Toward a clinical model of suicidal behavior in psychiatric patients

Beyond addiction: exploring the factors behind suicidal thoughts among methamphetamine users in Guangdong, China

BACKGROUND

Methamphetamine is one of the most abused drugs worldwide. Methamphetamine use disorders (MAUD) not only affect the physical and mental health of addicts but also increase the risk of suicide. Although the suicide rate of MAUD patients is high, there is little research on the clinical characteristics and risk factors of suicide risk in MAUD patients. So, it is necessary to investigate the related risk factors of suicidal ideation of MAUD.

METHODS

Using response-driven sampling (RDS), a total of 10,225 MAUDs were randomly selected from April to May 2023 in Guangdong, China. MAUD was evaluated by the Beck Scale for Suicide Ideation (BSSI) and divided into a case (n = 1228) and a control group (n = 8997). Multivariate generalized linear mixed model analysis was used to analyze the risk factors of suicidal ideation among MAUDs.

RESULTS

The result of multivariate generalized linear mixed model analysis showed that the dosage of each use of MA (OR = 5.52, 95%CI = 4.93～6.17), age (OR = 1.11, 95%CI = 1.03～1.20), childhood physical abuse(OR = 3.43, 95%CI = 3.17～3.71), childhood emotional neglect(OR = 2.77, 95%CI = 2.60～2.94), introverted and extroverted personality(OR = 2.85, 95%CI = 2.64～3.08), and neurotic personality(OR = 1.15, 95%CI = 1.02～1.30) were the risk factors of suicidal ideation among MAUDs in Guangdong, China.

CONCLUSION

Suicidal ideation among MAUDs is influenced by family, society, stress, and other factors, so it is necessary to take comprehensive intervention measures.

Anti-suicidal effectiveness of clozapine, lithium, and valproate in patients with schizophrenia and bipolar disorder: A real-world nationwide study

Despite advances in psychiatric treatment, individuals with schizophrenia (SZ) and bipolar disorder (BD) continue to experience alarmingly high suicide rates. Clozapine, lithium, and valproate are medications that may potentially reduce suicide in these populations, but evidence is limited and often inconsistent. This study aimed to evaluate the anti-suicidal effectiveness of these medications using a nationwide health insurance database in South Korea. A retrospective cohort study was conducted using data from the National Health Information Database. This study included 102,540 patients with SZ and 96,336 patients with BD diagnosed between 2007 and 2010. We assessed the association between suicide mortality and recent prescriptions of clozapine, lithium, and valproate, as well as other psychotropic drugs. Suicide hazard ratios (HR) were calculated using a time-dependent Cox regression analysis. Suicide rates per 100,000 person-years were 308.0 for SZ and 285.1 for BD. After adjustment for confounders, lithium and valproate prescriptions were associated with significantly lower suicide hazard ratios in both SZ (HR of lithium: 0.58, 95 % CI: 0.46-0.72; HR of valproate: 0.61, 95 % CI: 0.52-0.71) and BD (HR of lithium: 0.54, 95 % CI: 0.44-0.65; HR of valproate: 0.66, 95 % CI: 0.57-0.76). Clozapine was associated with a lower suicide hazard in patients with SZ but remained statistically non-significant. Lithium and valproate have significant anti-suicidal effects in patients with SZ and BD, underscoring the potential role of mood stabilizers in suicide prevention among them.

Suicide in adults within 30 days of discharge from hospital emergency department

Suicide remains a frequent cause of death in adults, often overlooked despite known risk factors like mental disorders, older age, and chronic illness. Emergency department visits offer critical opportunities to identify suicidal ideation and provide preventive care. This study reviewed deaths within 30 days of discharge from the emergency department of a major public hospital in Alicante, Spain, focusing on deaths by suicide. Over five years, 529,312 emergency visits were recorded, with 453,599 patients (85.7%) discharged home. Of the 356 patients (0.078%) who died within 30 days post-discharge, 7 (1.97%) died by suicide. Among these, four had a psychiatric history, and one had a history of substance abuse, both established risk factors. The overall suicide rate among adults discharged from the emergency department was 1.54 per 100,000. Compared with those who died from other causes within 30 days of discharge, patients who died by suicide were younger (median age 72 vs. 83 years; p = 0.037, adjusted OR: 0.59, 95% CI: 0.34-1.03; p = 0.06), had a lower Charlson Comorbidity Index (median 3 vs. 6; p = 0.003), and were more often male (6/7 vs. 50.1%; p = 0.1). The presence of psychiatric history was the most significant risk factor for suicide within 30 days of discharge from the emergency department among patients aged 15 and older. Men were more likely than women to die by suicide, with the majority between the ages of 65 and 79. Notably, only one individual had a prior suicide attempt.

Do Children's Mental Health Symptoms Impact Their Access to Unlocked Guns at Home?

OBJECTIVE

To test whether changes in children's mental health symptoms predict changes in their access to unlocked guns at home.

METHOD

This study used data from a longitudinal cohort study of 1,420 youth and their parents in the Southeastern US. Parents were assessed annually up to eight times about their child's mental health (i.e., conduct, oppositional defiant, depression, and anxiety symptoms) between ages 9 to 16 (6,674 observations total). Parents were also asked whether there were guns in their home and whether they were locked. Generalized linear mixed-effect models were used to test associations between changes in symptoms and in-home gun access adjusted for sociodemographic variables. Children with or without access to unlocked guns at baseline were differentiated in analyses.

RESULTS

Sixty-six percent of parents reported that their child had access to an unlocked gun at some point between ages 9-16. In homes in which children did not have gun access at baseline, changes in youth mental health symptoms did not increase or decrease the likelihood of child having access to unlocked guns subsequently. In homes in which children did have guns access at baseline, however, increases in some mental health symptoms (either oppositional defiant (OR= 0.43, CI=[0.35, 0.53], p<0.001), or depression symptom (OR=0.74, CI=[0.59, 0.92], p<0.008)) were associated with reduced gun access at the next timepoint. These associations were strongest for adolescents.

CONCLUSION

In an area where gun culture is strong, parents reported making safety-conscious adjustments to their children's gun access when their children displayed emotional or behavioral symptoms.

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.

Association of constipation with suicidal ideation among US adults and the partial mediating role of depression

The association between constipation and suicidal ideation remains inadequately explored. This study aims to investigate the potential correlation between constipation and suicidal ideation in US adults, while assessing the mediating role of depression.For this cross-sectional study, a total of 13,493 adults aged 20 years and older were included from the National Health and Nutrition Examination Survey 2005-2010. The definition of constipation was defined by considering the consistency or frequency of stool. The ninth item on the Patient Health Questionnaire-9 (PHQ-9) evaluated suicidal ideation, and depression was evaluated using the PHQ-8 score. Adjusted odds ratios (ORs) were calculated using multivariate logistic regression models. Sensitivity analysis was performed to ensure stable results. Furthermore, study employed mediation analysis to examine the effect of constipation on suicidal ideation through depression. The bootstrapping method was used to assess the significance of the mediation effect. After controlling for demographic factors, risk behaviors, comorbidities, dietary intake, and relevant medications, constipation was associated with an increased risk of suicidal ideation (OR 1.41, 95%CI 1.08-1.83, P = 0.011). Sensitivity analyses showed the stability of the results. Moreover, mediation analysis demonstrated a significant direct effect of constipation on suicidal ideation (P = 0.016), with depression playing a partial mediating role in this interaction (40.81%, P < 0.0001). In conclusion, this study demonstrated a significant association between constipation and suicidal ideation, with depression serving as a partial mediator in this relationship. Further prospective longitudinal studies are essential to establish a definitive causal relationship between these factors so as to guide the development and implementation of targeted intervention strategies.

Suicide reattempts in adolescents and young adults after a first suicide attempt. Results from the SURAYA prospective cohort study

INTRODUCTION

Suicide is a particularly major public health concern among young people as it is the fourth cause of death in youth aged 15-29. Despite various prevention strategies and efforts, the rate of suicide attempts among youth has increased over time and has risen even further since the COVID-19 pandemic.

OBJECTIVES

The aim of this study was to ascertain the prevalence of suicide reattempts within 3months in a cohort of young first-time suicide attempters aged 16 to 25years. Exploratory objectives were to investigate potential risk factors associated with reattempts in this population.

METHODS

We conducted a prospective, naturalistic, single-center cohort study including 182 patients hospitalized in emergency psychiatry for a first suicide attempt. Data on 31 sociodemographic, clinical and biological factors known to be associated with suicide were collected at baseline.

