Sociodemographic Antecedent Validators of Suicidal Behavior: A Review of Recent Literature

Suicide and dementia: A systematic review and meta-analysis of prevalence and risk factors

Dementia is a global health concern with increasing numbers of people living long enough to develop dementia. People with dementia (PwD) may be particularly vulnerable to suicidality. However, suicide in PwD has not been thoroughly explored. The objective of this review was to determine the prevalence and risk factors of suicide in PwD. Five databases were searched from inception to July 2023. Peer-reviewed publications reporting prevalence, risk factors or quantitative summary data for suicide outcomes in PwD were included. Random effects models were used to calculate the pooled prevalence and effect sizes. 54 studies met inclusion criteria. In PwD, the point prevalence of suicidal ideation was 10 % (95 %CI=6 %;16 %), 2-year period prevalence of suicide attempts was 0.8 % (95 %CI=0.3 %;2 %), 10-year period prevalence of suicide attempts was 8.7 % (95 %CI=6.0 %%;12.7 %) and the incidence of death by suicide 0.1 % (95 %CI=0.1 %;0.2 %). Compared to not having dementia, a diagnosis of dementia increased risk of suicidal ideation (OR=1.62[95 %CI=1.17;2.24]) but not risk of suicide attempt (OR=1.77 [95 %CI=0.85;3.69]) or death by suicide (OR=1.30 [95 %CI=0.81;2.10]). People with moderate dementia had significantly increased risk of suicidal ideation than those with mild dementia (OR=1.59[95 %CI=1.11;2.28]), younger PwD were at increased risk of dying by suicide (OR=2.82[95 %CI=2.16;3.68]) and men with dementia were more likely to attempt (OR=1.28[95 %CI=1.25;1.31]) and die by suicide (OR=2.88[95 %CI=1.54;5.39]) than women with dementia. This review emphasises the need for mental health support and suicide prevention in dementia care, emphasising tailored approaches based on age, symptoms, and being male.

Older adults coping with critical life events - results of the revised demoralization scale in a representative sample of older adulthood

Background

High suicide rates in older adults are a relevant public health concern. Social isolation or widowhood as well as physical decline play a crucial role for suicidality in older adulthood. Previous evidence suggested that demoralization is an important risk factor for suicide. Whether demoralization is a relevant phenomenon in older adulthood which possibly could account for high suicide rates remains unclear.

Methods

Demoralization Scale II (DS-II) scores assessed in a survey of the German general population were investigated with respect to older adults (aged ≥ 65 years). DS-II scores were compared between older (≥ 65 years) and younger (< 65 years) adulthood and between young-old (65-74y), middle-old (75-84y), and old-old (85+y) individuals. We tested the impact of sociodemographic factors on DS-II scores within older adults.

Results

The sample comprised N = 545 adults ≥ 65 years and N = 1922 adults < 65 years. DS-II scores increased in older compared to younger adults (F(1,2465) = 6.1; p = 0.013; d = 0.09) and further from young-old to old-old (Mdiff = 2.7; 95% CI 0.45, 5.46; p = 0.034). One-fourth of individuals ≥ 65 years and almost half of old-old individuals reported DS-II scores above the cut-off > 5. Living with a partner protected from demoralization in old-old individuals.

Discussion

This study provides first evidence for an increased rate of demoralization in very old adults, in particular women, which is partly related to partnership status. We suggest that demoralization is considered as a crucial entity in older adulthood which can be missed by standard psychological screenings.

Examining area- and individual-level differences in suicide ideation severity and suicide attempt among youth

Youth suicide is a pressing problem and suicide rates are not equally distributed across geographic areas or socioeconomic status (SES). Death by suicide is often preceded factors including hopelessness and suicide ideation, planning, and attempt. The current study examined area- and individual-level differences in suicide ideation severity and suicide attempt in a state-representative sample of youth from 2019 (N = 78,740) and 2021 (N = 61,396). Youth from higher SES and rural areas showed lower suicide ideation severity and odds of suicide attempt. After including individual-level covariates, SES differences in ideation severity and suicide attempt persisted for 2019 but not 2021. Rural differences for ideation severity persisted across years but not for suicide attempt. Further research on geographic variation in suicide risk is needed.

