Resilience as a focus of suicide research and prevention

Psychological resilience and suicidality in the general population: A cross-sectional study based on data from the National Mental Health Survey of Korea 2021

BACKGROUND

The relationship between suicidality and resilience is underexplored among the general population. This study aimed to explore the relationship between lifetime, one-year, and one-month prevalence of suicidality (ideation, plan, attempt) and resilience in the general population.

METHODS

Data on suicidality, resilience, prevalence of major mental disorders, and other key psychological factors were collected from the National Mental Health Survey of Korea 2021. Interviewees comprised 5511 South Koreans aged 18-79 years. The contribution of resilience to suicidality was evaluated using Rao-Scot logistic regression, adjusting for possible confounders such as mental disorder prevalence and demographic and psychological characteristics.

RESULTS

Significantly lower resilience levels were noted among participants who reported lifetime, one-year, and one-month suicidal ideation, plan, or attempts. High resilience levels predicted no suicidal ideation, plans, and attempts in the lifetime, and no suicidal ideation and plans in the one-year and one-month time frames.

LIMITATIONS

First, this study's cross-sectional design has limitations for ascertaining a causal relationship between resilience and suicidality. Second, because the number of participants who had attempted suicide in the past year and reported suicidal thoughts/attempts in the past month was small, there were limitations in the analysis of suicidality in these time frames. Third, it was difficult to rule out the mediating effects of personality and temperament on the relationship between resilience and suicidality.

CONCLUSIONS

High resilience levels predicted lower lifetime and current suicidal ideation and suicidal planning in the general population. This study shows that psychological resilience is an important factor in evaluating an individual's current suicidality.

Developmental pathways from insomnia to suicidality: A resilience perspective

BACKGROUND

Insomnia has been identified as a potential risk factor for suicidality. However, to date, few studies using the longitudinal-design have examined the underlying mechanism of this relationship. Based on a resilience perspective, this study aimed to investigate the dynamic longitudinal relationships between insomnia, resilience, and suicidality.

METHODS

A total of 5785 freshmen were sampled from a large-scale health-related cohort among Chinese college students. This study spanned six waves, covering the period from 2020 to 2022. Data from T1 to T4 were used because resilience was not measured at baseline (T0) and T5. The cross-lagged panel models and the latent growth curve mediation model were used to examine the longitudinal dynamic relationships between insomnia, resilience, and suicidality.

RESULTS

The results showed that insomnia symptoms and suicidality mutually predicted each other, and resilience played a longitudinal mediating role in linking insomnia symptoms and suicidality.

CONCLUSIONS

Given that resilience served as a mediator in the relation between insomnia symptoms and suicidality, some resilience-oriented prevention and intervention programs will be helpful in reducing the risk of suicide among university students.

Suicide Prevention Programming: Comparing Four Prominent Frameworks

OBJECTIVE

Suicide is a significant public health concern. About 48,000 individuals died by suicide in 2021 in the United States, and approximately one in 100 deaths globally are due to suicide. Continuing efforts in program development and evaluation are vital to preventing suicide. Multiple frameworks have been developed to reduce suicide rates, but they have not been compared to assess their comprehensiveness, nor have their components been classified.

METHODS

In 2019, the authors conducted a narrative review of the literature and identified four major frameworks for suicide prevention: the U.S. Department of Veterans Affairs (VA) Suicide Prevention Program, the Defense Suicide Prevention Program of the U.S. Department of Defense, Zero Suicide in Health and Behavioral Health Care, and the technical package developed by the Centers for Disease Control and Prevention. Program components for these frameworks were identified and classified by using two prevention strategy classification systems: the National Academy of Medicine's (NAM's) continuum-of-care model and the Substance Abuse and Mental Health Services Administration's (SAMHSA's) prevention model.

RESULTS

The cross-program comparison revealed that no single program included all components of suicide prevention programs. However, the VA program was the most comprehensive in terms of the number of components and their spread across prevention strategy classifications. The programs used few components categorized under NAM's promotion or selective prevention strategy classifications. The SAMHSA prevention strategy classifications of information dissemination, community-based processes, and positive alternatives were also used infrequently.

CONCLUSIONS

Organizations, health care systems, and policy makers may use these findings as they develop, improve, and implement suicide prevention programs.

Predictors of COVID-Related stress in a community sample in Turkey: a cross-sectional study

The distinctive mental health features associated with COVID-19 have gained importance as the psychological effects of the pandemic on the community become more visible. This study aims to assess the COVID-related stress status and associated factors in the community sample of Turkey. The sample of this cross-sectional study is composed of 2.065 people between the ages of 18-90. Data were collected through an online survey prepared by Google.docs between October-December, 2020. Mild to moderate stress was found in the community with the most common symptoms of the fear of contamination and danger. Some variables, such as being female and the severity of COVID-19 illness, were associated with higher COVID-related stress. Vulnerable groups associated with high stress should be monitored during the pandemic. The findings of this study will guide the practices of professionals working in the field of public health, healthcare, or mental health in possible future pandemics.

The Relationship Between Social Support and Suicide Resilience in Chinese Cancer Patients: A Serial Multiple Mediation Model Through Self-care Self-efficacy and Meaning in Life

BACKGROUND

A growing body of literature has shown a higher risk of suicide in cancer patients compared with the general population. Early detection of factors related to suicide resilience in cancer patients could prevent loss of life.

OBJECTIVE

The study aimed to investigate the serial-multiple mediation of self-care self-efficacy and meaning in life in the relationship between social support and suicide resilience among Chinese cancer patients.

METHODS

A cross-sectional investigation of 287 cancer patients using a battery of self-reported questionnaires was performed. For preliminary analyses, descriptive, univariate, and Pearson correlation analyses were performed. Mediation analyses were tested using a serial-multiple mediation model (PROCESS model 6).

RESULTS

Mediation analysis indicated the indirect effects of social support on suicide resilience mediated solely by either self-care self-efficacy (point estimate = 0.20; 95% confidence interval [CI], 0.12-0.30), or by meaning in life (point estimate = 0.06; 95% CI, 0.01-0.12), or by the multiple mediation of self-care self-efficacy to meaning in life (point estimate = 0.03; 95% CI, 0.01-0.06).

CONCLUSIONS

The findings demonstrated the crucial direct or indirect effects of social support, self-care self-efficacy, and meaning in life on facilitating cancer patients' suicide resilience.

IMPLICATIONS FOR PRACTICE

Oncology nurses, as 24-hour care providers for cancer patients, may interact with and be important sources for the psychosocial care of cancer patients at risk of suicide. Prevention and intervention efforts must be directed at assisting cancer patients, improving self-care self-efficacy, and finding meaning in life after a cancer diagnosis.

Suicide in individuals with no psychiatric disorders: what makes you vulnerable?

Globally, hundreds of thousands of people die by suicide every year. Suicides are usually associated with psychiatric illness. However, considerable evidence suggests that a significant number of individuals who die by suicide do not have diagnosable psychiatric disorders. The goal of this article is to attract attention to an overlooked issue of suicide in persons with no psychiatric disorders and to discuss some aspects of this issue. Research on identification and prevention of suicidal behavior in people with no psychiatric disorders is very limited. The available data indicate that suicides in individuals without psychiatric disorders are related to life stressors, lack of social support, and certain personality traits such as impulsivity. Suicide risk may be increased in military veterans with no psychiatric disorders. Many physical disorders, especially conditions associated with pain increase suicide risk in individuals with no diagnosable psychiatric disorders. Developmental, genetic and physical factors may play a role in the psychobiology of suicide in people with no psychiatric conditions. Promoting resilience may reduce suicide risk in the general population. Clinicians who work with medical or surgical patients need to have sufficient training in suicide prevention. Possibly, shifting some suicide prevention resources from individuals who are regarded as high-risk suicide patients to the general population may reduce suicide rates. Public education and better awareness about suicide may reduce suicide deaths among people with no psychiatric disorders.