RESULTS

Out of the 182 patients included, 146 participants remained for the 3-months follow-up analysis (mean age: 19.71±2.5years, 71.9% female). Twenty of them reattempted suicide: yielding a prevalence of 13.7% (14.3% of females and 12.2% of males). Only four clinical and biological factors under study were significantly associated with suicide reattempt.

CONCLUSION

Our findings underscore the critical need for targeted prevention strategies for adolescents and young adults, as they represent a high-risk group for early suicide reattempts. Further research into the factors associated with recurrent suicide attempts is essential to more accurately characterize the profiles of young individuals who reattempt suicide, thereby informing the development of effective preventive interventions and avoiding negative outcomes.

Cognitive control impairment in suicide behaviors: what do we know? A systematic review and meta-analysis of Stroop in suicide behaviors

BACKGROUND

Suicidal behavior results from a complex interplay between stressful events and vulnerability factors, including cognitive deficits. Poorer performance on the Stroop task, a measure of cognitive control, has been associated with suicidal behavior in numerous studies. The objective was to conduct an updated systematic review of the literature on the Stroop task as a neuropsychological test of vulnerability to suicidal acts in patients with mood and other psychiatric disorders, while also looking at how the type (classic versus emotional) or the version (paper or computerized) of the Stroop task, as well as the characteristics of the patient (clinical population, age, sex) moderated the Stroop effect.

METHODS

A search on Medline, Embase, PsycInfo databases, and article references was performed. 53 studies (6781 participants) met the selection criteria. Interference time and errors of the Stroop Test were assessed in at least 3 studies to be analyzed. Moderators, such as the type (classic versus emotional) of the Stroop task and the characteristics of the patient (clinical population, age, sex) were also assessed.

RESULTS

Interference time on Stroop performance was lower in suicide attempters than in patient controls (g = 0.20; 95%CI [0.10-0.30]) and healthy controls (g = 0.79; 95 % CI [0.29-1.29]), with patient controls scoring lower than healthy controls (g = -0.63; 95%CI [-1.01-0.25]). This was moderated by age and having a mood disorder. In terms of interference errors, suicide attempters performed worse than healthy controls (g = 0.57; 95%CI [0.01-1.15]) but did not perform differently from patient controls (g = 0.20; 95 % CI [-0.06-0.45]). Patient controls also did not score differently than healthy controls (g = -0.18; 95 % CI [-0.54-0.18]). There was a significant moderation effect for the type (i.e., original Stroop task) and version (i.e., paper format) of the Stroop task, and for some characteristics of the patient (i.e., older patients and having a mood disorder).

CONCLUSIONS

Cognitive control impairment was associated with a history of suicidal behavior in patients, especially in older populations and those with mood disorders, however this result was moderated by outcome measure (interference time vs. errors), the type (i.e., original Stroop task) and the version (i.e., paper format) of the Stroop task. Cognitive control processes may be an important factor of suicidal vulnerability. Choosing the right neurocognitive test in the right population to detect suicide vulnerability is important direction for future research.

Associations between NIH Toolbox Emotion Battery measures and previous suicide attempt in bipolar I disorder

Suicide attempts are more prevalent in people with bipolar I disorder (BD-I) than in the general population. Most prior studies of suicide in BD-I have focused on separate emotion-related assays or clinician-administered scales, whereas a single, brief, and multidimensional battery of self-report measures has not yet been explored. Here, we utilized the NIH Toolbox Emotion Battery (NIHTB-EB) to assess various emotional measures, determine which were cross-sectionally associated with prior suicide attempt in BD-I, evaluate whether the NIHTB-EB could be used to identify past suicide attempt in BD-I with machine learning, and compare model performance versus using clinical mood scales. The study included 39 participants with BD-I and history of suicide attempt, 48 with BD-I without history of suicide attempt, and 58 controls. We found that 9 of the 17 measures were associated with past suicide attempt in BD-I. The initial random forest model indicated that the most important distinguishing variables were perceived stress, emotional support, anger-hostility, anger-physical aggression, perceived rejection, loneliness, and self-efficacy. Overall, the models utilizing NIHTB-EB measures performed better (69.0 % to 70.1 % accuracy) than the model containing clinical mood scale information without the NIHTB-EB measures (57.5 % accuracy). These findings suggest the NIHTB-EB could be a useful and easy-to-deploy tool in understanding the role of emotion-related measures in suicide in BD-I. Furthermore, these results highlight specific emotional subdomains that could be promising targets for longitudinal studies or interventions aimed at reducing suicide in BD-I.

Exploring the mechanism of trait depression and cognitive impairment on the formation of among individuals with methamphetamine use disorder under varying degrees of social support

Background

Methamphetamine stands as one of the most widely abused drugs globally. Methamphetamine Use Disorder not only impairs the physical and mental wellbeing of addicts but also elevates their risk of suicide. Despite the high suicide rate among individuals with methamphetamine use disorder, research on their clinical characteristics and suicide risk factors remains scarce. Therefore, it is imperative to investigate the risk factors associated with suicidal ideation in individuals with methamphetamine use disorder.

Methods

Employing Respondent Driven Sampling (RDS), a total of 11,825 individuals with methamphetamine use disorder were selected from April to May 2023 in Guangdong, China. The individuals with methamphetamine use disorder were assessed using the Beck Scale for Suicide Ideation (BSSI), and the detection rate of suicidal ideation among these patients was 23.92%. The Bayesian Mindsponge Framework (BMF) analysis was utilized to examine the risk factors for suicidal ideation among these individuals.

Results

The result revealed that trait depression and cognitive impairment are positively correlated with suicidal ideation in people, whereas social support has a moderating effect on the relationship between trait depression and cognitive impairment with suicidal ideation.

Conclusion

Suicidal ideation in individuals with methamphetamine use disorder is influenced by a multitude of factors, including family, society, and stress. Consequently, comprehensive intervention measures are essential to address this issue.

Alcohol and substance use differentially impact suicidal ideation in a longitudinal cohort of bipolar disorder

BACKGROUND

Across bipolar disorders (BSDs), alcohol and substance use and suicidal ideation (SI) contribute to increased rates of morbidity and mortality. The goal of the present study was to investigate temporal relationships between the intensity/frequency (I/F) of use and impairment related to alcohol and substance use and SI in a longitudinal BSD cohort.

METHODS

Participants with BDI (n=565), BDII (n=162), and BD NOS (n=61) were included (median enrollment=72 months). Alcohol and substance use were measured using a modified version of the AUDIT administered every 6 months. SI was measured every 2 months using item 9 from the PHQ-9. Linear mixed effects models tested concurrent associations and Dynamic Structural Equation Models tested prospective associations between alcohol and substance use I/F and impairment with SI.

RESULTS

Cocaine I/F and alcohol and substance use impairment were concurrently associated with SI. When a person had more frequent and intense cannabis use compared to average, they had higher SI at the next timepoint. When individuals experienced more alcohol and substance use impairment than average, they had higher SI at the next timepoint.

CONCLUSIONS

I/F of cannabis use and alcohol and substance use impairment appear to lead to future increases in SI for those with BSDs.

Association of peripheral and cerebral inflammatory markers with suicidal deaths in Indian population

Globally, a suicide occurs every 43 seconds. In India, approximately 465 suicides took place daily in 2022, with a suicide rate of 12.4 per 100,000 population, exceeding the global rate of 9. This study aims to investigate differences in cytokine levels, including vascular endothelial growth factor (VEGF), between individuals who died by suicide and those who did not. Additionally, it aims to explore any pattern between plasma and cerebrospinal fluid (CSF) levels of these analytes. Concentrations of inflammatory cytokines, i.e., Interleukins: IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-13, Tumor Necrosis Factor-α and VEGF in plasma and CSF were analyzed among suicide death subjects (N = 6, cases) and non-suicidal death subjects (N = 59, controls). All analytes were quantified using a customized multiplex (9-plex) kit, with 50 µl of plasma and CSF in duplicates. Significantly higher levels of IL-6 (p < 0.001) and IL-10 (p < 0.05) were observed in the plasma of the suicidal group. However, no statistically significant changes were found in the rest of the analytes between the two groups. In CSF, only VEGF levels were significantly lower in the suicidal group (p < 0.01). In cases, significant positive correlations were observed between plasma and CSF levels of IL-1β, IL-4, IL-6, and IL-10, whereas in controls, only IL-8 demonstrated a significant positive correlation, indicating a moderate relationship between these cytokines systemic and central concentrations. Dysregulation of inflammatory biomarkers appears to play a crucial role in the pathophysiology of suicide. We conclude that higher levels of IL-6 are present in the plasma of suicide completers compared to non-suicidal deceased individuals.

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.

