Health Conditions and Passive Suicidal Ideation in the Survey of Health, Ageing, and Retirement in Europe

Osteoporosis and fracture as risk factors for self-harm and suicide: a systematic review and meta-analysis

BACKGROUND

Increase in presentations of self-harm to primary care, a risk factor of suicide, has led to a growing interest in identifying at-risk populations.

AIM

To examine whether osteoporosis or fractures are risk factors for self-harm, suicidal ideation, and suicide.

DESIGN AND SETTING

This was a systematic review of observational studies in adults (>18 years) that had examined the role of osteoporosis and/or fractures in subsequent self-harm, suicidal ideation, and/or suicide.

METHOD

Six databases were searched from inception to July 2019. Additional citation tracking of eligible studies was undertaken in November 2022. Screening, data extraction, and quality assessment of full-text articles were performed independently by at least two authors. Where possible, meta-analysis was run on comparable risk estimates.

RESULTS

Fifteen studies were included: two examined the outcome of self-harm, three suicidal ideation, and 10 suicide. In approximately half of studies on osteoporosis, the risk of suicidal ideation and suicide remained significant. However, pooling of adjusted odds ratios from three studies indicated no association between osteoporosis and suicide (1.14, 95% confidence interval = 0.88 to 1.49). Nine studies examined the risk of a mixture of fracture types across different outcomes, limiting comparisons. However, all studies examining vertebral fracture (n = 3) reported a significant adjusted negative association for self-harm and suicide.

CONCLUSION

Patients with vertebral fractures, a risk potential factor for suicide, may benefit from clinical case finding for mood disorders with personalised primary care management. However, because of the limited number and quality of studies and mixed findings, further examination of these associations is warranted.

Health, Suicidal Thoughts, and the Life Course: How Worsening Health Emerges as a Determinant of Suicide Ideation in Early Adulthood

Poor physical health places adults at greater risk for suicide ideation. However, the linkage between health and suicidal thoughts may emerge and become established during early adulthood, concomitant with other social processes underlying suicidality. Using nationally representative survey data from Waves III through V of the National Longitudinal Study of Adolescent to Adult Health (n = 8,331), we examine the emergence of health as a predictor of suicide ideation across the early adult life course (ages 18-43). We find that worsening health does not significantly predict suicide ideation until young adults approach the transition into midlife. Our findings suggest this may be due to the increasing severity of health problems, reduced social network engagement, and disruption of social responsibilities later in early adulthood. Our findings underscore the need for social science research to examine the relationship between mental and physical health from a life course perspective.

Factors associated with past-year medication use and psychotherapy in adults with suicidal ideation in France

BACKGROUND

The objective of the study is to assess the sociodemographic and clinical factors associated with past-year medication use and/or psychotherapy among adults with suicidal ideation in the past 12 months.

METHODS

Data were drawn from the 2017 Health Barometer survey, a large computer-assisted telephone survey on a representative sample of the general population aged 18 to 75 years living in metropolitan France (n = 25,319). Logistic and multinomial regression analyses were used to study past-year medication use and/or psychotherapy as a function of sociodemographic and clinical factors. Analyses were restricted to individuals reporting suicidal ideation in the past year (n = 1,148).

RESULTS

Overall, 43.6% of adults with suicidal ideation reported no treatment for a mental health reason in the past year; 36.6% reported using medication only, 4.8% psychotherapy only, and 15.0% both. Sociodemographic and clinical factors associated with increased probability of treatment varied as a function of the type of treatment received. Adjusting for key factors including clinical factors, older adults with suicidal ideation were more likely than younger adults to receive medication only.

CONCLUSIONS

The findings point to differential inequalities in access to medication and psychotherapy among adults with suicidal ideation in the general population of France.

