Estimating the risk of suicide associated with mental disorders: A systematic review and meta-regression analysis

Utilization of mental health care among people bereaved by suicide in Norway: A trajectory analysis

BACKGROUND

Losing a loved one to suicide is an extremely stressful event that is associated with mental health issues. However, little is known about the health care utilization of those bereaved by suicide. Identifying distinct trajectories of mental health care utilization can help reveal gaps in service provision, barriers to access, and opportunities for targeted interventions.

AIMS

To uncover distinct patterns of mental health care utilization in association with suicide bereavement and explore sociodemographic factors and subsequent suicide risk associated with these patterns.

METHOD

We analyzed Norwegian population-wide registry data on mental health care utilization at three different levels among 14 781 adults bereaved by suicide from 2010 to 2019 using group-based multi-trajectory modeling to identify groups with distinct mental health care utilization trajectories. Socio-demographic differences between trajectory groups were analyzed in multinomial logistic regression models and the associated risk of suicide was obtained with cox proportional hazards regression models.

RESULTS

We identified four distinct trajectories of mental health care utilization. Two distinct groups of individuals bereaved by suicide either rarely contacted mental health care providers ("Low") or only consulted with general practitioners only ("GP only"). In the latter group, the utilization rate increased post-bereavement. One group of bereaved ("Acute increase") increased their mental health care utilization significantly after the loss, while another group ("High") consistently had a high utilization rate. These groups differed with respect to kinship to the deceased and sociodemographic factors. Individuals in the "GP only" and "High" group had significantly higher risk of suicide when compared to those in the "Low" group.

CONCLUSIONS

Individuals bereaved by suicide exhibited diverse patterns of mental health care utilization, reflecting a broad spectrum of needs and responses to loss.

Life expectancy associated with specific mental disorders and the contribution of causes of death: a population-based study in the region of Catalonia

There is strong evidence that people with mental disorders have a premature mortality, with physical diseases, as well as suicide, accounting for it in large part. However, there is a lack of studies focused on common mental disorders in Southern Europe. This study aims to calculate the reduction in life expectancy for different mental disorders according to all-cause mortality and for specific causes of death using national registers from Catalonia (Spain). This population register-based study includes clinical information on all adults over 18 years of age using the Catalan public healthcare system from January 2005 to December 2016 (355,540 females and 182,529 males with mental disorders). Mental disorders were classified into eleven categories, and causes of death were grouped as natural and unnatural and then further divided into nine groups. For each disorder, the life-years lost were estimated for all-cause mortality and for each specific cause of death in males and females. All mental disorders showed a shorter remaining life expectancy after diagnosis than the reference population of the same age. The disorders associated with the largest reduction in life expectancy were alcohol and drug dependence and abuse, and schizophrenia. Natural causes and, to a lesser extent, suicide, were the predominant contributors to excess mortality for all types of mental disorders. Our findings suggest that mental disorders are associated with premature mortality in Catalonia. Furthermore, natural causes are the primary contributors to premature mortality, indicating the need for better management of medical conditions in this population.

Emotional memory biases in bipolar depressed patients with high suicide risk

Emotional memory bias, a neurocognitive deficit commonly observed in mood disorders, refers to the tendency to remember emotionally charged information more precisely than healthy individuals. While this phenomenon has been explored in various psychiatric conditions, its specific relationship with suicide risk in patients with bipolar disorder during major depressive episodes remains unknown. Given the high prevalence of suicide in bipolar disorder, this study sought to examine the association between emotional memory bias and suicide risk in patients with bipolar depression. A recognition memory task was utilized, where participants (51 high-risk, 21 low-risk) viewed words with positive or negative valence and later identified whether they had been previously presented. Mixed-model analyses of covariance, controlling for age and depression severity, revealed that the high-risk group demonstrated a stronger bias toward negative stimuli. They exhibited more accurate recognition of negative words ("hits") and a higher tendency to incorrectly identify non-presented negative words as presented ("false alarms") compared to the low-risk group. These findings suggest that heightened emotional memory bias, particularly toward negative information, may be a key cognitive marker of suicide risk in patients with bipolar depression. Understanding this bias may inform targeted interventions aimed at reducing suicide risk in this population.

Suicide methods and severe mental illness: A systematic review and meta-analysis

INTRODUCTION

People with severe mental illness (SMI) have a higher risk of suicide compared with the general population. However, variations in suicide methods between people with different SMIs have not been examined. The aim of this pre-registered (PROSPERO CRD42022351748) systematic review was to pool the odds of people with SMI who die by suicide versus those with no SMI, stratified by suicide method.

METHODS

Searches were conducted on December 11, 2023 across PubMed, PsycInfo, CINAHL, and Embase. Eligible studies were those that reported suicide deaths stratified by SMI and suicide methods. Studies were pooled in a random-effects meta-analysis, and risk of bias was measured by the Joanna Briggs Institute checklist.

RESULTS

After screening, 12 studies were eligible (n = 380,523). Compared with those with no SMI, people with schizophrenia had 3.38× higher odds of jumping from heights (95% CI: 2.08-5.50), 1.93× higher odds of drowning (95% CI: 1.50-2.48). People with bipolar disorder also had 3.2× higher odds of jumping from heights (95% CI: 2.70-3.78). Finally, people with major depression had 3.11× higher odds of drug overdose (95% CI: 1.53-6.31), 2.11× higher odds of jumping from heights (95% CI: 1.93-2.31), and 2.33× lower odds of dying by firearms (OR = 0.43, 95% CI: 0.33-0.56). No studies were classified as high risk of bias, and no outcomes had high levels of imprecision or indirectness.

CONCLUSION

These findings could inform lethal means counselling practices in this population. Additionally individual, clinical, community and public health interventions for people with SMI should prioritise, where feasible, means restriction including access to heights or drugs to overdose.

Rethinking Depression-Beyond Neurotransmitters: An Integrated Psychoneuroendocrineimmunology Framework for Depression's Pathophysiology and Tailored Treatment

It is known that the effectiveness of drug treatment for depression, ammine deficit based, is largely unsatisfactory. In this review, we examine the proposal of a precision therapy has emerged and has received a strong push by the identification of the role of inflammation in depression. However, precision psychiatry risks being caught in the reductionist trap of searching for the molecular switch that resets the whole system and switches off the disease. This is an illusion since the human being is complex and depression is a systemic and variable disorder. In this study, we show the inadequacy of the reductionist paradigm, and, at the same time, illustrate the superiority of the systemic paradigm centered on psychoneuroendocrineimmunology (PNEI). According to the PNEI paradigm, depression is a disease of the whole human being, caused by different sources working together: psychological, biological, and behavioral. This means knowing the biological and psychological history of the subject, identifying relational and biological crisis factors, and building personalized treatments targeting those factors with the tools of medicine and psychology, which are not reducible to the combination of drugs and psychotherapy. Our proposal presents a paradigm shift that is both theoretical and practical, which enables clinicians to assess patients experiencing depression in a unified way and treat them in an integrated manner.

Mental disorders and excess mortality: a systematic review protocol

BACKGROUND

There is developing evidence of excess mortality among people with mental disorders. This protocol presents the methodology to undertake a systematic review to definitively examine the current evidence on the risk of all-cause and cause-specific mortality in people with mental disorders (mood, anxiety, substance use, eating, personality and psychotic disorders) compared with populations without mental disorders in broadly representative studies of general populations worldwide. In addition, we seek to understand whether the excess mortality has increased further over time, and if the COVID-19 pandemic exacerbated the excess mortality in people with mental disorders.

METHODS

A systematic review of cohort studies will be conducted. The search strategy to yield peer-reviewed (in Medline Complete, CINAHL Complete, Embase and APA PsycInfo) and published grey literature will be developed in consultation with a liaison librarian. A preliminary scope of peer-reviewed literature in Medline Complete using the EBSCOhost platform was conducted on 20 November 2023. Epidemiological cohort or case-control studies will be eligible if they examine (1) diagnoses of mental disorders (according to the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases classification systems) and (2) risk of all-cause and/or cause-specific mortality. A critical appraisal of the included studies will be undertaken. A synthesis of the findings will include the characteristics of the included studies, critical appraisal and a summary of the key findings in texts and visually in tables. Where appropriate, meta-analyses and subgroup analyses will be performed.

ETHICS AND DISSEMINATION

This study is exempt from ethics approval, as it does not include identifiable human data. The outcomes of the proposed review will be shared in national/international conferences, published in a peer-reviewed journal and disseminated to new and existing networks.

PROSPERO REGISTRATION NUMBER

CRD42023477494.

Global, regional, and national burden of suicide, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Deaths from suicide are a tragic yet preventable cause of mortality. Quantifying the burden of suicide to understand its geographical distribution, temporal trends, and variation by age and sex is an essential step in suicide prevention. We aimed to present a comprehensive set of global, regional, and national estimates of suicide burden.

METHODS

We produced estimates of the number of deaths and age-standardised mortality rates of suicide globally, regionally, and for 204 countries and territories from 1990 to 2021, and disaggregated these results by age and sex. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 estimates of deaths attributable to suicide were broken down into two comprehensive categories: those by firearms and those by other specified means. For this analysis, we also produced estimates of mean age at the time of death from suicide, incidence of suicide attempts compared with deaths, and age-standardised rates of suicide by firearm. We acquired data from vital registration, verbal autopsy, and mortality surveillance that included 23 782 study-location-years of data from GBD 2021. Point estimates were calculated from the average of 1000 randomly selected possible values of deaths from suicide by age, sex, and geographical location. 95% uncertainty intervals (UIs) were derived from the 2·5th and 97·5th percentiles from a 1000-draw distribution.

