Search

Objective: to identify patterns in the cases of suicide attempts reported in the National Public Health Surveillance System by the mayor's office of the city of Bucaramanga, Colombia, during the period 2016-2023. Methodology: a quantitative approach is employed with the purpose of describing, explaining and predicting the phenomena studied, using the Knowledge Discovery in Databases method to guide the data mining process. Results: a high concentration of suicide attempts is shown, especially in the year 2022, underlining the importance of specific strategies for different age and gender groups. Discussion: it is highlighted that young people represent 40.5% of the cases, with an increased risk in the course of the pandemic, especially among those with mental disorders. Women account for 60.5% of cases, mostly in urban areas and in the contributory health care system. Conclusions: the importance of considering a history of previous attempts, tensions with the partner and the use of psychoactive substances as risk factors is emphasized. In addition, the connection between mental disorders and suicide attempts is highlighted, pointing out intoxication as the most common method. A higher risk is highlighted in people vulnerable to various forms of violence and precarious socioeconomic conditions. The Random Forest method proves to be effective in identifying key factors, while applied machine learning algorithms could improve early detection., Objetivo: identificar patrones en los casos de intentos suicidas reportados en el Sistema Nacional de Vigilancia en Salud Pública por la alcaldía de Bucaramanga, Colombia, durante el período 2016-2023. Metodología: se emplea un enfoque cuantitativo con el propósito de describir, explicar y predecir los fenómenos estudiados, utilizando el método Knowledge Discovery in Databases para guiar el proceso de minería de datos. Resultados: se muestra una alta concentración de intentos suicidas, especialmente en el año 2022, por lo que se subraya la importancia de implementar estrategias específicas para diferentes grupos de edad y género. Discusión: se destaca que los jóvenes representan el 40,5 % de los casos, con un riesgo aumentado en el trascurso de la pandemia, especialmente entre aquellos con trastornos mentales. Las mujeres constituyen el 60,5 % de los casos, mayormente en áreas urbanas y en el régimen contributivo de salud. Conclusiones: se enfatiza en la importancia de considerar los antecedentes de intentos previos, las tensiones con la pareja y el uso de sustancias psicoactivas como factores de riesgo. Además, se resalta la conexión entre trastornos mentales e intentos suicidas, señalando la intoxicación como el método más común. Se subraya un riesgo mayor en personas vulnerables a diversas formas de violencia y condiciones socioeconómicas precarias. El método Random Forest demuestra ser efectivo para identificar factores clave, mientras que los algoritmos aplicados de machine learning podrían mejorar la detección temprana.

Este estudo objetiva realizar uma revisão integrativa e qualitativa de produções científicas acerca da depressão e suicídio segundo a Fenomenologia Existencial e a Abordagem Centrada na Pessoa. A coleta de dados se deu nos bancos Scielo, Pepsic, ResearchGate e Periódicos CAPES. Foram selecionados 13 trabalhos que correlacionam os descritores utilizados e cumprem os critérios de inclusão e exclusão. Os resultados demonstram que, através da perspectiva fenomenológica existencial, a depressão e o suicídio são vistos como fenômenos multifacetados que levam em consideração a subjetividade, busca por sentido e autenticidade humana. Os autores discutem que o que leva o sujeito ao suicídio é a angústia existencial causada por fatores como: sociedade tecnicista, busca incessante pela felicidade, estigma social, individualismo, relações frágeis, famílias disfuncionais e priorização da medicalização em detrimento do cuidado. Os autores mais mencionados e que embasam os estudos encontrados são Heidegger, Sartre e Carl Rogers, que trazem similaridades, assim como diferenciações. Estudos que relacionam a depressão e o suicídio à Abordagem Centrada na Pessoa afirmam que estes fenômenos ocorrem por conta da distorção do self, que causa angústia e dor existencial, já que a autoimagem idealizada e a experiência real vivida são distintas. Incentiva-se a produção de mais artigos que trazem o olhar humanista sobre a depressão e o suicídio em outras etapas da vida que não seja a adolescência, como a terceira idade e infância. Também se encoraja a produção de mais estudos com enfoque na Abordagem Centrada na Pessoa, assim como estudos empíricos com a análise de casos., This study aims to conduct an integrative and qualitative review of scientific productions on depression and suicide according to Existential Phenomenology and Person-Centered Approach. Data collection was carried out in the Scielo, Pepsic, ResearchGate, and CAPES Periodicals databases. 13 articles that correlate the descriptors used and meet the inclusion and exclusion criteria were selected. The results show that, from the existential phenomenological perspective, depression and suicide are seen as multifaceted phenomena that take into account subjectivity, the search for meaning, and human authenticity. The authors discuss that what leads a person to suicide is existential anguish caused by factors such as a technicist society, the incessant search for happiness, social stigma, individualism, fragile relationships, dysfunctional families, and the prioritization of medicalization over care. The most cited authors supporting the studies found are Heidegger, Sartre, and Carl Rogers, who bring both similarities and differences. Studies relating depression and suicide to the Person-Centered Approach assert that these phenomena occur due to a distortion of the self, causing anguish and existential pain, as the idealized self-image and the real lived experience are distinct. It is encouraged to produce more articles that bring a humanistic perspective on depression and suicide in life stages beyond adolescence, such as old age and childhood. Additionally, it encourages the production of more studies focusing on the Person-Centered Approach, as well as empirical studies with case analyses., Este estudio tiene como objetivo realizar una revisión integrativa y cualitativa de producciones científicas sobre la depresión y el suicidio según la Fenomenología Existencial y el Enfoque Centrado en la Persona. La recopilación de datos se llevó a cabo en Scielo, Pepsic, ResearchGate y Periódicos CAPES, seleccionando 13 trabajos que cumplen con los criterios de inclusión y exclusión. Los resultados muestran que, desde la perspectiva fenomenológica existencial, la depresión y el suicidio son fenómenos multifacéticos que consideran la subjetividad, la búsqueda de sentido y la autenticidad humana. Los autores señalan que el suicidio se debe a la angustia existencial provocada por factores como la sociedad tecnicista, la búsqueda incesante de la felicidad, el estigma social, el individualismo, las relaciones frágiles, las familias disfuncionales y la priorización de la medicalización sobre el cuidado. Heidegger, Sartre y Carl Rogers son los autores más citados, aportando similitudes y diferencias en sus estudios. Según el Enfoque Centrado en la Persona, la depresión y el suicidio resultan de la distorsión del self, que genera angustia y dolor existencial debido a la discrepancia entre la autoimagen idealizada y la experiencia real vivida. Se fomenta la producción de más artículos que ofrezcan una perspectiva humanista sobre la depresión y el suicidio en diferentes etapas de la vida, como la tercera edad y la infancia. Además, se anima a la realización de más estudios con enfoque en el Enfoque Centrado en la Persona y estudios empíricos con análisis de casos.

Este estudo objetiva realizar uma revisão integrativa e qualitativa de produções científicas acerca da depressão e suicídio segundo a Fenomenologia Existencial e a Abordagem Centrada na Pessoa. A coleta de dados se deu nos bancos Scielo, Pepsic, ResearchGate e Periódicos CAPES. Foram selecionados 13 trabalhos que correlacionam os descritores utilizados e cumprem os critérios de inclusão e exclusão. Os resultados demonstram que, através da perspectiva fenomenológica existencial, a depressão e o suicídio são vistos como fenômenos multifacetados que levam em consideração a subjetividade, busca por sentido e autenticidade humana. Os autores discutem que o que leva o sujeito ao suicídio é a angústia existencial causada por fatores como: sociedade tecnicista, busca incessante pela felicidade, estigma social, individualismo, relações frágeis, famílias disfuncionais e priorização da medicalização em detrimento do cuidado. Os autores mais mencionados e que embasam os estudos encontrados são Heidegger, Sartre e Carl Rogers, que trazem similaridades, assim como diferenciações. Estudos que relacionam a depressão e o suicídio à Abordagem Centrada na Pessoa afirmam que estes fenômenos ocorrem por conta da distorção do self, que causa angústia e dor existencial, já que a autoimagem idealizada e a experiência real vivida são distintas. Incentiva-se a produção de mais artigos que trazem o olhar humanista sobre a depressão e o suicídio em outras etapas da vida que não seja a adolescência, como a terceira idade e infância. Também se encoraja a produção de mais estudos com enfoque na Abordagem Centrada na Pessoa, assim como estudos empíricos com a análise de casos., This study aims to conduct an integrative and qualitative review of scientific productions on depression and suicide according to Existential Phenomenology and Person-Centered Approach. Data collection was carried out in the Scielo, Pepsic, ResearchGate, and CAPES Periodicals databases. 13 articles that correlate the descriptors used and meet the inclusion and exclusion criteria were selected. The results show that, from the existential phenomenological perspective, depression and suicide are seen as multifaceted phenomena that take into account subjectivity, the search for meaning, and human authenticity. The authors discuss that what leads a person to suicide is existential anguish caused by factors such as a technicist society, the incessant search for happiness, social stigma, individualism, fragile relationships, dysfunctional families, and the prioritization of medicalization over care. The most cited authors supporting the studies found are Heidegger, Sartre, and Carl Rogers, who bring both similarities and differences. Studies relating depression and suicide to the Person-Centered Approach assert that these phenomena occur due to a distortion of the self, causing anguish and existential pain, as the idealized self-image and the real lived experience are distinct. It is encouraged to produce more articles that bring a humanistic perspective on depression and suicide in life stages beyond adolescence, such as old age and childhood. Additionally, it encourages the production of more studies focusing on the Person-Centered Approach, as well as empirical studies with case analyses., Este estudio tiene como objetivo realizar una revisión integrativa y cualitativa de producciones científicas sobre la depresión y el suicidio según la Fenomenología Existencial y el Enfoque Centrado en la Persona. La recopilación de datos se llevó a cabo en Scielo, Pepsic, ResearchGate y Periódicos CAPES, seleccionando 13 trabajos que cumplen con los criterios de inclusión y exclusión. Los resultados muestran que, desde la perspectiva fenomenológica existencial, la depresión y el suicidio son fenómenos multifacéticos que consideran la subjetividad, la búsqueda de sentido y la autenticidad humana. Los autores señalan que el suicidio se debe a la angustia existencial provocada por factores como la sociedad tecnicista, la búsqueda incesante de la felicidad, el estigma social, el individualismo, las relaciones frágiles, las familias disfuncionales y la priorización de la medicalización sobre el cuidado. Heidegger, Sartre y Carl Rogers son los autores más citados, aportando similitudes y diferencias en sus estudios. Según el Enfoque Centrado en la Persona, la depresión y el suicidio resultan de la distorsión del self, que genera angustia y dolor existencial debido a la discrepancia entre la autoimagen idealizada y la experiencia real vivida. Se fomenta la producción de más artículos que ofrezcan una perspectiva humanista sobre la depresión y el suicidio en diferentes etapas de la vida, como la tercera edad y la infancia. Además, se anima a la realización de más estudios con enfoque en el Enfoque Centrado en la Persona y estudios empíricos con análisis de casos.

