Poverty and suicide research in low- and middle-income countries: systematic mapping of literature published in English and a proposed research agenda

Self-reported suicidal behaviour among people living with disabilities: prevalence and associated factors from a cross-sectional nation-wide survey in Bangladesh

BACKGROUND

Disability marginalises a large portion of Bangladesh's population. Global pre- and post-pandemic research evidently states that, this group is more prone to develop mental health problems, which increases the risk of self-harm and suicide among them. It is crucial to comprehend and mitigate the mental health challenges among the people with disabilities which in turn can promote their greater participation in community, and in national socioeconomic development. However, currently there is limited information available, regarding the suicidal behaviour of this group in Bangladesh. Therefore, this study aimed to investigate the prevalence and contributing factors of suicidal behaviour among people with disabilities.

METHOD

A cross-sectional survey was conducted during September and October 2022, among the participants who had selected disabilities, by using probability proportional to size sampling technique across all eight divisions of Bangladesh. A semi-structured questionnaire comprising information about sociodemographic, lifestyle, health; and Suicidal Behaviour Questionnaire-Revision (SBQ-R) was used. The association between the determinants and mental health outcome was investigated using the Chi-square test, and the contributing factors were investigated using the multiple binary logistic regression.

RESULT

About 10.45% of the participants reported to have suicidal behaviour (e.g., suicidal ideation, attempts, completed suicide), considering the cut-off score as 7 for the SBQ-R in the study period. Approximately, 40% respondents mentioned suicidal ideation in their lifetime, whereas, 9.01% had suicidal ideation over the past 12 months. Additionally, 8.87% of the person with disabilities, mentioned about their suicidal intent to the family members, and 5.94% reported the likelihood of suicide in the future. Being female, having multiple disabilities, and not being connected with family and friends were found to be significantly associated with suicidal behaviour.

CONCLUSION

This research demonstrates the significance of treating mental health issues and expanding accessibility to pre-existing services to lessen the impact of the limitations generated by disabilities. Policymakers can utilize this baseline findings to design large scale research and develop measures for suicide prevention, and management for at-risk groups.

Teen Perspectives on Suicides and Deaths in an Affluent Community: Perfectionism, Protection, and Exclusion

Clusters of youth suicide and death are tragic for communities and present long-term consequences for the surviving youths. Despite an awareness of community-based patterns in youth suicide, our understanding of the social and community factors behind these events remains poor. While links between poverty and suicide have been well documented, wealthy communities are rarely targeted in suicide research. In response to this gap, we conducted ethnographic research in a wealthy U.S. town that, over a recent 10-year period, witnessed at least four youth suicides and seven more youth accidental deaths. Our interviews (n = 30) explored community values and stressors, interpersonal relationships, and high school experiences on participant perceptions of community deaths. Youth participants characterize their affluent community as having (1) perfectionist standards; (2) permissive and sometimes absent parents; (3) socially competitive and superficial relationships; and (4) a "bubble" that is protective but also exclusionary. Our qualitative findings reveal network influence in teen suicides and accidental deaths in a wealthy community. Greater attention paid to the negative effects of subcultural values and stressors in affluent communities is warranted. Further, our work promotes the value of ethnographic, community-based methodologies for suicidology and treatment.

Challenges and opportunities for improving mental health care and preventing suicide among people living with HIV: Perspectives of mental health professionals in Tanzania

People living with HIV (PLWH) experience unique stressors that contribute to emotional distress, and PLWH are more than twice as likely to die by suicide when compared to the general population. In countries like Tanzania, there is a relatively high burden of HIV but few resources to support mental health needs. To gain a better understanding of mental health challenges experienced by PLWH in northern Tanzania and identify opportunities for intervention, we interviewed 12 mental health professionals working in the Kilimanjaro region. Thematic analysis was used to explore drivers and impacts of emotional distress, community influences on mental health, and gaps and barriers to existing mental health care. Perspectives from mental health workers highlight the compounding effects of stress related to HIV status, family conflict, finances, and other social challenges, which can lead to poor HIV treatment outcomes and suicidal ideation. Cultural beliefs and stigma surrounding both mental health and HIV limit care-seeking behavior for mental health issues. Those who do seek care often encounter barriers related to poor mental health infrastructure, including a lack of providers, limited financial resources, and little integration into other health services. There is a clear need for investment in the mental health care system, as well as interventions to improve knowledge and perceptions of mental health and comprehensively address stressors. We describe feedback on a proposed telehealth counseling intervention integrated into routine HIV services, which shows strong potential to mitigate barriers to mental health treatment, reduce suicidal ideation, and support the wellbeing of PLWH.

Development of mental health first-aid guidelines for suicide risk: a Delphi expert consensus study in Argentina and Chile

BACKGROUND

Suicide continues to pose a significant global public health challenge and ranks as one of the leading causes of death worldwide. Given the prevalence of suicide risk in the community, there is a significant likelihood of encountering individuals who may be experiencing suicidal thoughts or plans, creating an opening for non-health professionals to offer support. This study aims to culturally adapt the original Australian Mental Health First Aid Guidelines for suicide risk to the Chilean and Argentine context.

METHODS

A two-round Delphi expert consensus study was conducted involving two panels, one comprising individuals with personal experience in suicide thoughts/attempts or caregiving for those with such experiences (n = 18), and the other consisting of professionals specialized in suicide assessment and support for individuals at risk (n = 25). They rated a total of 179 items mainly derived from guidelines developed by Australian experts and translated into Spanish (168), and new items included by the research team (11). The panel members were requested to assess each item utilizing a five-point Likert scale. During the second round, items that received moderate approval in the initial round were re-evaluated, and new items suggested by the local experts in the first round were also subjected to evaluation in the next round. Inclusion in the final guidelines required an 80% endorsement as "essential" or "important" from both panels.

RESULTS

Consensus of approval was reached for 189 statements. Among these, 139 statements were derived from the English-language guidelines, while 50 locally generated statements were accepted during the second round. A significant difference from the original guideline was identified concerning the local experts' reluctance to discuss actions collaboratively with adolescents. Furthermore, the local experts proposed the inclusion of an entirely new section addressing suicide risk in older individuals, particularly focusing on suicide methods and warning signs.

CONCLUSIONS

A Delphi expert consensus study was conducted to culturally adapt mental health first aid guidelines for assessing suicide risk in Chile and Argentina. This study involved professionals and individuals with lived experience. While many items were endorsed, some related to inquiring about suicide risk and autonomy, particularly for adolescents, were not. An additional section for older individuals was introduced. Future research should explore the implementation and impact of these adapted guidelines in training courses. This is vital for enhancing mental health support and implementing effective suicide prevention strategies in Chile and Argentina.

The prevalence of suicidal behaviour and its associated risk factors among school-going adolescents resident in the United Arab Emirates

Suicidal behaviour which includes suicidal ideation, having a plan to commit suicide and suicide attempts remains a global public health issue as it substantially impacts adolescent health and wellbeing. Suicidal behaviour, however, remains understudied in Middle Eastern contexts. This study analysed data from the 2016 Global School-based Student Health Survey collected in the United Arab Emirates (UAE). A sample of 5826 adolescents aged between 11 and 18 years were sampled. Potential risk factors associated with an elevated risk for engagement in suicidal behaviour were examined. These factors were stratified into categories for analysis (demographics, psychosocial, risky health, and socio-environmental). The age-adjusted prevalence of suicidal behaviour amongst the school-going adolescent population in the UAE was 54%. Analyses indicated that elevated risk was significantly associated with anxiety difficulties, the experience of loneliness, and amongst those who smoked tobacco. None of the socio-environmental factors emerged as significant. A dose-dependent relationship was evident in that the degree of risk that was evident appeared to compound as the number of adverse risk factors increased. The data suggest that suicidal behaviour may be highly prevalent in this location. Findings highlight the immense need to develop preventative interventions, some of which may be school-delivered and targeted at parents. Our findings provide initial indications as to which risk factors could be targeted for remediation in developing these interventions.

The effectiveness and safety of herbal medicine on suicidal behavior: A PRISMA-compliant systematic review and meta-analysis

BACKGROUND

Suicide is the leading cause of death worldwide. Herbal medicine (HM) has been reported to be related to clinical improvement of some risk factors for suicide including depression. This systematic review aimed to comprehensively investigate the effectiveness and safety of HM on suicidal behaviors.

METHODS

Fifteen electronic databases were searched to search relevant intervention studies, up to September 2022. The methodological quality of the included studies was assessed using the modified Cochrane risk-of-bias tool. In the included studies, outcome on suicidal behavior were analyzed, and the effect sizes were presented as mean differences (MDs) or risk ratios (RRs) with their 95% confidence intervals (CIs) through meta-analysis. The strength of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS

A total of 13 randomized controlled trials (RCTs) were included in this review. Two RCTs of HM in patients with suicidal behavior found significant benefits of HM as an adjunct to fluoxetine or cognitive therapy in improving symptoms of depression. In 11 RCTs of HM in patients with other conditions, there was no statistically significant difference between HM and antidepressants in cognitive disturbance (MD, 0.12; 95% CIs, -0.20 to 0.45), a subscale of the Hamilton Rating Scale for Depression (HAMD), and suicidal ideation (0.18; -0.16 to 0.53), an item of HAMD. The overall quality of the included studies was poor. The strength of evidence assessed by GRADE was low or very low.