ASSIP vs. Crisis Counseling for Preventing Suicide Re-attempts: Outcome Predictor Analysis of a Randomized Clinical Trial Data

OBJECTIVE

Knowledge of the effectiveness and limits of the suitability of brief interventions in suicide prevention is greatly needed. We investigated subgroup differences and predictors for suicide re-attempts within a clinical trial population recruited for a brief intervention to prevent re-attempts.

METHODS

Consenting adult patients receiving treatment for a suicide attempt in Helsinki City general hospital emergency rooms in 2016-2017 (n = 239) were randomly allocated to (a) the Attempted Suicide Short Intervention Program (ASSIP) or (b) Crisis Counseling (CC). Participants also received their usual treatment. Information on primary outcome repeat attempts and secondary outcomes was collected via telephone and from medical and psychiatric records for 2 years. As proportions of re-attempts did not differ significantly between ASSIP and CC (29.2 vs. 35.2%), patients were pooled and predictors for suicide re-attempts were analyzed using Kaplan-Meier and logistic regression analyses.

RESULTS

Re-attempts were predicted by participants' younger age (OR 0.965 [0.933-0.998]), previous suicide attempts (OR 2.437 [1.106-5.370]), psychiatric hospitalization in the year preceding baseline (OR 3.256 [1.422-7.458]), and clinical diagnosis of a personality disorder (OR 4.244 [1.923-9.370]), especially borderline personality disorder (OR 5.922 [2.558-13.709]).

CONCLUSIONS

Within a population of suicide attempters consenting to a brief intervention trial, the risk of re-attempt was strongly predicted by subjects' young age, history of previous attempts, psychiatric hospitalizations, and personality disorder, particularly borderline personality disorder. The composition of treated populations with regard to these characteristics may strongly influence the observed success of brief interventions. Their potential as moderators of treatment effectiveness and as indicators of the utility of brief interventions warrants further investigation.HIGHLIGHTSDuring the 2-year follow-up, 32% of trial participants reattempted suicide.Rates of reattempts varied and were strongly predicted by clinical subgroup.Subgroup composition may strongly influence brief interventions' observed outcome.

Association between hearing loss and suicidal ideation: Discrepancy between pure tone audiometry and subjective hearing level

BACKGROUND

This study aimed to evaluate hearing loss by combining pure tone audiometry (PTA) with subjective hearing level concerning suicidal ideation.

METHODS

A total of 23,215 individuals from the Korea National Health and Nutrition Examination Survey (KNHANES) between 2009 and 2013 were included. PTA was categorized according to average audiometric threshold levels: normal (≤25 dB), mild (26-40 dB), and moderate-severe (>40 dB). The subjective hearing level was categorized as "no discomfort," "mild discomfort," and "considerable discomfort" for hearing without a hearing aid. Next, we classified hearing loss into nine groups by combining PTA and subjective hearing levels. Suicidal ideation was defined as answering yes to the following question: "Have you ever seriously thought about killing yourself in the past 1 year?" We conducted chi-square tests and multiple logistic regression analyses.

RESULTS

Among the 23,215 participants aged ≥19 years (mean age 46.52 years), 3,214 (13%) reported having suicidal ideation. According to PTA, moderate to severe hearing loss was related to suicidal ideation (OR = 1.19, 95 % CI = 1.01-1.41). Subjective hearing loss was associated with suicidal ideation (mild: OR = 1.41, 95 % CI = 1.21-1.65; considerable: OR = 1.57, 95 % CI = 1.20-2.05). Moreover, as the subjective hearing level increased, the ORs of suicidal ideation increased in individuals with moderate to severe hearing loss (mild: OR = 1.52, 95 % CI = 1.24-1.88; considerable: OR = 1.81, 95 % CI = 1.39-2.36).

LIMITATIONS

The cross-sectional study limits the interpretation of causal relationships.

CONCLUSIONS

Subjective hearing loss was more strongly associated with suicidal ideation than hearing loss as measured by PTA.

Implementing Suicide Risk Screening in a Virtual Addiction Clinic

The purpose of this study was to describe the feasibility of implementing suicide risk screening in a virtual addiction clinic. Suicide risk screening was implemented in a virtual addiction clinic serving individuals with substance use disorders (SUD) using a quality improvement framework. One-hundred percent (252/252) of eligible patients enrolled in the clinic were screened for suicide risk (44% female; M[SD] age = 45.0[11.0] years, range = 21-68 years). Nineteen patients (8%) screened positive for suicide risk. After screening, no patients required emergency suicide interventions (100% non-acute positive). Notably, 74% (14/19) of those who screened positive did so by endorsing at least one past suicide attempt with no recent ideation. Suicide risk screening in virtual addiction clinics yields important clinical information for high-risk SUD populations without overburdening workflow with emergency services. Given the high proportion of non-acute positive screens based on suicide attempt histories with no recent ideation, clinicians may utilize information on suicide attempt history to facilitate further mental healthcare.