OBJECTIVES: Body dysmorphic disorder (BDD) is thought to be associated with considerable suicide risk. This nationwide cohort study quantified the risks of intentional self-harm - including non-suicidal self-injuries and suicide attempts - and death by suicide in BDD. METHODS: Individuals with a validated ICD-10 diagnosis of BDD in the Swedish National Patient Register, registered between January 1, 1997 and December 31, 2020, were matched with 10 unexposed individuals from the general population on birth year, sex, and county of residence. Conditional Poisson regression models estimated incidence rate ratios (IRR) and 95% confidence intervals (CIs) for intentional self-harm and stratified Cox proportional hazards models estimated hazard ratios (HRs) and 95% CIs for death by suicide. Models adjusted for sociodemographic variables and lifetime psychiatric comorbidities. RESULTS: Among 2,833 individuals with BDD and 28,330 unexposed matched individuals, 466 (16.45%) and 1,071 (3.78%) had at least one record of intentional self-harm during the study period, respectively (IRR=3.37; 95% CI, 3.02-3.76). In the BDD cohort, about two thirds (n=314; 67%) had their first recorded self-harm event before their first BDD diagnosis. A total of 17 (0.60%) individuals with BDD and 27 (0.10%) unexposed individuals died by suicide (HR=3.47; 95% CI, 1.76-6.85). All results remained robust to additional adjustment for lifetime psychiatric comorbidities. A higher proportion of individuals with BDD who died by suicide had at least one previous record of intentional self-harm, compared to unexposed individuals (52.94% vs. 22.22%; p=0.0363). CONCLUSIONS: BDD was associated with a three-fold increased risk of intentional self-harm and death by suicide.

Objetivo: descrever o cenário dos óbitos por suicídio, em Minas Gerais, 2020 - 2021. Avalia, também, uma série pregressa de 10 anos. Método: As informações foram obtidas de bancos de dados utilizando TabWin/Tabnet – DATASUS. Resultados: Os resultados mostraram correlação entre o desemprego e o envelhecimento da população na ocorrência de suicídios. Obteve-se uma razão de chances de 2,75 óbitos masculinos para cada feminino. Observou-se forte correlação entre os anos de estudo e o aumento da mortalidade proporcional por suicídios, havendo maior correlação para a população feminina. Conclusão: Foi possível a obtenção de dados e análises que podem subsidiar o planejamento de ações de prevenção do suicídio em Minas Gerais., Objective: to describe the scenario of deaths by suicide in Minas Gerais, 2020 - 2021. It also evaluates a 10-year series. Methods: Information was obtained from databases using TabWin/Tabnet – DATASUS. Results: The results showed a correlation between unemployment and the aging of the population in the occurrence of suicides. An odds ratio of 2.75 male deaths for each female was obtained. A strong correlation was observed between years of study and the increase in proportional mortality from suicides, with a greater correlation for the female population. Conclusion: It was possible to obtain data and analyzes that can support the planning of suicide prevention actions in Minas Gerais., Objetivo: describir el escenario de las muertes por suicidio en Minas Gerais, 2020 - 2021. También evalúa una serie de 10 años. Métodos: La información se obtuvo de bases de datos utilizando TabWin/Tabnet – DATASUS. Resultados: Los resultados mostraron una correlación entre el desempleo y el envejecimiento de la población en la ocurrencia de suicidios. Se obtuvo un odds ratio de 2,75 muertes masculinas por cada mujer. Se observó una fuerte correlación entre los años de estudio y el aumento proporcional de la mortalidad por suicidio, con mayor correlación para la población femenina. Conclusión: Fue posible obtener datos y análisis que puedan apoyar la planificación de acciones de prevención del suicidio en Minas Gerais.

Quando um suicídio ou uma tentativa de suicídio acontece, muitas pessoas se perguntam se algum sinal foi negligenciado. Todas as pessoas que entram em crise suicida dão sinais? Que sinais seriam esses? O presente artigo aborda essa questão por meio de uma análise da série “Os 13 porquês” que trata vários temas polêmicos, dentre eles as justificativas para o suicídio da jovem Hannah. A partir da série é possível identificar sinais que alguém está em crise suicida? Essa série é uma forma de prevenção do suicídio? Ou, ao contrário, pode até estimulá-lo? Por meio da análise de cenas e diálogos da série à luz da psicologia junguiana e outras referências em suicidologia, apresentamos reflexões pertinentes ao tema. Nossa análise permite concluir que a série possibilitou reflexões aprofundadas sobre a temática do suicídio sob vários aspectos, incluindo a questão dos sinais, que costumam fazer sentido após a tentativa e não antes. No entanto, seu formato pode também trazer a romantização do suicídio, bem como ser um estímulo para algum/a espectador/a em crise suicida., When a suicide or attempted suicide happens, many people wonder if any signs of the crisis were overlooked. Do all people who go into a suicidal crisis show signs? What signs would those be? This article addresses this issue through an analysis of the series “The 13 Whys” which deals with several controversial topics, including the justifications for young Hannah's suicide. From the series, is it possible to identify signs that someone is in a suicidal crisis? Is this series a form of suicide prevention? Or, on the contrary, can it even stimulate it? Through the analysis of scenes and dialogues from the series in the light of Jungian psychology and other references in suicidology, we present reflections relevant to the topic. Our analysis allows us to conclude that the series enabled in-depth reflections on the topic of suicide from several aspects, including the issue of signs, which usually make sense after the attempt. However, its format can also bring the romanticization of suicide, as well as being a stimulus for some spectator in a suicidal crisis., Cuando ocurre un suicidio o un intento de suicidio, muchas personas se preguntan si se pasó por alto algún signo de la crisis. ¿Todas las personas que entran en una crisis suicida muestran signos? ¿Qué señales serían esas? Este artículo aborda esta cuestión a través de un análisis de la serie “Los 13 porqués” que aborda varios temas controvertidos, entre ellos las justificaciones del suicidio de la joven Hannah. ¿Es posible identificar a partir de la serie señales de que alguien está en una crisis suicida? ¿Es esta serie una forma de prevención del suicidio? ¿O por el contrario puede incluso estimularlo? A través del análisis de escenas y diálogos de la serie a la luz de la psicología junguiana y otros referentes de la suicidología, presentamos reflexiones relevantes al tema. Nuestro análisis permite concluir que la serie permitió reflexionar en profundidad sobre el tema del suicidio desde varios aspectos, incluida la cuestión de los signos, que suelen tener sentido después del intento. Sin embargo, su formato también puede traer la romantización del suicidio, además de ser un estímulo para algún espectador en una crisis suicida.

Objetivo: descrever o cenário dos óbitos por suicídio, em Minas Gerais, 2020 - 2021. Avalia, também, uma série pregressa de 10 anos. Método: As informações foram obtidas de bancos de dados utilizando TabWin/Tabnet – DATASUS. Resultados: Os resultados mostraram correlação entre o desemprego e o envelhecimento da população na ocorrência de suicídios. Obteve-se uma razão de chances de 2,75 óbitos masculinos para cada feminino. Observou-se forte correlação entre os anos de estudo e o aumento da mortalidade proporcional por suicídios, havendo maior correlação para a população feminina. Conclusão: Foi possível a obtenção de dados e análises que podem subsidiar o planejamento de ações de prevenção do suicídio em Minas Gerais., Objective: to describe the scenario of deaths by suicide in Minas Gerais, 2020 - 2021. It also evaluates a 10-year series. Methods: Information was obtained from databases using TabWin/Tabnet – DATASUS. Results: The results showed a correlation between unemployment and the aging of the population in the occurrence of suicides. An odds ratio of 2.75 male deaths for each female was obtained. A strong correlation was observed between years of study and the increase in proportional mortality from suicides, with a greater correlation for the female population. Conclusion: It was possible to obtain data and analyzes that can support the planning of suicide prevention actions in Minas Gerais., Objetivo: describir el escenario de las muertes por suicidio en Minas Gerais, 2020 - 2021. También evalúa una serie de 10 años. Métodos: La información se obtuvo de bases de datos utilizando TabWin/Tabnet – DATASUS. Resultados: Los resultados mostraron una correlación entre el desempleo y el envejecimiento de la población en la ocurrencia de suicidios. Se obtuvo un odds ratio de 2,75 muertes masculinas por cada mujer. Se observó una fuerte correlación entre los años de estudio y el aumento proporcional de la mortalidad por suicidio, con mayor correlación para la población femenina. Conclusión: Fue posible obtener datos y análisis que puedan apoyar la planificación de acciones de prevención del suicidio en Minas Gerais.

Quando um suicídio ou uma tentativa de suicídio acontece, muitas pessoas se perguntam se algum sinal foi negligenciado. Todas as pessoas que entram em crise suicida dão sinais? Que sinais seriam esses? O presente artigo aborda essa questão por meio de uma análise da série “Os 13 porquês” que trata vários temas polêmicos, dentre eles as justificativas para o suicídio da jovem Hannah. A partir da série é possível identificar sinais que alguém está em crise suicida? Essa série é uma forma de prevenção do suicídio? Ou, ao contrário, pode até estimulá-lo? Por meio da análise de cenas e diálogos da série à luz da psicologia junguiana e outras referências em suicidologia, apresentamos reflexões pertinentes ao tema. Nossa análise permite concluir que a série possibilitou reflexões aprofundadas sobre a temática do suicídio sob vários aspectos, incluindo a questão dos sinais, que costumam fazer sentido após a tentativa e não antes. No entanto, seu formato pode também trazer a romantização do suicídio, bem como ser um estímulo para algum/a espectador/a em crise suicida., When a suicide or attempted suicide happens, many people wonder if any signs of the crisis were overlooked. Do all people who go into a suicidal crisis show signs? What signs would those be? This article addresses this issue through an analysis of the series “The 13 Whys” which deals with several controversial topics, including the justifications for young Hannah's suicide. From the series, is it possible to identify signs that someone is in a suicidal crisis? Is this series a form of suicide prevention? Or, on the contrary, can it even stimulate it? Through the analysis of scenes and dialogues from the series in the light of Jungian psychology and other references in suicidology, we present reflections relevant to the topic. Our analysis allows us to conclude that the series enabled in-depth reflections on the topic of suicide from several aspects, including the issue of signs, which usually make sense after the attempt. However, its format can also bring the romanticization of suicide, as well as being a stimulus for some spectator in a suicidal crisis., Cuando ocurre un suicidio o un intento de suicidio, muchas personas se preguntan si se pasó por alto algún signo de la crisis. ¿Todas las personas que entran en una crisis suicida muestran signos? ¿Qué señales serían esas? Este artículo aborda esta cuestión a través de un análisis de la serie “Los 13 porqués” que aborda varios temas controvertidos, entre ellos las justificaciones del suicidio de la joven Hannah. ¿Es posible identificar a partir de la serie señales de que alguien está en una crisis suicida? ¿Es esta serie una forma de prevención del suicidio? ¿O por el contrario puede incluso estimularlo? A través del análisis de escenas y diálogos de la serie a la luz de la psicología junguiana y otros referentes de la suicidología, presentamos reflexiones relevantes al tema. Nuestro análisis permite concluir que la serie permitió reflexionar en profundidad sobre el tema del suicidio desde varios aspectos, incluida la cuestión de los signos, que suelen tener sentido después del intento. Sin embargo, su formato también puede traer la romantización del suicidio, además de ser un estímulo para algún espectador en una crisis suicida.