Exploring suicide resilience experiences in Chinese youth after self-poisoning: A qualitative study

OBJECTIVE

This inquiry probes the suicide resilience experiences in suicide attempts by self-poisoning among Chinese youth. The study's goal is to provide healthcare professionals with critical insights to develop effective interventions that enhance suicide prevention measures and diminish the likelihood of subsequent attempts.

METHODS

Utilizing a qualitative phenomenological approach, we conducted semi-structured interviews with 12 youths (Mean age = 21.1 ± 2.8 years; n = 7 females) who survived suicide attempts by self-poisoning. Data analysis was performed using Colaizzi's seven-step method, a rigorous method entailing iterative reading for the extraction of key statements and the distillation of thematic essence.

RESULTS

Four primary themes with ten sub-themes were extracted: (1) New understanding of life (cherish life, and meaning of life), (2) Self-Reconciliation (self-acceptance, self-understanding, and self-openness), (3) Personal empowerment (increased self-reliance, increased responsibility, and increased emotional regulation), and (4) Life redesigning (faith in the future, and plan for the future).

CONCLUSIONS

The findings reveal a potential for psychological growth and beneficial transformation in youth following suicide attempts by self-poisoning. These insights advocate for the integration of positive psychology principles in therapeutic interventions for this demographic.

A systematic review of psychosocial protective factors against suicide and suicidality among older adults

BACKGROUND

Research on suicide rarely focuses on protective factors. The goal of this systematic review was to assess the evidence of the associations between protective factors and reduced suicidality among older adults.

METHOD

First, a scoping review was conducted to identify pertinent terms that refer to various protective factors against suicidality. A systematic review, following the PRISMA guidelines, was then conducted on a selection of 15 protective factors (e.g., perceived control, well-being and quality of life, life satisfaction, purpose-in-life, resilience, coping, religiosity, hope, self-regulation, sense of belonging, mattering, positive relationship, social support, social connectedness, and social participation), with separate searches performed on each factor in five databases. Empirical studies were eligible if participants were adults aged 60 years and over, and if the studies reported predictive statistical analysis.

RESULTS

A total of 70 studies were retained for the review. Suicidal ideation was the main outcome measure (91%). Significant associations were consistently observed between all protective factors and reduced suicidal ideations or behaviors, particularly for purpose-in-life, resilience, and positive relationships, indicating that these are solid components for suicide prevention. Using scales, instead of a single item, to measure protective factors (e.g. life satisfaction) was more efficient to capture the associations. On the other hand, results were similar whether studies used subjective (e.g., sense of belonging) or objective (e.g., social connectedness) measures.

CONCLUSION

Protective factors were inversely associated with suicidal ideation. Improving protective factors is essential for the development of late-life suicide prevention and interventions, instead of merely focusing on risk factors.

Bridging childhood to adulthood: the impact of early life stress on acute stress responses

Background

Childhood trauma exerts enduring impacts on the physical and psychological well-being of individuals in adulthood, influencing their daily functioning. This study aims to investigate the impact of childhood trauma on stress recovery in adults, concentrating on heart rate variations during acute stress exposure.

Methods

A cohort of 126 participants completed the Childhood Trauma Questionnaire (CTQ) and underwent the Trier Social Stress Test (TSST) to elicit acute stress, with continuous heart rate (HR) monitoring for stress recovery assessment.

Results

The results revealed a negative correlation between childhood trauma and stress recovery, prominently observed in instances of emotional neglect and abuse. Individuals with heightened childhood trauma exhibited protracted stress recovery following acute stress exposure.

Conclusion

Childhood traumatic experiences were associated with the recovery from acute stress, as indicated by heart rate indices. These findings contribute to the foundational framework for psychological interventions tailored to individuals with a history of childhood trauma.

Unveiling Adolescent Suicidality: Holistic Analysis of Protective and Risk Factors Using Multiple Machine Learning Algorithms

Adolescent suicide attempts are on the rise, presenting a significant public health concern. Recent research aimed at improving risk assessment for adolescent suicide attempts has turned to machine learning. But no studies to date have examined the performance of stacked ensemble algorithms, which are more suitable for low-prevalence conditions. The existing machine learning-based research also lacks population-representative samples, overlooks protective factors and their interplay with risk factors, and neglects established theories on suicidal behavior in favor of purely algorithmic risk estimation. The present study overcomes these shortcomings by comparing the performance of a stacked ensemble algorithm with a diverse set of algorithms, performing a holistic item analysis to identify both risk and protective factors on a comprehensive data, and addressing the compatibility of these factors with two competing theories of suicide, namely, The Interpersonal Theory of Suicide and The Strain Theory of Suicide. A population-representative dataset of 173,664 Norwegian adolescents aged 13 to 18 years (mean = 15.14, SD = 1.58, 50.5% female) with a 4.65% rate of reported suicide attempt during the past 12 months was analyzed. Five machine learning algorithms were trained for suicide attempt risk assessment. The stacked ensemble model significantly outperformed other algorithms, achieving equal sensitivity and a specificity of 90.1%, AUC of 96.4%, and AUCPR of 67.5%. All algorithms found recent self-harm to be the most important indicator of adolescent suicide attempt. Exploratory factor analysis suggested five additional risk domains, which we labeled internalizing problems, sleep disturbance, disordered eating, lack of optimism regarding future education and career, and victimization. The identified factors provided stronger support for The Interpersonal Theory of Suicide than for The Strain Theory of Suicide. An enhancement to The Interpersonal Theory based on the risk and protective factors identified by holistic item analysis is presented.

A Moderation Model for Bolstering Resilience to Suicidal Psychopathology: Positive Sociopsychological Constructs and Coping Flexibilities Buffering the Impact of Daily Life Stress Among Medical Students

ABSTRACT

Positive sociopsychological constructs and coping flexibility may be helpful for alleviating suicidal psychopathology, although relatively little research has examined this possibility among medical students. This survey aimed to investigate whether positive sociopsychological constructs and coping flexibility could buffer the negative impact of daily life stress and bolster the resilience to suicidal ideations and attempts among medical students. This cross-sectional model was based on a study of 787 Indian medical students (725 women and 62 men; mean age, 21.08 years; SD = 2.78; range, 19-37 years) who were asked to complete a battery of self-administered questionnaires. For the purpose of determining the independent and interaction impacts of potential variables of influence, hierarchical multiple linear regression models were used. The moderation analysis investigated that the association between daily life stress and suicidal ideation was buffered among the students having higher levels of positive mental health and coping flexibility, whereas this association was no longer significant at the highest level of positive mental health. Furthermore, the relationship between daily life stress and suicidal attempts continued to be buffered by above-average levels of coping flexibility, emotional stability (ES), and optimism. These findings represent that promoting positive mental health, coping flexibility, ES, and optimism may be a promising approach to mitigate suicidal thoughts and attempts in interventions for medical students at high risk. These modifiable moderating factors can be enhanced by empirically supported treatment and prevention efforts to bolster suicidal resilience.

Prevalence and correlates of suicidal ideation in the general public during the fifth wave of COVID-19 pandemic in Hong Kong

Introduction

Literature reveals increased suicidal ideation in the general population during pandemic. However, few COVID-19 studies comprehensively assessed factors associated with suicidal ideation, and mixed findings were observed. We aimed to examine prevalence and correlates of suicidal ideation in general public during the peak of fifth COVID-19 wave in Hong Kong based on a broad array of relevant measures.