Exploration of related factors of suicide ideation in hospitalized older adults

BACKGROUND

With the rapid aging of the population structure, and the suicide ideation rate also increasing year by year, the ratio of people over 65 to the total number of deaths is increasing yearly. The study provides a reference for researchers interested in older adults' care to explore SI further affecting older adults in the future and provide a reference for qualitative research methods or interventional measures.

OBJECTIVE

The objective of this study is to explore the influence of mental health status, life satisfaction, and depression status on suicidal ideation (SI) among hospitalized older adults.

METHODS

In a cross-sectional correlation study, taking inpatients over 65 years old in a regional teaching hospital in eastern Taiwan, and the BSRS-5 ≧ 5 points of the screening cases, a total of 228 older adults agree to conduct data analysis in this study. Mainly explore the influence of personal characteristics, mental health status, life satisfaction, and depressed mood on SI among the hospitalized older adults. The basic attributes of the cases used in the data, mental health status, cognitive function, quality of life, depression, and suicide ideation, the data obtained were statistically analyzed with SPSS 20/Windows, and the descriptive statistics were average, standard deviation, percentage, median, etc. In the part of inference statistics, independent sample t-test, single-factor analysis of variance, Pearson performance difference correlation, and logistic regression analysis were used to detect important predictors of SI.

RESULTS

Research results in (1) 89.5% of hospitalized older adults have a tendency to depression. 2.26.3% of the older adults had SI. (2) Here are significant differences in the scores of SI among hospitalized older adults in different economic status groups and marital status groups. (3) The age, marital status, and quality of life of the hospitalized older adults were negatively correlated with SI; economic status, self-conscious health, mental health, and depression were positively correlated with SI. (4) The results of the mental health status and SI is (r = .345, p < .001), higher the score on the BSRS-5 scale, the higher the SI. The correlation between the depression scale score (SDS-SF) and SI was (r = .150, p < .05), the higher the depression scale score, the higher the SI.

CONCLUSION

The results of the study found that there was a statistically significant correlation between SI in older adults and age, marital status, economic status, mental health, quality of life, and depression, and also showed that they might interact with each other; the older adults in BSRS-5, GDS-SF, quality of life scale scores have statistically significant differences as essential predictors of SI. The results of this study suggest that medical staff can use the BSRS-5 scale to quickly screen and evaluate the mental health status of older adults, hoping to detect early and provide preventive measures, thereby improving the quality of life of older adults.

Stigmas and childhood traumas associated with psychological help-seeking in suicide attempted individuals

PURPOSE

The aim was to investigate the possible associations of suicide attempt with childhood trauma, social support, psychological support seeking, stigmatizations. The study was case-control study and included 100 participants (50 suicide, 50 controls).

CONCLUSION

BDI, BAI scores were higher in the patient (p < 0.001). While scores of all-subscales of Childhood-Trauma-Questionnaire were higher (p < 0.05) in the patients, scores of Perceived-Social-Support were lower (p < 0.001). Repeating suicide attempts has higher Stigma-Scale-for-Receiving-Psychological-Help scores than the patients who attempted to the first time (p = 0.045).

PRACTICE IMPLICATION

Suicide is relationship with more childhood traumas, less social support. Repeating suicide attempts, individuals felt public stigma for receiving psychological help.

Association of socioeconomic status with nonsuicidal self-injury and suicidal ideation in young Korean adults

OBJECTIVE

Although nonsuicidal self-injury (NSSI) in youth is an important mental health concern worldwide, limited studies have investigated its sociodemographic correlates in early adulthood. This study explored associations between socioeconomic status (SES) and self-harm behaviors, including NSSI and suicidal ideation, in a community-based sample of young adults.

METHODS

A total of 414 Korean young adults engaged in NSSI and 200 controls completed online self-report questionnaires assessing sociodemographic and clinical characteristics, using logistic regression to estimate the odds ratio and analyzed risk factors for NSSI, especially the independent influence of SES on NSSI risk. Multivariate regression was performed to identify the role of socioeconomic disadvantage in suicidal ideation in NSSI people.

