Variations in Suicide Risk and Risk Factors After Hospitalization for Depression in Finland, 1996-2017

All-Cause and Cause-Specific Mortality Among Individuals With Major Depression: A Nationwide Danish Matched-Cohort Study

BACKGROUND

Mental disorders are associated with excess risk of death from unnatural and natural causes, but few studies have differentiated causes of death among patients with major depression. We examined cumulative and relative risks of all-cause and cause-specific mortality in individuals with major depression up to 50 years after diagnosis according to sex, age, and time since depression diagnosis.

METHODS

In this nationwide matched-cohort study, we included individuals diagnosed with major depression in Danish National Patient registries from 1970 through 2021 and a 1:5 matched sample of the general population (reference population). Individuals were followed for their underlying cause of death in the Danish Cause of Death Registry up to 2022, and we estimated cumulative risk and hazard ratios for all-cause and 10 specific causes of death.

RESULTS

The study included 330,577 adults diagnosed with major depression in Denmark (median age at first diagnosis, 45 years; 63.4%women) and 1,652,885 members of the matched reference population (median age, 45 years; 63.4%women). During the study period, 116,628 (35.2%) individuals with depression and 389,135 (23.5%) matches from the reference population died. Individuals with depression had considerably higher mortality risk at all time periods and ages compared to the reference population, and the increased risk was most pronounced in the first year after diagnosis. The lifetime risk of suicide was 11.2% in individuals with depression compared with 1% in the reference population, and before age 65 years, suicide was the leading cause of death in patients with depression. When compared with the reference population, individuals with depression also exhibited a higher risk of various specific natural causes of death before the age of 85 years.

CONCLUSIONS

The risk of death from suicide and medical disorders is elevated in individuals with depression, especially the first year after diagnosis. Because a large number of deaths can be attributed to depression shortly after onset, clinicians should be aware of this risk.

The Tormented Soul: Caring for Older Adults with Depression in Home Healthcare

This article explores depression in older adults, addressing types of depression, risk factors, signs and symptoms, prevention strategies, treatments, and the critical role of home care clinicians. It concludes with a discussion on the tragic issue of suicide among older adults, including its risk factors, prevention, and management.

Omega-3 polyunsaturated fatty acids in depression: insights from recent clinical trials

PURPOSE OF REVIEW

This review examines evidence from recent clinical trials on the therapeutic potential of omega-3 polyunsaturated fatty acids (PUFAs) in major depressive disorder (MDD). We focus on the effects in MDD with comorbidities, younger populations, and high-inflammation presentations.

RECENT FINDINGS

PubMed, Cochrane, and Embase databases were systematically searched for studies published between May 2022 and May 2024. The search was conducted on randomized controlled trials using omega-3 PUFAs with participants with a clinical diagnosis of depression.Higher doses of eicosapentaenoic acid (EPA) (>1 g/day) improved measures of depression, particularly in MDD with elevated inflammation markers, comorbid cardiovascular diseases, late-life onset, and children and adolescent populations. Improvements in depressive symptoms were associated with increases in omega-3 PUFA-derived anti-inflammatory and proresolving lipid mediators. As adjuvant treatments, omega-3 PUFAs have potential benefits in mood, cognitive and metabolic functions, kynurenine and serotonin pathways, and alterations in corticolimbic functional connectivity.

SUMMARY

While evidence suggests promise, particularly for high-dose EPA and in inflammatory MDD subtypes, more research is needed to establish optimal dosing regimens, treatment duration, and patient subgroups most likely to benefit. Future studies should focus on sex differences, long-term effects, and potential synergies with other treatments.

Ketamine treatment in youth for fast reduction of suicidality and engagement in psychotherapy: A randomized placebo-controlled trial protocol

BACKGROUND

Suicide is a leading cause of death in young persons. While ketamine has demonstrated rapid anti-suicidal effects, its safety and efficacy in youth has not been fully investigated. The Collaborative Assessment and Management of Suicidality (CAMS), a suicide-focused treatment shown to decrease suicidal ideation and symptom distress, has never been studied in combination with ketamine.

OBJECTIVES

This study investigates whether ketamine infusion, as compared to placebo, rapidly reduces severe suicidality in youth and young adults and enhances effectiveness of CAMS to decrease suicidality after acute treatment and at 3-month follow-up. We explore whether participants who receive ketamine, as compared to placebo, have decreased suicidality, suicide attempts, emergency department visits for suicidality, and psychiatric readmissions over 3-month follow-up.

METHODS

This randomized controlled trial is enrolling 140 participants (ages 14-30) hospitalized with severe suicidal ideation or after attempted suicide. While hospitalized, participants are randomized to receive up to 6 treatments of either ketamine or placebo. Concurrently, participants engage in CAMS sessions, starting while inpatient and continuing post-discharge for up to 12 sessions via telehealth or until resolution of suicidality criteria are met. Monthly follow-up assessments are conducted for 3 months.