BACKGROUND: Little is known about specific obsessive-compulsive clinical features associated with lifetime history of suicide attempt in individuals with obsessive-compulsive disorder (OCD) and major depression. METHODS: The study sample included 515 adults with OCD and a history of major depression. In exploratory analyses, we compared the distributions of demographic characteristics and clinical features in those with and without a history of attempted suicide and used logistic regression to evaluate the association between specific obsessive-compulsive clinical features and lifetime suicide attempt. RESULTS: Sixty-four (12%) of the participants reported a lifetime history of suicide attempt. Those who had attempted suicide were more likely to report having experienced violent or horrific images (52% vs. 30%; p < 0.001). The odds of lifetime suicide attempt were more than twice as great in participants with versus without violent or horrific images (O.R. = 2.46, 95%, CI = 1.45-4.19; p < 0.001), even after adjustment for other risk correlates of attempted suicide, including alcohol dependence, post-traumatic stress disorder, parental conflict, excessive physical discipline, and number of episodes of depression. The association between violent or horrific images and attempted suicide was especially strong in men, 18-29 year olds, those with post-traumatic stress disorder, and those with particular childhood adversities. CONCLUSIONS: Violent or horrific images are strongly associated with lifetime suicide attempts in OCD-affected individuals with a history of major depression. Prospective clinical and epidemiological studies are needed to elucidate the basis of this relationship.

Objectives To estimate the risk of suicide attempt repetition among individuals with an index attempt. It also aims to study the role of risk factors and prevention programme in repetition. Methods This systematic review and meta-analysis was conducted in keeping with the PRISMA 2020 guidelines. Studies on attempt repetition (both cohort studies and intervention studies) were searched from inception to 2022. Results A total of 110 studies comprising 248,829 attempters was reviewed. The overall repetition rate was 0.20 (0.17, 0.22). Repetition risk linearly increased over time. A higher risk of attempt repetition was associated with female sex and index attempts in which self-cutting methods were used. Moreover, a mental disorder diagnosis was associated with an increasing repetition risk (OR = 2.02, p < .01). The delivery of a preventive programme reduced the repetition risk, OR = 0.76, p < .05; however, this effect was significant for psychotherapy interventions, OR = 0.38, p < .01. Conclusion One in five suicide attempters will engage in a new suicide attempt. An elevated repetition risk is associated with being female, more severe index methods and psychiatric disorder diagnosis. Preventive programmes, particularly psychotherapy, may contribute to reducing repetition risk and eventually sabe lives., Depto. de Medicina Legal, Psiquiatría y Patología, Fac. de Medicina, TRUE, pub, APC financiada por la UCM

Objective: Associations between debt and suicidal behaviour have been identified, but the research is sparse. Thus, more research is needed to understand the association between economic vulnerability and suicide. The study aimed to generate further knowledge about over-indebted individuals who have attempted suicide at least once. Method: Participants were a Swedish sample comprising 641 over-indebted individuals. The inclusion criteria were that the participants should be indebted and have been subjected to debt collection measures and/or seizure orders by the Swedish Enforcement Authority. Participants answered questionnaires regarding socio-demographic variables, debt size, history of suicide attempt, critical life events, and social contacts, and filled the Hospital Anxiety and Depression Scale (HADS). In the statistical analyses, Chi(2) test for independence and t-test was used, and binary logistic regression to adjust for the confounding effects of the variables on each other. Results: The analysis revealed that nearly one in five (19.3%, N = 123) had attempted suicide at least once. A larger part of the respondents who had a history of suicide attempts reported that they were living alone (OR 2.30 (95% CI 1.34-3.89, p = .002). Many of those living alone were women (chi(2) (1, n = 121) = 4.88, p = 0.03, phi = 0.22). Conclusions: The results of the current study point to the fact that economic vulnerability is an important psychosocial aspect to take into serious consideration concerning mental health and suicide prevention. Longitudinal research is needed to explain, predict and prevent suicide due to over-indebtedness.

Objectives: To systematically assess the magnitude of suicidal behavior among PsA patients and identify associated risk factors. Also identify common genes or coinherited single nucleotide polymorphisms (SNPs) implicated in suicidal behavior and PsA. Methods: Based on the PRISMA guidelines, we conducted a systematic literature review of the online databases PubMed/Medline, Web of Science, and EMBASE from inception to May 2022. Full-text original articles that describe suicidal behavior in PsA patients were eligible. All registered genome-wide association study (GWAS) data in the GWAS catalog database for PsA and psychiatric traits, such as suicidal behavior, and depression, were downloaded for further analysis. Results: A total of 48 articles were identified, and 6 were relevant to the study question. Among the 122,160 PsA patients, 700 had suicidal behavior (0,57%). The range of age in one study was between 30 and 49 years, and 64% of PsA patients with suicidal behavior were female. Among 13,899 PsA patients 74 had suicidal ideation (0.53%) and 125 suicide attempts occurred (0.9%). In two studies, among 17,383 patients, 13 complete suicides occurred (0.07%). A genetic haplotype on chromosomal region 6p21.1, spanning from 29,597,596 to 32,251,264 Mb, contains predisposing SNPs for PsA and depression. 6p21.1–6p21.3 is the chromosomal region containing the HLA genes of classes I, II and III. Conclusion: Suicide behavior in PsA patients was associated with depression and other psychiatric comorbidities. Further evidence supports a genetic origin, at least partly. Awareness of these findings can help clinicians to recognize suicide behavior and prevent suicide attempts.

Introduction: Psychosis associated with coronavirus disease 2019 (COVID-19) has been previously, but infrequently, reported in the literature. We present a rare case of COVID-19-associated severe psychosis and suicide attempt in an 80-year-old male with no personal or known family history of psychiatric disease. Our patient’s symptoms appeared to be longer lasting than most other reported cases in the available literature. Case Report: After a COVID-19 diagnosis, our patient experienced fluctuating, long-lasting psychiatric symptoms over a six-month period. During this time, he was unable to function independently. Suggested mechanisms involve a multifactorial combination of neuroinflammation and increased societal stress due to the direct and indirect effects of the virus, respectively.Conclusion: More research is needed to help identify risk factors, prognostic indicators, and a standard of care for psychosis associated with COVID-19.

Objectives: To estimate the risk of suicide attempt repetition among individuals with an index attempt. It also aims to study the role of risk factors and prevention programme in repetition. Methods: This systematic review and meta-analysis was conducted in keeping with the PRISMA 2020 guidelines. Studies on attempt repetition (both cohort studies and intervention studies) were searched from inception to 2022. Results: A total of 110 studies comprising 248,829 attempters was reviewed. The overall repetition rate was 0.20 (0.17, 0.22). Repetition risk linearly increased over time. A higher risk of attempt repetition was associated with female sex and index attempts in which self-cutting methods were used. Moreover, a mental disorder diagnosis was associated with an increasing repetition risk (OR = 2.02, p < .01). The delivery of a preventive programme reduced the repetition risk, OR = 0.76, p < .05; however, this effect was significant for psychotherapy interventions, OR = 0.38, p < .01. Conclusion: One in five suicide attempters will engage in a new suicide attempt. An elevated repetition risk is associated with being female, more severe index methods and psychiatric disorder diagnosis. Preventive programmes, particularly psychotherapy, may contribute to reducing repetition risk and eventually save lives.

We investigated factors associated with benzodiazepine (BZD) use during late adolescence and early adulthood. The study population consisted of 508 adolescents admitted to psychiatric inpatient care between April 2001 and March 2006. Information on adolescents’ family- and school-related factors, suicidality and psychiatric disorders were obtained by semistructured interviews. Data on BZD prescriptions from 1999 to 2012 were collected from the Social Insurance Institution of Finland. In males heavy BZD use associated with adolescent substance-use disorder (OR, 3.5; P < 0.004) and parents’ psychiatric problems (OR, 3.5; P = 0.029). Among females, conduct disorder (OR, 3.3; P = 0.016), being a bully/bully-victim (OR, 3.3; P = 0.019) and parental substance-use problems (OR, 2.6; P = 0.024) were related to heavy BZD use. The mean (±SD) age of first BZD prescription was significantly lower in heavy, compared with mild users (men: 19.3 ± 2.5 vs. 21.0 ± 2.5 years, P = 0.027; women: 19.7 ± 2.6 vs. 21.5 ± 3.4 years, P = 0.027). Heavy, compared with mild, BZD use is associated with female suicide attempts (OR, 5.0; P = 0.049). Physicians should be cautious when prescribing BZDs to young adults and must allocate treatment to those with carefully evaluated clinical indications.

To develop machine learning models capable of predicting suicide and non-fatal suicide attempt as separate outcomes in the first 30 days after discharge from a psychiatric inpatient stay. Prospective cohort study using nationwide Danish registry data. We included individuals who were 18 years or older, and all discharges from psychiatric hospitalizations in Denmark from 1995 to 2018. We trained predictive models using 10-fold cross validation on 80% of the data and did testing on the remaining 20%. The best model for predicting non-fatal suicide attempt was an ensemble of predictions from gradient boosting (XGBoost) and categorical boosting (catBoost). The ROC-AUC for predicting suicide attempt was 0.85 (95% CI: 0.84-0.85). At a risk threshold of 4.36%, positive predictive value (PPV) was 11.0% and sensitivity was 47.2%. The best model for predicting suicide was an ensemble of predictions from random forest, XGBoost and catBoost. For suicide, the ROC-AUC was 0.71 (95% CI: 0.70-0.73). At a risk threshold of 0.15%, PPV was 0.34% and sensitivity was 56.0%. The most contributing predictors differed when predicting suicide and suicide attempt, indicating that separate models are needed. The ensemble model was fair across sex and age, and more so than the penalized logistic regression model. We achieved good performance for predicting suicide attempts and demonstrated a clinical application of ensemble models. Our results indicate a difference in predictive performance for models predicting suicide and suicide attempt, respectively. Thus, we recommend that suicide and suicide attempt are treated as two separate endpoints, in particular for clinical application. We demonstrated that the ensemble model is fairer across sex and age compared with a penalized logistic regression, and therefore we recommend the use of well-tested ensembles despite a more complex explainability.

Background: Suicide is a major global public health issue that is becoming increasingly common despite preventive efforts. Though current methods for predicting suicide risk are not sufficiently accurate, technological advances provide invaluable tools with which we may evolve toward a personalized, predictive approach. Objective: We aim to predict the short-term (1-week) risk of suicide by identifying changes in behavioral patterns characterized through real-time smartphone monitoring in a cohort of patients with suicidal ideation. Methods: We recruited 225 patients between February 2018 and March 2020 with a history of suicidal thoughts and behavior as part of the multicenter SmartCrisis study. Throughout 6 months of follow-up, we collected information on the risk of suicide or mental health crises. All participants underwent voluntary passive monitoring using data generated by their own smartphones, including distance walked and steps taken, time spent at home, and app usage. The algorithm constructs daily activity profiles for each patient according to these data and detects changes in the distribution of these profiles over time. Such changes are considered critical periods, and their relationship with suicide-risk events was tested. Results: During follow-up, 18 (8%) participants attempted suicide, and 14 (6.2%) presented to the emergency department for psychiatric care. The behavioral changes identified by the algorithm predicted suicide risk in a time frame of 1 week with an area under the curve of 0.78, indicating good accuracy. Conclusions: We describe an innovative method to identify mental health crises based on passively collected information from patients' smartphones. This technology could be applied to homogeneous groups of patients to identify different types of crises.

Objectives: To estimate the risk of suicide attempt repetition among individuals with an index attempt. It also aims to study the role of risk factors and prevention programme in repetition. Methods: This systematic review and meta-analysis was conducted in keeping with the PRISMA 2020 guidelines. Studies on attempt repetition (both cohort studies and intervention studies) were searched from inception to 2022. Results: A total of 110 studies comprising 248,829 attempters was reviewed. The overall repetition rate was 0.20 (0.17, 0.22). Repetition risk linearly increased over time. A higher risk of attempt repetition was associated with female sex and index attempts in which self-cutting methods were used. Moreover, a mental disorder diagnosis was associated with an increasing repetition risk (OR = 2.02, p < .01). The delivery of a preventive programme reduced the repetition risk, OR = 0.76, p < .05; however, this effect was significant for psychotherapy interventions, OR = 0.38, p < .01. Conclusion: One in five suicide attempters will engage in a new suicide attempt. An elevated repetition risk is associated with being female, more severe index methods and psychiatric disorder diagnosis. Preventive programmes, particularly psychotherapy, may contribute to reducing repetition risk and eventually save lives.