RESULTS

Logistic regression showed that low SES significantly increased NSSI risk. Multivariable regression also revealed that lower SES was related to more severe suicidal ideation in young adults with NSSI after controlling for gender and the higher-severity NSSI index, including the number of NSSI methods used and NSSI intrapersonal functions.

CONCLUSIONS

This is the first study to directly address socioeconomic gradients of a general population of young adults with NSSI and its effects, and socioeconomic status should be considered preemptively when defining suicide risks of this group and when intervening in self-injurious behaviors.

Factors associated with multiple suicide attempts in a nationally representative study of U.S. military veterans

OBJECTIVE

Veterans with a history of multiple suicide attempts are at increased risk for suicide mortality relative to those with a single attempt. However, little is known about factors that differentiate veterans who attempt suicide once compared to more than once. This study examined factors that distinguish single suicide attempters (SSA) from multiple suicide attempters (MSA) in a nationally representative sample of U.S. military veterans.

METHODS

Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a representative sample of 4069 U.S. veterans.

ANALYSES

(a) estimated the lifetime prevalence of SSA and MSA; and (b) examined factors that differentiated veterans with a SSA from MSA.

RESULTS

The lifetime prevalences of SSA and MSA were 1.9% and 2.0%. The strongest correlates of MSA were history of lifetime depression (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.43-8.35), non-suicidal self-injury (OR, 3.28; 95% CI, 1.27-8.45), drug use disorder (OR, 4.0; 95% CI, 1.67-9.54), and marital status (OR, 0.40, 95% CI, 0.18-0.87), which accounted for 15.5%-41.4% of the total explained variance in MSA.

DISCUSSION

Half of military veterans who have attempted suicide in the United States report more than one attempt, suggesting that suicide attempts are not a one-time occurrence for a substantial proportion of veterans. Veterans who attempt suicide more than once show more deliberate self-harm behavior and have greater psychiatric comorbidities relative to single attempters. Implications for future research examining risk factors for suicide attempts among veterans are discussed.

Sociological Narrative of Suicidal Behavior Among Older People

BACKGROUND

Globally, suicide is regarded as an immoral behavior and can be considered a criminal act in some societies. Sociological narrative views suicide not only as a result of mental illness suffered by the individuals but may also be caused by the social environment and other risk factors.

PURPOSE

The objective of this study is to examine the social risk factors that drive older people to have suicidal feelings or tendencies and the extent to which these factors arise from the changes that occur in their social environment as a result of the process of modernization and industrialization.

METHODS

This study employed the phenomenological approach through qualitative data collection technique. A total of 20 informants comprising 10 males and 10 females of Malay, Chinese and Indian ethnicity were selected for the study using purposive sampling technique. In-depth interviews were conducted with the informants. Data were transcribed and subsequently analyzed thematically using the NVivo 11 software.

RESULTS

The findings revealed five conditions that led older people toward suicidal intentions. These include social and cultural changes, lack of social support, conflict in religious belief, influence of economic uncertainty and socio-economic status, and depression as a result of the changes in their social environment.

CONCLUSION

The implication of this research is that these factors affect older people directly as they struggle to adapt and respond to the major changes that occur in the social structure of the society they live in, stemming from the process of modernization and industrialization. Efforts to enact better policies and services for older people need to be addressed especially in developing countries based on assessment of their needs, weaknesses, strengths, and capabilities by incorporating elements of the worldview of the older people based on their experiences of daily lives.

Living alone, loneliness and lack of emotional support as predictors of suicide and self-harm: A nine-year follow up of the UK Biobank cohort

BACKGROUND

The association between loneliness and suicide is poorly understood. We investigated how living alone, loneliness and emotional support were related to suicide and self-harm in a longitudinal design.

METHODS

Between 2006 and 2010 UK Biobank recruited and assessed in detail over 0.5 million people in middle age. Data were linked to prospective hospital admission and mortality records. Adjusted Cox regression models were used to investigate relationships between living arrangements, loneliness and emotional support, and both suicide and self-harm as outcomes.