Methods

This survey assessed 14,709 community-dwelling adults during March 15-April 3, 2022. Comprehensive assessment was administered including socio-demographics, pre-existing mental/physical morbidity, mental-health symptoms, resilience, loneliness, coping strategies, and pandemic-related factors. Presence of suicidal ideation was evaluated by ratings of item 9 on Patient-Health-Questionnaire-9.

Results

A total of 2,249 (15.3%) participants exhibited suicidal ideation. Multivariable-regression analysis found that being single and unemployed, pre-existing mental disorder, more severe depressive and anxiety symptoms, higher levels of loneliness and engagement in avoidant coping were significantly associated with suicidal ideation. Conversely, attaining tertiary educational level or above, greater resilience and adopting problem-focused coping were associated with lower likelihood of suicidal ideation. Although univariate-analyses revealed that a number of pandemic-related factors were linked to suicidal ideation, none remained significant in the multivariable model.

Conclusion

A significant proportion of people experienced suicidal ideation during the peak of fifth COVID-19 wave. Risk and protective factors identified would facilitate early identification of high-risk individuals and provision of targeted interventions to minimize suicidal ideation and risk of self-harm. Caution should be exercised due to study limitations of a cross-sectional design which precluded establishing causality among variables, and reliance on self-reported data.

Resilience buffers the association between psychotic-like experiences and suicide risk: a prospective study from a non-clinical sample

BACKGROUND

Several studies have reported that psychotic-like experiences are associated with low levels of resilience and increased suicide risk. However, it remains unknown as to whether resilience mediates or moderates the association between psychotic-like experiences and suicide risk. Therefore, in this study, we aimed to explore the moderating and mediating effect of resilience in the association between psychotic-like experiences and suicide risk.

METHODS

A total of 1100 non-clinical, young adults (aged 18 - 35 years) with a negative history of psychiatric treatment were enrolled. Participants were recruited by the snowball sampling methodology through advertisements posted in the online platform. They were followed-up for about 7 months. Variables of interest were recorded using self-reports. Psychopathological assessment was conducted using the Prodromal Questionnaire-16, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Traumatic Experience Checklist, the Childhood Experience of Care and Abuse Questionnaire, the Cannabis Problems Questionnaire, the Connor-Davidson Resilience Scale-10, and the Mini-International Neuropsychiatric Interview. The STROBE statement guidelines were followed.

RESULTS

The moderation analysis revealed that higher levels of psychotic-like experiences and related distress at baseline were associated with significantly higher suicide risk at the follow-up after adjustment for baseline sociodemographic characteristics, depressive and anxiety symptoms, a history of childhood trauma, and problematic cannabis use. The interaction between follow-up resilience and distress related to baseline psychotic-like experiences was significantly and negatively associated with suicide risk at the follow-up. Specifically, the correlation between the level of distress related to psychotic-like experiences and suicide risk was significant and positive only in participants with lower levels of resilience. This interaction did not reach statistical significance for the baseline level of psychotic-like experiences. No significant mediating effect of the follow-up resilience level in the association between baseline psychotic-like experiences and the follow-up suicide risk was found.

CONCLUSIONS

Findings from the present study indicate that resilience might protect against suicide risk in people with psychotic-like experiences. These findings could be applied in the formulation of early intervention strategies aimed at mitigating the risk of suicide. Future studies need to explore the effects of interventions targeting resilience for individuals with psychotic-like experiences.

Long COVID-19 and Suicide

Suicide is a significant public health problem around the world. More than 90% of individuals who die by suicide have a diagnosable psychiatric disorder, and most persons who attempt suicide also have a psychiatric illness. Depression, anxiety, posttraumatic symptoms, sleep disturbances, decreased energy, and cognitive abnormalities are the most frequently reported psychiatric symptoms of long COVID. All these conditions are associated with suicidal ideation and behavior. Therefore, individuals with long COVID may be at increased risk of suicide. Recent studies of patients with long COVID confirm that individuals with long COVID are at increased suicide risk. It is vital to educate clinicians taking care of long COVID individuals that patients with long COVID may be suicidal, that it is essential to screen patients with long COVID for suicidality, and if needed, suicide prevention interventions should be employed.

Feasibility of a 3-Minute Mindful Breathing Intervention for Enhancing Psychiatric Mental Health Nurses' Resilience During COVID: Findings From a 4-Week Pilot Study

COVID created a perfect storm of conditions leading to excessive and prolonged stress on already vulnerable nurses. This study examines the feasibility of enhancing psychiatric mental health nurses' (PMHNs') resilience by practicing a 3-minute mindfulness-based intervention. In this pilot study, we explored if PMHNs could be recruited and retained for intervention implementation, intervention acceptability, and measurement of any notable changes over the prescribed period. Study feasibility is reflected in high participant retention and increased postintervention resilience scores. Given the positive outcomes, a larger-scale study is warranted. Additional areas of opportunity include strategies for increasing participant uptake, and, due to limited acceptability feedback, the introduction of a usefulness scale.

School connectedness and psychological resilience as mediators in the relationship between childhood abuse and suicidal ideation among Chinese adolescents

Background: Suicide among adolescents is a huge public health concern around the world. Although childhood abuse has been established as a substantial risk factor for suicide behaviours, potential mediators in this relationship remain unclear.Objective: This study aimed to examine the mediating roles of school connectedness and psychological resilience in the association between childhood abuse and suicidal ideation among Chinese high school students.Methods: The sample involved 1607 adolescents from four high schools in Central China. Structural equation modelling (SEM) was conducted to investigate the mediation effects of school connectedness and psychological resilience on the relationship between childhood abuse and suicidal ideation.Results: The prevalence of suicidal ideation during the past week was 21.9%. Childhood abuse was positively related to the development of suicidal ideation directly and indirectly through school connectedness and psychological resilience. School connectedness and psychological resilience were also partial mediators of all three types of childhood abuse (emotional abuse, physical abuse and sexual abuse) when the types were examined separately.Conclusions: Suicidal ideation was widespread among Chinese high school students. Psychological resilience and school connectedness could attenuate the detrimental impact of childhood abuse on suicidal ideation. Findings underscore the improvement of psychological resilience and the connection to the school would be beneficial to suicide prevention among Chinese adolescents with childhood abuse.

Psychometric properties, predictive utility and diagnostic capacity of the Persian version of the Scale of Resilience to Suicide Attempts in army conscripts

INTRODUCTION

Suicide among army conscripts represents a poorly understood and complex public health issue that has escalated in recent decades. The early identification of individuals at risk holds the potential to significantly contribute to the effective prevention of suicide attempts. To address this, the Scale of Resilience to Suicide Attempts-18 (SRSA-18) has been developed to assess protective factors related to suicide attempts. The present study aimed to develop a Persian version of SRSA-18 (P-SRSA) and examine its psychometric properties and predictive utility within a sample of the Iranian Army.

METHODS

The initial study sample consisted of 400 male conscripts from the Iranian Army grand forces (M=19.86, SD=1.40). Subsequently, for the follow-up stage, 296 participants (M=19.83, SD=1.39) were recruited. The participants were assessed using various measures of resilience, social support, suicide and hopelessness at baseline and a 6-month follow-up.

RESULTS

In contrast to the original version, both exploratory and confirmatory factor analyses supported an 18-item two-factor model of the P-SRSA (root mean square error of approximation=0.076; 95% CI (0.069 to 0.086), comparative fit index=0.943, Tucker-Lewis index=0.936). P-SRSA strongly correlated with convergent/divergent measures and demonstrated satisfactory internal consistency (α=0.82). Furthermore, regression analysis revealed that the P-SRSA significantly predicted suicide reattempts at baseline and during a 6-month follow-up period.

