Suicide and suicide risk

Prediction and explanation of the increase in suicide risk of emerging adults: A comprehensive approach combining logistic regression, glasso network analysis, and Bayesian networks

BACKGROUND

The high suicide rate among emerging adults is a pressing public health issue. Identifying key suicide risk factors and understanding the mechanisms through which they affect individuals is crucial for intervention.

AIM

To uncover the complex factors influencing suicide risk among emerging adults and to elucidate how these risk factors interact and contribute to the overall risk of suicide.

METHODS

An online survey assessed mental health and suicide risk factors among 29,111 college students. Higher-risk students (n = 4820) were further evaluated using the Adolescent Suicidal Tendency Scale. This two-phase approach identified initial risk factors and subsequent suicide risk, which were analyzed through logistic regression, Glasso, and Bayesian network methods.

RESULTS

Logistic regression results indicated that adverse life events and social support can predict suicide risk, with the model achieving an Area Under the Curve (AUC) of 0.783. Glasso network analysis revealed a highly interconnected symptom network among all factors, where the highest centrality nodes, such as depression (1.465) and neuroticism personality traits (1.139), played central roles in the evolving dynamics of suicide risk. The Bayesian network analysis emphasized the mediating role of social support in the relationship between other risk factors and suicidal ideation.

LIMITATIONS

The lack of repeated measurements and the exclusion of pandemic-related variables may limit a comprehensive understanding of the risk factors.

CONCLUSIONS

Intervening in the mental health issues of individuals with suicidal tendencies and strengthening social support are crucial for reducing suicide risk, and this deserves the attention of mental health professionals.

Self-harm thoughts among postpartum women - associated factors

BACKGROUND

Even though in many countries suicide is the leading cause of maternal deaths during the postpartum period, the prevalence of thoughts of self-harm (SHTs), an important risk factor for suicide attempts, is still not well documented.

AIM

We aimed to investigate the prevalence of SHTs in a Polish cohort of postpartum women and identify socio-demographic and maternal mental health factors associated with experiencing SHTs.

METHOD

1545 women took part in a midwife-led postpartum depression (PPD) screening. 337 of them reported SHTs. The Edinburgh Postpartum Depression Scale (EPDS) was administered. Specifically, we used an abbreviated 5-item version to assess depression symptoms, item 10 to assess SHTs, a composite score of items 1 and 2 - anhedonia, and a composite score of items 3, 4, and 5 - anxiety. Logistic regression analyses were performed to examine associations between variables.

RESULTS

Approximately 2% (n = 337) of women self-reported experiencingSHTs. Within the group of postpartum mothers who self-reported SHTs, 65.60% (n = 221) manifested the symptoms of PPD, and 56.40% (n = 190) - of anxiety. The symptoms of PPD, a mood disorder diagnosed in the past, and younger age were predictors of SHTs.

CONCLUSION

The results of this study can contribute to the development of prevention strategies: analysing separately items from PPD screening questionnaires focusing on SHTs can be an important part of prevention. The lack of the symptoms of PPD and anxiety risk does notexclude experiencing SHTs.

Development and validation of a neutrophil-lymphocyte ratio-based nomogram for suicidal ideation in first-episode drug-naïve schizophrenia patients: A large-scale cross-sectional study

BACKGROUND

Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and platelet-neutrophil ratio (PNR) play a significant role in the pathophysiology of suicidal ideation (SI) in schizophrenia (SZ). The objective of this research was to create a nomogram that utilizes these markers to forecast the likelihood of SI in patients with first-episode drug-naïve (FEDN) SZ.

METHODS

This research analyzed 582 FEDN SZ patients cross-sectionally. The Positive and Negative Syndrome Scale (PANSS) was utilized to evaluate symptoms, depressive and cognitive factors in patients. The complete blood count was measured to calculate derived inflammatory indicators. Patients were divided into SI and non-SI groups based on the Beck Scale for Suicide Ideation scores and then randomly allocated to a training group (70 %, n = 407) and a validation group (30 %, n = 175). LASSO and binary logistic regression identified SI-associated variables in the training group, and a nomogram was built for SI prediction. The model's discrimination, calibration, and clinical utility were assessed by analyzing the area under the receiver operating characteristic curve (AUC), calibration plots, decision curve analysis (DCA), and internal validation procedures.

RESULTS

We developed a nomogram integrating NLR, PLR, PNR, and depressive factors to predict SI in FEDN SZ patients. AUCs were 0.748 (95 % CI: 0.700-0.796) for the training group and 0.795 (95 % CI: 0.723-0.866) for the validation group. Calibration analysis confirmed the nomogram's accuracy, and DCA supported its clinical utility.

CONCLUSIONS

This study successfully developed and validated a nomogram for early identification of high-risk SI in FEDN SZ patients, facilitating the establishment of effective suicide prevention measures.

Construction and verification of risk prediction model for suicidal attempts of mood disorder based on machine learning

BACKGROUND

Mood disorders (MD) are closely related to suicide attempt (SA). Developing an effective prediction model for SA in MD patients could play a crucial role in the early identification of high-risk groups.

METHODS

1099 patients with MD were collected to Model construction. 387 MD patients were enrolled for external validate. The least absolute shrinkage and selection operator (LASSO) regression was used to screen features that may be related to SA as predictors. Ten machine learning algorithms were applied to the training set to construct the SA prediction model. The machine learning model with the best sensitivity and stability was selected according to AUC, F1 score, accuracy and other indicators. The locally explanatory technique of Shapley Additive Explanations (SHAP) was used to rank and interpret the importance of features collected in best model to analyze the potential impact of each feature on SA. Meanwhile, to further validate the stability of the model, the sensitivity analysis utilizing k-fold cross-validation and external validate in another center were performed.

RESULTS

This study incorporates 8 features. Prediction models was constructed based on 10 different machine learning methods. The results showed that the prediction model constructed by Random Forest (RF) method had good discriminant ability and stability (AUC of Testing = 0.741, AUC of Training = 0.786, AUC of validation = 0.788) and acceptable discriminant. Further, the prediction model showed that the most valuable features for predicting SA were Polarity and previous SA.

CONCLUSION

The RF method can better construct the risk prediction model of SA in MD patients.

Suicidal ideation, suicide plans and suicide attempts among Australian adults: Findings from the 2020-2022 National Study of Mental Health and Wellbeing

OBJECTIVE

This study aimed to describe the epidemiology of suicidal ideation, suicide plans and suicide attempts, examine services received for suicide attempts, and explore the relationship between suicide attempts and self-harm without suicidal intent.

METHODS

We used survey data from the 2020-2022 National Study of Mental Health and Wellbeing, which involved a nationally representative sample of Australian adults aged 16-85 (n = 15,893). Comparisons were made with the 2007 National Study of Mental Health and Wellbeing (n = 8841).

RESULTS

In 2020-2022, the proportions of adults who had experienced suicidal ideation, suicide plans and suicide attempts during their lifetime were 16.6%, 7.5% and 4.9%, respectively. The proportions who had experienced these in the past 12 months were 3.3%, 1.1% and 0.3%. The odds of experiencing suicidal ideation and making a suicide plan were significantly higher in 2020-2022 than in 2007. Groups at heightened risk of suicidal ideation, suicide plans and/or suicide attempts in the previous 12 months were males, young people, people who were gay, lesbian, or bisexual or used some other term to describe their sexual identity, people outside the labour force, people from disadvantaged areas and people with mental disorders. Two-fifths of those who attempted suicide during the previous 12 months did not use health services following their attempt, and two-thirds also self-harmed without suicidal intent.

CONCLUSION

The implications of these findings for the forthcoming National Suicide Prevention Strategy are discussed. Suicidal thoughts and behaviours confer risk for suicide and are significant problems in their own right. Their prevention requires a strong whole-of-government response.

Comparison between aborted/interrupted and actual suicide attempt: An observational study on clinical and sociodemographic characteristics

BACKGROUND

Little is known about the differences between actual suicide attempts and aborted/interrupted attempts, but evidence suggests some clinical distinctions. The present study aimed to provide information on the rates of aborted/interrupted and actual suicide attempts, and analyze associated sociodemographic and clinical characteristics, relying on a sample of patients admitted to emergency departments in four different regions of Switzerland (Geneva, Neuchâtel, Valais, Vaud).

METHODS

We compared groups (aborted/interrupted vs actual attempts) using independent t-tests and Pearson's Chi-Square tests. Odds ratios (OR) were calculated using univariable logistic regression. A multivariable logistic regression was run including variables associated with the outcome.

RESULTS

Among 687 individuals, 230 (33.5 %) presented an aborted/interrupted and 457 (66.5 %) an actual attempt. Those from the Valais region presented a doubled significant risk for an actual attempt. Those aged 24-44 were more at risk of presenting an aborted/interrupted attempt compared to those aged 45-65 (OR: 0.34; 95 % CI: 0.17-0.70). Compared to those admitted for an intoxication, those using other methods such as cutting object (OR: 0.19: 95 % CI: 0.10-0.38), jumping (OR: 0,05; 95 % CI: 0.02-0.12), strangulation (OR: 0.02; 95 % CI: 0.01-0.07), vehicular impact (OR: 0.08; 95 % CI: 0.02-0.40) and other methods (OR: 0.16; 95 % CI: 0.07-0.39) were significantly more likely to present an aborted/interrupted suicide attempt.

