Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review

Impulsivity profiles across five harmonized longitudinal childhood preventive interventions and associations with adult outcomes

This study aimed to parse between-person heterogeneity in growth of impulsivity across childhood and adolescence among participants enrolled in five childhood preventive intervention trials targeting conduct problems. In addition, we aimed to test profile membership in relation to adult psychopathologies. Measurement items representing impulsive behavior across grades 2, 4, 5, 7, 8, and 10, and aggression, substance use, suicidal ideation/attempts, and anxiety/depression in adulthood were integrated from the five trials (N = 4,975). We applied latent class growth analysis to this sample, as well as samples separated into nonintervention (n = 2,492) and intervention (n = 2,483) participants. Across all samples, profiles were characterized by high, moderate, low, and low-increasing impulsive levels. Regarding adult outcomes, in all samples, the high, moderate, and low profiles endorsed greater levels of aggression compared to the low-increasing profile. There were nuanced differences across samples and profiles on suicidal ideation/attempts and anxiety/depression. Across samples, there were no significant differences between profiles on substance use. Overall, our study helps to inform understanding of the developmental course and prognosis of impulsivity, as well as adding to collaborative efforts linking data across multiple studies to better inform understanding of developmental processes.

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

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

Epigenetics and suicidal behavior in adolescents: a critical review

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

Explaining suicidal ideation among divorced parents by coping strategies and personality characteristics: A mediation model

The study's purpose was to examine the variables related to suicidal ideation to identify the factors that may reduce the phenomenon. The study offers an innovative model that examines the combined effect of personality characteristics among populations with high suicidal ideation and their coping strategies with suicide ideation. Participants were 423 divorced parents, 275 men, and 148 women, who had been divorced for an average of seven years. It was found that the relationship between personality characteristics and suicidality was not direct for the most part, but was mediated by coping strategies, and that some combinations of personality characteristics and coping strategies were associated with higher suicidal ideation. Awareness of how the various personality characteristics and coping strategies affect suicidal ideation may be essential for the care provider. It may lead to a reduction in suicide rates through adapted intervention processes.

Development and Validation of the Self-Rating Suicide Risk Screening Questionnaire

Since suicide is one of the major health problems worldwide, the goal of the present study is to develop a psychometrically sound suicide risk screening tool named Suicide Screening Questionnaire- Self-Rating (SSQ-SR) to quantify the risk of suicidal behavior. The development process includes item generation, item revision and refinement, and validation. A total sample of 2,238 adults in South Korea was used for analysis. The results of factor analysis showed that the SSQ-SR, containing 25 items, supported a three-factor model: "Situational factors," "Negative self-perceptions and mental health factors," and "Suicidal thoughts and behaviors." Also, SSQ-SR showed satisfying internal consistency, concurrent validity and discriminant validity. Lastly, the results of ROC analysis showed a cut-off point of 33.5 for the low-risk group and 36.5 for the high-risk group. Considering these results, the current results demonstrate the SSQ-SR is a valid scale and therefore can contribute to future suicide-related studies and prevention.

Factors of suicide-related behaviors based on stress-vulnerability model and prevention strategies among nurses: a scoping review

Objective

The objective of this scoping review was to explore, appraise and synthesize the current literature regarding the incidence, factors influencing, and prevention strategies related to suicide risk among nurses.

Methods

An extensive literature search was conducted using databases such as PubMed, Web of Science, Medline, and Embase from its formation to June 20, 2024, specifically focusing on the suicide-related behaviors of nurses written in Chinese or English. Two researchers independently screened the literature, and disagreements were debated until a consensus was reached. Data extraction was conducted for the studies that were included. The process of data synthesis was carried out using narrative analysis.

Results

The study encompassed 40 papers from 15 different countries. This study found that nurses' suicide ideation ranged from 4.3 to 44.58%, while suicide attempts ranged from 2.9 to 12.6%. Based on the stress-vulnerability model, factors influencing nurses' suicide-related behaviors include vulnerability (personality traits, coping styles), stressors (mental disorders, workplace bullying, etc.) and protective factors (social support, resilience, etc.). The strategies for preventing nurse suicide encompass primary prevention (for all nurses), secondary prevention (for nurses at risk of suicide), and tertiary prevention (for nurses who have attempted suicide).

Conclusion

The suicide rate among nurses exceeds that of the general population. Mental disorders and workplace bullying are significant stressors that contribute to nurse suicide. Suicide-related behaviors among nurses can be effectively prevented and managed through the implementation of the tertiary prevention strategies. Primary prevention is essential in reducing suicide. Cognitive exercises and schedule shifts reasonably are primary preventive measures tailored for nurses. This study addresses the gaps in influencing factors about suicide-related behaviors among nurses and the strategies for preventing suicide, and provides a complete review of the current situation of nurses' suicide-related behaviors, providing references for the safe management of nurses' suicide.

Suicide risk among residents and PhD students: A systematic review of the literature

Residents and PhD students (any discipline) are susceptible to various mental health issues, including suicidal thoughts and behaviors. This systematic review aimed to (1) estimate the prevalence of suicide-related outcomes among residents/PhD students and (2) assess the associated variables. PubMed, PsycINFO, and Scopus databases were searched for articles documenting quantitative information about suicide-related outcomes among residents and PhD students from inception until April 30, 2023. Sixty studies were included. Estimates of the current prevalence of the following suicide-related outcomes were: death wishes (DW), 9.1%; suicidal ideation (SI), 8.6%; suicidal planning (SP), 3.2%; non-suicidal self-injury (NSSI), 1.9%; suicide attempt(s) (SA), .8%. Additionally, estimates of the lifetime prevalence were: lifetime SI (L-SI), 25.9%; lifetime SP (L-SP), 10.0%; lifetime SA (L-SA), 3.1%. Depression, burnout, hopelessness, loneliness, low quality of the relationship with the supervisor and experiencing workplace mistreatment frequently co-occurred with the assessed outcomes. Many outcomes (DW, SI, SP, L-SI, L-SP, L-SA) had a higher prevalence compared to the general population, while some (SI, NSSI, SA) were lower compared to undergraduates. Interventions for individuals at risk in this population are vital together with the modification of the work environment and the promotion of a supportive academic and professional culture to reduce suicide risk.

Are we Using the Right Evidence to Inform Suicide Prevention in Low- and Middle-Income Countries? An Umbrella Review

OBJECTIVE

Suicide disproportionately affects low- and middle-income countries and evidence regarding prevention approaches developed in high income countries may not be applicable in these settings. We conducted an umbrella review to assess whether the conclusions of suicide prevention systematic reviews accurately reflect the studies contained within those reviews in terms of setting generalizability.

METHODS

We conducted database searches in PubMed/Medline, Embase, PsycInfo, PsychExtra, OVID global health, and LILACS/BECS. We included systematic reviews with the outcome of suicide, including bereavement studies where suicide death was also the exposure.

RESULTS

Out of the 147 reviews assessed, we found that over 80% of systematic reviews on suicide deaths do not provide an accurate summary of review findings with relation to geographic relevance and ultimately generalizability.

CONCLUSION

Systematic reviews are often the resource used by practitioners and policymakers to guide services. Misleading reviews can detrimentally impact suicide prevention efforts in LMICs. We call for systematic reviewers to be responsible when generalizing the findings of their reviews particularly in the abstracts.

Minimal Variation in Functional Connectivity in Relation to Daily Affect

Reported associations between functional connectivity and affective disorder symptoms are minimally reproducible, which can partially be attributed to difficulty capturing highly variable clinical symptoms in cross-sectional study designs. "Dense sampling" protocols, where participants are sampled across multiple sessions, can overcome this limitation by studying associations between functional connectivity and variable clinical states. Here, we characterized effect sizes for the association between functional connectivity and time-varying positive and negative daily affect in a nonclinical cohort. Data were analyzed from 24 adults who attended four research visits, where participants self-reported daily affect using the PANAS-X questionnaire and completed 39 min of functional magnetic resonance imaging across three passive viewing conditions. We modeled positive and negative daily affect in relation to network-level functional connectivity, with hypotheses regarding within-network connectivity of the default mode, salience/cingulo-opercular, frontoparietal, dorsal attention, and visual networks and between-network connectivity of affective subcortical regions (amygdala and nucleus accumbens) with both default mode and salience/cingulo-opercular networks. Effect sizes for associations between affect and network-level functional connectivity were small and nonsignificant across analyses. We additionally report that functional connectivity variance is largely attributable to individual identity with small relative variance (<3%) accounted for by within-subject daily affect variation. These results support previous reports that functional connectivity is dominated by stable subject-specific connectivity patterns, while additionally suggesting relatively minimal influence of day-to-day affect. Researchers planning studies examining functional connectivity in relation to daily affect, or other varying stable states, should therefore anticipate small effect sizes and carefully consider power in study planning.