FINDINGS

Globally, 746 000 deaths (95% UI 692 000-800 000) from suicide occurred in 2021, including 519 000 deaths (485 000-556 000) among males and 227 000 (200 000-255 000) among females. The age-standardised mortality rate has declined over time, from 14·9 deaths (12·8-15·7) per 100 000 population in 1990 to 9·0 (8·3-9·6) per 100 000 in 2021. Regionally, mortality rates due to suicide were highest in eastern Europe (19·2 [17·5-20·8] per 100 000), southern sub-Saharan Africa (16·1 [14·0-18·3] per 100 000), and central sub-Saharan Africa (14·4 [11·0-19·1] per 100 000). The mean age at which individuals died from suicide progressively increased during the study period. For males, the mean age at death by suicide in 1990 was 43·0 years (38·0-45·8), increasing to 47·0 years (43·5-50·6) in 2021. For females, it was 41·9 years (30·9-46·7) in 1990 and 46·9 years (41·2-52·8) in 2021. The incidence of suicide attempts requiring medical care was consistently higher at the regional level for females than for males. The number of deaths by suicide using firearms was higher for males than for females, and substantially varied by country and region. The countries with the highest age-standardised rate of suicides attributable to firearms in 2021 were the USA, Uruguay, and Venezuela.

INTERPRETATION

Deaths from suicide remain variable by age and sex and across geographical locations, although population mortality rates have continued to improve globally since the 1990s. This study presents, for the first time in GBD, a quantification of the mean age at the time of suicide death, alongside comprehensive estimates of the burden of suicide throughout the world. These analyses will help guide future approaches to reduce suicide mortality that consider a public health framework for prevention.

FUNDING

Bill & Melinda Gates Foundation.

Suicidal Ideation Among Persons With Psychiatric Disorders: A Cross-Sectional Study at Outpatient Clinics in Iraq

Background and Aims

Mental illness is an important risk factor for suicidal ideation. However, little has been known about the burden and associated factors of suicidal ideation among persons with psychiatric disorders in Iraq. We aim to investigate the rate and the associated demographic and clinical factors of suicidal ideation among persons with mental illness in Iraq.

Methods

Data were collected from 388 persons with mental disorders from psychiatric outpatient clinics in Baghdad in 2023 for this cross-sectional study. The instrument contained socio-demographic and clinical variables, and the Columbia-Suicide Severity Rating Scale (C-SSRS). A descriptive analysis was conducted using the Chi-square test to determine the relationships in which a significance level of 0.05 was considered.

Results

Among the 388 respondents, 67% were males, and about half of the patients were younger than 40 years old. Affective (49.8%) and psychotic disorders (17.5%) were the most common mental disorders. The prevalence of suicidal ideation was 37.1% in the last year. The majority of suicidal ideation fell into a low severity range on the C-SSRS, particularly for patients who had no prior history of suicidal behavior. Suicidal ideation was significantly associated with female gender, crowded accommodations experiencing recent psychological trauma, presence of a family history of mental disorder, and family history of suicidal behavior.

Conclusions

Suicidal ideation was present in more than one-third of persons with psychiatric disorders. Policy-level implications could be warranted during regular appointments of psychiatric patients to identify risky individuals in outpatient settings.

States' COVID-19 policy contexts and suicide rates among US working-age adults

Despite expectations that suicide rates would surge during the pandemic, the national suicide rate declined in the United States in 2020 before returning to pre-pandemic levels in 2021. Explanations of the decline in suicides at the national level include a "pulling-together effect" in the face of a crisis and a shorter than expected pandemic recession. However, suicide rates and the change over time in suicide rates vary substantially across US states. At various times during the pandemic states enacted physical-distancing and economic support policies that may have affected suicide rates. We examined the association between state-level physical-distancing and economic support policy contexts and suicide rates among US adults ages 25-64 years during the COVID-19 pandemic. We found that a 1-SD increase in the stringency of a state's physical-distancing policies was associated with a 5.3% reduction in male suicide rates but was not associated with female suicide rates. Economic support policies were not associated with suicide rates for the period as a whole. The results support the growing evidence that COVID-19 policies had indirect and unintended consequences beyond their direct effect on COVID-19 transmission and death, in this case to reduce suicides among working-age males.

Latent Profiles of Early Maladaptive Schemas and Their Associations With Suicide Risk Factors in Patients With Mood Disorders

PURPOSE

Although early maladaptive schemas (EMSs) have been linked to suicidal ideation, their heterogeneous nature has not been fully explored in this relationship. This study sought to identify distinct latent profiles based on 18 EMSs in a clinical sample and examine how these profiles differ in relation to suicidal ideation and suicide risk factors, such as perceived burdensomeness, thwarted belongingness and fearlessness about death.

METHOD

Data from routine clinical assessments of 799 outpatients with mood disorders (aged 18-49 years, 513 female, 286 male, Mage = 28.71) were analysed. Latent profile analysis was performed to identify distinct EMS profiles, and their associations with suicide risk factors were examined using the Bolck-Croon-Hagenaars method.

RESULTS

Five distinct EMS profiles emerged: Low, Below Average, Above Average, Specific Elevation and High Risk. The Specific Elevation profile demonstrated specifically elevated levels of social isolation/alienation, defectiveness/shame, failure, dependence/incompetence and insufficient self-control/self-discipline, while the levels of most other schemas were similar to the Above Average profile. The High Risk profile showed elevated levels across all schemas. Both the Specific Elevation profile and the High Risk profile exhibited the highest levels of perceived burdensomeness, thwarted belongingness and suicidal ideation, with no significant differences between them. Fearlessness about death did not differ among the profiles.

CONCLUSION

The identified EMS profiles offer unique utility in predicting perceived burdensomeness, thwarted belongingness and suicidal ideation. The specific schemas that showed elevation in the Specific Elevation profile may serve as promising targets for mitigating suicide risk in patients with mood disorders.

Excess mortality and life-years lost in people diagnosed with depression: A 20-year population-based cohort study of 126,573 depressed individuals followed for 1,139,073 persons-years

Depression is associated with premature mortality, but evidence is mainly derived from Western countries. Very limited research has evaluated shortened lifespan in depression using life-years-lost (LYLs), a recently developed mortality metric taking into account the illness onset for life expectancy estimation. Temporal trends of differential mortality gap are understudied. This population-based cohort study, which utilized a territory-wide medical-record database of public inpatient and outpatient healthcare services in Hong Kong, evaluated the extent of premature mortality in 126,573 individuals with depression (persons-years=1,139,073) between January 2002 and December 2021 regarding the standardized mortality ratio (SMR) and excess LYLs. Trends in annual SMRs over 20 years were assessed by joinpoint analyses. The results showed that individuals with depression exhibited significantly higher all-cause (SMR=1.84 [95% CI=1.82-1.88]), natural-cause (1.69 [1.66-1.72]), and unnatural-cause (5.24 [4.97-5.51]) mortality rates than the general population. Suicide-specific SMR was markedly elevated (7.92 [7.47-8.38]), particularly in the 15-34 year-olds (12.75 [10.87-14.79]). Respiratory diseases, cardiovascular diseases and cancers accounted for the majority of deaths. Excess LYLs extended to men (5.67 years, 95% CI = 5.45-5.90) and women (4.06 years, 95% CI = 3.89-4.23). Overall and natural-cause mortality rates improved over time, but unnatural-cause and suicide-related mortality gaps persisted. Taken together, this study indicates that depression is associated with increased premature mortality and reduced lifespan in a predominantly Chinese population, mainly attributed to natural causes. Relative suicide-specific mortality is substantially elevated, especially among young people. The pronounced mortality gap underscores an urgent need for effective interventions targeting improved physical health and suicide risk reduction in individuals with depression.

Occupational Injury and Suicide in Washington State, Adjusting for Pre-Injury Depression

INTRODUCTION

Occupational injuries have been associated with increased suicide mortality, but prior studies have not accounted for pre-injury depression.

METHODS

We linked injuries that occurred from 1994 to 2000 in the Washington State workers' compensation system with Social Security Administration data on earnings and mortality through 2018. We estimated the subdistribution hazard ratio (sHR) and 95% confidence interval using competing risks regression of suicide deaths with lost time compared with medical-only injuries separately for men and women, adjusting for age, pre-injury annual earnings, and industry. We further adjusted for pre-injury diagnosis of major depressive disorder by using a quantitative bias analysis (QBA), with the prevalence of this disorder in workers derived from an external health insurance claims data set.

RESULTS

Elevated suicide mortality was observed following lost-time injuries compared with medical-only injuries for men (sHR = 1.49, 95% CI [1.14, 1.93]) and women (sHR = 1.30, 95% CI [1.00, 1.69]), adjusting for age, pre-injury earnings, and industry. Adjusted for pre-injury depression using a QBA, elevated suicide risk in men remained statistically significant (median sHR = 1.33, simulation interval [1.18, 1.47]) but not for women.

DISCUSSION

Workplace injury requiring time off work appeared to remain influential in increasing suicide risk among men, even after controlling for pre-injury depression. The relationship between mental health before and after occupational injury is complex and studies should better integrate mental health pre-injury.

CONCLUSIONS

Though many questions remain on the complex relationship between work, depression, injuries, and suicide, employers should work to prevent injuries and consider implementing mental health programs, which could be helpful in reducing suicide risk.

