The causal effect of education and cognitive performance on risk for suicide attempt: A combined instrumental variable and co-relative approach in a Swedish national cohort

Breakfast consumption was associated with suicidal ideation, plan, and attempt: a population-based cross-sectional study

Background

Although several studies have explored the association between breakfast consumption and suicidal behaviors among children and adolescents, such associations have been less frequently reported among adults and seniors.

Method

This population-based cross-sectional study was conducted in Hebei Province, China. A total of 21, 376 community residents aged 18 years and older were interviewed. This study evaluated the breakfast frequency per week (BFF), full breakfast frequency (FBF), suicidal ideation, suicide plans, and suicide attempts of the participants. Sociodemographic variables, living alone, and sleep quality were also measured.

Results

The prevalence of suicidal ideation, plans, and attempts were 1.4, 0.3, and 0.2%, respectively. Compared to ≥6 days/week BFF, 2-3 days/week BFF was positively associated with suicidal ideation (OR = 1.93, p < 0.01), suicide plan (OR = 2.73, p < 0.05), and suicide attempts (OR = 3.46, p < 0.05). In addition, participants with 2-3 days/week FBF was also at higher risk of suicidal ideation (OR = 2.06, p < 0.001), comparing with never FBF.

Conclusion

The reported prevalence of suicidal ideation, plans, and attempts were lower compared to other countries. Lower breakfast frequency was positively associated with suicidal behaviors, and participants with 2-3 days/week of full breakfast consumption were also at a higher risk of suicidal ideation.

Suicidal Thoughts and Behaviors in People on the Autism Spectrum

PURPOSE OF REVIEW

This review synthesizes recent research on suicidal thoughts and behaviors among autistic individuals. We present literature on risk and protective factors, risk assessment, intervention, and crisis services, and recommendations for future research.

RECENT FINDINGS

Literature on this topic has grown substantially in recent years. Areas of advancement include improved understanding of risk factors (e.g., Interpersonal Theory of Suicide constructs, autistic burnout, mental health conditions, cognitive factors, diagnosis timing, emotion dysregulation), screening, assessment, acute-care services, and suicide-specific psychosocial treatments (e.g., safety planning, dialectical behavior therapy). Gaps include protective factors, impact of intersectional identities, and tailored approaches to screening, assessment, and intervention. Heightened awareness of suicide risk in autistic individuals has led to increased understanding of why autistic individuals think about and attempt suicide and the strategies used to identify and reduce suicide risk. We recommend community-partnered, multi-faceted, and strength-based approaches to inform tailored prevention and intervention efforts.

Proinflammatory cytokine levels, cognitive function, and suicidal symptoms of adolescents and young adults with major depressive disorder

Whether proinflammatory cytokine dysregulation and cognitive dysfunction are associated with suicidal symptoms in adolescents and young adults with major depressive disorder (MDD) remains uncertain. We assessed the cognitive function and proinflammatory cytokine levels of 43 and 51 patients aged 15-29 years with MDD and severe and mild suicidal symptoms, respectively, as well as those of 85 age- and sex-matched healthy controls. Specifically, we measured serum levels of C-reactive protein, tumor necrosis factor-α (TNF-α), interleukin-2, and interleukin-6 and assessed cognitive function by using working memory and go/no-go tasks. The severity of the patients' suicidal symptoms was based on Item 10 of the Montgomery-Åsberg Depression Rating Scale; scores of ≤ 2 and ≥ 4 indicated mild and severe symptoms, respectively. The patients with MDD and severe suicidal symptoms had higher levels of C-reactive protein (p = .019) and TNF-α (p = .002) than did the patients with mild symptoms or the healthy controls. The number of errors committed on the go/no-go by patients with MDD and severe suicidal symptoms (p = .001) was significantly higher than those by patients with MDD and mild symptoms or by controls. After adjusting for nonsuicidal depressive symptoms, we observed suicidal symptoms to be positively associated with TNF-α levels (p = .050) and errors on the go/no-go task (p = .021). Compared with mild suicidal symptoms, severe symptoms are associated with greater serum levels of proinflammatory cytokines and inferior cognitive function in adolescents and young adults with MDD.

Inpatients with a history of suicide attempts in routine clinical care exhibit specific characteristics regarding sociodemographics, life events, personality, and symptom burden

Research indicates that patients with a lifetime history of suicide attempts are particularly burdened. However, investigations of their characteristics and comparisons with other patients are scarce. This study aimed to fill this research gap, using routine clinical data and guided by theoretical models. Data of N = 706 patients (54.4% women) was collected at the psychosomatic inpatient/day-clinic unit of a German university clinic. It comprised sociodemographic data and information about previous experiences (e.g., childhood abuse and neglect), symptom measures (e.g., the PHQ-9) and individual differences (e.g., the level of personality functioning assessed with the OPD-SQS). Groups were compared using independent t-tests or χ2-tests. Of the total sample, 118 patients (16.7%) reported suicide attempts. Those with a history of suicide attempts were more likely to have a migration background and a lower level of education, smoke (heavily) and use illegal substances. They reported lower levels of personality functioning, more current symptoms and traumatic previous experiences of abuse and neglect. Screening for previous suicidal behavior as well as associated factors can yield valuable information for clinical practice. Many group differences map onto previously observed specific risk factors for suicidal behavior, supporting the conceptual models and underscoring their relevance among clinical populations as well.

