Suicidal Behaviours During Covid-19 Pandemic: A Review

Association of the COVID-19 pandemic with the incidence of suicidal/self-harm emergencies in Japan: dependence of trend on the regional length of movement restriction

OBJECTIVES

Reportedly, coronavirus disease pandemic 2019 (COVID 19) was associated with an increased rate of emergency department visits related to suicide in youth. This study analyzed the influence of the pandemic on the incidence of emergency transportation associated with suicide attempts and self-harm.

METHODS

This retrospective cohort study used the Nationwide Emergency Medical Services Transportation Database between 2016 and 2021 for main analyses and extended database for resuscitation-attempted out-of-hospital cardiac arrests cases for secondary analyses.

RESULTS

We analyzed 204,081 cases with suicidal/self-harm emergencies. Compared with corresponding periods of 4 pre-pandemic years, the incidence of suicidal/self-harm emergencies increased after the end of the first nationwide declaration of emergency and remained high in youth (incidence rate ratio; 95% lower/upper interval, 1.29; 1.22-1.37 and 1.33; 1.28-1.39,), particularly in females (1.35; 1.27-1.46 and 1.40; 1.33-1.48) during the remaining pandemic period (Phase I (June 2020 to December 2020) and Phase II (2021), respectively). Compared with other emergencies, suicidal/self-harm emergencies were associated with a much higher proportion of outpatient deaths regardless of the pandemic. Suicidal out-of-hospital cardiac arrests cases were associated with much poorer outcomes.

CONCLUSION

The incidence of suicidal/self-harm emergency transportation in youth considerably increased during COVID 19 after the end of the first state of emergency declaration in Japan. This pandemic's impact varied among sex and region, appearing most prominently in young females. Rapid accumulation of suicidal/self-harm emergency transportation incidences may serve as an early warning sign for mental health problems and suicidality in Japan.

Do changes in eating behaviors signal rising mental health concerns among Saudi high schoolers?

BACKGROUND

Deteriorated eating attitudes have emerged as a prominent psychiatric illness with increasing prevalence in industrialized societies. This research endeavors to investigate the relationships between deteriorated eating patterns and mental health among Saudi high school students after the COVID-19 outbreak.

METHODS

A sample of 2817 students from two high schools in Jeddah, Saudi Arabia, completed a questionnaire about their demographic characteristics and symptoms of anxiety (GAD-7), depression (PHQ-9), and deteriorated eating patterns (Eating Attitudes Test 26) via convenience sampling technique. Multiple regression analysis was carried out to predict the potential associations between deteriorated eating patterns and levels of anxiety and depression among the study participants.

RESULTS

The findings demonstrated a moderate and statistically significant correlation between deteriorated eating patterns and levels of anxiety and depression among the participants in the study. In evaluating the three dimensions of deteriorated eating patterns through regression analysis, it is observed that dieting (anxiety: β = 0.275, depression: β = 0.287) exhibits the highest potential in predicting the levels of anxiety and depression, followed by oral control (anxiety: β = 0.240, depression: β = 0.232) and bulimia & food preoccupation (anxiety: β = 0.218, depression: β = 0.186).

CONCLUSIONS

The findings highlight the necessity to place additional emphasis on students displaying deteriorated eating patterns and symptoms, as these individuals may potentially be experiencing accompanying mental health concerns warranting further assessment.

Prevalence and factors associated with smartphone addiction among nursing postgraduates during the COVID-19 pandemic: a multilevel study from China's mainland

BACKGROUND

Smartphone addiction is prevalent among college students, and there is a concern that the COVID-19 pandemic may bring an increased prevalence of smartphone addiction due to constant online classes and repeat quarantine policies. This study aims to assess the prevalence and influencing factors of smartphone addiction among Chinese nursing postgraduates during the pandemic by examining variables, including loneliness, perceived stress, resilience, and sense of security.

METHODS

This online cross-sectional survey recruited 224 nursing postgraduates in four cities in 2022, using Smartphone Addiction Scale for College Students, the Chinese version of Perceived Stress Scale, UCLA Loneliness Scale Version 3, Chinese version of the 10-item Connor-Davidson Resilience Scale, and the Security Questionnaire. Hierarchical regression analysis and logistic regression analysis were performed to explore the associated factors and predictors of smartphone addiction.

RESULTS

During the COVID-19 pandemic, the prevalence of smartphone addiction was 10.41%. There was a positive correlation between smartphone addiction and loneliness, perceived stress (P < 0.001), and a negative relationship with resilience and sense of security (P < 0.001). The logistic regression analysis identified five risk factors that contribute to smartphone addiction, including daily duration of using a smartphone (3-5 h) (OR = 11.085, 95%CI = 1.21-101.79), numbers of smartphone (OR = 3.704, 95%CI = 1.33-10.30), perceived stress (OR = 1.163, 95%CI = 1.06-1.28), loneliness (OR = 1.071, 95%CI = 1.01-1.13), age of using a smartphone first time (OR = 0.754, 95%CI = 0.60-0.95). Two protective factors, resilience (OR = 1.098, 95%CI = 1.01-1.20) and sense of security (OR = 0.950, 95%CI = 0.90-1.00), were identified.

CONCLUSIONS

Collectively, our study found that during the COVID-19 pandemic, smartphone addiction was prevalent among nursing postgraduates, and loneliness and perceived stress are important risk factors for smartphone addiction. Therefore, administrators should adopt targeted interventions to reduce smartphone addiction and the negative impacts on the psychological well-being of nursing postgraduates during a sudden outbreak of a national epidemic crisis.