LIMITATIONS

The study has a cross-sectional design, and longitudinal studies are warranted to further understand the direction of the associations.

CONCLUSIONS

Despite these differences, the groups overlapped among several characteristics. Thus, clinical risk staging based on the nature of the attempt might not be recommended, in line with current recommendation for self-harm.

Differentiating adolescent suicidal and nonsuicidal self-harm with artificial intelligence: Beyond suicidal intent and capability for suicide

Clinical differentiation between adolescent suicidal self-harm (SSH) and nonsuicidal self-harm (NSSH) is a significant challenge for mental health professionals, and its feasibility is controversial. The aim of the present study was to determine whether adolescent SSH can be differentiated from NSSH based on a holistic multimodel domain analysis (HMDA) of individual, psychological, sociodemographic, and environmental data without relying on intent and acquired capability for suicide. The study also sought to compare the compatibility of the HMDA result with four theories of suicide: the interpersonal theory of suicide, the three-steps theory, the integrated motivational-volitional model, and the theory of adolescent suicidality and self-destruction. This cross-sectional study analyzed data from a nationwide survey conducted from 2017 to 2019 in Norway. The sample included 26,904 adolescents (mean age = 15.01; 29.9 % males), who self-reported suicidal and nonsuicidal self-harm. The meta-learner classification model reached an AUC of 77.0 % and a 70.0 % for both sensitivity and specificity in differentiating the two conditions. Exploratory factor analysis suggested eight factors for clustering the important risk and protective indicators: 1) disordered eating and future orientation, 2) sleep disturbance, 3) orientation toward affects and self, 4) risk-taking behavior, 5) peer relationships, 6) victimization, safety, and security, 7) family relationships, and 8) substance use. These factors emphasize that domains central to adolescent physical, personal, social, and expected future well-being provide invaluable information about risk of suicidal and self-destructive behavior. The results also indicated that despite their high comorbidity, adolescent SSH and NSSH are multifaceted and can be differentiated without relying on suicide-related information. These findings fully supported the theory of adolescent suicidality and self-destruction and partially supported the ideation-to-action theories.

Reducing Depression and Suicidal Ideation Among Elder Abuse Victims Using PROTECT

OBJECTIVE

Elder abuse is prevalent and often unaddressed despite poor health and high mortality outcomes. One third of victims suffer from depression. This study examined whether: 1) suicidal ideation (SI) is associated with victims' demographic or abuse characteristics; 2) PROTECT psychotherapy reduces depression regardless of suicidal ideation; and 3) it reduces suicidal ideation.

DESIGN

Partner agencies referred depressed victims and received PROTECT for 10 weeks. Depression severity and SI were measured at each visit.

PARTICIPANTS

A sample of 158 depressed EA victims (PHQ-9 ≥ 10) without cognitive impairment (Tele-MoCA ≥ 11).

INTERVENTION

PROTECT is a behavioral psychotherapy delivered in 45-minute sessions in person or remotely (phone or video) for 10 weeks.

MEASURES

Data on demographics and abuse were collected at baseline, and depression severity (PHQ-9) and SI (PHQ-9 item 9) weekly. We examined trajectories of response to PROTECT with mixed-effects models to compare response among SI and Non-SI participants and change in SI throughout treatment.

RESULTS

There was no association between victims' demographic or elder abuse characteristics and SI. PROTECT led to overall reduction in depression severity: the SI group showed an estimated mean improvement of 5.58 points on the PHQ-9 (95% CI: 4.11, 7.06), and non-SI group improved by 5.25 (95% CI: 4.53, 5.97) points. SI decreased over time, with 19% of participants endorsing SI at baseline and 5.7% at end of treatment.

CONCLUSIONS

Suicidal ideation is equally prevalent across EA victims from different backgrounds. PROTECT can reduce depression and suicidal ideation in elder abuse victims.

Inflammatory markers and suicidal behavior: A comprehensive review of emerging evidence

BACKGROUND

Suicidal behavior represents a significant public health challenge, and identifying biological markers associated with its risk is critical for prevention and intervention. Emerging evidence suggests a link between inflammation and suicidality, highlighting the role of inflammatory markers as potential biomarkers and therapeutic targets.

METHODS

We conducted a systematic search across four electronic databases, including PubMed, Web of Science, EMBASE, and PsycINFO, to identify studies examining the association between inflammatory markers (e.g., C-reactive protein, interleukin-6, tumor necrosis factor-alpha) and suicidal ideation or behavior.

RESULTS

31 studies met the inclusion criteria. Elevated levels of inflammatory markers were consistently associated with an increased risk of suicidal behavior across diverse populations. This relationship's mechanisms likely involve cytokine-mediated alterations in neurotransmitter systems, neuroplasticity, and stress response pathways. Though robust clinical trials are scarce, preliminary evidence suggests that anti-inflammatory interventions may reduce suicidality.

CONCLUSIONS

Inflammation appears to play a significant role in the pathophysiology of suicidal behavior, offering promising avenues for biomarker development and novel therapeutic strategies. Future research should prioritize longitudinal studies, standardized methodologies, and exploration of personalized anti-inflammatory treatments to better elucidate the inflammation-suicidality link and enhance clinical applicability.

The relationship between suicidal ideation and eating disorders in the context of violence experiences

BACKGROUND

Suicidal ideation and eating disorders (EDs) are significant mental health concerns that can have devastating consequences and both cases were independently associated with violence experiences. The purpose was to investigate the relationship between suicidal ideation and eating disorders within the context of violence experiences.

METHODS

This cross-sectional study was conducted with 935 participants aged 18-40. Sociodemographic questionnaire, the Suicide Probability Scale (SPS), the Eating Disorder Evaluation Scale short form (EDE-Q-13) and the Violence Experiences Questionnaire-Revised (VEQ-R) were the data collection instruments.

RESULTS

50.6% of the participants were male, 56.5% were single and the mean age was 29.46 ± 5.96 years. As the educational and economic status of the participants increased, SPS median scores also increased significantly. Higher SPS median scores were found in single, smoking, and substance-using participants. Females, overweight, and obese participants scored significantly higher on the EDE-Q-13. Lower economic status, smoking, and substance use were associated with higher VEQ-R median scores. EDs, suicidal ideation, and experiences of violence showed a significant, albeit weak, positive relationship. In multiple regression analysis, both violence experiences and EDs influenced suicide probability. The median EDE-Q-13 score was higher in participants with divorced parents or a family history of chronic disease. The median VEQ-R score was higher in individuals with divorced parents, a family history of chronic disease, or deceased parents or fathers.

CONCLUSIONS

Our results suggest that various forms of childhood violence are linked to both EDs and suicidal thoughts. Furthermore, the correlation between EDs and suicidal ideation may exist independently of childhood violence.

The real-world evidence to the effects of primary psychological healthcare system in diluting risks of suicide ideation in underrepresented children/adolescents: an observational, multi-center, population-based, and longitudinal study

BACKGROUND

Establishing a primary psychological healthcare system to prevent suicide was eagerly advocated. Such system was developed as a low-cost healthcare framework integrating family, school, and hospitals to provide early psychological screening and intervention. However, it remains unclear whether such a policy-driven and low-cost healthcare system could be practical, especially with equal benefits for underrepresented children/adolescents. We aimed to examine the real-world practical effects of the primary psychological healthcare system in preventing suicide ideation among children/adolescents, particularly underprivileged ones.

METHODS

The study was conducted using an observational, multi-center, population-based, and longitudinal design. A total of 19,140 children and adolescents were sampled from lower- and middle-income areas in Nanchong, western China, with the majority for being underprivileged and underrepresented. They were followed up for one year. The primary outcome was the incidence of reported severe suicide ideation after implementing the primary psychological healthcare system at the 0.5-year and 1-year follow-ups, compared to baseline. Subgroup analysis was conducted to examine the equal benefits of the system for underrepresented children/adolescents.

RESULTS

The risks of suicide ideation for children/adolescents included in the system were found to be significantly lower compared to those not included at 0.5-year (adjusted relative risk [aRR] 0.28, 95%CI 0.23-0.33; p < 0.001) and 1-year follow-ups (aRR 0.28, 95% CI 0.23-0.33; p < 0.001). The effects were also observed among underrepresented children/adolescents, including "left-behind" children/adolescents, "single-parent" children/adolescents and children/adolescents in especially difficult circumstances (CEDC, all pcorrected < 0.001). The effects in "left-behind" children/adolescents, CEDC, and "single-parent" children/adolescents were found to be non-inferior to the typically developing cohort at non-inferiority thresholds of 30%, 35%, and 45%, respectively (all pcorrected < 0.05).

CONCLUSIONS

The primary psychological healthcare system was effective in reducing suicide ideation risks among children/adolescents over a period of at least 1 year. However, certain underprivileged groups, such as orphans and unattended children, did not experience the same level of benefits, highlighting the need for targeted improvements.

