Pedersen MG, Mortensen PB, Norgaard-Pedersen B, Postolache TT. Toxoplasma gondii infection and self-directed violence in mothers. Arch General Psychiatry. 2012; 69(11):1123-1130.

Flegr J. How and why Toxoplasma makes us crazy. Trends Parasitology. 2013;29 (4):156-63.

Seguin M, Beauchamp G, Robert M, DiMambro M, Turecki G. Developmental model of suicide trajectories. British Journal Psychiatry. 2014;205(2):120-126.

Brent DA, Melhem NM, Oquendo M, et al. Familial pathways to early-onset suicide attempt: A 5.6-year prospective study. JAMA Psychiatry. 2015;72(2):160-168.

Lee FS, Heimer H, Giedd JN, et al. Mental health. adolescent mental health-opportunity and obligation. Science. 2014; 346(6209):547–549.

King CA, Grupp‐Phelan J, Brent D, Dean JM, Webb M, Bridge JA, Spirito A, Chernick LS, Mahabee‐Gittens EM, Mistry RD, Rea M. Predicting 3‐month risk for adolescent suicide attempts among pediatric emergency department patients. Journal of Child Psychology and Psychiatry. 2019;21.

Teen Suicide: Understanding the Risk and Getting Help.
Available:newsinhealth.nih.gov/2019/09

Harkavy-Friedman J. Suicide risk, assessment and intervention in early psychosis. Intervening Early in Psychosis: A Team Approach. 2019;335.

Walker RL, Talavera DC, Nomamiukor F, Madubata IJ, Alfano C, Vujanovic AA. Sleep-related problems and suicide behavior and ideation among Black and White trauma-exposed psychiatric inpatients. Comprehensive Psychiatry. 2019;91:22-28.

Dilillo D, Mauri S, Mantegazza C, Fabiano V, Mameli C, Zuccotti GV. Suicide in pediatrics: epidemiology, risk factors, warning signs and the role of the pediatrician in detecting them. Italian Journal Pediatrics. 2015;41(1):49.

Kjølseth I, Ekeberg Ø, Steihaug S. Why do they become vulnerable when faced with the challenges of old age? Elderly people who committed suicide, described by those who knew them. International Psychogeriatrics. 2009;21(5):903-912. ‏‏

Sarfraz A, Castle D. A Muslim suicide. Australasian Psychiatry. 2002;10:49.

Sabry WM, Vohra A. Role of Islam in the management of Psychiatric disorders. Indian Journal Psychiatry. 2013;55(Suppl 2):S205-214.

The Holy Quran; Surah An-Nisa, verses. 4:29.

Sahih al-Bukhari. 2:23:446.

Rezaeian M. Suicide among young Middle Eastern Muslim females. Crisis. 2010;31: 36-42.

Malakouti SK, Davoudi F, Khalid S, Asl MA, Khan MM, Alirezaei N, Mirabzadeh A, De Leo D. The epidemiology of suicide behaviors among the countries of the Eastern Mediterranean Region of WHO: A Systematic Review. Acta Medica Iranica. 2015;53(5):257-265.

Larsen ME, Nicholas J, Christensen H. A systematic assessment of smartphone tools for suicide prevention. PloS One. 2016;11(4):e0152285.

Robinson J, Cox G, Bailey E, Hetrick S, Rodrigues M, Fisher S, Herrman H. Social media and suicide prevention: A systematic review. Early Intervention Psychiatry. 2016;10(2):103-21.

Weinberg I, Ronningstam E, Goldblatt MJ, Schechter M, Wheelis J, Maltsberger JT. Strategies in treatment of suicidality: Identification of common and treatment-specific interventions in empirically supported treatment manuals. Journal Clinical Psychiatry. 2010;71(6):699-706.

Rabon JK, Hirsch JK, Chang EC. Positive psychology and suicide prevention: An introduction and overview of the literature. In: A Positive Psychological Approach to Suicide. Springer, Cham. 2018;1-15.

Stoffers JM, Vollm BA, Rucker G, Timmer A, Huband N, Lieb K. Psychological therapies for people with borderline personality disorder. Cochrane Database Systematic Review. 2012;8:CD005652.

Tarrier N, Taylor K, Gooding P. Cognitive-behavioral interventions to reduce suicide behavior: A systematic review and meta-analysis. Behavior Modification. 2008;32 (1):77-108.

Rudd MD, Bryan CJ, Wertenberger EG, Peterson AL, Young-McCaughan S, Mintz J, et al. Brief cognitive-behavioral therapy effects on post-treatment suicide attempts in a military sample: Results of a randomized clinical trial with 2-year follow-up. American Journal Psychiatry. 2015; 172(5):441-449.