Why Do Some Depressive Patients Have Suicidal Ideation but Others Not? Suicidal Ideation From the Perspective of Affective Neuroscience Personality Traits

INTRODUCTION

Although major depression is the disorder most frequently associated with suicidal behavior, it is unclear that major depressive disorder patients may develop suicidal ideation. Basic affective system theory may provide a novel and beneficial viewpoint in this field. The goal of this study was to investigate the basic affective system in relation to suicidal ideation in individuals with depression.

METHOD

The study population comprised 160 participants who had been formally diagnosed with major depressive disorder. Participants were divided into two groups according to whether they had suicide ideation (depression with suicide [DS]) (N = 93) or not (depression with no suicidal ideation [DNS]) (N = 67). The Beck Depression Inventory (BDI), the Suicide Probability Scale (SPS), the Beck Hopelessness Scale (BHS), and the Affective Neuroscience Personality Scale (ANPS) were applied. Statistical Product and Service Solutions (SPSS) 24 and the SPSS macroprocess, which were specifically developed for assessing complex models including serial mediators, were used to analyze the data.

RESULTS

The mean age of all participants was 31.1 ± 11 years, and most of them were female (65%). The DS group had a higher family history of psychiatric medication use and suicidal attempts. In addition, BDI, BHS, and SPS total scores were higher, as well as ANGER subscale scores were higher in the DS group. In mediation analysis, the ANGER subscale significantly predicted the presence of suicide ideation. We observed a direct effect of the ANGER subscale score on suicide ideation as well as an indirect effect of the ANGER subscale score on suicidal ideation via depression severity.

CONCLUSION

Higher scores on ANGER are associated with suicidal ideation. Neurobiological correlates, including the ANGER system, may be promising in understanding suicidal behaviors.

Anger as a Correlate of and Longitudinal Risk Factor for Suicidal Ideation in Adolescents

Suicide a leading cause of death among adolescents and is nearly always preceded by suicidal ideation (SI). Concerningly, SI during adolescence is not uncommon, as it is reported by as much as 20% of American youth. As such, SI in adolescence has been the subject of substantial research. Literature points to anger in adolescence as a relatively strong correlate of SI. However, work is limited, focusing on cross-sectional associations between anger in adolescence and SI and conceptualizing anger as a broad construct, failing to investigate the many narrow facets that comprise it. We address these gaps by investigating anger in adolescence as a (1) cross-sectional and (2) prospective correlate of SI and (3) investigating broad versus narrow conceptualizations of anger in adolescence as they relate to SI. Among two samples (Study 1, nationally representative community-based youth, n = 1,729; Study 2, high-risk juvenile justice involved youth, n = 1,406), anger in adolescence was cross-sectionally related to SI. However, when controlling for SI at baseline, anger in adolescence was not a prospective risk factor for SI at follow-up, nine years later. Finally, narrow facets of anger (e.g., argumentative, defiant, irritable, resentful, spiteful) were not more closely related than broad conceptualizations of anger to SI. These findings indicate that while anger in adolescence is cross-sectionally associated with SI, it should not necessarily be viewed as a valid risk factor for development of SI over the course of nearly a decade. Further, findings did not elucidate any narrow facets of anger that are particularly linked with SI.

Does personality dysfunction add incremental utility over general psychopathology when modeling previous suicide attempts in adolescent patients?

BACKGROUND

Identifying patients at risk for a suicide attempt (SA) is critical in adolescents with mental disorders. The current study aimed to 1) examine whether personality dysfunction (PD) is associated with previous SA, 2) explore the incremental utility of PD over psychiatric disorders in modeling previous SA.

METHODS

The sample comprised of n = 498 adolescent patients (mean age = 15.41 years, 79.12 % females, inpatient 48.8 %, outpatient 51.2 %). SA in the past year, PD according to the alternative DSM-5 model for personality disorders, and psychiatric diagnoses were assessed using semi-structured interviews. Logistic regression and principal component analysis examining the associations and specific patterns of PD and SA in the past year were conducted. Hierarchical (stepwise) logistic regression was applied to investigate the incremental utility of PD over that of psychiatric diagnoses to identify individuals with SA in the past year.

RESULTS

Including all facets of PD revealed a significant model with SA in the past year as outcome (χ2(12) = 106.65, McFaddens Pseudo-R2 = 0.17, p < 0.01). Adding PD to the model explained a significant amount of variance in past SA over that of psychiatric diagnoses (Pseudo-R2 = 0.18, Wald χ2 = 43.05, p < 0.01).

LIMITATIONS

As we only studied past SA and due to the cross-sectional design, no conclusion regarding the prediction of future SA can be drawn.

DISCUSSION

PD should routinely be assessed in adolescent patients since individuals with PD are more likely to have attempted suicide even when controlling for comorbid psychiatric disorders. PD may represent an important target for intervention in those with suicidal thoughts and behaviors.

Identifying behaviour-related and physiological risk factors for suicide attempts in the UK Biobank

Suicide is a global public health challenge, yet considerable uncertainty remains regarding the associations of both behaviour-related and physiological factors with suicide attempts (SA). Here we first estimated polygenic risk scores (PRS) for SA in 334,706 UK Biobank participants and conducted phenome-wide association analyses considering 2,291 factors. We identified 246 (63.07%) behaviour-related and 200 (10.41%, encompassing neuroimaging, blood and metabolic biomarkers, and proteins) physiological factors significantly associated with SA-PRS, with robust associations observed in lifestyle factors and mental health. Further case-control analyses involving 3,558 SA cases and 149,976 controls mirrored behaviour-related associations observed with SA-PRS. Moreover, Mendelian randomization analyses supported a potential causal effect of liability to 58 factors on SA, such as age at first intercourse, neuroticism, smoking, overall health rating and depression. Notably, machine-learning classification models based on behaviour-related factors exhibited high discriminative accuracy in distinguishing those with and without SA (area under the receiver operating characteristic curve 0.909 ± 0.006). This study provides comprehensive insights into diverse risk factors for SA, shedding light on potential avenues for targeted prevention and intervention strategies.

Impulsivity in fatal suicide behaviour: A systematic review and meta-analysis of psychological autopsy studies

Our aim is to review and perform a meta-analysis on the role of impulsivity in fatal suicide behaviour. We included papers who used psychological autopsy methodology, assessed adult death by suicide, and included assessment of impulsivity. We excluded papers about assisted suicide, terrorist suicide, or other cause of death other than suicide or postmortem diagnosis made only from medical records or database. 97 articles were identified. 33 were included in the systematic review and nine in the meta-analysis. We found that people who die by suicide with high impulsivity are associated with younger age, substance abuse, and low intention to die, whereas those with low impulsivity were associated with older age, depression, schizophrenia, high intention to die and low social support. In the meta-analysis, suicide cases had higher impulsivity scores than living controls (Hedges' g = 0.59, 95 % CI [0.28, 0.89], p=.002). However, studies showed heterogeneity (Q = 90.86, p<.001, I2=89.0 %). Impulsivity-aggressiveness interaction was assessed through meta-regression (β=0.447, p=.045). Individuals with high impulsivity would be exposed to a higher risk of fatal suicide behaviour, aggressiveness would play a mediating role. People who die by suicide with high and low impulsivity display distinct characteristics, which may reflect different endophenotypes leading to suicide by different pathways.