Brief interventions for suicidal ideation in primary care: a systematic review

BACKGROUND

General practitioners (GPs) play a crucial role in assessing and diagnosing suicidal ideation, often acting as the first person of contact for individuals with mental health concerns. Given the time constraints faced by primary care providers, interventions need to be brief and easily implemented. This systematic review seeks to identify, compare, and critically evaluate effective brief interventions for managing suicidality in primary care, offering a comprehensive overview and discussion of key findings.

METHODS

A systematic literature review was conducted using databases including MEDLINE, EMBASE, The Cochrane Library, PSYNDEX, and PsychINFO, supplemented by manual searches. Our search strategy focused on studies from 2000 to 2023. Risk of bias was assessed using the Cochrane RoB 2 Tool, and evidence quality was evaluated using GRADE, with adherence to the PRISMA-DTA checklist. A protocol was published in PROSPERO.

RESULTS

The search yielded 1248 publications. Of those, 44 were assessed for eligibility after screening, ultimately resulting in five included studies addressing four brief interventions for suicidality in primary care. Motivational interviews, safety planning, structured follow-ups, and collaborative care models were identified as key elements for future interventions to enhance the role of primary care in suicide prevention.

CONCLUSION

This review highlights the need for further research to adapt brief interventions for primary care suicide prevention. Given their central role in patient care, GPs are well-positioned to identify and support individuals at risk. While initial promising approaches have emerged, further research in primary care suicide prevention is needed, and interventions tailored to the GP setting must be developed.

Comparing self-guided and traditional crisis response planning: A pilot randomized controlled trial in US military veterans

US Military Veterans demonstrate a heightened prevalence of suicides when compared to the general population, but many within this population experience significant barriers to receiving efficacious suicide prevention interventions, including brief interventions such as Crisis Response Planning (CRP). We conducted a pilot randomized controlled trial comparing the relative effectiveness of traditional CRP administered by a trained individual to a self-guided version (CRP-S) in reducing suicidal ideation intensity over a one-week period following administration in 72 US military Veterans with past-month death or suicidal ideation. Results of estimated growth curve models demonstrated suicidal ideation non-significantly decreased across one-week follow-up, with results consistent across CRP and CRP-S; participants reported greater use of either version of the intervention on days when they had more severe suicidal ideation. Suicidal ideation did not significantly change as a function of any combination of administration type or CRP/-S use. These results indicted the CRP and CRP-S may perform similarly in reducing suicidal ideation over a one-week period, however, use of these interventions is limited.

Neuroimaging pattern interactions for suicide risk in depression captured by ensemble learning over transcriptome-defined parcellation

BACKGROUND

For suicide in major depression disorder, it is urgent to seek for a reliable neuroimaging biomarker with interpretable links to molecular tissue signatures. Accordingly, we developed an ensemble learning scheme over transcriptome-defined parcellations (TDP) to explore homogeneously parcellated brain patterns and their interactions.

METHODS

96 depressed patients without suicide attempt (SA), 86 with SA and 102 healthy controls were recruited for resting state fMRI scanning. Six genetic dimensions were created by homogenous transcriptomic delineations from Allen Human Brain Atlas. Spatially-continuous TDPs were generated according to expression-levels of each brain region along diverse dimensions. Subsequently, TDPs were integrated with a three-layer ensemble learning scheme, where brain dysfunction of each TDP related to suicide was quantified with a resting-state functional abnormality (RSFA) score. Then, personalized index of brain dysfunction was produced according to the interactive pattern across TDPs.

RESULTS

Ensemble learning over TDPs displayed higher suicide predictive performance, relative to that over the regions level, and over null model (95 % CI of accuracy: 73.23 ± 1.07 %; 64.59 ± 3.00 %; 65.41 ± 3.97 %, respectively). Empowered by specific parieto-occipital TDP (PO-TDP) pattern quantified with RSFA score in suicide risk prediction, its alternations of SA effects were spatially associated with transcriptional profiles of GRIN2A and GABRG2. Moreover, glutamatergic and GABAergic synapse were overrepresented in enrichment analysis.

CONCLUSION

Glutamatergic and GABAergic dysfunction in the visual cortex was suggested via the PO-TDP specific interaction pattern. The inherent excitatory/inhibitory imbalance could contribute to aberrant emotional processing and neurocognitive impairment, ultimately leading to suicide.

Let's Move Towards Precision Suicidology

PURPOSE OF REVIEW

Suicidal behaviour remains a critical public health issue, with limited progress in reducing suicide rates despite various prevention efforts. The introduction of precision psychiatry offers hope by tailoring treatments based on individual genetic, environmental, and lifestyle factors. This approach could enhance the effectiveness of interventions, as current strategies are insufficient-many individuals who die by suicide had recently seen a doctor, but interventions often fail due to rapid progression of suicidal behaviour, reluctance to seek treatment, and poor identification of suicidal ideation.

RECENT FINDINGS

Precision medicine, particularly through the use of machine learning and 'omics' techniques, shows promise in improving suicide prevention by identifying high-risk individuals and developing personalised interventions. Machine learning models can predict suicidal risk more accurately than traditional methods, while genetic markers and environmental factors can create comprehensive risk profiles, allowing for targeted prevention strategies. Stratification in psychiatry, especially concerning depression, is crucial, as treating depression alone does not effectively reduce suicide risk. Pharmacogenomics and emerging research on inflammation, psychological pain, and anhedonia suggest that specific treatments could be more effective for certain subgroups. Ultimately, precision medicine in suicide prevention, though challenging to implement, could revolutionise care by offering more personalised, timely, and effective interventions, potentially reducing suicide rates and improving mental health outcomes. This new approach emphasizes the importance of suicide-specific strategies and research into stratification to better target interventions based on individual patient characteristics.

Men's mental health and suicide prevention service landscape in Australia: a scoping review

BACKGROUND

Men represent the majority of suicide deaths globally and men are more likely to die by suicide without contact with formal mental health services. In Australia, three-quarters of suicide deaths are men. If services were better able to meet their needs, men might be more likely to seek help. In this scoping review, we sought to describe the formal and informal service landscape for men at risk of suicide in Australia, and to determine the extent of research evidence for the effectiveness of these in lowering suicidality, and improving mental health or help-seeking behaviours. We limited our investigation to Australian services, in order to comprehensively identify all community and health system services.

METHODS

Relevant services and initiatives in Australia were identified through multiple methods: (1) a hand search of key websites and directories; (2) a systematic search of PsycINFO, Cochrane Central, EmBASE, and PubMed; and (3) suggestions by researchers, consumers and clinicians. Evaluations were also identified using multiple methods, including the initial systematic search, targeted website searches, and via multiple search engines. Findings are presented using narrative synthesis.

RESULTS

Included services and initiatives (N = 88) were diverse in their characteristics (e.g., cost to the user, mode of delivery, location), however, there was considerable overlap in the types of components offered. Awareness and education were the most commonly offered (84.1% of services and initiatives). Only 22.7% of services and initiatives had been formally evaluated and existing evaluations varied in quality. Pre-post intervention designs were most often used, and only three evaluations assessed outcomes in a randomised controlled trial.

CONCLUSIONS

The service landscape for Australian men is broad. However, there appears to be substantial overlap in the components offered by services and initiatives. The prevalence of awareness and education-based offerings is disproportionate to evidence about men's preferences for support. There is a lack of high-quality evaluations. We conclude that the cohesiveness of men's suicide prevention approaches must improve through service development and policy.

Interactions between early-life adversity, pandemic stress, and social support on psychiatric disorders in a nationally representative sample of Canadian adults

PURPOSE

This study examined how pre-existing early-life adversity (ELA) and current social support interacted with COVID-specific pandemic stressors in relation to risk of psychiatric disorders in a nationally-representative sample of Canadian adults.

METHODS

Participants (n = 9,409) were from the Mental Health and Access to Care Survey, a cross-sectional survey of Canadian adults during later stages of the COVID pandemic (March to July 2022). Measures included pandemic stressors (Statistics Canada), ELA (Childhood Experiences of Violence Questionnaire), social support (Social Provisions Scale), and past 12-month psychiatric problems (WHO-CIDI). Statistical analyses included two-step logistic regression models adjusted for covariates and weighted for complex survey design.

RESULTS

Higher odds of psychiatric problems were predicted by ELA (aOR = 1.24 [1.15-1.35]-aOR = 1.53 [1.39-1.69] across psychiatric disorders) and pandemic stress (aOR = 1.18 [1.12-1.25]-aOR = 1.32 [1.26-1.39] across psychiatric disorders). Significant interactions between ELA and pandemic stress for depression (aOR = 0.96 [0.93-0.98]) suggested an attenuated effect of pandemic stress at higher levels of ELA. Social support was associated with reduced psychiatric problems (aOR = 0.88 [0.86-0.91]-aOR = 0.97 [0.94-0.99]), while pandemic stress was associated with increased psychiatric problems (aOR = 1.20 [1.15-1.26]-aOR = 1.33 [1.27-1.40]). An interaction between social support and pandemic stress for suicidality (aOR = 1.02 [1.01-1.03]) indicated that higher levels of social support were associated with increased odds of suicidality in the presence of pandemic stress, though the effect was small and of questionable clinical significance.