DISCUSSION

Historically, hospital admissions have not decreased suicidal behavior following discharge. We hypothesize that ketamine, as compared to placebo, will lead to rapid improvement in suicidality and enhance engagement in CAMS, requiring significantly fewer sessions to resolve high-risk suicidality after discharge. We hypothesize that the ketamine group will have decreased suicidality, suicide attempts, and readmissions compared to the placebo group over 3-month follow-up.

Rural-urban and age differences in association between depression and suicidal attempt: a large retrospective clinical sample study in China

OBJECTIVES

To assess the association between depression and suicide attempt (SA) by age and region.

DESIGN

Cross-sectional study.

SETTING

First Affiliated Hospital of Wannan Medical College from January 2021 to January 2022.

PARTICIPANTS

Hospitalised patients.

PRIMARY OUTCOME MEASURES

SA was the primary outcome and data on SA was obtained from the electronic medical records of hospitalised patients.

METHODS AND ANALYSIS

In this study, data on inpatients of the First Affiliated Hospital of Wannan Medical College from January 2021 to January 2022 were extracted from the medical record system using the convenience sampling method. According to the exclusion criteria, 7593 eligible research subjects were obtained. Logistic regression analysis was used to assess the association between depression and SA, combining age and region. Subgroup analyses were carried out to assess the relationship between age, region and SA in depressed patients, after excluding non-depressed patients, and to inspect the interaction of age and region. Finally, further comparisons of the disparities in suicide patterns among different age groups and regional groups were made.

RESULTS

Among 7593 patients (3630 males), 655 (8.6%) patients with SA were observed. We found that depression was significantly associated with SA by age and region (all p<0.05). Specifically, depressed juveniles and adults had a higher risk of SA compared with non-depressed adults, and ORs (95% CIs) were 2.62 (1.59 to 4.30) and 1.67 (1.30 to 2.13), respectively. Furthermore, rural individuals with depression, urban individuals without depression and urban individuals with depression had a higher risk of SA compared with rural participants without depression, and ORs (95% CIs) were 1.60 (1.22 to 2.12), 1.29 (1.04 to 1.61) and 2.53 (1.83 to 3.49), respectively. In subgroup analyses, we further found that depression was strongly associated with SA in juveniles (OR 2.84, 95% CI 1.19 to 6.76, p=0.018) and urban patients (OR 1.67, 95% CI 1.15 to 2.40, p=0.006). Notably, the predominant methods of suicide among individuals with depression were the utilisation of sleeping pills or antidepressants.

CONCLUSION

Our study found individuals with depression are at higher risk of SA, especially juveniles and urban individuals. Effective integration of mental health and urban-rural services could mitigate the risk of suicide and contribute to better outcomes.

Risk Factors for Suicide in Pakistan: A Mixed Methods Study of Psychological Autopsies and Perspectives of Health Professionals

BACKGROUND

Suicide is a significant but understudied public health concern in developing nations like Pakistan, where risks factors have not been investigated by mixed methods studies. Hence, we aimed to explore the risk factors for suicide based on a mixed methodology.

METHODS

This study followed a mixed methods convergent component design. A retrospective case-control psychological autopsy with a semistructured interview protocol was performed. Additionally, health professionals' opinions on the psychiatric risk factors for suicide were assessed through qualitative interviews. Data were collected between 2021 and 2022 and analyzed by SPSS (V-25) and thematic analysis (NVIVO-12 Plus).

RESULTS

Based on the mixed methods meta-inferences, suicidal ideation; depression; hopelessness; social isolation; previous history of self-harm and traumatic experiences; lack of motivation; purposelessness; feeling like a burden; substance abuse; impulsivity; anger; anxiety; psychiatric disorders such as personality disorders, bipolar disorder, schizophrenia, gaming addiction, and eating disorders; and family history of psychiatric illness were identified as risk factors for suicide.

CONCLUSION

More must be learned about the mental health components contributing to suicide and the culturally appropriate prevention methods used in Pakistan. This study reveals novel targets for suicide prevention and may aid policymaking by providing a better understanding of predictors and specific psychiatric characteristics of suicide in Pakistan.

Association of different types of milk with depression and anxiety: a prospective cohort study and Mendelian randomization analysis

Background

The relationship between different types of milk and depression and anxiety remains unclear, with limited evidence from prospective cohort studies. This study aims to evaluate this relationship using data from the UK Biobank cohort and to explore its potential causality through Mendelian randomization (MR) analysis.

Methods

Cox proportional hazards models were used to assess the association between different milk types and the risk of depression and anxiety among 357,568 UK Biobank participants free of these conditions at baseline. To further explore causality, a 2-sample MR analysis was conducted using data from the FinnGen study.

Results

During a median follow-up period of 13.5 years (interquartile range, 12.6-14.2 years), among 357,568 participants (mean [SD] age, 56.83 [8.06] years, 171,246 male individuals [47.9%]), a total of 13,065 and 13,339 participants were diagnosed with depression and anxiety, respectively. In the fully adjusted model (adjusted for sociodemographics characteristics, lifestyle behaviors and health indicators), full cream milk was related to a lower risk of anxiety (HR = 0.84, 95% CI: 0.75-0.94). Semi-skimmed milk had a lower risk of depression (HR = 0.88, 95% CI: 0.80-0.96) and anxiety (HR = 0.90, 95% CI: 0.82-0.98). No significant relationships were found between skimmed milk and depression/anxiety. Other types were related to an increased risk of depression (HR = 1.14, 95% CI: 1.02-1.28). After Bonferroni correction, the 2-sample MR analysis revealed a potential protective causal relationship between semi-skimmed milk and depression (OR = 0.83, 95% CI: 0.73-0.95, p = 0.006) and anxiety (OR = 0.71, 95% CI: 0.59-0.85, p < 0.001).