CONCLUSION

The study confirms that the P-SRSA, comprising a two-factor, 18-item solution, is a reliable measure of resilience, displaying robust discriminant and predictive validity. These findings provide substantial support for implementing P-SRSA in samples from the Iranian Army, highlighting its potential to identify suicidal conscripts effectively.

The effect of childhood trauma on suicide risk: the chain mediating effects of resilience and mental distress

BACKGROUND

Suicide is the fourth leading cause of death among young people aged 15-29 years. A large number of studies have found that mental disorder in adulthood is closely related to childhood trauma, and the relationship between childhood trauma and suicide risk is influenced by resilience and mental distress. This study aimed to explore the effects of childhood trauma on suicide risk among young people and the potential roles of resilience and mental distress in the relationship between childhood trauma on suicide risk.

METHODS

A cross-sectional survey was conducted among 742 young adults who were in graduate school stage from multiple provinces and cities in China. The Childhood Trauma Questionnaire (CTQ-Short Form), Connor-Davison Resilience Scale (CD-RISC) and Suicide Behavior Questionnaire-Revised (SBQ-R) were used to measure young adults' childhood trauma, resilience and suicide risk, respectively. 9-items Patient Health Questionnaire (PHQ-9) and 7-items self-report Generalized Anxiety Disorder Scale (GAD-7) were used together to measure mental distress. Correlation analysis was performed to explore the initial relationships among the main variables. Structural equation modeling (SEM) was conducted to examine the chain mediating effects of resilience and mental distress in the relationship between childhood trauma and suicide risk.

RESULTS

The structural equation modeling produced goodness of fit indices (χ2 /df = 3.668, p < 0.001, RMSEA = 0.060, NFI = 0.959, CFI = 0.969, GFI = 0.969, TLI = 0.955). Childhood trauma significantly predicted suicide risk (β = 0.232, p < 0.001) and mental distress (β = 0.181, p < 0.001), which had negative effect on resilience (β = -0.233, p < 0.001). Resilience negatively affected mental distress (β = -0.483, p < 0.001) and suicide risk (β = -0.142, p = 0.001), while mental distress positively associated with suicide risk (β = 0.219, p < 0.001).

CONCLUSION

The current study revealed that resilience and mental distress played chain-mediating roles in the relationship between childhood trauma and suicide risk. This suggests that we should view the suicide risk of graduate students from a comprehensive perspective.

A network study to differentiate suicide attempt risk profiles in male and female patients with major depressive disorder

Suicide attempts are a possible consequence of Major Depressive Disorder (MDD), although their prevalence varies across different epidemiological studies. Suicide attempt is a significant predictor of death by suicide, highlighting its importance in understanding and preventing tragic outcomes. Researchers are increasingly recognizing the need to study the differences between males and females, as several distinctions emerge in terms of the characteristics, types and motivations of suicide attempts. These differences emphasize the importance of considering gender-specific factors in the study of suicide attempts and developing tailored prevention strategies. We conducted a network analysis to represent and investigate which among multiple neurocognitive, psychosocial, demographic and affective variables may prove to be a reliable predictor for identifying the 'suicide attempt risk' (SAR) in a sample of 81 adults who met DSM-5 criteria for MDD. Network analysis resulted in differences between males and females regarding the variables that were going to interact and predict the SAR; in particular, for males, there is a stronger link toward psychosocial aspects, while for females, the neurocognitive domain is more relevant in its mnestic subcomponents. Network analysis allowed us to describe otherwise less obvious differences in the risk profiles of males and females that attempted to take their own lives. Different neurocognitive and psychosocial variables and different interactions between them predict the probability of suicide attempt unique to male and female patients.

Profiles, Transitions, and Resilience Factors of Suicide Risk in Early Chinese Adolescents

As a severe public health concern directly endangering life safety, adolescent suicide has been extensively investigated in variable-centered studies. However, gaps remain in the knowledge of heterogeneous suicide risk patterns and their developmental nature. Additionally, little is known about protective factors associated with suicide risk patterns and changes. This study applied person-centered approaches to explore suicide risk profiles and transitions over time in early Chinese adolescents, along with their protective factors. A total of 1518 junior high school students (49.6% girls, Mage = 13.57, SD = 0.75) participated in two surveys within a 12-month interval. Latent Profile Analysis and Latent Transition Analysis were used to model the profiles and transitions of suicide risk. Three risk profiles were identified at both time points: low risk profile (73.9, 78.3%), medium risk-high threat profile (16.2, 10.2%), and high risk profile (9.9, 10.2%). Low risk profile was stable, while medium risk-high threat and high risk profiles showed great transitions over 12 months. Sense of control, meaning in life, and regulatory emotional self-efficacy served as protective factors against suicide risk profiles and transitions. Findings underscore the importance of comprehensively illustrating suicide risk states from multiple aspects, as well as understanding the fluid nature of transitions between different risk states. Prevention and intervention strategies aimed at enhancing resilience, such as increasing sense of control, perceived meaningfulness, and belief in emotional regulation, may contribute to reducing the risk of suicide among adolescents.

Prevalence and factors associated with suicidal ideation, cannabis, and alcohol use during the COVID-19 pandemic in Saskatchewan: findings from a joint-effect modeling

BACKGROUND

Generally, pandemics such as COVID-19 take an enormous toll on people's lives. As the pandemic now turns to an endemic state, growing attention has been paid to the multiple adverse mental health and behavioral issues, such as suicidal ideation and substance use. However, the interplay of suicidality and substance misuse during the pandemic has been limited. We aimed to investigate the prevalence of co-occurrence of suicide ideation, alcohol and cannabis misuse, and the factors that are associated with these co-occurrences in the province of Saskatchewan during the COVID-19 pandemic.

METHODS

We performed a multivariable trivariate probit regression on a sample of 666 Saskatchewan adolescents and adults (16 years or older), drawn from the cycle 10 data collection (March 2022) of the Mental Health Commission of Canada, and Canadian Centre on Substance Use and Addiction (MHCC-CCSA) dataset.

RESULTS

The prevalence of suicidal ideation was higher among respondents who reported both problematic cannabis and alcohol use (25.8%) than single users of alcohol (23.2%) and cannabis (18.7%). Younger respondents (16-34 years) and those who reported recent changes in other substance use were independent factors that were associated with the common experience of suicide ideation, problematic cannabis, and alcohol use. Having a diagnosis of mental health disorders either before or during the pandemic, and the perceived inability to bounce back after the pandemic (low resilience) are strong correlates of suicidal ideation. Those who lived alone, between 35 and 55 years of age were more likely to report problematic alcohol use. Those who reported changes in alternative activities, who reported pandemic stress, and declared a LGBTQIA2S + identity had higher probability of problematic cannabis use.

CONCLUSIONS

As the pandemic persists, improving access to suicide and substance use interventions for the vulnerable groups identified in this study may be impactful.