CONCLUSION

ELA and pandemic stress increased psychiatric disorder likelihood, while social support was protective. However, interactions indicate nuanced relationships in mental health risk during the pandemic.

The complex relationship between NSSI exposure and suicidal risk: Insights from a short-term longitudinal study

OBJECTIVE

Adolescent suicide has become a critical global public health issue. While non-suicidal self-injury (NSSI) is closely associated with suicide, the role of NSSI exposure remains unclear. This study aims to explore possible mechanisms among NSSI exposure, NSSI engagement, and future suicidal risk.

METHOD

A total of 2,155 Chinese middle school students (47.9 % girls; M = 13.38 years, SD = 0.66) participated in the study. During the first survey, they reported demographic information, NSSI exposure, and NSSI engagement. Three months later, they completed follow-up assessments on suicidal risk and depressive symptoms.

RESULTS

Our results revealed three distinct relational patterns between NSSI exposure, NSSI engagement, and future suicidal risk: (1) NSSI exposure is associated with future suicidal risk through the mediating role of NSSI engagement (indirect effect = 0.145, SE = 0.02, 95 % CI [0.107, 0.183]); (2) NSSI exposure independently impact suicidal risk without NSSI engagement (β = 0.046, SE = 0.018, t = 2.299, p < 0.05); (3) NSSI exposure amplifies the predictive effect of NSSI engagement (β = 0.053, SE = 0.014, t = 3.844, p < 0.001, 95 % CI [0.023, 0.010]).

CONCLUSIONS

Our findings highlight the importance of interpersonal exposure, rather than media exposure, in these pathways. This study uncovers multiple pathways through which NSSI exposure influences suicidal risk, offering preliminary evidence for targeted prevention strategies.

"Razones para Vivir": Hybrid implementation study in Colombia for health governance and improving suicidal behavior

Objectives

To describe the implementation of a strategy to promote reasons for living and to assess its impact on acute mental health symptoms, psychosocial disability, and perceptions of health services.

Methods

A quasi-experimental methodology that incorporates methods from a Type I hybrid implementation study. The Caldas Scale, Self-Reporting Questionnaire (SRQ-20), and the Zarit Caregiver Burden Scale were applied to people with a history of mental disorder and suicidal ideation, before and after the implementation of the "Razones para Vivir" strategy, to determine psychosocial disability associated with mental disorders and caregiver burden.

Results

The Razones para Vivir strategy has modified the relationship between the quality and perception of health services and psychosocial disability associated with mental disorders. Large effect sizes were found for the variables of occupational disability (r = 0.68), social disability (r = 0.55), therapeutic adherence (r = 0.71), and perception of services (r = 0.51), with a moderate effect size for acute mental health symptoms (r = 0.41).

Conclusions

The implementation of the strategy contributed to institutional involvement in promoting mental health, in addition to the improvement of acute mental health symptoms and some psychosocial disability variables. Mental health promotion strategies can be integrated with implementation frameworks to facilitate their development in specific sociopolitical contexts.

Genetically informed disassortative brain morphometric similarities revealing suicide risk in bipolar disorder

BACKGROUND

Cortical structure alterations in bipolar disorder (BD) have consistently been reported in association with suicide with high heritability. Currently, multifaceted genetic landscape responsible for replicable neuroanatomical alterations with suicidal effects is poorly explored to develop personalized risk assessments in clinic.

METHODS

Anatomically informed suicidal effects quantified with morphometric similarity network (MSN) upon structural MRI was evaluated in two independent BD cohorts consisted of patients with or without suicide attempt (SA and NSA) (discovery: 63 BD-SAs\72 BD-NSAs with 6 potential suicide-related SNPs examined in 46 BD-SAs\55 BD-NSAs; replication: 23 BD-SAs\23 BD-NSAs) and 119 healthy controls. In discovery study, transcriptomic and neurotransmitter correlates of suicide-relevant MSN deficits were examined by partial least squares regression on Allen Human Brain Atlas and dominance analysis on 9 distinct neurotransmitter systems. Molecularly informed MSN deficits were orthogonally validated by estimating genetic risks from targeted SNP genotyping utilizing a multi-level mediation analysis. Reproducible pattern of genetically decoding suicide-relevant MSN changes was validated in replication study.

RESULTS

Opioid receptor was consistently suggested to be responsible for the reproducible suicide-relevant MSN alterations identified in entorhinal and left lateral occipital cortices. MSN deficits of entorhinal cortex positively mediated the effects of genetic risks of OPRM1 on suicide attempted (portion of mediated = 61.3%, β=6.99e-2, p=.02, 95% CI = [3.34e-2, 0.11]).

CONCLUSION

Abnormal cytoarchitecture communities, especially maladaptive changes in neuronal communication between entorhinal cortex and reward circuit regulated by opioid receptors reflected by enhanced morphometric similarities could mediate the effect on increased suicidal tendencies involved in OPRM1 gene variants in BD.

Decoding vital variables in predicting different phases of suicide among young adults with childhood sexual abuse: a machine learning approach

Young adults with childhood sexual abuse (CSA) are an especially vulnerable group to suicide. Suicide encompasses different phases, but for CSA survivors the salient factors precipitating suicide are rarely studied. In this study, from a progressive perspective of suicidal thoughts and behaviors (STB), we aim to identify distinct risk factors for predicting different stages of STB, i.e., suicidal ideation (SI), suicide plan (SP), and suicide attempt (SA), among young adults with CSA experience. Based on mental health profiles of 4,070 young adult CSA survivors from a cross-sectional survey, we constructed five random forest classification models to respectively classify high suicidality, SI, SP, and SA. The common crucial factors for predicting SI, SP, and SA included NSSI and depression. The special important predictors for SI included OCD, anxiety, PTSD, and social rhythm. Co-occurrence of other types of childhood abuse and traumatic events was a special important predictor for SP among participants with SI. Self-compassion was the most crucial factor in classifying SA from those with SI. Social rhythm, co-occurrence of other types of childhood abuse, domestic violence, fear of happiness, and self-compassion made specific contribution to the prediction of SI, SP, and SA. However, the random forest model failed to accurately classify SA from those with SP, which was consistent with existing research. Our findings highlighted the importance of identifying suicidal characteristics for specified interventions at different stages of suicide for young people with CSA experiences.

Global spatiotemporal analysis of suicide epidemiology and risk factor associations from 2000 to 2019 using Bayesian space time hierarchical modeling

Suicide is a significant global public health issue, with marked disparities in rates between countries. Much of the existing research has concentrated on high-income nations, creating a gap in the understanding of global suicide epidemiology. This study aims to address this gap through a comprehensive spatiotemporal analysis of global suicide trends from 2000 to 2019. Data were collected from the Global Health Observatory, encompassing 183 countries across five regions. Bayesian spatiotemporal modeling and cluster detection techniques were employed to assess variations in suicide rates and identify high-risk clusters, alongside examining associations with various risk factors. The findings indicate diverse global and regional age-standardized suicide trends, with overall rates decreasing from an average of 12.97 deaths per 100,000 population in 2000 to 9.93 deaths per 100,000 in 2019. Significant regional variations were noted, particularly in Europe, Asia, and Africa, where high-risk clusters were identified. Additionally, age and sex-specific trends revealed consistently higher rates among males, although these rates have been declining over time. Spatial maps illustrated hotspots of elevated suicide rates, which can inform targeted intervention strategies. Risk factor analysis further revealed associations with socioeconomic and health indicators. The results underscore the necessity for tailored prevention strategies and highlight the importance of international collaboration and surveillance systems in addressing the complexities of global suicide epidemiology. This study contributes valuable insights into suicide patterns and offers implications for mental health policies worldwide.

Characterizing suicidal thoughts and behaviours in individuals presenting to a psychiatric emergency department: a protocol for a multimethod approach for suicide prevention research

INTRODUCTION

Identifying individuals at risk of suicide remains an ongoing challenge. Previous research investigating risk factors for suicidal thoughts and behaviours (STB) has been informative for assessing suicide risk. However, the complex biological, psychological and sociocultural factors underlying STB have not been comprehensively captured to date, which has limited our understanding of how these factors interact to influence STB. Moreover, acute care settings, such as emergency departments (EDs), are often first points of contact for individuals with STB, highlighting a need for more research in these settings.

METHODS AND ANALYSIS

We aim to (1) characterize a cohort seeking care for STB and their clinical trajectories; (2) situate the cohort by comparing its characteristics and outcomes to other groups seeking emergency care; (3) explore their experiences of seeking care; and (4) examine blood-based biomarkers modulating risk for STB. Using a multimethod, prospective cohort design, we will follow up to 500 people aged 16 or older presenting to the ED with STB at a psychiatric hospital over 1 year. Analyses will involve descriptive statistics and latent profile analysis to characterize the cohort, hypothesis tests and regression models to situate the cohort, qualitative analysis based on a realist research framework to understand experiences, and within-participant comparisons of proteins, mRNA and epigenetic DNA modifications to examine biomarkers of contrasting states of STB.