Suicide warning signs that are challenging to recognize: a psychological autopsy study of Korean adolescents

BACKGROUND

In South Korea, the leading cause of youth death has been suicide for about 20 years. In this study, we conducted a multi-method psychological autopsy to identify the psychiatric diagnosis, developmental history, personality traits, family history, school life, warning signs of suicide, and risk factors related to suicide for the first time in Korea.

METHODS

This was a postmortem, retrospective, and descriptive study of 36 adolescents who died by suicide between August 2015 and July 2021 in South Korea. We obtained qualitative and quantitative data from the Korean Psychological Autopsy of Adolescent, conducted by the Suicide and School Mental Health Institute, the official student mental health policy-focused research institute of the Korean Ministry of Education.

RESULTS

The adolescents comprised equal percentage of girls and boys. Approximately half of the deaths (55.6%) occurred at home and most (72.2%) involved jumping from a height. Most of the adolescents (97.2%) had one major psychiatric disorder before death, with depressive disorder being the most prevalent (75%). They were at a high risk for internet addiction before death. The most common personality trait was avoidance (28.6%), followed by submissiveness (27.3%). Half of the parents reported that the adolescents were satisfied with their school life and the teachers observed that they had no behavioral problems. One year before death, seven (19.4%) adolescents injured themselves and five (13.9%) had attempted suicide. Most of the deceased (80.6%) had expressed suicide warning signs to their families within one year before death. Adolescents had a long experience of family-related adverse events.

CONCLUSIONS

Most of the adolescents had mental health disorders and expressed suicidal intentions using verbal and nonverbal signs. However, it was challenging for families to recognize the risk signs because of adolescents' personality traits or a good school life. To prevent adolescent suicide, adolescents, parents, and teachers need to be educated to recognize signs of suicide warning signs and equipped to guide adolescents to appropriate care.

Psychiatric Morbidity and Suicidal Ideation Among Early Survivors Following the 2023 Kahramanmaras Earthquake in Turkey

OBJECTIVE

The aim of this study was to investigate the effects of psychiatric morbidity along with sociodemographic and earthquake-related data on suicidal ideation among survivors of the 2023 Kahramanmaras earthquake in Turkey.

METHOD

The study included 270 volunteers who experienced the 2023 earthquake in Kahramanmaras, a province in middle east region of Turkey. These individuals were informed of the use of their personal data within the scope of the personal data protection law numbered 6698 and consent was obtained. The volunteers participated in the study online and were evaluated with a sociodemographic data form, Suicidal Ideation Scale and DSM-5 level one cross-sectional symptom scale.

RESULTS

Single individuals (p = .009) and those who stated that they had insufficient social support (p = .001), had been injured or had lost a relative during the earthquake (p = .02), felt discrimination-exclusion after the earthquake (p = .03), and those who could not attend the funeral or funeral ceremony of their deceased relative (p < .001) scored higher on the Suicidal Ideation Scale. The DSM-5 level one cross-sectional symptom scale scores indicated that the scores in the depression (p = .024), somatization (p = .001), personality (p < .001) and addiction (0.039) subscales were more related to suicidal ideation.

CONCLUSION

After a mass trauma, it is very important to investigate the risk factors that may be associated with suicidal ideation among survivors and to be aware of possible psychiatric symptoms. Preventive actions in the earthquake-affected regions can be made more effective by considering these factors.

Association between the Big Five personality traits and suicide-related behaviors in Japanese institutionalized youths

Aim

Inmates in correctional institutions experience higher rates of suicide attempt (SA), suicidal ideation (SI), and nonsuicidal self-injury (NSSI) than the general population. This study aimed to examine the association between the Big Five personality traits and suicide-related behavior, and to estimate the prevalence rate of such behaviors among Japanese institutionalized youth.

Methods

The participants were 436 youths who had been admitted to four juvenile classification homes (JCHs) between September 2021 and March 2023; they were asked to respond to a self-report questionnaire after obtaining informed consent.

Results

A total of 8.1% and 19.3%, 29.4% and 44.7%, and 46.3% and 75.3% of males and females had experienced SA, SI, and NSSI in their lifetime, respectively. Females reported significantly higher instances of suicide-related behaviors than males considering all suicide-related behaviors. Logistic regression analyses revealed that neuroticism significantly increased the odds ratios for SA, SI, and NSSI on controlling for sex, age, and number of admissions to JCHs. For NSSI, the odds ratio for agreeableness was significantly lower than 1, indicating a lower probability of NSSI.

Conclusion

The findings of our study demonstrate that neuroticism, one of the Big Five traits, was consistently and significantly associated with all suicide-related behaviors, including SA, SI, and NSSI, among youth offenders, while agreeableness was found as a protective factor only against NSSI. The results of this study might help correctional officers identify justice-involved youth at higher risk for suicide and allow the development of early interventions to prevent suicide.

Role of stressful life events and personality traits on the prevalence of wish to die among French physicians

Background

Suicide rates are higher among physicians than in the general population. We aimed to investigate the role of stressful life events (related or not to work conditions) and personality traits on wish to die, a proxy measure of suicidal ideation.

Methods

This cross-sectional study took place in France from March 2018 to September 2018. Physicians completed an online questionnaire. A multiple logistic regression model estimated factors associated with wish to die. Moderated moderation models were used to assess the effect of personality traits on the relationship between stressful events and wish to die.

Results

1,020 physicians completed the questionnaire. Most (75%) had endorsed a work-related stressful event and one in six (15.9%) endorsed a wish to die the year before. Wish to die was associated with burnout (OR = 2.65, 95%CI = 1.82-3.88) and work-related stressful events (OR = 2.18, 95%CI = 1.24-3.85) including interpersonal conflicts, harassment and work-overload. Emotional stability was the only personality trait associated with wish to die in the logistic regression (OR = 0.69, 95%CI = 0.59-0.82). In moderation models, we observed a significant interaction involving three personality traits-emotional stability, extraversion, and agreeableness-along with gender, influencing the impact of stressful events on the wish to die.

Limitations

Our study is limited by the impossibility to control for risk factors associated with suicide like psychiatric comorbidities.

Conclusion

Work-related stressful events significantly contribute to the manifestation of a wish to die among physicians. The impact of stressful events on the wish to die is moderated by factors such as gender and personality traits, including emotional stability and extraversion. These results are overall consistent with prior studies concerning the risk of burnout and suicide among physicians.

Predicting Acute Changes in Suicidal Ideation and Planning: A Longitudinal Study of Symptom Mediators and the Role of the Menstrual Cycle in Female Psychiatric Outpatients With Suicidality

OBJECTIVE

Cross-sectional and preliminary longitudinal findings suggest that cyclical ovarian hormone fluctuations influence acute suicide risk. The authors provide the first analyses in females with suicidality to investigate which daily symptoms covary with suicidal ideation and planning thoughts, the role of the menstrual cycle in daily symptom variation, how daily fluctuations in symptoms mediate the menstrual cycle-suicidality relationship, and how these associations vary across individuals.

METHODS

Naturally cycling psychiatric outpatients (N=119) with past-month suicidal ideation provided daily ratings of psychiatric symptoms (depression, hopelessness, anxiety, feeling overwhelmed, agitation, anhedonia, worthlessness, rejection sensitivity, anger, perceived burdensomeness, and interpersonal conflict), suicidal ideation, and suicidal planning across at least one menstrual cycle. Symptom ratings were decomposed into trait (person-centered mean) and state (daily person-centered mean deviation) components. Five cycle phases were identified in relation to menses onset and ovulation (surge in urine luteinizing hormone level). Hypotheses were tested in multilevel structural equation models.

RESULTS

Nearly all psychiatric symptoms covaried with fluctuations in daily suicidal ideation, and a limited set of symptoms (depression, hopelessness, rejection sensitivity, and perceived burdensomeness) predicted within-person increases in suicidal planning. Many patients demonstrated perimenstrual worsening of psychiatric symptoms, suicidal ideation, and suicidal planning. Depressive symptoms (depression, hopelessness, perceived burdensomeness, and anhedonia) were the most robust statistical mediators predicting perimenstrual exacerbation of suicidality.

CONCLUSIONS

Research on the menstrual cycle and suicide has been limited historically by small, cross-sectional samples. This study provides the first evidence that measuring day-to-day correlates of suicidality in a large transdiagnostic sample of females with suicidal ideation can contribute to understanding the pathways by which the menstrual cycle influences acute suicide risk.