Prevalence and impact of comorbid mental disorders in hospitalized patients with obstructive sleep apnea (OSA): a nationwide study using administrative data

This study aimed to compare the prevalence of mental comorbidities between hospitalization episodes with and without obstructive sleep apnea (OSA), and to analyze the association of those mental comorbidities with modifiable risk factors that may potentiate OSA. An observational retrospective analysis was conducted using an administrative database of discharges from all Portuguese mainland public hospitals. All-cause adult hospitalizations occurring between 2008-2015 were dichotomized according to the existence of an OSA code (ICD-9-CM 327.23). Mental disorders were clustered into categories 650-670 of Clinical Classifications Software. Within the OSA group, binary logistic regressions were performed to analyze associations between mental comorbidities and modifiable OSA risk factors. Of 6 072 538 admissions, 36 385 had a primary or secondary diagnosis of OSA, which was associated with greater odds of comorbid anxiety disorders (adjusted odds ratio [aOR] = 1.84), bipolar disorders (aOR = 2.68), depressive disorders (aOR = 2.38), alcohol abuse (aOR = 1.29) and suicidal behaviors (aOR = 1.52) compared to those without OSA (all p < 0.05). Each of these mental comorbidities was associated with significantly greater odds of at least two of the four studied risk factors that may potentiate OSA (namely obesity, smoking, alcohol abuse and opioid/sedative abuse). These findings emphasize the complex interplay between OSA and mental disorders, suggesting relevant bidirectional relationships, and highlight the importance of comprehensive assessment and management of mental health in individuals with OSA.

Physical pain and suicide-related outcomes across the lifespan: systematic review and meta-analysis

Suicide is a complex and multifactorial phenomenon, with increasing evidence highlighting the link between physical pain and suicidal thoughts and behaviors. This meta-analysis examines suicide-related outcomes among individuals with and without physical pain. We searched PubMed, PsycINFO, and Cochrane databases, including 91 studies in the review and 88 in the meta-analysis. Data were analyzed using Comprehensive Meta-Analysis software (version 3.7). The findings revealed that people experiencing physical pain were significantly more likely to have suicide-related outcomes than those without pain. The strongest associations were found for lifetime death wish (OR = 2.10), current suicidal ideation (OR = 1.93), and lifetime suicide attempts (OR = 1.94). Among adolescents, self-harm was notably higher among those with pain, while adults showed a higher risk of lifetime suicide attempts and suicide death. In older adults, suicidal ideation and suicide attempts were more strongly linked to pain. Females had higher odds of suicidal ideation compared to males. Specific painful conditions, like fibromyalgia, abdominal pain, and migraines, were also linked to increased suicide risk. Limitations include high heterogeneity and lack of data on some suicide-related outcomes. Pain is a significant risk factor for suicidality across all ages and in specific populations, as conceptualized by ideation-to-action framework suicide models.

Navigating the depths: A comprehensive narrative review on depression in people with epilepsy

Epilepsy presents a significant global health challenge, impacting millions worldwide. Alarmingly, over half of individuals living with epilepsy (PWE) also face concurrent medical conditions, with psychiatric complications, particularly depression, standing out as prevalent issues. The relationship between epilepsy and depression is complex and bidirectional, with approximately a quarter of adults with epilepsy receiving a diagnosis of depression. This complexity underscores the challenges in diagnosing depression in epilepsy patients, hindered by overlapping symptoms and distinct manifestations of depression in this population. Our review highlights that the use of most antidepressant pharmacotherapies does not increase the risk of seizure occurrences. On the contrary, compelling evidence suggests that such treatments may even decrease seizure frequency, offering hope for patients. In addition to pharmacology, non-pharmacological interventions are emerging as vital alternatives, enriching the therapeutic landscape. However, despite these promising avenues, a significant gap in our understanding persists, characterized by a lack of comprehensive, prospective research. Our review rigorously explores the latest pathophysiological insights linking depression and epilepsy while critically evaluating contemporary treatment paradigms for individuals grappling with these comorbid conditions. By focusing on the most current developments, this review aims to equip clinicians with cutting-edge knowledge, fostering a more nuanced and effective approach to managing the intricate interplay between epilepsy and comorbid depression.

Mood disorders and suicide: pilot study on postmortem toxicologic evidence and adherence to psychiatric therapy by determining blood levels of medications

Suicide is one of the leading causes of death today, and among all mental illness, mood disorders account for one of the main risk factors. It is well known and proven that suicides are very common among people undergoing treatment and prescribed psychiatric medication. So far, however, there have only been a few studies dealing with this particular phenomenon. For this reason, autopsy patients who died by suicide, suffered from a mood disorder, and were known to be taking psychiatric medication at the time of death were selected for this study. The blood and urine samples taken during the autopsy underwent toxicological analysis and the results were compared with the prescribed therapy. A total of 22 people were included in the study: 12 presenting with depression and 10 with bipolar disorder. The toxicological analysis revealed that only 6 cases (27%) showed a qualitative match with the prescribed medication. In 5 cases (22.7%) the medication was only partially complied with and in 11 cases (50%) it was not complied with at all. Furthermore, even when medication was present, the value was often below the therapeutic range. Overall, more than 70% of the test subjects adhered to their medication only partially or not at all. Since treatment adherence is considered as a key factor in reducing the risk of suicide, this inevitably raises relevant clinical and forensic questions. Against this background, prospective monitoring of post-mortem medication levels in suicidal individuals and synergistic collaboration between clinicians and forensic pathologists could help to evaluate the effectiveness of specific medical interventions, highlight existing critical problems and develop new approaches to suicide prevention.

The Pooled Prevalence of Attributed Factors of Suicide in Iran: A Systematic Review and Meta-analysis

BACKGROUND

Suicide poses a critical global public health concern, and distinguishing between suicides and suicide attempts underscores the need for targeted interventions. This investigation aimed to determine the pooled prevalence of factors contributing to suicide in Iran, including socio-economic, demographic, and geographical factors.

METHODS

A systematic search was conducted across Web of Science, Scopus, PubMed, SID, Magiran, Elmnet, ISC, Irandoc, and Noormags databases up to July 2023. We included primary observational studies of acceptable quality that examined the prevalence of factors contributing to suicide in Iranian regions. The findings were screened for eligibility and quality, followed by a review of selected articles, from which data were extracted and analyzed.

RESULTS

Out of 1646 initial articles, 68 were selected for review and 54 for meta-analysis. The pooled prevalence rates of contributing factors were calculated as follows: male gender (64.3, 95% CI: 62.6‒66.0%), age over 25 (57.9%, 95% CI: 51.0‒64.5%), under diploma education (73.4%, 95% CI: 62.1‒82.3%), employment issues (66.4%, 95% CI: 59.7‒72.5%), urban living (61.7%, 95% CI: 53.8‒69.1%), past medical history (8.5%, 95% CI: 4.9‒14.2%), past psychiatric history (20.7%, 95% CI: 15.5‒27.1%), past suicidal attempt (12.2%, 95% CI: 8.5‒17.0%), substance abuse history (28.4%, 95% CI: 20.1‒38.3%), spring season (29.8%, 95% CI: 26.7‒33%), and hanging method (46.1%, 95% CI: 41.6‒50.6%). Significant regional differences were observed in the prevalence of gender, age, and suicide methods between western and non-western areas.

CONCLUSION

This study describes key factors of suicides in Iran. Despite higher rates among those over 25, many young individuals are affected. Urban living and low educational attainment are significant factors. Moreover, notable regional differences were observed in gender, age, and suicide methods between western and non-western areas. These findings highlight the need for additional research related to record-keeping challenges and can guide Iranian health policymakers in developing strategies for screening and treating vulnerable individuals.

Beyond NMDA Receptors: A Narrative Review of Ketamine's Rapid and Multifaceted Mechanisms in Depression Treatment

The rising prevalence of depression, with its associated suicide risk, demands effective fast-acting treatments. Ketamine has emerged as promising, demonstrating rapid antidepressant effects. While early studies show swift mood improvements, its precise mechanisms remain unclear. This article aims to compile and synthesize the literature on ketamine's molecular actions. Ketamine primarily works by antagonizing NMDA receptors, reducing GABAergic inhibition, and increasing glutamate release. This enhanced glutamate activates AMPA receptors, triggering crucial downstream cascades, including BDNF-TrkB and mTOR pathways, promoting synaptic proliferation and regeneration. Moreover, neuroimaging studies have demonstrated alterations in brain networks involved in emotional regulation, including the Default Mode Network (DMN), Central Executive Network (CEN), and Salience Network (SN), which are frequently disrupted in depression. Despite the promising findings, the literature reveals significant inaccuracies and gaps in understanding the full scope of ketamine's therapeutic potential. For instance, ketamine engages with opioid receptors, insinuating a permissive role of the opioid system in amplifying ketamine's antidepressant effects, albeit ketamine does not operate as a direct opioid agonist. Further exploration is requisite to comprehensively ascertain its safety profile, long-term efficacy, and the impact of genetic determinants, such as BDNF polymorphisms, on treatment responsiveness.

Associations between violence in childhood, depression and suicide attempts in adolescence: evidence from a cohort study in Luwero district, Uganda

BACKGROUND

Many studies have documented an association between violence victimisation and poor mental health. However, few studies use longitudinal data from low- and middle-income countries with attention to how associations differ by experiencing specific types of violence or alongside different contexts of peer and family support. In this study, we quantify the association between experiences of violence in early adolescence and depression and suicide attempts in late adolescence and explore whether this association is modified by family and peer connectedness.