Objectives: To estimate the risk of suicide attempt repetition among individuals with an index attempt. It also aims to study the role of risk factors and prevention programme in repetition. Methods: This systematic review and meta-analysis was conducted in keeping with the PRISMA 2020 guidelines. Studies on attempt repetition (both cohort studies and intervention studies) were searched from inception to 2022. Results: A total of 110 studies comprising 248,829 attempters was reviewed. The overall repetition rate was 0.20 (0.17, 0.22). Repetition risk linearly increased over time. A higher risk of attempt repetition was associated with female sex and index attempts in which self-cutting methods were used. Moreover, a mental disorder diagnosis was associated with an increasing repetition risk (OR = 2.02, p < .01). The delivery of a preventive programme reduced the repetition risk, OR = 0.76, p < .05; however, this effect was significant for psychotherapy interventions, OR = 0.38, p < .01. Conclusion: One in five suicide attempters will engage in a new suicide attempt. An elevated repetition risk is associated with being female, more severe index methods and psychiatric disorder diagnosis. Preventive programmes, particularly psychotherapy, may contribute to reducing repetition risk and eventually save lives.

This article is about suicide on the Phenomenological Existential Psychology perspective. The question that guides this study is: how does the Phenomenological Existential Psychology understands and analyses the suicide subject? The general goal of the article is to discuss the matter of the suicide under the heideggerian Phenomenological Existential Psychology’s view. The specific goals are: contextualize the suicide matter; to understand the finitude, death and autonomy categories; and analyse the discussion of moralization, blaming and pathologizing of the suicide. This is a narrative literature review that attempts to describe the development of such theme, through the analysis of scientific production. Starting with a statistical analysis and the different ways of understanding of the suicide, this article attempted to reach a deeper reflection about the existential matters about the phenomenon. Going through reflections about the meaning of finitude, using some ideas, such as anguish, freedom and choice, and also aspects involving matters of cause and motive. Lastly, we attempted to deepen the interpretations of traditional labelers that that remains about the ways of understanding the behavior of putting an end to one’s own life. With an emphasis for the moralizing view, of blaming and pathologizing. We hope that the discussions made can favor a point of view that encompasses the subjectivity and complexity of each existence regarding suicide., El presente trabajo aborda el tema del suicidio desde la perspectiva de la Psicología Fenomenológica Existencial. La pregunta orientadora del estudio es: ¿cómo la Psicología Fenomenológica Existencial entiende y analiza el tema del suicidio? El objetivo general es discutir el tema del suicidio desde la perspectiva de la Psicología Fenomenológica Existencial de inspiración heideggeriana. Los objetivos específicos son: contextualizar la cuestión del suicidio; comprender las categorías de finitud, muerte y autonomía; y analizar la discusión sobre moralización, culpa y patologización del suicidio. Es una revisión de literatura narrativa, que busca describir el desarrollo de un tema determinado a través del análisis de la producción científica. Partiendo de un análisis estadístico y de las diferentes formas de entender el suicidio, se intentó llegar a una reflexión más profunda acerca de las cuestiones existenciales relacionadas con este fenómeno, pasando por reflexiones sobre los significados de la finitud a partir de algunas ideas, como la angustia, la desesperación, la libertad y la elección, y repasando aspectos que implican cuestiones de causa y motivo. Finalmente, se buscó profundizar en las interpretaciones tradicionales del etiquetado que prevalecen sobre las formas de entender el acto de poner fin a la propia vida, con énfasis en la mirada moralizante, culpabilizadora y patologizadora. Se espera que las discusiones realizadas favorezcan una visión que contemple la subjetividad y complejidad de cada existencia frente al suicídio., O presente trabalho versa sobre o tema do suicídio na perspectiva da Psicologia Fenomenológica Existencial. A pergunta norteadora do estudo é: como a Psicologia Fenomenológica Existencial compreende e analisa o tema do suicídio? O objetivo geral é discutir a problemática do suicídio sob o olhar da Psicologia Fenomenológica Existencial de inspiração heideggeriana. Como objetivos específicos apresentam-se: contextualizar a questão do suicídio; compreender as categorias de finitude, morte e autonomia; e analisar a discussão da moralização, culpabilização e patologização do suicídio. Trata-se de uma revisão narrativa de literatura, pela qual se busca descrever o desenvolvimento de determinado tema por meio da análise da produção científica. Partindo de uma análise estatística e dos diferentes modos de compreensão do suicídio, procurou-se alcançar uma reflexão mais profunda acerca das questões existenciais referentes a tal fenômeno, percorrendo reflexões acerca dos sentidos da finitude a partir de algumas ideias, tais como angústia, desespero, liberdade e escolha, e passando por aspectos envolvendo questões sobre causa e motivo. Por fim, buscou-se aprofundar as interpretações rotuladoras tradicionais que prevalecem sobre os modos de compreensão do ato de colocar fim à própria vida, com destaque para a visão moralizante, de culpabilização e de patologização. Espera-se que as discussões realizadas possam favorecer uma visão que contemple a subjetividade e a complexidade de cada existência a respeito do suicídio.

This article is about suicide on the Phenomenological Existential Psychology perspective. The question that guides this study is: how does the Phenomenological Existential Psychology understands and analyses the suicide subject? The general goal of the article is to discuss the matter of the suicide under the heideggerian Phenomenological Existential Psychology’s view. The specific goals are: contextualize the suicide matter; to understand the finitude, death and autonomy categories; and analyse the discussion of moralization, blaming and pathologizing of the suicide. This is a narrative literature review that attempts to describe the development of such theme, through the analysis of scientific production. Starting with a statistical analysis and the different ways of understanding of the suicide, this article attempted to reach a deeper reflection about the existential matters about the phenomenon. Going through reflections about the meaning of finitude, using some ideas, such as anguish, freedom and choice, and also aspects involving matters of cause and motive. Lastly, we attempted to deepen the interpretations of traditional labelers that that remains about the ways of understanding the behavior of putting an end to one’s own life. With an emphasis for the moralizing view, of blaming and pathologizing. We hope that the discussions made can favor a point of view that encompasses the subjectivity and complexity of each existence regarding suicide., El presente trabajo aborda el tema del suicidio desde la perspectiva de la Psicología Fenomenológica Existencial. La pregunta orientadora del estudio es: ¿cómo la Psicología Fenomenológica Existencial entiende y analiza el tema del suicidio? El objetivo general es discutir el tema del suicidio desde la perspectiva de la Psicología Fenomenológica Existencial de inspiración heideggeriana. Los objetivos específicos son: contextualizar la cuestión del suicidio; comprender las categorías de finitud, muerte y autonomía; y analizar la discusión sobre moralización, culpa y patologización del suicidio. Es una revisión de literatura narrativa, que busca describir el desarrollo de un tema determinado a través del análisis de la producción científica. Partiendo de un análisis estadístico y de las diferentes formas de entender el suicidio, se intentó llegar a una reflexión más profunda acerca de las cuestiones existenciales relacionadas con este fenómeno, pasando por reflexiones sobre los significados de la finitud a partir de algunas ideas, como la angustia, la desesperación, la libertad y la elección, y repasando aspectos que implican cuestiones de causa y motivo. Finalmente, se buscó profundizar en las interpretaciones tradicionales del etiquetado que prevalecen sobre las formas de entender el acto de poner fin a la propia vida, con énfasis en la mirada moralizante, culpabilizadora y patologizadora. Se espera que las discusiones realizadas favorezcan una visión que contemple la subjetividad y complejidad de cada existencia frente al suicídio., O presente trabalho versa sobre o tema do suicídio na perspectiva da Psicologia Fenomenológica Existencial. A pergunta norteadora do estudo é: como a Psicologia Fenomenológica Existencial compreende e analisa o tema do suicídio? O objetivo geral é discutir a problemática do suicídio sob o olhar da Psicologia Fenomenológica Existencial de inspiração heideggeriana. Como objetivos específicos apresentam-se: contextualizar a questão do suicídio; compreender as categorias de finitude, morte e autonomia; e analisar a discussão da moralização, culpabilização e patologização do suicídio. Trata-se de uma revisão narrativa de literatura, pela qual se busca descrever o desenvolvimento de determinado tema por meio da análise da produção científica. Partindo de uma análise estatística e dos diferentes modos de compreensão do suicídio, procurou-se alcançar uma reflexão mais profunda acerca das questões existenciais referentes a tal fenômeno, percorrendo reflexões acerca dos sentidos da finitude a partir de algumas ideias, tais como angústia, desespero, liberdade e escolha, e passando por aspectos envolvendo questões sobre causa e motivo. Por fim, buscou-se aprofundar as interpretações rotuladoras tradicionais que prevalecem sobre os modos de compreensão do ato de colocar fim à própria vida, com destaque para a visão moralizante, de culpabilização e de patologização. Espera-se que as discussões realizadas possam favorecer uma visão que contemple a subjetividade e a complexidade de cada existência a respeito do suicídio.

Background and aims Substance-induced psychosis has previously been linked to an excess risk of suicide; however, the association between substance-induced psychosis and suicide attempt has hitherto not been investigated. We investigated whether substance-induced psychosis was associated with a higher risk of subsequent suicide attempt. Design Nation-wide prospective register-based cohort study. Setting Denmark. Participants All people living in Denmark aged 13 years or more during 1995 to 2017. Measurements Substance-induced psychosis and suicide attempts were identified through hospital records as ICD-10 codes. Findings A total of 8900 (78.8% males) individuals were diagnosed with a substance-induced psychosis, and 740 of these had a suicide attempt during follow-up. People with a substance-induced psychosis had a higher risk of a subsequent suicide attempt [hazard ratio (HR) = 13.4, 95% confidence interval (CI) = 12.4–14.4] when compared with the general population. The highest hazard ratios were found for psychosis induced by opioids (HR = 26.4, 95% CI = 18.2–38.2); alcohol (HR = 17.7, 95% CI = 15.2–20.6); sedatives (HR = 17.2, 95% CI = 8.9–33.0); and cocaine (HR = 15.6, 95% CI = 10.7–22.8), while cannabis-induced psychosis was linked to an HR of 8.9 (95% CI = 7.7–10.3). Approximately 15% of patients with substance-induced psychosis had had a suicide attempt within 20 years of their substance-induced psychosis diagnosis. Conclusions In Denmark, substance-induced psychosis appears to be strongly associated with subsequent suicide attempt, underscoring the importance of attention and better follow-up for this patient group., Background and aims: Substance-induced psychosis has previously been linked to an excess risk of suicide; however, the association between substance-induced psychosis and suicide attempt has hitherto not been investigated. We investigated whether substance-induced psychosis was associated with a higher risk of subsequent suicide attempt. Design: Nation-wide prospective register-based cohort study. Setting: Denmark. Participants: All people living in Denmark aged 13 years or more during 1995 to 2017. Measurements: Substance-induced psychosis and suicide attempts were identified through hospital records as ICD-10 codes. Findings: A total of 8900 (78.8% males) individuals were diagnosed with a substance-induced psychosis, and 740 of these had a suicide attempt during follow-up. People with a substance-induced psychosis had a higher risk of a subsequent suicide attempt [hazard ratio (HR) = 13.4, 95% confidence interval (CI) = 12.4–14.4] when compared with the general population. The highest hazard ratios were found for psychosis induced by opioids (HR = 26.4, 95% CI = 18.2–38.2); alcohol (HR = 17.7, 95% CI = 15.2–20.6); sedatives (HR = 17.2, 95% CI = 8.9–33.0); and cocaine (HR = 15.6, 95% CI = 10.7–22.8), while cannabis-induced psychosis was linked to an HR of 8.9 (95% CI = 7.7–10.3). Approximately 15% of patients with substance-induced psychosis had had a suicide attempt within 20 years of their substance-induced psychosis diagnosis. Conclusions: In Denmark, substance-induced psychosis appears to be strongly associated with subsequent suicide attempt, underscoring the importance of attention and better follow-up for this patient group.