Risk of suicidal behavior as a function of alcohol use disorder typologies: A Swedish population-based study

BACKGROUND AND AIMS

Alcohol use disorder (AUD) is one of the strongest predictors of suicidal behavior. Here, we measured risk of suicide attempt and death as a function of AUD typologies.

DESIGN

We used AUD typologies from previous latent class analysis: (i) externalizing subtype (characterized by externalizing symptomatology and early age of onset; individuals in this group have lower education and higher familial/social difficulties); (ii) subtype described by minimal psychopathology; and (iii) internalizing subtype (characterized by internalizing symptomatology and later age of onset; individuals in this group have higher education). We used class membership to predict distal outcomes (attempt and death) and performed regressions to evaluate whether differences in suicidal behavior were explained by the group characteristics (sex, age of onset, number and type of AUD registrations, familial/genetic risk for AUD, externalizing and internalizing behaviors, socio-economic indicators, marital status and childhood family status). We also evaluated the effect of suicide attempt prior to AUD.

SETTING AND PARTICIPANTS

Based on longitudinal Swedish registry data, we included 217 074 individuals with AUD born 1950-80.

MEASUREMENTS

Suicide attempts were identified using medical registers and deaths using the mortality register.

FINDINGS

Individuals with the externalizing subtype had higher risks of suicidal behavior than other groups [attempt: externalizing versus minimal psychopathology: odds ratio (OR) = 1.35, 95% confidence interval (CI) = 1.35, 1.35; externalizing versus internalizing: OR = 1.47, 95% CI = 1.46, 1.48; death: externalizing versus minimal psychopathology: OR = 1.57, 95% CI = 1.57, 1.58; externalizing versus internalizing: OR = 1.99, 95% CI = 1.93, 2.06]. Individuals with minimal psychopathology had higher risks than those with internalizing symptomatology (attempt: OR = 1.09, 95% CI = 1.08, 1.10, death: OR = 1.26, 95% CI = 1.23, 1.30). These differences were explained by age at registration and were related to the number of registrations, sex, education, family disruption and suicide attempt prior to AUD.

CONCLUSIONS

Among people in Sweden, considering alcohol use disorder (AUD) heterogeneity appears to be a meaningful way to evaluate suicide risk. The highest risk of suicide attempt and death occurs in the externalizing subtype of AUD, followed by the minimal psychopathology subtype, and then the internalizing subtype.

Suicide Risk Analysis and Psycho-Emotional Risk Factors Using an Artificial Neural Network System

Suicidal behavior among young people has become an increasingly relevant topic after the COVID-19 pandemic and constitutes a public health problem. This study aimed to examine the variables associated with suicide risk and determine their predictive capacity. The specific objectives were: (1) to analyze the relationship between suicide risk and model variables and (2) to design an artificial neural network (ANN) with predictive capacity for suicide risk. The sample comprised 337 youths aged 18-33 years. An ex post facto design was used. The results showed that emotional attention, followed by problem solving and perfectionism, were variables that contributed the most to the ANN's predictive capacity. The ANN achieved a hit rate of 85.7%, which is much higher than chance, and with only 14.3% of incorrect cases. This study extracted relevant information on suicide risk and the related risk and protective factors via artificial intelligence. These data will be useful for diagnosis as well as for psycho-educational guidance and prevention. This study was one of the first to apply this innovative methodology based on an ANN design to study these variables.

Risk of non-fatal suicide attempt in individuals with substance use disorder: the roles of aggregate genetic liability and environmental exposures in a Swedish population-based cohort

BACKGROUND AND AIMS

Substance use disorder (SUD) is related to widespread adverse consequences, including higher suicidality. Shared genetic liability has been demonstrated between SUD and suicidality. Here, we measured the factors that contribute to increased risk of non-fatal suicide attempt among individuals with SUD by focusing upon aggregate genetic risks and both childhood and past-year environmental factors.

DESIGN

Longitudinal study. Family genetic risk scores and environmental factors (childhood, aged from 0 to 15 years, and the year preceding SUD registration) were used to predict the relative risk of non-fatal suicide attempt using Cox proportional hazards models. Additional analyses employed a co-relative design, accounting for genetic factors and shared familial environment, to test for potential causality.

SETTING AND PARTICIPANTS

Based on longitudinal Swedish registry data, 228 617 individuals with SUD registrations from 1991 to 2015 were included.

MEASUREMENTS

SUD and suicide attempts were identified using medical records (International Classification of Diseases codes). SUD was also identified using pharmacy and criminal registries.

FINDINGS

In multivariable analyses that jointly accounted for all the selected potential predictors, individuals with SUD were at higher risk for non-fatal suicide attempt if they had experienced a parental death [hazard ratio (HR) = 1.58; 95% confidence interval (CI) = 1.30, 1.93], were female (HR = 1.53, 95% CI = 1.49, 1.57), had low educational attainment (HR = 1.50, 95% CI = 1.46, 1.55), received social welfare (HR = 1.21, 95% CI = 1.17, 1.25) or had lived in a non-intact family (HR = 1.11, 95% CI = 1.08, 1.14). In co-relative analyses, low education was supported as a possible causal factor for suicide attempt. Aggregate genetic risks interacted with low education and being raised in a non-intact family, with increased prevalence of suicide attempt in people with high genetic risks and unfavorable environmental exposures.

CONCLUSIONS

Aggregate genetic liability, childhood environmental experiences and specific socio-economic indicators are important risk factors for non-fatal suicide attempt among individuals with substance use disorder.