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

Loneliness in the college student population: Prevalence and associations with substance use outcomes

Objectives: We assessed the prevalence of loneliness by gender and gender-specific associations between loneliness and substance use in university students. Participants: Participants were students enrolled in colleges and universities throughout the United States (n = 84,481). Methods: Gender was self-reported and categorized as male, female, and transgender/nonbinary. Descriptive analyses were conducted, and logistic regression was used to measure associations between loneliness and substance use by gender and substance. Results: Loneliness prevalence was 58% in the sample, and loneliness was most prevalent among transgender/nonbinary students (79%). Loneliness was associated with reduced odds of alcohol use and increased odds of benzodiazepine use in all genders, and increased odds of marijuana, stimulant, and opioid misuse in females and males. Conclusions: Loneliness is prevalent in college students, especially in transgender/nonbinary students, and it is associated with increased odds of substance use. College administrators should consider implementing interventions to reduce loneliness in this population.

Neuroticism, loneliness, all-cause and cause-specific mortality: A 17-year study of nearly 500,000 individuals

BACKGROUND

Neuroticism is related to mental and physical health. This study examined whether neuroticism and its underlying components were associated with risk of all-cause and cause-specific mortality.

METHODS

Community-dwelling adults (N = 491,323) in the UK Biobank completed a neuroticism scale between 2006 and 2010. Vital status was tracked up to December 2022 via linkage with the UK National Health Service.

RESULTS

Over 17 years of follow-up, 43,400 (8.8 %) participants died. Accounting for age, sex, and ethnicity, participants who scored 1 SD higher on neuroticism had a 10 % greater risk of dying (HR = 1.10, 95%CI = 1.09-1.11), an association that remained significant but was explained partly by socioeconomic status, health behaviors, and chronic conditions. Item-level analyses found that loneliness was the neuroticism item most predictive of mortality (HR = 1.46, 95%CI = 1.43-1.49), especially in males. Neuroticism and loneliness were more predictive of mortality among relatively younger adults and those with lower education. Among the causes of death, neuroticism and loneliness had the strongest association with deaths due to intentional self-harm, respiratory and digestive system diseases.

LIMITATIONS

Loneliness was assessed with a single item. The associations could be due to increases in neuroticism and loneliness approaching death. However, contrary to expectations from reverse causality, the associations were similar when excluding deaths within the first five or ten years of follow-up. Future research should examine whether findings from this high-income country replicate in middle- and lower-income communities.

CONCLUSIONS

Loneliness was the component of neuroticism most strongly associated with premature mortality, including from intentional self-harm, respiratory, and digestive system causes of death.

Occurrence and predictors of lifetime suicidality and suicidal ideation in autistic adults

LAY ABSTRACT

Over the past few years, more and more research is showing that many autistic people are at an increased risk for suicide. In this study, we asked participants from the Netherlands Autism Register, which is longitudinal register including individuals with autism, about their possible experiences with thoughts and feelings about suicide. Specifically, we looked at whether these thoughts and feelings in their lifetime and in the past month were related to various factors (such as their age, gender, and having psychiatric disorder diagnoses). We found that 80% of the participants had experienced thoughts about or even attempted to take their own life at least once throughout their lifetime. Furthermore, in a subgroup of participants, we found that the presence of a psychiatric disorder diagnosis, feelings of loneliness, and a higher number of autistic traits were associated with experiencing suicidal thoughts and feelings in their lifetime. For those who experienced these suicidal thoughts in the past month, we found that having (multiple) psychiatric disorder diagnoses and a higher number of autistic traits were related to more severe and frequent thoughts about suicide in the past month. Our findings show that additional factors in autistic individuals should be considered when assessing the suicide risk, and it brings us one step closer to understanding why suicide is more common for autistic people.

The associations of social health, self-injurious thoughts and behaviors with or without childhood trauma: A UK biobank study

BACKGROUND

Childhood trauma was known to increase risks of social isolation, loneliness and self-injurious thoughts and behaviors in adulthood. The aim of this study was to examine the protect and risk factors of social health, self-injurious thoughts and behaviors between adults with or without childhood trauma.

METHOD

This was a cross-sectional study comprising of 145,043 participants enrolled in the UK Biobank. Childhood trauma was determined by the Childhood Trauma Screener. Social health included social isolation, loneliness and emotional support. Outcomes of self-injurious thoughts and behaviors included suicide ideation, suicide attempt and non-suicidal self-injury (NSSI). Demographic data, self-reported morbidities and other confounding variables were covariates. Stata 17.0 and SPSS 27.0 was used to analysis data.

RESULTS

Compared with participants without childhood trauma, there was no protective effect of emotional support for NSSI in participants with childhood trauma (β-value difference = 0.334, p = 0.008). The risk effect of loneliness for suicide ideation, suicide attempt and NSSI were also weaker in participants experiencing childhood trauma (p<0.05). Social isolation was no longer a risk factor for NSSI in all participants, while loneliness remained as a threat (p < 0.05).

LIMITATIONS

Many variables were measured using core items of the scale in UK Biobank, meanwhile, the childhood trauma data collected in adulthood may have recall bias.

CONCLUSIONS

Adults reported childhood trauma were less vulnerable to self-injurious thoughts and behaviors when experiencing loneliness, but they could also not be protected from NSSI through emotional support. Emotional dysregulation caused by childhood trauma may contribute to this.

Estimating the direct effects of the genetic liabilities to bipolar disorder, schizophrenia, and behavioral traits on suicide attempt using a multivariable Mendelian randomization approach

Bipolar disorder (BD) and schizophrenia (SZ) are associated with higher odds of suicide attempt (SA). In this study, we aimed to explore the effect of BD and SZ genetic liabilities on SA, also considering the contribution of behavioral traits, socioeconomic factors, and substance use disorders. Leveraging large-scale genome-wide association data from the Psychiatric Genomics Consortium (PGC) and the UK Biobank (UKB), we conducted a two-sample Mendelian randomization (MR) analysis to evaluate the putative causal effect of BD (41,917 cases, 371,549 controls) and SZ (53,386 cases, 77,258 controls) on SA (26,590 cases, 492,022 controls). Then, we assessed the putative causal effect of BD and SZ on behavioral traits, socioeconomic factors, and substance use disorders. Considering the associations identified, we evaluated the direct causal effect of behavioral traits, socioeconomic factors, and substance use disorders on SA using a multivariable MR approach. The genetic liabilities to BD and SZ were associated with higher odds of SA (BD odds ratio (OR) = 1.24, p = 3.88 × 10-12; SZ OR = 1.09, p = 2.44 × 10-20). However, while the effect of mental distress (OR = 1.17, p = 1.02 × 10-4) and risk-taking (OR = 1.52, p = 0.028) on SA was independent of SZ genetic liability, the BD-SA relationship appeared to account for the effect of these risk factors. Similarly, the association with loneliness on SA was null after accounting for the effect of SZ genetic liability. These findings highlight the complex interplay between genetic risk of psychiatric disorders and behavioral traits in the context of SA, suggesting the need for a comprehensive mental health assessment for high-risk individuals.

Resilience and social support as protective factors against suicidal ideation among tertiary students during COVID-19: a cross-sectional study

BACKGROUND

Suicidal ideation is a depression symptom which represents a key (cognitive) component of suicidality and plays an important role in suicide risk detection, intervention, and prevention. Despite existing research showing the importance of certain factors of depression symptoms and suicidal ideation, less is known about the interaction between the various risk and protective factors. The aim of the study was to examine whether living conditions characteristics and personal circumstances during the COVID-19 pandemic predicted the presence of depression symptoms and suicidal ideation among tertiary students and whether resilience and social support can mitigate the detrimental effects of difficult life circumstances.

METHOD

A large online cross-sectional study was conducted in March 2021 among 4,645 Slovenian tertiary students. Hierarchical multiple regression and hierarchical logistic regression methods were used to assess and compare the effect of life circumstances variables, as opposed to resilience and social support, on depression symptoms and suicidal ideation.

RESULTS

Female gender, single relationship status, living alone, a higher degree of household conflict, having a history of mental illness and chronic disease diagnosis were significant predictors of depression scores. All but gender were also predictors of suicidal ideation. Household conflict and a history of mental illness were the factors showing the strongest effect in both cases. On the other hand, social support and, in particular, resilience proved to be strong protective factors against depression symptoms and suicidal ideation. After accounting for one's resilience and social support, the explained variance in depression scores was more than doubled, while the harmful effect of household conflict and history of mental illness significantly decreased.