ETHICS AND DISSEMINATION

This study was approved by the hospital's Research Ethics Board with safeguards in place to ensure the well-being of participants and research team. An integrated knowledge translation approach will be used for dissemination, wherein patient and family advisors are engaged throughout each study phase. Findings will enhance our understanding of the multifactorial nature of suicide risk, inform strategies for prevention and provide important insights into characteristics, experiences and outcomes of individuals with STB, who are under-represented in mental health research.

TLR4 identified as a major depressive disorder gene signature mediating effects through multiple immune cells

The pathogenesis of major depressive disorder (MDD) is currently unclear and lacks objective diagnostic criteria. The complexity and heterogeneity of MDD also limit precise treatment. Using bioinformatics methods, we identified 18 gene signatures of MDD from the GSE98793 dataset, and validated them in an independent dataset GSE44593 (Area under the curve values were 0.92, 0.72, and 0.70 for the training, validation, and test sets, respectively). Among the gene signatures, TLR4 had the largest absolute coefficient value (coefficient = -6.13). We further identified three CD 14 + monocyte-associated gene signatures and two immune-related subtypes. The expression of TLR4 is significantly increased in subtype A of MDD (lower predicted probability), and is significantly correlated with the composition of multiple immune cells (P < 0.05). We validated that TLR4 acts as a protective factor in MDD (OR = 0.91, 95% CI = 0.85 to 0.98, P = 0.012), and its expression is driven by the same causal variants as MDD (H4/(H3 + H4) = 98.62%). Further analysis showed that the relationship between TLR4 and MDD is influenced by eight immune cell signatures. Our research provided genetic support that the immune factors may play an important role in MDD, and proposed a possible strategy for the diagnosis and treatment of MDD.

Genetics of Suicide

Over the past two decades, suicide has consistently ranked among the leading causes of death in the United States. While suicide deaths are closely associated with uicidal ideation and attempts, these are not good predictors of future suicide deaths. Establishing who is at risk of suicide remains a challenge that is mostly hampered by the lack of understanding of its pathophysiology. Nonetheless, evidence continues to accumulate suggesting that suicide is driven by a complex and dynamic interaction between environmental factors and genetics. The identification of genes that place people at risk of suicide remains elusive, but data are rapidly evolving. In this narrative review, we describe how Tryptophan hydroxylase (TPH) genes, particularly TPH1 and TPH2, have been associated with suicide in various publications. There is also replicated evidence linking the brain-derived neurotrophic factor gene to suicide, with its most consistent results originating from epigenetic studies. Not surprisingly, many genes involved in the hypothalamic-pituitary-adrenal axis have been connected with suicide, but these data require replication. Finally, among the inflammatory genes studied in suicide, only specific polymorphisms in TNF-alpha and IL-6 may increase susceptibility to suicidal behavior. In conclusion, significant work remains to be performed as inconsistencies undermine the reliability of genetic results in suicide. Potential avenues for future research are proposed.

Trace lithium concentrations in mental disorders and suicidal behavior: A cross-sectional study

BACKGROUND

Studies have demonstrated a negative correlation between lithium trace concentrations in drinking water and suicide rates; however, a study focused on clinical significance of lithium concentrations in individual patients was needed. Therefore, we aimed to assess lithium trace concentrations in individuals with mental disorders and compare them to healthy controls to evaluate whether lithium concentrations are associated with mental disorders and/or suicidal behavior.

METHOD

We enrolled 50 patients diagnosed with mental disorders without a history of suicidal behavior, 51 patients hospitalized after a suicidal attempt, and 46 healthy individuals as a control group for the analysis and comparison of lithium trace concentrations in blood serum. The suicidality risk was evaluated using the Mini International Neuropsychiatric Interview. Quantile regression (QR) was used to evaluate lithium concentrations (as the outcome) between the control and patient groups (as predictors), along with a set of covariates.

RESULTS

The median of serum lithium concentration overall was 1.76 µg/L (IQR 1.17-3.42); range 0.2-26.95 µg/L. Mutivariable QR analysis, adjusted for age, gender, and suicidality risk, revealed that at the 75th quantile, in patients' lithium concentrations were significantly lower compared to the controls. A high suicidality risk was associated with decreased lithium concentrations at the 75th quantile (B = - 2.073, p = 0.014).

CONCLUSION

The serum lithium concentrations in the highest quantiles were significantly lower in patients with mental disorders compared to healthy individuals and lower lithium concentrations in serum were associated with a higher risk of suicidality.

Navigating Dual-Harm: Integrating Self- and Other-Harm Into Public Health Inquiry

Dual-harm, the co-occurrence of self- and other-harm, recognizes the overlap between these outcomes of aggressive behavior and their potential shared causes. Little progress has been made in preventing and responding to dual-harm in the broader population, and it remains understudied in public health research. We posit that the scientific investigation of dual-harm would greatly benefit from the application of public health principles and methods. In this essay, we operationalize dual-harm as a public health problem and identify gaps in knowledge, addressing its conceptual and definitional issues, prevalence estimates, methodological considerations, theoretical foundations, risk factors, and prevention strategies. We also offer a series of recommendations to advance dual-harm study and challenge the notion of conflating nonfatal dual-harm with homicide-suicide as part of a continuum, arguing that they are distinct phenomena. We identify the need for epidemiological studies to characterize those engaging in dual-harm and better understand their mechanisms and outcomes, focusing on adolescence as a critical developmental period. Future studies should develop, implement, and evaluate targeted intervention and preventive efforts for individuals involved in or at risk for dual-harm. (Am J Public Health. 2025;115(4):596-604. https://doi.org/10.2105/AJPH.2024.307940).

Personality factors associated with manner of death: A psychological autopsy study

Psychological autopsies are a well-established tool for understanding contributing factors in suicide completion. These tools have been used less often to understand personality characteristics of people with other manners of death (e.g. overdose). This study examined personality characteristics related to the manner of death in 83 autopsy cases using the UTHealth Psychological Autopsy Interview Schedule (UTH-PAIS), a psychological autopsy which assesses the presence of mental illness or substance use disorder but also includes items to capture transdiagnostic personality factors. Exploratory factor analysis of the items assessing personality factors was used to examine patterns in personality, and these factors were confirmed via k-means clustering. This analysis uncovered four distinct personality factors: (1) perseverance and self-regulation, (2) aggression, (3) sensitivity to rejection, and (4) extraversion. Of these personality factors, only perseverance and self-regulation differed by the manner of death. Individuals who died of natural causes or by completed suicide had a higher perseverance and self-regulation factor score than those who died by substance overdose, and these patterns were further supported by cluster analysis. The findings suggest that, in this autopsy sample, suicide was a planned, rather than an impulsive, act, though this interpretation is made cautiously given the sample size which also prohibited analysis of overdose death between those with vs. without a prior suicide attempt. Additionally, the results support prior work suggesting substance use disorders are associated with poor self-regulation, which may contribute to overdose deaths in these individuals. The study demonstrates the utility of psychological autopsy for studying personality factors related to the manner of death in cases where ante mortem data is unavailable.

Psychological impact of the end of lockdown on the Moroccan population

This work is a descriptive cross-sectional study that aimed to assess by means of an online survey the well-being and psychological impact, mainly depression, anxiety, stress and post-traumatic stress disorder (PTSD), experienced by the general population after the end of lockdown following the COVID-19 pandemic. In this study, we used the PCL-S scales to assess PTSD and the DASS scale to assess depression, anxiety, and stress related to end of quarantine. Our study found that following the decontamination related to COVID-19, the psychological impact was not negligible with a significant prevalence of occurrence for several psychological disorders. We found depression (68.8%), anxiety (57.47%), stress (45.50%) and post-traumatic stress disorder (31.5%) in the subjects of our study. Following the decontamination related to COVID-19, the psychological impact was found to be as important or even more serious than the other situations that preceded it. The development of a database allowing us to understand the effect of the decontamination on the mental health of Moroccans could be useful in order to watch and prevent the occurrence of complications for psychological disorders such as depression, anxiety, stress or even a state of post-traumatic stress.

Gender differences in the network of suicidal ideation, interpersonal needs and depressive symptoms among Chinese college students

Interpersonal needs and depression are two recognized significant risk factors for suicidal ideation. Previous studies have preliminarily revealed the gender-dependent effects of interpersonal needs and depression on suicidal ideation. However, there are very few studies that place these variables within a single framework and apply symptom-level analysis to investigate the gender-dependent relationships among them. This study applied symptom-level network analysis to construct female and male networks using data from 781 female and 628 male young adults. The networks included interpersonal needs, depressive symptoms, and suicidal ideation. Key characteristics of networks, including edge connections, bridge expected influence (BEI), and global expected influence (GEI), were compared. The results suggested that gender significantly impacts edge connections, node BEI, and GEI of the final networks. Several significantly gender-dependent connections were disclosed, such as perceived burdensomeness (PB)-suicidal ideation, hopelessness-suicidal ideation, PB-sense of failure, and PB-sadness. PB (marginally) and thwarted belongingness show significant gender differences in their impact on depressive symptoms. The GEI of the female network is significantly greater than that of the male network. These findings offer valuable insights for modern theoretical frameworks examining gender differences in the connections between suicidal ideation, interpersonal needs, and depressive symptoms. Additionally, results provide empirical support for selecting screening, prevention, and intervention strategies for suicidal ideation and depression across genders.