METHODS

Data came from the Contexts of Violence Against Children (CoVAC) cohort study in Luwero District, Uganda, involving 2773 participants aged 11-14 years at Wave 1 (2014) and 15-18 years at Wave 2 (2018). Physical, sexual, and emotional violence were measured at Wave 1. Mental health outcomes, depression symptoms in the past two weeks, and lifetime suicide attempts were measured at Wave (2) We used logistic regression models, stratified by sex, to estimate adjusted odds ratios with an interaction term to test for effect modification by peer and family connectedness at Wave 1.

FINDINGS

At Wave 1, the prevalence of any violence from any perpetrator was 90% (physical violence: 87%, physical violence excluding caning: 68%, sexual violence: 6.3%, emotional violence: 56.8%). At Wave 2, 13.3% of participants had scores indicative of depression and 4.3% reported ever attempting suicide. Physical violence excluding caning, emotional violence, and sexual violence during early adolescence increased the odds of depression and attempting suicide in late adolescence for both boys and girls. Experiencing any violence (including caning) in early adolescence was not associated with depression in late adolescence, including in sex-stratified models. Childhood experience of any violence was associated with a suicide attempt violence in early adolescence (aOR: 2.60; 95%CI: 1.08, 6.27). High peer support mitigated the effect of any violence and physical violence on depression.

CONCLUSIONS

Findings highlight the importance of efforts to prevent violence and improve access to response and support services for violence and mental health for young people. Findings also underscore the important role friends and peer networks can play in mitigating the effects of violence as young people grow up.

Depression at the intersection of race/ethnicity, sex/gender, and sexual orientation in a nationally representative sample of US adults: a design-weighted intersectional MAIHDA

This study examined how race/ethnicity, sex/gender, and sexual orientation intersect under interlocking systems of oppression to socially pattern depression among US adults. With cross-sectional data from the 2015-2020 National Survey on Drug Use and Health (n = 234 722), we conducted a design-weighted, multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) under an intersectional framework to predict past-year and lifetime major depressive episodes (MDEs). With 42 intersectional groups constructed from 7 race/ethnicity, 2 sex/gender, and 3 sexual orientation categories, we estimated age-standardized prevalence and excess or reduced prevalence attributable to 2-way or higher interaction effects. Models revealed heterogeneity across groups, with prevalence ranging from 1.9% to 19.7% (past-year) and 4.5% to 36.5% (lifetime). Approximately 12.7% (past year) and 12.5% (lifetime) of total individual variance was attributable to between-group differences, indicating key relevance of intersectional groups in describing the population distribution of depression. Main effects indicated, on average, that people who were White, women, gay/lesbian, or bisexual had greater odds of MDE. Main effects explained most between-group variance. Interaction effects (past year: 10.1%; lifetime: 16.5%) indicated another source of heterogeneity around main effects average values, with some groups experiencing excess or reduced prevalence compared with main effects expectations. We extend the MAIHDA framework to calculate nationally representative estimates from complex sample survey data using design-weighted, Bayesian methods. This article is part of a Special Collection on Mental Health.

Conditional cash transfers and mortality in people hospitalised with psychiatric disorders: A cohort study of the Brazilian Bolsa Família Programme

BACKGROUND

Psychiatric patients experience lower life expectancy compared to the general population. Conditional cash transfer programmes (CCTPs) have shown promise in reducing mortality rates, but their impact on psychiatric patients has been unclear. This study tests the association between being a Brazilian Bolsa Família Programme (BFP) recipient and the risk of mortality among people previously hospitalised with any psychiatric disorders.

METHODS AND FINDINGS

This cohort study utilised Brazilian administrative datasets, linking social and health system data from the 100 Million Brazilian Cohort, a population-representative study. We followed individuals who applied for BFP following a single hospitalisation with a psychiatric disorder between 2008 and 2015. The outcome was mortality and specific causes, defined according to International Classification of Diseases 10th Revision (ICD-10). Cox proportional hazards models estimated the hazard ratio (HR) for overall mortality and competing risks models estimated the HR for specific causes of death, both associated with being a BFP recipient, adjusted for confounders, and weighted with a propensity score. We included 69,901 psychiatric patients aged between 10 and 120, with the majority being male (60.5%), and 26,556 (37.99%) received BFP following hospitalisation. BFP was associated with reduced overall mortality (HR 0.93, 95% CI 0.87,0.98, p 0.018) and mortality due to natural causes (HR 0.89, 95% CI 0.83, 0.96, p < 0.001). Reduction in suicide (HR 0.90, 95% CI 0.68, 1.21, p = 0.514) was observed, although it was not statistically significant. The BFP's effects on overall mortality were more pronounced in females and younger individuals. In addition, 4% of deaths could have been prevented if BFP had been present (population attributable risk (PAF) = 4%, 95% CI 0.06, 7.10).

CONCLUSIONS

BFP appears to reduce mortality rates among psychiatric patients. While not designed to address elevated mortality risk in this population, this study highlights the potential for poverty alleviation programmes to mitigate mortality rates in one of the highest-risk population subgroups.

Epidemiology of Mental Health Challenges in Children and Adolescents

In this narrative review, we will discuss current understandings and evidence on child and adolescent mental health including epidemiologic research methods, prevalence rates of mental health difficulties before the coronavirus disease 2019 pandemic, changes in mental health challenges after the pandemic onset, and clinical implications.

Page: investigating the predictors of general psychological help seeking intention among people who attempted suicide by using structural equation modeling

BACKGROUND

The aim of this study was to determine the role of suicide literacy, suicide stigma, perceived social support, and attitudes toward seeking professional psychological help (ATSPPH) in predicting general help-seeking intention among individuals who have attempted suicide by structural equation modeling.

METHODS

This cross-sectional study was conducted among 462 people who were referred to the hospital due to suicide attempt in one of the cities of eastern Iran in 2023. The sampling method in this study was consecutive sampling. The Pearson correlation, One-way ANOVA, and Independent-samples t-test were used to analyze data by SPSS software. Also, AMOS software was used for conducting structural equation modeling and checking the standardized direct effects and standardized indirect effects between variables.

RESULTS

Only 0.9% (n = 4) of participants answered correctly more than 17 questions regarding suicide literacy. The structural equation modeling (SEM) results showed that suicide literacy, suicide stigma, perceived social support, and ATSPPH predicted 51% variance in the general help-seeking intention (R2 = 0.51, PGFI = 0.607, PCFI = 0.568, RMSEA = 0.064). The variables of suicide literacy (estimate total effect = 0.615), ATSPPH (estimate total effect = 0.368), perceived social support (estimate total effect = 0.123), and suicide stigma (estimate total effect = 0.033) had the greatest impact in predicting the general help-seeking intention.

CONCLUSION

The SEM results highlight the importance of paying more attention to suicide literacy, reducing suicide stigma, promoting social support, improving the positive attitude toward mental health services, encouraging people who have attempted suicide to seek psychological help, and finally preventing suicide attempt.

Glutamatergic Modulators for Major Depression from Theory to Clinical Use

Major depressive disorder (MDD) is a chronic, burdensome, highly prevalent disease that is characterized by depressed mood and anhedonia. MDD is especially burdensome as approved monoamine antidepressant treatments have weeks-long delays before clinical benefit and low remission rates. In the past 2 decades, a promising target emerged to improve patient outcomes in depression treatment: glutamatergic signaling. This narrative review provides a high-level overview of glutamate signaling in synaptogenesis and neural plasticity and the implications of glutamate dysregulation in depression. Based on this preclinical evidence implicating glutamate in depression and the rapid improvement of depression with ketamine treatment in a proof-of-concept trial, a range of N-methyl-D-aspartate (NMDA)-targeted therapies have been investigated. While an array of treatments has been investigated in registered phase 2 or 3 clinical trials, the development of most of these agents has been discontinued. Multiple glutamate-targeted antidepressants are actively in development, and two are approved. Nasal administration of esketamine (Spravato®) was approved by the US Food and Drug Administration (FDA) in 2019 to treat adults with treatment-resistant depression and in 2020 for adults with MDD with acute suicidal ideation or behavior. Oral combination dextromethorphan-bupropion (AXS-05, Auvelity® extended-release tablet) was FDA approved in 2022 for the treatment of MDD in adults. These approvals bolster the importance of glutamate in depression and represent an exciting breakthrough in contemporary psychiatry, providing new avenues of treatment for patients as first-line therapy or with either poor response or unacceptable side effects to monoaminergic antidepressants.

Associations between oral health and depression and anxiety: A cross-sectional and prospective cohort study from the UK Biobank

AIM

To investigate the associations between oral health and depression, anxiety and their comorbidity in the UK Biobank cohort.

MATERIALS AND METHODS

Oral health problems were self-reported at baseline. Symptoms of depression and anxiety were assessed using the Mental Health Questionnaire (PHQ-4) in a cross-sectional study. In the cohort study, diagnoses of depression and anxiety disorders were based on hospital records. Logistic regression and Cox regression models were used to analyse the association between oral health and depression/anxiety.

RESULTS

A total of 305,188 participants were included in the cross-sectional study, and multivariate analysis showed that periodontal disease was associated with depression and/or anxiety (odds ratio [OR]: 1.79, 95% confidence interval [CI]: 1.73-1.86). In the prospective cohort study involving 264,706 participants, periodontal disease was significantly associated with an increased risk of depression and/or anxiety (hazard ratio [HR]: 1.14, 95% CI: 1.10-1.19), depression (HR: 1.19, 95% CI: 1.13-1.25) and anxiety (HR: 1.13, 95% CI: 1.07-1.19). Periodontal disease was also significantly associated with comorbid depression and anxiety (HR: 1.27, 95% CI: 1.16-1.38). Multiple mediation analysis using baseline inflammatory factors showed that white blood cell count and C-reactive protein explained 3.07% and 3.15% of the association between periodontal disease and depression and anxiety, respectively. However, the results of longitudinal multiple mediation analysis of inflammatory factors at first follow-up (N = 10,673) were not significant.