Symptoms characteristics of personality disorders associated with suicidal ideation and behaviors in a clinical sample of adolescents with a depressive disorder

Introduction

Pathological personality traits have repeatedly been identified as important risk factors for suicidal ideation and behaviors. Moreover, impulsive-aggressive traits, have shown a consistent association with suicidal behaviors across the lifespan. Adolescence represents a critical period for the emergence of different personality traits, mood disorders, and suicidal behaviors, but the relationship between these variables remain poorly understood.

Methods

These variables were examined in a cross-sectional case-control design involving three groups: 30 adolescents with a depressive disorder and past suicide attempt (Mean Age = 16.2, Females = 26), 38 adolescents with a depressive disorder but without past suicide attempt (Mean age = 16.0, Females = 29), and 34 healthy adolescent controls (Mean age = 15.2, Females = 22). Suicidal ideations were indexed using Suicidal Behavior Questionnaire (SBQ-R), psychiatric disorder assessed using a semi-structured questionnaire (K-SADS-PL), depressive symptoms with the Beck Depressive Inventory (BDI), symptoms characteristics of personality disorders with the Scheduled Clinical Interview for the DSM-IV (SCID-II) screening questionnaire, and impulsivity with the Barratt Impulsivesness Scale (BIS).

Results

Findings showed that impulsivity (F = 11.0, p < 0.0001) and antisocial symptoms characteristics of personality disorders (p < 0.001, d = 0.70) displayed the most robust association with adolescent suicide attempts. Borderline symptoms characteristics of personality disorders did not discriminate attempters from non-attempters but presented high correlations with suicidal ideation and depression severity. In an item-wise analysis, suicide attempt status was uniquely correlated with symptoms characteristics of an antisocial personality disorder. Suicide attempt status also correlated with non-suicidal self-injury and a chronic feeling of emptiness.

Discussion

The caveats of this cross-sectional study include the stability of symptoms characteristics of personality disorders in adolescence and the limited sample size. In sum, suicidal behaviors were characteristically correlated with increased impulsivity and antisocial symptoms characteristics of personality disorders, but other symptoms characteristics of personality disorders were relevant to adolescent depression and suicidal ideation. Understanding the emergence of symptoms characteristics of personality disorders and suicidal behaviors in a developmental context can ultimately inform not only the neurobiological origin of suicidal behaviors, but also provide new avenues for early detection and intervention.

Interpersonal Needs, Mental Pain, and Hopelessness in Psychiatric Inpatients with Suicidal Ideation

INTRODUCTION

Suicide is a leading cause of death worldwide and models may help the understanding of the phenomenon and ultimately reduce its burden through effective suicide prevention strategies. The Interpersonal Theory of Suicide and Shneidman's Model have tried to describe different unmet needs related to suicidal ideation. The study aims to assess the association between thwarted belongingness, perceived burdensomeness, and suicidal ideation in a sample of psychiatric inpatients and the mediating role of hopelessness and mental pain in this association.

METHODS

112 consecutive adult psychiatric inpatients were administered the Columbia Suicide Severity Rating Scale (C-SSRS), the Italian version of the Interpersonal Needs Questionnaire-15-I (INQ-15-I), the Physical and Psychological Pain Scale, and the Beck Hopelessness Scale (BHS).

RESULTS

Mediation models indicated a significant indirect effect of perceived burdensomeness (with thwarted belongingness as covariates) on suicidal ideation intensity with hopelessness as a mediator. When thwarted belongingness (controlling for perceived burdensomeness as a covariate) was included in a model as an independent variable, direct and indirect effects on suicidal ideation intensity were not significant.

CONCLUSIONS

Psychosocial interventions focusing on identifying and decreasing the perception of being a burden for others and the feeling hopeless could represent a powerful pathway for reducing suicidal ideation. Moreover, the attention toward unmet interpersonal needs may help increase and focus clinical discussions on risk factors, which may help engagement toward psychiatric care and downsize the stigma related to suicide. Raising awareness toward mental health topics is a goal of healthcare services globally.

Impulsivity traits and suicide related outcomes: A systematic review and meta-analysis using the UPPS model

BACKGROUND

The affective, cognitive, and behavioral aspects of impulsivity involved in suicide-related outcomes can be investigated through the UPPS model, which conceptualizes these facets in multidimensional terms related to negative and positive urgency, lack of premeditation and perseverance, and sensation seeking. This systematic review and meta-analysis provided a comprehensive understanding of the role of all facets of impulsivity in the development of suicidal ideation and behaviors.

METHODS

We conducted a systematic search on six databases (PsycINFO, PsycARTICLES, PubMed, MEDLINE, Scopus, and Web of Science) until May 5,2023. Overall, 49 studies met the criteria for systematic review, of which 37 were included in a meta-analysis of data from 17.898 individuals. Additional moderation analyses included age, gender, sample status, country of study conduct, assessment instruments, type of suicide-related outcome, study quality, and research design.

RESULTS

We found significant relationships between aspects of impulsivity and suicide-related outcomes. Specially, affective facets related to impulsivity showed a stronger association with suicidal ideations and attempts than cognitive and behavioral dimensions, recommending the main involvement of emotional aspects-positive and negative-in suicide-related dimensions.

LIMITATIONS

The limited number of studies may have negatively impacted the power of moderation analyses. In addition, for most dimensions of impulsivity, the limited number of longitudinal studies did not allow to test the moderating role of research design.

CONCLUSIONS

This study supports the role of impulsivity in suicidal ideation and behavior, identifying the affective component of impulsivity as the most involved, providing a significant contribution from a clinical and diagnostic point of view.

Relationship between self-esteem and suicidal ideation before and during COVID-19 in a non-clinical sample: mediating effects of psychological distress and hopelessness

Introduction

Several studies have highlighted the impact of the novel coronavirus disease (COVID-19) pandemic on suicide. Accordingly, investigating the risk factors of suicide during this crisis is important. Based on the escape theory of suicide, the current study examined the serial mediating roles of psychological distress and hopelessness in the relationship between self-esteem and suicidal ideation. It also aimed to explore whether or not the COVID-19 pandemic changed the mediation effect in any way.

Methods

Data were collected from 645 university students before and during the pandemic. The study employed mediation and multi-group analyses to test the hypotheses.

Results

The results demonstrated that individuals with low self-esteem reported high psychological distress, which further lead to hopelessness and eventually heightened suicidal ideation. Multi-group analysis revealed that psychological distress exerted a greater impact on suicidal ideation during COVID-19.

Discussion

The finding suggested that self-esteem, hopelessness, and psychological distress could help elucidate the development of suicidal ideation. Clinicians may target these factors in suicide prevention programs, particularly in the settings of the COVID-19 pandemic or future crisis.

Temperament and adolescent suicide attempts: a case-control study with multi-ethnic Asian adolescents

BACKGROUND

Suicide is the leading cause of death for adolescents in several parts of Asia, including Singapore. This study examines the relationship between temperament and youth suicide attempts in a sample of multi-ethnic Singaporean adolescents.

METHODS

A case-control design compared 60 adolescents (Mage = 16.40, SDage = 2.00) with a recent suicide attempt (i.e., past 6 months) with 58 adolescents (Mage = 16.00, SDage = 1.68) without any history of suicide attempts. Presence of suicide attempts was established using the semi-structured interviewer-administered Columbia Suicide Severity Rating Scale. Participants also completed self-report measures on temperament traits, psychiatric diagnoses, stressful life events, and perceived parental rejection in an interview-based format.

RESULTS

Psychiatric comorbidity, recent stressful life events, perceived parental rejection, and all five "difficult temperament" traits, were significantly overrepresented among adolescent cases relative to healthy controls. Adjusted logistic regression models revealed significant associations between suicide attempt, MDD comorbidity (OR: 10.7, 95% Cl: (2.24-51.39)), "negative mood" trait (OR: 1.12-1.18, 95% Cl: (1.00-1.27)), and the interaction term of "positive mood" and "high adaptability" traits (OR: 0.943 - 0.955, 95% Cl: (0.900 - 0.986)). Specifically, "positive mood" predicted lower likelihood of a suicide attempt when "adaptability" was high (OR: 0.335 - 0.342, 95% Cl: (0.186 - 0.500)) but not low (OR: 0.968 - 0.993, 95% Cl: (0.797 - 1.31)).