RESULTS

For men, both living alone (Hazard Ratio (HR) 2.16, 95%CI 1.51-3.09) and living with non-partners (HR 1.80, 95%CI 1.08-3.00) were associated with death by suicide, independently of loneliness, which had a modest relationship with suicide (HR 1.43, 95%CI 0.1.01-2.03). For women, there was no evidence that living arrangements, loneliness or emotional support were associated with death by suicide. Associations between living alone and self-harm were explained by health for women, and by health, loneliness and emotional support for men. In fully adjusted models, loneliness was associated with hospital admissions for self-harm in both women (HR 1.89, 95%CI 1.57-2.28) and men (HR 1.74, 95%CI 1.40-2.16).

LIMITATIONS

Loneliness and emotional support were operationalized using single item measures.

CONCLUSIONS

For men - but not for women - living alone or living with a non-partner increased the risk of suicide, a finding not explained by subjective loneliness. Overall, loneliness may be more important as a risk factor for self-harm than for suicide. Loneliness also appears to lessen the protective associations of cohabitation.

Suicidal behaviour and cognition: A systematic review with special focus on prefrontal deficits

BACKGROUND

Suicide is a major health concern worldwide, thus, identifying risk factors would enable a more comprehensive understanding and prevention of this behaviour. Neuropsychological alterations could lead to difficulties in interpreting and managing life events resulting in a higher risk of suicide.

METHOD

A systematic literature search from 2000 to 2020 was performed in Medline (Pubmed), Web of Science, SciELO Citation Index, PsycInfo, PsycArticles and Cochrane Library databases regarding studies comparing cognition of attempters versus non-attempters that share same psychiatric diagnosis.

RESULTS

1.885 patients diagnosed with an Affective Disorder (n = 1512) and Schizophrenia/ Schizoaffective Disorder (n = 373) were included. In general comparison, attention was found to be clearly dysfunctional. Regarding diagnosis, patients with Schizophrenia and previous history of suicidal behaviour showed a poorer performance in executive function. Patients with current symptoms of an Affective Disorder and a previous history of suicidal attempt had poorer performance in attention and executive function. Similarly, euthymic affective patients with history of suicidal behaviour had worse decision-making, attention and executive function performance compared to euthymic non-attempters.

LIMITATIONS

The number of papers included in this review is limited to the few studies using non-attempter clinically-matched control group and therefore results regarding diagnosis, symptomatology and time of the attempt are modest and contradictory.

CONCLUSIONS

Patients who have attempted suicide have a poorer neuropsychological functioning than non-attempters with a similar psychiatric disorder in attention and executive function. These alterations increase vulnerability for suicide.

Estimation of the relationship between the persistent decrease of the suicide rate and the changes in sociodemographic composition in Hungary between 1990 and 2011

From the end of the 1980s, the Hungarian suicide rate, which had been until that point the highest in the world for decades, has decreased drastically. The reason behind this decrease was probably due to the changes in numerous and often interlinked risk factors. Studies on this topic have mostly ignored to interrogate to what extent the change of the population composition, for example the improvement of educational level, contributed to the decrease of the rate in the given period? Our aim was to assess the contribution of changes in some sociodemographic factors to the decrease of the suicide rate in Hungary. During the analysis, data from 1990 were compared with data from 2011. For the statistical calculations, the method of “Standardization and Decomposition (SDA)” was used, which according to our best knowledge, has not yet been applied in Hungarian suicide studies. The results show that the improvement of educational level helped to decrease the rate for men by about a third, while for women only by about a tenth. However, the benefit of the improvement in educational attainment during the period investigated was significantly offset by the changes primarily in marital status (the ratios of unmarried and divorced subjects increased for both genders) and in age distribution (the ratio of the elderly persons increased for both genders). The results of our study emphasise the inverse relationship between suicide and educational level and support the hypothesis that we can regard educational policy as indirect health policy.

Older adults on involuntary hold status in the emergency department

BACKGROUND

As the United States' population ages, the health care system will experience overall change. This study aims to identify factors in the older adult that may contribute to involuntary hold status in the ED.

METHODS

This study is a retrospective review conducted at a suburban acute-care hospital ED of adult patients evaluated while on involuntary hold from January 1, 2014, through November 30, 2015. Older adults (patients born on or before 06/31/1964) were compared to younger adults (born on or after 07/01/1964) according to demographic and clinical variables including medical comorbidity, ED length of stay, reason for involuntary hold, psychiatric disorder, suicide attempt, substance use disorder, serum alcohol level, urine drug testing, medical comorbidity, violence in the ED, 30-day ED readmission, and 30-day mortality.