CONCLUSIONS

The findings stress the importance of one's resilience and social support and explain why some people manage to maintain mental well-being despite finding themselves in difficult life circumstances, which was the case for many tertiary students during the COVID-19 pandemic. These insights may inform preventive efforts against developing suicidal ideation and may be used as support for the design and implementation of interventions for improving resilience and social support from childhood onward.

Suicide attempts in the absence of depression: Differences between broad cultural groups

Suicide is one of the leading causes of death worldwide (WHO, 2021). Depression is a common precursor to suicide and suicidality; however, individuals' experience of depression and the meaning of suicide differs depending on one's cultural background (Colucci, 2013; Goodmann et al., 2021; Kleinman, 2004). The current study explores the relationship between suicide and depression among six broad cultural groups in a large sample (N = 17,015) of adults representing six broad cultural groups (Latin America, South Asia, former Soviet Bloc, Western English-speakers, Chinese, and Arab World). Participants were recruited to a multilingual depression and suicide screening study via Google Ads (Leykin et al., 2012; Gross et al., 2014). As expected, the presence of depression was associated with suicide attempts. However, cultural group moderated this association, with Chinese participants being most likely to report suicide attempts while screening negative for depression. Although depression remains an important predictor of suicidality, it appears that certain cultural groups may be at higher risk even when depression is not present. Clinicians should consider using culturally adapted assessments for depression and suicidality.

Time-varying living arrangements and suicide death in the general population sample: 14-year causal survival analysis via pooled logistic regression

AIMS

While past research suggested that living arrangements are associated with suicide death, no study has examined the impact of sustained living arrangements and the change in living arrangements. Also, previous survival analysis studies only reported a single hazard ratio (HR), whereas the actual HR may change over time. We aimed to address these limitations using causal inference approaches.

METHODS

Multi-point data from a general Japanese population sample were used. Participants reported their living arrangements twice within a 5-year time interval. After that, suicide death, non-suicide death and all-cause mortality were evaluated over 14 years. We used inverse probability weighted pooled logistic regression and cumulative incidence curve, evaluating the association of time-varying living arrangements with suicide death. We also studied non-suicide death and all-cause mortality to contextualize the association. Missing data for covariates were handled using random forest imputation.

RESULTS

A total of 86,749 participants were analysed, with a mean age (standard deviation) of 51.7 (7.90) at baseline. Of these, 306 died by suicide during the 14-year follow-up. Persistently living alone was associated with an increased risk of suicide death (risk difference [RD]: 1.1%, 95% confidence interval [CI]: 0.3-2.5%; risk ratio [RR]: 4.00, 95% CI: 1.83-7.41), non-suicide death (RD: 7.8%, 95% CI: 5.2-10.5%; RR: 1.56, 95% CI: 1.38-1.74) and all-cause mortality (RD: 8.7%, 95% CI: 6.2-11.3%; RR: 1.60, 95% CI: 1.42-1.79) at the end of the follow-up. The cumulative incidence curve showed that these associations were consistent throughout the follow-up. Across all types of mortality, the increased risk was smaller for those who started to live with someone and those who transitioned to living alone. The results remained robust in sensitivity analyses.

CONCLUSIONS

Individuals who persistently live alone have an increased risk of suicide death as well as non-suicide death and all-cause mortality, whereas this impact is weaker for those who change their living arrangements.

The association between living alone, loneliness and suicide mortality and effect modification by age: A case:control study

BACKGROUND

Social isolation is a potentially reversible risk factor for suicide.

METHODS

A matched case control study design was used. The study population was from England and identified from an electronic primary case database with linkage to a secondary care database and Office for National Statistics mortality data. Cases were individuals who had been recorded as dying by suicide. Controls were randomly selected, matched by primary care centre and date of suicide mortality.

RESULTS

Data were available from 14,515 cases who died from suicide and 580,159 controls. After adjustment for age and sex, the risk of suicide in individuals who had previously been reported to be either living alone or suffering loneliness was increased (Odds ratio OR 4.9; 95 % confidence intervals CI: 4.4 to 5.5). Age affected the level of this risk, with individuals aged 15 to 34 years who were lonely or lived alone having a much higher risk of suicide (OR 16.4; 95 % CI: 8.7 to 31.1).

LIMITATIONS

We can demonstrate an association between loneliness and living alone, but this may not be a causal effect. The conclusions may not be generalisable to societies outside the UK.

CONCLUSIONS

Loneliness and social isolation are associated with an approximately five-fold increase in risk of mortality from suicide, which was substantially higher in younger adults. These represent potentially reversible risk factors for suicide mortality and may also help identify individuals who are at a higher risk of suicide.

Predictive factors and risk and protection groups for loneliness in older adults: a population-based study

BACKGROUND

Loneliness is considered a public health problem, particularly among older adults. Although risk factors for loneliness have been studied extensively, fewer studies have focused on the protected and risk groups that these factors configure. Our objective is to analyze the variables and latent factors that predict loneliness in older adults and that enable risk and protected groups to be configured.

METHODS

We employed an epidemiological, cross-sectional survey that was carried out on a random sample of 2060 people over 65 years extracted from the census. A structured telephone interview was used to assess mental and physical health, habits, quality of life, and loneliness, applying the COOP-Wonca, Goldberg General Health (GHQ-12), and Barber Questionnaires.

RESULTS

Predictors of loneliness were: mental health, living alone, quality of life, depressive symptoms, low educational level, and some deficiency situations such as having no one to turn to for help. The factors extracted (Factorial Analysis) were: a subjective experience of poor health, objective isolation, and psychological isolation. We established at risk and protected groups ("Decision Tree" procedure), and loneliness was referred to by 73.2% of the people living alone and with poor mental health and quality of life (risk group). By contrast, only 0.8% of people living with others, with good mental health and good quality of life felt loneliness (protected group).

CONCLUSION

In a well-developed city, subjective and objective factors are associated with loneliness. These factors, especially those associated with at risk or protected groups, must be considered to develop strategies that address loneliness.

The association between social connectedness and euthanasia and assisted suicide and related constructs: systematic review

BACKGROUND

Euthanasia and assisted suicide (EAS) requests are common in countries where they are legal. Loneliness and social isolation are modifiable risk factors for mental illness and suicidal behaviour and are common in terminal illness. Our objective was to summarise available literature to clarify whether these and related measures of social connectedness might contribute to requests for EAS.

METHODS

We conducted a pre-registered (PROSPERO CRD42019160508) systematic review and narrative synthesis of quantitative literature investigating associations between social connectedness and a) requested/actual EAS, b) attitudes towards EAS, and c) a desire for hastened death (DHD) by searching six databases (PsycINFO, MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar) from inception to November 2022, rating eligible peer-reviewed, empirical studies using the QATSO quality assessment tool.

RESULTS

We identified 37 eligible studies that investigated associations with a) requested/actual EAS (n = 9), b) attitudes to EAS (n = 16), and c) DHD (n = 14), with limited overlap, including 17,359 participants. The majority (62%) were rated at medium/high risk of bias. Focussing our narrative synthesis on the more methodologically sound studies, we found no evidence to support an association between different constructs of social connectedness and requested or actual EAS, and very little evidence to support an association with attitudes to EAS or an association with DHD.

CONCLUSIONS

Our findings for all age groups are consistent with a those of a previous systematic review focussed on older adults and suggest that poor social connectedness is not a clear risk factor for EAS or for measures more distally related to EAS. However, we acknowledge low study quality in some studies in relation to sampling, unvalidated exposure/outcome measures, cross-sectional design, unadjusted analyses, and multiple testing. Clinical assessment should focus on modifying established risk factors for suicide and EAS, such as hopelessness and depression, as well as improving any distressing aspects of social disconnectedness to improve quality of life.

FUNDING

UKRI, NIHR.

Emotional regulation and suicidal ideation-Mediating roles of perceived social support and avoidant coping

Introduction

Recent research has uncovered a wide prevalence variation of suicidal ideation in university students ranging from 9.7% to 58.3%. India has witnessed a 4.5% increase in suicide rates in the year 2021. The interplay between cognitive reappraisal of a stressful situation, suppression of emotional expression, and coping strategies for suicidal ideation of Indian University students is yet to be explored. We aim to determine whether suicidal ideation would differ across different types of family units, and to predict the extent to which perceived social support and avoidant coping could mediate the relation between emotion regulation processes and suicidal ideation.