BackgroundExposure to adverse childhood experiences (ACE) have been found to have profound negative consequences on an individuals' health. Non-suicidal self-injury (NSSI) is a clinically complex and serious global health issue and is closely related to suicide attempts. Previous research has found associations between ACE and NSSI and suicide attempts in clinical samples. However, this association has to our knowledge not been studied to this extent in a sample of forensic psychiatric patients. The aim of this study was therefore to describe the prevalence of adverse childhood experiences (ACE) and their associations with non-suicidal self-injury (NSSI) and/or suicide attempts in forensic psychiatric patients.MethodsThe current study is a cross-sectional study of a consecutive cohort of 98 forensic psychiatric patients (86.7% male) in Sweden. We invited 184 patients with a predicted stay of > 8 weeks who had been cleared for participation by their treating psychiatrist. Of these, 83 declined and 98 eligible patients provided informed consent. Information on ACE, NSSI, and suicide attempts derived from files, self-reports (Childhood Trauma Questionnaire-Short Form; CTQ-SF), and interviews were compared separately among participants with and without NSSI or suicide attempts using t-tests. The dose-response association between ACE and NSSI/suicide attempts was analysed using binary logistic regression.ResultsIn file reviews, 57.2% of participants reported physical abuse, 20% sexual abuse, and 43% repeated bullying by peers during childhood. NSSI and suicide attempts were associated significantly with CTQ-SF total scores, with medium effect sizes (d = .60 to .63, p < .01), and strongly with several CTQ-SF subscales. Parental substance abuse was also associated with NSSI (p = .006, OR = 3.23; 95% confidence interval [CI] = 1.36 to 7.66) and suicide attempts (p = .018, OR = 2.75; 95% CI = 1.18 to 6.42). Each additional ACE factor predicted an increased probability

The aim of this article is to analyse possible factors that influence behaviours related to female suicide: ideation and attempt. To this end, the influence of different indicators has been observed like socio-demographic indicators, support networks, gender-based violences suffered and fear of their partner through a quantitative analysis using a secondary data source, the Study Nº 3235 “Macrosurvey on Violence against Women” (CIS, 2019). Both descriptive and inferential analysis techniques have been used, applying multiple logistic regression to two constructed models: suicidal thinking and suicide attempt. Among the results, it stands out that psychological and control violence, as well as fear of their partner, influence the suicidal thinking and attempt of women., El objetivo de este artículo es analizar posibles factores que infieren en conductas relacionadas con el suicidio femenino: la ideación y el intento. Para ello, se ha observado la influencia de diferentes indicadores sociodemográficos, redes de apoyo, violencias de género sufridas y miedo a la pareja actual mediante un análisis cuantitativo a través de una fuente de datos secundaria, el estudio n.º 3235 «Macroencuesta de Violencia contra la Mujer» (CIS, 2019). Se han utilizado tanto técnicas de análisis descriptivas como inferenciales, aplicando la regresión logística múltiple a dos modelos construidos: pensamiento suicida e intento suicida. Entre los resultados destaca que la violencia psicológica y de control, así como el miedo a la pareja, influyen en el pensamiento e intento suicida de las mujeres.

Objectives To estimate the risk of suicide attempt repetition among individuals with an index attempt. It also aims to study the role of risk factors and prevention programme in repetition. Methods This systematic review and meta-analysis was conducted in keeping with the PRISMA 2020 guidelines. Studies on attempt repetition (both cohort studies and intervention studies) were searched from inception to 2022. Results A total of 110 studies comprising 248,829 attempters was reviewed. The overall repetition rate was 0.20 (0.17, 0.22). Repetition risk linearly increased over time. A higher risk of attempt repetition was associated with female sex and index attempts in which self-cutting methods were used. Moreover, a mental disorder diagnosis was associated with an increasing repetition risk (OR = 2.02, p < .01). The delivery of a preventive programme reduced the repetition risk, OR = 0.76, p < .05; however, this effect was significant for psychotherapy interventions, OR = 0.38, p < .01. Conclusion One in five suicide attempters will engage in a new suicide attempt. An elevated repetition risk is associated with being female, more severe index methods and psychiatric disorder diagnosis. Preventive programmes, particularly psychotherapy, may contribute to reducing repetition risk and eventually save lives.

Introduction Major depressive disorder (MDD) is associated with suicide events and with increased healthcare resource utilization (HRU). The aim was to analyze the pattern of HRU prior to death by suicide or suicide attempt in patients with MDD using national registries. Methods Danish adults with MDD, who died by suicide or had a first-time suicide attempt, were matched with MDD controls on age, sex, and MDD severity and analyzed for psychiatric and non-psychiatric hospital and private practitioner contacts, and prescriptions 1 year prior to the event. For individuals having a second suicide attempt, HRU prior to first and second suicide attempt was analyzed. Results Among 1061 individuals dying by suicide and 3759 individuals with suicide attempt, compared with their controls, the proportion with psychiatric hospitalization was more than 50% increased, mainly accounted for by acute contacts. The difference to the matched controls decreased with increasing MDD severity. Non-psychiatric HRU was increased as well. The proportion with psychiatric hospitalizations or ED visits was reduced prior to the second attempt compared with first attempt. Conclusion Among individuals with MDD, psychiatric and non-psychiatric HRU was increased 1 year prior to suicide event. The proportion of individuals who had psychiatric HRU decreased from first to second suicide attempt., IntroductionMajor depressive disorder (MDD) is associated with suicide events and with increased healthcare resource utilization (HRU). The aim was to analyze the pattern of HRU prior to death by suicide or suicide attempt in patients with MDD using national registries. MethodsDanish adults with MDD, who died by suicide or had a first-time suicide attempt, were matched with MDD controls on age, sex, and MDD severity and analyzed for psychiatric and non-psychiatric hospital and private practitioner contacts, and prescriptions 1 year prior to the event. For individuals having a second suicide attempt, HRU prior to first and second suicide attempt was analyzed. ResultsAmong 1061 individuals dying by suicide and 3759 individuals with suicide attempt, compared with their controls, the proportion with psychiatric hospitalization was more than 50% increased, mainly accounted for by acute contacts. The difference to the matched controls decreased with increasing MDD severity. Non-psychiatric HRU was increased as well. The proportion with psychiatric hospitalizations or ED visits was reduced prior to the second attempt compared with first attempt. ConclusionAmong individuals with MDD, psychiatric and non-psychiatric HRU was increased 1 year prior to suicide event. The proportion of individuals who had psychiatric HRU decreased from first to second suicide attempt.

Introduction Major depressive disorder (MDD) is associated with suicide events and with increased healthcare resource utilization (HRU). The aim was to analyze the pattern of HRU prior to death by suicide or suicide attempt in patients with MDD using national registries. Methods Danish adults with MDD, who died by suicide or had a first-time suicide attempt, were matched with MDD controls on age, sex, and MDD severity and analyzed for psychiatric and non-psychiatric hospital and private practitioner contacts, and prescriptions 1 year prior to the event. For individuals having a second suicide attempt, HRU prior to first and second suicide attempt was analyzed. Results Among 1061 individuals dying by suicide and 3759 individuals with suicide attempt, compared with their controls, the proportion with psychiatric hospitalization was more than 50% increased, mainly accounted for by acute contacts. The difference to the matched controls decreased with increasing MDD severity. Non-psychiatric HRU was increased as well. The proportion with psychiatric hospitalizations or ED visits was reduced prior to the second attempt compared with first attempt. Conclusion Among individuals with MDD, psychiatric and non-psychiatric HRU was increased 1 year prior to suicide event. The proportion of individuals who had psychiatric HRU decreased from first to second suicide attempt., IntroductionMajor depressive disorder (MDD) is associated with suicide events and with increased healthcare resource utilization (HRU). The aim was to analyze the pattern of HRU prior to death by suicide or suicide attempt in patients with MDD using national registries. MethodsDanish adults with MDD, who died by suicide or had a first-time suicide attempt, were matched with MDD controls on age, sex, and MDD severity and analyzed for psychiatric and non-psychiatric hospital and private practitioner contacts, and prescriptions 1 year prior to the event. For individuals having a second suicide attempt, HRU prior to first and second suicide attempt was analyzed. ResultsAmong 1061 individuals dying by suicide and 3759 individuals with suicide attempt, compared with their controls, the proportion with psychiatric hospitalization was more than 50% increased, mainly accounted for by acute contacts. The difference to the matched controls decreased with increasing MDD severity. Non-psychiatric HRU was increased as well. The proportion with psychiatric hospitalizations or ED visits was reduced prior to the second attempt compared with first attempt. ConclusionAmong individuals with MDD, psychiatric and non-psychiatric HRU was increased 1 year prior to suicide event. The proportion of individuals who had psychiatric HRU decreased from first to second suicide attempt.

[Objectives] To estimate the risk of suicide attempt repetition among individuals with an index attempt. It also aims to study the role of risk factors and prevention programme in repetition., [Methods] This systematic review and meta-analysis was conducted in keeping with the PRISMA 2020 guidelines. Studies on attempt repetition (both cohort studies and intervention studies) were searched from inception to 2022., [Results] A total of 110 studies comprising 248,829 attempters was reviewed. The overall repetition rate was 0.20 (0.17, 0.22). Repetition risk linearly increased over time. A higher risk of attempt repetition was associated with female sex and index attempts in which self-cutting methods were used. Moreover, a mental disorder diagnosis was associated with an increasing repetition risk (OR = 2.02, p < .01). The delivery of a preventive programme reduced the repetition risk, OR = 0.76, p < .05; however, this effect was significant for psychotherapy interventions, OR = 0.38, p < .01., [Conclusion] One in five suicide attempters will engage in a new suicide attempt. An elevated repetition risk is associated with being female, more severe index methods and psychiatric disorder diagnosis. Preventive programmes, particularly psychotherapy, may contribute to reducing repetition risk and eventually save lives.

