Unemployment and underemployment are causes of suicide

Identifying differences between those with suicidal ideation-with-action, compared to ideation alone, using a community representative sample

BACKGROUND

Few studies examine suicidal ideation in the general population and who might act on suicidal thoughts. It is important to understand ideators, the largest group on the suicidality continuum.

OBJECTIVES

This study examines factors associated with suicidal ideation among community-dwelling individuals, and sociodemographic, health and help-seeking factors associated with ideation accompanied by planning or suicide attempt ('ideation-with-action') compared to ideation alone.

METHODS

Using the 2002 and 2012 Canadian Community Health Surveys - Mental Health cycles (CCHS-MH), this cross-sectional cohort study examined 14,708 Ontarians 15 years and older who answered questions about suicidal ideation, and compared characteristics between non-ideators, ideators with a plan or previous attempt, and ideators alone, with chi-square tests and logistic regression.

RESULTS

2.1% of CCHS respondents reported past-year ideation alone (n = 302) and another 0.5% reported ideation with plan or past-year suicide attempt (n = 76). The risk profile of ideators compared to non-ideators was similar to that of ideators-with-action compared to ideators-without-action: male, younger, unpartnered, less educated, have lower income, no job, have a mood and anxiety disorder, a substance use disorder and seek help for mental health problems. Most ideators (65%) do not seek help, and those with a plan or previous suicide attempt are more likely to do so.

CONCLUSION

Ideators differ in profile in terms of whether they have ideation only, have made a plan or had previous attempts. Risk factors differentiating ideators from non-ideators are the same factors that further differentiate ideators-with-action compared to those with only ideation, suggesting the existence of a suicidality continuum and opening up the opportunity for targeting common risk factors in prevention efforts.

Associations of perceived social support, resilience and posttraumatic growth among young and middle-aged patients with first-episode psychosis

Background

The prevalence of mental disorders among young and middle-aged populations has demonstrated a significant upward trend, with first-episode psychosis (FEP) frequently associated with psychological distress and functional impairments during initial onset. While persons affected by FEP frequently report psychological distress and reduced quality of life during early illness stages, they may also experience post-traumatic growth (PTG), which fosters positive changes that facilitate their recovery. Yet there is limited attention on PTG in young and middle-aged patients with FEP. Therefore, this study aimed to investigate the level of PTG and identify significant correlates and mediators of PTG among young and middle-aged patients with FEP.

Methods

From January 2021 to December 2023, two hundred eight patients with first-episode psychosis were enrolled from a tertiary hospital in Shandong Province, China, through convenience sampling. The Perceived Social Support Scale (PSSS), Posttraumatic Growth Inventory-Short Form (PTGI-SF), and Connor-Davidson Resilience Scale (CD-RISC10) were administered. Hierarchical linear regression modeling was performed to examine the associations between perceived social support and PTG and the mediating effect of resilience.

Results

The PTG score was 31.22 ± 6.59, and resilience and PSS could positively predict the variance in PTG. Resilience partially mediated the relationship between PSS and PTG, and the value of the mediating effect was 22.8%.

Conclusions

Young and middle-aged patients with FEP have a moderate level of PTG. Resilience partially mediates the relationship between PSS and PTG. Therefore, interventions focusing on promoting PSS and resilience should be developed to encourage PTG in young and middle-aged patients with FEP.

The Community's Role in Rural Youth Suicide Prevention: Perspectives From the Field

OBJECTIVE

This study explored how rural communities can be involved in suicide prevention efforts for young people aged 12-25. It provides a focus on who is best placed to drive these efforts and what support these people need to implement initiatives in their communities.

SETTING

The research was conducted across Australia, with a focus on rural areas, where suicide rates are higher due to unique challenges, including geographic isolation, stigma and limited access to health services. These areas require community-driven solutions tailored to local contexts.

PARTICIPANTS

Thirty-seven participants aged 29-72 contributed insights, with diverse professional roles and lived experiences in rural youth suicide prevention, including service providers, programme leaders, researchers and policymakers.

DESIGN

A qualitative approach was used, with semi-structured interviews and focus groups conducted between January and September 2021. Data were thematically analysed using a reflective approach to identify key factors supporting rural youth suicide prevention.

RESULTS

Two key themes emerged: (1) Program planning and implementation: highlighting the need for adaptable, stigma-sensitive and culturally responsive approaches, and (2) Breaking down silos: emphasising collaboration between schools, families, health services and community leaders. Trusted local figures such as teachers, sports coaches and peers were identified as crucial for fostering engagement and early intervention. Lived experience voices were recognised as integral to co-designing and sustaining community-led efforts.