Methods

Two hundred randomly selected University students (Mean age = 19.9, SD = 1.43) participated. Kruskal-Wallis, Pearson's product-moment correlation, and GLM mediation model were computed.

Results and discussion

Lifetime suicidal ideation significantly differed between those who stay alone and those who live in a nuclear family (p < 0.01), and also those who stay in a joint family (p < 0.05). Cognitive reappraisal predicted a reduction in suicidal ideation mediated by perceived social support (B = -0.06, p < 0.05) and avoidant coping (B = -0.07, p < 0.05). Whereas, expressive suppression predicted induced levels of suicidal ideation through perceived social support (B = 0.05, p < 0.05), and avoidant coping (B = 0.06, p < 0.05) as mediators.

Conclusion

Though our sample size restricts the generalization, our findings implied the importance of regular psychological consultation regarding the efficacy of the said coping processes in dealing with suicidal ideation.

Longitudinal associations between exposure to potentially morally injurious events and suicidal ideation among recently discharged veterans - The mediating roles of depression and loneliness

BACKGROUND

Exposure to potentially morally injurious events (PMIEs) during military service is associated with heightened suicidal ideation (SI). However, no longitudinal study has established temporal associations between these variables and examined the possible mediating roles of depression and loneliness in this effect.

METHODS

Participants were 374 active-duty Israeli combatants who participated in a five-year longitudinal study with four measurement points: T1- one year before enlistment, T2- one month before discharge from army service, and then again six months and twelve months following their discharge (T3 and T4, respectively). Data were assessed through semi-structured interviews and validated self-report questionnaires.

RESULTS

Above and beyond pre-enlistment personal characteristics (T1) and combat exposure (T2), PMIEs-'betrayal' (T2) predicted more frequent SI over the past twelve months (T4) through the mediation of depression. Moreover, both PMIEs-'betrayal' and 'self' (T2) predicted more frequent SI over the past twelve months (T4) through the mediation of loneliness.

LIMITATIONS

We used self-report measures to assess PMIEs and SI, which may suffer from various biases.

CONCLUSIONS

Our findings are the first to provide evidence of longitudinal, temporal associations between exposure to PMIEs and SI. Notably, potential interventions might consider addressing the loneliness experienced following exposure to PMIEs during military service, among recently discharged traumatized veterans.

Loneliness and suicide risks in the general population before and during first-year COVID-19 in Taiwan

PURPOSE

Loneliness is a critical issue affecting the general population. Current evidence from national surveys of loneliness is scarce. The study aimed to examine the impact of COVID-19 pandemic on the prevalence of loneliness and its associating suicide risks in Taiwan.

METHODS

Four annual telephone interview surveys were performed by the Taiwan Suicide Prevention Center in 2015-2017 and 2020 during COVID outbreak. Each year the sample was randomly selected by stratifying the general public in different geographical areas and fulfilled a questionnaire collecting information including loneliness, psychological distress, and suicide risk assessment. All the data were analyzed using SPSS25 analysis.

RESULTS

A total of 8460 participants were recruited. The average prevalence of loneliness was 12.6 %. Feelings of loneliness was significantly correlated with psychological distress and most risk factors relating to suicide. The odds of loneliness for lifetime suicidal ideation, lifetime suicide attempt, and future suicide intent were 4.9, 5.1, and 9.2, respectively. During the COVID-19 period, loneliness and suicidality demonstrated a noteworthy decline trend, whereas "no one trustworthy to talk to" was the only item that showed significant increase under the pandemic and also impacted on loneliness.

CONCLUSION

Nearly one in ten Taiwanese people felt lonely before and during COVID-19. Loneliness was closely linked with various suicide risk factors such as lifetime suicide ideation and attempt or future intention. Although psychological distress and suicide risk were not increased during COVID-19, maintaining trustful relationships to seek support appeared to be critical to prevent the risks of loneliness or suicide.

The protective effect of social support on all-cause and cardio-cerebrovascular mortality among middle-aged and older adults in the US

The relationship between social support and mortality, especially cardio-cerebrovascular mortality, still has some limitations in the assessment of social support, sample selection bias, and short follow-up time. We used the data from 2005 to 2008 National Health and Nutrition Examination Survey to examine this relationship. The study analyzed a total of 6776 participants, divided into Group 1, Group 2, and Group 3 according to the social support score (0-1; 2-3; 4-5). Multivariable adjusted COX regression analyses of our study showed that Group 3 and Group 2 had a reduced risk of all-cause and cardio-cerebrovascular mortality (Group 3 vs 1, HR: 0.55, P < 0.001; HR: 0.4, P < 0.001; Group 2 vs 1, HR: 0.77, P = 0.017; HR: 0.58, P = 0.014) compared with Group 1. The same results were observed after excluding those who died in a relatively short time. Additionally, having more close friends, being married or living as married, and enough attending religious services were significantly related to a lower risk of mortality after adjustment. In brief, adequate social support is beneficial in reducing the risk of all-cause mortality and cardio-cerebrovascular mortality in middle-aged and older adults, especially in terms of attending religious services frequency, the number of close friends, and marital status.

The social determinants of mental health and disorder: evidence, prevention and recommendations

People exposed to more unfavourable social circumstances are more vulnerable to poor mental health over their life course, in ways that are often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage and poor health. Addressing these challenges is an imperative matter of social justice. In this paper we provide a roadmap to address the social determinants that cause mental ill health. Relying as far as possible on high-quality evidence, we first map out the literature that supports a causal link between social determinants and later mental health outcomes. Given the breadth of this topic, we focus on the most pervasive social determinants across the life course, and those that are common across major mental disorders. We draw primarily on the available evidence from the Global North, acknowledging that other global contexts will face both similar and unique sets of social determinants that will require equitable attention. Much of our evidence focuses on mental health in groups who are marginalized, and thus often exposed to a multitude of intersecting social risk factors. These groups include refugees, asylum seekers and displaced persons, as well as ethnoracial minoritized groups; lesbian, gay, bisexual, transgender and queer (LGBTQ+) groups; and those living in poverty. We then introduce a preventive framework for conceptualizing the link between social determinants and mental health and disorder, which can guide much needed primary prevention strategies capable of reducing inequalities and improving population mental health. Following this, we provide a review of the evidence concerning candidate preventive strategies to intervene on social determinants of mental health. These interventions fall broadly within the scope of universal, selected and indicated primary prevention strategies, but we also briefly review important secondary and tertiary strategies to promote recovery in those with existing mental disorders. Finally, we provide seven key recommendations, framed around social justice, which constitute a roadmap for action in research, policy and public health. Adoption of these recommendations would provide an opportunity to advance efforts to intervene on modifiable social determinants that affect population mental health.

Mapping loneliness through comparative analysis of USA and India using social intelligence analysis

Loneliness, a widespread global public health concern, has far-reaching implications for mental and physical well-being, as well as economic productivity. It also increases the risk of life-threatening conditions. This study conducts a comparative analysis of loneliness in the USA and India using Twitter data, aiming to contribute to a global public health map on loneliness. Collecting 4.1 million tweets globally in October 2022 containing keywords like "lonely", "loneliness", and "alone", the analysis focuses on sentiment and psychosocial linguistic features. Utilizing the Valence Aware Dictionary for Sentiment Reasoning (VADER) for sentiment analysis, the study explores variations in loneliness dynamics across cities, revealing geographical distinctions in correlated topics. The tweets with negative sentiment were further analyzed for psychosocial linguistic features to find a meaningful correlation between loneliness and socioeconomic and emotional themes and factors. Results give detailed top correlated topics with loneliness for each city. The results showed that the dynamics of loneliness through the topics correlated vary across geographical locations. Social media data can be used to capture the dynamics of loneliness which can vary from one place to another depending on the socioeconomic and cultural norms and sociopolitical policies. Social media data to understand loneliness can also provide useful information and insight for public health and policymaking.

Prevalence and correlates of suicidal ideation in the general public during the fifth wave of COVID-19 pandemic in Hong Kong

Introduction

Literature reveals increased suicidal ideation in the general population during pandemic. However, few COVID-19 studies comprehensively assessed factors associated with suicidal ideation, and mixed findings were observed. We aimed to examine prevalence and correlates of suicidal ideation in general public during the peak of fifth COVID-19 wave in Hong Kong based on a broad array of relevant measures.