Background and aims Substance-induced psychosis has previously been linked to an excess risk of suicide; however, the association between substance-induced psychosis and suicide attempt has hitherto not been investigated. We investigated whether substance-induced psychosis was associated with a higher risk of subsequent suicide attempt. Design Nation-wide prospective register-based cohort study. Setting Denmark. Participants All people living in Denmark aged 13 years or more during 1995 to 2017. Measurements Substance-induced psychosis and suicide attempts were identified through hospital records as ICD-10 codes. Findings A total of 8900 (78.8% males) individuals were diagnosed with a substance-induced psychosis, and 740 of these had a suicide attempt during follow-up. People with a substance-induced psychosis had a higher risk of a subsequent suicide attempt [hazard ratio (HR) = 13.4, 95% confidence interval (CI) = 12.4–14.4] when compared with the general population. The highest hazard ratios were found for psychosis induced by opioids (HR = 26.4, 95% CI = 18.2–38.2); alcohol (HR = 17.7, 95% CI = 15.2–20.6); sedatives (HR = 17.2, 95% CI = 8.9–33.0); and cocaine (HR = 15.6, 95% CI = 10.7–22.8), while cannabis-induced psychosis was linked to an HR of 8.9 (95% CI = 7.7–10.3). Approximately 15% of patients with substance-induced psychosis had had a suicide attempt within 20 years of their substance-induced psychosis diagnosis. Conclusions In Denmark, substance-induced psychosis appears to be strongly associated with subsequent suicide attempt, underscoring the importance of attention and better follow-up for this patient group., Background and aims: Substance-induced psychosis has previously been linked to an excess risk of suicide; however, the association between substance-induced psychosis and suicide attempt has hitherto not been investigated. We investigated whether substance-induced psychosis was associated with a higher risk of subsequent suicide attempt. Design: Nation-wide prospective register-based cohort study. Setting: Denmark. Participants: All people living in Denmark aged 13 years or more during 1995 to 2017. Measurements: Substance-induced psychosis and suicide attempts were identified through hospital records as ICD-10 codes. Findings: A total of 8900 (78.8% males) individuals were diagnosed with a substance-induced psychosis, and 740 of these had a suicide attempt during follow-up. People with a substance-induced psychosis had a higher risk of a subsequent suicide attempt [hazard ratio (HR) = 13.4, 95% confidence interval (CI) = 12.4–14.4] when compared with the general population. The highest hazard ratios were found for psychosis induced by opioids (HR = 26.4, 95% CI = 18.2–38.2); alcohol (HR = 17.7, 95% CI = 15.2–20.6); sedatives (HR = 17.2, 95% CI = 8.9–33.0); and cocaine (HR = 15.6, 95% CI = 10.7–22.8), while cannabis-induced psychosis was linked to an HR of 8.9 (95% CI = 7.7–10.3). Approximately 15% of patients with substance-induced psychosis had had a suicide attempt within 20 years of their substance-induced psychosis diagnosis. Conclusions: In Denmark, substance-induced psychosis appears to be strongly associated with subsequent suicide attempt, underscoring the importance of attention and better follow-up for this patient group.

Background Traumatic brain injury (TBI) can cause long-lasting sequelae that may increase the risk of suicidal or criminal behaviour, but large-scale longitudinal studies are lacking on the link between TBI and events of suicide attempt and violent crime. This study examined the incidence of suicide attempt and violent crime following hospital contact for TBI in a nationwide cohort study. Methods We used nationwide register data covering all individuals aged 10+ living in Denmark during 1980-2016 (n = 7 783 951). Of these, 587 522 individuals had a hospital contact for TBI. Incidence rate ratios (IRR) were calculated by Poisson regression analyses while adjusted for relevant covariates including other fractures and psychiatric diagnoses. Results Individuals with TBI had higher rates of suicide attempt (females IRR, 2.78; 95% CI 2.71-2.85; males IRR, 3.00; 95% CI 2.93-3.08) compared to individuals without TBI in adjusted analyses. Multiple TBI and temporal proximity to TBI were associated with higher rates of suicide attempt. Individuals with TBI had higher rates of violent crime (females IRR, 2.43; 95% CI 2.36-2.49; males IRR, 1.80, 95% CI 1.78-1.82) compared with individuals without TBI. Higher rates of violent crime were found after multiple TBI and temporal proximity to TBI. Conclusions This nationwide cohort study found higher rates of suicide attempt and violent crime among individuals with prior hospital diagnosed TBI, compared with individuals without TBI. This emphasises the need for preventive efforts immediately after TBI diagnosis, which might mitigate the risks of a trajectory toward suicidal or violent behaviours.

Background: Suicide is a leading cause of death worldwide, and nonfatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders. Methods: We conducted a genome-wide association study (GWAS) of 29,782 suicide attempt (SA) cases and 519,961 controls in the International Suicide Genetics Consortium (ISGC). The GWAS of SA was conditioned on psychiatric disorders using GWAS summary statistics via multitrait-based conditional and joint analysis, to remove genetic effects on SA mediated by psychiatric disorders. We investigated the shared and divergent genetic architectures of SA, psychiatric disorders, and other known risk factors. Results: Two loci reached genome-wide significance for SA: the major histocompatibility complex and an intergenic locus on chromosome 7, the latter of which remained associated with SA after conditioning on psychiatric disorders and replicated in an independent cohort from the Million Veteran Program. This locus has been implicated in risk-taking behavior, smoking, and insomnia. SA showed strong genetic correlation with psychiatric disorders, particularly major depression, and also with smoking, pain, risk-taking behavior, sleep disturbances, lower educational attainment, reproductive traits, lower socioeconomic status, and poorer general health. After conditioning on psychiatric disorders, the genetic correlations between SA and psychiatric disorders decreased, whereas those with nonpsychiatric traits remained largely unchanged. Conclusions: Our results identify a risk locus that contributes more strongly to SA than other phenotypes and suggest a shared underlying biology between SA and known risk factors that is not mediated by psychiatric disorders.

Introduction: Our goal in this study was to identify stimulant abuser patients who are at specifically high risk of suicide attempt (SAT), in order to prioritize them in preventive and risk mitigation programs.Methods: We used the California State Emergency Department Database (SEDD) to obtain discharge information for 2011. The SEDD contains discharge information on all outpatient ED encounters, including uninsured patients and those covered by Medicare, Medicaid, and private insurance. We identified SAT and stimulant abuse by using the relevant International Classification of Diseases, Ninth Revision, codes.Results: The study included 10,124,598 outpatient ED visits. Stimulant abuse was observed in 0.97% of ED visits. Stimulant abuse was more common among young and middle-aged males and people with low median household income. Moreover, it was more common among Native American (1.8%) and Black (1.8%), followed by non-Hispanic White (1.1%) patients. The prevalence of SAT was 2.0% (N = 2000) for ED visits by patients with a history of stimulant abuse, and 0.3% (N = 28,606) for ED visits without a history of stimulant abuse (odds ratio 7.29, 95% confidence interval, 6.97-7.64). The SATs were directly associated with stimulant abuse, younger age (age groups >10), and non-Hispanic White and Native American race. Association of SAT with stimulant abuse was stronger in female patients.Conclusion: Stimulant abuse was the only modifiable risk factor for suicide attempt in our study. Reaching out to populations with higher prevalence of stimulant abuse (young and middle-aged individuals who are Native American or Black, with lower household income) to control the stimulant abuse problem, may reduce the risk of SAT. In this regard, people who are at higher risk of SAT due to non-modifiable risk factors (younger age, and Native American or White race) should be prioritized. Moreover, controlling stimulant abuse among women may be specifically effective in SAT prevention.

BackgroundSuicide is a leading cause of death worldwide, and nonfatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders.MethodsWe conducted a genome-wide association study (GWAS) of 29,782 suicide attempt (SA) cases and 519,961 controls in the International Suicide Genetics Consortium (ISGC). The GWAS of SA was conditioned on psychiatric disorders using GWAS summary statistics via multitrait-based conditional and joint analysis, to remove genetic effects on SA mediated by psychiatric disorders. We investigated the shared and divergent genetic architectures of SA, psychiatric disorders, and other known risk factors.ResultsTwo loci reached genome-wide significance for SA: the major histocompatibility complex and an intergenic locus on chromosome 7, the latter of which remained associated with SA after conditioning on psychiatric disorders and replicated in an independent cohort from the Million Veteran Program. This locus has been implicated in risk-taking behavior, smoking, and insomnia. SA showed strong genetic correlation with psychiatric disorders, particularly major depression, and also with smoking, pain, risk-taking behavior, sleep disturbances, lower educational attainment, reproductive traits, lower socioeconomic status, and poorer general health. After conditioning on psychiatric disorders, the genetic correlations between SA and psychiatric disorders decreased, whereas those with nonpsychiatric traits remained largely unchanged.ConclusionsOur results identify a risk locus that contributes more strongly to SA than other phenotypes and suggest a shared underlying biology between SA and known risk factors that is not mediated by psychiatric disorders.

While mental health problems according psychotropic drug purchases and sick leave spells for psychiatric disorders have increased in Sweden the past 15 years, this is not reflected in trends of psychiatric diagnoses or suicide mortality. In parallel, labor markets have undergone structural changes pressuring employers to increase their flexibility to ensure permanence. In consequence, this may introduce greater uncertainty about employment continuity and involuntary job transitions for the employees. While evidence suggest that employment uncertainty increases the risk of self-reported mental health problems, the relation to clinically pertinent mental health conditions remains unclear. Therefore, this thesis aimed to investigate if employment uncertainty and involuntary labor market transitions, was associated with common and with severe clinically defined mental health conditions. All four studies relied on national health registers for ascertainment of clinically defined mental health conditions. Studies I and II relied on information from registers to operationalize downsizings/workplace closures, while Study III and IV obtained information about cognitive and affective job insecurity from the Longitudinal Occupational Survey of Health and the Swedish Work Environment Survey, respectively. According to Study I, employees who left the downsizing organization for another or no job increased their purchases of psychotropic drugs prior to the downsizing more than unexposed employees, while their purchases decreased in connection to the exits. For employees staying in the organization, psychotropic drug purchases increased from 1 year before the downsizing to 4 years after, particularly in close proximity to the downsizing. Study II showed that older employees exposed to downsizing/workplace closure before permanently exiting into old age retirement, sickness absence/disability pension or unemployment exhibited a smaller or no decline in psychotropic drug purchases d

Psychoeducational groups have been used to address many health needs. Yet, there are few such options available for people who have attempted suicide. This study presents preliminary findings from an open trial of Eclipse, an 8-week closed, psychoeducational group for people who have attempted suicide. It examined the effectiveness of the Eclipse program in reducing suicidal ideation, depressive symptoms, perceived burdensomeness and thwarted belongingness, and increasing resilience and help-seeking. Results showed statistically significant improvements in depressive symptoms, perceived burdensomeness, resilience and help-seeking from baseline (T1) to immediate post-test (T2), and in perceived burdensomeness from T1 to 1-month follow-up (T3). A pervasiveness analysis showed that over half of the participants reported improvements in key study outcomes, respectively, as a result of participating in the Eclipse group. Psychoeducational support groups could provide broad application for those who have previously attempted suicide in decreasing severity of suicidal thinking by reductions in depressive symptoms, burdensomeness, and thwarted belongingness.

Objectives: The aim of this study was to analyze whether individuals reporting exposure to workplace bullying had a higher risk of suicidal behavior, including both suicide attempt and death by suicide, than those not reporting such exposure. Methods: Using a prospective cohort study design, we linked data from nine Danish questionnaire-based surveys (2004–2014) to national registers up to 31 December 2016. Exposure to workplace bullying was measured by a single item. Suicide attempts were identified in hospital registers and death by suicide in the Cause of Death Reg-ister. Among participants with no previous suicide attempts, we estimated hazard ratios (HR) and 95% confidence intervals (CI), adjusting for sex, age, marital status, socioeconomic status, and history of psychiatric morbidity. Results: The sample consisted of 98 330 participants (713 798 person-years), 63.6% were women, and the mean age was 44.5 years. Of these participants, 10 259 (10.4%) reported workplace bullying. During a mean follow-up of 7.3 years, we observed 184 cases of suicidal behavior, including 145 suicide attempts, 35 deaths by suicide and 4 cases that died by suicide after surviving a suicide attempt. The fully-adjusted HR for the association between workplace bullying and suicidal behavior was 1.65 (95% CI 1.06–2.58). The HR for suicide attempts and death by suicide were 1.65 (1.09–2.50) and 2.08 (0.82–5.27), respectively. Analyses stratified by sex showed a sta-tistically significant association between workplace bullying and suicidal behavior among men but not women. Conclusions: The results suggest that exposure to workplace bullying is associated with an elevated risk of suicidal behavior among men.