CONCLUSION

Temperament screening may be important to identify adolescents at higher or lower risk of suicide at an early stage. More longitudinal and neurobiological research converging on these temperament findings will be helpful in ascertaining temperament screening as an effective suicide prevention methodology for adolescents.

Antisocial traits and neuroticism as predictors of suicidal behaviour in borderline personality disorder: A retrospective study

INTRODUCTION

The spectrum of suicidal behaviour (SB) is nuclear in the clinic and management of borderline personality disorder (BPD). The pathological personality traits of BPD intervene as risk factors for SB in confluence with other clinical and sociodemographic variables associated with BPD. The objective of this work is to evaluate the specific personality traits of BPD that are related to SB.

METHODS

A cross-sectional, observational and retrospective study was carried out on a sample of 134 patients diagnosed with BPD according to DSM-5 criteria. The Millon-II, Zuckerman-Kuhlman and Barrat questionnaires were used to assess different personality parameters. Variable comparisons were made using the χ² test and the Student's t-test. The association between variables was analysed using multivariate logistic regression.

RESULTS

Statistically significant differences were observed between SB and related factors and the neuroticism-anxiety dimension in the Zuckerman-Kuhlman test. It is also significantly related to the phobic and antisocial subscale of the Millon-II. Impulsivity measured with the Zuckerman-Kuhlman and Barrat tests does not appear to be related to SB.

CONCLUSIONS

The results presented raise the role of phobic, antisocial and neuroticism traits as possible personality traits of BPD related to SB, suggesting an even greater importance within the relationship between BPD and SB than that of impulsivity. Looking to the future, longitudinal studies would increase the scientific evidence for the specified findings.

A Latent Class Analysis of Suicidal Behaviors in Adolescents

OBJECTIVE

The purpose of the present study was to identify adolescents' suicide subgroups using five indicators (depression, anxiety, suicide ideation, and planned and attempted suicide), and explore the distinctive features of each subgroup.

METHODS

This study included 2,258 teenagers from four schools. Both adolescents and their parents, who voluntarily agreed to participate in the study, completed a series of self-reported questionnaires on depression, anxiety, suicide, self-harm, self-esteem, impulsivity, childhood maltreatment, and deviant behaviors. The data were analyzed using latent class analysis, a person-centered method.

RESULTS

Four classes were detected: "high risk for suicide without distress," "high risk for suicide with distress," "low risk for suicide with distress," and "healthy." The "high risk for suicide with distress" class was the most severe on all evaluated psychosocial risk factors, namely, impulsivity, low self-esteem, self-harming behaviours, deviant behaviour problems, and childhood maltreatment, followed by "high risk for suicide without distress."

CONCLUSION

This study identified two high risk subgroups for adolescent' suicidality, "high risk for suicide with or without distress." Both high risk subgroups for suicide showed higher scores for all psychosocial risk factors than low risk subgroups for suicide. Our findings suggest that special attention needs to be paid to the latent class "high risk for suicide without distress," as this group's "cry for help" might be relatively difficult to detect. Specific interventions for each group (e.g., distress safety plans for "suicidal potential with or without emotional distress") need to be developed and implemented.

The safe pilot study: A prospective naturalistic study with repeated measures design to test protective factors against violence in and after discharge from forensic facilities

Assessing violence risk amongst forensic patients is a vital legal and clinical task. The field of violence risk assessment has developed considerably over the past two decades but remains primarily risk focused. Despite this, growing attention to and work on protective factors or strengths has occurred. In this prospective naturalistic study with repeated observer-rated measures of 27 forensic patients, we tested the role of three potentially important but understudied dynamic protective factors: hope, insight, and resilience, along with a history of criminality, in terms of their impact on violence. Main effects models indicated that higher hopelessness and past criminal convictions were predictive of violence acts; higher resilience was associated with lower violence. In interaction models, hopelessness remained predictive. Importantly, there were significant interactions between resilience and past criminal convictions, with higher levels of resilience leading to lower violence, most amongst those with criminal convictions, and between resilience and hopelessness related emotional distress, in that higher resilience at high levels of patient acknowledged emotional distress due to hopelessness led to lower violence. Findings indicate the importance of focusing on strengths or protective factors in the assessment of risk and treatment planning for forensic patients. Despite the small sample, the repeated measures design was feasible and informative.

How social media expression can reveal personality

Background

Personality psychology studies personality and its variation among individuals and is an essential branch of psychology. In recent years, machine learning research related to personality assessment has started to focus on the online environment and showed outstanding performance in personality assessment. However, the aspects of the personality of these prediction models measure remain unclear because few studies focus on the interpretability of personality prediction models. The objective of this study is to develop and validate a machine learning model with domain knowledge introduced to enhance accuracy and improve interpretability.

Methods

Study participants were recruited via an online experiment platform. After excluding unqualified participants and downloading the Weibo posts of eligible participants, we used six psycholinguistic and mental health-related lexicons to extract textual features. Then the predictive personality model was developed using the multi-objective extra trees method based on 3,411 pairs of social media expression and personality trait scores. Subsequently, the prediction model's validity and reliability were evaluated, and each lexicon's feature importance was calculated. Finally, the interpretability of the machine learning model was discussed.

Results

The features from Culture Value Dictionary were found to be the most important predictors. The fivefold cross-validation results regarding the prediction model for personality traits ranged between 0.44 and 0.48 (p < 0.001). The correlation coefficients of five personality traits between the two "split-half" datasets data ranged from 0.84 to 0.88 (p < 0.001). Moreover, the model performed well in terms of contractual validity.

Conclusion

By introducing domain knowledge to the development of a machine learning model, this study not only ensures the reliability and validity of the prediction model but also improves the interpretability of the machine learning method. The study helps explain aspects of personality measured by such prediction models and finds a link between personality and mental health. Our research also has positive implications regarding the combination of machine learning approaches and domain knowledge in the field of psychiatry and its applications to mental health.

The Synergistic Effects of Neuroticism and Extraversion on Suicidal Ideation, Single Attempts, and Multiple Attempts in an Inpatient Sample

The current study sought to investigate the differential risk/protective factors of neuroticism and extraversion among individuals with only suicide ideation, those with a single suicide attempt, and those with multiple attempts. We hypothesized that extraversion would moderate the relation between neuroticism and suicide attempts (single and multiple) but not ideation. Patients in a private facility (N = 3343) completed measures assessing suicide history and general personality traits. Four moderation analyses were conducted with extraversion moderating the relationship between neuroticism and suicide ideation, single attempt (compared to zero attempts), and multiple attempts (compared to zero attempts and to single attempts). Extraversion moderated neuroticism only when comparing individuals with multiple suicide attempts to those with no attempts. Individuals who were low in both neuroticism and extraversion had higher levels of attempts than individuals with low neuroticism and high extraversion, highlighting the importance of considering biological predispositions as risk factors for suicide.

The global assessment of OCD

Obsessive Compulsive Disorder (OCD) is a common mental disorder that often causes great sufferance, with substantial impairment in social functioning and quality of life and affects family and significant relationships. Notwithstanding its severity, OCD is often not adequately diagnosed, or it is diagnosed with delay, leading often to a long latency between onset of the OCD symptoms and the start of adequate treatments. Several factors contribute to the complexity of OCD's clinical picture: early age of onset, chronic course, heterogeneity of symptoms, high rate of comorbidity with other psychiatric disorders, slow or partial response to therapy. Therefore, it is of primary importance for clinicians involved in diagnosing OCD, to assess all aspects of the disorder. This narrative review focuses on the global assessment of OCD, highlighting crucial areas to explore, pointing out the clinical features which are relevant for the treatment of the disorder, and giving an overview of the psychometric tools that can be useful during the screening procedure.

The Mediating Role of Depression Severity on the Relationship Between Suicidal Ideation and Self-Injury in Adolescents With Major Depressive Disorder

Objectives

Suicide is the leading cause of death among adolescents in South Korea, and depression and personality profiles have been identified as significant risk factors for self-injurious behavior. This study examined the influence of depressive mood and temperament/ character on self-injury in adolescents.