Association between functional disability type and suicide-related outcomes among U.S. adults with disabilities in the National Survey on Drug Use and Health, 2015-2019

While research on suicidal behavior for people with disability (PWD) suggests they experience higher risk than people without disability, less is known about variations among individuals with different disability types. This nationally representative, cross-sectional study compared differences in suicide-related outcomes (ideation, planning, attempts) among PWD by functional disability type (hearing, vision, cognitive, mobility, complex activity) and number. Secondary analysis of adult PWD in the 2015-2019 National Survey on Drug Use and Health (unweighted N = 35,544; representing 47,723,378 PWD, weighted) was used to estimate relationships between suicide-related outcomes and disability type and number. Most respondents were female (55.9%), and 36.0% were aged ≥65 years. Adjusted odds ratios (AORs) from multivariable logistic regression indicated that suicidal ideation and suicide attempt, respectively, were significantly more likely among individuals with cognitive (AOR = 1.71, 95% CI = 1.24-2.35; AOR = 2.54, 95% CI = 1.31-4.91), complex activity (AOR = 1.96, 95% CI = 1.37-2.81; AOR = 2.67, 95% CI = 1.32-5.41), and ≥2 limitations (AOR = 2.02, 95% CI = 1.52-2.69; AOR = 3.46, 95% CI = 1.84-6.50) than hearing limitation. Also, relative to other disability types, suicide-related outcomes were significantly more likely among individuals with cognitive limitation and complex activity limitation (p < 0.001). Additionally, suicide-related outcomes elevated in likelihood as the number of limitations increased, with the largest associations among those with ≥5 limitations for suicidal ideation (AOR = 2.31, 95% CI = 1.46-3.66), suicide planning (AOR = 3.34, 95% CI = 1.97-5.68), and suicide attempt (AOR = 6.37, 95% CI = 3.76-10.79). Subgroup analyses showed that presence of cognitive limitation and multiple limitations differentiated between suicidal ideators and suicide attempters. Further research is needed to identify causes of these risks and develop suicide prevention efforts for these particularly vulnerable groups.

Blood Pressure, Depression, and Suicidal Ideation Among Pregnant Women with HIV

Although prior research has examined associations between blood pressure (BP), depression, and suicidal ideation, few studies have examined this in high-risk populations such as pregnant women with HIV (WHIV). The current study examined the association of BP with depression and suicidal ideation among pregnant WHIV (n = 217) in rural South Africa. BP data (measured ≤ 1 month before the study visit) was extracted from medical records. Depressive symptomatology and suicidal ideation were assessed using the Edinburgh Postnatal Depression Scale. Diastolic BP was positively associated with both suicidal ideation and depressive symptomatology, even after controlling for demographic variables, gestational age, and intimate partner violence. These findings suggest that WHIV with elevated BP may be at greater risk for antenatal depression and suicidal ideation. Future research should utilize longitudinal designs to examine potential mechanisms and the directionality of the relationship, as well as other contributing factors.

Promoting Social Connection in Dementia Caregivers: A Call for Empirical Development of Targeted Interventions

Social connection is an understudied target of intervention for the health of individuals providing care for a family member with Alzheimer's disease and related dementias (ADRD). To guide future research, we discuss considerations for interventions to promote social connection, with a particular focus on reducing loneliness: (a) include caregiver perspectives in designing and delivering interventions; (b) adapt to stages of dementia; (c) consider caregiving demands, including the use of brief interventions; (d) specify and measure mechanisms of action and principles of interventions; (e) consider dissemination and implementation at all stages of research. With support from the National Institute on Aging for a Roybal Center for Translational Research in the Behavioral and Social Sciences of Aging, we are developing a portfolio of mechanism-informed and principle-driven behavioral interventions to promote social connection in ADRD caregivers that can be flexibly applied to meet a diverse set of needs while maximizing resources and reducing demands on caregivers.

Association Between Disability and Suicide-Related Outcomes Among U.S. Adults

INTRODUCTION

Although research has analyzed the sociodemographic and socioeconomic risks for suicide, only recently has suicide risk for people with disabilities been examined. This study investigates the associations between disability and distinct suicide-related outcomes, including suicidal ideation, suicide planning, and suicide attempt.

METHODS

This nationally representative, cross-sectional study comprised secondary analyses of the 2015-2019 National Survey on Drug Use and Health conducted in 2020 (N=198,640, representing 229,556,289 U.S. adults). Disability status comprised the presence of any disability; hearing, vision, mobility, cognitive, complex activity, or ≥2 limitations; and 1, 2, 3, 4, or ≥5 limitations. Suicide-related outcomes in the past year included none, suicidal ideation only, suicide planning, and suicide attempt. Multivariable logistic regression was applied to estimate the AORs.