Methods

This survey assessed 14,709 community-dwelling adults during March 15-April 3, 2022. Comprehensive assessment was administered including socio-demographics, pre-existing mental/physical morbidity, mental-health symptoms, resilience, loneliness, coping strategies, and pandemic-related factors. Presence of suicidal ideation was evaluated by ratings of item 9 on Patient-Health-Questionnaire-9.

Results

A total of 2,249 (15.3%) participants exhibited suicidal ideation. Multivariable-regression analysis found that being single and unemployed, pre-existing mental disorder, more severe depressive and anxiety symptoms, higher levels of loneliness and engagement in avoidant coping were significantly associated with suicidal ideation. Conversely, attaining tertiary educational level or above, greater resilience and adopting problem-focused coping were associated with lower likelihood of suicidal ideation. Although univariate-analyses revealed that a number of pandemic-related factors were linked to suicidal ideation, none remained significant in the multivariable model.

Conclusion

A significant proportion of people experienced suicidal ideation during the peak of fifth COVID-19 wave. Risk and protective factors identified would facilitate early identification of high-risk individuals and provision of targeted interventions to minimize suicidal ideation and risk of self-harm. Caution should be exercised due to study limitations of a cross-sectional design which precluded establishing causality among variables, and reliance on self-reported data.

Enhancing emotion regulation with an in situ socially assistive robot among LGBTQ+ youth with self-harm ideation: protocol for a randomised controlled trial

INTRODUCTION

Purrble, a socially assistive robot, was codesigned with children to support in situ emotion regulation. Preliminary evidence has found that LGBTQ+ youth are receptive to Purrble and find it to be an acceptable intervention to assist with emotion dysregulation and their experiences of self-harm. The present study is designed to evaluate the impact of access to Purrble among LGBTQ+ youth who have self-harmful thoughts, when compared with waitlist controls.

METHODS AND ANALYSIS

The study is a single-blind, randomised control trial comparing access to the Purrble robot with waitlist control. A total of 168 LGBTQ+ youth aged 16-25 years with current self-harmful ideation will be recruited, all based within the UK. The primary outcome is emotion dysregulation (Difficulties with Emotion Regulation Scale-8) measured weekly across a 13-week period, including three pre-deployment timepoints. Secondary outcomes include self-harm (Self-Harm Questionnaire), anxiety (Generalised Anxiety Disorder-7) and depression (Patient Health Questionnaire-9). We will conduct analyses using linear mixed models to assess primary and secondary hypotheses. Intervention participants will have unlimited access to Purrble over the deployment period, which can be used as much or as little as they like. After all assessments, control participants will receive their Purrble, with all participants keeping the robot after the end of the study. After the study has ended, a subset of participants will be invited to participate in semistructured interviews to explore engagement and appropriation of Purrble, considering the young people's own views of Purrble as an intervention device.

ETHICS AND DISSEMINATION

Ethical approval was received from King's College London (RESCM-22/23-34570). Findings will be disseminated in peer review open access journals and at academic conferences.

TRIAL REGISTRATION NUMBER

NCT06025942.

Mapping loneliness through social intelligence analysis: a step towards creating global loneliness map

OBJECTIVES

Loneliness is a prevalent global public health concern with complex dynamics requiring further exploration. This study aims to enhance understanding of loneliness dynamics through building towards a global loneliness map using social intelligence analysis.

SETTINGS AND DESIGN

This paper presents a proof of concept for the global loneliness map, using data collected in October 2022. Twitter posts containing keywords such as 'lonely', 'loneliness', 'alone', 'solitude' and 'isolation' were gathered, resulting in 841 796 tweets from the USA. City-specific data were extracted from these tweets to construct a loneliness map for the country. Sentiment analysis using the valence aware dictionary for sentiment reasoning tool was employed to differentiate metaphorical expressions from meaningful correlations between loneliness and socioeconomic and emotional factors.

MEASURES AND RESULTS

The sentiment analysis encompassed the USA dataset and city-wise subsets, identifying negative sentiment tweets. Psychosocial linguistic features of these negative tweets were analysed to reveal significant connections between loneliness, socioeconomic aspects and emotional themes. Word clouds depicted topic variations between positively and negatively toned tweets. A frequency list of correlated topics within broader socioeconomic and emotional categories was generated from negative sentiment tweets. Additionally, a comprehensive table displayed top correlated topics for each city.

CONCLUSIONS

Leveraging social media data provide insights into the multifaceted nature of loneliness. Given its subjectivity, loneliness experiences exhibit variability. This study serves as a proof of concept for an extensive global loneliness map, holding implications for global public health strategies and policy development. Understanding loneliness dynamics on a larger scale can facilitate targeted interventions and support.

Associations between constructs related to social relationships and mental health conditions and symptoms: an umbrella review

BACKGROUND

Loneliness and social isolation are increasingly recognised as prevalent among people with mental health problems, and as potential targets for interventions to improve quality of life and outcomes, as well as for preventive strategies. Understanding the relationship between quality and quantity of social relationships and a range of mental health conditions is a helpful step towards development of such interventions.

PURPOSE

Our aim was to give an overview of associations between constructs related to social relationships (including loneliness and social isolation) and diagnosed mental conditions and mental health symptoms, as reported in systematic reviews of observational studies.

METHODS

For this umbrella review (systematic review of systematic reviews) we searched five databases (PsycINFO, MEDLINE, EMBASE, CINAHL, Web of Science) and relevant online resources (PROSPERO, Campbell Collaboration, Joanna Briggs Institute Evidence Synthesis Journal). We included systematic reviews of studies of associations between constructs related to social relationships and mental health diagnoses or psychiatric symptom severity, in clinical or general population samples. We also included reviews of general population studies investigating the relationship between loneliness and risk of onset of mental health problems.

RESULTS

We identified 53 relevant systematic reviews, including them in a narrative synthesis. We found evidence regarding associations between (i) loneliness, social isolation, social support, social network size and composition, and individual-level social capital and (ii) diagnoses of mental health conditions and severity of various mental health symptoms. Depression (including post-natal) and psychosis were most often reported on, with few systematic reviews on eating disorders or post-traumatic stress disorder (PTSD), and only four related to anxiety. Social support was the most commonly included social construct. Our findings were limited by low quality of reviews and their inclusion of mainly cross-sectional evidence.

CONCLUSION

Good quality evidence is needed on a wider range of social constructs, on conditions other than depression, and on longitudinal relationships between social constructs and mental health symptoms and conditions.

A qualitative study on lived experience of self-harm in South Asians in the UK: From reasons to recovery

OBJECTIVES

Self-harm rates and clinical presentations differ by ethnicity. South Asian women are at risk of self-harm. Previous research suggested investigating individuals' experiences with self-harm with qualitative studies in developing self-harm prevention strategies. This research aims to explore self-harm experiences among South Asians in the United Kingdom.

DESIGN

Qualitative study.

METHODS

Participants were recruited via third-sector organizations and online platforms. Semi-structured interviews were conducted with 11 South Asian individuals with a history of self-harm living in the United Kingdom. The data were analysed based on a reflective thematic analysis approach.

RESULTS

Results revealed four main themes: (1) reasons for self-harm; (2) recovery journey; (3) culture and mental health; and (4) the transition to suicidal thoughts and behaviours. Reasons for self-harm included negative life circumstances, social life difficulties, challenges faced during COVID-19 and mental health problems. Participants described their recovery journey by acknowledging the role of professional help, self-care, psychoeducation and personal growth, improving social relationships, and faith and spirituality. Cultural factors included generational differences and stigma. Culturally adapted psychological interventions were perceived as promising. The reported transition from self-harm to suicidal behaviours was linked to experiencing major stressful life events and the use of severe methods of self-harm.

CONCLUSIONS

The findings suggest that socio-cultural factors impact mental health and recovery processes among South Asians. Mental health services should consider improving culturally sensitive clinical practices in responding to self-harm among South Asian communities.

A systematic review on suicide because of social isolation/and loneliness: does COVID-19 make a difference?

BACKGROUND

Suicide is a significant cause of death worldwide. Various purposes can explain why people choose to attempt or commit suicide such as mental-health disorders, income-related-factors, quality of life or issues related to social context. This study aims to identify an updated association between 'isolation' and suicides.