Toxoplasma gondii, suicidal behaviour and suicide risk factors in US Veterans enrolled in mental health treatment

Markers of chronic infection Toxoplasma gondii (Nicolle et Manceaux, 1908) have been associated with suicidal self-directed violence (SSDV). We present the results of the first study relating T. gondii IgG serology with suicide attempts and suicidal ideation in United States Veterans, known to have higher suicide rates than members of the general population. We also related T. gondii serology to SSDV risk factors, including valid and reliable measures of trait impulsivity, aggression, self-reported depression, and sleep disturbance. We recruited 407 Veterans enrolled at three Veterans Affairs Medical Centers with mean (S.D.) age = 45.6 (11.6) years; 304 men (74.7%); 203 with a history of SSDV and 204 with no history of any self-directed violence (SDV). Seropositivity and serointensity, categorised as high (top quartile) or low (lower three quartiles), were analysed in relationship to SSDV, suicidal ideation and clinical risk factors using age and gender-adjusted linear and logistic methods, after transformations and nonparametric tests when appropriate. Associations between seropositivity and SSDV and its risk factors were not significant in all groups. High serointensity, while not associated with SSDV or repeat suicide attempts, was positively associated with suicidal ideation, depression, impulsivity, and daytime dysfunction due to sleepiness (p < 0.05), but only in Veterans with a history of SSDV. In Veterans without a history of SDV, no associations were significant. These associations remained significant after adjustment for certain socioeconomic factors (i.e., income, homelessness, military rank). Including education in the model downgraded the statistical significance of suicidal ideation and depression to statistical trends, but the significance of associations with impulsivity and daytime dysfunction due to sleepiness remained. Major limitations include the cross-sectional design, overall low seropositivity within the sample, and potentially spurious results due to multiple comparisons. Thus, the results of this report need to be replicated in larger samples, ideally longitudinally.

Effect of dietary live microbe intake on the prevalence and mortality risks of depression and suicidal ideation in adults: Evidence from a nationwide population-based study

BACKGROUND

Gut microbial dysbiosis has been implicated in the pathogenesis of depression. Dietary interventions offer promising microbial-targeted therapeutics for depression. However, limited evidence exists regarding the associations between dietary live microbe intake and the prevalence of depression, as well as its impact on mortality risks.

METHODS

This study included 28,133 participants from the U.S. National Health and Nutrition Examination Survey (2005-2018), and ascertained their underlying causes of death. Weighted logistic regression was utilized to assess the relationships between live microbe intake and risks of depression and suicidal ideation. Independent and joint associations between live microbe and mortality outcomes were evaluated using multivariable Cox regression and Kaplan-Meier survival curves to calculate relative risks.

RESULTS

In the fully adjusted model, participants with high dietary live microbe intake had a significantly lower prevalence of depression (OR = 0.727, 95%CI: 0.627,0.844) and suicidal ideation (OR = 0.778, 95%CI: 0.648,0.935) than those with low intake. The multivariable-adjusted HRs for individuals in the G1 were 1.217 (95%CI, 1.081, 1.370) for all-cause mortality and 1.307 (95%CI, 1.029,1.661) for cardiovascular disease mortality, compared to participants in the G3. Kaplan-Meier survival analysis revealed that cumulative hazard of cardiovascular mortality was progressively lower among participants with depression in the G3 than those without depression.

CONCLUSIONS

Higher live microbe intake was associated with a lower prevalence of depression and suicidal ideation, and was linked to significantly decreased risks of all-cause and cardiovascular mortality. Further larger prospective studies are essential to verify the health effects of live microbes, and personalized dietary recommendations are necessary.

Changes in Rates of Suicide by Mass Shooters, 1980-2019

OBJECTIVE

The rate of worldwide mass shootings increased almost 400% over the last 40 years. About 30% are followed by the perpetrator's fatal or nonfatal suicide attempt.

METHOD

We examined the rate of fatal and nonfatal attempts among 528 mass shooters over the last 40 years and their relationship to detected mental illness to better understand this specific context of suicide. We collected information on U.S.-based, personal-cause mass murders that involved one or more firearms, from online sources.

RESULTS

A greater proportion of mass shooters from 2000 to 2019 took or attempted to take their own lives (40.5%) compared with those from 1980 to 1999 (23.2%, p < 0.001). More than double the proportion of perpetrators who made a fatal or nonfatal suicide attempt had a history of non-psychotic psychiatric/neurologic symptoms (38.9%), compared with perpetrators who did not make a fatal or nonfatal suicide attempt (18.1%; p < 0.001). Among mass shooters who made fatal or nonfatal suicide attempts, 77 of 175 (44%) did not have any recorded psychiatric, neurologic, or substance use condition. Of the 98 mass shooters who made fatal or non-fatal suicide attempts and had a psychiatric, substance use, or neurologic condition, 41 had depressive disorders.

CONCLUSION

It is possible that a lack of information about the perpetrators' mental health or suicidal ideation led to an underestimation of their prevalence. These data suggest that suicide associated with mass shootings may represent a specific context for suicide, and approaches such as psychological autopsy can help to ascertain when psychiatric illness mediates the relationship between mass shootings and suicide.

Suicide and sudden violent death among young people: Two sides of the same coin?

The aim of the present study was to compare risk factors for death by suicide and sudden violent death (SVD) among young people aged 10-25 years. Two target samples, 63 consecutive cases of youth suicide and 62 cases of SVD, were compared on potential risk factors differentiating the two groups from 104 controls. Data on psychiatric diagnoses, psychosocial factors, adverse childhood experiences, stressful life events, and coping strategies were collected in psychological autopsy interviews. Distinguishing for the suicide group was lower frequency of living in a steady relationship, adult psychiatric care, depression, autism spectrum disorder, being sexually assaulted, higher frequency of recent stressful life events, and lowest levels of adaptive coping. Distinguishing for the SVD group was a predominance of males, lower elementary school results, abuse of psychoactive drugs, being investigated or sentenced for criminal acts, conduct disorder or antisocial personality disorder. Common risk factors for both kinds of premature unnatural death included lower educational level, absence of work or studies, different forms of addiction, child and adolescent psychiatric care, borderline personality disorder, adverse childhood experiences, and less adaptive coping. Accordingly, there is a common ground of vulnerabilities, early adversities, and recent strains in life for both forms of premature death, but also substantial differences between these contrasting lethal developments. Prevention of both suicide and SVD should focus on adverse childhood experiences, learning difficulties, meaningful occupation, more adaptive coping, addiction, and treatment of borderline personality disorder. Suicide prevention should comprise promotion of adaptive stress management skills, depression prevention and treatment, and paying attention to young people with autism. SVD prevention should involve early response to learning difficulties, abuse of psychoactive drugs and delinquent behavior, and treatment of conduct disorder and antisocial personality disorder.

Network based evidence of suicidal ideation among teachers

This study investigates the relationship between risk and protective factors and suicidal ideation among teachers, a group often overlooked in suicide prevention efforts. Using the diathesis-stress model as a partial framework, the research explores how depression and anxiety, as risk factors, and emotional intelligence, resilience, and positive thoughts, as protective factors, influence suicidal ideation. A cross-sectional design was employed, involving 1,270 Spanish teachers (median age: 46, 70.2% female). Key measures included the Positive and Negative Suicidal Ideation scale (PANSI), the Brief Emotional Intelligence Scale (BEIS-10), the Brief Resilient Coping Scale (BRCS) for resilience, and the General Health Questionnaire (GHQ-12) for depression and anxiety. A network approach was used to examine the relationships between these variables. Results showed that depression had a stronger relationship with negative ideation than anxiety, while emotional intelligence and positive thoughts acted as protective factors. Positive ideation was negatively associated with depression and anxiety, and positively linked to emotional intelligence and resilience. Emotional intelligence emerged as the most critical protective factor. These findings provide valuable evidence to inform the development of emotional management and resilience-building programs aimed at enhancing teachers' mental health and performance, which could also indirectly benefit students.

The Relationship Between Metacognitive Beliefs and Suicidal Ideation Among Chinese Male Prisoners: A Network Analysis

BACKGROUND

The relationship between metacognitive beliefs and suicidal ideation is complex, yet there is limited research exploring 'the fine-grained and comorbid pathways between the two variables', particularly in prisoners.

METHODS

Data were collected from prisoners who completed demographic surveys and psychological scales between February and March 2024. Demographic information included age, educational background and duration of imprisonment. The Metacognitions Questionnaire-30 (MCQ-30) and Self-Rating Idea of Suicide Scale (SIOSS) were administered. Using R 4.2.3 software, a network model of metacognitive beliefs and suicidal ideation was constructed, with expected influence (EI) and bridge expected influence (BEI) calculated to compare the roles of specific symptoms within the network.