The Use of Photoplethysmography in the Assessment of Mental Health: Scoping Review

BACKGROUND

With the rise in mental health problems globally, mobile health provides opportunities for timely medical care and accessibility. One emerging area of mobile health involves the use of photoplethysmography (PPG) to assess and monitor mental health.

OBJECTIVE

In recent years, there has been an increase in the use of PPG-based technology for mental health. Therefore, we conducted a review to understand how PPG has been evaluated to assess a range of mental health and psychological problems, including stress, depression, and anxiety.

METHODS

A scoping review was performed using PubMed and Google Scholar databases.

RESULTS

A total of 24 papers met the inclusion criteria and were included in this review. We identified studies that assessed mental health via PPG using finger- and face-based methods as well as smartphone-based methods. There was variation in study quality. PPG holds promise as a potential complementary technology for detecting changes in mental health, including depression and anxiety. However, rigorous validation is needed in diverse clinical populations to advance PPG technology in tackling mental health problems.

CONCLUSIONS

PPG holds promise for assessing mental health problems; however, more research is required before it can be widely recommended for clinical use.

Suicide before and during the COVID-19 Pandemic: A Systematic Review with Meta-Analysis

Synthesizing evidence to examine changes in suicide-related outcomes before and during the pandemic can inform suicide management during the COVID-19 crisis. We searched 13 databases as of December 2022 for studies reporting both the pre- and peri-pandemic prevalence of suicidal ideation, suicide attempts, or rate of death by suicide. A random-effects model was used to pool the ratio of peri- and pre-pandemic prevalence of suicidal ideation and attempt (Prevalence Ratio-PR) and rate of death by suicide (Rate Ratio; RR). We identified 51, 55, and 25 samples for suicidal ideation, attempt, and death by suicide. The prevalence of suicidal ideation increased significantly among non-clinical (PR = 1.142; 95% CI: 1.018-1.282; p = 0.024; k = 28) and clinical (PR = 1.134; 95% CI: 1.048-1.227; p = 0.002; k = 23) samples, and pooled estimates differed by population and study design. Suicide attempts were more prevalent during the pandemic among non-clinical (PR = 1.14; 95% CI: 1.053-1.233; p = 0.001; k = 30) and clinical (PR = 1.32; 95% CI: 1.17-1.489; p = 0.000; k = 25) participants. The pooled RR for death by suicide was 0.923 (95% CI: 0.84-1.01; p = 0.092; k = 25), indicating a nonsignificant downward trend. An upward trend of suicidal ideation and suicide attempts was observed during the COVID-19 pandemic, despite suicide rate remaining stable. Our findings suggest that timely prevention and intervention programs are highly needed for non-clinical adult population and clinical patients. Monitoring the real-time and long-run suicide risk as the pandemic evolves is warranted.

Body mass index and quality of life in individuals with polycystic ovary syndrome: Dysmorphic concerns and eating disorders as mediators

Objective

Weight issues, dysmorphic concerns and eating disorders are common among individuals with polycystic ovary syndrome (PCOS) and are linked to poor quality of life (QoL). The goal of the current study was to examine whether the association between body mass index (BMI) and QoL was mediated by dysmorphic concerns, examining also the relations with eating disorder symptomatology.

Methods

Questionnaires were administered to 435 individuals with PCOS aged between 18 and 40 years (M = 27.62; SD = 4.83) to measure dysmorphic concerns, eating disorder symptoms and QoL. Participants were also asked to report their height and weight to compute their BMI.

Results

Structural equation modeling was used to observe the relationship between the variables. The results revealed a direct relationship between QoL, BMI, dysmorphic concerns and eating disorder symptomatology. In addition, dysmorphic concerns were related to BMI and eating disorder symptomatology. Furthermore, the results showed the mediating role of dysmorphic concerns and eating disorder symptoms in the relationship between BMI and QoL.

Conclusion

The current results highlight the potential importance of harmful relationships with one's own body and food, explaining why weight issues may be linked to different levels of QoL in PCOS individuals. The implications of these findings are discussed.

Hair cortisol level might be indicative for a 3PM approach towards suicide risk assessment in depression: comparative analysis of mentally stable and depressed individuals versus individuals after completing suicide

Depression and suicidal behavior are interrelated, stress-associated mental health conditions, each lacking biological verifiability. Concepts of predictive, preventive, and personalized medicine (3PM) are almost completely missing for both conditions but are of utmost importance. Prior research reported altered levels of the stress hormone cortisol in the scalp hair of depressed individuals, however, data on hair cortisol levels (HCL) for suicide completers (SC) are missing. Here, we aimed to identify differences in HCL between subject with depression (n = 20), SC (n = 45) and mentally stable control subjects (n = 12) to establish the usage of HCL as a new target for 3PM. HCL was measured in extracts of pulverized hair (1-cm and 3-cm hair segments) using ELISA. In 3-cm hair segments, an average increase in HCL for depressed patients (1.66 times higher; p = .011) and SC (5.46 times higher; p = 1.65 × 10⁻⁵) compared to that for controls was observed. Furthermore, the average HCL in SC was significantly increased compared to that in the depressed group (3.28 times higher; p = 1.4 × 10⁻⁵). A significant correlation between HCL in the 1-cm and the 3-cm hair segments, as well as a significant association between the severity of depressive symptoms and HCL (3-cm segment) was found. To conclude, findings of increased HCL in subjects with depression compared to that in controls were replicated and an additional increase in HCL was seen in SC in comparison to patients with depression. The usage of HCL for creating effective patient stratification and predictive approach followed by the targeted prevention and personalization of medical services needs to be validated in follow-up studies.