RESULTS

Overall, 19.8% reported any disability. Results showed that people with disabilities were significantly more likely than those without disabilities to report suicidal ideation (AOR=2.13, 95% CI=1.93, 2.36), suicide planning (AOR=2.66, 95% CI=2.27, 3.11), and suicide attempt (AOR=2.47, 95% CI=2.05, 2.98). Furthermore, individuals within each limitation count group were significantly more likely than people without disabilities to report suicide-related outcomes (p<0.001), with the largest magnitudes among those with ≥5 limitations for suicidal ideation (AOR=3.80, 95% CI=2.32, 6.23), suicide planning (AOR=6.45, 95% CI=3.52, 11.80), and suicide attempt (AOR=8.19, 95% CI=4.45, 15.07).

CONCLUSIONS

People with various types of functional disabilities had an elevated risk for suicide-related outcomes, compared with people without disabilities. The more limitations a person had progressively increased their risk. These findings call for focused attention to the mental health of people with disabilities, including suicide prevention efforts that accommodate their needs.

End-to-end multimodal clinical depression recognition using deep neural networks: A comparative analysis

BACKGROUND AND OBJECTIVE

Major Depressive Disorder is a highly prevalent and disabling mental health condition. Numerous studies explored multimodal fusion systems combining visual, audio, and textual features via deep learning architectures for clinical depression recognition. Yet, no comparative analysis for multimodal depression analysis has been proposed in the literature.

METHODS

In this paper, an up-to-date literature overview of multimodal depression recognition is presented and an extensive comparative analysis of different deep learning architectures for depression recognition is performed. First, audio features based Convolutional Neural Networks (CNNs) and Long Short-Term Memory (LSTM) are studied. Then, early-level and model-level fusion of deep audio features with visual and textual features through LSTM and CNN architectures are investigated.

RESULTS

The performance of the proposed architectures using an hold-out strategy on the DAIC-WOZ dataset (80% training, 10% validation, 10% test split) for binary and severity levels of depression recognition is tested. Using this strategy, a set of experiments have been performed and they have demonstrated: (1) LSTM-based audio features perform slightly better than CNN ones with an accuracy of 66.25% versus 65.60% for binary depression classes. (2) the model level fusion of deep audio and visual features using LSTM network performed the best with an accuracy of 77.16%, a precision of 53% for the depressed class, and a precision of 83% for the non-depressed class. The given network obtained a normalized Root Mean Square Error (RMSE) of 0.15 for depression severity level prediction. Using a Leave-One-Subject-Out strategy, this network achieved an accuracy of 95.38% for binary depression detection, and a normalized RMSE of 0.1476 for depression severity level prediction. Our best-performing architecture outperforms all state-of-the-art approaches on DAIC-WOZ dataset.

CONCLUSIONS

The obtained results show that the proposed LSTM-based surpass the proposed CNN-based architectures allowing to learn temporal dynamics representations of multimodal features. Furthermore, model-level fusion of audio and visual features using an LSTM network leads to the best performance. Our best-performing architecture successfully detects depression using a speech segment of less than 8 seconds, and an average prediction computation time of less than 6ms; making it suitable for real-world clinical applications.

'Wish to die' is independently associated with cardiovascular mortality in later life. Data from TILDA

BACKGROUND

There is an established bidirectional relationship between mental and heart health in later life but the link between wish to die (WTD) and cardiovascular mortality is less well-defined.

METHODS

This is a longitudinal study examining the association between WTD and mortality over 9-year follow-up in a large population-representative sample of older adults. Individual-level survey data was linked to official death registration data, divided into cardiovascular and noncardiovascular causes. WTD was defined as answering affirmatively when asked 'In the last month, have you felt that you would rather be dead?' Regression models were used to obtain hazard ratios for the association between WTD at Wave 1 and mortality. Kaplan-Meier plots were used to compare survival across groups.