CONCLUSION

Rural communities are central to youth suicide prevention. By leveraging local relationships, addressing stigma and fostering collaboration, communities can create supportive environments that save lives. Policy and practice must prioritise funding and resources for community-led, culturally sensitive approaches.

Suicidal ideation among mental health patients at hospital discharge: prevalence and risk factors

BACKGROUND

Evidence indicates that suicide risk is much higher for psychiatric patients in the weeks immediately following discharge from the hospital. It is, therefore, crucial to evaluate suicide risk accurately at discharge to provide supportive and lifesaving interventions as appropriate.

AIM

In this study, the prevalence and risk factors for suicide ideations were examined among patients ready to be discharged from psychiatric units in Alberta province, Canada.

METHODS

Researchers conducted face-to-face meetings with potential participants to determine if they were interested in participating. Eligible individuals in this epidemiological cross-sectional study used an online quantitative survey to assess suicide ideations using the appropriate question contained in the Patient Health Questionnaire (PHQ-9) scale. Information was also gathered regarding patient demographics, clinical information, and responses to the Generalized Anxiety Disorder (GAD-7), and World Health Organization Well-Being Index (WHO-5) questionnaires.

RESULTS

We recruited 1,004 patients from an initial pool of 1,437 patients. We found that the prevalence of suicidal ideation among patients about to be discharged was 48.9%, i.e., nearly half of all patients had active suicidal thinking prior to discharge. We found that factors that were most significantly associated with this were age, ethnicity, employment status, primary mental health diagnoses, anxiety, and poor well-being at baseline.

CONCLUSION

Here, in a large cohort of psychiatric patients in Alberta, Canada, we found that nearly half of patients being discharged from an acute psychiatric unit reported suicidal ideation. Given the increased short-term risk to this group, there is an urgent need for additional research on the underlying reasons and reliable predictors of suicidal ideation in these patients. Additionally, appropriate interventions and supportive services must be provided both prior and after discharge to mitigate this substantial risk.

Artificial intelligence, recessionary pressures and population health

Economic and labour policies have a considerable influence on health and well-being through direct financial impacts, and by shaping social and physical environments. Strong economies are important for public health investment and employment, yet the rapid rise of generative artificial intelligence (AI) has the potential to reshape economies, presenting challenges beyond mere temporary market disruption. Generative AI can perform non-routine cognitive tasks, previously unattainable though traditional automation, creating new efficiencies. While this technology offers opportunities for innovation and productivity, its labour-displacing potential raises serious concerns about economic stability and social equity, both of which are critical to health. Job displacement driven by generative AI could worsen income inequality, shrink middle-class opportunities and reduce consumer demand, triggering recessionary pressures. In this article, we propose the existence of an AI-capital-to-labour ratio threshold beyond which a self-reinforcing cycle of recessionary pressures may emerge, and which market forces alone cannot correct. Traditional responses to such pressures, like fiscal stimulus or monetary easing, may be ineffective in addressing structural disruptions to labour markets caused by generative AI. We call for a proactive global response to harness the benefits of generative AI while mitigating risks. This response should focus on reorienting economic systems towards collective well-being, as emphasized in the World Health Assembly resolution Economics of health for all and the United Nations' Global Digital Compact. Integrated strategies that combine fiscal policy, regulation and social policies are critical to ensuring generative AI advances societal health and equity while avoiding harm from excessive job displacement.

A Digital Approach for Addressing Suicidal Ideation and Behaviors in Youth Mental Health Services: Observational Study

BACKGROUND

Long wait times for mental health treatments may cause delays in early detection and management of suicidal ideation and behaviors, which are crucial for effective mental health care and suicide prevention. The use of digital technology is a potential solution for prompt identification of youth with high suicidality.

OBJECTIVE

The primary aim of this study was to evaluate the use of a digital suicidality notification system designed to detect and respond to suicidal needs in youth mental health services. Second, the study aimed to characterize young people at different levels of suicidal ideation and behaviors.

METHODS

Young people aged between 16 and 25 years completed multidimensional assessments using a digital platform, collecting demographic, clinical, social, functional, and suicidality information. When the suicidality score exceeded a predetermined threshold, established based on clinical expertise and service policies, a rule-based algorithm configured within the platform immediately generated an alert for treating clinicians. Subsequent clinical actions and response times were analyzed.