Conclusion

These findings indicate that semi-skimmed milk consumption may be linked to a lower risk of depression and anxiety, potentially highlighting its role in dietary strategies to promote mental health.

Patterns and outcomes of individuals admitted at emergency units following intentional self-harm in Northern Uganda

We retrospectively reviewed charts of 253 self-harming patients admitted to emergency units in Northern Uganda in 2021. Twenty-two (8.7%) died by suicide, especially due to organophosphate poisoning (n = 14, 63.6%). Regarding self-harm management, observed differences were noted in the type of hospital and the use of antidotes between public and private facilities. There is a need for more studies and a multisector approach to prevent and treat self-harm in Uganda.

Depressive symptoms and its relation to all-cause and cardiovascular mortality among United States adults with different diabetic status

OBJECTIVE

The relationship between diabetes, depressive symptoms, and mortality is well established. However, the effect of depressive symptoms on prediabetes and its relationship with mortality remains unclear. This study seeks to investigate the effects of depressive symptoms on mortality across different diabetic statuses.

METHODS

The study analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, with a final sample size of 36,246 participants. Mortality status and cause of death were determined by cross-referencing records with the publicly accessible National Death Index through 2019. Kaplan-Meier survival curves and Cox regression analysis were utilized to assess the relationship between depressive symptoms and mortality across different diabetic statuses from nondiabetic to prediabetic to diabetic.

RESULTS

In the non-diabetic group, no effect of depression severity on all-cause mortality or cardiovascular mortality was found in the final models. In the prediabetic group, however, the hazard ratios were increased for both mild depressive symptoms (HR = 1.349, 95% CI = 1.138-1.600) and moderate-to-severe depressive symptoms (HR = 1.651, 95% CI = 1.309-2.082). In the diabetic group, surprisingly, the risk was somewhat lower than in the pre-diabetic group (HR = 1.279, 95% CI = 1.084-1.509 for mild and HR = 1.285, 95% CI = 1.056-1.563 for moderate-to-severe depressive symptoms). Similar risk patterns were noted for cardiovascular disease (CVD) mortality, where risk of moderate-severe symptoms was even greater in the prediabetic group (HR = 1.834, 95% CI = 1.180-2.851).

CONCLUSION

In this prospective cohort study of a nationally representative sample of U.S. adults, a positive association was found between depressive symptoms and mortality across different diabetic statuses. These findings highlight the importance of evaluating depressive symptoms across the glycemic spectrum, especially among individuals with prediabetes.

Self-confidence as a mediator in the relationship between executive functioning and depression among ICU survivors: a latent variable analysis

BACKGROUND

Executive dysfunction and depression are common among ICU survivors, yet the mechanisms linking these two factors remain poorly understood. Self-confidence has been implicated as a key mediator in the relationship between cognitive impairments and mental health outcomes. This study aimed to explore the mediating role of self-confidence in the association between executive functioning and depression in ICU survivors.

METHOD

A provisional questionnaire was used in a cross-sectional study to assess quality of life in 395 adult ICU survivors, each with a minimum 72-h stay at one of three ICUs at a Swedish university hospital, six months to three years post-discharge. Responses to questions on executive function, self-confidence, and depression were analysed. Structural equation modelling and confirmatory factor analysis were employed to examine the mediating effect of self-confidence on the relationship between executive function and depression. Model fit was evaluated using established indicators. Reliability of the measures was assessed using McDonald's Omega and Cronbach's Alpha.

RESULTS

A significant positive correlation was found between depressive symptoms and both diminished self-confidence (r = 0.80, p < 0.001) and poorer executive function (r = 0.55, p < 0.001). Additionally, a correlation was observed between reduced self-confidence and compromised executive function (r = 0.62, p < 0.001). Age was negatively associated with depression, self-confidence, and executive function, while male gender was positively correlated with higher self-confidence. Mediation analysis revealed that the effect of impaired executive function on depressive symptoms was fully mediated by diminished self-confidence (B = 0.45; 95% CI 0.34-0.59). The direct effect of executive function on depression became non-significant when self-confidence was included in the model (B = 0.07, p = 0.18), suggesting complete mediation. The overall model fit was satisfactory (CFI = 0.962; RMSEA = 0.075), highlighting the robustness of the mediation pathway.

CONCLUSIONS

Self-confidence mediates the relationship between executive function and depression among ICU survivors. Interventions aimed at enhancing self-confidence could mitigate depressive symptoms in the ICU survivor population. Longitudinal studies are needed to confirm these findings and further explore the causal pathways involved. Trial registration ClinicalTrials.gov Ref# NCT02767180; Registered 28 April 2016.