Environmental Ethics and Mental Health during COVID-19

As the cause of the COVID-19 pandemic, climate change, population density, ecological changes, etc. natural phenomena are shown. The physical, chemical, biological, socioeconomic, cultural and psychological effects of COVID-19 have been felt all over the world. COVID-19 negatively affects the environment with an unbalanced increase in medical waste and disposable products, while quarantine and pandemic measures have given an opportunity for nature to renew itself. The causes and consequences of COVID-19 have brought the concepts of environmental health and therefore environmental ethics to the agenda of healthcare professionals. As the environmental ethics attitudes and behaviors of health professionals develop, health professionals will be able to take initiatives to create these attitudes and behaviors in society. Environmental ethics has been evaluated in the context of public health, mostly in the physical health. However, environmental ethics is also very important in terms of community mental health. Living in an unhealthy environment threatens mental health. Because people want to live in a safe environment, every factor that threatens this trust poses a risk for mental health. There is actually literally no way to talk about happiness in an environment where there is no environmental order and nature is deteriorated and polluted. Therefore, we aimed to explain the concepts of environmental health, environmental ethics and mental health during the COVID-19 process. Thus, an important strategy development in the pandemic process can be achieved by enabling the assessment and management of the causes of the COVID-19 pandemic from a broader perspective.

Insights into the potential benefits of triphala polyphenols toward the promotion of resilience against stress-induced depression and cognitive impairment

In response to environmental challenges, stress is a common reaction, but dysregulation of the stress response can lead to neuropsychiatric disorders, including depression and cognitive impairment. Particularly, there is ample evidence that overexposure to mental stress can have lasting detrimental consequences for psychological health, cognitive function, and ultimately well-being. In fact, some individuals are resilient to the same stressor. A major benefit of enhancing stress resilience in at-risk groups is that it may help prevent the onset of stress-induced mental health problems. A potential therapeutic strategy for maintaining a healthy life is to address stress-induced health problems with botanicals or dietary supplements such as polyphenols. Triphala, also known as Zhe Busong decoction in Tibetan, is a well-recognized Ayurvedic polyherbal medicine comprising dried fruits from three different plant species. As a promising food-sourced phytotherapy, triphala polyphenols have been used throughout history to treat a variety of medical conditions, including brain health maintenance. Nevertheless, a comprehensive review is still lacking. Here, the primary objective of this review article is to provide an overview of the classification, safety, and pharmacokinetics of triphala polyphenols, as well as recommendations for the development of triphala polyphenols as a novel therapeutic strategy for promoting resilience in susceptible individuals. Additionally, we summarize recent advances demonstrating that triphala polyphenols are beneficial to cognitive and psychological resilience by regulating 5-hydroxytryptamine (5-HT) and brain-derived neurotrophic factor (BDNF) receptors, gut microbiota, and antioxidant-related signaling pathways. Overall, scientific exploration of triphala polyphenols is warranted to understand their therapeutic efficacy. In addition to providing novel insights into the mechanisms of triphala polyphenols for promoting stress resilience, blood brain barrier (BBB) permeability and systemic bioavailability of triphala polyphenols also need to be improved by the research community. Moreover, well-designed clinical trials are needed to increase the scientific validity of triphala polyphenols' beneficial effects for preventing and treating cognitive impairment and psychological dysfunction.

The Importance of Timing, Fundamental Attitudes, and Appropriate Interventions as Key Aspects of Chaplain Suicide Prevention: A European Expert Panel of Mental Health Chaplains

An expert panel consisting of six mental health chaplains from several European countries was convened to ascertain the specific contribution of mental health chaplains to suicide prevention, and to generate good practices for suicide prevention. Three themes emerged: (1) the importance of timing; (2) fundamental attitudes of the chaplain towards the patient, and (3) appropriate interventions.

Sex-specific risk and resilience correlates of suicidal ideation in U.S. military veterans

OBJECTIVES

To estimate the prevalence and identify gender-specific risk factors associated with suicidal ideation (SI) in a nationally representative sample of U.S. military veterans.

METHODS

Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of 4069 veterans. Bivariate and multivariable analyses were conducted to identify factors associated with SI in male and female veterans.

RESULTS

The prevalence of SI was significantly higher in female than male veterans (18.1 % vs. 11.2 %). In female veterans, results of a relative importance analysis revealed that the majority of explained variance in SI (Nagelkerke R² = 0.54) was accounted for by lower psychological resilience (44.4 %), and history of non-suicidal self-injury (24.4 %) and alcohol use disorder (20.6 %). In male veterans, the majority of explained variance in SI (Nagelkerke R² = 0.32) was accounted for by higher loneliness (19.5 %) and hostility (19.1 %), and lower purpose in life (16.3 %).

CONCLUSIONS

Suicidal ideation is prevalent among U.S. veterans, particularly in female veterans. Different risk factors emerged as strong correlates of SI in female and male veterans, which may be used to inform gender-specific suicide prevention and treatment efforts in this population.

Beyond burnout: a four-year survey of osteopathic medical student mental health and the implications for the development of wellness and mental health programs

CONTEXT

The mental health crisis in medicine cannot be explained by burnout alone. Physicians are not immune to this crisis and are known to have higher rates of suicide and depression than the general population. A high prevalence of mental health symptoms has been observed in early medical training.

OBJECTIVES

This study was completed to characterize medical students' mental well-being and provide guidance for timely intervention.

METHODS

An annual prospective, voluntary, anonymous, cross-sectional survey of medical students was completed over a 4-year period in medical school from 2016 to 2019. The survey was created based on standardized psychiatric screening tools assessing symptoms of depression, anxiety, burnout, and sleep problems. In each of those years, 1,257 (2016), 1,254 (2017), 1,221 (2018), and 1,220 (2019) enrolled students, respectively, were invited to participate. Data on students' mental health were analyzed in relation to their year of school separately for each survey year utilizing SAS 9.4.

RESULTS

A total of 973 students in 2016, 889 students in 2017, 547 students in 2018, and 606 students in 2019 participated in the study. For depression and burnout subscales, an increase in symptom scores were observed every survey year (2016, 2017, 2018, and 2019) by the second or third year of medical school with a clinically significant effect size. Persistently high levels of anxiety were observed throughout medical school, with significant increases after the first year noted in the 2016 and 2017 surveys, but not in the 2018 or 2019 surveys. Similarly, significant changes in sleep disturbance were found in the 2016 and 2017 surveys, but not in 2018 or 2019.

CONCLUSIONS

Symptoms of burnout, depression, and anxiety were observed throughout all four years of medical school, with increases starting after the first year. Early intervention is needed to support students' mental health and increase access to care and resources.

A Longitudinal Network Analysis of the Interactions of Risk and Protective Factors for Suicidal Potential in Early Adolescents

Few studies have applied the "ideation-to-action" theories and the buffering hypothesis of resilience to suicide in early adolescents, and existing research is primarily cross-sectional. This study examined the interactions between risk factors (i.e., thwarted belongingness, perceived burdensomeness, and hopelessness), protective factors (i.e., resilience, self-efficacy, and subjective happiness), and suicidal potential (i.e., family distress, anxious-impulsive depression, and suicidal ideation or acts) in early adolescents. The participants (N = 1615; 55.6% females; M age = 10.93, SD age = 1.14, range: 9-15) who were recruited from four primary and four secondary schools in Hong Kong completed the survey in 2020 and 2021. The contemporaneous networks suggested that perceived burdensomeness and hopelessness were positively associated with suicidal potential. Protective factors were negatively associated with risk factors studied and suicidal potential. The node with the greatest centrality strength was anxious-impulsive depression. The nodes most likely to connect with other constructs were self-efficacy and hopelessness. A temporal network suggested the predictive effect of hopelessness and the protective effect of subjective happiness on future suicidal ideation or acts. Moreover, self-efficacy was found to buffer the impact of hopelessness on future suicidal ideation or acts. These findings highlighted the contribution of hopelessness to suicidal potential among early adolescents and the buffering effects of subjective happiness and self-efficacy.

Physical disability, low self-esteem, and suicidal ideation among Chinese nursing home residents: the moderating role of resilience

OBJECTIVES

This study aimed to investigate the mediating role of self-esteem in the relationship between physical disability and suicidal ideation, and whether the mediation effect was moderated by resilience among nursing home residents.