RESULTS

Just over 3% (275/8124) of participants reported WTD. Mortality data was available for 9% of participants (755/8124). WTD was significantly associated with all-cause mortality, with a hazard ratio of 1.41 (95% confidence interval [CI]: 1.00-1.99). Findings were attenuated and no longer significant after excluding participants with heart disease or depression/anxiety/other psychiatric illness. WTD was significantly associated with cardiovascular mortality (hazard ratio: 2.14 [95% CI: 1.21-3.78]), even after excluding participants with depression/anxiety/other illnesses but not heart disease. WTD was not associated with an increased risk of death due to non-cardiovascular causes.

CONCLUSIONS

Older people who report a wish to die have double the risk of death from cardiovascular disease in the following 9 years, even when those with depression, anxiety or other mental health problems are excluded.

Relationship between physical conditions and attempted or completed suicide in more than 9,300 individuals from the United Kingdom: a case-control study

AIMS

The present study of 9,352 adults from the United Kingdom aimed to analyze associations between physical conditions and attempted or completed suicide.

METHODS

This case-control study included patients aged 16-90 years with a first attempted or completed suicide who were followed in general practices in the United Kingdom between January 2008 and December 2017 (index date). Individuals who had not attempted or completed suicide were matched (1:1) to those who had attempted or completed suicide by sex, age, index year, index month, and practice. Variables included sex, age, index year, index month, and all physical and psychiatric conditions diagnosed in more than 1% of patients who had attempted or completed suicide in the year prior to the index date. A multivariable logistic regression analysis was performed to assess possible associations.

RESULTS

The case-control study included 4,676 patients who had and 4,676 patients who had not attempted or completed suicide. After (1:1) matching, 52.1% of the patients were women and the mean (standard deviation) age was 33.6 (15.1) years. After adjusting for psychiatric conditions, we found that three past-year physical conditions were significantly associated with attempted or completed suicide. These conditions were unspecified injuries to the head (odds ratio [OR]=4.26, 95% confidence interval [CI]=2.27-8.00), sleep disorders (OR=1.60, 95% CI=1.09-2.32), and epilepsy (OR=1.57, 95% CI=1.04-2.39).

CONCLUSIONS

Head injuries, sleep disorders, and epilepsy were associated with attempted or completed suicide. Further research is needed to gain a better understanding of the mechanisms underlying these relationships.

The relationship between age and suicidal thoughts and attempted suicide among prisoners

BACKGROUND

Suicide is a major problem across the lifespan, yet rates are highest among middle-aged and older adults; a trend which remains relatively stable across varying sociological settings, including prisons. Despite this understanding, there is limited knowledge on the nature of suicidal thoughts and attempts among older prisoners, especially with respect to how they compare to younger counterparts. The present study aimed to increase insight into the relationship between age and suicidal thoughts and attempted suicide among prisoners, with particular focus on factors that may explain age-based variability.

RESULTS

Cross-sectional data were drawn from a nationally representative sample of 18,185 prisoners housed within 326 prisons across the United States. In general, analyses revealed that: (a) attempted suicide was more commonly reported among younger prisoners, while suicidal ideation was more commonly reported among older prisoners; (b) the relationship between age and probability of reporting suicidal thoughts and behavior is curvilinear; (c) younger and older prisoners exhibit somewhat differing predictive patterns of suicidal thoughts and behavior (e.g., physical illness is directly associated with suicidal history for younger prisoners, whereas the effect of physical illness on suicidal history for older prisoners is mediated by depression).

CONCLUSIONS

There is evidence to suggest that suicidal thoughts and behavior may manifest differently for younger and older prisoners, with differing patterns of risk. More research is needed on age-based variability in suicidal thoughts and attempted suicide among prisoners, as well as those factors that might explain this variability. Importantly, future research must continue to investigate the nature of suicidal thoughts and behavior among older prisoners.

Characterizing the phenomenology of passive suicidal ideation: a systematic review and meta-analysis of its prevalence, psychiatric comorbidity, correlates, and comparisons with active suicidal ideation

BACKGROUND

Compared to active ideation, passive ideation remains relatively understudied and its clinical importance poorly defined. The weight that should be accorded passive ideation in clinical risk assessment is therefore unclear.

METHODS

We conducted a systematic review and meta-analysis of the prevalence of passive ideation, its psychiatric comorbidity, associated sociodemographic characteristics, as well as psychological and environmental correlates. For reference, pooled effects were also calculated for direct comparisons of passive and active ideation with respect to potential correlates. Relevant articles published since inception to 9 September 2019 were identified through a systematic search of MEDLINE and PsycINFO.