Suicide-related stigma and its relationship with help-seeking, mental health, suicidality and grief: scoping review

BACKGROUND

Suicide-related stigma (i.e. negative attitudes towards people with suicidal thoughts and/or behaviours as well as those bereaved by suicide) is a potential risk factor for suicide and mental health problems. To date, there has been no scoping review investigating the association between suicide-related stigma and mental health, help-seeking, suicide and grief across several groups affected by suicide.

AIMS

To determine the nature of the relationship between suicide-related stigma and mental health, help-seeking, grief (as a result of suicide bereavement) and suicide risk.

METHOD

This review was registered with PROSPERO (CRD42022327093). Five databases (Web of Science, APA PsycInfo, Embase, ASSIA and PubMed) were searched, with the final update in May 2024. Studies were included if they were published in English between 2000 and 2024 and assessed both suicide-related stigma AND one of the following: suicide, suicidal thoughts or suicidal behaviours, help-seeking, grief or other mental health variables. Following screening of 14 994 studies, 100 eligible studies were identified. Following data charting, cross-checking was conducted to ensure no relevant findings were missed.

RESULTS

Findings across the studies were mixed. However, most commonly, suicide-related stigma was associated with higher levels of suicide risk, poor mental health, lowered help-seeking and grief-related difficulties. A model of suicide-related stigma has been developed to display the directionality of these associations.

CONCLUSIONS

This review emphasises the importance of reducing the stigma associated with suicide and suicidal behaviour to improve outcomes for individuals affected by suicide. It also identifies gaps in our knowledge as well as providing suggestions for future research.

The Prevention of Suicide in Older Military Veterans

Suicidal behavior among older military veterans is an important medical and social problem. The goal of this literature review is to discuss this underappreciated issue and identify suicide preventive interventions that can be utilized with the older military veteran population. Older veterans experience psychiatric, medical, and social problems associated with their age and/or military experience that can contribute to suicide risk. These problems include relationship losses through death or estrangement, depression, cognitive decline, loneliness, isolation, frailty, mobility issues, and chronic pain. Therefore, older veterans face a unique set of challenges. Suicide prevention in older veterans should take a multipronged approach which includes screening for suicidality, management of psychiatric and medical disorders, social assistance, safety planning, lethal means restriction, and involving family members in the veteran's healthcare. Family members should be included in the safety planning process when possible. Gatekeeper training programs can be utilized to train individuals who are working with older veterans to reduce suicides amongst this age group.

'From that time onwards my role changed'. Disclosing suicidality in Australian workplaces a qualitative study

Individuals experiencing suicidality at work may face complex disclosure decisions, involving assessing the risks versus benefits of disclosure or non-disclosure. This study aimed to identify barriers and enablers to disclosing suicidality in workplaces and to explore the responses, support, and accommodation needs for workers experiencing suicidality. We conducted semi-structured interviews with a purposive sample of 30 working adults who reported experiencing suicidality at work and may or may not have disclosed. Using reflexive thematic analysis, we constructed four themes: (i) stigma and discrimination are fears realized, (ii) leaders should address psychosocial hazards, (iii) there's a price to pay when considering revealing and protecting social identities, and (iv) having safe people and safe systems would help. The study findings indicate that creating more compassionate and empathetically supportive workplaces may help address some of the barriers to disclosure of suicidality, including potentially decreasing stigma and discrimination and addressing psychosocial hazards that act as barriers to disclosure. Considering the role of identity by applying a socioecological lens that includes understanding the role of social identity, belongingness, culture, and marginalization may help to increase understanding of suicidality disclosure decision-making in workplaces. The findings further indicate a need to implement multi-layered systems-level approaches for workplaces to be better equipped to support workers who experience suicidality.

Suicide Risk and Living Alone With Depression or Anxiety

Importance

Living alone and mental health disorders, including depression and anxiety, are associated with high suicide risk, but their combined impact remains underexplored.

Objective

To examine the association of living arrangements and depression or anxiety with suicide risk.

Design, Setting, and Participants

This population-based cohort study used data from the Korean National Health Insurance Service database from January 1, 2009, to December 31, 2021, that included adults aged 20 years or older who participated in the General Health Screening Program in Korea in 2009. Individuals with incomplete data and those who died by suicide within the first year were excluded to minimize the possibility of reverse causation. Data were analyzed from December 28, 2023, to December 27, 2024.

Exposures

Living arrangements, categorized as living alone (≥5 years) or living with others, and depression and anxiety, determined using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes.

Main Outcomes and Measures

The primary outcome was death by suicide, identified through national death records. Multivariable Cox proportional hazards regression models were used to estimate adjusted hazard ratios (AHRs) and 95% CIs for suicide risk.

Results

The study included 3 764 279 adults (mean [SD] age, 47.2 [14.0] years; 55.8% male). Of these individuals, 112 460 (3.0%) had depression, 232 305 (6.2%) had anxiety, and 319 993 (8.5%) lived alone. Compared with individuals who had neither depression nor anxiety nor lived alone, individuals living alone with both depression and anxiety exhibited a 558% increased risk of suicide (AHR, 6.58 [95% CI, 4.86-8.92]). Living alone with depression was associated with a 290% increased risk (AHR, 3.91 [95% CI, 2.96-5.16]), and living alone with anxiety was associated with a 90% increased risk (AHR, 1.90 [95% CI, 1.48-2.43]). The AHRs were higher for the association between living alone and suicide among middle-aged individuals (aged 40 to 64 years) and men compared with other demographic groups.

Conclusions and Relevance

In this cohort study of 3 764 279 individuals, living alone with depression or anxiety was associated with an increased risk of suicide, particularly among middle-aged individuals and men. These findings underscore the importance of preventing mental illness, such as depression and anxiety, while addressing living arrangements as a critical factor in suicide risk assessments for individuals with these conditions.

Intimate partner relationship breakdown and suicidal ideation in a large representative cohort of Australian men

This study examined moderators of the association between intimate relationship breakdown and suicidal ideation using data from a large representative cohort of Australian men. Across four waves (2013-2022), participants (n = 14,610) responded to measures of past 12-month relationship breakdown, past 2-week suicidal ideation, theorised but to-date untested moderators (age, social support, alcohol use, and masculine norms of self-reliance and emotional control), and demographic covariates. Binomial logistic regression models using generalised estimating equations modelled the association between relationship breakdown and suicidal ideation at both proximal (i.e., within-wave), and future (i.e., at the next wave) timepoints, with iterative adjustments for wave, demographics, other covariates, and prior-wave suicidal ideation. Interaction terms in sequential models examined moderation. In multi-wave cross-sectional analyses, after full adjustment, relationship breakdown was associated with 82 % greater odds of suicidal ideation (OR = 1.82, 95 % CI 1.56-2.12). Moderation analyses indicated that this association was specific to men without prior-wave suicidal ideation (OR = 2.18, 95 % CI 1.85-2.56), in comparison to men who had reported prior-wave suicidal ideation (OR = 1.19, 95 % CI 0.94-1.51). The association between relationship breakdown and proximal ideation did not differ by men's age, levels of social support, harmful alcohol use, or endorsement of self-reliance or emotional control. Finally, longitudinal models highlighted relationship breakdown was not associated with men's suicidal ideation at a subsequent wave, after adjustment for covariates and proximal suicidal ideation. Our findings suggest that suicidal ideation should be monitored in men known to have experienced relationship breakdown in the past year, especially those without a recent history of suicidal ideation.

Suicide Trends, Factors, and Associated Burden for Suicide Loss Survivors in Ghana

Background: Suicide remains a taboo subject for many people in Ghana, buried in cultural beliefs. Suicide deaths are frequently addressed without regard for the effect such events have on the bereaved relatives. Aim: To explore what is known about suicide in Ghana and how suicide bereavement might impact families. Method: Narrative review based on a thorough literature search in PsycINFO, Scopus, and PubMed. Gray literature as well as organizational reports and newspaper articles were also included. Demographics, trends, patterns, and factors for suicidal behavior are explored. Results: The findings are contextualized within the Ghanaian social context of suicide and the ramifications for the bereaved individuals. Suicidal behavior is influenced by elements in an individual's micro- and macro-systems, such as conflicting relationships, poor academic achievement, cultural practices, the death of a spouse, and socioeconomic reasons. These variables render a death by suicide more challenging for the bereaved. Limitation: The findings cannot be generalized to other countries. Conclusion: The devastating impact of suicide bereavement in Ghana must be understood within a sociocultural context. Nonetheless, few studies have investigated the experiences of suicide loss survivors, leaving a substantial gap in the understanding and development of postvention and suicide bereavement support in this country.