RESULTS

The network model revealed 21 significant edges between metacognitive beliefs and the suicidal ideation community. The most vital edges across communities included 'Negative beliefs about worry' and 'Despair', 'Cognitive confidence' and 'Despair', 'Cognitive self-consciousness' and 'Optimism', and 'Cognitive confidence' and 'Sleep' (with edge weights of 0.30, 0.16, -0.16 and 0.11, respectively). 'Despair' demonstrated the highest EI value, exerting the strongest impact on the network. The highest BEI values were found for 'Negative beliefs about worry' and 'Despair'.

CONCLUSION

Network analyses underscore the intricate interplay between metacognitive beliefs and suicidal ideation among prisoners at the symptom level. These findings highlight specific areas for therapeutic focus, potentially leading to more effective mental health support for incarcerated individuals.

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.

The influence of negative life events on college students' suicidal ideation: the mediating role of entity theory and the moderating role of meaning in life

Suicidal ideation is a desire, thought, or conception that is closely associated with suicide, which is an important risk factor for suicidal behavior. Negative life events may impact college students' suicidal ideation. According to the suicide susceptibility-stress model, the interaction between susceptibility factors and stressors may influence college students' suicidal ideation. The present study investigated the role of entity theory and meaning in life in the influence of negative life events on suicidal ideation among college students. A nationwide questionnaire survey was conducted among 938 college students. The Beck Scale for Suicide Ideation, the Implicit Personality Theory Questionnaire, the Adolescent Life Events Scale, and the Meaning in Life Questionnaire were used. The results showed that negative life events were positively correlated with suicidal ideation, entity theory played a mediating role, and meaning in life moderated the mediation of entity theory. Finally, meaning in life and entity theory may bring some benefits to college students; that is, when faced with negative life events, meaning in life and entity theory may attenuate students' suicidal ideation.

Implicit measures of suicide vulnerability: Investigating suicide-related information-processing biases and a deficit in behavioral impulse control in a high-risk sample and healthy controls

OBJECTIVE

Relevant implicit markers of suicidal thoughts and behaviors (STBs) have only been studied in isolation with mixed evidence. This is the first study that investigated a suicide attentional bias, a death-identity bias and a deficit in behavioral impulsivity in a high-risk sample and healthy controls.

METHOD

We administered the Death Implicit Association Test, the Modified Suicide Stroop Task, and a Go/No-Go Task to inpatient suicide ideators (n = 42), suicide attempters (n = 40), and community controls (n = 61).

RESULTS

Suicide ideators and attempters showed a suicide attentional bias and a death-identity bias compared to healthy controls. Ideators and attempters did not differ in these implicit information-processing biases. Notably, only attempters were more behaviorally impulsive compared to controls; however, ideators and attempters did not significantly differ in behavioral impulsivity. Moreover, implicit scores were positively intercorrelated in the total sample.

CONCLUSION

In line with the Cognitive Model of Suicide, ideators and attempters display suicide-related information processing biases, which can be considered as implicit cognitive markers of suicide vulnerability. Furthermore, attempters have elevated levels of behavioral impulsiveness. These results are highly relevant in the context of crisis intervention strategies and warrant further research.

Ecological momentary assessments of cognitive dysfunction and passive suicidal ideation among college students

Cognitive dysfunction (CD), inclusive of specific cognitive content (e.g., hopelessness, unbearability) or impaired cognitive processes (e.g., attentional fixation on suicide, rumination), is a key risk factor for suicidal ideation (SI). This study aimed to evaluate multiple forms of CD using ecological momentary assessment (EMA) to determine the unique contributions of CD to concurrent and prospective SI. Fifty-five college students with a history of SI or non-suicidal self-injury completed EMA surveys measuring momentary CD and passive SI ("Wish to Die" [WTD], "Wish to Stay Alive" [WTL]) four times a day for 14 days (2149 total observations). Passive SI and CD variables showed notable within-person variability. Multiple CD variables were significant predictors of concurrent ideation when examined simultaneously in multilevel models with random intercepts and fixed slopes, and associations were stronger when participants were around others. Controlling for concurrent passive SI, between-person rumination was a significant predictor of prospective WTD, and both within-person unbearability and between-person hopelessness were each predictive of prospective WTL. These findings provide evidence for the roles of specific types of CD in conferring risk for passive SI and highlight potentially malleable factors that can be changed through targeted interventions.

Suicides, Other External Causes of Death, and Psychiatric Status in Suicide Attempters: A National Registry-Based Analysis in Israel, 2006-2020

OBJECTIVE

To assess risk factors and rates of suicide and other external cause deaths, among suicide attempters compared to the total population, stratified by psychiatric hospitalization discharge and mental diagnosis.

METHODS

A national registry-based analysis of suicide and external cause mortality was performed among suicide attempters between 2006 and 2020 in Israel in the National Hospital ED database. Data was stratified by psychiatric hospitalization status by linking to the national psychiatric case registry. Age adjusted mortality rates were calculated.A multivariate cox regression model assessed the relative risk of demographic factors and psychiatric diagnosis and hospitalization on outcomes.

RESULTS

Among 57,579 first suicide attempters, of whom 16,874 had a psychiatric hospitalization, there were 853 suicides (1.5%) and 473 deaths from other external causes (0.8%), 485 suicides (2.9%) and 199 external cause deaths (1.2%) in the psychiatric group. Suicide risk was highest in the year after the attempt, but continued throughout the study, particularly in the psychiatric hospitalized group. Suicide rates within one year of first suicide attempt were 137 (95% CI 122-152) times higher than the total population, 190 (155-233) times in females and 128 (112-145) times in males, 178 (153-207), 243 (181-325) and 158 (132-190) times higher, respectively, in those with a psychiatric hospitalization.

CONCLUSIONS

We found a greatly increased risk for suicide and significant increase for other external causes of death amongst a cohort of suicide attempters, compared to the total population, particularly those with a history of psychiatric hospitalization.

Risk factors of suicide re-attempt: A two-year prospective study

BACKGROUND

History of suicide attempt (SA) is the strongest predictor of a new SA and suicide. It is primordial to identify additional risk factors of suicide re-attempt. The aim of this study was to identify risk factors of suicide re-attempt in patients with recent SA followed for 2 years.

METHODS

In this multicentric cohort of adult inpatients, the median of the index SA before inclusion was 10 days. Clinicians assessed a large panel of psychological dimensions using validated tools. Occurrence of a new SA or death by suicide during the follow-up was recorded. A cluster analysis was used to identify the dimensions that best characterized the population and a variable "number of personality traits" was created that included the three most representative traits: anxiety, anger, and anxious lability. Risk factors of re-attempt were assessed with adjusted Cox regression models.

RESULTS

Among the 379 patients included, 100 (26.4 %) re-attempted suicide and 6 (1.6 %) died by suicide. The two major risk factors of suicide re-attempt were no history of violent SA and presenting two or three personality traits among trait anxiety, anger and anxious lability.

LIMITATIONS

It was impossible to know if treatment change during follow-up occur before or after the re-attempt.

DISCUSSION

One of the most important predictors of re-attempt in suicide attempters with mood disorders, was the presence of three personality traits (anger, anxiety, and anxious lability). Clinicians should provide close monitoring to patients presenting these traits and proposed treatments specifically targeting these dimensions, especially anxiety.

Does suicide contagion (Werther effect) take place in response to social media? A systematic review

INTRODUCTION

The Werther, Copycat or contagion effect of suicidal behaviour is a complex phenomenon that can arise due to exposure to media stories in which identifiable people take their lives. On the contrary, the Papageno effect prevents people from suicide by promoting positives examples of suicidal crisis management. Impact of both effects has been widely studied in different types of situations, but its existence in social media is a source of much debate.

METHODS

A systematic search following the PRISMA guidelines of PubMed, Scopus, Embase, PsycInfo, Web of Science and the references of prior reviews yielded 25 eligible studies.

RESULTS

Most of the studies found were observational, with very different methodologies and generally with low risk of bias. In these, the results suggest the existence of the Werther effect in response to social media stories about suicide. This is mediated by multiple factors, including the characteristic of the users, the type of interaction and the content of the publications. At the same time, the Papageno effect is also described. Evidence found by type of social media and future implications are discussed.

CONCLUSION

Suicidal content on social media can be both contagious and protective. It is confirmed that the Werther and Papageno effects may occur in response to social media, so they could be an interesting target for preventive interventions.

From Social Stress and Isolation to Autonomic Nervous System Dysregulation in Suicidal Behavior

PURPOSE OF REVIEW

In this narrative review we wanted to describe the relationship of autonomic nervous system activity with social environment and suicidal spectrum behaviors.