Methods

A total of 116 adolescents (aged 12–18 years) with a primary diagnosis of major depressive disorder (MDD) and their parents were enrolled in this study. The participants were divided into three groups based on adolescent’s self-injury frequency, and their Children’s Depression Inventory (CDI), Youth Self-Report (YSR), and Temperament and Character Inventory (TCI) scores were compared. Finally, mediation analysis was conducted to investigate the relationship between suicidal ideation and self-injury.

Results

Of study participants, 75.9% answered that they had suicidal ideation, and 55.2% answered that they had engaged in self-injurious behavior in the last six months. There were significant differences in CDI and suicidal ideation among the groups. After adjusting for age and sex, mediation analysis indicated that depressive mood mediated the relationship between suicidal ideation and self-injury.

Conclusion

This study emphasizes the importance of evaluating and managing depressive mood severity in adolescents with MDD as these factors partially mediate the transition from suicidal ideation to self-injury.

Neuroticism, rumination, depression and suicidal ideation: A moderated serial mediation model across four countries

Background/objective

Research has highlighted the role of neuroticism, rumination, and depression in predicting suicidal thoughts, but studies on how these variables interplay are scarce. The aims of the present study were to test a model in which emotional stability (i.e., low neuroticism) would act as an antecedent and moderator of rumination and depressed mood in the prediction of suicidal ideation (i.e., moderated serial-mediation), and to explore their replicability across four countries and sex, among college students as an at-risk-group for suicide.

Method

Participants were 3482 undergraduates from U.S, Spain, Argentina, and the Netherlands. Path analysis and multi-group analysis were conducted.

Results

Emotional stability was indirectly linked to suicidal ideation via rumination and depressed mood. Moreover, emotional stability moderated the associations between rumination and depressed mood, and between depressed mood and suicidal ideation. Findings were consistent in males and females, and across countries studied.

Discussion

Regardless of sex and country, people with low emotional stability reported higher levels of rumination, which in turn was associated with more depressed mood, and these were associated with higher reports of suicidal thoughts. This cascade of psychological risk factors for suicidal ideation seems to be more harmful in people who endorse low levels of emotional stability.

Blind box over-engagement and suicide risk among adolescents and young adults: Results of a large-scale survey

BACKGROUND

Gambling appears to be an independent risk factor for suicide among the young population worldwide. Blind boxes are collectable toys packed randomly in the box, which share certain similarities with gambling and are popular among the young population. This is the first study that examined the association between blind box engagement and suicide risk in the young population, the leading consumption group of blind boxes.

METHODS

This study is part of a large-scale, cross-sectional study using convenience sampling conducted Oct 26 to Nov 18, 2021, which covered all the university and college students in the Jilin province, China. A total of 73,206 participants completed the survey with valid data for the current study (male: N = 28,762; female: N = 44,444; Mean age = 19·59). Participants' blind box engagement, suicide risk, depression, anxiety, alcohol use, smoking habit, and sociodemographic characteristics were assessed. First, we used univariate and multivariable binary logistic regression models to examine the relationship between blind box engagement and suicide risk in all participants. Second, we tested whether depression and anxiety would mediate the association between blind box engagement and suicide risk. Third, we analysed the association between "Frequency (i.e., frequency of blind box engagement)," "Bet (i.e., expenditure on the blind box that exceeds affordability)," "Tolerance (i.e., level of addiction)," "Borrowed (i.e., the amount of money borrowed for blind box engagement)," and suicide risk in the group with blind box engagement history.

FINDINGS

4,195 participants (5·73%) have engaged in blind boxes, with 3,255 females (77·59%) and 940 males (22·41%). In the univariate models, binary logistic regression showed that blind box engagement was associated with suicide risk in both male and female participants (male: OR = 2·21, 95% CI = 1·86-2·63; female: OR = 1·64, 95% CI = 1·50-1·78). In the multivariable models, after controlling age, subjective socioeconomic status, per capita disposable income, alcohol use, and smoking habit, blind box engagement still was associated with suicide risk across genders (male: OR = 2·25, 95% CI = 1·89-2·68; female: OR = 1·58, 95% CI = 1·45-1·73). Depression (male: indirect effect = 0·31, SE = 0·04, p < 0·001; female: indirect effect = 0·20, SE = 0·02, p < 0·001) and anxiety (male: indirect effect = 0·26, SE = 0·03, p < 0·001; female: indirect effect = 0·13, SE = 0·02, p < 0·001) mediate the association between blind box engagement and suicide risk. Within the blind box engagement group, forward binary logistic regression revealed that "Tolerance" was associated with participants' suicide risk in both males (p = 0·001) and females (p < 0·001); "Borrowed" (p = 0·019) alone was associated with the male participants' suicide risk.

INTERPRETATION

Our findings showed that blind box over-engagement is positively associated with suicide risk in both young males and females, and this association persisted after adjusting for influencing factors. In spite of the limitations in this study (e.g., cross-sectional, convenience sampling), current findings can assist policymakers in developing regulations for such a prosperous youth-dominant consumption industry while protecting youth's mental health worldwide.

FUNDING

None.

Suicidal ideation in college students having major depressive disorder: Role of childhood trauma, personality and dysfunctional attitudes

BACKGROUND

Suicide in college students is a major public health concern. Suicidal ideation (SI) is associated with childhood trauma, personality, dysfunctional attitudes and depressive symptoms, but how they interact to predict SI remains unclear.

METHODS

Using cross-sectional design and convenience sampling method, a survey was conducted among 565 college students having major depressive disorder (MDD). The Childhood Trauma Questionnaire, Eysenck Personality Questionnaire, Dysfunctional Attitudes Scale and Hamilton Depression Scale assessed participants' psychosocial factors. Chi-square test, t-test, Pearson correlation, and Structural Equation Model were used in data analysis.

RESULTS

Overall, 66.02% of participants with MDD had SI. Those with SI showed significant differences in physical abuse, emotional abuse, physical neglect, emotional neglect, psychoticism, neuroticism, extroversion, dysfunctional attitudes and depressive symptoms compared with those without SI. Childhood trauma, psychoticism, neuroticism, extroversion and dysfunctional attitudes affected SI through chain mediation. In addition, depressive symptoms, psychoticism, neuroticism and extroversion directly affected SI.

LIMITATIONS

The convenience sampling method may limit the generalizability of the findings. Results may be biased due to the self-report nature of the data collection procedure, the number of research subjects and differences in suicide risk assessment. The cross-sectional study cannot be used to infer causality.

CONCLUSIONS

The factors of childhood trauma, personality and dysfunctional attitudes affect SI through chain mediation. In addition, depressive symptoms and personality independently predict the occurrence of SI.

Personality factors associated with suicidal ideation, plans and attempts in adolescents

BACKGROUND

Suicide is the leading cause of death among young Australians, therefore identifying factors that increase risk is important. The aims of this study was to investigate the association between personality domains and suicidal ideation, plans and attempts in a community-based sample of adolescents.

METHODS

1428 students from thirteen secondary schools in Australia completed a survey consisting of demographic information (gender and age), personality risk across four domains (Hopelessness, Impulsivity, Sensation Seeking and Anxiety Sensitivity) as measured by the Substance Use Risk Profile Scale, and psychological distress measured by the Distress Questionnaire 5 scale. Outcome measures included suicidal ideation, plans and attempts measured by the Youth Risk Behavior Survey.

RESULTS

Students were aged between 11 and 17 years old (mean: 13.3, SD = 1.2) with 59% identifying as female. Proportions of participants reporting suicidal ideation, plans and at least one attempt were 14%, 9% and 7% respectively. Hopelessness was associated with twice the odds (OR = 3.1 and 2.9) of suicidal thoughts and plans respectively. Hopelessness also had 45% increased odds for suicide attempt (OR = 2.1), however this was not significant in the suicidal ideation sub-group. Impulsivity and sensation seeking were associated with suicidal ideation (OR = 1.3), while only impulsivity was associated with attempt (OR = 1.5).