Epigenetics and suicidal behavior in adolescents: a critical review

Suicide continues to be a significant public health issue globally, claiming over 700,000 lives annually. It is, therefore, important to assess the suicide risk properly and provide intervention in a timely fashion. While the heritability of suicidal behavior is around 50%, it does not explain the factors involved in causality. Recent evidence suggests that gene x environment interaction plays a vital role in suicidal behavior. In this paper, we critically evaluate the association between adolescent suicidal behavior and epigenetic modifications, including DNA methylation, histone modification, and non-coding RNAs, as well as epigenetic-based treatment options. It was noted that the prevalence of suicidal behavior in adolescents varied by age and sex and the presence of psychiatric disorders. Childhood adversity was closely associated with suicidal behavior. Studies show that alterations in epigenetic modifications may increase the risk of suicidal behavior independent of mental illnesses. Because epigenetic factors are reversible, environmental enrichment or the use of pharmacological agents that can target specific epigenetic modulation may be able to reduce suicidal behavior in this population.

Multiple pathways to suicide: A network analysis based on three components of psychological pain

BACKGROUND

Psychological pain is a multidimensional structure that has long been recognized as an important risk factor for suicidal ideation and behavior. The roles of interactions among psychological pain subfactors at different stages of suicidality remain unclear.

METHODS

A relatively large sample of outpatients with major depressive disorder (N = 501) was recruited to complete the Three-Dimensional Psychological Pain Scale (TDPPS). Exploratory graphical analysis (EGA) was conducted to explore the factor structure of TDPPS, thereby ensuring that the psychological pain subfactor was measured accurately. Network analysis included all TDPPS items, depression, passive suicidal ideation (PSI), active suicidal ideation (ASI), and history of suicidal action (SA) to identify key loops of suicidality.

RESULTS

EGA disclosed a three-factor structure of TDPPS comprising cognitive, affective, and motivational factors. Network analysis revealed that items of motivational factors, but none of the items of cognitive and affective factors, were directly linked to PSI, ASI, and SA. Furthermore, three communities were identified by a "walktrap" algorithm. Depression and cognitive factor coalesced into a 'cognitive' community, affective factor constituted an 'affective' community, and motivational factor, PSI, ASI, and SA comprised a 'suicidal' community.

LIMITATIONS

This study used a cross-sectional design that cannot provide information on causal relationships among variables in the network.

CONCLUSIONS

Psychological pain avoidance may be a direct driver of suicidality, and therefore its assessment and intervention in clinical practice is necessary.

Comprehensive view of suicide: A neuro-immune-endocrine approach

Suicide is defined as the act of a person attempting to take their own life by causing death. Suicide is a complex phenomenon that is influenced by a multitude of factors, including psychosocial, cultural, and religious aspects, as well as genetic, biochemical, and environmental factors. From a biochemical perspective, it is crucial to consider the communication between the endocrine, immune, and nervous systems when studying the etiology of suicide. Several pathologies involve the bidirectional communication between the peripheral activity and the central nervous system by the action of molecules such as cytokines, hormones, and neurotransmitters. These humoral signals, when present in optimal quantities, are responsible for maintaining physiological homeostasis, including mood states. Stress elevates the cortisol and proinflammatory cytokines levels and alter neurotransmitters balance, thereby increasing the risk of developing a psychiatric disorder and subsequently the risk of suicidal behavior. This review provides an integrative perspective about the neurochemical, immunological, and endocrinological disturbances associated with suicidal behavior, with a particular focus on those alterations that may serve as potential risk markers and/or indicators of the state preceding such a tragic act.

Mental states and temperaments contributing to suicidal crisis in psychiatric inpatients: a cross-sectional and validation study

BACKGROUND

A suicide crisis represents a psychological state preceding a suicide behavior and occurs when an individual experiences intolerable emotions. Only a few instruments have been developed so far to assess cognitions and emotions associated with a specific interpretative model of the suicide crisis.

OBJECTIVES

We aimed to (1) evaluate the psychometric properties of a new questionnaire (Suicidal Crisis Evaluation Scale, SCES) that could potentially assess cognitions and emotions relevant to the suicide crisis; (2) evaluate whether cognitions and emotions investigated with the SCES were characteristics of psychiatric patients at greater risk for suicide; (3) investigate whether the presence and severity of suicide-relevant cognitions and mental states could be associated with affective temperaments; and (3) study whether the severity of current depression at least partially mediated the association between affective temperaments and negative mental states.

METHODS

We included 188 adult psychiatric inpatients admitted to the Sant'Andrea Hospital psychiatric inpatient unit in Rome. We administered the SCES and questionnaires to measure current depression, and affective temperaments.

RESULTS

A common factor explained around 70% of SCES variance, and SCES scores were significantly higher in patients with a recent suicide attempt than in other patients. Part of the variance in common between some affective temperaments and SCES scores was explained by the presence and severity of current depressive symptoms.

CONCLUSION

Psychiatric patients need to be assessed for the presence and severity of cognitions and emotions present during the suicide crisis for a better understanding of the complex architecture of suicide risk. The SCES is a valid and reliable measure that could capture such mental states. More studies are necessary to confirm and expand our results in independent samples.

Suicidality in Adolescence: Insights from Self-Reports on Depression and Suicidal Tendencies

Background and Objectives. Suicide represents a primary global health concern, particularly among young individuals aged 15 to 29. Clinicians are actively engaged in efforts to prevent suicide and implement timely interventions. This study aimed to evaluate the effectiveness of self-reported measures in differentiating between adolescents exhibiting suicidal ideation (SI) only and those at risk or with a previous history of suicide attempts (SA). Methods. Seventy-eight adolescent patients (mean age: 15.53 ± 1.49) were classified into two groups using the Columbia Suicide Severity Rating Scale (C-SSRS). Forty-five patients presented with SI but lacked a prior history of SA, while 33 adolescents had a documented history of either concrete or interrupted SA. Notably, all participants in the SA group also reported SI. Participants completed the Multi-Attitude Suicide Tendency Scale (MAST) and the Beck Depression Inventory-Short Form (BDI-SF) to assess protective and risk factors associated with suicidality, as well as perceived depression. Results. Attraction toward life (AL) exhibited a negative correlation with perceived depression in both groups, whereas attraction toward death (AD) was positively correlated with depression in the SA group. In the SI group, scores for repulsion by life (RL) demonstrated a positive correlation with depression. Furthermore, RL scores were significantly higher in the SA group. ROC analysis revealed good accuracy for both assessment tools in differentiating the two groups. Conclusions. The BDI-SF and MAST are effective instruments for identifying adolescents at risk for suicide and implementing tailored preventive and therapeutic interventions. The user-friendly nature and adaptability make those self-report measures useful in various settings, allowing administration without clinician involvement.

Impairment in personality functioning predicts young adult suicidal ideation and suicide attempt above and beyond depressive symptoms

Interpersonal factors and depression are believed to be some of the main drivers of suicidal thoughts and behaviors, but other factors may be equally or more important. Drawing on psychodynamic (mentalization) theory, we propose that personality functioning, in particular an incoherent sense of self, may be an important driver of suicidal thoughts and behaviors over and above factors of interpersonal functioning and depression. To evaluate this, we examined associations between personality functioning and suicidal ideation and suicide attempt in young adults. Participants (N=153; Mage=20.93) were recruited from a college sample (N=90) and a clinical sample with borderline personality disorder (N=63). Personality functioning (self and interpersonal components) was measured with the Level of Personality Functioning Scale - Brief Form 2.0. Suicidal ideation was measured with the Personality Assessment Inventory. Suicide attempt history was assessed with the Columbia-Suicide Severity Rating Scale. Depression symptoms were measured with the Symptom Checklist 90. Regressions examined relationships between personality functioning, depression symptoms, and suicidal ideation or attempt while controlling for age and gender. Overall personality functioning was significantly associated with suicidal ideation (β=.584, p<.001) and suicide attempt (β=.384, p<.001). Overall personality functioning was a stronger predictor than depression symptoms, age, and gender when included in the same model predicting suicidal ideation or attempt. Both the self and interpersonal components of personality functioning were significantly associated with suicidal ideation and attempt, with larger effect sizes for self-functioning. Findings underscore the importance of considering personality functioning, especially self-functioning, in suicide risk assessment and treatment.

Pathways to suicide for children and youth in Guyana: A life charts analysis

BACKGROUND

Suicide is the third leading cause of death among youth aged 15 to 29 years old globally. Guyana has the highest rate of youth suicide in the world, yet only limited research exists.

AIM

The aim of this study is to identify key features of the suicide pathway for Guyanese children and youth and to distinguish meaningful subgroups.

METHOD

The psychological autopsy (PA) method was used to generate life charts for 15 Guyanese children and youth (10-29 years) who died by suicide. Nineteen close contacts of these individuals were interviewed about the life events of the decedent between 6 months and 5 years after their death. Semi-structured interviews lasting 30 to 150 min took place between November 2021 and January 2022. The interview data were converted into life charts and these were reviewed to uncover meaningful subgroups of suicide pathways.

RESULTS

Three groups with distinct suicide pathways were identified: hard life (46%), mental illness (20%) and interpersonal stress (20%). There were also two male youths for whom the suicidal antecedents and pathways were unclear. Interpersonal stress, alcohol, exposure to suicide and family history of suicide were common factors identified across groups.