RECENT FINDINGS

Patients with suicidal ideation/suicide attempt have higher sympathetic nervous system (SNS) and lower parasympathetic nervous system (PNS) activity in resting conditions and during acute stress tasks compared with patients without suicidal ideation/suicide attempt. Death by suicide and violent suicide attempt also are related to SNS hyperactivation. Similarly, a SNS/PNS imbalance has been observed in people with childhood trauma, stressful life events or feelings of loneliness and isolation. Social support seems to increase PNS control and resilience. Due to the importance of the social context and stressful life events in suicidal behavior, SNS/PNS imbalance could act as a mediator in this relationship and be a source of relevant biomarkers. Childhood trauma and stressful life events may impair the autonomic nervous system response in suicidal patients. Loneliness, isolation and social support may act as moderators in acute stress situations.

Exploring risk factors and their differences on suicidal ideation and suicide attempts among depressed adolescents based on decision tree model

BACKGROUND

Suicide has been recognized as a major global public health issue. Depressed adolescents are more prone to experiencing it. We explore risk factors and their differences on suicidal ideation and suicide attempts to further enhance our understanding of suicidal behavior.

METHODS

2343 depressed adolescents aged 12-18 from 9 provinces/cities in China participated in this cross-sectional study. We utilized decision tree model, incorporating 32 factors encompassing participants' suicidal behavior. The feature importance of each factor was measured using Gini coefficients.

RESULTS

The decision tree model demonstrated a good fit with high accuracy (SI = 0.86, SA = 0.85 and F-Score (SI = 0.85, SA = 0.83). The predictive importance of each factor varied between groups with suicidal ideation and with suicide attempts. The most significant risk factor in both groups was depression (SI = 16.7 %, SA = 19.8 %). However, factors such as academic stress (SI = 7.2 %, SA = 1.6 %), hopelessness (SI = 9.1 %, SA = 5.0 %), and age (SI = 7.1 %, SA = 3.2 %) were more closely associated with suicidal ideation than suicide attempts. Factors related to the schooling status (SI = 3.5 %, SA = 10.1 %), total years of education (SI = 2.6 %, SA = 8.6 %), and loneliness (SI = 2.3 %, SA = 7.4 %) were relatively more important in the suicide attempt stage compared to suicidal ideation.

LIMITATIONS

The cross-sectional design limited the ability to capture changes in suicidal behavior among depressed adolescents over time. Possible bias may exist in the measurement of suicidal ideation.

CONCLUSION

The relative importance of each risk factor for suicidal ideation and attempted suicide varies. These findings provide further empirical evidence for understanding suicide behavior. Targeted treatment measures should be taken for different stages of suicide in clinical interventions.

Association of clinical characteristics, depression remission and suicide risk with discrepancies between self- and clinician-rated suicidal ideation: Two large naturalistic cohorts of outpatients with depression

Clinician- and self-rating of suicidal ideation (SI) are often discrepant. The aim of this study was to determine: 1) Association between discrepant self- and clinician-rated SI with clinical characteristics, depression remission and SA (SA) risk; 2) which SI assessment (self or clinician) predicted depression remission and risk of SA. LUEUR and GENESE are two large, prospective, naturalistic cohorts of French adult outpatients with unipolar depression treated and followed for 6 weeks. SI presence was assessed and defined with a score to the suicidal item of the Montgomery-Åsberg Depression Rating Scale ≥3. Discordant SI was defined as SI detection by only one of the two evaluators (patient or clinician). In both cohorts, 49.3 % (GENESE) and 34 % (LUEUR) patients had discordant SI. Clinical characteristics were more severe, and risk of SA was higher in patients with current SI (concordant and discordant) than in patients without SI and in the concordant than in the discordant group. Prediction of the risk of SA and of depression non-remission was comparable by the two ratings. Patients with SI (concordant and discordant) have more severe clinical characteristics and patients with concordant SI are the most at risk of SA during the follow-up. It is crucial to assess SI and to improve how it is evaluated.

Real-world evidence from a retrospective study on suicide during depression: clinical characteristics, treatment patterns and disease burden

BACKGROUND

Suicide stands as both a primary symptom and the direst outcome of major depressive disorder (MDD). The scarcity of effective treatment strategies makes managing MDD patients with suicide especially challenging. Hence, it is crucial to investigate disease characteristics and efficacious therapeutic strategies for these patients, drawing insights from disease databases and real-world data.

METHODS

In this retrospective study, MDD patients hospitalized between January 2013 and December 2020 were investigated using Electronic Health Records (EHR) data from Beijing Anding Hospital. The study enrolled 4138 MDD patients with suicidal ideation or behavior (MDS) and 3848 without (MDNS). Demographic data, clinical attributes, treatment approaches, disease burden, and re-hospitalization within one year of discharge were extracted and compared.

RESULTS

Patients in the MDS group were predominantly younger and female, exhibiting a higher prevalence of alcohol consumption, experiencing frequent life stress events, and having an earlier onset age. Re-hospitalizations within six months post-discharge in the MDS group were significantly higher than in the MDNS group (11.36% vs. 8.91%, p < 0.001). Moreover, a more considerable fraction of MDS patients underwent combined electroconvulsive therapy treatment (56.72% vs. 43.71%, p < 0.001). Approximately 38% of patients in both groups were prescribed two or more therapeutic regimes, and over 90% used antidepressants, either alone or combined. Selective serotonin reuptake inhibitors (SSRIs) were the predominant choice in both groups. Furthermore, antidepressants were often prescribed with antipsychotics or mood stabilizers. When medication alterations were necessary, the favoured options involved combination with antipsychotics or transitioning to alternative antidepressants. Yet, in the MDS group, following these initial modifications, the addition of mood stabilizers tended to be the more prioritized alternative.

CONCLUSIONS

MDD patients with suicidal ideation or behaviour displayed distinctive demographic and clinical features. They exhibited intricate treatment patterns, a pronounced burden of illness, and an increased likelihood of relapse.

Analysis of risk factors of suicidal ideation in adolescent patients with depression and construction of prediction model

BACKGROUND

Major depressive disorder is a common mental illness among adolescents and is the largest disease burden in this age group. Most adolescent patients with depression have suicidal ideation (SI); however, few studies have focused on the factors related to SI, and effective predictive models are lacking.

AIM

To construct a risk prediction model for SI in adolescent depression and provide a reference assessment tool for prevention.

METHODS

The data of 150 adolescent patients with depression at the First People's Hospital of Lianyungang from June 2020 to December 2022 were retrospectively analyzed. Based on whether or not they had SI, they were divided into a SI group (n = 91) and a non-SI group (n = 59). The general data and laboratory indices of the two groups were compared. Logistic regression was used to analyze the factors influencing SI in adolescent patients with depression, a nomogram prediction model was constructed based on the analysis results, and internal evaluation was performed. Receiver operating characteristic and calibration curves were used to evaluate the model's efficacy, and the clinical application value was evaluated using decision curve analysis (DCA).

RESULTS

There were differences in trauma history, triggers, serum ferritin levels (SF), high-sensitivity C-reactive protein levels (hs-CRP), and high-density lipoprotein (HDL-C) levels between the two groups (P < 0.05). Logistic regression analysis showed that trauma history, predisposing factors, SF, hs-CRP, and HDL-C were factors influencing SI in adolescent patients with depression. The area under the curve of the nomogram prediction model was 0.831 (95%CI: 0.763-0.899), sensitivity was 0.912, and specificity was 0.678. The higher net benefit of the DCA and the average absolute error of the calibration curve were 0.043, indicating that the model had a good fit.

CONCLUSION

The nomogram prediction model based on trauma history, triggers, ferritin, serum hs-CRP, and HDL-C levels can effectively predict the risk of SI in adolescent patients with depression.

The Impact of Recent Life Events, Internalizing Symptoms, and Emotion Regulation on the Severity of Non-Suicidal Self-Injury in Adolescents: A Mediation Analysis

Background

Previous studies have demonstrated a strong association between recent stressful life events and non-suicidal self-injury (NSSI) among adolescents. Internalizing symptoms and difficulty in emotion regulation (DER) may mediate this relationship. This study aimed to investigate the relationship between recent stressful life events and NSSI severity in adolescents and the potential moderating role of internalizing symptoms and DER.

Methods

A total of 224 adolescent inpatients (78.6% female) participated in the study, with an age range of 12-18 years old. Data on recent stressful life events, internalizing symptoms, DER, and NSSI behaviors were collected using a clinician-rated questionnaire. A structural equation model was used to test the hypothesized model.