CONCLUSIONS

Periodontal disease was found to be consistently associated with an increased risk of depression, anxiety and their comorbidity.

The global burden of suicide mortality among people on the autism spectrum: A systematic review, meta-analysis, and extension of estimates from the Global Burden of Disease Study 2021

We aimed to quantify the risk, mortality, and burden of suicide among autistic persons. We searched PubMed, Embase, and PsycINFO on 5th April 2023 for sources reporting the relative risk (RR) of suicide or suicide attempt among autistic persons (PROSPERO registration: CRD42021265313). Autism spectrum prevalence and suicide mortality and years of life lost (YLLs), were sourced from the Global Burden of Disease Study 2021. RRs pooled via meta-regression and health metrics estimates were used to estimate the excess suicide mortality and YLLs among autistic persons. We sourced 983 unique studies of which ten studies met inclusion criteria, consisting of 10.4 million persons. The pooled RR for suicide for autistic persons was 2·85 (95% UI: 2·05-4·03), which was significantly higher for autistic females than autistic males. No evidence of publication bias was detected via inspection of funnel plot and Egger's test. Globally, we estimated 13 400 excess suicide deaths among autistic persons in 2021, equating to 1·8% of all suicide deaths and 621 000 excess YLLs. Studies were limited in number and geographical coverage. Effective suicide prevention strategies for autistic persons may substantially reduce the fatal burden of suicides globally and reduce the health burden experienced within this population.

Insomnia and unhealthy alcohol use in a National Sample of Women Veterans 50 years and older enrolled in the Veterans Health Administration

In this study, we examined rates of insomnia and co-occurring unhealthy alcohol use in a national sample of women Veterans age 50 years and older. We further explored associations between sociodemographic measures, insomnia-related clinical characteristics, and unhealthy alcohol use, and analyzed whether women with insomnia were more likely to report unhealthy alcohol use. Study aims were evaluated using national Veterans Health Administration (VA) electronic health records data from VA's Corporate Data Warehouse. Data were extracted for women Veterans ≥50 years old with ≥1 VA primary care visit in each study year (2018: 3/11/18-3/10/19; 2020: 3/11/20-3/10/21; 2022: 3/11/22-3/10/23). Cases of insomnia were identified via diagnostic codes and prescription medications for insomnia. Unhealthy alcohol use was identified via Alcohol Use Disorders Identification Test-Consumption screening scores indicating unhealthy alcohol use. Annual sample sizes ranged from 240,420-302,047. Over the study timeframe, insomnia rates (diagnosis or medication) among women ≥50 years old ranged from 18.11-19.29%; co-occurring insomnia and unhealthy alcohol use rates ranged from 2.02-2.52%. Insomnia and unhealthy alcohol use rates were highest among women aged 50-59 years old. Depression and physical health comorbidities were consistently associated with insomnia; associations by race and ethnicity were less consistent. Compared to women without insomnia, women Veterans with either concurrent or unremitting insomnia were more likely to endorse unhealthy alcohol use. Findings signal a potential need for assessment and preventative efforts aimed at addressing insomnia and unhealthy alcohol use among women Veterans.

Therapeutic patient education for severe mental disorders: A systematic review

Objective

This systematic review aimed to review therapeutic patient education (TPE) programmes in managing psychiatric disorders, considering the diversity in delivering agents, intervention formats, targeted skills, and therapeutic outcomes.

Methods

Comprehensive database searches, including Web of Science, PubMed, and COCHRANE, were conducted from September 2019 to January 2023, yielding 514 unique records, with 33 making it through rigorous evaluation for full-text review. Eleven studies met the inclusion criteria, focusing on various psychiatric disorders such as depression, bipolar disorder, psychosis, and multiple serious mental illnesses. A total of 38 studies were included from our previous review to supplement the current database search.

Results

TPE programmes exhibited diversity in delivering agents and intervention formats, with a notable presence of multidisciplinary teams and various professionals. The interventions prioritized coping strategies and disease management techniques, though the extent varied based on the disorder. Effectiveness was heterogeneous across studies; some interventions showed significant benefits in areas such as symptom management, coping, and functional improvement, while others reported no significant outcomes.

Conclusion

The findings underscore the potential of TPE in psychiatric care, revealing its multifaceted nature and varied impact. TPE not only addresses deficits but also leverages patients' existing strengths and capabilities. Despite the reported benefits, a portion of the interventions lacked statistical significance, indicating the necessity for continuous refinement and evaluation.

Substance use and risk of suicide among adults who sought mental health and addiction specialty services through a centralised intake process in Nova Scotia: a cross-sectional study

OBJECTIVES

The objectives of this study are as follows: (1) to estimate the prevalence of suicide risk among individuals seeking mental health and addiction (MHA) services in Nova Scotia; (2) to examine the relationship between substance use and suicide risk among this population.

SETTING

MHA intake programme, a province-wide centralised intake process established in 2019 by the Department of Health and Wellness of Nova Scotia.

PARTICIPANTS

We included 22 500 MHA intake clients aged 19-64 years old who contacted MHA intake from 2020 to 2021.

PRIMARY OUTCOME MEASURES

During the intake assessment, clients were assessed for suicide risk (past suicide attempt, suicidal ideation during the interview or 2 weeks before the interview).

RESULTS

The lifetime prevalence of suicide attempt was 25.25% in the MHA clients. The prevalence of mild and moderate/high suicide risk was 34.14% and 4.08%, respectively. Clients who used hallucinogens had the highest prevalence of mild and moderate/high suicide risk (61.3% and 12.9%, respectively), followed by amphetamine/methamphetamine (47.6% and 13.3%, respectively) and sedative/hypnotics (47.2% and 8.9%, respectively) users. Stimulant (aOR=1.84, 95% CI 1.23 to 2.75) and hallucinogen (aOR=3.54, 95% CI 1.96 to 6.43) use were associated with increased odds of moderate/high suicide risk compared with denying current use. Additionally, alcohol (aOR=1.17, 95% CI 1.06 to 1.30) and tobacco (aOR=1.20, 95% CI 1.10 to 1.30) use were associated with increased odds of mild suicide risk.

CONCLUSION

Suicide behaviours were prevalent among clients seeking MHA services. Substance use is an important factor associated with suicide risk in this population. This result underscored the importance of considering substance use patterns when assessing suicide risk and highlighted the need for targeted interventions and preventive measures for individuals engaging in substance use. Future interventional studies are needed to identify and evaluate effective strategies for reducing substance use and suicide risk among clients of MHA central intake.

Evaluation of a student pharmacist-led depression screening program in a community pharmacy

Introduction

One in 5 adults in the United States have depression and are at risk for suicide, the 11th leading cause of death in the United States. Community pharmacy settings are ideal for increasing access to mental health services. Our objectives were to assess PHQ-9 scores and evaluate participant satisfaction in a student pharmacist-led depression screening program in a community pharmacy.

Methods

Student pharmacists trained in mental health first aid recruited participants 18 to 90 years old in a community pharmacy to complete the PHQ-9 and provided mental health education, referrals, and resources. A 2-week follow-up was completed, and participants reported on actions taken since the initial visit. Descriptive statistics, independent t tests, and χ 2 tests were used in data analysis.

Results

Twelve depression screening events were held, and 70 participants completed the screenings. The mean age was 52 years, and 75.7% were female. PHQ-9 scores ranged from 0 to 24 with an average of 3.96. Most participants (92.9%) reported the depression screening program was helpful. More than 90% of participants completed the 2-week follow-up, and 92.3% reported being comfortable seeking mental health services from a pharmacist. About half (53.8%) reported reading the educational materials, 24.6% helped a friend or family member, and 16.9% made an appointment with their health care provider.

Discussion

Student pharmacists successfully provided depression screenings and mental health education in a community pharmacy. Most participants had low PHQ-9 scores, found the program helpful, and are willing to utilize mental health services in a community pharmacy.

Detection of Schizophrenia from EEG Signals using Selected Statistical Moments of MFC Coefficients and Ensemble Learning

Schizophrenia is a mental disorder characterized by neurophysiological dysfunctions that result in disturbances in thinking, perception, and behavior. Early identification of schizophrenia can help prevent potential complications and facilitate effective treatment and management of the condition. This paper proposes a computer aided diagnosis system for the early detection of schizophrenia using 19-channel Electroencephalography (EEG) signals from 28 subjects, leveraging statistical moments of Mel-frequency Cepstral Coefficients (MFCC) and ensemble learning. Initially, the EEG signals are passed through a high-pass filter to mitigate noise and remove extraneous data. The feature extraction technique is then employed to extract MFC coefficients from the filtered EEG signals. The dimensionality of these coefficients is reduced by computing their statistical moments, which include the mean, standard deviation, skewness, kurtosis, and energy. Subsequently, the Support Vector Machine based Recursive Feature Elimination (SVM-RFE) is applied to identify pertinent features from the statistical moments of the MFC coefficients. These SVM-RFE-based selected features serve as input for three base classifiers: Support Vector Machine, k-Nearest Neighbors, and Logistic Regression. Additionally, an ensemble learning approach, which combines the predictions of the three classifiers through majority voting, is introduced to enhance schizophrenia detection performance and generalize the results of the proposed approach. The study's findings demonstrate that the ensemble model, combined with SVM-RFE-based selected statistical moments of MFCC, achieves encouraging detection performance, highlighting the potential of machine learning techniques in advancing the diagnostic process of schizophrenia.