RESULTS

A total of 86 studies were included in this review. The prevalence of passive ideation was high across sample types, ranging from 5.8% for 1-year prevalence to 10.6% for lifetime prevalence in the general population. Passive ideation was strongly associated with sexual minority status, psychiatric comorbidity, psychological characteristics implicated in risk, and suicide attempts. Preliminary evidence exists for a large association with suicide deaths. The effect sizes for individual correlates of passive and active ideation were largely equivalent and mostly non-significant in head-to-head comparisons.

CONCLUSIONS

Passive ideation is a prevalent clinical phenomenon associated with significant psychiatric comorbidity. Current evidence also suggests notable similarities exist between passive and active ideation in terms of psychiatric comorbidity and psychological and other characteristics traditionally associated with risk.

Domains of Functional Impairment and Their Associations with Thwarted Belonging and Perceived Burden in Older Adults

Objectives: Functional impairment and social disconnection are risk factors for suicide in later life. This paper examines associations between domains of functional impairment and two forms of social disconnection that are empirically linked to suicide in later life - low (or thwarted) belonging and perceived burden on others.Methods: Participants are 62 older primary care patients (67.68% female, mean age = 72.05) who endorsed feeling lonely or like a burden. Participants completed self-report measures of low belonging and perceived burden (INQ-R) and domains of functional impairment (WHODAS 2.0) at a single time point.Results: Greater perceived burden was associated with greater impairment in activities of daily living ("self-care"), while greater thwarted belonging was associated with greater impairment in social functioning, when controlling for depressive symptoms and age. Domains of mobility, cognition and social participation were not associated with either belonging or perceived burden.Conclusions: Impairment in self-care (ADLs) and social functioning may be more strongly associated with perceived burden and thwarted belonging than other domains of functional impairment.Clinical Implications: Considering specific domains of functional impairment - rather than functioning more broadly - may facilitate tailored interventions to target suicide risk.

Suicide Has Many Faces, So Does Ketamine: a Narrative Review on Ketamine's Antisuicidal Actions

PURPOSE OF REVIEW

Suicidal behaviours are a challenge for a medical system and public health, partly due to the current lack of evidence-based, effective, rapid tools for suicidal crisis management. Ketamine and its enantiomer esketamine have raised hopes regarding this issue in the recent years. However, their efficacy in suicidal behaviours and mechanisms for it remain a topic of debate.

RECENT FINDINGS

Subanesthetic ketamine doses rapidly, albeit transiently decrease suicidal ideation, with effects emerging within an hour and persisting up to a week. Current evidence points to various and not necessarily exclusive mechanisms for ketamine's antisuicidal action, including effects on neuroplasticity, inflammation, reward system and pain processing. Ketamine rapidly decreases suicidal ideation, but whether it leads to meaningful clinical outcomes past 1 week is unclear. Multiple putative mechanisms drive ketamine's antisuicidal action. Future studies will have to show long-term ketamine treatment outcomes and further elucidate its mechanisms of action.

The burden of suicidal ideation across Europe: a cross-sectional survey in five countries

BACKGROUND

Suicidal ideation (SI) is an associated risk of depression, affecting 30-40% of the depressed population. However, there is a paucity of studies investigating the impact of SI in Europe. This retrospective observational study examined the burden of SI among adults with major depressive disorder (MDD) in the 2017 National Health and Wellness Survey in five European countries: France, Germany, Italy, Spain, and the UK.

METHODS

Bivariate analyses evaluated group differences between respondents with MDD with and without SI according to demographic characteristics, self-reported health-related quality of life, work productivity and activity impairment (WPAI), and healthcare resource utilization (HRU). Generalized linear models examined group differences country-wise, after controlling for relevant confounders.

RESULTS

Among 52,060 respondents, 3,308 individuals were diagnosed with MDD, comprising SI (n=905) and non-SI (nSI) (n=2403) patients. Adjusted differences (ADs), compared to the general population, were observed using the Medical Outcomes Study Short Form Survey (SF-12v2) mental component summary scores (AD: SI=-20.02, nSI=-10.77), physical component summary scores (AD: SI=-4.49, nSI=-2.50), and EuroQoL-5 Dimensions (AD: SI=-0.34, nSI=-0.15) (for all, p<0.001). Significantly greater WPAI and higher HRU were associated with SI compared to nSI.