Results

The rate of NSSI reporting among adolescents in the past 12 months was 65.18%. Recent stressful life events were found to be directly associated with NSSI severity (β = 0.128, P = 0.023). A chain-mediating effect between recent stressful life events and NSSI was also confirmed (β = 0.034, P = 0.023), with DER and internalizing symptoms playing a chain-mediating role and DER having a significantly indirect association with NSSI through internalizing symptoms.

Conclusion

Recent stressful life events appear to play a role in the etiology of NSSI, particularly punishment and interpersonal relationship events that warrant special attention. DER and internalizing symptoms play a chain-mediating role in the relationship between life events and NSSI. Reducing recent stressful life events, screening for internalizing symptoms, and improving emotion regulation may decrease NSSI behavior among adolescents.

The Relationship between Depression Severity and Prefrontal Hemodynamic Changes in Adolescents with Major Depression Disorder: A Functional Near-infrared Spectroscopy Study

Objective

: Numerous studies have identified hemodynamic changes in adults with major depressive disorder (MDD) by using functional near-infrared spectroscopy (fNIRS). However, studies on adolescents with MDD are limited. As adolescence is a stage of rapid brain development, differences may occur depending on age. This study used fNIRS as an objective tool to investigate hemodynamic changes in the frontal lobe according to depression severity and age in adolescents with MDD.

Methods

: Thirty adolescents (12 aged 12-15 years and 18 aged 16-18 years) were retrospectively investigated. The Children's Depression Inventory was used as a psychiatric evaluation scale, fNIRS was used as an objective brain function evaluation tool, and the Verbal Fluency Test was performed.

Results

: During the Verbal Fluency Test, in the younger MDD group, oxygenated-hemoglobin concentration increased in the right dorsolateral prefrontal cortex region as the severity of depression increased. In the older MDD group, the oxygenated-hemoglobin concentration decreased in the right dorsolateral prefrontal cortex region as the severity of depression increased.

Conclusion

: These results suggest that fNIRS may be an objective tool for identifying age differences among adolescents with MDD. To generalize the results and verify fNIRS as a potential biomarker tool, follow-up studies with a larger sample group should be conducted.

Evolutionary conservation of putative suicidality-related risk genes that produce diminished motivation corrected by clozapine, lithium and antidepressants

Background

Genome wide association studies (GWAS) and candidate gene analyses have identified genetic variants and genes that may increase the risk for suicidal thoughts and behaviors (STBs). Important unresolved issues surround these tentative risk variants such as the characteristics of the associated genes and how they might elicit STBs.

Methods

Putative suicidality-related risk genes (PSRGs) were identified by comprehensive literature search and were characterized with respect to evolutionary conservation, participation in gene interaction networks and associated phenotypes. Evolutionary conservation was established with database searches and BLASTP queries, whereas gene-gene interactions were ascertained with GeneMANIA. We then examined whether mutations in risk-gene counterparts in C. elegans produced a diminished motivation phenotype previously connected to suicide risk factors.

Results and conclusions

From the analysis, 105 risk-gene candidates were identified and found to be: 1) highly conserved during evolution, 2) enriched for essential genes, 3) involved in significant gene-gene interactions, and 4) associated with psychiatric disorders, metabolic disturbances and asthma/allergy. Evaluation of 17 mutant strains with loss-of-function/deletion mutations in PSRG orthologs revealed that 11 mutants showed significant evidence of diminished motivation that manifested as immobility in a foraging assay. Immobility was corrected in some or all of the mutants with clozapine, lithium and tricyclic antidepressant drugs. In addition, 5-HT2 receptor and muscarinic receptor antagonists restored goal-directed behavior in most or all of the mutants. These studies increase confidence in the validity of the PSRGs and provide initial clues about possible mechanisms that mediate STBs.

To be or not to be: The active inference of suicide

Suicide presents an apparent paradox as a behavior whose motivation is not obvious since its outcome is non-existence and cannot be experienced. To address this paradox, we propose to frame suicide in the integrated theory of stress and active inference. We present an active inference-based cognitive model of suicide as a type of stress response hanging in cognitive balance between predicting self-preservation and self-destruction. In it, self-efficacy emerges as a meta-cognitive regulator that can bias the model toward either survival or suicide. The model suggests conditions under which cognitive homeostasis can override physiological homeostasis in motivating self-destruction. We also present a model proto-suicidal behavior, programmed cell death (apoptosis), in active inference terms to illustrate how an active inference model of self-destruction can be embodied in molecular mechanisms and to offer a hypothesis on another puzzle of suicide: why only humans among brain-endowed animals are known to practice it.

The mediating role of sleep problems and depressed mood between psychological abuse/neglect and suicidal ideation in adolescent childhood: a multicentred, large sample survey in Western China

BACKGROUND

Adolescent suicidal ideation are associated with factors including psychological abuse/neglect, sleep problems, and depressed mood, but the systematic effects of these factors on suicidal ideation remain unclear, which is a research gap this work aims to fill.

METHODS

A multi-center, the cluster sampling method was employed to collect general demographic data, such as age, gender, the experience of being left behind, and parents' marital status, from 12,192 students across 17 secondary schools in China. The Child Psychological Abuse and Neglect Scale (CPANS), Pittsburgh Sleep Quality Index (PSQI), the Chinese version of the Depressed mood, Anxiety and Stress Scale - 21 Items (DASS-21) and Chinese version of Positive and Negative Suicide Ideation Inventory (PANSI) were utilized. Data were analyzed using t-tests, chi-square tests, correlation analyses, and structural equation modeling mediation analyses.

RESULTS

The prevalence of psychological abuse/neglect and adolescent suicidal ideation was 34.8% and 13%, respectively. This mediation analysis suggests that, in the relationship between psychological abuse/neglect and suicidal ideation, sleep problems and depressed mood play both parallel and sequential mediating roles.

CONCLUSION

Sleep problems and depressed mood play a mediating role in the development of suicidal ideation in adolescents. Good sleep habits and depressed mood interventions help reduce the risk of suicidal ideation in adolescents who experience psychological neglect/abuse.

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.

EEG wakefulness regulation in transdiagnostic patients after a recent suicide attempt

OBJECTIVE

Decades of research have not yet produced statistically reliable predictors of preparatory behavior eventually leading to suicide attempts or deaths by suicide. As the nature of suicidal behavior is complex, it is best investigated in a transdiagnostic approach, while assessing objective markers, as proposed by the Research Domain Criteria (Cuthbert, 2013).

METHODS

A 15-min resting-state EEG was recorded in 45 healthy controls, and 49 transdiagnostic in-patients with a recent (<6 months) suicide attempt. Brain arousal regulation in eyes-closed condition was assessed with the Vigilance Algorithm Leipzig (VIGALL) (Sander et al., 2015).

RESULTS

A significant incline of median vigilance and vigilance slope was observed in patients within the first 3-min of the EEG recording. Additionally, a significant positive correlation of self-reported suicidal ideation with the vigilance slope over 15-min recording time, as well as a significant negative correlation with EEG vigilance stage A1 during the first 3-min was found.

CONCLUSIONS

Transdiagnostic patients with a recent suicide attempt show a distinct vigilance regulation pattern. Further studies including a control group consisting of patients without life-time suicide attempts are needed to increase the clinical utility of the findings.

SIGNIFICANCE

These findings might serve as potential objective markers of suicidal behavior.

"I Can't See an End in Sight." How the COVID-19 Pandemic May Influence Suicide Risk

Background: The COVID-19 pandemic and its consequences may affect population mental health and suicide risk. Aims: To explore the experiences among suicidal individuals who made calls to a suicide prevention hotline and to identify factors and psychological responses that may influence suicide risk. Method: We identified 60 eligible recorded calls to Taiwan's suicide prevention hotline (January 23, 2020-May 31, 2020) and analyzed the transcripts using a framework analysis. Results: We identified three themes: (a) effects of the COVID-19 pandemic on society (impacts on local economies, the fear of contagion, and disruptions caused by outbreak control measures); (b) stress experienced by callers, including increased challenges (financial burden, restricted freedom of movement, interpersonal conflicts, feelings of uncertainty, and education/career interruption) and reduced support (reduced access to health services and social support); and (c) the callers' psychological responses to stress, including anxiety, sleep disturbance, depression, loneliness, hopelessness, and entrapment, which may increase suicide risk. Limitations: Only the experiences among those who sought help by calling the hotline during the early months of the pandemic in 2020 were explored. Conclusion: Our findings revealed the potential process underlying the impact of the COVID-19 pandemic on suicide risk and have implications for prevention and intervention strategies.