RESULTS

A total of 2021 individuals participated, of whom 266 (11%) triggered one or more high suicidal ideation and behaviors notification. Of the 292 notifications generated, 76% (222/292) were resolved, with a median response time of 1.9 (range 0-50.8) days. Clinical actions initiated to address suicidality included creating safety plans (60%, 134/222), conducting safety checks (18%, 39/222), psychological therapy (8%, 17/222), transfer to another service (3%, 8/222), and scheduling of new appointments (2%, 4/222). Young people with high levels of suicidality were more likely to present with more severe and comorbid symptoms, including low engagement in work or education, heterogenous psychopathology, substance misuse, and recurrent illness.

CONCLUSIONS

The digital suicidality notification system facilitated prompt clinical actions by alerting clinicians to high levels of suicidal ideation and behaviors detected among youth. Further, the multidimensional assessment revealed complex and comorbid symptoms exhibited in youth with high suicidality. By expediting and personalizing care for those displaying elevated suicidality, the digital notification system can play a pivotal role in preventing rapid symptom progression and its detrimental impacts on young people's mental health.

Suicide risk among adult subjects hospitalized in an acute psychiatric ward: 6-year retrospective investigation

BACKGROUND

The phenomenon of suicide risk (SR) represents a psychiatric, social and environmental emergency. The acute psychiatric ward as the Italian Service for Psychiatric Diagnosis and Care (SPDC) represents the place where SR is high due to the acute and serious conditions of people hospitalized. The objective of this study was to evaluate the characteristics of subjects admitted to a SPDC over a 6-year period for SR represented by: suicidal ideation, attempted and failed suicide.

METHODS

With a retrospective single-center observational design, we collected hospitalizations from 01/01/2017 to 31/12/2022 in the SPDC of AUSL-Modena for SR, analyzed the modality of SR and compared the demographic and clinical variables of subjects with SR with those hospitalized for other clinical reasons in the same period. Data were statistically analyzed.

RESULTS

In the 6-year of study period, we collected 2,930 hospitalizations in the SPDC of AUSL- Modena and among them, 68% (n = 528) were carried out due to SR, which represented the second leading cause of hospitalization (18%), in particular among females (Pearson Chi2 = 17.41, p < 0.001). Individuals with SR were more frequently voluntary admitted (Pearson Chi2 = 215.41, p < 0.001) for a shorter period (7.36 ± 8.16 vs 11.66 ± 15.93, t = 6.03, t-test, p < 0.001) and less frequently repeated the hospitalization during the study period for the same reason (Pearson Chi2 = 6.0, p = 0.014). The most frequent psychiatric disorders associated with SR were depressive, personality and adjustment disorders, which represented the most common factor associated with SR (68%), followed by family/relationship problems (12%) and alcohol/substance abuse (8%). We highlighted three kinds of suicidal risk: suicidal ideation (40%), often associated with personality disorders and substance use disorders, drug ingestion (30%) concomitant with conflicting family relationships and use of violent means (30%) associated with depressive disorders (Pearson Chi2 = 42.83, p = 0.002).

CONCLUSIONS

Our study provides a real-world setting evaluation of subjects hospitalized for SR and, in accordance with literature, suggests that suicidal behavior is the product of many clinical and social factors' interaction, that occurred in a crucial moment of life in vulnerable individuals. The identification of subjects at SR represents the first step of preventive multi-professional interventions.

Cumulative effect of unemployment on suicide mortality in South Korean workers (2018-2019)

BACKGROUND

While unemployment is known to increase the risk of suicide, its cumulative effect remains underexplored. This study investigates how unemployment affects suicide mortality and whether the effect varies based on the number of unemployment spells using two years of nationwide data.

METHODS

Using the data from the National Statistical Office and Employment Insurance Database for 2018 and 2019, we identified an average of 2365 cases of suicide over two years among 7.76 million workers aged 25-64 years who had been employed within one year before their suicide. The number of unemployment spells was counted using the employment history of the past five years. We calculated crude suicide mortality rates per 100 000 population, age- and sex- standardized mortality rates (SMRs), and proportionate mortality rates (PMRs) for suicide.

RESULTS

Over the two years, the crude suicide rate was 30.0 per 100 000 among the general population and 30.5 among workers. Workers with no unemployment spells in the past five years had a significantly lower SMR (0.44; 0.42-0.46), while those with four or more unemployment spells had a significantly higher SMR (3.13; 2.92-3.35) than the general population. These findings were consistent across all sex and age groups. Additionally, workers with four or more unemployment spells had a significantly higher PMR than the general population.