CONCLUSIONS

Though some of the studies reported significant benefits of HM in improving suicidal behavior in patients with depression, further clarification on some unsolved questions is needed in future well-designed clinical trials.

Hope and Suicidal Ideation Among Older Adults Living in the Rural Mid-Hills of Nepal

OBJECTIVES

The current study investigated whether hope and its two components (agency and pathways) weakened the relations between perceived burdensomeness, thwarted belongingness, and fearlessness about death and suicidal ideation among older adults living in rural Nepal.

METHODS

A community sample of 300 people aged from 60 to 90 years (Mage = 67.07, SDage = 6.23) who resided in the rural mid-hills of Nepal completed standardized measures.

RESULTS

Hope and agency moderated the relationship between perceived burdensomeness and suicidal ideation and pathways moderated the relationship between thwarted belongingness and suicidal ideation.

CONCLUSIONS

Hope, and particularly agency, may play a protective role in reducing suicidal ideation among older Nepali adults living in rural areas who experience perceived burdensomeness. In contrast, pathways may be an additional risk factor for older adults experiencing unmet belongingness needs. Research is required to understand fearlessness about death and suicidality among older Nepali adults.

CLINICAL IMPLICATIONS

Increasing hope and particularly agency may be associated with a reduction in suicidal ideation among older Nepali adults who experience feelings of being a burden. However, increasing pathways may be associated with an increase in suicidal ideation among those who experience unmet belongingness needs. Research is needed to understand how to accurately assess suicide risk among Nepali older adults.

Using iterative random forest to find geospatial environmental and Sociodemographic predictors of suicide attempts

Introduction

Despite a recent global decrease in suicide rates, death by suicide has increased in the United States. It is therefore imperative to identify the risk factors associated with suicide attempts to combat this growing epidemic. In this study, we aim to identify potential risk factors of suicide attempt using geospatial features in an Artificial intelligence framework.

Methods

We use iterative Random Forest, an explainable artificial intelligence method, to predict suicide attempts using data from the Million Veteran Program. This cohort incorporated 405,540 patients with 391,409 controls and 14,131 attempts. Our predictive model incorporates multiple climatic features at ZIP-code-level geospatial resolution. We additionally consider demographic features from the American Community Survey as well as the number of firearms and alcohol vendors per 10,000 people to assess the contributions of proximal environment, access to means, and restraint decrease to suicide attempts. In total 1,784 features were included in the predictive model.

Results

Our results show that geographic areas with higher concentrations of married males living with spouses are predictive of lower rates of suicide attempts, whereas geographic areas where males are more likely to live alone and to rent housing are predictive of higher rates of suicide attempts. We also identified climatic features that were associated with suicide attempt risk by age group. Additionally, we observed that firearms and alcohol vendors were associated with increased risk for suicide attempts irrespective of the age group examined, but that their effects were small in comparison to the top features.

Discussion

Taken together, our findings highlight the importance of social determinants and environmental factors in understanding suicide risk among veterans.

A high sense of coherence can mitigate suicidal ideation associated with insomnia

BACKGROUND

The present study aimed to investigate whether insomnia is associated with suicidal ideation (SI) among Japanese workers by conducting a multi-level analysis with sense of coherence (SOC) as a random effect.

PARTICIPANTS AND PROCEDURE

A cross-sectional survey was conducted among 19,481 workers in Tsukuba, Japan. Data from 7,175 participants aged 20-65 years were included in the analysis. The Athens Insomnia Scale (AIS) was used as the independent variable, and SI over the past year was used as the dependent variable. SOC was measured using the five-point SOC-13 scale, and socioeconomic and health factors were investigated as covariates. Participants were divided into three groups (low, medium, and high) based on their SOC scores. Multilevel logistic regression analysis was performed to calculate odds ratios (OR) and 95% confidence intervals (95% CI).

RESULTS

In the high-SOC group, only one person had SI. In a multi-level logistic analysis that excluded the high SOC group, insomnia was found to be associated with SI (OR = 2.26, 95% CI [1.75, 2.93]). Furthermore, the AIS sub-items "Final awakening earlier than desired" (OR = 1.26, 95% CI [1.05, 1.50]) and "Sense of well-being during the day" (OR = 1.63, 95% CI [1.34, 1.99]) were associated with SI. 8.95% or 11% of the variation in the presence or absence of SI was found to be explained by differences between SOC groups.

CONCLUSIONS

The study highlights that insomnia is associated with SI, and that high SOC may reduce SI even under insomnia. Future longitudinal studies are needed to confirm whether high SOC reduces SI due to insomnia.

Increased suicide rates in Mexico City during the COVID-19 pandemic outbreak: An analysis spanning from 2016 to 2021

Objective

Coronavirus disease 2019 (COVID-19) has impacted mental health worldwide, and suicide can be a serious outcome of this. Thus, suicide characteristics were examined before and during the COVID-19 pandemic in Mexico City.

Methods

This is a retrospective study including all Mexico City residents who had a coroner's record with a cause of death of intentional self-harm (ICD-10) from January 2016 to December 2021.

Results

From 2016 to 2021, 3636 people committed suicide, of which 2869 were males (78.9%) and 767 females (21.1%). From 2016 to 2019 the suicide rate remained constant (∼6 per 100000) and dramatically increased in 2020 (10.45 per 100,000), to return to the levels of the previous year in 2021 (6.95 per 100000). The suicide rate in 2020 specifically increased from January to June (COVID-19 outbreak) in all age groups. Moreover, every year young people (15-24 years) have the maximum suicide rate and depression was the main suicide etiology.

Conclusion

The COVID-19 pandemic outbreak increased the suicide rate, regardless of age, but suicide prevalence was higher in males and young people, regardless of the COVID-19 pandemic. These findings confirm that suicide is a complex and multifactorial problem and will allow the establishment of new guidelines for prevention and care strategies.

Suicidal behavior among inpatients with severe mental conditions in a public mental health hospital in Uganda

BACKGROUND

Suicidal behaviors are prevalent among inpatients with severe mental conditions and may result in many dying by suicide. Few studies have focused on the burden of suicidal behaviors among these inpatients in low-income settings, despite suicide being consistently higher in lower-income countries such as Uganda. This study, therefore, provides the prevalence and associated factors of suicidal behaviors and suicide attempts among inpatients with severe mental conditions in Uganda.

METHOD

This was a retrospective chart review of all individuals admitted with severe mental conditions to a large psychiatry inpatient unit in Uganda for four years (2018-2021). Two separate logistic regressions were conducted to determine the factors associated with suicidal behaviors or suicidal attempts among the admitted individuals.

RESULTS

The prevalence of suicidal behavior and suicidal attempts among 3104 (mean age = 33, Standard deviation [SD] = 14.0; 56% were males) were 6.12% and 3.45%, respectively. Having a diagnosis of depression increased the likelihood of both suicidal behaviors (adjusted odds ratio [aOR]: 5.36; 95% confidence interval [CI]: 2.14-13.37; p =0.001) and attempts (aOR: 10.73; 95% CI: 3.44-33.50; p < 0.001). However, a diagnosis of substance-related disorder increased the likelihood of having attempted suicide (aOR: 4.14; 95% CI: 1.21-14.15; p = 0.023). The likelihood of having suicidal behavior decreased as one increased in age (aOR: 0.97; 95% CI: 0.94-0.99; p = 0.006) and increased among individuals reporting stress from financial constraints (aOR: 2.26; 95% CI: 1.05-4.86; p = 0.036).

CONCLUSION

Suicidal behaviors are common among inpatients managed for severe mental health conditions in Uganda, especially those with substance use and depressive disorders. In addition, financial stressors are a main predictor in this low-income country. Therefore, regular screening for suicide behaviors is warranted, especially among individuals with depression, and substance use, among those who are young, and among those reporting financial constraints/stress.

Mediation effect of insomnia symptoms between positive psychotic like experiences and suicidal ideation among Lebanese young adults

BACKGROUND

Psychotic symptoms reported by healthy individuals in the general population are referred to as psychotic-like experiences (PLEs) and have been proven to increase the risk of suicidal ideation (SI) in these individuals. As it is well established that PLEs and insomnia share a bidirectional association and also that insomnia is linked to SI, we hypothesized that insomnia may represent a mediator underlying the relationship between PLEs and SI. Our aim was to validate this hypothesis among Lebanese young adults.

METHODS

A total of 3103 young adults (mean age 21.73 ± 3.80 years; 63.6% females) recruited from all Lebanese governorates completed a self-administered online questionnaire. PLEs were assessed using the CAPE-42 scale, SI using the Columbia Suicide Rating Scale, and insomnia using the Insomnia Severity Index). We conducted a mediation analysis using SPSS PROCESS v3.4 model 4 with three pathways. Variables that showed a p < 0.25 in the bivariate analysis were entered in the path analysis.