Alterations of BDNF, mGluR5, Homer1a, p11 and excitatory/inhibitory balance in corticolimbic brain regions of suicide decedents

BACKGROUND

Developing biological based approaches for preventing suicide has become a priority. In recent years, there has been a surge in studies investigating the role of the glutamatergic system in suicide, although it remains unclear.

METHODS

We evaluated changes in the gene expression of the metabotropic glutamate receptor 5 (mGluR5) and its scaffolding proteins Homer1a and p11 in the dorsolateral prefrontal cortex (DLPFC), amygdala (AMY), and hippocampus (HIP) of 28 suicide decedents (S) (with no clinical psychiatric history or treatment with anxiolytics or antidepressants) and 26 controls (C) by real-time PCR (qPCR). Indeed, we measured BDNF gene expression and VGluT1 and VGAT immunoreactivities in the HIP by qPCR and immunohistochemistry, respectively. Cases and controls matched for age (C: 48.6 ± 11.6 years; S: 46.9 ± 14.5 years) and postmortem interval (PMI; C: 20.1 ± 13h; S: 16.9 ± 5h).

RESULTS

In DLPFC, S had lower p11 gene expression levels, but no differences were found in mGluR5 or Homer1a. In the AMY and HIP, mGluR5 and Homer1a were increased, p11 and BDNF were reduced. In the HIP, there were less VGAT-ir and more VGluT1-ir.

LIMITATIONS

Future studies are necessary to evaluate protein levels, and determine the cell types and potential compensatory mechanisms in a larger sample including S diagnosed with psychiatric disorders, females and different ethnicities.

CONCLUSIONS

This study identified significant alterations in mGluR5, Homer1a, p11, BDNF and excitatory/inhibitory balance in corticolimbic brain areas of S. These results further characterize the biological basis of suicide, contributing to the identification of potential biomarkers for suicide prevention.

Establishment of a risk prediction model for suicide attempts in first-episode and drug naïve patients with major depressive disorder

BACKGROUND

Suicide is common in patients with major depressive disorder (MDD) and has serious consequences for individuals and families. This study aims to establish a risk prediction model for suicide attempts in MDD patients to make the detection of suicide risk more accurate and effective.

METHODS

A cross-sectional survey, clinical examination, and biochemical indicator tests were performed on 1718 first-episode and drug naïve patients with major depressive disorder. We used Machine Learning to establish a risk prediction model for suicide attempts in FEDN patients with MDD.

RESULTS

Five predictors were identified by LASSO regression analysis from a total of 20 variables studied, namely psychotic symptoms, anxiety symptoms, thyroid peroxidase antibodies (ATPO), total cholesterol (TC), and high-density lipoprotein-cholesterol (HDL-C). The model constructed using the five predictors displayed moderate predictive ability, with an area under the ROC of 0.771 in the training set and 0.720 in the validation set. The DCA curve showed that the nomogram could be applied clinically if the risk threshold was between 22 % and 60 %. The risk threshold was found to be between 20 % and 60 % in external validation.

CONCLUSION

Introducing psychotic symptoms, anxiety symptoms, ATPO, TC, and HDL-C to the risk nomogram increased its usefulness for predicting suicide risk in patients with MDD. It may be useful in clinical decision-making or in discussions with patients, especially in crisis interventions.

Insights into the neurobiology of suicidality: explicating the role of glutamatergic systems through the lens of ketamine

Suicidality is a prevalent mental health condition, and managing suicidal patients is one of the most challenging tasks for health care professionals due to the lack of rapid-acting, effective psychopharmacological treatment options. According to the literature, suicide has neurobiological underpinnings that are not fully understood, and current treatments for suicidal tendencies have considerable limitations. To treat suicidality and prevent suicide, new treatments are required; to achieve this, the neurobiological processes underlying suicidal behavior must be thoroughly investigated. Although multiple neurotransmitter systems, particularly serotonergic systems, have been studied in the past, less has been reported in relation to disruptions in glutamatergic neurotransmission, neuronal plasticity, and neurogenesis that result from stress-related abnormalities of the hypothalamic-pituitary-adrenal system. Informed by the literature, which reports robust antisuicidal and antidepressive properties of subanaesthetic doses of ketamine, this review aims to provide an examination of the neurobiology of suicidality (and relevant mood disorders) with implications of pertinent animal, clinical, and postmortem studies. We discuss dysfunctions in the glutamatergic system, which may play a role in the neuropathology of suicidality and the role of ketamine in restoring synaptic connectivity at the molecular levels.

Prospective associations of emotion reactivity and risk behaviors with suicide attempts in US Army soldiers

BACKGROUND

Emotion reactivity and risk behaviors (ERRB) are transdiagnostic dimensions associated with suicide attempt (SA). ERRB patterns may identify individuals at increased risk of future SAs.

METHODS

A representative sample of US Army soldiers entering basic combat training (n = 21 772) was surveyed and followed via administrative records for their first 48 months of service. Latent profile analysis of baseline survey items assessing ERRB dimensions, including emotion reactivity, impulsivity, and risk-taking behaviors, identified distinct response patterns (classes). SAs were identified using administrative medical records. A discrete-time survival framework was used to examine associations of ERRB classes with subsequent SA during the first 48 months of service, adjusting for time in service, socio-demographic and service-related variables, and mental health diagnosis (MH-Dx). We examined whether associations of ERRB classes with SA differed by year of service and for soldiers with and without a MH-Dx.

RESULTS

Of 21 772 respondents (86.2% male, 61.8% White non-Hispanic), 253 made a SA. Four ERRB classes were identified: 'Indirect Harming' (8.9% of soldiers), 'Impulsive' (19.3%), 'Risk-Taking' (16.3%), and 'Low ERRB' (55.6%). Compared to Low ERRB, Impulsive [OR 1.8 (95% CI 1.3-2.4)] and Risk-Taking [OR 1.6 (95% CI 1.1-2.2)] had higher odds of SA after adjusting for covariates. The ERRB class and MH-Dx interaction was non-significant. Within each class, SA risk varied across service time.

CONCLUSIONS

SA risk within the four identified ERRB classes varied across service time. Impulsive and Risk-Taking soldiers had increased risk of future SA. MH-Dx did not modify these associations, which may therefore help identify risk in those not yet receiving mental healthcare.

A Systematic Review of MRI Studies and the "Emotional paiN and social Disconnect (END)" Brain Model of Suicidal Behavior in Youth

Introduction

Risk of suicidal ideation and suicidal behaviors greatly increases during adolescence, and rates have risen dramatically over the past two decades. However, few risk factors or biomarkers predictive of suicidal ideation or attempted suicide have been identified in adolescents. Neuroimaging correlates hold potential for early identification of adolescents at increased risk of suicidality and risk stratification for those at high risk of suicide attempt.

Methods

In this systematic review, we evaluated neural regions and networks associated with suicidal ideation and suicide attempt in adolescents derived from magnetic resonance imaging (MRI) studies. A total of 28 articles were included in this review.

Results

After descriptively synthesizing the literature, we propose the Emotional paiN and social Disconnect (END) model of adolescent suicidality and present two key neural circuits: (1) the emotional/mental pain circuit and (2) the social disconnect/distortion circuit. In the END model, the emotional pain circuit-consisting of the cerebellum, amygdala, and hippocampus-shows similar aberrations in adolescents with suicidal ideation as in those with a history of a suicide attempt (but to a smaller degree). The social disconnect circuit is unique to adolescent suicide attempters and includes the lateral orbitofrontal cortex (OFC), the temporal gyri, and the connections between them.

Conclusion

Our proposed END brain model of suicidal behavior in youth, if confirmed by future prospective studies, can have implications for clinical goals of early detection, risk stratification, and intervention development. Treatments that target emotional pain and social disconnect may be ideal interventions for reducing suicidality in adolescents.

Constipation is associated with depression of any severity, but not with suicidal ideation: insights from a large cross-sectional study

OBJECTIVE

The association between constipation and depression or suicidal ideation (SI) has not been adequately studied. This study aims to examine whether constipation is associated with depression or SI in US adults.

METHOD

4,562 adults aged 20 and older were selected from the National Health and Nutrition Examination Survey 2009-2010 for the sample. The Bowel Health Questionnaire provided constipation information. Clinical depression and depression severity were assessed by the validated Patient Health Questionnaide-9 (PHQ-9), and item 9 of the PHQ-9 assessed SI. Adjusted odds ratios (ORs) were calculated using multivariate logistic regression models. Stability of the results was ensured by a subgroup analysis.