IMPORTANCE Children who are placed in out-of-home care may have poorer outcomes in adulthood, on average, compared with their peers, but the direction and magnitude of these associations need clarification. OBJECTIVE To estimate associations between being placed in out-of-home care in childhood and adolescence and subsequent risks of experiencing a wide range of social and health outcomes in adulthood following comprehensive adjustments for preplacement factors. DESIGN, SETTING, PARTICIPANTS This cohort and cosibling study of all children born in Finland between 1986 and 2000 (N = 855622) monitored each person from their 15th birthday either until the end of the study period (December 2018) or until they migrated, died, or experienced the outcome of interest. Cox and Poisson regression models were used to estimate associations with adjustment for measured confounders (from linked population registers) and unmeasured familial confounders (using sibling comparisons). Data were analyzed from October 2020 to August 2021. EXPOSURES Placement in out-of-home care up to age 15 years. MAIN OUTCOMES AND MEASURES Through national population, patient, prescription drug, cause of death, and crime registers, 16 specific outcomes were identified across the following categories: psychiatric disorders; low socioeconomic status; injuries and experiencing violence; and antisocial behaviors, suicidality, and premature mortality. RESULTS A total of 30127 individuals (3.4%) were identified who had been placed in out-of-home care for a median (interquartile range) period of 1.3 (0.2-5.1) years and 2 (1-3) placement episodes before age 15 years. Compared with their siblings, individuals who had been placed in out-of-home care were 1.4 to 5 times more likely to experience adverse outcomes in adulthood (adjusted hazard ratio [aHR] for those with a fall-related injury, 1.40; 95% CI, 1.25-1.57 and aHR for those with an unintentional poisoning injury, 4.79; 95% CI, 3.56-6.43, respectively). The

Objective Whether perceived job insecurity increases the risk of suicidal behaviors is unclear. Improved understanding in this area could inform efforts to reduce suicide risk among those experiencing elevated job insecurity during the COVID-19 pandemic as well as post-pandemic. We aimed to investigate if perceived job insecurity predicted increased risk of suicide mortality and suicide attempts. Method Employees (N=65 571), representative of the Swedish working population who participated in the Swedish Work Environment Survey in 1991–2003, were followed up through 2016 in the National Inpatient and Death Registers. Suicide deaths and suicide attempts were defined according to International Classification of Diseases (ICD) 10 and ICD-8/9 codes of underlying cause of death and in-/outpatient care. Job insecurity and subsequent risk of suicide and suicide attempt were investigated with marginal structural Cox regression analyses and inverse probability of treatment weighting to control for confounding. Results Perceived job insecurity was associated with an elevated risk of suicide [hazard ratio (HR) 1.51, 95% confidence interval (CI) 1.03–2.20], but not with incident suicide attempts (HR 1.03, CI 0.86–1.24). Estimates remained similar after considering prevalent/previous poor mental health, other work factors, and when restricting the follow up time to ten years. Conclusion The study suggests that job insecurity is associated with an increased risk of suicide mortality. Concerns about elevated job insecurity and suicide levels in the wake of the current pandemic could thus be considered in strategies to reduce the population health impact job insecurity both during and following the COVID-19 pandemic.

While mental health problems according psychotropic drug purchases and sick leave spells for psychiatric disorders have increased in Sweden the past 15 years, this is not reflected in trends of psychiatric diagnoses or suicide mortality. In parallel, labor markets have undergone structural changes pressuring employers to increase their flexibility to ensure permanence. In consequence, this may introduce greater uncertainty about employment continuity and involuntary job transitions for the employees. While evidence suggest that employment uncertainty increases the risk of self-reported mental health problems, the relation to clinically pertinent mental health conditions remains unclear. Therefore, this thesis aimed to investigate if employment uncertainty and involuntary labor market transitions, was associated with common and with severe clinically defined mental health conditions. All four studies relied on national health registers for ascertainment of clinically defined mental health conditions. Studies I and II relied on information from registers to operationalize downsizings/workplace closures, while Study III and IV obtained information about cognitive and affective job insecurity from the Longitudinal Occupational Survey of Health and the Swedish Work Environment Survey, respectively. According to Study I, employees who left the downsizing organization for another or no job increased their purchases of psychotropic drugs prior to the downsizing more than unexposed employees, while their purchases decreased in connection to the exits. For employees staying in the organization, psychotropic drug purchases increased from 1 year before the downsizing to 4 years after, particularly in close proximity to the downsizing. Study II showed that older employees exposed to downsizing/workplace closure before permanently exiting into old age retirement, sickness absence/disability pension or unemployment exhibited a smaller or no decline in psychotropic drug purchases d

BACKGROUND: Suicide is a leading cause of death worldwide, and nonfatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders. METHODS: We conducted a genome-wide association study (GWAS) of 29,782 suicide attempt (SA) cases and 519,961 controls in the International Suicide Genetics Consortium (ISGC). The GWAS of SA was conditioned on psychiatric disorders using GWAS summary statistics via multitrait-based conditional and joint analysis, to remove genetic effects on SA mediated by psychiatric disorders. We investigated the shared and divergent genetic architectures of SA, psychiatric disorders, and other known risk factors. RESULTS: Two loci reached genome-wide significance for SA: the major histocompatibility complex and an intergenic locus on chromosome 7, the latter of which remained associated with SA after conditioning on psychiatric disorders and replicated in an independent cohort from the Million Veteran Program. This locus has been implicated in risk-taking behavior, smoking, and insomnia. SA showed strong genetic correlation with psychiatric disorders, particularly major depression, and also with smoking, pain, risk-taking behavior, sleep disturbances, lower educational attainment, reproductive traits, lower socioeconomic status, and poorer general health. After conditioning on psychiatric disorders, the genetic correlations between SA and psychiatric disorders decreased, whereas those with nonpsychiatric traits remained largely unchanged. CONCLUSIONS: Our results identify a risk locus that contributes more strongly to SA than other phenotypes and suggest a shared underlying biology between SA and known risk factors that is not mediated by psychiatric disorders.

BACKGROUND: Suicide is a leading cause of death worldwide, and nonfatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders. METHODS: We conducted a genome-wide association study (GWAS) of 29,782 suicide attempt (SA) cases and 519,961 controls in the International Suicide Genetics Consortium (ISGC). The GWAS of SA was conditioned on psychiatric disorders using GWAS summary statistics via multitrait-based conditional and joint analysis, to remove genetic effects on SA mediated by psychiatric disorders. We investigated the shared and divergent genetic architectures of SA, psychiatric disorders, and other known risk factors. RESULTS: Two loci reached genome-wide significance for SA: the major histocompatibility complex and an intergenic locus on chromosome 7, the latter of which remained associated with SA after conditioning on psychiatric disorders and replicated in an independent cohort from the Million Veteran Program. This locus has been implicated in risk-taking behavior, smoking, and insomnia. SA showed strong genetic correlation with psychiatric disorders, particularly major depression, and also with smoking, pain, risk-taking behavior, sleep disturbances, lower educational attainment, reproductive traits, lower socioeconomic status, and poorer general health. After conditioning on psychiatric disorders, the genetic correlations between SA and psychiatric disorders decreased, whereas those with nonpsychiatric traits remained largely unchanged. CONCLUSIONS: Our results identify a risk locus that contributes more strongly to SA than other phenotypes and suggest a shared underlying biology between SA and known risk factors that is not mediated by psychiatric disorders.

Bakgrund: Över 700 000 människor dör varje år till följd av suicid runt om i världen och den största riskfaktorn för att begå suicid är tidigare suicidförsök. Forskning visar att människor som begår suicid ofta söker till akutmottagningar en eller flera gånger innan de tar sitt liv. Akutmottagningar är därför en viktig plats för förebyggandet av suicid. Forskning visar att suicidförsök och självskadebeteende blir allt vanligare samt att självskadebeteende är en viktig riskfaktor för suicid. Sjuksköterskor på akutmottagningar möter ofta patienter med självskadebeteenden, patienter som genomgått suicidförsök och patienter som funderar på att ta sitt liv. Syfte: Syftet var att beskriva akutsjuksköterskors upplevelser och erfarenheter av att vårda patienter som inkommit till akutmottagningar till följd av självskadebeteenden och suicidförsök, samt beskriva akutsjuksköterskors attityder gentemot dessa patienter. Metod: En systematisk litteraturöversikt med integrativ design. Systematiska artikelsökningar har utförts i tre medicinska databaser med hjälp av PEO-modellen. Tio inkluderade vetenskapliga artiklar av kvalitativ, kvantitativ och mixad metod har granskats och analyserats. Resultat: I resultatet framkom följande fem teman: I. Sjuksköterskors attityder; II. Sjuksköterskors prioritering av fysisk framför psykisk hälsa; III. Arbetslivserfarenhet på akutmottagningen; IV. Barriärer inom akutmottagningens kontext; och V. Sjuksköterskors upplevda kompetenser & färdigheter. Slutsats: Då resultatet visar att många akutsjuksköterskor uppger osäkerhet och otrygghet vid vården av patienter med självskadebeteende och patienter som begått suicidförsök, bör mer utbildning erbjudas på akutmottagningar kring just dessa tillstånd. För att kunna bedriva en mer hållbar och patientsäker vård bör även akutmottagningar försöka behålla och rekrytera kompetenta och erfarna sjuksköterskor., Background: Each year, more than 700 000 people around the world die because of suicide, and the biggest risk factor for committing suicide is previous suicide attempts. Research shows that people who commit suicide often visit the emergency department one, up to several times before taking their own lives. Emergency departments are therefore an important place for preventing suicide. Research shows that suicide attempts and self-harming behavior are becoming more common, and that selfharming behavior is an important risk factor for suicide. In emergency departments, nurses often meet patients with self-harming behaviors, patients who have attempted suicide and patients with suicidal ideation. Aim: The aim was to describe the emergency nurses’ experiences of caring for patients who have been admitted to emergency rooms because of self-harming behaviors and suicide attempts, and to describe emergency nurses' attitudes towards these patients Method: A systematic literature review with integrative design. Systematic searches have been conducted in three medical databases using the PEO model. Ten included scientific articles of qualitative, quantitative, and mixed method designs have been reviewed and analyzed. Results: The results highlight five main themes: I. Nurses’ attitudes; II. Nurses’ treatment of physical over mental health; III. Work experience in the emergency department; IV. Barriers in the context of the emergency department; and V. Nurses’ perceived competencies and skills. Conclusions: As the result show that many emergency nurses' report insecurity in the care of patients with self-harming behavior and patients who have attempted suicide, more training should be offered in emergency departments around these conditions. Emergency departments should also try to retain and recruit competent and experienced nurses, to provide more sustainable and patient-safe care.