RESULTS

A total of 1378 participants (44.4%) had insomnia; 18.8% had SI; 42.5% reported at least one positive PE 'nearly always', and 30.5% reported at least one negative PE with this frequency. The results of the mediation analysis showed that insomnia severity partially mediated the association between positive dimension and SI; higher positive dimension was significantly associated with more insomnia severity, which was, in turn, significantly associated with more SI. Finally, more positive dimension was significantly and directly associated with more SI.

CONCLUSION

These preliminary findings might encourage the implementation of new preventive measures to reduce SI among PLEs patients. Treating symptoms of insomnia might help reduce the risk of suicide.

The association between nation-level social and economic indices and suicide rates: A pilot study

Ever since the pioneering work of Emile Durkheim, it has been known that regional or national suicide rates can be influenced by a variety of social and economic factors. Recent research has found a robust association between two country-level economic indices-gross national product and unemployment rate-and suicide rates, particularly in men. However, the association between other country-level social indices-such as measures of social integration, inequality, environmental preservation and political freedom-and suicide rates has not been studied at the cross-national level. In the current study, national suicide rates for men and women were examined in relation to seven indices measuring subjective wellbeing, sustainable development, type of political regime, economic and gender inequality, and social capital. It was found that the Happy Planet Index, a composite measure of subjective wellbeing and sustainable development, was negatively associated with suicide rates independent of gender, and even after adjusting for possible confounding factors. Economic inequality was associated with suicide in men, and social capital was associated with suicide in women. Moreover, the strength and direction of the associations observed between socioeconomic indices and suicide varied across income groups. These results highlight the need for a closer evaluation of the link between large-scale ("macro") social factors and individual ("micro") psychological factors, as well as the importance of integrating these factors into suicide prevention programmes at the national level.

Identification of Risk Factors for Suicide and Insights for Developing Suicide Prevention Technologies: A Systematic Review and Meta-Analysis

Suicide is a termite that engulfs close to seven hundred thousand people worldwide each year. Existing work on risk factors that predict suicide lacks statistical associations, does not consider most countries, and has a wide range of risk factor domains. The goal of this systematic review and meta-analysis is to enhance our current understanding of suicidality by identifying risk factors that are most strongly associated with suicide and their impact on developing technological interventions for suicide prevention. A search strategy was carried out on four databases: (1) PsycINFO, (2) IEEE Xplore, (3) the ACM Digital Library, and (4) PubMed, and twenty-five studies were included based on the inclusion criteria. Factors statistically associated with suicide are any diagnosed mental disorder, adverse life events, past suicide attempts, low education level, loneliness or high levels of isolation, bipolar disorder, depression, multiple chronic health conditions, family history of suicide, sexual trauma, and being female. Domain-wise, comorbid disorders, and behavior-related risk factors are most strongly associated with suicide. We present a new hierarchical model of risk factors for suicide that advances our understanding of suicide and its causes. Finally, we present open research directions and considerations for developing suicide prevention technologies.

Perspectives on reasons for suicidal behaviour and recommendations for suicide prevention in Kenya: qualitative study

BACKGROUND

Little is known about the reasons for suicidal behaviour in Africa, and communities' perception of suicide prevention. A contextualised understanding of these reasons is important in guiding the implementation of potential suicide prevention interventions in specific settings.

AIMS

To understand ideas, experiences and opinions on reasons contributing to suicidal behaviour in the Coast region of Kenya, and provide recommendations for suicide prevention.

METHOD

We conducted a qualitative study with various groups of key informants residing in the Coast region of Kenya, using in-depth interviews. Audio-recorded interviews were transcribed and translated from the local language before thematic inductive content analysis.

RESULTS

From the 25 in-depth interviews, we identified four key themes as reasons given for suicidal behaviour: interpersonal and relationship problems, financial and economic difficulties, mental health conditions and religious and cultural influences. These reasons were observed to be interrelated with each other and well-aligned to the suggested recommendations for suicide prevention. We found six key recommendations from our thematic content analysis: (a) increasing access to counselling and social support, (b) improving mental health awareness and skills training, (c) restriction of suicide means, (d) decriminalisation of suicide, (e) economic and education empowerment and (f) encouraging religion and spirituality.

CONCLUSIONS

The reasons for suicidal behaviour are comparable with high-income countries, but suggested prevention strategies are more contextualised to our setting. A multifaceted approach in preventing suicide in (coastal) Kenya is warranted based on the varied reasons suggested. Community-based interventions will likely improve and increase access to suicide prevention in this study area.

Epidemiology of suicide in the Tri-City metropolitan area in Poland in 2010-2019

The paper, which is a continuation of our previous epidemiological studies on the phenomenon of suicide in the Tri-City metropolitan area, presents the results of statistical analyses of suicides in the autopsy material of the Department of Forensic Medicine of the Medical University of Gdańsk in the years 2010-2019. The purpose of the study was to analyse in detail demographic data of suicides (age, sex, place of death), as well as to assess suicide methods and the impact of alcohol on suicides in the study area. During the 10-year study period, 8495 autopsies were performed, of which 1261 were suicides (14.8%). Statistical analyses were conducted using the statistical data analysis software system STATISTICA, version 13 (StatSoft, Tulsa, Oklahoma, USA). The results of the study indicate a continuing downward trend in the number of suicides since the beginning of the 21th century, with the number of suicides in rural areas increasing over the same period. In the analysed cohort, suicides were committed in particular by middle-aged men and the number of suicides among older people (65 +) increased at the same time. The increase in suicide occurred in late autumn and early spring. The most common method of suicide was hanging. There was a high percentage of inebriated victims (45%), and a comparison of the present studies with previous ones indicates the increasing impact of alcohol on suicide.

Worry-related sleep problems and suicidal thoughts and behaviors among adolescents in 88 low-, middle-, and high-income countries: an examination of individual- and country-level factors

A strong association between sleep problems and suicidal thoughts and behaviors (STBs) has been demonstrated in high-income countries. The sleep-STB relationship, however, is minimally understood among youth in low and middle-incomes countries. There also is a limited understanding of how individual- (i.e., age, sex) and country-level (i.e., economic inequality, economic quality) factors may moderate the magnitude of the sleep-STB association among youth. Data were analyzed from the cross-national Global School-based Health Survey 2003-2017, which assessed a range of health behaviors among school-enrolled adolescents aged 11-18 years from 88 low-, lower-middle, upper-middle, and high-income countries. Multilevel models were used to examine the influence of individual- and country-level factors on the association between past-year worry-related sleep problems and past-year suicide ideation, suicide plans, and suicide attempts. Worry-related sleep problems were significantly associated with suicide ideation, plans, and attempts. Adolescent sex, country economic quality (income group designation), and country economic inequality moderated the sleep-STB association, but age did not. The sleep-STB relationship was stronger for males and across macroeconomic indices, the relationship was generally strongest among upper-middle income countries (economic quality) and countries with a big income gap (economic inequality). When examining how individual-level factors differentially affected the sleep-STB relationship within economic quality (income group designation), the effects were driven by older adolescents in high-income countries for suicide ideation and suicide plans. Study findings suggest an important role for global macroeconomic factors, for males, and older adolescents in high-income countries in the sleep-STB relationship. Future directions include expanding worldwide coverage of countries, assessing a wider range of sleep problems, and longitudinal work to understand potential mechanisms in the sleep-STB relationship.

Patterns of Unnatural Deaths Among Children and Adolescents: Autopsy Study (2011-2018)

BACKGROUND AND AIMS

The problem of unnatural death in children is still relevant because of their vulnerability. This work aimed to describe the epidemiological profile and patterns of these medicolegal deaths in children and adolescents in northern Tunisia.

METHODS

We conducted a retrospective study from January 2011 to December 2018, within the Forensic Department of Charles Nicolle Hospital in Tunis. All children who died of unnatural causes were included (767 cases).

RESULTS

An overall male predominance was observed (sex ratio = 2.4). Accidental deaths represent the most common manner of death (81.4%) involving most frequently domestic accidents occurring in children aged between 1 and 4 years. In cases of suicide, the highest risk profile was a female child aged between 15 and 18 years. The suicide occurred most often in the victim's home with hanging representing the common means of suicide. For the criminal form, the most common means in those cases were stabbing and blunt injuries.

CONCLUSION

Our study delivered a broad picture of unnatural deaths among children in Tunisia. These deaths, largely absent from child survival initiatives presently on the global agenda, can be prevented if they are addressed strategically, as their injury prevention strategies differ from adults.

Have Deaths of Despair Risen during the COVID-19 Pandemic? A Systematic Review

This systematic review synthesized literature on potential impacts of protracted isolation and other disruptions during the COVID-19 pandemic on deaths of despair (suicide, overdoses, and drug-related liver diseases). Five electronic databases were searched yielding 70 eligible articles. Extant evidence mostly from high-income countries indicates COVID-19-related disruption may not have influenced suicide rates so far, but there have been reports of increased drug-related and liver disease mortality. Minority groups and women were more vulnerable, indicating the need for stronger equity focus on pandemic recovery and resilience strategies. Further high-quality studies with longer-term follow-up, especially from low-income countries, will inform these strategies.