Ougrin D, Tranah T, Stahl D, Moran P, Asarnow JR. Therapeutic interventions for suicide attempts and self-harm in adolescents: Systematic review and meta-analysis. Journal American Academy Child Adolescent Psychiatry. 2015;54(2):97–107.e2.

Harris F, Maxwell M, O’ Connor R, Coyne C, Arensman E, Coffey C, et al. Exploring synergistic interactions and catalysts in complex interventions: longitudinal, mixed methods case studies of an optimized multi-level suicide prevention intervention in four European countries (Ospi-Europe). BMC Public Health. 2016;16:268.

Perry Y, Werner-Seidler A, Calear AL, Christensen H. Web-based and mobile suicide prevention interventions for young people: A systematic review. Journal Canadian Academy Child Adolescent Psychiatry. 2016;25(2):73.

Preventing suicide: A community engagement toolkit. Geneva: World Health Organization; Licence: CC BY-NC-SA 3.0 IGO; 2018.

Kral M, Wiebe P, Nisbet K, Dallas C, Okalik L, Enuaraq N, et al. Canadian Inuit community engagement in suicide prevention. International Journal Circumpolar Health. 2009;68(3):292-308.

Gibbons RD, Brown CH, Hur K, Davis J, Mann JJ. Suicidal thoughts and behavior with antidepressant treatment: Reanalysis of the randomized placebo-controlled studies of fluoxetine and venlafaxine. Archives General Psychiatry. 2012;69(6): 580–587.

Vitiello B, Emslie G, Clarke G, Wagner KD, Asarnow JR, Keller M, et al. Long-term outcome of adolescent depression initially resistant to selective serotonin reuptake inhibitor treatment: A follow-up study of the TORDIA sample. Journal Clinical Psychiatry. 2011;72(3):388-396.

Grunebaum MF, Ellis SP, Duan N, Burke AK, Oquendo MA, John Mann J. Pilot randomized clinical trial of an SSRI vs bupropion: Effects on suicidal behavior, ideation, and mood in major depression. Neuropsychopharmacology. 2012;37(3): 697-706.

Stone M, Laughren T, Jones ML, et al. Risk of suicidality in clinical trials of antidepressants in adults: Analysis of proprietary data submitted to US Food and Drug Administration. British Medical Journal. 2009;339:b2880.

Libby AM, Orton HD, Valuck RJ. Persisting decline in depression treatment after FDA warnings. Archives General Psychiatry. 2009;66(6):633-639.

Lu CY, Zhang F, Lakoma MD, Madden J M, Rusinak D, Penfold RB, et al. Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: Quasi-experimental study. BMJ. 2014;348:g3596.

Ludwig J, Marcotte DE, Norberg K. Anti-depressants and suicide. Journal Health Economy. 2009;28(3):659-676.

Baldessarini RJ, Tondo L, Davis P, Pompili M, Goodwin FK, Hennen J. Decreased risk of suicides and attempts during long-term lithium treatment: A meta-analytic review. Bipolar Disorders. 2006;8(5p2):625-639.

Vita A, De Peri L, Sacchetti E. Lithium in drinking water and suicide prevention: A review of the evidence. International Clinical Psychopharmacology. 2015;30 (1):1-5.

Sondergard L, Lopez AG, Andersen PK, Kessing LV. Mood-stabilizing pharmacological treatment in bipolar disorders and risk of suicide. Bipolar Disorder. 2008;10(1):87-94.

Goodwin FK, Fireman B, Simon GE, Hunkeler EM, Lee J, Revicki D. Suicide risk in bipolar disorder during treatment with lithium and divalproex. JAMA. 2003; 290(11):1467-1473.

Cipriani A, Hawton K, Stockton S, Geddes JR. Lithium in the prevention of suicide in mood disorders: Updated systematic review and meta-analysis. BMJ. 2013;346: f3646.

O’Donnell KC, Gould TD. The behavioral actions of lithium in rodent models: Leads to develop novel therapeutics. Neuroscience Biobehavior Review. 2007; 31(6):932-962.

Meltzer HY, Alphs L, Green AI, Altamura AC, Anand R, Bertoldi A, et al. Clozapine treatment for suicidality in schizophrenia: international suicide prevention trial (InterSePT). Archives General Psychiatry. 2003;60(1):82-91.

Hennen J, Baldessarini RJ. Suicidal risk during treatment with clozapine: A meta-analysis. Schizophrenia Research. 2005; 73(2–3):139-145.