METHODS

Participants were 538 nursing home residents recruited from 37 nursing homes in Jinan, China (mean age = 78.13 years, SD = 8.72). The Lawton and Brody Activities of Daily Living Scale, Rosenberg Self-Esteem Scale, 10-item version of the Connor-Davidson Resilience Scale, and Beck Suicidal Ideation Inventory-Chinese Version were used. Mediation and moderated mediation analyses were performed using Models 4 and 15 of the PROCESS macro for SPSS.

RESULTS

The prevalence of suicidal ideation among the nursing home residents was 14.90%. The mediation analysis showed that self-esteem partially mediated the association between physical disability and suicidal ideation. Resilience was a protective factor for suicidal ideation and moderated the relationship between physical disability and suicidal ideation, and between self-esteem and suicidal ideation.

CONCLUSION

Both physical disability and lower self-esteem are important in understanding the development of suicidal ideation among nursing home residents. Improving resilience may be crucial for suicide prevention.

Protective factors against suicide attempt in Iranian Kurdish women: a qualitative content analysis

BACKGROUND

A proper understanding of the protective factors against suicide attempt can provide the basis for planning preventive interventions. This study aimed to identify protective factors against suicide attempt among women.

METHODS

This qualitative study was conducted in Kermanshah, Iran between January and May 2021. Participants were 20 Kurdish women, survivors of suicide attempt, selected by purposive sampling method. The data collection method was face-to face and audio-recorded semi-structured interview. Qualitative data analysis was done according to Diekelmann 7-step approach.

FINDINGS

According to the results, the main topic was protective factors against suicide attempt in women, with two categories; "Individual factors" and "Social factors". "Individual factors" had five subcategories including coping strategies, reasons for living, resilience, religious beliefs, and fear of death, and "social factors" had two subcategories including social support and effective communication.

CONCLUSION

This study showed that women who intend to commit suicide may encounter some individual and social factors that play a protective role against suicide. It is recommended to identify and strengthen these protective factors for the effectiveness of suicide prevention interventions.

Suicide: An Overview for Clinicians

Most suicides have a diagnosable psychiatric disorder, most frequently, a mood disorder. Psychosocial issues and neurobiological abnormalities such as dysregulation in stress response systems contribute to suicidal behavior. All psychiatric patients need to be screened for the presence of suicidal ideation. Clinicians are expected to gather information about patient's clinical features and to formulate decisions about patient's dangerousness to self and the treatment plan. As psychiatric disorders are a major risk factor for suicide their pharmacologic and psychological treatment is of utmost importance to prevent suicide. Restriction of access to lethal means is important for suicide prevention.

Agreement for diagnosis of depression and anxiety between self-assessment with e-questionnaire and psychiatric telephone interview among post-COVID-19 patients

BACKGROUND

Psychological disorders, such as depression and anxiety, are common among individuals who have experienced coronavirus disease 2019 (COVID-19); however, diagnosis may be challenging and subjected to invalidity. This study aimed to examine agreement between online self-assessment and psychiatric telephone interview among COVID-19 survivors.

MATERIALS AND METHODS

This cross-sectional descriptive study was carried out from March to June 2021 in Afzalipour Hospital, Kerman, Iran. The inpatients confirmed with COVID-19 were contacted within the first week after discharge and were asked to fill the Hospital Anxiety and Depression scale (HADS) and socio-demography questionnaire. They were later interviewed using Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A). Agreement between the data extracted from self-report and telephone interview was analyzed using Cohen's kappa coefficient, sensitivity, and specificity.

RESULTS

Out of 200 post-COVID patients, 60 participants completed all assessments. Prevalence of depression was observed to be 88% via telephone interview and 45% via self-assessment. Moreover, 83% of the participants were diagnosed with anxiety according to the telephone interview, in comparison to 31% diagnosed with anxiety using self-report questionnaire. The agreement between online self-assessment and telephone interview for depression and anxiety was not significant (κ = 0.08 and κ = 0.1, respectively).

CONCLUSION

The discordance between online self-report and clinician's assessment via phone contact interview indicates that using self-report evaluations is not sufficient as the single assessment tool for mental health monitoring and reflects the need to employ multiple assessments for diagnosis of psychiatric problems in pandemics.

School bullying among Chinese third to fifth grade primary school students in a cross-sectional study: The protective effect of psychological resilience

School bullying is a major concern for school-aged youth and has great impacts on children's health and well-being, and an increasing number of school bullying cases have been reported in China. Many studies have indicated that psychological resilience may have a well-established association with school bullying. However, only a limited number of studies have explored this association, especially among primary school students. The present study aimed to investigate the relationship between school bullying and psychological resilience among primary school students from a Chinese city. The participants were 6,011 primary school students aged 7-14 years who were recruited in a cross-sectional survey in Luzhou, China. The statistical significance of differences between groups was tested using the χ2 test or t test. Binary logistic regression analyses were conducted to explore the association between psychological resilience and school bullying. The incidence rates of bullies and victims were 30.00% (1803/6011; 95% CI: 28.84%-31.16%) and 69.89% (4201/6011; 95% CI: 68.73%-71.05%), respectively. Psychological resilience was a protective factor of school bullying among primary school students (for bullying perpetrators, OR = 0.76, 95%CI:0.62-0.93, and for bully victims OR = 0.74, 95%CI:0.61-0.90), especially among female students (for bullying perpetrators, OR = 0.63, 95%CI: 0.47-0.85, and for bully victims, OR = 0.69, 95%CI: 0.53-0.90). School bullying among primary school students in Luzhou City was highly prevalent. High levels of psychological resilience might be a protective factor in preventing primary students from being involved in school bullying, especially among females.

Early psychological intervention in adult patients after hospitalization during COVID-19 pandemia. A single center observational study

The coronavirus disease 2019 pandemic has represented an individual and collective trauma with an impact on mental health. COVID-19 survivors need to be screened for psychological distress regularly for timely intervention. After March 2020, an outpatients clinic for follow up of discharged COVID-19 patients was set up at Infectious Diseases Department of the Hospital of Lecco, Italy. Blood exams, specialistic visits were performed for each patients and IES-R and BDI scales were dispensed. 523 patients were referred to the clinic; 93 of them resulted positive at IES-R and/or BDI self-report and 58 agreed to have early interviews with psychologist specialist. Patients could receive only a short psychoeducation/psychological support intervention or in addition to the same, even a specific trauma-focused psychotherapeutic intervention with EMDR where clinically indicated. IES-R e BDI were administered pre- and post-intervention. The results show that the average of the post-traumatic stress scores detected at IES-R is above the clinical cut-off for the entire sample. There is an overall change in the decrease in mean scores on the IES and BDI scales before and after psychological intervention. Among the patients for whom psychopharmacological therapy was also necessary, those who had COVID-mourning in family improved the most at IES-R scale post- intervention. With respect to EMDR treatment, there is a significant improvement in depressive symptoms noticed at BDI for male patients who have received neither psychotropic drugs nor CPAP. Being hospitalized for coronavirus has a significant impact on the patient's mental health and it is a priority to arrange early screening to intercept psychological distress and give it an early response.

Correlation between psychological resilience and suicide probability in patients with psychiatric disorder

PURPOSE

It was aimed to evaluate the correlation between psychological resilience and possibility of suicide in psychiatric patients.

DESIGN AND METHODS

The data of the research were collected using "Individual Information Form", "Resilience Scale for Adults (RSA)," and "Suicide Probability Scale (SPS)".