RESULTS

Of 251 patients, 90 (35.9%) were older adults. The most common reason for involuntary hold in both cohorts was suicidal ideation. Medical comorbidities were more prevalent in older adults [60 (66.7%) vs. 64 (39.8%), P ≤.0001]. Older adults were less likely to report current drug abuse [31 (34.4%) vs. 77 (47.8%), P = .04]. The most commonly misused substance in both groups was alcohol; however, despite similar rates, blood alcohol levels (BAC) and urine drug screen (UDS) were performed less often in older adults. Cohorts were not significantly different with respect to sex, race, violence in the ED, psychiatric diagnosis, and ED LOS.

CONCLUSIONS

Involuntary older adult patients present with medical comorbidities that impact mental health. In the ED, they are less likely report substance use, and drug screening may be underutilized. Medical needs make their care unique and may present challenges in transfer of care to inpatient psychiatric facilities.

Ecological factors associated with suicide mortality among non-Hispanic whites

BACKGROUND

In this paper, we examine the ecological factors associated with death rates from suicide in the United States in 1999 and 2017, a period when suicide mortality increased in the United States. We focus on Non-Hispanic Whites, who experienced the largest increase in suicide mortality. We ask whether variation in suicide mortality among commuting zones can be explained by measures of the social and economic environment and access to lethal means used to kill oneself in one's area of residence.

METHODS

We use vital statistics data on deaths and Census Bureau population estimates and define area of residence as one of 704 commuting zones. We estimate separate models for men and women at ages 20-64 and 65 and above. We measure economic environment by percent of the workforce in manufacturing and the unemployment rate and social environment by marital status, educational attainment, and religious participation. We use gun sellers and opioid prescriptions as measures of access to lethal means.

RESULTS

We find that the strongest contextual predictors of higher suicide mortality are lower rates of manufacturing employment and higher rates of opiate prescriptions for all age/sex groups, increased gun accessibility for men, and religious participation for older people.

CONCLUSIONS

Socioeconomic characteristic and access to lethal means explain much of the variation in suicide mortality rates across commuting zones, but do not account for the pervasive national-level increase in suicide mortality between 1999 and 2017.

[Suicidal behavior in light of COVID-19 outbreak: Clinical challenges and treatment perspectives]

OBJECTIVE

The COVID-19 pandemic affected today more than 3,000,000 worldwide, and more than half of humanity has been placed in quarantine. The scientific community and the political authorities fear an epidemic of suicide secondary to this crisis. The aim of this review is to analyze the impact of the COVID-19 pandemic on the dimensions of the suicidal process and its interaction with the various risk factors. We also propose innovative strategies to manage suicidal behavior in the context of pandemic.

METHODS

We carried out a narrative review of international publications dealing with major pandemics (COVID-19, SARS) and their influence on suicidal vulnerability.

RESULTS

Many factors are likely to increase the emergence of suicidal ideation and suicide attempts during this crisis. Social distancing and quarantine could increase the feeling of disconnection and the perception of social pain in vulnerable individuals. Some populations at high suicidal risk could be further impacted by the current pandemic: the elderly, medical staff and individuals exposed to economic insecurity. Several innovative tools adapted to the constraints of social distancing and quarantine may prevent suicide risk: e-health, VigilanS, buddhist-derived practices and art engagement.

CONCLUSIONS

This unprecedented crisis may interact with certain dimensions of the suicidal process. However, it is time to innovate. Several suicide prevention tools all have their place in new modes of care and should be tested on a large scale.

Is suicidality a mental disorder? Applying DSM-5 guidelines for new diagnoses

Suicidality-specific diagnoses have been proposed recently, but suicidologists are only just beginning to evaluate their merits. To advance this discussion, I introduce the term suicidal syndrome to describe the underlying entity, present a rationale for why a formal diagnosis is necessary, define the major features of the syndrome, and show how the syndrome could meet the requirements for new diagnostic candidates used in the development of the DSM-5. Against this backdrop, I examine common objections to a suicidality-specific diagnosis. Finally, I discuss several challenges with the creation of new diagnostic entities as they apply to suicidal syndrome.