METHODS

In this regard, we had made a systematic review of the most recent papers, published from January 2016 to March 2022, thought the most acknowledged databases. This review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. To the best of our knowledge, this issue is very important due to the indirect relationship between COVID-19 and suicides.

RESULTS

Our analysis demonstrates that suicide and -social isolation and loneliness- have a positive and direct relationship although these findings varied slightly by areas. Moreover, most of the attention is focused on the youth during the most recent period and this is a real problem because economies cannot afford losing (young) population.

CONCLUSIONS

In order to prevent suicides, public policies should prevent suicidal thoughts that it could induce to terminate the lives of individuals in their most productive years and harmful outcomes to their families and friends.

Psychosocial predictors of COVID-19 infection in UK biobank (N = 104 201)

BACKGROUND

Since the outbreak of COVID-19, data on its psychosocial predictors are limited. We therefore aimed to explore psychosocial predictors of COVID-19 infection at the UK Biobank (UKB).

METHODS

This was a prospective cohort study conducted among UKB participants.

RESULTS

The sample size was N = 104 201, out of which 14 852 (14.3%) had a positive COVID-19 test. The whole sample analysis showed significant interactions between sex and several predictor variables. Among females, absence of college/university degree [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.45-1.66] and socioeconomic deprivation (OR 1.16 95% CI 1.11-1.21) were associated with higher odds of COVID-19 infection, while history of psychiatric consultation (OR 0.85 95% CI 0.77-0.94) with lower odds. Among males, absence of college/university degree (OR 1.56, 95% CI 1.45-1.68) and socioeconomic deprivation (OR 1.12, 95% CI 1.07-1.16) were associated with higher odds, while loneliness (OR 0.87, 95% CI 0.78-0.97), irritability (OR 0.91, 95% CI 0.83-0.99) and history of psychiatric consultation (OR 0.85, 95% CI 0.75-0.97) were associated with lower odds.

CONCLUSION

Sociodemographic factors predicted the odds of COVID-19 infection equally among male and female participants, while psychological factors had differential impacts.

Estimating the direct effects of the genetic liabilities to bipolar disorder, schizophrenia, and behavioral traits on suicide attempt using a multivariable Mendelian randomization approach

Bipolar disorder (BD) and schizophrenia (SZ) are associated with higher odds of suicide attempt (SA). In this study, we aimed to explore the effect of BD and SZ genetic liabilities on SA, also considering the contribution of behavioral traits, socioeconomic factors, and substance use disorders. Leveraging large-scale genome-wide association data from the Psychiatric Genomics Consortium (PGC) and the UK Biobank (UKB), we conducted a two-sample Mendelian randomization (MR) analysis to evaluate the putative causal effect of BD (41,917 cases, 371,549 controls) and SZ (53,386 cases, 77,258 controls) on SA (26,590 cases, 492,022 controls). Then, we assessed the putative causal effect of BD and SZ on behavioral traits, socioeconomic factors, and substance use disorders. Considering the associations identified, we evaluated the direct causal effect of behavioral traits, socioeconomic factors, and substance use disorders on SA using a multivariable MR approach. The genetic liabilities to BD and SZ were associated with higher odds of SA (BD odds ratio (OR)=1.24, p=3.88×10-12; SZ OR=1.09, p=2.44×10-20). However, while the effect of mental distress (OR=1.17, p=1.02×10-4) and risk-taking (OR=1.52, p=0.028) on SA was independent of SZ genetic liability, the BD-SA relationship appeared to account for the effect of these risk factors. Similarly, the association with loneliness on SA was null after accounting for the effect of SZ genetic liability. These findings highlight the complex interplay between genetic risk of psychiatric disorders and behavioral traits in the context of SA, suggesting the need for a comprehensive mental health assessment for high-risk individuals.

Living alone and mental health: parallel analyses in UK longitudinal population surveys and electronic health records prior to and during the COVID-19 pandemic

BACKGROUND

People who live alone experience greater levels of mental illness; however, it is unclear whether the COVID-19 pandemic had a disproportionately negative impact on this demographic.

OBJECTIVE

To describe the mental health gap between those who live alone and with others in the UK prior to and during the COVID-19 pandemic.

METHODS

Self-reported psychological distress and life satisfaction in 10 prospective longitudinal population surveys (LPSs) assessed in the nearest pre-pandemic sweep and three periods during the pandemic. Recorded diagnosis of common and severe mental illnesses between March 2018 and January 2022 in electronic healthcare records (EHRs) within the OpenSAFELY-TPP.

FINDINGS

In 37 544 LPS participants, pooled models showed greater psychological distress (standardised mean difference (SMD): 0.09 (95% CI: 0.04; 0.14); relative risk: 1.25 (95% CI: 1.12; 1.39)) and lower life satisfaction (SMD: -0.22 (95% CI: -0.30; -0.15)) for those living alone pre-pandemic. This gap did not change during the pandemic. In the EHR analysis of c.16 million records, mental health conditions were more common in those who lived alone (eg, depression 26 (95% CI: 18 to 33) and severe mental illness 58 (95% CI: 54 to 62) more cases more per 100 000). For common mental health disorders, the gap in recorded cases in EHRs narrowed during the pandemic.

CONCLUSIONS

People living alone have poorer mental health and lower life satisfaction. During the pandemic, this gap in self-reported distress remained; however, there was a narrowing of the gap in service use.

CLINICAL IMPLICATIONS

Greater mental health need and potentially greater barriers to mental healthcare access for those who live alone need to be considered in healthcare planning.

Association of loneliness with suicide risk and depression in individuals with schizophrenia: moderating effects of self-esteem and perceived support from families and friends

Loneliness is prevalent among individuals with mental illnesses. This cross-sectional survey study examined the moderating effects of self-esteem and perceived support from families and friends on the association of loneliness with suicide risk and depression in individuals with schizophrenia. In total, 300 participants (267 with schizophrenia and 33 with schizoaffective disorder) completed the University of California, Los Angeles, Loneliness Scale (Version 3); suicide module of the Mini International Neuropsychiatric Interview; Center for Epidemiologic Studies Depression Scale; Family and Friend Adaptability, Partnership, Growth, Affection, and Resolve Index; and Rosenberg Self-Esteem Scale. Moderation analysis was performed to examine the moderating effects of self-esteem and perceived support from families and friends on the association of loneliness with suicide risk and depression. The results found that self-esteem was significantly associated with a reduced magnitude of depression in participants with loneliness. In addition, perceived support from friends was significantly associated with a reduced magnitude of suicide risk in participants with loneliness. Our findings indicate the importance of intervention programs that strengthen support from friends and self-esteem in reducing suicide risk and depression among lonely individuals with schizophrenia.

Suicidal Behaviour among School-Going Adolescents in Saint Lucia: Analysis of Prevalence and Associated Factors

Suicide poses a debilitating threat to adolescents' lives worldwide. Although suicide prevention efforts are evident globally, there is limited evidence on the prevalence and correlations of suicidal behaviour among school-going adolescents in Saint Lucia. We used a dataset from the 2018 Global School-based Student Health Survey to examine the prevalence and associated factors of suicidal behaviour among 1864 students from schools in Saint Lucia. Prevalence rates of 25.5%, 22.1%, and 17.5% were found for suicidal ideation, suicide plan, and suicide attempt, respectively. After adjusting for other factors, being male and having understanding parents were protective against suicidal behaviour. However, suicidal ideation was predicted by being physically attacked and bullied, parental guidance, tobacco use, loneliness, and worry. Moreover, being a victim of physical attacks and bullying, having close friends, being lonely, and worrying were predictive of making suicidal plans among adolescents. Attempting suicide was predicted by cigarette smoking, current use of tobacco and related products, bullying, having close friends, being lonely, and worrying. School-based preventive interventions are required to help address triggers of suicidal behaviour among adolescents in Saint Lucia and to help attain the targets for suicide prevention in the global Sustainable Development Goals.

The Effect of Loneliness on Non-Suicidal Self-Injury Behavior in Chinese Junior High School Adolescents: A Moderated Mediation Model

Purpose

This study explore the interaction between loneliness and non-suicidal self-injury behaviors (hereinafter "NSSI"), and to further examine the mediating role of self-control and the moderating role of social connection.

Methods

A total of 414 junior high school students (age 14.05±0.84) in Sichuan province in China were investigated on their loneliness, self-control, social connection and NSSI by questionnaire.