LIMITATIONS

The study was cross-sectional, considered suicidal thoughts and behaviors in past 12 months only and used one measure of personality.

CONCLUSIONS

Personality traits may be important for determining suicide risk in adolescents. Developing screening and interventions targeting personality may have implications for the detection and prevention of suicide.

Temperament and Character of High Suicide Risk Group Among Psychiatric Patients

OBJECTIVE

The purpose of this study was to classify patients with suicidal tendencies into suicide attempts (SA), suicidal ideation (SI), and non-suicidal self-injury (NSSI) and to identify differences in temperaments and characters of the groups. It also aimed to identify difference between the groups and non-suicidal tendencies.

METHODS

Using psychiatric diagnostic data of 195 patients, temperaments and characters were measured with the Temperament and Character Inventory, and the level of depression was measured with the Beck Depression Inventory. The subjects were classified into SA, SI, NSSI, psychiatric patients without suicidal tendencies (PP), and non-patient (Normal) groups, and multivariate analysis of variance and multinomial logistic regression were conducted.

RESULTS

The NSSI group had higher novelty seeking compared to the SI group, while having higher harm avoidance, lower persistence, and lower self-directedness compared to the SA group. Furthermore, low persistence was a better predictor for the SA group between SA and NSSI groups, and low novelty seeking was found to be a better predictor for the SI group between the SI and NSSI groups.

CONCLUSION

As a result, the group differences in temperaments and characters were found, which would be useful to identify patients with suicidal tendencies and provide appropriate interventions tailored to the temperaments and characters of each group.

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.

Attentional Bias to Emotional Facial Expressions in Undergraduates With Suicidal Ideation: An ERP Study

Individuals who with suicide behaviors pay more attention to negative signals than positive ones. However, it is unclear that whether this bias exists when suicide ideators perceive interpersonal stimuli (such as faces with emotion) and the underlying neural mechanism of the attention process. The present study aimed to examine the attentional bias toward emotional facial expressions by employing event-related potentials in a population with suicide ideation. Twenty-five undergraduates with suicide ideation (SI group) and sixteen undergraduates without suicide ideation (NSI group) participated in a modified dot-probe task. Compared to the NSI group, the SI group exhibited: (1) a longer mean reaction time to fearful faces; (2) a larger N1 component to fearful faces; (3) a larger N1 component to the location of sad faces, as well as to the opposite location of fearful faces and happy faces; and (4) a larger N1 component to the contralateral location of happy faces, whereas the NSI group elicited a larger N1 component to the ipsilateral location of happy faces. These results indicated that the SI group was more sensitive to negative emotions (fearful and sad faces) than positive emotions (happy faces), and the negative interpersonal stimuli in suicide ideators was processed at an early attention stage.

Various Types of Negative Life Events Among Youth Predict Suicidal Ideation: A Cross-Sectional Study Based on Gender Perspective

We sought to investigate potential gender differences in various types of negative life events and suicidal ideation among Chinese high school and university students, as well as to analyze the interrelations between different types of negative life events and suicidal ideation among these young students. Participants were 2,018 high school and university students from northwestern China, who completed a demographics questionnaire and self-report measures of negative life events and suicidal ideation. Significant gender differences emerged in the types of negative life events reported and in students’ degree of suicidal ideation. Within each gender group, different types of negative life events were predictive of the intensity of suicidal ideation. The present study provides evidence of the role of negative life events in predicting adolescents’ and young adults’ suicidal ideation regardless of their gender. However, gender differences did emerge in the specific type of negative life events that were predictive of suicidal ideation. For males, greater reports of punishment and adaptation had a significant positive impact on the intensity of their suicidal ideation. For females, greater reports of academic stress, personal loss, interpersonal relationships, and adaptation were all significantly and positively predictive of their suicidal ideation. Parents’ marital status emerged as a significant indicator of suicidal ideation across genders, while age was significant negative predictor of suicidal ideation among females only.

Mediation of Resilience in the Association Between Personality Traits and Suicidal Ideation Among Chinese Adolescents

A positive connection has been established between personality traits and suicidal ideation (SI). However, the possible mediation of resilience within this association has never been thoroughly discussed. In this study, we aimed to investigate this topic by using population-based cross-sectional survey data of 4,489 Chinese children and adolescents. A self-administered questionnaire was used to collect information from the participants. Univariate and multivariate logistic regression models were adopted to measure the crude and adjusted associations between personality traits, SI, and resilience. Path analysis was performed to evaluate the mediation of resilience in the association between personality traits and SI. For 4,489 study subjects, the mean age was 13.4 years, ethnic minorities accounted for 71.8%, and over a half (54.6%) were middle school students. The reported prevalence rates for 1-week, 1-year, and lifetime SI were 27.6% (95% CI: 24.9%, 30.0%), 35.5% (95% CI: 30.8%, 41.0%), and 56.7% (95% CI: 52.3%, 61.0%), respectively. Girls reported a significantly higher prevalence of SI than boys. Path analysis results revealed a prominent mediation of resilience; moreover, for different dimensions of personality traits, the proportion of mediation by resilience varied. Our major findings suggest that resilience-based intervention measures could be considered in preventing personality traits related to suicidal risk among youngsters. For children and adolescents, the measuring of personality dimensions may also be helpful in targeting key subpopulations of intervention priority.

Assessing Mental Pain as a Predictive Factor of Suicide Risk in a Clinical Sample of Patients with Psychiatric Disorders

According to contemporary suicidology, mental pain represents one of the main suicide risk factors, along with more traditional constructs such as depression, anxiety and hopelessness. This work aims to investigate the relationship between the levels of mental pain and the risk to carry out suicide or suicide attempt in the short term in order to understand if a measurement of mental pain can be used as a screening tool for prevention. For this purpose, 105 outpatients with psychiatric diagnosis were recruited at the university hospital of Varese during a check-up visit and were assessed by using psychometric scales of mental pain levels, hopelessness, anxiety and depression. Clinical and sociodemographic variables of the sample were also collected. A period of 18 months following the recruitment was observed to evaluate any suicides or attempted suicides. Subjects numbering 11 out of 105 committed an attempted suicide. From statistical analyses, high values of the Beck Depression Inventory (BDI-II), Mental Pain Questionnaire (OMMP) and Hamilton Rating Scale for Depression (HAM-D) scales showed a significant association with the risk of carrying out a suicide attempt and, among these, OMMP and BDI-II showed characteristics of good applicability and predictivity proving suitable to be used as potential tools for screening and primary prevention of suicidal behavior.

Protective effects of reasons for living against suicidal ideation in daily life

How do individuals resist suicidal urges in a crisis? Deterrents for suicide can be conceptualized as reasons for living (RFL), but our understanding of their protective effects is predominantly informed by cross-sectional research. We examined the protective effects of RFL on suicidal ideation (SI) in daily life in a high-risk sample. We also tested whether personality traits moderated the strength of the dynamic RFL-SI link. Adults with a borderline personality disorder diagnosis (N = 153, n_{suicide attempters} = 105) completed a 21-day ambulatory assessment protocol. Daily endorsements of RFL were negatively linked to SI at the within-person but not the between-person level. Whereas suicide attempters endorsed RFL less frequently than non-attempters, the protective effect of RFL was undiminished in this group. Furthermore, RFL's protective effect was particularly pronounced in those with higher average levels of suicidal ideation. While people high on extraversion endorsed RFL more often, this increase was not protective against SI, indicating that RFL reflect heterogeneous underlying psychological processes, only some of which protect against SI.

Problem Gaming and Suicidality: A Systematic Literature Review

•

This is the first review on the association between problem gaming and suicidality.

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12 studies were identified, all of which found a positive association.

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Future studies should investigate the causality and mechanisms in the relationship.

Background

No studies have so far synthesised the current evidence concerning a possible relationship between problem gaming and suicidality. We therefore conducted a systematic review of the literature. Our objective was to investigate the relationship between problem gaming and suicidality. The review was funded by the Norwegian Competence Center for Gambling and Gaming Research.