RESULT

After adjusting for covariates such as demographics, risk behaviors, associated comorbidities, dietary intake, and related medications, the PHQ-9 score and clinical depression were both significantly associated with constipation, with ORs and 95%CIs of 1.13 (1.10-1.16) and 3.76 (2.65-5.34). Depression of all severities was also significantly associated with constipation. The ORs and 95%CIs of constipation with mild depression, moderate depression, and moderately severe to severe depression were 2.21 (1.54-3.16), 3.69 (2.34-5.81) and 6.84 (4.19-11.15), respectively. Subgroup analyses showed no statistically significant interactions (P > 0.05), and the association was stronger in men than in women (OR: 7.81, 95%CI: 3.67-16.61 vs OR: 3.46, 95%CI: 2.31-5.19). The association between constipation and SI was not significant (OR: 1.36, 95%CI: 0.78-2.37).

CONCLUSION

In conclusion, constipation was significantly associated with depression of any severity, but not with SI, suggesting that enough attention should be paid to the emotional and psychological status of patients with constipation, especially male patients.

Correlations between negative life events and suicidal ideation among Chinese adolescents: a meta-analysis

Background

Suicide ideation (SI) has become a serious social issue worldwide, and research has found a certain correlation between negative life events (NLE) and SI. Nevertheless, this relationship is still not clear among Chinese adolescents, a special population. Hence, this investigation performed a meta-analysis of observational research on the correlation between NLE and SI among adolescents in China, to further clarify the association.

Methods

We performed an extensive search on seven electronic databases starting from their establishment until March 10, 2023. The research mainly focused on cross-sectional studies conducted on samples of Chinese adolescents. To examine the association between NLE and SI, a meta-analysis model using random effects was utilized. To investigate moderating factors such as age, region, assessment tools for SI, and year of publication, subgroup and meta-regression analyses were performed. The AHRQ evaluated the quality of the study. The synthesis of data was conducted utilizing STATA software (version 16).

Results

Ultimately, a total of 30 cross-sectional studies were selected for this analysis, including 39,602 individuals in the participant sample. The results showed that NLE was moderately positively correlated with SI among Chinese adolescents (r = 0.29, 95% CI: 0.26, 0.32). In addition, this relationship was moderated by regional differences and the measurement tool used for SI. Studies conducted in Western China showed a higher correlation coefficient than those conducted in Eastern and Central China. Moreover, research conducted with the SSIOSS demonstrated a stronger correlation coefficient compared to studies utilizing the BSI-CV or other assessment instruments.

Conclusion

This meta-analysis indicates that NLE is linked to SI in Chinese teenagers, especially those residing in Western regions of China. Identifying and intervening in NLE and associated risk factors are crucial to prevent suicide within this demographic.

Childhood Trauma and Suicide

Background: Suicide is a leading cause of death worldwide, and childhood trauma has been found to be an important risk factor. However, the mechanisms linking trauma to suicide risk remain unclear. Aims: The current registered report sought to (1) investigate whether childhood trauma and its subtypes were related to suicide risk in adulthood and (2) explore the potential mechanisms associating childhood trauma with suicide and well-being, especially executive functioning, impulsivity, and stress. Method: A cross-sectional survey of 457 individuals who reported experiencing suicide ideation in the past 12 months. Results: Childhood trauma and its subtypes were associated with an increased risk of reporting recent suicide thoughts, COVID-19-related suicide attempts, and recent suicide attempts. There were also significant indirect effects of childhood trauma on recent suicide ideation and well-being through executive functioning and impulsivity. Conclusion: These findings show that childhood trauma is associated with suicide risk in adulthood and suggest that poorer executive functioning and higher levels of impulsivity contribute to this increased risk. These results have implications for the development of future interventions to reduce suicide vulnerability.

Exploring the relationship between distress rumination, resilience, depression, and self-injurious behaviors among Chinese college athletes infected with COVID-19: a cross-sectional study

Objectives

Distress rumination is a cause of suicidality and self-injurious behavior (SSIB) among individuals. Although previous studies have shown that distress rumination, SSIB, resilience, and depression are significantly related, the interaction mechanism remains unclear. This study aimed to evaluate resilience and depression as mediators of the relationship between distress rumination and SSIB among Chinese college athletes infected with COVID-19.

Methods

Convenience sampling was used to recruit participants from the National College Football Championship in Guangxi City, China from January to February 2023. Participants completed the Ruminative Responses Scale (RRS), a subscale of the Health-Risk Behavior Inventory (HBI), the Mental Toughness Index (MTI) and the Patient Health Questionnaire (PHQ-9). We used the PROCESS macro for SPSS to determine the mediating effect of resilience and depression between distress rumination and SSIB.

Results

A total of 350 Chinese college athletes participated in this study and completed the questionnaire survey. 289 (81.7% boys; Mage = 20.31 years, SD = 1.60) of them have been infected with COVID-19. 59.9% (n = 173) participants were from urban areas and 15.6% (n = 45) of participants have engaged in self-injurious behaviors or suicidal ideation. College athletes' distress rumination was significantly negatively correlated with resilience (r = - 0.28, p < 0.01), and was significantly positively correlated with depression (r = 0.49, p < 0.01) and SSIB (r = - 0.18, p < 0.01). Resilience was significantly negatively correlated with depression (r = - 0.35, p < 0.01) and SSIB (r = - 0.30, p < 0.01). Finally, depression was significantly positively correlated with SSIB (r = - 0.38, p < 0.01). Resilience and depression played a mediating role of the total effects of distress rumination and SSIB, respectively. Meanwhile, the chain mediating effect of resilience and depression was also significant.

Conclusion

This study found that distress rumination can directly predict SSIB, and indirectly predict SSIB through the mediating effect of resilience and depression, and the chain mediating effect of resilience-depression. Therefore, reducing the degree of distress rumination of college athletes infected by COVID-19 and improving their resilience, as well as reducing their depression may help prevent SSIB.

Risk of suicide and self-harm in university students entering different university programs - a national register-based cohort study in Sweden

PURPOSE

It is not known whether the elevated suicide risk in certain occupations, such as health care professionals, is partly attributable to a selection of individuals with prior vulnerability. We aimed to determine the risk of suicide and self-harm already in students entering different university programs.

METHODS

We used national registers to identify 621,218 Swedish residents aged 18-39 years with registration for a university program 1993-2013. Outcomes were suicide and self-harm within three years. We applied logistic regression analyses to calculate odds ratios (OR) and 95% confidence intervals (CI) of risk of suicide and self-harm, with the Education program category as a reference. Results were adjusted for sex, age, time period and for history of hospitalization due to mental disorder or self-harm, as a measure of previous vulnerability. In the second step, we stratified results by sex.

RESULTS

There was a higher risk of suicide (OR 2.4) in female nursing students and natural science students (OR 4.2) and of self-harm in female and male Nursing/Health care students (OR range 1.2 -1.7). Subcategorization into nursing students only strengthened the association with self-harm for both sexes. Prior vulnerability did not fully explain the increased risk.

CONCLUSION

The elevated risk of suicide in nursing and health care occupations partly has its onset in vulnerability factors present before or emerging during university studies. Increased efforts in identifying and treating mental disorders and preventing self-harm in university students could be an important step in preventing future suicides.

The benefits of making peace with pain: chronic pain acceptance moderates the indirect effect of perceived burdensomeness between pain severity and suicidal cognitions

OBJECTIVE

The purpose of this study was (1) to examine the degree to which perceived burdensomeness mediates the relationship between pain severity and suicidal cognitions and (2) to determine whether this mediated relationship was moderated by pain acceptance. We predicted that high levels of pain acceptance would buffer relationships on both paths of the indirect effect.

METHODS

Two-hundred seven patients with chronic pain completed an anonymous self-report battery of measures, including the Chronic Pain Acceptance Questionnaire, the Interpersonal Needs Questionnaire, the Suicidal Cognitions Scale, and the pain severity subscale of the West Haven-Yale Multidimensional Pain Inventory. Conditional process models were examined with Mplus.

RESULTS

Chronic pain acceptance significantly moderated both paths of the mediation model. Results from the conditional indirect effect model indicated that the indirect effect was significant for those with low (b = 2.50, P = .004) and medium (b = 0.99, P = .01) but not high (b = 0.08, P = .68) levels of pain acceptance and became progressively stronger as pain acceptance scores decreased. The nonlinear indirect effect became nonsignificant at acceptance scores 0.38 standard deviation above the mean-a clinically attainable treatment target.

CONCLUSIONS

Higher acceptance mitigated the relationship between pain severity and perceived burdensomeness and the relationship between perceived burdensomeness and suicidal cognitions in this clinical sample of patients experiencing chronic pain. Findings indicate that any improvement in pain acceptance can be beneficial, and they provide clinicians with a clinical cut-point that might indicate lower vs higher suicide risk.