Results

(1) there was a significant positive correlation between loneliness and NSSI; (2) self-control played a mediating role in the relationship between loneliness and NSSI; and (3) after controlling for gender, family structure, and family economic level, the social connectedness played a moderating role in the relationship between loneliness and NSSI, as well as between self-control and NSSI.

Conclusion

The results verify the relationship between loneliness and NSSI, expands and deepens the internal logical relationship between them, and provides a reference that can be used in the future for the prevention and intervention of NSSI in adolescents.

Impact of loneliness on suicidal ideation during the COVID-19 pandemic: findings from a cross-sectional online survey in Japan

OBJECTIVES

We aim to reveal how loneliness relates to suicidal ideation following the onset of the COVID-19 pandemic.

DESIGN

Cross-sectional online survey.

SETTING

Community cohort study in Japan.

PARTICIPANTS

The second wave of a large web-based survey, Japan COVID-19 and Society Internet Survey, was conducted in February 2021, and we analysed the data of 6436 men and 5380 women who were aged 20-59 years.

MAIN OUTCOME MEASURES

The prevalence ratios (PRs) of suicidal ideation due to loneliness, depression, social isolation and decline in income during the pandemic and other sociodemographic and economic information were adjusted in the analysis.

STATISTICAL METHODS

Estimations were conducted by separating a male and female sample. The survey weight (inverse probability weighting) was applied for analyses, and a Poisson regression model was used with all the potential confounders adjected.

RESULTS

Overall, 15.1% of male and 16.3% of female participants were found to have had suicidal ideation during the COVID-19 pandemic. Among them, 23% of male and 20% of female participants experienced suicidal ideation for the first time. The results of the Poisson regression suggested that those who were feeling lonely had higher PRs for suicidal ideation (4.83 for men (95% CI, 3.87 to 6.16) and 6.19 for women (95% CI, 4.77 to 8.45)). The relationship between loneliness and suicidal ideation remained robust even after adjusting for depression, although there were declines in PRs. Additionally, the results showed that those who were lonely, and continued to feel lonely during the pandemic, had the highest PRs of suicidal ideation.

CONCLUSION

Loneliness had both direct and indirect effects on suicidal ideation mediated through depression. Those who felt lonelier during the pandemic had the highest risk of suicidal ideation. It is necessary to adopt national measures focused on providing psychological support to people who feel lonely to prevent them from taking their own lives.

Effects of social support on suicide-related behaviors in patients with severe mental illness: A systematic review and meta-analysis

OBJECTIVE

Patients with severe mental illness have a high risk of suicide and frequently living eliminated from mainstream society, but the effects of social support on suicide-related behaviors among this crowd is inconclusive. The present study aimed to explore such effects among patients with severe mental illness.

METHODS

We implemented a meta-analysis and a qualitative analysis of relevant studies published before February 6, 2023. Correlation coefficients (r) and 95 % CI were selected as the effect size index in meta-analysis. Studies that did not report correlation coefficients were employed for qualitative analysis.

RESULTS

Out of 4241 identified studies, 16 were identified in this review (6 for meta-analysis, 10 for qualitative analysis). The meta-analysis presented that the pooled correlation coefficients (r) were - 0.163 (95%CI = -0.243, -0.080, P < 0.001), suggesting a negative correlation between social support and suicidal ideation. The subgroup analysis showed that this effect works in all bipolar disorder, major depression, and schizophrenia. Concerning qualitative analysis, social support presented positive effects on reducing suicidal ideation, suicide attempts, and suicide death. The effects were consistently reported in female patients. However, there existed some unaffected results in males.

LIMITATIONS

The included studies were from middle- and high-income countries and used inconsistent measurement tools, our results may have some bias.

CONCLUSIONS

The effects of social support in reducing suicide-related behaviors were positive, but it showed better effects in both female patients and adults. Males and adolescents deserve more attention. Future research needs to pay more attention to the implementation methods and effects of personalized social support.

Loneliness-a clinical primer

INTRODUCTION

loneliness is prevalent worldwide. It is also associated with an increased risk for depression, high blood pressure, cardiovascular disease, stroke and early death. As such, loneliness is a major public health issue. This paper summarizes the salient points clinicians should know and encourages clinicians to assume an active part in the identification, mitigation and prevention of loneliness.

SOURCES OF DATA

white papers, academic publications.

AREAS OF AGREEMENT

loneliness is a distressful subjective experience, which does not always correlate with social isolation. Both internal (personal) and external (contextual, societal) factors determine whether an individual would feel lonely in a given situation.

AREAS OF CONTROVERSY

identifying loneliness in the clinic may be time consuming and challenging. There is a scarce robust evidence to support interventions.

GROWING POINTS

due to increased individualization and incidence of infectious diseases, loneliness is likely to become even more prevalent.

AREAS TIMELY FOR DEVELOPING RESEARCH

more research is needed to further elucidate the health impacts of loneliness as well as to find evidence-based interventions to prevent and mitigate loneliness that could then be implemented by policy-makers and clinicians.

The association of family, social and romantic loneliness in relation to suicidal ideation and self-injurious behaviours

Over 703,000 people die by suicide every year. The association between loneliness and self-injurious thoughts and behaviours has received increasing amounts of attention, with a significant link consistently being identified. However the impact that different types of loneliness have on physical and mental health remains under-researched. The current study aimed to explore how different forms of loneliness might be associated with self-injury, based on findings from existing theory-driven research. This cross-sectional online study investigated three types of loneliness (family, romantic, social) as well as loneliness as a unidimensional construct (global loneliness) in relation to suicidal ideation and several established variables associated with suicidal ideation (defeat, entrapment and depression). 582 participants (age 18-70 years) completed the survey between May and October 2021. Results showed that all forms of loneliness were associated with suicidal ideation, and all loneliness measures significantly, independently, moderated the association between entrapment and suicidal ideation. Furthermore, depression significantly mediated between family, romantic and global loneliness and suicidal ideation, but not social loneliness. The findings suggest that the quality and/or quantity of family, romantic and global relationships, should be explored when considering loneliness as a possible risk factor for suicidal ideation and may have a significant impact on mental and physical health. In particular, romantic loneliness may have a particularly adverse association with negative affect and suicidal ideation. Future work would benefit from replicating these findings longitudinally.

Association Between Loneliness and Suicidal Behaviour: A Scoping Review

OBJECTIVE

Suicide is a public health issue, and there are several factors leading to suicide, like mental illness and psychosocial stressors. Actual loneliness (living alone) and subjective loneliness (feeling of being alone) and different suicidal behaviors have been reported to have some link. This scoping review aimed to assess the association between loneliness and suicidal behaviour by exploring the existing literature.

METHODS

A scoping review was conducted implementing the appropriate framework and in accord with the PRISMA-ScR extension. A PubMed database search was made using a combination of terms to find publications in English from 2011 to 2021. Studies were included if they reported quantitative outcomes of the association between loneliness and suicidal experiences, including suicidal thoughts, plans, and/or attempts. Screening and data charting of the published literature was conducted by a panel of authors. The accuracy and clarity of extracted data was checked by three reviewers.

RESULTS

Among 421 articles found, 31 full texts were evaluated based on exclusion and inclusion criteria, out of which, 18 papers that reported quantitative outcomes of the association between loneliness and suicidal experiences were included. We found that association between loneliness and suicidal behaviour is determined by individual, social and cultural factors. Co-existing mental illness, substance use disorder and economic hardship play an important role for the completion of suicide.

CONCLUSION

Loneliness is correlated with suicide, and the knowledge about this association could assist in the identification of suicidal individuals or those at elevated risk of suicidal behaviour. Future studies should focus on loneliness and its relation to suicidal ideation in individuals with different mental health disorders and personalities.

Living Alone and Suicide Risk in the United States, 2008‒2019

Objectives. To evaluate the association between living alone and suicide and how it varies across sociodemographic characteristics. Methods. A nationally representative sample of adults from the 2008 American Community Survey (n = 3 310 000) was followed through 2019 for mortality. Cox models estimated hazard ratios of suicide across living arrangements (living alone or with others) at the time of the survey. Total and sociodemographically stratified models compared hazards of suicide of people living alone to people living with others. Results. Annual suicide rates per 100 000 person-years were 23.0 among adults living alone and 13.2 among adults living with others. The age-, sex-, and race/ethnicity-adjusted hazard ratio of suicide for living alone was 1.75 (95% confidence interval = 1.64, 1.87). Adjusted hazards of suicide associated with living alone varied across sociodemographic groups and were highest for adults with 4-year college degrees and annual incomes greater than $125 000 and lowest for Black individuals. Conclusions. Living alone is a risk marker for suicide with the strongest associations for adults with the highest levels of income and education. Because these associations were not controlled for psychiatric disorders, they should be interpreted as noncausal. (Am J Public Health. 2022;112(12):1774-1782. https://doi.org/10.2105/AJPH.2022.307080).