Assistance related to suicidal behavior at a mobile emergency service: Sociodemographic and clinical associated factors

It is important to investigate the care given to people with suicidal behavior, as it is an important predictor of future death by suicide and there is a lack of studies on this issue in Brazil. This study had the objective of investigating assistance related to suicidal behavior at a mobile emergency service and sociodemographic and clinical associated factors. This was a quantitative, cross-sectional study based on documental information. The data were collected through manual consultation of nursing records in which call-outs for suicidal behavior in the year 2014 were documented. The data were analyzed using descriptive statistics, Chi-squared test, Fisher's exact test, correlation tests, and comparison of means tests. In the 313 records analyzed there was a predominance of adult women with self-inflicted drug poisoning, attended to in their own residence and referred to pre-hospital emergency medical services. There was a lack of documentation on signs, symptoms, and grievances in most cases. The interventions most carried out by the nurses were related to monitoring of clinical parameters. There were differences related to the victim's sex and lethality, suicide attempt method, referral to emergency services, and semester of occurrence (January-June, July-December). Suicide attempts through self-poisoning or self-inflicted injuries differed in relation to time of call-out, waiting time, lethality, documentation on clinical assessment and interventions, and referral to emergency services. This study enabled the charting of factors linked with suicidal behavior and associated factors; it offers reflections on limitations and nursing care potential in the prevention of reoccurrence of suicidal behavior.

Suicidal ideation and attempts in population-based samples of women: temporal changes between 1989 and 2015

BACKGROUND

Little is known about temporal changes in the prevalence of self-reported suicidal ideation and attempts within general populations of women. The aim of this study was to assess the prevalence of self-reported suicidal ideation and attempts over a 26 year period (1989-2015) among women from the general population aged 20-49 years. A further aim was to investigate associations between sociodemographic factors and lifetime suicidal ideation over this study period.

METHODS

A total of 2072 structured personal interviews were performed with a stratified population-based sample of women between 1989 and 2015. Questions about lifetime suicidal ideation and attempts as well as sociodemographic factors were assessed at four data collection waves. Lifetime prevalence of suicidal ideation and attempts were compared through analysis of differences between two independent proportions and their 95% Confidence Intervals (CI). Associations between sociodemographic factors and lifetime suicidal ideation were estimated by weighted odds ratios (OR).

RESULTS

Women aged 20-30 years reported higher lifetime prevalence of suicidal ideation in 2013-2015 compared to 1989-1991 (45 and 33% respectively). Rates of lifetime suicide attempts remained similar between these time points (3.5 and 3.1% respectively). Women aged 31-49 years reported higher lifetime prevalence of suicidal ideation in 2013-2015 compared to 2000-2002 (35.4 and 23.1% respectively). In this age group, lifetime suicide attempts increased from 0.0% in 2000-2002 to 3.6% in 2013-2015. Women aged 20-30 years who were single, unemployed or had low educational attainment had higher OR of lifetime suicidal ideation compared to the reference categories in most of the study waves. In 2013-2015, young students had lower OR of lifetime suicidal ideation (OR 0.34; 95% CI 0.17-0.69) compared to those with employment. Women aged 31-49 years, who were single, had higher OR of lifetime suicidal ideation (OR 2.61; 95% CI 1.06-6.44) than married, cohabiting women and this was observed in 2013-2015.

CONCLUSION

The results raise a general concern about an increasing trend in suicidal ideation among young and middle-aged women. The current study expands on previous research by demonstrating that sociodemographic factors may show changing patterns in the associations with lifetime suicidal ideation over time.

A Complex Relationship Between Suicide, Dementia, and Amyloid: A Narrative Review

Background: Suicide rates are high among older adults and many conditions have been related to suicide in this population: chronic illnesses, physical disabilities, cancer, social isolation, mental disorders and neurocognitive disorders.

Objectives: Among neurocognitive disorders, analysis of the relationships between dementia and suicidal behaviors led to conflicting results and some questions are still without answer. Particularly, it is not known whether (i) Alzheimer's disease (AD) increases the risk of suicidal ideation and suicide attempts (SA) or the frequency of death by suicide; (ii) the presence of suicidal ideation or SA in people older than 65 years of age is an early dementia sign; and (iii) amyloid load in frontal areas facilitates SA by modifying the decision-making pathway.

Methods: Therefore, in this narrative review, we searched the PubMed database using the medical subject heading (MeSH) terms (“Suicide” AND “Depression”) OR (“Amyloid” OR “Dementia”) to identify recent (from 2000 to 2017) original studies on the links between suicidal behavior, dementia and brain amyloid load. We also explored the clinical and pathophysiological role of depression in these relationships.

Results and Discussion: The findings from these studies suggest that late stage dementia could protect against suicidal ideation and SA. Conversely, the risk of complete suicide is increased during the early phase of cognitive decline.