While mental health problems according psychotropic drug purchases and sick leave spells for psychiatric disorders have increased in Sweden the past 15 years, this is not reflected in trends of psychiatric diagnoses or suicide mortality. In parallel, labor markets have undergone structural changes pressuring employers to increase their flexibility to ensure permanence. In consequence, this may introduce greater uncertainty about employment continuity and involuntary job transitions for the employees. While evidence suggest that employment uncertainty increases the risk of self-reported mental health problems, the relation to clinically pertinent mental health conditions remains unclear. Therefore, this thesis aimed to investigate if employment uncertainty and involuntary labor market transitions, was associated with common and with severe clinically defined mental health conditions. All four studies relied on national health registers for ascertainment of clinically defined mental health conditions. Studies I and II relied on information from registers to operationalize downsizings/workplace closures, while Study III and IV obtained information about cognitive and affective job insecurity from the Longitudinal Occupational Survey of Health and the Swedish Work Environment Survey, respectively. According to Study I, employees who left the downsizing organization for another or no job increased their purchases of psychotropic drugs prior to the downsizing more than unexposed employees, while their purchases decreased in connection to the exits. For employees staying in the organization, psychotropic drug purchases increased from 1 year before the downsizing to 4 years after, particularly in close proximity to the downsizing. Study II showed that older employees exposed to downsizing/workplace closure before permanently exiting into old age retirement, sickness absence/disability pension or unemployment exhibited a smaller or no decline in psychotropic drug purchases d

Introduction: Our goal in this study was to identify stimulant abuser patients who are at specifically high risk of suicide attempt (SAT), in order to prioritize them in preventive and risk mitigation programs.Methods: We used the California State Emergency Department Database (SEDD) to obtain discharge information for 2011. The SEDD contains discharge information on all outpatient ED encounters, including uninsured patients and those covered by Medicare, Medicaid, and private insurance. We identified SAT and stimulant abuse by using the relevant International Classification of Diseases, Ninth Revision, codes.Results: The study included 10,124,598 outpatient ED visits. Stimulant abuse was observed in 0.97% of ED visits. Stimulant abuse was more common among young and middle-aged males and people with low median household income. Moreover, it was more common among Native American (1.8%) and Black (1.8%), followed by non-Hispanic White (1.1%) patients. The prevalence of SAT was 2.0% (N = 2000) for ED visits by patients with a history of stimulant abuse, and 0.3% (N = 28,606) for ED visits without a history of stimulant abuse (odds ratio 7.29, 95% confidence interval, 6.97-7.64). The SATs were directly associated with stimulant abuse, younger age (age groups >10), and non-Hispanic White and Native American race. Association of SAT with stimulant abuse was stronger in female patients.Conclusion: Stimulant abuse was the only modifiable risk factor for suicide attempt in our study. Reaching out to populations with higher prevalence of stimulant abuse (young and middle-aged individuals who are Native American or Black, with lower household income) to control the stimulant abuse problem, may reduce the risk of SAT. In this regard, people who are at higher risk of SAT due to non-modifiable risk factors (younger age, and Native American or White race) should be prioritized. Moreover, controlling stimulant abuse among women may be specifically effective in SAT prevention.

Objectives: To study age group differences in clinical characteristics in older, middle-aged and younger adults with actual suicide attempts (SA). Design: Cross-sectional cohort study. Setting: 3 Swedish university hospitals. Participants: 821 persons who presented with self-harm at psychiatric emergency departments participated. Those with non-suicidal self-injury according to the Columbia Suicide Severity Rating Scale (C-SSRS) were excluded, leaving a total of 683 with an actual SA (18–44 years, n = 423; 45-64 years, n = 164; 65+, n = 96). Measurements: Suicidal behavior was characterized with the C-SSRS and the Suicide Intent Scale (SIS); symptoms associated with suicide were rated with the Suicide Assessment Scale (SUAS). Diagnoses were set using the Mini-International Neuropsychiatric Interview. Patients self-rated their symptoms with the Karolinska Affective and Borderline Symptoms Scale (KABOSS). Results: Older adults scored higher than the younger group on SIS total score and on the subjective subscale, but no age group differences were detected for the objective subscale. Half of the 65+ group fulfilled criteria for major depression, compared to 3-quarters in both the middle-aged and young groups. Anxiety disorders, as well as alcohol and substance use disorders were also less prevalent in the 65+ group, while serious physical illness was more common. Older adults scored lower on all symptom scales; effect sizes were large. Conclusions: While older adults with an SA showed higher suicide intent than young adults, they had lower scores on all ratings of psychiatric symptomatology. Low ratings might interfere with clinicians’ assessments of the needs of older adults with intentional self-harm.

Objectives: To study age group differences in clinical characteristics in older, middle-aged and younger adults with actual suicide attempts (SA). Design: Cross-sectional cohort study. Setting: 3 Swedish university hospitals. Participants: 821 persons who presented with self-harm at psychiatric emergency departments participated. Those with non-suicidal self-injury according to the Columbia Suicide Severity Rating Scale (C-SSRS) were excluded, leaving a total of 683 with an actual SA (18–44 years, n = 423; 45-64 years, n = 164; 65+, n = 96). Measurements: Suicidal behavior was characterized with the C-SSRS and the Suicide Intent Scale (SIS); symptoms associated with suicide were rated with the Suicide Assessment Scale (SUAS). Diagnoses were set using the Mini-International Neuropsychiatric Interview. Patients self-rated their symptoms with the Karolinska Affective and Borderline Symptoms Scale (KABOSS). Results: Older adults scored higher than the younger group on SIS total score and on the subjective subscale, but no age group differences were detected for the objective subscale. Half of the 65+ group fulfilled criteria for major depression, compared to 3-quarters in both the middle-aged and young groups. Anxiety disorders, as well as alcohol and substance use disorders were also less prevalent in the 65+ group, while serious physical illness was more common. Older adults scored lower on all symptom scales; effect sizes were large. Conclusions: While older adults with an SA showed higher suicide intent than young adults, they had lower scores on all ratings of psychiatric symptomatology. Low ratings might interfere with clinicians’ assessments of the needs of older adults with intentional self-harm.

Objectives: To study age group differences in clinical characteristics in older, middle-aged and younger adults with actual suicide attempts (SA). Design: Cross-sectional cohort study. Setting: 3 Swedish university hospitals. Participants: 821 persons who presented with self-harm at psychiatric emergency departments participated. Those with non-suicidal self-injury according to the Columbia Suicide Severity Rating Scale (C-SSRS) were excluded, leaving a total of 683 with an actual SA (18–44 years, n = 423; 45-64 years, n = 164; 65+, n = 96). Measurements: Suicidal behavior was characterized with the C-SSRS and the Suicide Intent Scale (SIS); symptoms associated with suicide were rated with the Suicide Assessment Scale (SUAS). Diagnoses were set using the Mini-International Neuropsychiatric Interview. Patients self-rated their symptoms with the Karolinska Affective and Borderline Symptoms Scale (KABOSS). Results: Older adults scored higher than the younger group on SIS total score and on the subjective subscale, but no age group differences were detected for the objective subscale. Half of the 65+ group fulfilled criteria for major depression, compared to 3-quarters in both the middle-aged and young groups. Anxiety disorders, as well as alcohol and substance use disorders were also less prevalent in the 65+ group, while serious physical illness was more common. Older adults scored lower on all symptom scales; effect sizes were large. Conclusions: While older adults with an SA showed higher suicide intent than young adults, they had lower scores on all ratings of psychiatric symptomatology. Low ratings might interfere with clinicians’ assessments of the needs of older adults with intentional self-harm.

BackgroundSuicide is a leading cause of death worldwide, and nonfatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders.MethodsWe conducted a genome-wide association study (GWAS) of 29,782 suicide attempt (SA) cases and 519,961 controls in the International Suicide Genetics Consortium (ISGC). The GWAS of SA was conditioned on psychiatric disorders using GWAS summary statistics via multitrait-based conditional and joint analysis, to remove genetic effects on SA mediated by psychiatric disorders. We investigated the shared and divergent genetic architectures of SA, psychiatric disorders, and other known risk factors.ResultsTwo loci reached genome-wide significance for SA: the major histocompatibility complex and an intergenic locus on chromosome 7, the latter of which remained associated with SA after conditioning on psychiatric disorders and replicated in an independent cohort from the Million Veteran Program. This locus has been implicated in risk-taking behavior, smoking, and insomnia. SA showed strong genetic correlation with psychiatric disorders, particularly major depression, and also with smoking, pain, risk-taking behavior, sleep disturbances, lower educational attainment, reproductive traits, lower socioeconomic status, and poorer general health. After conditioning on psychiatric disorders, the genetic correlations between SA and psychiatric disorders decreased, whereas those with nonpsychiatric traits remained largely unchanged.ConclusionsOur results identify a risk locus that contributes more strongly to SA than other phenotypes and suggest a shared underlying biology between SA and known risk factors that is not mediated by psychiatric disorders.

BACKGROUND: Suicide is a leading cause of death worldwide, and nonfatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders. METHODS: We conducted a genome-wide association study (GWAS) of 29,782 suicide attempt (SA) cases and 519,961 controls in the International Suicide Genetics Consortium (ISGC). The GWAS of SA was conditioned on psychiatric disorders using GWAS summary statistics via multitrait-based conditional and joint analysis, to remove genetic effects on SA mediated by psychiatric disorders. We investigated the shared and divergent genetic architectures of SA, psychiatric disorders, and other known risk factors. RESULTS: Two loci reached genome-wide significance for SA: the major histocompatibility complex and an intergenic locus on chromosome 7, the latter of which remained associated with SA after conditioning on psychiatric disorders and replicated in an independent cohort from the Million Veteran Program. This locus has been implicated in risk-taking behavior, smoking, and insomnia. SA showed strong genetic correlation with psychiatric disorders, particularly major depression, and also with smoking, pain, risk-taking behavior, sleep disturbances, lower educational attainment, reproductive traits, lower socioeconomic status, and poorer general health. After conditioning on psychiatric disorders, the genetic correlations between SA and psychiatric disorders decreased, whereas those with nonpsychiatric traits remained largely unchanged. CONCLUSIONS: Our results identify a risk locus that contributes more strongly to SA than other phenotypes and suggest a shared underlying biology between SA and known risk factors that is not mediated by psychiatric disorders.

BackgroundDispositional gratitude has been implicated as a psychological characteristic that may modulate risk for mental health outcomes. Using a population-based sample of U.S. military veterans, this study evaluated the association between dispositional gratitude and the development of psychopathology and suicidal behaviors over a 7-year period.MethodsA nationally representative sample of U.S. veterans was surveyed at four timepoints across seven years. Analyses were restricted to veterans without incident outcomes at baseline. Multivariable analyses were conducted to examine the relation between baseline levels of dispositional gratitude and risk of developing (a) major depressive disorder (MDD), generalized anxiety disorder (GAD), or posttraumatic stress disorder (PTSD); (b) suicidal ideation; and (c) suicide attempts.ResultsA total 9.6% of veterans developed MDD, GAD, and/or PTSD, 9.5% developed suicidal ideation, and 2.8% reported having attempted suicide over the 7-year follow-up period. Among veterans with high levels of dispositional gratitude, incidence was lower for MDD/GAD/PTSD (8.0%), suicidal ideation (6.8%), and suicide attempts (1.5%). Conversely, veterans with low dispositional gratitude were at substantially higher risk of developing MDD/GAD/PTSD (27.7%), suicidal ideation (33.6%), and suicide attempts (20.3%).ConclusionsHigh dispositional gratitude may help protect against the development of psychopathology and suicidal behaviors in U.S. military veterans, whereas low gratitude may increase risk of developing these outcomes. Collectively, these results support the potential utility of enhancing gratitude as part of primary prevention efforts for veterans, service members, and other populations at heightened risk for adverse mental health outcomes.