'They Sent Me Out to School, and I Came Back with a Baby': Perinatal Women's Experiences of Biographical Disruption and Nonfatal Suicidal Behaviour

Exploring perinatal women's experience of nonfatal suicidal behaviour (NFSB) could help illuminate the contexts in which perinatal suicide occurs and new ways to conceptualise maternal suicide prevention. Our aim was to explore perinatal women's subjective experience of NFSB in South Africa. Data were collected via in-depth interviews with seven perinatal women hospitalised following NFSB. Thematic analysis showed how poverty and gender norms shape experiences of pregnancy and highlighted the need for eco-systemic interventions for perinatal women in resource scarce environments to increase social support, assist with childcare, improve educational retention, challenge gender norms and increase paternal involvement. Pregnancy can precipitate biographical disruption by disturbing women's view of themselves and their futures. An inability to reconstruct a coherent narrative and re-imagine the future impedes the transition to motherhood and provides a context for suicide. Using the concept of biographical disruption to frame perinatal suicide, could identify novel approaches to suicide prevention.

Systematic review of suicide prevention studies with data on youth and young adults living in low-income and middle-income countries

OBJECTIVES

This review aimed to provide a summary of peer-reviewed, published literature on suicide preventive interventions with data on youth and young adults in low-income and middle-income countries (LMIC).

DESIGN

A systematic review was conducted using electronic databases of PubMed/MEDLINE, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Education Resources Information Center and The Campbell Collaboration databases for English-language articles published between 1 January 1990 and 15 February 2022.

ELIGIBILITY CRITERIA

Interventions of interest could include behavioural, community, clinical/medical or policy studies, or any combination of these, so long as the studies had at least one outcome of interest and at least one control group or control period. Outcomes included suicide ideation, suicide attempt and suicide. Interventions must have been conducted in an LMIC. Studies with individuals ages 0-25 in the sample were included. Articles describing data on individuals over age 25 could be included if individuals ages 0-25 were part of the sample.

RESULTS

A total of 44 eligible studies were identified, representing a broad range of universal, selective and indicated interventions. Most studies assessed interventions designed to address lethal means or mental health. Most studies were conducted in lower-middle-income or upper-middle-income countries, with the largest proportion in Asia. Assessment of outcomes across studies was heterogeneous and there were few large-scale investigations tailored specifically for youth.

CONCLUSIONS

Most of the published, peer-reviewed suicide intervention research from LMIC is concentrated in a few countries. While geographical coverage to date has been limited, strategies and samples in included studies were diverse, representing populations in clinical, educational and community settings. While current findings hold promise, this review identified a need for large-scale studies designed specifically for youth.

Magnitude and determinants of suicide among overweight reproductive-age women, Chacha and Debre Berhan Town, Ethiopia: community based cross-sectional study

Background

The magnitude and impact of women's suicidal behaviors, like suicidal ideation and suicidal attempts, are an important public health problem in low and middle-income countries, including Ethiopia. Suicidal behavior and being overweight are typical complications of reproductive age with many undesired consequences. Despite both having a serious impact on women of reproductive age, they are neglected in Ethiopia. Accordingly, this study aimed to examine the magnitude and determinants of suicide among overweight reproductive-age women in Chacha and Debre Berhan towns, Ethiopia.

Methods

A community-based cross-sectional study design was once employed from April 1, 2020 to June 1, 2020. The Composite International Diagnostic Interview was used to measure suicidal attempts and ideation, and the data was collected by direct interview. All collected data were entered into Epi Data version 4.6 and analyzed with SPSS version 25. Bivariate and multivariable regression models were used to determine the factors associated with a suicidal attempt and ideation. A p-value of less than 0.05 was considered statistically significant.

Result

Of the total participants, 523 were included, with a response rate of 93.7%. The prevalence of suicidal ideation was 13.0% (95% CI 10.1–15.9), whereas suicidal attempt was 2.3% (95% CI 1.1–3.6). Based on multivariable regression analysis, the odds of suicidal ideation have been higher among overweight women with stressful life events, depression, and younger age groups.

Conclusion

Suicidal ideation was frequent in overweight reproductive-age women. Preventing, treating, and using coping mechanisms regarding identified factors is a good way to minimize the burden of suicide.

Risk-Taking Behavior among Suicide Attempters

Background: Suicidal behavior is a major mental health concern both for the individual and for the public health. Among others, suicidal behavior is associated with impulsivity, risk taking, pain tolerance, and a state of overarousal. In the present study, we investigated if suicide attempters (SAs) reported higher scores for risk-taking when compared with healthy controls (HC) of the general population. Methods: A total of 616 individuals (mean age: 27.07 years; 51.5% females) took part in the study; of those, 240 (39%) were individuals with a suicide attempt (SA) within a time lapse of one to three months, and 376 (61%) were healthy controls (HC). Participants completed a series of self-rating questionnaires covering sociodemographic information, risk-taking (Risk-Taking Questionnaire 18; RT-18), and suicidal behavior (Suicide Behaviors Questionnaire-Revised; SBQ-R). Results: Compared with HCs, individuals with SA reported higher risk-taking and suicidal behavior scores. The risk-taking questionnaire yielded a four-factor solution: Thrill and sensation seeking; Cautious procedure; Cautious decision making; Impulsive behavior. Compared with HCs, SAs showed the highest scores for thrill and sensation seeking and impulsive behavior. Conclusions: Compared with healthy controls, individuals reporting a recent suicide attempt also reported a higher propensity to thrill and sensation seeking and impulsive behavior as a proxy of risk-taking behavior. The present results corroborate the notion that, among others, suicide attempts appeared to be less related to premeditation, but rather to impulsive and thus spontaneous behavior.

A mixed-methods systematic review of suicide prevention interventions involving multisectoral collaborations

Background

Governments and third-sector organizations (TSOs) require support to reduce suicide mortality through funding of suicide prevention services and innovative research. One way is for researchers to engage individuals and services in multisectoral collaborations, to collaboratively design, develop and test suicide prevention services and programmes. However, despite widespread support, to date, it remains unclear as to the extent to which stakeholders are being included in the research process, or if they are, how these partnerships occur in practice. To address this gap, the authors conducted a systematic review with the aim of identifying evidence of multisectoral collaborations within the field of suicide prevention, the types of stakeholders involved and their level of involvement.

Methods

The authors conducted a strategic PRISMA-compliant search of five electronic databases to retrieve literature published between January 2008 and July 2021. Hand-searching of reference lists of key systematic reviews was also completed. Of the 7937 papers retrieved, 16 papers finally met the inclusion criteria. Because of data heterogeneity, no meta-analysis was performed; however, the methodological quality of the included studies was assessed.

Results

Only one paper included engagement of stakeholders across the research cycle (co-ideation, co-design, co-implementation and co-evaluation). Most stakeholders were represented by citizens or communities, with only a small number of TSOs involved in multisectoral collaborations. Stakeholder level of involvement focused on the co-design or co-evaluation stage.

Conclusion

This review revealed a lack of evidence of multisectoral collaborations being established between researchers and stakeholders in the field of suicide prevention research, even while such practice is being espoused in government policies and funding guidelines. Of the evidence that is available, there is a lack of quality studies documenting the collaborative research process. Also, results showed that the inclusion of co-researchers from communities or organizations is defined as co-creation, but further analysis revealed that collaboration was not consistent across the duration of projects. Researchers and practitioners should consider issues of power and equity in multisectoral collaborations and encourage increased engagement with TSOs, to rigorously research and evaluate suicide prevention services.

People Who Die by Suicide Without Receiving Mental Health Services: A Systematic Review

Introduction

The majority of people who die by suicide have never seen a mental health professional or been diagnosed with a mental illness. To date, this majority group has largely been ignored, with most existing research focusing on predictors of suicide such as past suicide attempts. Identifying the characteristics of people who die by suicide without receiving services, often with a fatal first attempt, is crucial to reduce suicide rates through guiding improvements to service pathways and “just in time” interventions.

Methods

In this systematic review, PsycInfo, PubMed, CINAHL, and Web of Science were searched for peer-reviewed articles published from 1980 to 1st March 2021. Included studies examined predictors of non-receipt of formal mental health services among people who died by suicide. Data were extracted from published reports and the quality of included studies was assessed using a modified version of the Joanna Briggs Institute Checklist for Analytical Cross Sectional Studies. This review was registered with PROSPERO, CRD 42021226543.

Results

Sixty-seven studies met inclusion criteria, with sample sizes ranging from 39 to 193,152 individuals. Male sex, younger or older age, and rural location were consistently associated with non-receipt of mental health services. People not receiving mental health services were also less likely to have a psychiatric diagnosis, past suicidal behavior or contact with general health services, and more likely to use violent means of suicide. There was some evidence that minority ethnicity and psychosocial stressors were associated with service non-receipt.

Conclusion

People who die by suicide without receiving mental health services are likely to have diverse profiles, indicating the need for multifaceted approaches to effectively support people at risk of suicide. Identifying the needs and preferences of individuals who are at risk of suicide is crucial in developing new support pathways and services, and improving the quality of existing services.

Systematic Review Registration

http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42021226543.