Methods

The review was pre-registered in PROSPERO International prospective register of systematic reviews (CRD42021279774). Searches were conducted in Web of Science, PsycINFO, EMBASE, PubMed and Google Scholar, September 2021. Studies that reported data on the relationship between problem gaming and suicidality, published between 2000 and 2021, and written in any European language were included. Studies investigating internet addiction/problematic internet use and not problem gaming, specifically, and studies investigating mental health in general or mental health outcomes other than suicidality, were excluded. Data from the included studies were extracted independently by two coders who also evaluated for risk of bias using the Newcastle-Ottawa Quality Assessment Scale. The results from each included study were presented in a table.

Results

A total of 12 cross-sectional studies, with in total 88,732 participants, were included in the review. In total 10 studies investigated the association between problem gaming and suicidal ideation. One of these also investigated the association between problem gaming and suicide attempts. Two studies combined suicidal ideation and suicide attempts into one variable and investigated the association between that variable and problem gaming. In total 11 of the 12 included studies found positive, crude associations between problem gaming and suicidal ideation/attempts. Five studies adjusted for possible confounding variables. Three of these still found significant associations between problem gaming and suicidal ideation, one found a positive but not statistically significant association, and the fifth found an inverse, non-significant association.

Discussion

The current findings indicate that there is an association between problem gaming and suicidal ideation, and likely between problem gaming and suicide attempts. The most important limitation of the included studies is the lack of longitudinal designs. Future studies should aim to investigate the causality and mechanisms in the relationships using more stringent designs.

Treating Avoidant Personality Disorder With Combined Individual Metacognitive Interpersonal Therapy and Group Mentalization-Based Treatment: A Pilot Study

ABSTRACT

Avoidant personality disorder (AvPD) is a severe but understudied condition. The current pilot project reports data on acceptability and outcomes of a novel treatment combining biweekly individual metacognitive interpersonal therapy (MIT) and weekly mentalization-based therapy (MBT) group therapy. A total of 30 patients with AvPD were consecutively included in the program. The primary outcome was AvPD-specific personality functioning measured by self-report after treatment. Secondary outcomes were symptom distress, interpersonal problems, quality of life, and psychosocial functioning. Twenty-two patients completed treatment, with a mean duration of 13 months. On the primary outcome, effect sizes were generally moderate to large (effect size range: 0.59-1.10). On secondary outcomes, effect sizes were large (effect size range: 0.77-2.3). Both in terms of acceptability and outcomes, results are promising for the combination of MIT and MBT for AvPD. The approach is a strong candidate for further investigation in future large-scale randomized controlled trial.

Factors precipitating suicide attempts vary across race

OBJECTIVE

Although research has identified interpersonal, intrapersonal, and achievement-related factors that precipitate suicide attempts (SAs), how these factors vary by race/ethnicity is unknown. We examined racial/ethnic differences in SA precipitants in a racially/ethnically diverse sample of young adults (YAs) with a SA history.

METHOD

Two-hundred twenty-nine young adults, ages 18-33 (87% women), reported their method of attempt, and 200 of those reported on their SA precipitants. The latter were coded by three independent judges (Data were collected March 2012-December 2016.).

RESULTS

SAs were most often precipitated by intrapersonal factors, followed by interpersonal factors. Logistic regressions revealed that Hispanic, Asian, and Biracial YAs had higher odds of reporting interpersonal precipitants compared to Black YAs.

CONCLUSION

Suicide prevention and intervention should address both interpersonal and intrapersonal factors that increase vulnerability to SA across racial/ethnic groups, although interventions with Black YAs might focus more on intrapersonal than on interpersonal factors.

Impact of the COVID-19 Pandemic on the Suicidal Behavior in Romania

Suicide rates reflect the mental health status in certain countries or regions. As the COVID-19 infection developed as a pandemic and governments imposed certain measures to stop the spread of the virus, mental health was affected worldwide. Romania was no exception as the government issued a complete lockdown with restriction regarding travels, social gatherings, transition to working from home and others. The increase in the rate of unemployment, the difficulties in accessing the health services and the social distancing generated by the restrictions had a major impact on lifestyle with a potential surge of psychiatric disorders, with or without history of illness. In this study, we analyzed the changes in regard to the number of suicides and suicide attempts as well as the methods employed and the underlying psychiatric pathology in Cluj County, Romania, throughout the first year of the pandemic. The results had not revealed changes in the overall suicide rate, but in the case of mild cognitive disorders and dementia the suicide figures increased, while a decrease was observed in the number of suicides related to substance use disorders. The long-term effects of the pandemic remain unknown, but there is a clear impact on mental health and measures should be taken in order to prevent suicides.

Psychological Distress and Personality Dimensions Associated with Romantic Orientation Among Japanese Adults

Purpose: Evidence is scarce regarding the associations of romantic orientation with mental health and personality. The aims of the present study, therefore, were to examine psychological distress among homoromantic, biromantic, and heteroromantic adults and to investigate how personality dimensions influence their distress. Methods: A cross-sectional survey study was conducted between August 2018 and January 2021. Psychological distress, personality, and romantic orientation were assessed with the 6-item Kessler Psychological Distress Scale (K6), the Ten-Item Personality Inventory (TIPI), and a question about romantic orientation, respectively, in a web-based survey distributed to 11,922 participants. Saliva samples were collected for DNA extraction. After excluding those who did not cluster with Japanese ancestry and those whose genotypic sex did not match their reported sex, 11,662 individuals were included in further analyses. Results: The prevalence of being homoromantic or biromantic was 1.0% and 2.0% for females and 1.5% and 1.2% for males, respectively. Homoromantic males, but not females, had significantly higher K6 scores than their heteroromantic counterparts. Both male and female biromantic participants had significantly higher K6 scores than their heteroromantic counterparts. Furthermore, a significant association was found between romantic orientation and TIPI scores. Accounting for personality profiles did not alter the observed association between romantic orientation and psychological distress. Conclusion: Biromantic adults and homoromantic male adults of genetically confirmed Japanese ancestry living in Japan experienced higher psychological distress than heteroromantic individuals. The mental health disparities of the romantic minority individuals were irrespective of their personality profiles, suggesting the involvement of other factors such as minority stress in Japan.

Prevalence and individual and work-related factors associated with suicidal thoughts and behaviours among veterinarians in Norway: a cross-sectional, nationwide survey-based study (the NORVET study)

OBJECTIVES

Several studies have shown increased suicide rates among veterinarians. We investigated the self-reported prevalence of suicidal thoughts and behaviours and contributing and independent factors associated with suicidal thoughts and behaviours among veterinarians in Norway.

DESIGN

Cross-sectional, nationwide survey.

PARTICIPANTS

2596 veterinarians in Norway (response rate: 75%).

MAIN OUTCOME MEASURE

Paykel's five-item questionnaire.

RESULTS

In total, 27% (n=682/2567) of veterinarians in Norway felt that life was not worth living during the last year, 5% (n=139/2562) had serious suicidal thoughts, and 0.2% (n=6/2537) had attempted suicide. Female veterinarians reported significantly higher prevalence of suicidal feelings and thoughts than males. For serious suicidal thoughts, women had nearly twice the prevalence as their male colleagues (6.2% (n=108/1754) vs 3.6% (n=28/766), χ²: 6.5, p=0.011). Independent factors associated with serious suicidal thoughts were being single (OR 1.76, 95% CI 1.13 to 2.72, p<0.05), negative life events (OR=1.43, 95% CI 1.22 to 1.68, p<0.001) and the presence of mental distress (OR 2.75, 95% CI 2.14 to 3.52, p<0.001). The veterinarians related their serious suicidal thoughts to work and personal problems, and a lesser degree to family, social and other problems. Nearly twice as many women (53%, n=57/108) as men (28%, n=7/25) reported work problems as the most important contributing factor to their serious suicidal thoughts (χ²: 4.99, p=0.03). 4% (n=6/139) reported work problems as the only factor of importance.

CONCLUSIONS

Veterinarians in Norway have relatively high prevalence of suicidal feelings and thoughts, including serious suicidal thoughts. In multivariable analyses, the individual factors were more important than work-related ones, while work problems were the most reported contributing factor to serious suicidal thoughts by the veterinarians themselves. The role of gender and specific work-related factors should be further investigated to better understand the complexity of suicidal behaviour among veterinarians.