Suicidal behaviours (ideation, plan and attempt) among school-going adolescents: A study of prevalence, predisposing, and protective factors in Saint Vincent and the Grenadines

Suicide occurs throughout life and is among the leading causes of death among adolescents globally. Aside from the growing literature on this serious mental health issue, little is known about the prevalence of suicide and the variables that predispose and protect adolescents against it in Saint Vincent and the Grenadines. We analysed the Global School-based Student Health Survey data collection among school-going adolescents in Saint Vincent and the Grenadines to explore the prevalence, risk and protective variables associated with suicidal behaviours. We observed prevalence rates of 26%, 26%, and 19% for suicide ideation, plan, and attempt, respectively. Furthermore, sex (being male) and having parents or guardians who understand the problems and worries of adolescents served as protective factors against all three suicide behaviours. However, we observed truancy, cigarette smoking, bullying victims (on/off school property), being cyberbullied, loneliness, and worry as risk factors for suicide ideation among adolescents. Risk for suicide plan was predicted by truancy, cigarette smoking, physical fight, bullying victims (on/off school property), being cyberbullied, loneliness, and worry. After controlling for other factors, truancy, amphetamine or methamphetamine use, cigarette smoking, physical fight, bullying victims (on/off school property), serious injury, close friends, loneliness, and worrying about life issues predicted suicide attempt risk among adolescents in Saint Vincent and the Grenadines. Early identification and suicide prevention interventions focusing on identified protective and risk factors may help minimise the prevalence of suicide behaviours among school-going adolescents in Saint Vincent and the Grenadines.

Scrutinizing the Profile and Risk Factors of Suicide: A Perspective from a Case-Control Study Focused on a Northern Region of Spain

Suicide is a major public health problem the prevention of which has become a priority, and, to this end, knowledge of its risk factors is essential. This study aims to evaluate the impact of some social, medico-legal, and clinical issues on suicide deaths. A total of 135 cases were identified as suicides that occurred in a region of northern Spain between 2018 and 2020. Controls (three for each case) were matched by age, sex, and urban-rural areas. The information was collected retrospectively through electronic health record systems. A binary logistic regression analysis was performed to study the association between individual risk factors and suicide. Being male (78.5%), between 40 and 60 years of age, unmarried (70.9%), and unemployed (85%) were associated with suicide deaths. Although the existence of a previous self-harm attempt is presented as the most robust risk factor (OR 22.121 [8.997-54.389]), the presence of a psychiatric diagnosis (OR 12.583 [7.686-20.601]) and cancer (OR 3.729 [1.845-7.536]) also showed a significant relationship with suicide (p < 0.05). Defining and knowing the risk factors for suicide helps to better understand the profiles of those individuals who are vulnerable, and enables prevention actions to be taken in both social and medical spheres.

Living alone is associated with a higher prevalence of psychiatric morbidity in a population-based cross-sectional study

Background

Living alone has been linked to poor mental health, however large-scale epidemiological studies on the association between living alone and psychiatric morbidity including depression and anxiety are lacking. The aim of this study was to investigate this issue in a large Taiwanese cohort.

Methods

In this cross-sectional study, we enrolled 121,601 volunteers from 29 community recruitment stations in Taiwan and divided them into two groups based on whether or not they lived alone. Psychiatric morbidity was defined as a Generalized Anxiety Disorder 2-item score ≥ 3, Patient Health Questionnaire 2-item score ≥ 3, or self-reported depression. Logistic regression was used to explore the associations between living alone and psychiatric morbidity.

Results

The participants who lived alone had a higher prevalence of psychiatric morbidity [odds ratio (OR) = 1.608, 95% confidence interval (CI) = 1.473 to 1.755] after adjusting for potential confounders. In a subgroup analysis, married subjects who lived alone and divorce/separation (OR = 2.013, 95% CI = 1.763 to 2.299) or widowing (OR = 1.750, 95% CI = 1.373 to 2.229) were more likely to have psychiatric morbidity than those who were married and not living alone.

Conclusions

Our findings suggest that living alone is a risk factor for psychiatric morbidity, especially for married subjects who live alone in concordance with divorce, separation, or the death of a spouse.

Loneliness and the onset of new mental health problems in the general population

PURPOSE

Loneliness is associated with poor health including premature mortality. There are cross-sectional associations with depression, anxiety, psychosis, and other mental health outcomes. However, it is not known whether loneliness is causally linked with the new onset of mental health problems in the general population. Longitudinal studies are key to understanding this relationship. We synthesized evidence from longitudinal studies investigating the relationship between loneliness and new onset of mental health problems, in the general population.

METHOD

We systematically searched six electronic databases, unpublished sources, and hand-searched references, up to August 2021. We conducted a meta-analysis of eight independent cohorts and narrative synthesis of the remaining studies.

RESULTS

We included 32 studies, of which the majority focused on depression. Our narrative synthesis found most studies show loneliness at baseline which is associated with the subsequent new onset of depression. The few studies on anxiety and self-harm also showed a positive association. Our meta-analysis found a pooled adjusted odds ratio of 2.33 (95% CI 1.62-3.34) for risk of new onset depression in adults who were often lonely compared with people who were not often lonely. This should be interpreted with caution given evidence of heterogeneity.

CONCLUSION

Loneliness is a public mental health issue. There is growing evidence it is associated with the onset of depression and other common mental health problems. Future studies should explore its impact across the age range and in more diverse populations, look beyond depression, and explore the mechanisms involved with a view to better informing appropriate interventions.

Volunteer peer support frameworks supporting older women living alone

Volunteer peer support is an approach that enables a supportive connection between volunteers and a sub-set of community members with shared experiences or interests. To implement co-designed strategies to support older women to maintain independence and optimise wellbeing in Australia, a volunteer peer support approach was proposed. There was limited literature describing volunteer peer support frameworks to underpin interventions of this kind; and given the increasing desire for engagement of individuals and communities, articulation of the key components of such a framework is warranted. In this paper, we define volunteers and peer support, and outline existing frameworks for volunteering and peer support. We then describe the volunteer peer support framework developed for this intervention, outlining the key requirements. This information will enable others to develop an effective and sustainable structure for peer support volunteer services.

Examining Differences, Relationships, and Predictors for Loneliness in an Adult Population: The Roles of Personal Characteristics, Place of Residence, Leisure Activities, Mental Health, and Social Outcomes

Loneliness is associated with poor mental and social outcomes globally. The literature suggests an association between loneliness and personal characteristics, place of residence, and leisure activities. However, the current literature has produced inconsistent findings and has focused largely on older adults. This study is one of the first to examine the differences, relationships, and predictors of loneliness in an adult population, and the roles of personal characteristics, place of residence, leisure activities, mental health, and social outcomes. A cross-sectional online survey was undertaken. A sample of 155 adults responded, with a mean age of 34.5 years (SD = 13.2), and with 54.1% identifying as female. An analysis revealed experiences of loneliness across the sample. In addition, age was moderately associated with loneliness, while psychological distress, depressive symptoms, and social networks were significantly associated with loneliness. Depressive symptoms were a positive predictor for loneliness, and social networks were a negative predictor for loneliness. This study has confirmed findings from previous research and provided new information on loneliness, which can guide future research and interventions to prevent or support people who suffer from loneliness.

Development of a Checklist for Predicting Suicidality Based on Risk and Protective Factors: The Gwangju Checklist for Evaluation of Suicidality

OBJECTIVE

The aim of the study was to develop a checklist for mental health clinicians to predict and manage suicidality.

METHODS

A literature review of the risk and protective factors for suicide was conducted to develop a checklist for evaluating suicidality.