Prevalence of suicidal ideation in pregnancy and the postpartum: A systematic review and meta-analysis

BACKGROUND

Suicidal ideation, a significant risk factor of suicide, is considered a potential trigger for intervention prior to self-harm or suicide; however, the prevalence of maternal suicidal ideation varied widely between studies. This review aims to synthesis the available evidence to estimate the prevalence of maternal suicidal ideation before and after pregnancy.

METHODS

We searched six English databases (PubMed, Web of Science, Embase, the Cochrane Library, PsycINFO, CINAHL) and three Chinese databases (China National Knowledge Infrastructure, Wang Fang, Chinese Biomedical Literature Databases) from database inceptions before August 31, 2020; and checked the reference list for relevant studies. Data in the included studies were used to calculate the prevalence of maternal suicidal ideation. Subgroup analysis and meta-regression were performed to detect the potential sources of heterogeneity.

RESULTS

6094 potentially studies were identified. 71 studies, including 23 cohort studies, 47 cross-sectional studies, and 1 RCT study, were included for final analysis. The total participants were 92146, with sample size ranged from 23 to 22118. The included studies were from 23 different countries distributing on six continents, most of the studies were conducted in Asia (n = 18), North America (n = 16), and South America (n = 15). The pooled prevalence of maternal suicidal ideation reported by eligible studies was 8% (95% CI 7-10%), with 10% in antenatal and 7% in postpartum. Prevalence significantly varied based on measuring tools, study design, study countries, and publication year, while prevalence was not conditional on the time-point assessment, sample size, and maternal age.

LIMITATION

Obvious heterogeneity and no standardization tools for measuring suicidal ideation may limit the results' interpretation.

CONCLUSION

Our systematic review reported the prevalence of suicidal ideation in pregnancy and postpartum was 8%. Future studies should establish standardization tools for measuring suicidal ideation and identify strategies of prevention and treatment.

Association of chronic diseases and lifestyle factors with suicidal ideation among adults aged 18-69 years in Eswatini: evidence from a population-based survey

Background

How chronic diseases and lifestyle affect suicidal ideation in the sub-Saharan region remains unclear. We investigated the association of chronic diseases and lifestyle with suicidal ideation in the past year and the potential modifying role of sociodemographic status on this association. The findings can guide suicide prevention interventions.

Methods

We analyzed 3026 respondents from the World Health Organization STEPwise approach to noncommunicable disease risk factor surveillance conducted in Eswatini in 2014. The outcome was past-year suicidal ideation, and the main predictors were chronic diseases and lifestyle. Multiple logistic regression was used to estimate predictors, and subgroup analysis was performed to assess effect modification.

Results

The prevalence of past-year suicidal ideation was 9.9%. After adjustment for covariates, including sex, marital status, employment status, and education level, individuals aged 18–30 years (adjusted odds ratio [aOR]: 2.27, 95% confidence interval [CI]: 1.22–4.22) were more likely to have had past-year suicidal ideation than those aged 45–69 years. After adjustment for covariates among employed individuals, having high blood pressure (aOR: 3.38, 95% CI: 1.54–7.40), not exercising (aOR: 2.65, 95% CI: 1.09–6.39), drinking alcohol (aOR: 2.40, 95% CI: 1.14–5.05), being aged 18–30 years (aOR: 3.50, 95% CI: 1.01–12.1), and being exposed to threats (aOR: 2.37, 95% CI: 1.01–5.53) were significantly associated with past-year suicidal ideation.

Conclusions

Among currently employed individuals, having high blood pressure, not exercising, and drinking alcohol were associated with past-year suicidal ideation. The findings highlight the importance of developing and strengthening systems for early identification of suicidal ideation risk.

Impact of spirituality and religiosity on suicidal risk among a sample of lebanese psychiatric in-patients

OBJECTIVES

To evaluate the prevalence of suicidality among the psychiatric inpatients community in Lebanon, and to elucidate the effect of religiosity and spirituality on suicidal thoughts or behaviours.

METHODS

A total sample of 159 patient consecutively admitted to a psychiatric hospital was interviewed. The Ask Suicide-screening Questionnaire (ASQ) was used to assess suicidal risk; the Mature Religiosity Scale (MRS) and the Spirituality Index for Well Being (SIWB) scales were used to assess religiosity and spirituality.

RESULTS

We found that 45.6% of the participants screened positively on the ASQ, including 37.5% with acute suicidal ideation. A backward logistic regression, taking the negative/positive screening ASQ as the dependent variable, showed that a positive family history of suicide and depression were significantly associated with higher positive suicidal screening, whereas higher spirituality was significantly associated with lower positive suicidal screening. When forcing the mature religiosity scale as an independent variable, the results remained the same.

CONCLUSION

Spiritual well-being might be considered an important factor to explore among psychiatric patients. Psychiatric inpatients have a high risk for suicide; the challenge remains for clinicians to identify upon admission patients that are most likely to die from suicide.Key pointsA positive family history of suicide and depression was significantly associated with higher suicidality.Higher spirituality, but not religiosity, was significantly associated with lower suicidality.Spiritual well-being might be considered an important factor to explore among psychiatric patients.The challenge remains for clinicians to identify patients that are most likely to die from suicide upon admission.

Social Determinants on Suicidal Thoughts among Young Adults

OBJECTIVE

The main objective of this study was to investigate the relationship between poverty, religion, and suicidal thoughts among U.S. youth. The disparities regarding gender, race, and ethnicity with regard to suicidal thoughts were also assessed.

METHODS

A cross-sectional correlational research design was used for this study and a national representative sample of 1945 young adults aged 18 to 25 was selected from the 2014 National Survey on Drug Use and Health. Logistic regression analysis with interaction effects was utilized to determine if poverty and religion were associated with suicidal thoughts.

RESULTS

About 43 percent of the sample reported having suicidal thoughts when things got worse and this prevalence rate varied by gender and race/ethnicity with white males self-disclosing the highest rate of suicidal thoughts. After adjusting for demographic and socioeconomic characteristics, black males who lived up to two times the poverty line had a higher likelihood of suicidal thoughts (p = 0.011), and religion protected against suicidal thoughts (p = 0.012). Youth with lower education and poor health were more inclined to have suicidal thoughts than their peers.

CONCLUSIONS

Suicide is the second leading cause of death for American young adults aged 18 to 25. Understanding these differences between social determinants of suicide can help public health researchers strategize how to make evidence-based recommendations for suicide prevention efforts.

Self-inflicted injuries: The intersection of mental health and traumatic injury in Malawi

Self-inflicted injury, the most common form of intentional injury, disproportionately affects low-income countries, but is poorly described in this setting. This retrospective review of the 2008-2018 trauma registry at a referral hospital in Malawi included all victims of intentional injury ≥10 years. Self-inflicted injuries were compared to assaults. The primary outcome was in-hospital mortality. Common mechanisms of self-inflicted injuries were fall from height, poisoning, and penetrating injury. In-hospital mortality from self-inflicted injury was 8.8% vs. 1.9% for assault. Those who died from self-inflicted injury were more often older (median 34 vs. 26 years, p < 0.001), male (91.9% vs. 67.8%, p < 0.001), unemployed (32.8% vs. 6.4%, p < 0.001), and most commonly died by hanging (60%). The odds of in-hospital mortality after self-inflicted injury was four times assault (OR 4.0 [95% CI 1.4-11.5], p = 0.01). The trauma registry proved useful for describing self-inflicted injury in this setting.

Risk Factors and Effects of the Morbus: COVID-19 through the Biopsychosocial Model and Ecological Systems Approach to Social Work Practice

Utilizing the biopsychosocial model and the ecological systems theory, this disquisition explores on the risk factors associated with the COVID-19 pandemic. The discourse shows the interconnectedness of biological, psychological, and social domains in expatiating on the COVID-19 pandemic. It calls for the need to strengthen the resilience of the global community in the face of health outbreaks such as COVID-19. It emphasizes on the perspectives that pandemics are managed before they emerge through building systems that are resilient. Thus, it appreciates the need for a therapeutic milieu as a building block to resilience. The article calls for the adoption of a developmental stance to analyzing health outbreaks and clinical issues. The adumbration shows the reciprocity effects of the health outbreak [macrocosms] and individual factors [microcosms]. To its end, the paper implies that COVID-19 is a call for integration toward effective health planning between social policy formulators, urban and rural planners, epidemiologists, development practitioners, clinicians, researchers to mention but a few. Ultimately, the paper calls for social workers to consider a developmental-clinical social work approach which helps foster "health in all policies" so as to build resilience against the morbus and limit the proliferation of diseases.

Universal interventions for suicide prevention in high-income Organisation for Economic Co-operation and Development (OECD) member countries: a systematic review

INTRODUCTION

To examine the effectiveness of universal suicide prevention interventions on reducing suicide mortality in high-income Organisation for Economic Co-operation and Development (OECD) member countries.