Suicide-related internet use among mental health patients who died by suicide in the UK: a national clinical survey with case-control analysis

Background

Suicide-related internet use (SRIU) has been shown to be linked to suicide. However, there is limited research on SRIU among mental health patients, who are at 4 to 7 times increased risk of suicide compared to the general population. This study aims to address this gap by exploring the prevalence of SRIU among mental health patients who died by suicide in the UK and describing their characteristics.

Methods

The study was carried out as part of the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH). Data were collected on sociodemographic, clinical, suicide characteristics and engagement in SRIU of patients who died by suicide between 2011 and 2021. The study utilised a case-control design to compare patients who engaged in suicide-related internet use with those who did not.

Findings

The presence or absence of SRIU was known for 9875/17,347 (57%) patients; SRIU was known to be present in 759/9875 (8%) patients. The internet was most often used to obtain information on suicide methods (n = 523/759, 69%) and to visit pro-suicide websites (n = 250/759, 33%) with a significant overlap between the two (n = 152/759, 20%). Engaging in SRIU was present across all age groups. The case-control element of the study showed patients who were known to have engaged in SRIU were more likely to have been diagnosed with autism spectrum disorder (OR = 2.13, 95% CI: 1.43-3.18), have a history of childhood abuse (OR = 1.70, 95% CI: 1.36-2.13) and to have received psychological treatment (OR = 1.43, 95% CI: 1.18-1.74) than controls. Additionally, these patients were more likely to have died on or near a salient date (OR = 2.11, 95% CI: 1.61-2.76), such as a birthday or anniversary.

Interpretation

The findings affirm SRIU as a feature of suicide among patients of all ages and highlight that clinicians should inquire about SRIU during assessments. Importantly, as the most common type of SRIU can expand knowledge on suicide means, clinicians need to be aware of the association between SRIU and choice of methods. This may be particularly relevant for patients approaching a significant calendar event.

Funding

The Healthcare Quality Improvement Partnership.

The synergy of depression and flourishing/languishing on suicidal thoughts and behaviors: Findings from a national sample of emerging adult students in higher education in the United States

BACKGROUND

Suicide is a leading cause of death among students in higher education, driven in large part by mental illness, but also mental wellness. Relatively few studies have examined the extent to which depression and flourishing/languishing interact in relation to suicidal thoughts and behaviors.

METHODS

We analyzed data from the Healthy Minds Study (2020-2021; emerging adult students aged 18-29; N = 101,435), and calculated interaction contrast ratios to estimate the interaction between depression and flourishing/languishing on suicidal thoughts and behaviors, using an additive scale, adjusting for age, gender, race/ethnicity, and food insecurity.

RESULTS

When compared with students who were flourishing without depression, the students who were languishing without depression, and the students who were depressed but still flourishing had significantly greater odds of suicidal thoughts and behaviors. However, students who were depressed and languishing had the greatest odds, exceeding the sum of the individual effects.

CONCLUSION

The interaction of depression and flourishing/languishing produced a synergy that increased odds of suicidal thoughts and behaviors. Flourishing interventions may prove to be an effective strategy for universal suicide prevention.

Association Between COVID-19 and Self-Harm: Nationwide Retrospective Ecological Spatiotemporal Study in Metropolitan France

Background

The COVID-19 pandemic has not been associated with increases in suicidal behavior at the national, regional, or county level. However, previous studies were not conducted on a finer scale or adjusted for ecological factors.

Objective

Our objective was to assess the fine-scale spatiotemporal association between self-harm and COVID-19 hospitalizations, while considering ecological factors.

Methods

Using the French national hospital discharge database, we extracted data on hospitalizations for self-harm of patients older than 10 years (from 2019 to 2021) or for COVID-19 (from 2020 to 2021) in metropolitan France. We first calculated monthly standardized incidence ratios (SIRs) for COVID-19 between March 2020 and December 2021, using a Besag, York, and Mollié spatiotemporal model. Next, we entered the SIRs into an ecological regression in order to test the association between hospital admissions for self-harm and those for COVID-19. Lastly, we adjusted for ecological variables with time lags of 0 to 6 months.

Results

Compared with a smoothed SIR of ≤1, smoothed SIRs from 1 to 3, from 3 to 4, and greater than 4 for COVID-19 hospital admissions were associated with a subsequent increase in hospital admissions for self-harm, with a time lag of 2 to 4 months, 4 months, and 6 months, respectively.

Conclusions

A high SIR for hospital admissions for COVID-19 was a risk factor for hospital admission for self-harm some months after the epidemic peaks. This finding emphasizes the importance of monitoring and seeking to prevent suicide attempts outside the epidemic peak periods.

Impulsive Decision-Making, Affective Experiences, and Parental History of Self-Injurious Thoughts and Behaviors within Parent-Adolescent Dyads

Impulsive decision-making, particularly during states of affective intensity, is associated with greater risk of engagement in self-injurious thoughts and behaviors (SITBs) during adolescence. The proximal (dyadic parent-adolescent affect and impulsivity) and distal (family history of SITBs) risk factors that occur within the family system could be relevant processes at stake in the intergenerational transmission of risk. The current study tests the interdependence of parent-adolescent factors associated with risk for SITBs and probes the extent to which parent-adolescent affective states influence their own (actor-effects) and each other's (partner-effects) impulsive decision-making, and further whether these relationships are moderated by a parent's history of SITBs. Participants included 212 (106 dyads) community parents and their adolescents who completed self-report and behavioral tasks related to positive and negative affective states, impulsive decision-making, and lifetime history of SITBs. Application of the Actor-Partner Interdependence Model (APIM) revealed a partner-effect where greater parent negative affect in the past week was associated with elevated adolescent impulsive decision-making among families with a history of SITBs (Estimate = 0.66, Standard Error = 0.13, p < 0.001). In addition, a significant actor-effect was observed where greater positive affect was associated with decreased impulsive decision-making among adolescents (Estimate = -0.21, Standard Error = 0.10, p = 0.03), however, moderating effects of parent history of SITBs were not detected. Findings from the present study shed light on the interdependence of affect and impulsivity within parent-adolescent dyads, and the extent to which these interactions may be particularly salient for families with known vulnerabilities for SITBs.

Psychotropic medications and mortality from cardiovascular disease and suicide for individuals with depression in Taiwan

BACKGROUND

Polypharmacy for treatment of depression has been increasing in Taiwan.

METHODS

Individuals having depressive disorders were identified in a national database for healthcare services and followed up for 5 years. The mean dosage of antidepressants, antipsychotics, mood stabilizers, and sedative-hypnotics was calculated; the associations between the exposure dosage to different psychotropic medications and patients' overall death and death due to cardiovascular diseases (CVD) and suicide were examined.

RESULTS

A total of 400,042 individuals with depressive disorders (63.8% women) were identified. Compared with those with no exposure to antidepressants, patients prescribed antidepressants had decreased mortality. Use of antipsychotics had a dose-related increase in overall mortality risk compared to no exposure group. Contrarily, depressed patients taking sedative-hypnotics had decreased overall and CVD mortality compared to no exposure group, with the most prominent decrease in CVD mortality of up to 54.9% for those in the moderate exposure group (hazard ratio: 0.451, 95% confidence interval: 0.405-0.503). A moderate or high dose of antidepressants or sedative-hypnotics was shown to be associated with a significantly increased mortality for suicide compared to those with no exposure.

CONCLUSIONS

Antidepressant and sedative-hypnotic use was associated with decreased all-cause and CVD-related mortality and use of antipsychotics was associated with a dose-related increase in mortality risk. Future studies are needed to further clarify the involved mechanisms and benefits and risks should be carefully weighed when prescribing psychotropic medications in patients with depressive disorders.

Management of Depression in Adults: A Review

Importance

Approximately 9% of US adults experience major depression each year, with a lifetime prevalence of approximately 17% for men and 30% for women.

Observations

Major depression is defined by depressed mood, loss of interest in activities, and associated psychological and somatic symptoms lasting at least 2 weeks. Evaluation should include structured assessment of severity as well as risk of self-harm, suspected bipolar disorder, psychotic symptoms, substance use, and co-occurring anxiety disorder. First-line treatments include specific psychotherapies and antidepressant medications. A network meta-analysis of randomized clinical trials reported cognitive therapy, behavioral activation, problem-solving therapy, interpersonal therapy, brief psychodynamic therapy, and mindfulness-based psychotherapy all had at least medium-sized effects in symptom improvement over usual care without psychotherapy (standardized mean difference [SMD] ranging from 0.50 [95% CI, 0.20-0.81] to 0.73 [95% CI, 0.52-0.95]). A network meta-analysis of randomized clinical trials reported 21 antidepressant medications all had small- to medium-sized effects in symptom improvement over placebo (SMD ranging from 0.23 [95% CI, 0.19-0.28] for fluoxetine to 0.48 [95% CI, 0.41-0.55] for amitriptyline). Psychotherapy combined with antidepressant medication may be preferred, especially for more severe or chronic depression. A network meta-analysis of randomized clinical trials reported greater symptom improvement with combined treatment than with psychotherapy alone (SMD, 0.30 [95% CI, 0.14-0.45]) or medication alone (SMD, 0.33 [95% CI, 0.20-0.47]). When initial antidepressant medication is not effective, second-line medication treatment includes changing antidepressant medication, adding a second antidepressant, or augmenting with a nonantidepressant medication, which have approximately equal likelihood of success based on a network meta-analysis. Collaborative care programs, including systematic follow-up and outcome assessment, improve treatment effectiveness, with 1 meta-analysis reporting significantly greater symptom improvement compared with usual care (SMD, 0.42 [95% CI, 0.23-0.61]).