RESULTS

The fixed risk factors included sex (male), age (older individuals), history of childhood adversity, and a family history of suicide. Changeable risk factors included marital status (single), economic status (poverty), physical illness, history of psychiatric hospitalization, and history of suicide attempts. Recent discharge from a mental hospital and a recent history of suicide attempts were also included. Manageable risk factors included depression (history and current), alcohol problems (frequent drinking and alcohol abuse), hopelessness, agitation, impulsivity, impaired reality testing, and command hallucinations. Protective factors included responsibility to family, social support, moral objections to suicide, religiosity, motivation to get treatment, ability to cope with stress, and a healthy lifestyle. A final score was assigned based on the sum of the risk and protective factor scores.

CONCLUSION

We believe that the development of this checklist will help mental health clinicians to better assess those at risk for suicidal behavior. Further studies are necessary to validate the checklist.

Suicide mortality among the elderly population in Italy: A nationwide cohort study on gender differences in sociodemographic risk factors, method of suicide, and associated comorbidity

OBJECTIVES

This study aimed at investigating gender differences in the relationship between sociodemographic factors and suicide mortality, as well as in the method used for suicide and the presence of comorbidities in an older population in Italy.

METHODS/DESIGN

We conducted a historical cohort study based on individual record linkage across the 15th Italian Population Census, the Italian Population Register, and the National Register of Causes of Death. Suicides among people aged 75 years or older from 2012 to 2017 were analyzed. Crude mortality rates were computed, and cause-specific mortality rate ratios were estimated using negative binomial regression models. Chi-square tests were used to evaluate significant gender differences in suicide methods and comorbidities associated with suicide.

RESULTS

The study included 9,686,698 individuals (41% men, 59% women). Compared to living alone, living with children or partners reduced suicide mortality, especially among men. Having high or medium educational levels was associated with lower mortality than low educational levels among men. Foreign citizens had lower mortality among men, but not among women. Living in urban areas was associated with lower suicide rates in men and higher rates in women. Methods of suicide significantly differed by gender: leading methods were hanging, strangulation, and suffocation in men, and falling from height in women. Mental comorbidity was significantly more frequent among women, especially at ages 75-84 years.

CONCLUSIONS

We believe that our findings might help to promote public health strategies taking gender differences in old age into account to improve social support and quality of life of older men and women.

Suicidal Ideation among University Students: A Moderated Mediation Model Considering Attachment, Personality, and Sex

The present study aimed to examine the link between attachment, personality traits, and suicidal ideation with consideration of the potential moderating role of age and sex. The Suicidal History Self-Rating Screening Scale, the Personality Inventory for DSM-5-Brief Form, and the Attachment Style Questionnaire were administered to 183 students. There was a significant indirect effect of need for approval on suicidal ideation via detachment. Moreover, the moderated mediation models of need for approval and preoccupation with relationships on suicidality via negative affectivity were significant in men, but not women, whereas the moderated mediation model of need for approval on suicidality via detachment was significant in women, but not men. Young men and women seem at risk for increased suicidal ideation based on specific attachment and personality characteristics, which should be considered for the development of prevention and therapeutic interventions.

Depression and loneliness may predict work inefficiency among professionally active adults

Purpose

Both depression and loneliness have been recognized as major public health issues, yet investigation into their role among young and middle-aged, professionally active persons is still required. The aim of the present study was to evaluate whether depression and loneliness may independently predict inefficiency at work among professionally active adults.

Methods

This is a cross-sectional study on a representative, nationwide sample. 1795 questionnaires were gathered from among professionally active adults from Poland from 1 to 31 July 2018 with a direct pen-and-paper interview. The sample was chosen by means of the stratified random method. The survey included a Patient Health Questionnaire (PHQ-9) to measure depression and questions, devised by the authors, relating to loneliness and inefficiency at work. Regression models were constructed with depression and loneliness as predictors of inefficiency at work, unadjusted and adjusted for selected sociodemographic, health- and work-related factors.

Results

In the unadjusted models, both depression and loneliness were independently associated with an increase of work inefficiency and absence from work, with effect sizes being higher for loneliness than for depression. After accounting for the control variables (i.e., sociodemographic, work- and health-related factors), the PHQ-9 score, but not the loneliness score, was associated with an increased probability of frequent thoughts about changing or leaving a job.

Conclusion

Depression and loneliness independently predicted occupational functioning and differentially affect its various aspects. Counteracting depression and loneliness among employees should be regarded as a public health priority.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-022-01869-1.

Predicting self-harm and suicide ideation during the COVID-19 pandemic in Indonesia: a nationwide survey report

BACKGROUND

It is estimated that 77.0% of suicide cases occurred in low-and-middle-income countries (LMICs), which would increase because of the COVID-19 pandemic and socioeconomic inequity. However, there is lack of reports on this topic from LMICs, especially during the pandemic. Therefore, this nationwide study aimed to explore self-harm and suicide ideation and its predictive variables during the pandemic in Indonesia as a MIC with the highest COVID-19 fatality rate in Asia.

METHODS

Non-random sampling online survey was conducted nationwide between 25 May and 16 June 2021. The collected data were demographic variables (i.e. age group), loneliness from social isolation using The UCLA Loneliness Scale Six Items (ULS-6), and self-harm and suicide ideation using item 9 of The Patient Health Questionnaire-9 (PHQ-9). Predictive model was analyzed using hierarchical logistic regression.

RESULTS

A total of 5211 participants from all 34 provinces in Indonesia completed the survey. Among 39.3% of them reported self-harm and suicide ideation during the pandemic, which significantly correlated with loneliness. The predictive variables associated with the likelihood of self-harm and suicide ideation were age, residence, job, religion, sex-gender, sexual orientation, HIV status, disability status, and loneliness. The predictive model showed a significant goodness-of-fit to the observed data (x² [ (15)] = 1803.46, p < .001), R_N² = .40.

CONCLUSION

Four out of 10 Indonesians experienced self-harm and suicide ideation during the COVID-19 pandemic, particularly people within the age range of 18-24, living in the Java Island, unemployed/student/retired and freelancer, women, members of minority and marginalized communities, and experience of loneliness during the pandemic.

The influence of personality on the risk of myocardial infarction in UK Biobank cohort

Personality is a strong determinant for several health-related behaviours and has been linked to the development of cardiovascular diseases. However, the reports of personality's mediating role have been inconsistent with no data available from large population-based cohorts. The study aimed to create proxies for the Big Five personality traits, extraversion, agreeableness, conscientiousness, openness and neuroticism, to examine the longitudinal relationship between personality and myocardial infarction in the UK Biobank. The study sample comprised of 484,205 participants (55% female, 45% male, mean age 56.4 ± 8.1 years) from UK Biobank cohort with a mean follow-up of 7 years. The personality proxies sociability, warmth, diligence, curiosity and nervousness were created using self-reported data on psychological factors, mental health and social support, to match the facets of the Big Five traits. As neuroticism is the only Big Five personality trait available in the UK Biobank, it was included to validate the personality proxies. Myocardial infarction outcome information was collected from hospital records, death registries or was self-reported. Logistic regression and Cox proportional hazard regression were used to estimate odds ratio (OR) and hazard ratios (HR), respectively with 95% confidence intervals (CI) adjusted for demographics (age, sex, socioeconomic status, ethnicity), health-related factors (BMI, diabetes, systolic and diastolic blood pressure) and lifestyle factors (alcohol intake, smoking, and moderate-to-vigorous physical activity). Diligence was found to be significantly associated with lower prevalent myocardial infarction [OR: 0.87; (CI 0.84-0.89)] and lower incident myocardial infarction [HR: 0.88; (CI 0.85-0.92)]. Sociability was also protective against prevalent [OR: 0.89; (CI 0.87-0.92)] and incident [HR: 0.90; (CI 0.87-0.93)] myocardial infarction. Conversely, nervousness inferred a higher risk for both prevalent [OR: 1.10; (CI 1.08-1.12)] and incident [HR: 1.07; (CI 1.04-1.09)] myocardial infarction during follow-up. Sex-stratified analyses revealed that nervousness significantly increases the risk for incident myocardial infarction among women [HR: 1.13; (CI 1.08-1.19)] compared to men [HR: 1.05; (CI 1.02-1.08)]. By using our created proxies, we were able to investigate the impact of personality on the development of myocardial infarction. Persons with higher levels of diligence and sociability mimicking predominantly conscientiousness and extraversion personalities respectively are less likely to experience myocardial infarction, while personalities predominantly characterised by nervousness pose higher risk for developing myocardial infarction. These initial findings invite further validation of the use of the personality proxies in UK Biobank cohort.