CONCLUSION

The impact of unemployment on suicide mortality intensifies as the number of unemployment spells increases. These results underscore the necessity for additional social and psychological support along with economic assistance for individuals facing recurrent unemployment.

The rise in mortality due to intentional self-poisoning by medicines in Brazil between 2003 and 2022: relationship with regional and global crises

In recent years, suicide rates in Brazil have increased, but little is known about the temporal behavior and characteristics of suicides due to intentional self-poisoning by medicines. The aim of the present study was to provide an overview of sociodemographic characteristics and place of death related to suicide due to intentional self-poisoning by medicines, to evaluate the trend of mortality rates in Brazil between 2003 and 2022, and its relationship with regional and global crises. Ecological time series study with data from the Mortality Information System of the Brazilian Ministry of Health, related to individuals aged 10 years and over, who committed suicides due to intentional drug overdose, in the period from 2003 to 2022. The analyses were performed in the R environment in RStudio. Between 2003 and 2022, there was a predominance of deaths in women (55.5%), individuals aged 30-49 years (47.2%), of White race/color (53.2%), occurring in health facilities (67.0%), using drugs or unspecified substances (40.4%); a higher concentration in the southern region (22.8%) and a positive trend in mortality rates due to intentional drug overdose, especially from 2016 onwards. A rise of 264% was observed in the comparison of 2022 and 2003. A peculiar sociodemographic profile was observed in the victims of intentional self-poisoning by medicines and a positive temporal trend in mortality rates, especially in a period marked by regional and global crises.

Dynamic learning of individual-level suicidal ideation trajectories to enhance mental health care

There has recently been an increase in ongoing patient-report routine outcome monitoring for individuals within clinical care, which has corresponded to increased longitudinal information about an individual. However, many models that are aimed at clinical practice have difficulty fully incorporating this information. This is in part due to the difficulty in dealing with the irregularly time-spaced observations that are common in clinical data. Consequently, we built individual-level continuous-time trajectory models of suicidal ideation for a clinical population (N = 585) with data collected via a digital platform. We demonstrate how such models predict an individual's level and variability of future suicide ideation, with implications for the frequency that individuals may need to be observed. These individual-level predictions provide a more personalised understanding than other predictive methods and have implications for enhanced measurement-based care.

Navigating a stable transition to the age of intelligence: A mental wealth perspective

In the grand narrative of technological evolution, we are transitioning from the "Age of Information" to the "Age of Intelligence." Rapid advancements in generative artificial intelligence (AI) are set to reshape society, revolutionize industries, and change the nature of work, challenging our traditional understanding of the dynamics of the economy and its relationship with human productivity and societal prosperity. As we brace for this transformative shift, promising advancements in healthcare, education, productivity, and more, there are concerns of large-scale job loss, mental health repercussions, and risks to social stability and democracy. This paper proposes the concept of Mental Wealth as an action framework that supports nations to proactively position themselves for a smooth transition to the Age of Intelligence while fostering economic and societal prosperity.

The long-term changing patterns of suicide mortality in China from 1987 to 2020: continuing urban-rural disparity

BACKGROUND

Over the past three decades, China has experienced significant changes in urban-rural, gender, and age-specific suicide mortality patterns. This study aimed to investigate the long-term trends in suicide mortality in China from 1987 to 2020.

METHODS

Suicide mortality data were obtained from China's National Health Commission. Joinpoint regression analysis was used to examine changes in trends and age-period-cohort modeling to estimate age, period, and cohort effects on suicide mortality from 1987 to 2020. Net drift, local drift, longitudinal age curves, and period relative risks were also calculated.

RESULTS

Crude and age-standardized suicide mortality in China showed continuing downward trends from 1987 to 2020, with a more pronounced decrease in rural areas (net drift = -7.07%, p<0.01) compared to urban areas (net drift = -3.41%, p<0.01). The decline curve of urban areas could be divided into three substages. Period and cohort effects were more prominent in rural areas. Suicide risk was highest among individuals aged 20-24 and gradually increased after age 60. Females, particularly those of childbearing age, had higher suicide risk than males, with a reversal observed after age 50. This gender reversal showed distinct patterns in urban and rural areas, with a widening gap in urban areas and a relatively stable gap in rural areas.