Conclusions and Relevance

Effective first-line depression treatments include specific forms of psychotherapy and more than 20 antidepressant medications. Close monitoring significantly improves the likelihood of treatment success.

Anxiety symptoms preceding suicide: A Swedish nationwide record review

BACKGROUND

The literature on the relationship between anxiety and suicidal behaviors is limited and findings are mixed. This study sought to determine whether physicians noted anxiety symptoms and suicidality in their patients in the weeks and months before suicide.

METHODS

Data were derived from a nationwide medical record review of confirmed suicides in Sweden in 2015. Individuals with at least one documented physician consultation in any health care setting during 12 months before suicide (N = 956) were included. Clinical characteristics were compared between decedents with and without a notation of anxiety symptoms. Odds ratios were calculated to estimate associations between anxiety symptoms and suicidality in relation to suicide proximity.

RESULTS

Anxiety symptoms were noted in half of individuals 1 week before suicide. Patients with anxiety were characterized by high rates of depressive symptoms, ongoing substance use issues, sleeping difficulties, and fatigue. After adjustment for mood disorders, the odds of having a notation of elevated suicide risk 1 week before death were doubled in persons with anxiety symptoms. Associations were similar across time periods (12 months - 1 week). Two-thirds had been prescribed antidepressants at time of death.

LIMITATIONS

Data were based on physicians' notations which likely resulted in underreporting of anxiety depending on medical specialty. Records were not available for all decedents.

CONCLUSIONS

Anxiety symptoms were common in the final week before suicide and were accompanied by increases in documented elevated suicide risk. Our findings can inform psychiatrists, non-psychiatric specialists, and GPs who meet and assess persons with anxiety symptoms.

Changes in suicidal ideation during treatment among patients with major depressive disorder: A 6-month naturalistic follow-up study

AIM

There is limited evidence regarding predictors of changes in suicidal ideation (SI) in patients with major depressive disorder (MDD). The objective of this study was to describe changes in SI over a 6-month period and identify their predictors from naturalistic observations of MDD patients.

METHODS

In the cross-sectional analysis, we examined 257 patients with MDD at the first-visit assessment. Among the patients, 119 who completed the 6-month assessment (completers) were included in the longitudinal analysis. For the evaluation of depressive symptoms, including SI, the Quick Inventory of Depressive Symptomatology-Japanese version was administered at both the first-visit and follow-up assessments. At baseline, we also administered the Japanese version of the Ten Item Personality Inventory to assess personality traits and the PRIME Screen-Revised to assess psychotic symptoms.

RESULTS

In the cross-sectional analysis of first-visit patients, 36.2% (93/257) exhibited SI. Among completers, 14.3% (17/119) had prolonged SI. Among the completers with SI at the first-visit assessment, 38.6% (17/44) had SI at the follow-up assessment (prolonged SI). In linear regression models including all completers, prolonged SI was positively associated with endorsement of suspiciousness/persecutory ideas and negatively associated with higher age.

CONCLUSION

More than one-third of completers who had SI at the first-visit assessment experienced prolonged SI (SI at follow-up). Our findings can help clinicians predict the course of MDD by identifying associated demographic and clinical characteristics.

Role of individual deprivation and community-level deprivation on suicidal behaviors: Insights from the UK Biobank study

Introduction

This study aimed to investigate the impact of individual- and community-level deprivation on suicidal behaviors among community members.

Methods

Data from 350,884 UK Biobank participants were employed to construct an individual deprivation index. Absolute poverty was defined as a pre-tax annual household income below ₤18,000. Predictors for absolute poverty incorporated variables such as sex, ethnicity, type of accommodation, tenure status, number of vehicles owned, educational qualifications, current employment status, and subjective health rating. The individual deprivation index was constructed using a logistic regression model to predict absolute poverty. Townsend Deprivation Index (TDI) was employed to represent community-level deprivation. The associations between the individual deprivation index, TDI, and suicidal behaviors were examined through multivariate linear regression. Interaction analyses were conducted to investigate effect modification.

Results

The logistic regression model demonstrated high predictive accuracy for absolute poverty (area under the receiver operating curve = 0.840). The associations between individual deprivation index and suicidal behaviors were observed to be more substantial than those between TDI and suicidal behaviors. A positive interaction between the individual deprivation index and TDI was detected, indicating an amplifying effect of community-level deprivation on the impact of individual-level deprivation on suicidal behaviors.

Conclusion

Our study successfully constructed a comprehensive individual deprivation index that could be applied widely to measure individual-level deprivation. Our findings revealed that individual-level deprivation and community-level deprivation have a synergistic effect on suicidal behaviors, underscoring the importance of multilevel interventions in suicide prevention.

The burden of major depressive disorder in the Middle East and North Africa region, 1990-2019

BACKGROUND

Major depressive disorder (MDD) is one of the leading causes of disability. We aimed to report the MDD-attributable prevalence, incidence and years lived with disability (YLDs) in the Middle East and North Africa (MENA) region from 1990 to 2019 by age, sex and socio-demographic index (SDI).

METHODS

Publicly available data on the burden of MDD were retrieved from the Global Burden of Disease (GBD) study 2019 for the 21 countries in MENA. The counts and age-standardised rates (per 100,000) were presented, along with their corresponding 95% uncertainty intervals.

RESULTS

In 2019, MDD had an age-standardised point prevalence of 3322.1 and an incidence rate of 4921.7 per 100,000 population in MENA. Furthermore, there were 4.1 million YLDs in 2019. However, there were no substantial changes in the MDD burden over the period 1990-2019. In 2019, Palestine had the highest burden of MDD. The highest prevalence, incidence and YLDs attributable to MDD were found in the 35-39 age group. In 2019, the YLD rate in MENA was higher than the global rate for almost all age groups. Furthermore, there was a broadly negative association between the YLD rate and SDI.

CONCLUSION

The study highlights the need to prevent the disorder using a multidisciplinary approach and for the provision of cost-effective treatments for those affected, in order to increase their quality of life.

Worldwide Prevalence and Disability From Mental Disorders Across Childhood and Adolescence: Evidence From the Global Burden of Disease Study

Importance

The period from childhood to early adulthood involves increased susceptibility to the onset of mental disorders, with implications for policy making that may be better appreciated by disaggregated analyses of narrow age groups.

Objective

To estimate the global prevalence and years lived with disability (YLDs) associated with mental disorders and substance use disorders (SUDs) across 4 age groups using data from the 2019 Global Burden of Disease (GBD) study.

Design, Setting, and Participants

Data from the 2019 GBD study were used for analysis of mental disorders and SUDs. Results were stratified by age group (age 5 to 9, 10 to 14, 15 to 19, and 20 to 24 years) and sex. Data for the 2019 GBD study were collected up to 2018, and data were analyzed for this article from April 2022 to September 2023.

Exposure

Age 5 to 9 years, 10 to 14 years, 15 to 19 years, and 20 to 24 years.

Main Outcomes and Measures

Prevalence rates with 95% uncertainty intervals (95% UIs) and number of YLDs.

Results

Globally in 2019, 293 million of 2516 million individuals aged 5 to 24 years had at least 1 mental disorder, and 31 million had an SUD. The mean prevalence was 11.63% for mental disorders and 1.22% for SUDs. For the narrower age groups, the prevalence of mental disorders was 6.80% (95% UI, 5.58-8.03) for those aged 5 to 9 years, 12.40% (95% UI, 10.62-14.59) for those aged 10 to 14 years, 13.96% (95% UI, 12.36-15.78) for those aged 15 to 19 years, and 13.63% (95% UI, 11.90-15.53) for those aged 20 to 24 years. The prevalence of each individual disorder also varied by age groups; sex-specific patterns varied to some extent by age. Mental disorders accounted for 31.14 million of 153.59 million YLDs (20.27% of YLDs from all causes). SUDs accounted for 4.30 million YLDs (2.80% of YLDs from all causes). Over the entire life course, 24.85% of all YLDs attributable to mental disorders were recorded before age 25 years.

Conclusions and Relevance

An analytical framework that relies on stratified age groups should be adopted for examination of mental disorders and SUDs from childhood to early adulthood. Given the implications of the early onset and lifetime burden of mental disorders and SUDs, age-disaggregated data are essential for the understanding of vulnerability and effective prevention and intervention initiatives.

Effect of next-step antidepressant treatment on suicidal ideation: findings from the VAST-D trial

BACKGROUND

Major depressive disorder (MDD) contributes to suicide risk. Treating MDD effectively is considered a key suicide prevention intervention. Yet many patients with MDD do not respond to their initial medication and require a 'next-step'. The relationship between next-step treatments and suicidal thoughts and behaviors is uncharted.

METHOD

The VA Augmentation and Switching Treatments for Depression trial randomized 1522 participants to one of three next-step treatments: Switching to Bupropion, combining with Bupropion, and augmenting with Aripiprazole. In this secondary analysis, features associated with lifetime suicidal ideation (SI) and attempts (SA) at baseline and current SI during treatment were explored.