CONCLUSION

The results illustrate the unique impact of SI within the MDD population and the need to reduce the burden.

The prevalence of suicidal ideation and suicide attempt in patients with rheumatic diseases: a systematic review and meta-analysis

A number of studies have reported the suicidal ideation (SI) or suicide attempts (SA) of patients with rheumatic diseases. However, the estimated prevalence of those disorders varies substantially between studies. This systematic review aimed to describe the prevalence of SI and SA in rheumatic diseases. Literature search was done using Web of Science, Embase, the Cochrane database library, PubMed and CNKI database through June 2017. Studies were screened according to inclusion and exclusion criteria and the qualities of included studies were evaluated. The data was analyzed using STATA version 12.0. A random-effect meta-analysis was conducted on all eligible data. A total of 17 identified studies matched the inclusion criteria, involving 5174 participants with systemic lupus erythematosus (SLE), osteoarthritis (OA), rheumatoid arthritis (RA) and fibromyalgia (FM). Meta-analysis showed that rheumatic diseases patients have high prevalence of SI (26%, 95% CI: 19%-32%, I²=96.2%) and SA (12%, 95% CI: 3%-21%, I²=96.6%). We also found the prevalence of SI and SA in females may be higher than in males. All of these indicated that rheumatologists should screen for SI and SA in their patients. Early appropriate intervention is therefore essential to promote the patients' good mental health.

Functional disability and suicidal behavior in middle-aged and older adults: A systematic critical review

BACKGROUND

Middle-aged and older adults have elevated rates of suicide around the globe, but there is a paucity of knowledge about risk factors for suicide in these age groups. One possible risk factor may be functional disability, which is more common at later ages.

METHODS

The current systematic critical review examined findings regarding the associations between functional disability and suicidal behavior (suicidal ideation, suicide attempts, and death by suicide) in middle-aged and older adults (i.e. age 50 and older).

RESULTS

Forty-five studies were found that examined these associations. The majority of studies supported a significant association between functional disability and suicidal ideation. In addition, findings to date strongly suggest that depression serves as a mediator of the association between functional disability and suicidal ideation, though most studies did not directly test for mediation.

LIMITATIONS

Firm conclusions regarding suicide attempts and death by suicide, as well as mediation, cannot be drawn due to a relative lack of research in these areas.

CONCLUSIONS

The association between functional disability and suicidal behavior suggests an important area for prevention and intervention among middle-aged and older adults, but additional research is necessary to clarify the specifics of these associations and examine appropriate intervention strategies. Important future directions for research in this area include the direct comparison of associations of risk factors with different types of suicidal behavior, greater use of longitudinal data with multiple time points, and further examination of potential mediators and moderators of the association between functional disability and suicidal behavior.

The burden of suicidal ideation among persons with type II diabetes: A scoping review

OBJECTIVE

Diabetes is a major global health concern. People with diabetes have worse mental health outcomes than those without diabetes. Researchers have recently sought to examine the relationship between diabetes and suicidal ideation. The aim of this study is to determine the burden of suicidal ideation among adults with type II diabetes from existing literature.

METHODS

We conducted a scoping review of published literature in PubMed, PsycINFO, CINAHL, Web of Science, and Google Scholar published before March 2017. To identify relevant literature, search terms included suicidal ideation and type II diabetes. The search was limited to English language peer-reviewed journal articles. The main outcome of interest was suicidal ideation captured on a validated scale in a population with type II diabetes.

RESULTS

This review resulted in 10 relevant studies, which reported the prevalence of suicidal ideation ranging from 2.5-51.4% with a median prevalence of 18.6% among adults with diabetes. Across the five studies reporting the associated risks, all but one study found a significant risk for persons with diabetes to endorse suicidal ideation and only three studies adjusted for depression.

CONCLUSIONS

This review demonstrates the need for future studies to investigate potential mechanistic pathways of suicidality among persons with diabetes.