CONCLUSIONS

Suicide mortality in China has consistently declined over the past three decades. However, disparities in age, gender, and urban-rural settings persist, with new patterns emerging. Targeted suicide prevention programs are urgently needed for high-risk groups, including females of childbearing age and the elderly, and to address the slower decrease and reversing urban-rural gender trends.

Mental health impacts of COVID-19: A retrospective analysis of dynamic modelling projections for Australia

Background

In early 2020, we developed a dynamic model to support policy responses aimed at mitigating the adverse mental health effects of the COVID-19 pandemic in Australia. As the pandemic has progressed, it has become clear that our initial model forecasts overestimated the impacts of infection control measures (lockdowns, physical distancing, etc.) on suicide, intentional self-harm hospitalisation, and mental health-related emergency department (ED) presentation rates.

Methods

Potential explanations for the divergence of our model predictions from observed outcomes were assessed by comparing simulation results for a set of progressively more refined models with data on the prevalence of moderate to very high psychological distress and numbers of suicides, intentional self-harm hospitalisations, and mental health-related ED presentations published after our modelling was released in July 2020.

Results

Allowing per capita rates of spontaneous recovery and intentional self-harm to differ between people experiencing moderate to very high psychological distress prior to the pandemic and those developing comparable levels of psychological distress only as a consequence of infection control measures substantially improves the fit of our model to empirical estimates of the prevalence of psychological distress and leads to significantly lower predicted effects of COVID-19 on suicide, intentional self-harm hospitalisation, and mental health-related ED presentation rates.

Conclusion

Accommodating the influence of prior mental health on the psychological effects of population-wide social and economic disruption is likely to be critical for accurately forecasting the mental health impacts of future public health crises as they inevitably arise.

Trends in suicide mortality in Spain from 1998 to 2021 and its relationship with the COVID-19 pandemic: A joinpoint regression analysis

In the European Union, a rate of 11.9 cases per 100,000 was estimated in 2019.In Spain, suicide is the leading cause of external death. Social crises can have an impact on suicide rates. We analyzed changes in suicide mortality trends in Spain following the COVID-19 pandemic. We used statistical data from the National Institute of Statistics of Spain (1998-2021). We calculated age-specific rates, age and sex-adjusted rates, and analyzed trends and changes using joinpoint-regression models. Rates decrease in both sexes at the ages of 65 and older. In women, they increase in the ages of 1-29 years and 45-59 years. In men, they decrease in the ages of 15-39 years. Among women, age-adjusted rates remained stable between 1998 and 2021, with a non-significant annual decrease of 0.4 %. Among men, there was a significant annual decrease of 0.7 %. The years 2020 and 2021 had 8 % higher mortality compared to the two years prior to the COVID-19 pandemic. Suicide mortality in Spain slightly decreased among men and remained stable among women between 1998 and 2021, but there seems to be an increase following the COVID-19 pandemic.

Short working hours and perceived stress: Findings from a population-based nationwide study

Background

Evidence on the potential negative health effects of short working hours remains limited. This study aimed to investigate the association between short working hours and perceived stress in a population-based sample from China.

Methods

This cross-sectional study included 4368 participants aged 18-65 years from the China Health and Nutrition Surveys (CHNS) 2015. Working hours were categorized into <35, 35-40, 41-54, and ≥55 h/week. Perceived stress was assessed using the Perceived Stress Scale-14 (PSS-14).

Results

Of the 4368 participants, 817 (18.7 %) reported short working hours (<35 h/week) and 1817 (41.6 %) reported perceived stress. Short working hours were associated with higher perceived stress compared to standard working hours (35-40 h/week) (Adjusted odds ratios (AOR) = 1.25, 95 % confidential intervals (CI): 1.04-1.51). Stratified analysis showed that short working hours were significantly associated with more perceived stress in subjects aged 36-50 years (AOR = 1.43, 95 % CI: 1.16-1.70), while long working hours (≥55 h/week) were significantly related to less perceived stress among low-income subjects (AOR = 0.56, 95 % CI: 0.33-0.94). Reduced income partially mediated the effects of short working hours on perceived stress (indirect effects = -0.002, 95 % CI: -0.007∼-0.001).

Conclusion

Reduced working hours may be associated with increased risk of perceived stress in China, particularly among people aged 36-50 years and those with low income. Reduced income may be a possible reason for the increased perceived stress caused by short working hours. Future longitudinal studies are needed to examine these relationships and to explore mechanisms.