FINDINGS

It was found that the mean total score of SPS was 70.97 ± 12.82 and moderate risk, the mean total score of RSA was 112.50 ± 25.38, and the levels of psychological resilience were at a good level. It has been determined that patients with low levels of psychological resilience have a higher risk of committing suicide.

PRACTICE IMPLICATIONS

Findings show that a high level of resilience reduces the risk of suicide. Implementing interventions to improve psychological resilience will help prevent suicide.

Resilience and Depressive Symptoms Mediated Pathways from Social Support to Suicidal Ideation Among Undergraduates During the COVID-19 Campus Lockdown in China

Purpose

The COVID-19 pandemic has greatly affected people's mental health. The direct and indirect pathways between social support and suicidal ideation in the period are still unclear. This study explores the pathways from social support to suicidal ideation through resilience and depressive symptoms among undergraduates during the COVID-19 campus lockdown.

Methods

During two weeks of the COVID-19 campus lockdown, a total of 12,945 undergraduates at a university in eastern China completed the questionnaire including sociodemographic characteristics, suicidal ideation, social support, resilience, and depressive symptoms. A structural equation modeling (SEM) approach was used to analyze the direct and indirect pathways from social support to suicidal ideation via the mediators of resilience and depressive symptoms.

Results

Of the 12,917 undergraduates included in this study, 7.4% (n = 955) reported they sometimes had suicidal ideation, 0.8% (n = 109) reported they often had suicidal ideation, 0.9% (n = 122) reported they always had suicidal ideation, and 13.2% (n = 1704) reported they had depressive symptoms. Social support exerted significant direct (β = -0.058), indirect (β = -0.225), and total (β = -0.283) effects on suicidal ideation; 20.5% of the total effect was direct, and 79.5% was indirect. Social support predicted suicidal ideation through resilience (β = -0.038), and depressive symptoms (β = -0.087), explaining 13.4%, and 30.7% of the total effect, respectively. Social support predicted suicidal ideation through the sequential mediation of resilience and depressive symptoms (β = -0.099), explaining 35.0% of the total effect.

Conclusion

This is the first study to provide the evidence of pathways from social support to suicidal ideation through resilience and depressive symptoms during the COVID-19 campus lockdown among undergraduates in China. Both direct and indirect pathways from social support to suicidal ideation were identified as intervention targets to reduce suicidal ideation.

Relationship between parental psychological control and suicide ideation in Chinese adolescents: Chained mediation through resilience and maladjustment problems

Suicide ideation is an essential predictor of suicide deaths and is highly prevalent among Chinese adolescents. Several studies have highlighted the significant association between parental psychological control and suicide ideation. However, few studies have focused on the potential mechanisms underlying this relationship. This study investigated the chained mediating effects of resilience and maladjustment problems on the relationship between parental psychological control and suicide ideation among Chinese adolescents. A total of 2,042 students in junior high school completed measurements. The results revealed significant correlations among parental psychological control, resilience, maladjustment problems and suicide ideation. Even after controlling for the effects of gender and grade, parental psychological control positively predicted a significant effect of suicide ideation. Furthermore, suicide ideation was linked with parental psychological control through three pathways: the mediating role of resilience, the mediating role of maladjustment problems, and the chained mediating roles of resilience and maladjustment problems. These findings have broad implications for the field of suicide studies. High levels of parental psychological control, low levels of resilience, and high levels of maladjustment problems may increase the occurrence of suicide ideation.

Reasons for living, positive psychological constructs and their relationship with suicide ideation in people with moderate to severe traumatic brain injury: A cross-sectional study

Positive psychological constructs such as reasons for living, self-esteem and resilience have previously been shown to act as protective psychological barriers against negative psychological outcomes, including suicide ideation in both clinical populations and the general population. This study aims to explore the positive psychological constructs of reasons for living, self-esteem, resilience and their relationship with suicide ideation and predictors of suicide ideation (depression, hopelessness) for N = 50 people who have a severe TBI and are currently receiving community rehabilitation at Liverpool Brain Injury Rehabilitation Unit (LBIRU), NSW. Results indicated good reliability for the use of the RFLI with people who have TBI, with the most frequently endorsed subscale (range 0-5) being "survival and coping beliefs" (4.7 ± 1.0) and the least frequently being "fear of suicide" (2.2 ± 1.1). The shortened version of the RFLI (BRFLI) also displayed good reliability. Positive psychological constructs (reasons for living, resilience, self-esteem) were all significantly inversely associated with suicide and suicide predictors (depression, hopelessness). This study suggests that positive psychological constructs can act as a buffer against suicide ideation after moderate to severe TBI.

Resilience to suicidal behavior in young adults: a cross-sectional study

Despite decades of research on suicide risk factors in young people, there has been no significant improvement in our understanding of this phenomenon. This study adopts a positive deviance approach to identify individuals with suicide resilience and to describe their associated psychological and sociodemographic profiles. Australian young adults aged 18–25 years with suicidal thoughts (N = 557) completed an online survey covering sociodemographic, mental health status, emotion regulatory and suicide-related domains. Latent class analysis was used to identify the individuals with suicide resilience. The predictors of suicide resilience were assessed using logistic regression models. The results suggested that one in ten (n = 55) met the criteria for suicide resilience. Factors that had a significant association with suicide resilience included greater cognitive flexibility, greater self-efficacy in expressing positive affect, reduced use of digital technology and less self-harm and substance use as a response to emotional distress. This study identified the factors that may protect young adults with suicidal thoughts from progressing to suicide attempts. Suicide prevention programs might be optimised by shifting from a deficit-based to a strength-based approach through promoting cognitive flexibility, self-efficacy and reducing maladaptive coping.

Effectiveness of a resilience-targeted intervention based on "I have, I am, I can" strategy on nursing home older adults' suicidal ideation: A randomized controlled trial

BACKGROUND

Despite the potential for benefit, resilience remains an emergent area in late-life mental health care, and evidence of resilience intervention for suicide among nursing home residents is especially limited. This study aims to evaluate the effects of a resilience-targeted program based on the "I have, I am, and I can" strategy on suicidal ideation and related problems.

METHODS

From the 562 nursing home residents who were contacted, 68 with suicidal ideation were recruited and then randomly assigned to a resilience intervention group (eight-week resilience training; n = 34) or a wait-list control group (eight-week health education; n = 34). Self-reported suicidal ideation, and depression and anxiety symptoms as outcomes, and resilience as potential mediators were assessed at baseline, postintervention, and one-month follow-up.

RESULTS

Resilience training participants reported significant improvement in suicidal ideation (group × time interaction x²=12.564, p = 0.002) and depression symptoms (x²=9.441, p = 0.009) compared to wait-list control group participants. Changes in resilience mediated the intervention's effects on changes in suicidal ideation and depression symptoms. Limitations The observed effects must be considered preliminary due to the small sample size.

CONCLUSIONS

The findings support the benefits of resilience training based on the "I have, I am, and I can" strategy in reducing suicidal ideation and suicide-related symptoms in nursing home older adults, and provide insight into possible mechanisms.

Epidemiological Risk Factors of Suicidal Behavior and Effects of the Components of Coping Strategies on Suicidal Behavior in Medical Students: A North-Indian Institution-Based Cross-Sectional Study

Background  Mental stresses and adoption of poor coping strategies can be a cause of suicidal behavior in medical students.