RESULTS

Compared to those with SI only, those with lifetime SI + SA were more likely to be female, divorced, or separated, unemployed; and to have experienced more childhood adversity. They had a more severe depressive episode and were more likely to respond to 'next-step' treatment. The prevalence of SI decreased from 46.5% (694/1492) at baseline to 21.1% (315/1492) at end-of-treatment. SI during treatment was associated with baseline SI; low positive mental health, more anxiety, greater severity and longer duration of current MDD episode; being male and White; and treatment with S-BUP or C-BUP as compared to A-ARI.

CONCLUSION

SI declines for most patients during next-step medication treatments. But about 1 in 5 experienced emergent or worsening SI during treatment, so vigilance for suicide risk through the entire 12-week acute treatment period is necessary. Treatment selection may affect the risk of SI.

Factors Associated With Family Surrogate Decisional-Regret Trajectories

CONTEXT/OBJECTIVES

The scarce research on factors associated with surrogate decisional regret overlooks longitudinal, heterogenous decisional-regret experiences and fractionally examines factors from the three decision-process framework stages: decision antecedents, decision-making process, and decision outcomes. This study aimed to fill these knowledge gaps by focusing on factors modifiable by high-quality end-of-life (EOL) care.

METHODS

This observational study used a prior cohort of 377 family surrogates of terminal-cancer patients to examine factors associated with their membership in the four preidentified distinct decisional-regret trajectories: resilient, delayed-recovery, late-emerging, and increasing-prolonged trajectories from EOL-care decision making through the first two bereavement years by multinomial logistic regression modeling using the resilient trajectory as reference.

RESULTS

Decision antecedent factors: Financial sufficiency and heavier caregiving burden increased odds for the delayed-recovery trajectory. Spousal loss, higher perceived social support during an EOL-care decision, and more postloss depressive symptoms increased odds for the late-emerging trajectory. More pre- and postloss depressive symptoms increased odds for the increasing-prolonged trajectory. Decision-making process factors: Making an anticancer treatment decision and higher decision conflict increased odds for the delayed-recovery and increasing-prolonged trajectories. Making a life-sustaining-treatment decision increased membership in the three more profound trajectories. Decision outcome factors: Greater surrogate appraisal of quality of dying and death lowered odds for the three more profound trajectories. Patient receipt of anticancer or life-sustaining treatments increased odds for the late-emerging trajectory.

CONCLUSION

Surrogate membership in decisional-regret trajectories was associated with decision antecedent, decision-making process, and decision outcome factors. Effective interventions should target identified modifiable factors to address surrogate decisional regret.

Risk factors for mortality in patients admitted to a psychiatric acute ward: A prospective cohort study

INTRODUCTION

Associations between psychiatric disorders and mortality have been extensively studied, but limited evidence exists regarding influence of clinical characteristics on mortality risk, at the time of acute psychiatric hospitalization.

METHODS

A prospective total-cohort study included all patients consecutively admitted to Haukeland University Hospital's psychiatric acute ward in Bergen, Norway between 2005 and 2014 (n = 6125). Clinical interviews were conducted at the first admission within the study period, and patients were subsequently followed for up to 15 years in the Norwegian Cause of Death Registry. Competing risks regression models were used to investigate associations between clinical characteristics at first admission and the risk of natural and unnatural death during follow-up.

RESULTS

The mean age at first admission and at time of death was 42.5 and 62.8 years, respectively, and the proportion of women in the sample was 47.2%. A total of 1381 deaths were registered during follow-up, of which 65.5% had natural, 30.4% unnatural, and 4.1% unknown causes. Higher age, male sex, unemployment, cognitive deficits, and physical illness were associated with increased risk of natural death. Male sex, having no partner, physical illness, suicide attempts, and excessive use of alcohol and illicit substances were associated with increased risk of unnatural death.

CONCLUSION

Psychiatric symptoms, except suicide attempts, were unrelated to increased mortality risk. In the endeavor to reduce the increased mortality risk in people with mental disorders, focus should be on addressing modifiable risk factors linked to physical health and excessive use of alcohol and illicit substances.

Prevalence and correlates of suicide risk among non-psychiatric inpatients in a general hospital in China

OBJECTIVE

This study aims to investigate the suicide risk and mental health status of non-psychiatric inpatients in general hospital and explore the risk factors of suicide.

METHODS

A prospective study was conducted at a tertiary general hospital in Guangzhou, Guangdong Province, China. On-line assessment of mental health status and suicide was completed at admission and discharge. We assessed depression, anxiety, insomnia and suicide of inpatients and binary logistics regression was used to examine the risk factors of suicide.

RESULTS

From April 1, 2021 and January 31, 2022, 3685 inpatients were included. The detection rates of depression, anxiety and insomnia were 14.6 %, 9.0 % and 17.8 %, respectively. There were 2.7 % of inpatients at suicide risk. Binary logistics regression demonstrated that the inpatients with anxiety were at higher risk of suicide.

LIMITATIONS

(1) Single-center study limits the generalization of conclusion, (2) low response rate at discharge.

CONCLUSIONS

The comorbidity of physical illnesses and mental health problems, including depression, anxiety, insomnia, and suicide among non-psychiatric patients in general hospital was common. An assessment of anxiety may help identify individuals at high suicide risk. Medical staff in general hospitals should be trained to improve their ability to identify mental disorders and high-risk individuals for suicide, provide timely interventions and effectively reduce the suicide risk of patients.

Whole-brain structural and functional neuroimaging of individuals who attempted suicide and people who did not: A systematic review and exploratory coordinate-based meta-analysis

Suicide is the cause of death of approximately 800,000 people a year. Despite the relevance of this behaviour, risk assessment tools rely on clinician experience and subjective ratings. Given that previous suicide attempts are the single strongest predictors of future attempts, we designed a systematic review and coordinate-based meta-analysis to demonstrate whether neuroimaging features can help distinguish individuals who attempted suicide from subjects who did not. Out of 5,659 publications from PubMed, Scopus, and Web of Science, we summarised 102 experiments and meta-analysed 23 of them. A cluster in the right superior temporal gyrus, a region implicated in emotional processing, might be functionally hyperactive in individuals who attempted suicide. No statistically significant differences in brain morphometry were evidenced. Furthermore, we used JuSpace to show that this cluster is enriched in 5-HT1A heteroreceptors in the general population. This exploratory meta-analysis provides a putative neural substrate linked to previous suicide attempts. Heterogeneity in the analytical techniques and weak or absent power analysis of the studies included in this review currently limit the applicability of the findings, the replication of which should be prioritised.

Factors associated with medico-legal autopsy of decedents with psychiatric disorders

INTRODUCTION

Autopsy rates are declining worldwide, resulting in increasing selectivity in referral for forensic autopsy and increased uncertainty about the validity of assigned causes of death. Persons with psychiatric disorders have high rates of premature death but not all are referred for forensic autopsies. Knowledge is needed on which decedents with psychiatric disorders are chosen for forensic autopsy to determine whether causes of death are at risk of being misclassified among certain subgroups of decedents.

METHODS

We conducted a nationwide register-based case-control study including all decedents with psychiatric disorders in Denmark in the period 1998-2015. Using multivariate logistic regression, we examined associations between demographic and socioeconomic factors, comorbidities, healthcare utilization, and referral for forensic autopsy, overall and stratified by age at death (<45, 45-64, ≥65 years).

RESULTS

Of the 152,799 decedents in the study population, 7043 (4.61 %) had a forensic autopsy. Decedents referred for forensic autopsy were more likely to be young, have a history of substance use, and have schizophrenia or an affective disorder (factors listed in diminishing order of strength of association). Increasing severity of comorbidities as measured by the Charlson comorbidity index was associated with decreasing likelihood of being autopsied. Patterns of association with sex, alcohol use, habitation and education did not vary by age at death. Schizophrenia and drug use were most strongly associated with forensic autopsy in decedents < 45 years of age, whereas death early in the study period was more strongly associated with autopsy in the oldest age groups.

DISCUSSION

The decision to refer a decedent for forensic autopsy was predominantly based on the decedent's age, history of drug use, and the absence of non-psychiatric comorbidities. Causes of death in decedents with comorbidities or recent contact with the healthcare system and decedents > 65 years may be more likely to be inaccurate, particularly in drug users.

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.

State-dependent alterations of implicit emotional dominance during binocular rivalry in subthreshold depression

Binocular rivalry, a visual perception phenomenon where two or more percepts alternate every few seconds when distinct stimuli are presented to the two eyes, has been reported as a biomarker in several psychiatric disorders. It is unclear whether abnormalities of binocular rivalry in depression could occur when emotional rivaling stimuli are used, and if so, whether an emotional binocular rivalry test could provide a trait-dependent or state-dependent biomarker. In the current study, 34 individuals with subthreshold depression and 31 non-depressed individuals performed a binocular rivalry task associated with implicit emotional processing. Participants were required to report their perceived orientations of the rival gratings in the foreground and to neglect emotional face stimuli in the background. The participants were retested after an approximately 4-month time interval. Compared to the non-depressed group, the subthreshold depression group showed significantly longer perceptual dominance durations of the grating with emotional faces as the background (i.e., implicit emotional dominance) at the initial assessment. However, the abnormality was not found at the follow-up assessment. More importantly, we found smaller changes in depressive severity at the follow-up assessment for individuals displaying longer emotional dominance at the initial assessment than for individuals with weaker emotional dominance. The current emotional binocular rivalry test may provide an objective, state-dependent biomarker for distinguishing individuals with subthreshold depression from non-depressed individuals.