METHODS

We implemented a comprehensive search strategy across three electronic databases: MEDLINE (Ovid), PsycINFO (Ovid) and Embase (Ovid). All studies using time-series, retrospective, prospective, pre-post or cross-sectional study designs were included. Studies were required to examine suicide mortality as the outcome of interest. To help organise the results, studies were grouped into six broad categories of universal interventions consistent with the World Health Organization (WHO) Comprehensive Mental Health Action Plan. A narrative synthesis of results was used to describe the findings.

RESULTS

Of the 15 641 studies identified through the search strategy, 100 studies were eligible in the following categories: law and regulation reforms (n=66), physical barriers (n=13), community-based interventions (n=9), communication strategies (n=4), mental health policies and strategies (n=7), and access to healthcare (n=1). Overall, 100% (13/13) of the included physical barrier interventions resulted in a significant reduction in suicide mortality. Although only 70% (46/66) of the law and regulation reform interventions had a significant impact on reducing suicide, they hold promise due to their extended reach. Universal suicide prevention interventions seem to be more effective at reducing suicide among males than females, identifying a need to stratify results by sex in future studies.

CONCLUSIONS

These findings suggest that universal suicide prevention interventions hold promise in effectively reducing suicide mortality in high-income OECD countries.

Suicide Attempts, Neurocognitive Dysfunctions and Clinical Correlates in Middle-Aged and Elderly Chinese Schizophrenia Patients

Background: Suicide is a common and complex symptom of schizophrenia that may be related to clinical variables and neurocognitive function. This study aimed to investigate the associated correlates of suicide attempts in Chinese middle-aged and elderly inpatients with schizophrenia, including demographic and clinical characteristics and cognitive level, which has not yet been reported. Methods: A total of 426 schizophrenia inpatients were recruited for this study. Clinical symptoms were evaluated using the Positive and Negative Syndrome Scale (PANSS). Neurocognitive function was measured by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Results: The prevalence of suicide attempts in middle-aged and elderly Chinese schizophrenia patients was 13.3%. Female patients had a higher suicide rate than male patients. Patients with suicide attempts had significantly higher PANSS-positive subscores, depressive subscores, and RBANS-story recall than non-attempter patients (all p < 0.05). Multiple logistic regression showed that gender, positive subscore, depressive subscore and RBANS-story recall (OR = 1.10-2.19, p < 0.05) were independently associated with suicide attempts in middle-aged and elderly schizophrenia patients. Conclusions: Our study showed that the rate of suicide attempts in Chinese middle-aged and elderly schizophrenia patients is high. Compared to non-attempters, there are less cognitive impairments, more clinical symptoms, and more female patients in the suicide attempters.

Prevalence and Associated Factors of Suicidal Behavior Among Patients and Residents in Northwest Ethiopia

There are a million suicide deaths in the world annually, and 75% of these occur in low- and middle-income countries (LMICs). However, there are limited resources to prevent suicidal deaths in those regions. The aim was to assess the prevalence of suicidal behavior and associated factors among patients visiting for medical care at a health center and residents in the community. A comparative study was employed by interviewing 2,625 residents in the community and 1,363 patients at the health center about suicidal behavior in northwest Ethiopia, from March 2017 to February 2018. Logistic analysis was employed with adjusted odds ratios and 95% confidence interval (CI) and with p-value < 0.05. The total prevalence of suicidal behavior (ideation, plan, and attempt) was found to be 5.6% (with 95% CI range 5-6%). It was found to be 4.4% with 95% CI range 4-5% in residents and 7.9% with 95% CI range 6-9% in patients. Female sex, depressive symptoms, physical/verbal abuse, and feeling stigmatized were identified as a risk factors for suicidal behavior, whereas a healthy lifestyle, such as eating regular meals of fruits and vegetables, doing physical exercise regularly, and having public health insurance were identified as protective risk factors for suicidal behavior even after adjusting for being a patient or not. The proportion of suicidal behavior was double in patients compared with residents. Suicidal behavior should be assessed in patients who visit for medical help and integration of mental health service within the primary health care system is recommended, especially in low-income countries.

Characteristics associated with later self-harm hospitalization and/or suicide: A follow-up study of the HUNT-2 cohort, Norway

BACKGROUND

To improve suicide and self-harm prevention in adults, better knowledge on preexisting characteristics and risk factors is of great importance.

METHODS

This is a population-based case-control study; baseline measures were collected in the second wave of the North-Trøndelag Health Study (HUNT-2, 1995-1997) in Norway, and outcomes were observed for up to 19 years. Average follow up time was 4.9 years for self-harm and 6.8 years for suicides. Out of 93,898 eligible adult inhabitants aged 20 and above, a total of 65,229 (70%) participated in the study. The data were linked to the National Mortality Registry and hospital patient records in the three hospitals covering the HUNT-2 catchment area.

RESULTS

Among the participants, 332 patients (68% women) were hospitalized because of self-harm (HSH), and 91 patients (32% women) were died by suicide (SU). A total of 10% of those who died by SU had previously been HSH. People in the HSH and SU groups were younger, reported more depression and anxiety symptoms, sleeping problems, higher use of alcohol and tobacco, poorer social network and more economic problems, compared to the rest of the HUNT-2 population. In addition, the HSH group reported more somatic health problems, higher use of health services, higher sick leave, and lower work participation than the SU group.

LIMITATIONS

Younger adults (20-40 years) were under-represented in HUNT-2. Younger adults (20-40 years) were constituted 31.7% in HUNT-2, 50% in HSH and 33% in SU. Further, we did not identify less severe self-harm, not requiring hospitalization. Life changes, adverse events, and other possible triggers to self-harming behavior were not recorded.

CONCLUSION

Psychological problems were long-term predictors of both HSH and SU. Somatic health problems and lower functional performance were more present in HSH-group compared to the SU-group.

Epidemiological status of suicide in the Middle East and North Africa countries (MENA) from 1990 to 2017

Background

Suicide is proposed as an important and growing issue in public health. The aim of this study is to compare suicide load in the Middle East and North Africa (MENA) countries in order to pave the way for correct health policy making.

Methods

The population included 21 MENA countries. The data of Global Burden of Diseases in 2017 that estimate death rate for 264 causes was used. The GBD considers suicide according to definition of the ninth and tenth editions of the international classification of diseases as death due to poisoning or intentional self-injury. All suicide-related analyzes were evaluated using these indicators in excel 2016.

Results

The highest percentage of total suicide DALY attributable to risk factors of Alcohol and drug use are related to United Arab Emirates and Afghanistan countries, respectively. Iran is the sole country without suicide DALY attributable to alcohol consumption risk factor. Moroccan women and Libya, Afghanistan and Yemen men have the highest DALY rates in terms of ASR in the region, respectively. Suicide incidence have an increasing trend until the age group of 20–24 and then a decreasing trend. This trend is on the rise again since the age of 65.

Discussion

The necessity to improve social, cultural and economic factors along with effective measures on suicide prevention especially among low and middle income countries, performing more studies and precise registration of the cases especially in the areas that suicide is considered social stigma and crime should be considered as high agenda in national and regional strategies.

Cross-national prevalence and factors associated with suicide ideation and attempts in older and young-and-middle age people

Objectives: To report prevalence estimates of 12-month suicide ideation and attempts in young-and-middle age adults and older people, as well as their respective associated factors.Methods: A total of 52,150 community-dwelling adults who completed the adapted version of the Composite International Diagnostic Interview-Depression Module were included from SAGE and COURAGE in Europe studies. The presence of 12-month suicide ideation and attempts was measured among the participants who screened positively in the Depression Module. Global and national prevalence estimates of 12-month suicide ideation and attempts were calculated according to the total sample. Logistic regression analyses were conducted to separately determine factors associated with suicidal ideation and with suicide attempts in young-and-middle age adults and older adults.Results: Higher estimates of 12-month suicidal ideation were found for high-income countries and people aged 65 years and older. Higher negative affect, higher disability, and presence of food insecurity were associated with 12-month suicidal ideation and suicide attempts for young-and-middle-adults and older adults. Higher isolation, being female, and greater number of chronic health conditions were also related to 12-month suicidal ideation in both age groups. Younger age was associated with 12-month suicidal ideation for older people, and with suicide attempts in the young-and-middle age group. Finally, higher income was related to lower rates of 12-month suicidal ideation for the young-and-middle age group.Conclusions: Older people are at increased risk of suicidal ideation globally and of suicide attempts in some countries. There were common and different factors related to suicide in adults and older adults.

Serum oxytocin concentrations in current and recent suicide survivors are lower than in healthy controls

BACKGROUND

Suicide and suicide attempts are dramatic events both for the individuals concerned and for their social circles. From a psychopathological perspective, suicidal behavior could be understood as a severe breakdown in relations with their social worlds. Oxytocin is a neuropeptide highly involved in the perception of facets of social relationship such as their quality feelings of belongingness, and mutual trust. Given this, we expected that serum oxytocin concentrations would be lower in current and recent suicide survivors than in healthy controls.

METHODS

A total of 48 participants (mean age: 27 years; 62.5% females) took part in the study. Of these, 16 (62.5% females) survived a suicide attempt 12-24 h ago; 16 (62.5% females) had made a suicide attempt about 12 weeks ago, and 16 (62.5% females) were healthy age- and gender-matched controls. Blood samples were taken in the morning to assess serum oxytocin concentrations. Participants also completed questionnaires covering sociodemographic information and a scale assessing suicidal ideation.