Objective  The aim of this study is to evaluate the prevalence and risk factors of suicidal behavior, and effects of the components of coping strategies on suicidal behavior among medical students

Methodology  An institution-based cross-sectional study was conducted among medical students of a college located in North India for a period of 2 months from February to March 2021. A total of 531 study participants (calculated sample size) were selected, and then allocated proportionally to each academic year, both through stratified random sampling technique. Then, the participants were asked to complete a self-administered questionnaire consisting of sociodemographic characteristics, Patient Health Questionnaire-9, Suicidal Behaviors Questionnaire-Revised (SBQ-R), and coping inventory. A pretest was done to modify the coping inventory and then exploratory factor analysis was performed on it to classify the components of coping strategies. Chi-square test and multiple logistic regression analysis were used to determine the risk factors and their association with suicidal behavior.

Results  A total of 104 (19.6%) respondents had reported SBQ-R cutoff score > 7 and had suicidal behavior. The rate of lifetime suicidal ideation, plan, and attempt was 20.3, 10.3, and 2.3%, respectively, among medical students, with 1-year prevalence of suicidal ideation at 33%. The mean age of the participants was 21.26 years (standard deviation = 1.99). The identified risk factors significantly associated with higher suicidal behavior were depression (odds ratio [OR] = 9.6), dissatisfaction with academic performances (OR = 4.9), and coping with mental disengagement (OR = 4.6), while coping with supportive strategies (OR = 0.57) was investigated as a preventive factor for the suicidal behavior.

Conclusion  The prevalence of suicidal behavior is found to be highly alarming, revealing that depression and poor coping strategies are risk factors among medical students. The analysis recommends that quantification of the problems, treatment at an early stage, and proactive student counseling to help them embrace the appropriate coping strategies, should be the first steps in prevention of suicidal behavior.

Factors associated with remission of suicidal thoughts and behaviors in U.S. military veterans with a history of suicide attempt

Suicide is a major public health problem in U.S. military veterans, but little is known about factors associated with remission from suicide attempts in this population. We aimed to identify risk and protective correlates of remission from suicidal thoughts and behavior (STB) in U.S. veterans with a prior suicide attempt. Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study survey. A broad range of sociodemographic, military, physical and mental health, and psychosocial variable were assessed. Purpose in life, dispositional gratitude, and conscientiousness emerged as independent correlates of STB remission (24.3%-40.3% of explained variance), even after accounting for other relevant risk and protective factors. While the cross-sectional nature of the study precludes the ability to determine whether the identified protective factors are causally related to STB remission, results suggest three potentially modifiable targets for suicide prevention efforts in veterans. Longitudinal studies are needed to better understand the role of purpose in life, dispositional gratitude, and conscientiousness in promoting remission from STBs in veterans and other populations at risk for suicide.

Psychological Resilience to Suicidal Experiences in People with Non-Affective Psychosis: A Position Paper

It is important to understand the psychological factors which underpin pathways to suicidal experiences. It is equally as important to understand how people develop and maintain resilience to such psychological factors implicated in suicidal experiences. Exploring optimal routes to gaining this understanding of resilience to suicidal thoughts and acts in people with severe mental health problems, specifically non-affective psychosis, was the overarching aim of this position paper. There are five central suggestions: 1. investigating resilience to suicidal experiences has been somewhat over-looked, especially in those with severe mental health problems such as schizophrenia; 2. it appears maximally enlightening to use convergent qualitative, quantitative and mixed research methods to develop a comprehensive understanding of resilience to suicide; 3. relatedly, involving experts-by-experience (consumers) in suicide research in general is vital, and this includes research endeavours with a focus on resilience to suicide; 4. evidence-based models of resilience which hold the most promise appear to be buffering, recovery and maintenance approaches; and 5. there is vast potential for contemporary psychological therapies to develop and scaffold work with clients centred on building and maintaining resilience to suicidal thoughts and acts based on different methodological and analytical approaches which involve both talking and non-talking approaches.

COVID-19 and Mortality, Depression, and Suicide in the Polish Population

Aim

The study was aimed at assessing the mortality of the population, the occurrence of the phenomenon of depression and suicide before and during the COVID-19 pandemic.

Methods

Data on total mortality in Poland in 2017–2021 came from the report of the Ministry of Health. Data on the number of sick leave due to mental disorders were taken from the report of the ZUS (Social Insurance Institution in Poland). Data on the number of suicides came from police statistics.

Results

Increase in the number of deaths in Poland in 2021 compared to the 2017–2019 average – 26.86%. In 2018–2020, the greatest number of fatal suicides was recorded in the age group – 60–64 years (in 2018 N = 565; 10.90%; in 2020 N = 524; 10.15%).

Conclusions

In the years 2020-2021, an increase in mortality was observed in Poland compared to the previous years. Moreover, in 2020 there was an increase in sickness absence due to ICD-10 F.32 and an increase in the number of suicide attempts.

Prevalence of Suicidality and its Association with Quality of Life in Older Patients with Clinically Stable Psychiatric Disorders in China During the COVID-19 Pandemic

AIMS

The pattern of suicidality in older patients with psychiatric disorders during the COVID-19 pandemic is not clear. This study examined the prevalence of suicidality and its association with quality of life (QOL) among older clinically stable patients with psychiatric disorders during the COVID-19 pandemic.

METHODS

A multicenter, cross-sectional study was conducted from May 22 to July 15, 2020, among four major tertiary psychiatric hospitals in China. Suicidality was assessed by asking 3 standardized questions. Depressive symptoms, pain, and QOL were assessed with the 9-item Patient Health Questionnaire (PHQ-9), the numeric pain rating scale (NPRS), and the World Health Organization Quality of Life Questionnaire-brief version, respectively.

RESULTS

A total of 1063 clinically stable patients participated and completed the assessment. The prevalence of suicidality was 11.8% (95% CI: 9.9%-13.7%) during the COVID-19 pandemic. Multiple logistic regression analysis revealed that poor treatment adherence (P = .009, OR = 1.86, 95% CI: 1.17-2.96) and perceived illness worsening during the COVID-19 outbreak (P = .02, OR = 2.07, 95% CI: 1.15-3.73), being diagnosed with major depressive disorder (P < .001, OR = 2.79, 95% CI: 1.68-4.64), PHQ-9 total score (P < .001, OR = 1.20, 95% CI: 1.15-1.24) and NPRS total score (P = .002, OR = 1.17, 95% CI: 1.06-1.29) were associated with higher risk of suicidality. After controlling for covariates, older psychiatric patients with suicidality had lower QOL compared to those without (F(1, 1063) =16.5, P<.001).

CONCLUSIONS

Suicidality was common in older patients with clinically stable psychiatric disorders during the COVID-19 pandemic. Considering its negative impact on QOL and personal suffering, routine screening and preventive suicide measures should be implemented for older psychiatric patients.

The meaning of life after a suicide attempt

INTRODUCTION

Understanding the meaning of life after a suicide attempt experience provides greater knowledge about the process of resignification, connections and commitment to life, which can be useful in different therapeutic approaches.

OBJECTIVE

Understand the meaning of life after a suicide attempt.

METHOD

Qualitative study with eight Brazilian adults assisted in mental health service. The data were collected in 2018 by semi-strutured interviews and group meetings that used artistic resources to facilitate expression.The Symbolic Interactionism was the theoretical reference used and the data were submitted to thematic analysis.

RESULTS

Three themes were identified: "Searches in the affective, relational and spiritual field" (manifestations of affection, zeal, understanding and welcome and seemed to increase the link and commitment to life, as well as the openness to resignify it); "Life and the constancy of impermanence" (life as an alternation between weakness and strength, crisis and well-being, problems and overcoming); and "Discoveries and relationship with one's own self" (a self previously self-destructive could be resigned as capable of overcoming, resisting and developing resilience).

CONCLUSIONS

The study provides important insights to be addressed in clinical practice, in the protocol design, institutional policies, as well as in the training of professionals.