Conclusions: Serious cognitive impairment and decline of executive functions could protect against negative thoughts related to cognitive disability awareness and against suicide planning.Several factors, including brain amyloid load, could be involved in the increased suicide rate early after the diagnosis of dementia.

Suicide in older adults: current perspectives

Suicidal behavior in older adults (65 years old and over) is a major public health issue in many countries. Suicide rates increase during the life course and are as high as 48.7/100,000 among older white men in the USA. Specific health conditions and stress factors increase the complexity of the explanatory model for suicide in older adults. A PubMed literature search was performed to identify most recent and representative studies on suicide risk factors in older adults. The aim of our narrative review was to provide a critical evaluation of recent findings concerning specific risk factors for suicidal thoughts and behaviors among older people: psychiatric and neurocognitive disorders, social exclusion, bereavement, cognitive impairment, decision making and cognitive inhibition, physical illnesses, and physical and psychological pain. We also aimed to approach the problem of euthanasia or physician-assisted suicide in older adults. Our main findings emphasize the need to integrate specific stress factors, such as feelings of social disconnectedness, neurocognitive impairment or decision making, as well as chronic physical illnesses and disability in suicide models and in suicide prevention programs in older adults. Furthermore, the chronic care model should be adapted for the treatment of older people with long-term conditions in order to improve the treatment of depressive disorders and the prevention of suicidal thoughts and acts.

Behavior Characteristics and Risk Factors for Suicide Among the Elderly in Rural China

We examine the characteristics of suicide behavior and associated risk factors in the elderly in rural China, compared with the nonelderly. Paired case-control design and psychological autopsy were used for subject recruitment and data collection. The included cases were 104 suicides of the elderly aged 60 years or older, 86 suicides of the nonelderly, and sex- and age-paired controls from the same villages. Although the characteristics of suicide behavior were similar between the two age groups of victims, the elderly who died by suicide had a greater tendency to experience negative life events and not live with a spouse. Suicide of the nonelderly was associated with family history of suicide, poor social support, and impulsivity. The influence of negative life events on the risk of suicide was greater in the elderly. Thus, efforts for suicide prevention must be tailored to the needs of specific age groups.

Demographic and Clinical Characteristics of Completed Suicides in Mexico City 2014-2015

Objective: To analyze sex differences in demographic and clinical characteristics of individuals who died by suicide in Mexico City. Method: Statistical analysis of residents of Mexico City whose cause of death was suicide, during two years period from January 2014 to December 2015, with a coroner's report. Suicide mortality rates were calculated by age, sex, and location within the city. The Chi-squared test was used to assess statistical differences. Results: From January 2014 to December 2015, 990 residents of Mexico City died by suicide (men: 78.28%, women: 21.72%). Among males, the highest mortality rates were among the groups of 20-24 and 75-79 years old, whereas in women, the group with the highest mortality rate was 15 to 19 years old. 74% of the sample used hanging as suicide method. However, men had higher rates of a positive result in the toxicology test (40%) (p < 0.05). There was no concordance between male and female suicide by city jurisdictions. Conclusion: Our results provide evidence that the characteristics of Mexico City's residents who committed suicide had significant sex-related differences, including where they used to live. Understanding the contributory factors associated with completed suicide is essential for the development of effective preventive strategies.

Considerations on nonclinical approaches to modeling risk factors of suicidal ideation and behavior

Given the serious nature of suicidal ideation and behavior (SIB) and the possibility of treatment-emergent SIB, pharmaceutical companies are now applying more proactive approaches in clinical trials and are considering the value of nonclinical models to predict SIB. The current review summarizes nonclinical approaches to modeling three common risk factors associated with SIB: aggression, impulsivity, and anhedonia. For each risk factor, a general description, advantages and disadvantages, species considerations, nonclinical to clinical translation, and pharmacological validation with respect to treatments associated with SIB are summarized. From this review, several gaps were identified that need to be addressed before use of these nonclinical models can be considered a viable option to predict the relative risk for SIB. Other future directions that may compliment these nonclinical approaches, including the use of selectively-bred or genetically-modified rodent models, transgenic models, gene expression profiling, and biomarker analysis, are discussed. This article was developed with the support of the DruSafe Leadership Group of the International Consortium for Innovation and Quality in Pharmaceutical Development (IQ, www.iqconsortium.org).