RESULTS

Compared to healthy controls, suicide survivors had significantly lower serum oxytocin concentrations, but these levels did not differ between current and recent suicide survivors. Compared to healthy controls and recent suicide attempters, current suicide attempters recorded significantly higher scores on the Beck scale for suicidal ideation. Across the sample as a whole, higher scores for suicidal ideation were associated with lower serum oxytocin concentrations. Serum oxytocin concentrations and scores on the Beck scale for suicidal ideation did not differ between females and males.

CONCLUSIONS

Given that oxytocin is a neurobiological correlate of subjectively perceived quality of social interaction and social relationships, the results support the notion that suicide attempts are closely linked to suicide survivors' perceptions of the quality of their social lives. Speculatively, and based on the serum oxytocin concentrations, it also appears that 12 weeks after a suicide attempt, the survivor's perceived quality of social life has not significantly improved.

Suicidal behavior in problematic substance uses in South Gondar zone, Northwest Ethiopia: a cross-sectional survey

Background

Suicidal behavior has a significant contribution to the global burden of disease that affects individuals, families and communities at different age groups. Sadly, up to 75% of suicides in the world occur in low-and- middle income countries which have no adequate resource to prevent it. The aim of this study was to assess suicidal behavior and associated factors among community residents with problematic substance use in South Gondar zone, northwest Ethiopia.

Methods

Community based cross-sectional survey was conducted by using a suicidal behavior revised questionnaire from January 15 to March 15, 2019. A total of 4035 participants were screened for problematic substance use by using multi stage cluster sampling and 846 participants were positive for problematic substance use then asked for suicidal behavior. Multiple logistic regression analyses used to see adjusted odd rations (AOR). Multilevel binary logistic regression was used to account for the hierarchical structure of the two-level data within individual and districts level.

Results

The prevalence of suicidal behavior over the last 12 months in problematic substance uses was found to be 41.4% with 95% of confidence interval (CI) (38.2–44.9). Perceived stigma, [AOR = 1.605, 95% CI (1.16–2.23)], family history of suicide [AOR = 3.22, 95% CI (1.46–7.10)], physical illness [AOR = 2.45 95% CI (1.157–3.84)], rural resident [AOR = 1.74, 95% CI (1.16–2.62)], depression [AOR = 4.44, 95% CI (3.15–6.27)] and living alone (AOR = 1.61, 95% CI (1.16–2.24) were risks factors for suicidal behavior.

Conclusion

Suicidal behavior in problematic substance uses found to be high. Health workers should pay attention to decrease suicidal behavior and to control amendable factors.

Early-life stressful events and suicide attempt in schizophrenia: Machine learning models

Childhood abuse and neglect predicts suicide attempt. Furthermore, other early-life stressful events may predict lifetime suicide attempt in psychiatric disorders. We assessed 189 schizophrenics for suicide attempt and stressful life events. Early-life stressful events were used as predictors of lifetime suicide attempt in three machine learning models. In our sample, 38% of the schizophrenics had at least one suicide attempt lifetime. The machine learning models provided an overall significant prediction (accuracy range: 62-69%). Childhood sexual molestation and mental illness were important predictors of suicide attempt. Early-life stressful events should be included in models aiming at predicting suicide attempt in schizophrenia.

Sex Differences in Mental Health Outcomes of Suicide Exposure

Past research has robustly supported differences in prevalence and severity of mental health disorders between males and females in general. Less is known in regards to how suicide exposure and related factors may be associated with these mental health outcomes in men and women. This study seeks to explore similarities and differences between suicide exposure experiences of males and females in regards to number of exposures to suicide, relationships to the deceased, perceptions of closeness to the deceased, and related mental health correlates. Clinical applications are then discussed. A dual-frame, random digit dial survey was utilized to identify sex-differentiated demographic and suicide-related factors associated with these correlates in a statewide sample of 1,736 adults. t-tests revealed statistically higher depression, anxiety, and prolonged grief mean scores for suicide-exposed females; statistically higher suicide ideation levels in suicide-exposed males, and no statistical differences between sexes in PTSD scores. Logistic regression analyses provided an in-depth look at similarities and differences in risk and protective factors between male and female outcomes with perceptions of closeness and kinship levels as most salient risk factors. Cross-sectional design limits assertions of causality and retrospective nature of study may introduce recall bias. Males and females may differ in mental health impacts after suicide exposure. Implications for future research, prevention program planning, and bereavement counseling approaches are discussed.

Efficacy of psychosocial interventions for mental health outcomes in low-income and middle-income countries: an umbrella review

BACKGROUND

Mental health conditions are leading causes of disability worldwide. Psychosocial interventions for these conditions might have a key role in their treatment, although applicability of findings to poor-resource settings might be a challenge. We aimed to evaluate the strength and credibility of evidence generated in low-income and middle-income countries (LMICs) on the efficacy of psychosocial interventions for various mental health outcomes.

METHODS

We did an umbrella review of meta-analyses of randomised studies done in LMICs. Literature searches were done in Medline, Embase, PsychINFO, CINAHL, Cochrane Library, and Epistemonikos from Jan 1, 2010, until May 31, 2019. Systematic reviews of randomised studies investigating the efficacy of psychosocial interventions for mental health conditions in LMICs were included. Systematic reviews of promotion, prevention, and protection interventions were excluded, because the focus was on treatment interventions only. Information on first author, year of publication, outcomes, number of included studies, and reported summary meta-analytic estimates was extracted from included meta-analyses. Summary effects were recalculated using a common metric and random-effects models. We assessed between-study heterogeneity, predictive intervals, publication bias, small-study effects, and whether the results of the observed positive studies were more than expected by chance. On the basis of these calculations, strength of associations was assessed using quantitative umbrella review criteria, and credibility of evidence using the GRADE approach. This study is registered with PROSPERO, number CRD42019135711.

FINDINGS

123 primary studies from ten systematic reviews were included. The evidence on the efficacy of psychosocial interventions in adults with depression in humanitarian settings (standardised mean difference 0·87, 95% CI 0·67-1·07; highly suggestive association, GRADE: moderate) and in adults with common mental disorders (0·49, 0·36-0·62; highly suggestive association, GRADE: moderate) was supported by the most robust evidence. Highly suggestive strength of association was found for psychosocial interventions in adults with schizophrenia for functional outcomes, in adults with depression, and in adults with post-traumatic stress disorder in humanitarian settings. In children in humanitarian settings, and in children with disruptive behaviour, psychosocial interventions were supported by suggestive evidence of efficacy.

INTERPRETATION

A relatively large amount of evidence suggests the benefit of psychosocial interventions on various mental health outcomes in LMICs. However, strength of associations and credibility of evidence were quite variable, depending on the target mental health condition, type of population and setting, and outcome of interest. This varied evidence should be considered in the development of clinical, policy, and implementation programmes in LMICs and should prompt further studies to improve the strength and credibility of the evidence base.

FUNDING

University of Verona.

Culturally informed gatekeeper training for youth suicide prevention in Guyana: A pilot examination

Adolescent suicide is a pressing concern in Guyana, a low-to middle-income country in South America with the highest adolescent suicide rate globally. Gatekeeper trainings for suicide prevention conducted in high-income countries have been found to increase knowledge of suicide prevention, increase referrals of at-risk youth, and reduce stigma toward help-seeking for suicidality. The current study sought to engage in a pilot examination of the effectiveness, acceptability, and feasibility of a culturally informed gatekeeper training suicide prevention program for Guyanese youth. Secondary school teachers and staff ( N = 16) were trained in a culturally informed, evidence-based gatekeeper suicide prevention program. Mixed methods analyses revealed significant increases in knowledge of suicide prevention, as well as decreases in rigid or judgmental attitudes toward suicide post-training among secondary school teachers and staff. Further, results indicated that participants deemed the program culturally acceptable and feasible for use in the school setting. Findings have implications for the delivery and implementation of culturally informed gatekeeper training programs for suicide prevention in low-to middle-income countries.

Association between perinatal depressive symptoms and suicidal risk among low-income South African women: a longitudinal study

PURPOSE

The aim of this study was to assess the association between depressive symptoms and suicidal risk over time among perinatal women at risk for depression antenatally, and assess modifying effects of age, perinatal stage and depressive symptom trajectory.

METHODS

A total of 384 adult pregnant women were recruited from two antenatal clinics in an informal settlement near Cape Town, South Africa, and followed up at eight months gestation, and at 3- and 12-month postpartum. The MINI 6.0 Suicidality module and the Hamilton Depression Rating Scale (HDRS) were used to measure suicidal risk and depression, respectively. Generalised Estimating Equations were used to assess the association between change in depressive symptoms from one assessment to the next (predictor) and change in suicide score or change in suicidal risk (score ≥ 9) (outcomes).