CONCLUSIONS

The findings emphasise the role of both acute and protracted interpersonal stress for child and youth suicide in Guyana. The structure and dynamics of Indo-Guyanese families are discussed. Interventions recommended include enhancing child and youth community engagement, improving mental health and suicide literacy, alcohol restriction, increasing access to support services, and reducing stigma.

Explaining Suicide Among Indian Women: Applying the Cultural Theory of Suicide to Indian Survivors of Gender-Based Violence Reporting Suicidal Ideation

Indian women account for 36.6% of suicide-related deaths worldwide and gender-based violence (GBV) is a key social determinant. The cultural theory of suicide (CTS), which synthesizes risk factors and explanations of suicide among racial/ethnic minorities, posits four tenets: idioms of distress, cultural sanctions, and social discord. Our study applied the CTS to Indian women from slums reporting GBV to explore (1) culturally relevant risk pathways towards suicidal ideation using qualitative analyses, and test (2) the association between idioms of distress and suicidal ideation. 112 women from urban slums were recruited and 99 completed surveys. A subset were administered qualitative interviews. Aim 1 explored the CTS framework among participants describing suicidal ideation in qualitative interviews [n = 18]; Aim 2 explored if idioms of distress severity was associated with suicidal ideation through an ANCOVA [N = 99]. Idioms of distress such as 'tension' indicated suicidal ideation. Communities did not sanction suicidal ideation, leading to secrecy regarding disclosure. Women in 'love marriages' (versus arranged marriages) reported minority stress. Social discord heightened suicidal thoughts. Results of the ANCOVA confirmed that women reporting suicidal ideation had higher idioms of distress severity (M = 28.56, SD = 6.37), compared to women who did not (M = 21.77, SD = 6.07), F(1, 96) = 28.58, p < .001 (ηp2 = .23). Our study empirically validates the CTS among Indian GBV survivors. Culturally responsive suicide prevention can include assessing idioms of distress, improving family support, and educating to reduce stigma and enhance help-seeking.

Suicide prevention strategies in South Korea: What we have learned and the way forward

Suicide is a serious global public health concern. South Korea has consistently reported one of the highest suicide rates among Organization for Economic Cooperation and Development countries over the past few decades. In response to the increasing suicide rate, South Korea enacted the Suicide Prevention Act in 2011, and allocated significant budget funding for implementation of various policies according to its national strategy for suicide prevention. Suicide prevention policies, such as restricting access to highly hazardous pesticides, implementing emergency room-based follow-up management programs, and adhering to safety guidelines for the media while reporting on suicide, were effective. Thereafter, the overall suicide rate and the suicide rate in older people steadily declined. However, the suicide rate among younger age groups has increased since 2017, and South Korea continues to report higher suicide rates than those of most other countries. Further research is needed to develop and implement suicide prevention strategies that address the recently changing trends.

National analysis of hospital-presenting suicidal ideation and self-harm among males

OBJECTIVES

There is evidence of increasing rates of hospital presentations for suicidal crisis, and emergency departments (EDs) are described as an intervention point for suicide prevention. Males account for three in every four suicides in Ireland and are up to twice as likely as females to eventually die by suicide following a hospital presentation for suicidal crisis. This study therefore aimed to profile the characteristics of ED presentations for suicidal ideation and self-harm acts among males in Ireland, using clinical data collected by self-harm nurses within a dedicated national service for crisis presentations to EDs.

METHODS

Using ED data from 2018-2021, variability in the sociodemographic characteristics of male presentations was examined, followed by age-based diversity in the characteristics of presentations and interventions delivered. Finally, likelihood of onward referral to subsequent care was examined according to presentation characteristics.

RESULTS

Across 45,729 presentations, males more commonly presented with suicidal ideation than females (56% v. 44%) and less often with self-harm (42% v. 58%). Drug- and alcohol-related overdose was the most common method of self-harm observed. A majority of males presenting to ED reported no existing linkage with mental health services.

CONCLUSIONS

Emergency clinicians have an opportunity to ensure subsequent linkage to mental health services for males post-crisis, with the aim of prevention of suicides.

An Explainable Artificial Intelligence Text Classifier for Suicidality Prediction in Youth Crisis Text Line Users: Development and Validation Study

BACKGROUND

Suicide represents a critical public health concern, and machine learning (ML) models offer the potential for identifying at-risk individuals. Recent studies using benchmark datasets and real-world social media data have demonstrated the capability of pretrained large language models in predicting suicidal ideation and behaviors (SIB) in speech and text.

OBJECTIVE

This study aimed to (1) develop and implement ML methods for predicting SIBs in a real-world crisis helpline dataset, using transformer-based pretrained models as a foundation; (2) evaluate, cross-validate, and benchmark the model against traditional text classification approaches; and (3) train an explainable model to highlight relevant risk-associated features.

METHODS

We analyzed chat protocols from adolescents and young adults (aged 14-25 years) seeking assistance from a German crisis helpline. An ML model was developed using a transformer-based language model architecture with pretrained weights and long short-term memory layers. The model predicted suicidal ideation (SI) and advanced suicidal engagement (ASE), as indicated by composite Columbia-Suicide Severity Rating Scale scores. We compared model performance against a classical word-vector-based ML model. We subsequently computed discrimination, calibration, clinical utility, and explainability information using a Shapley Additive Explanations value-based post hoc estimation model.

RESULTS

The dataset comprised 1348 help-seeking encounters (1011 for training and 337 for testing). The transformer-based classifier achieved a macroaveraged area under the curve (AUC) receiver operating characteristic (ROC) of 0.89 (95% CI 0.81-0.91) and an overall accuracy of 0.79 (95% CI 0.73-0.99). This performance surpassed the word-vector-based baseline model (AUC-ROC=0.77, 95% CI 0.64-0.90; accuracy=0.61, 95% CI 0.61-0.80). The transformer model demonstrated excellent prediction for nonsuicidal sessions (AUC-ROC=0.96, 95% CI 0.96-0.99) and good prediction for SI and ASE, with AUC-ROCs of 0.85 (95% CI 0.97-0.86) and 0.87 (95% CI 0.81-0.88), respectively. The Brier Skill Score indicated a 44% improvement in classification performance over the baseline model. The Shapley Additive Explanations model identified language features predictive of SIBs, including self-reference, negation, expressions of low self-esteem, and absolutist language.

CONCLUSIONS

Neural networks using large language model-based transfer learning can accurately identify SI and ASE. The post hoc explainer model revealed language features associated with SI and ASE. Such models may potentially support clinical decision-making in suicide prevention services. Future research should explore multimodal input features and temporal aspects of suicide risk.

Practitioners' perspective: a mixed-methods study on dealing with suicidality from the perspective of oncological healthcare professionals

PURPOSE

Healthcare professionals (HCPs) play a critical role in suicide prevention and clinical guidelines recommend inquiring about suicidality as part of medical history and diagnosis. Emerging evidence indicates a lack of implementation of such policies in clinical practice. However, to date, no comprehensive mixed-methods study has examined this issue in the field of oncology.

METHODS

A preregistered mixed-methods study was conducted with oncological HCPs (N = 20) from various professions, using semi-structured interviews and validated questionnaires. Employing an explorative theory-generating approach, qualitative content analysis was applied to the interviews. The different data sources are integrated and contrasted. Comparisons according to sociodemographic variables (profession, age, and gender) and frequency distributions were used to examine the questionnaire data.

RESULTS

Most HCPs reported direct or indirect experiences with suicidality in cancer patients. Nineteen HCPs did not routinely explore suicidality, of whom five reported not inquiring about it at all. Those who explored suicidality were more confident, less emotionally overwhelmed and reported higher subjective knowledge. HCPs also differed regarding their endorsement of suicide myths.

CONCLUSION

The study highlights difficulties with active suicide exploration and differences among HCPs. Integrating these findings into education and training could improve HCPs' skills and reduce disparities, supporting successful suicide prevention.

Rare but Relevant: Characterizing Self-Inflicted Burn Injuries in the United States

Self-inflicted burns (SIBs) represent a distinct entity in burn care often associated with an underlying psychiatric etiology. In this review, we summarize the existing evidence on SIBs in North America to inform targeted prevention and interventions for patients afflicted with SIBs. The following databases were queried to identify relevant articles used for literature review: PubMed, Embase, and Scopus. The main outcome measures were burn characteristics and risk factors of SIBs in the American population. A total of 14,189 patients were included across 13 included studies. The percent of total body surface area burned ranged from less than 1% to 100%, with a mean of 29.6% ± 20.7%. Depressive disorders were the most reported overall; however, among mood disorders, bipolar disorder was also reported frequently, while anxiety was reported least. Motives for self-inflicting burn injury included premeditated self-injury as a coping mechanism, escape or response to delusions, impulsive self-injury, and most commonly, suicidal intention. The majority of the studies reported that preadmission drug and alcohol abuse were associated with the occurrence of SIBs. Other identified risk factors for SIB injury included female sex, younger age, unemployment, and unmarried status. From this, it is imperative that targeted interventions are developed to address the complex interplay of psychiatric disorders, drug use, and other demographic risk factors among the American population. It is crucial for initiatives to emphasize early identification of individuals at risk of self-harm, better access to mental health services, and stronger drug abuse programs to target SIB occurrence in the United States.