Haukka J, Tiiho Haukka J, Tiihonen J, Härkänen T, Lönnqvist J. Association between medication and risk of suicide, attempted suicide and death in nationwide cohort of suicidal patients with schizophrenia. Pharmacoepidemiology Drug Safety. 2008;17(7):686-696.

Fond G, Loundou A, Rabu C, et al. Ketamine administration in depressive disorders: A systematic review and meta-analysis. Psychopharmacology (Berl). 2014;231(18):3663–76.

Luke LG, Radu R. Low-Dose Ketamine for Depression and suicide ideation in the Emergency Department: An open-label feasibility study. EC Emergency Medicine Critical Care. 2019;3:425-431. ‏

Zhan Y, Zhang B, Zhou Y, Zheng W, Liu W, Wang C, et al. A preliminary study of anti-suicidal efficacy of repeated ketamine infusions in depression with suicidal ideation. Journal Affective Disorders. 2019; 251:205-212.

Witt K, Potts J, Hubers A, Grunebaum MF, Murrough JW, Loo C, et al. Ketamine for suicidal ideation in adults with psychiatric disorders: A systematic review and meta-analysis of treatment trials. Australian & New Zealand Journal Psychiatry. 2019; 54(1):29-45.

De Berardis D, Fornaro M, Valchera A, Cavuto M, Perna G, Di Nicola M, et al. Eradicating suicide at its roots: Preclinical bases and clinical evidence of the efficacy of ketamine in the treatment of suicidal behaviors. International Journal Molecular Sciences. 2018;19(10):2888.

Trujillo KA, Heller CY. Ketamine sensitization: Influence of dose, environment, social isolation and treatment interval. Behavioral Brain Research. 2020; 378:112271.

Bowdle AT, Radant AD, Cowley DS, Kharasch ED, Strassman RJ, Roy-Byrne PP. Psychedelic effects of ketamine in healthy volunteers relationship to steady-state plasma concentrations. Anesthesiology: Journal American Society Anesthesiologists. 1998;88(1):82-88.

Pai A, Heining M. Ketamine. Continuing education in anaesthesia. Critical Care & Pain. 2007;7(2):59-63.

Mamdani M, Gomes T, Greaves S, Manji S, Juurlink DN, Tadrous M, et al. Association between angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and suicide. JAMA network open. 2019;2(10):e1913304.

Fink M, Kellner CH, McCall WV. The role of ECT in suicide prevention. Journal ECT. 2014;30(1):5-9.

Avery D, Winokur G. Suicide, attempted suicide and relapse rates in depression. Arch General Psychiatry.1978;35(6):749-753.

Hadley D, Anderson BS, Borckardt JJ, Arana A, Li X, Nahas Z, George MS. Safety, tolerability and effectiveness of high doses of adjunctive daily left prefrontal repetitive transcranial magnetic stimulation for treatment-resistant depression in a clinical setting. Journal ECT. 2011;27(1):18-25.

Al Madni OM, Kharoshah MA, Zaki MK, Murty OP. Trends of suicide in Dammam Kingdom of Saudi Arabia. Journal Forensic Medicine Toxicology. 2010;27(2):58-62.

Madadin M, Mahmoud A, Alsowayigh K, Alfaraidy M. Suicide deaths in Dammam, Kingdom of Saudi Arabia: retrospective study. Egyptian Journal Forensic Sciences. 2013;3(2):39-43.

Al Madni OM, Kharoshah MA, Zaki MK, Ghaleb SS. Hanging deaths in Dammam, Kingdom of Saudi Arabia. Journal Forensic Legal Medicine. 2010;17(5):265-268.

Elfawal MA. Cultural influence on the incidence and choice of method of suicide in Saudi Arabia. American Journal Forensic Medicine Pathology. 1999;20(2): 163-168.

Issa SY, El Dossary M, Salam MA, Al Madani O, Al Mazroua MK, Alsowayigh K, et al. Suicidal deaths in depth-Eastern Province-Saudi Arabia. Egyptian Journal Forensic Sciences. 2016;6; 240-247.

Payne-James J, Busuttil A, Smock W. (editors). Shari’ah law and the judicial system. In: Forensic Medicine: Clinical and Pathological Aspects, Greenwich Medical Media Ltd., UK. 2003;3:29-37.

The Holy Quran. Surah Al-Baqarah (Cow/Heifer), verses 2:195.

Gao J, Cheng Q, Duan J, Xu Z, Bai L, Zhang Y, et al. Ambient temperature, sunlight duration, and suicide: A systematic review and meta-analysis. Science Total Environment. 2001;646: 1021-1029.

Krug BG, et al. Self-directed violence. In: World Report on Violence and Health. Geneva, World Health Organization. Geneva; 2002.