RESULTS

HDRS scores were positively correlated with suicide score (95% CI 0.35, 0.78; p < 0.001), and with odds of being at moderate risk for suicide, after controlling for risk of suicide at the previous assessment (adjusted odds ratio = 1.15; 95% CI 1.09, 1.22; p < 0.001). Age was a significant effect modifier: change in HDRS scores was not associated with change in suicide scores among participants aged 35-45 years. Secondary analyses indicated that a decrease in HDRS score was associated with a decrease in suicide scores, but an increase in HDRS score was not associated with change in suicide score.

CONCLUSIONS

Depression and suicide are overlapping but relatively independent phenomena, especially among older or more chronically depressed perinatal women.

Social cognition remediation interventions: A systematic mapping review

Background

Impairments in social cognition have been described in several psychiatric and neurological disorders. Given the importance of the relationship between social cognition and functioning and quality of life in these disorders, there is a growing interest in social cognition remediation interventions. The aim of this study was to carry out a systematic mapping review to describe the state of the art in social cognition training and remediation interventions.

Methods

Publications from 2006 to 2016 on social cognition interventions were reviewed in four databases: Scopus, PsycINFO, PubMed and Embase. From the initial result set of 3229 publications, a final total of 241 publications were selected.

Results

The study revealed an increasing interest in social cognition remediation interventions, especially in the fields of psychiatry and psychology, with a gradual growth in the number of publications. These were frequently published in high impact factor journals and underpinned by robust scientific evidence. Most studies were conducted on schizophrenia, followed by autism spectrum disorders. Theory of mind and emotional processing were the focus of most interventions, whilst a limited number of studies addressed attributional bias and social perception. Targeted interventions in social cognition were the most frequent practice in the selected papers, followed by non-specific treatment interventions and broad-based interventions.

Conclusions

Research in social cognition remediation interventions is growing. Further studies are needed on attributional bias and social perception remediation programs, while the comparative efficacy of different interventions also remains unclear.

Prevalence of suicidal ideation, suicidal attempt and completed suicide in Ethiopia: a systematic review and meta-analysis protocol

BACKGROUND

Suicide is an emergency psychiatric problem that needs an urgent intervention. Ethiopia, as a nation, has been experiencing high burden of suicide. Cultural taboo, stigma, and criticism associated with suicidal behaviors affect the communities' attitude and practice toward suicide and its help-seeking behaviors. Thus, this systematic review and meta-analysis will provide the pooled prevalence of suicidal ideation, suicidal attempt, and completed suicide in Ethiopia.

METHODS

This review protocol is designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P 2015 Guidelines). Studies reporting the prevalence of suicidal ideation, suicidal attempt, and completed suicide will be included from the databases of PubMed/MEDLINE, Cochrane Library, SCOPUS, EMBASE, and Web of Sciences. The reference lists of retrieved articles, Google Scholar, and national health database reporting suicide will be also searched. No time and language restrictions will be imposed on the search strategy. The methodological quality of included studies will be assessed using the Joanna Briggs Institute critical appraisal tool. The heterogeneity between studies will be measured by the index of heterogeneity (I2 statistics) test. Funnel plots and Egger's test will be used to determine publication bias. Moreover, subgroup and sensitivity analyses will be carried out. The pooled prevalence of suicidal ideation, suicidal attempt, and completed suicide will be calculated by metaprop command using random effects model with the Dersimonian and Laird method.

DISCUSSION

This systematic review and meta-analysis aims to explore the available epidemiological evidences about suicidal ideation, suicidal attempt, and completed suicide. The final results of this review will be submitted for publication in a peer-reviewed journal and presented at conferences. The review of the results will help to raise awareness about the burden of suicidal ideation, suicidal attempt, and completed suicide in Ethiopia.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018112836.

Pharmacological interventions in social cognition deficits: A systematic mapping review

Social cognition is an important research field in psychiatry due to its relevance in the functioning and quality of life of patients. The objective of this work is to conduct a systematic mapping review of pharmacological strategies for improving social cognition deficits. Publications from 2006 to 2016 were reviewed in Scopus, PsycINFO, PubMed, and Embase. From the initial 1059 publications obtained, a final number of 110 were selected. The results show an increasing interest in pharmacological approaches in different medical fields (especially psychiatry, pharmacology, and endocrinology, with schizophrenia and autism as the most studied disorders), as can be observed in the progressive increase in the number of publications, the high degree of scientific evidence, and the high impact factor of publications. However, it is also observed that most studies were conducted with oxytocin, psychostimulants, and antipsychotics (mainly risperidone and olanzapine), with few studies using other drugs. In the different social cognition domains, the majority of publications were focused on emotional processing or theory of mind, with few studies in other domains. Thus, this systematic mapping review shows that, even though there are increasing research activities, there are some important gaps to cover in future investigation.

Non-fatal suicidal behaviour, depression and poverty among young men living in low-resource communities in South Africa

Background

Suicide is a serious public health problem in low- and middle-income countries. Understanding the context- and gender-specific risk factors for non-fatal suicidal behaviour is the cornerstone of evidence-based public health interventions to reduce suicide. Poverty and symptoms of depression are well established risk factors for suicidal behaviour. However, little is understood about how proximal economic factors (such as losing one’s job, or food insecurity) may confound the effects of symptoms of depression to increase the risk of non-fatal suicidal behaviour in vulnerable populations, such as young men living under conditions of endemic poverty. The aim of this study was to explore the extent to which a wide range of poverty-related variables account for non-fatal suicidal behaviour independent of, or in addition to, symptoms of depression among young men living in low-resource communities in South Africa (SA).

Methods

Data were collected from a clustered sample of 647 young men living in low-resource communities in the Western Cape province of SA. Multivariate regressions were used to identify the associations between poverty-related measures, symptoms of depression, and past-month prevalence of non-fatal suicidal behaviour.

Results

Non-fatal suicidal behaviour in the last month was reported by 47 (6.13%) participants: suicidal ideation (n = 43; 5.97%); suicide plan (n = 5; 0.77%); suicide attempt (n = 4; 0.62%), and deliberate self-harm without intent to die (n = 4; 0.62%). Past-month prevalence of non-fatal suicidal behaviour was significantly associated with particular dimensions of poverty (living in a home without a toilet on the premises, having previously been fired, and food insecurity), but not with other dimensions of poverty (such as prolonged unemployment and low levels of income). However, symptoms of depression were a more significant predictor of non-fatal suicidal behaviour than any measure of poverty (aOR=1.093, 95% CI=1.058-1.129, p < .000).

Conclusions

Depressive symptoms are more strongly associated with non-fatal suicidal behaviour than a range of proximal and distal economic factors among young men living under conditions of endemic poverty in South Africa. This has important public health implications and highlights the importance of increasing young men’s access to psychiatric services and targeting depression as an integral component of suicide prevention in low resource communities.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6104-3) contains supplementary material, which is available to authorized users.

Cholecystokinin (CCK) level is higher among first time suicide attempters than healthy controls, but is not associated with higher depression scores

Suicide and suicide attempts are dramatic events for both the individuals concerned and for their social environments. Efforts have been made to identify reliable biological predictors of suicide and suicide attempts. In the present study, we focused on one potential marker, cholecystokinin (CCK), among first time suicide attempters. A total of 25 suicide attempters (mean age: 30 years; 80% females) and 23 healthy controls were enrolled in the present cross-sectional study. Experts rated participants' symptoms of depression (Hamilton Depression Rating Scale; HDRS). Blood levels of CCK levels were assessed. Suicide attempters had CCK levels 22.67 times higher and HDRS scores 14.33 higher than healthy controls. CCK levels were only weakly associated with HDRS scores. CCK appears to be a fairly reliable biomarker for suicide attempts. However, CCK levels were not associated with depression scores, making it difficult to match biological markers to depressive behaviour.

Epidemiology of Suicide and the Psychiatric Perspective

Suicide is a worldwide phenomenon. This review is based on a literature search of the World Health Organization (WHO) databases and PubMed. According to the WHO, in 2015, about 800,000 suicides were documented worldwide, and globally 78% of all completed suicides occur in low- and middle-income countries. Overall, suicides account for 1.4% of premature deaths worldwide. Differences arise between regions and countries with respect to the age, gender, and socioeconomic status of the individual and the respective country, method of suicide, and access to health care. During the second and third decades of life, suicide is the second leading cause of death. Completed suicides are three times more common in males than females; for suicide attempts, an inverse ratio can be found. Suicide attempts are up to 30 times more common compared to suicides; they are however important predictors of repeated attempts as well as completed suicides. Overall, suicide rates vary among the sexes and across lifetimes, whereas methods differ according to countries. The most commonly used methods are hanging, self-poisoning with pesticides, and use of firearms. The majority of suicides worldwide are related to psychiatric diseases. Among those, depression, substance use, and psychosis constitute the most relevant risk factors, but also anxiety, personality-, eating- and trauma-related disorders as well as organic mental disorders significantly add to unnatural causes of death compared to the general population. Overall, the matter at hand is relatively complex and a significant amount of underreporting is likely to be present. Nevertheless, suicides can, at least partially, be prevented by restricting access to means of suicide, by training primary care physicians and health workers to identify people at risk as well as to assess and manage respective crises, provide adequate follow-up care and address the way this is reported by the media. Suicidality represents a major societal and health care problem; it thus should be given a high priority in many realms.