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Objective: Heightened sensitivity to rejection is a feature of personality pathology, particularly of clinical and subclinical manifestations of borderline personality disorder (BPD). Yet, little consideration has been given to the differentiation between the cognitive and affective components of rejection sensitivity, to its trait and state aspects, as well as to its link with narcissistic functioning. Here, we investigate how pathological personality traits (borderline and narcissistic traits) relate to trait rejection sensitivity (expectation of rejection and negative anticipated emotions to rejection) and to experiences of state rejection in daily life, including a focus on the affective reactions to daily rejection. Methods: Community adults completed dispositional measures of rejection sensitivity, BPD traits, and pathological narcissism (grandiose and vulnerable traits). Then, they initiated a one-week Ecological Momentary Assessment (EMA) data collection and completed measures of perceived social rejection and affective states in an event-contingent design: participants were instructed to fill in the EMA measures whenever they had a face-to-face or online interpersonal interaction with another person lasting at least 5 minutes. The final sample (N = 189, 149 women, mean age = 22.77) evaluated 2,971 interpersonal interactions (1,388 face-to-face), with a mean number of EMA observations per participant of 15.72 (SD = 7.49, range = 5-42). Results of multiple regressions indicated that vulnerable narcissism uniquely predicted anticipated anger and anxiety for rejection, while grandiose narcissism was only negatively associated with anticipatory anxiety for rejection (dispositional rejection sensitivity). As to state rejection, multilevel models indicated that borderline traits uniquely predicted higher experienced rejection in in daily life. Personality traits amplified some specific affective reactions to perceived state rejection: for example, borderline traits predicted higher self-directed aggressive impulses in response to perceived rejection. These findings highlight that sensitivity to social rejection is an important feature of maladaptive personality functioning.

Pathological narcissism refers to a pathology of self-esteem, with core antagonistic themes. Both in its clinical and subclinical manifestations, pathological narcissism can hinder psychotherapy. Moreover, it is associated with deviations from consensual interpersonal perceptions, both of self and others. In our contribution, we will present an empirical study aimed at investigating whether pathological narcissism accounts for distinctiveness (construal) of patients’ interpersonal perceptions, with a focus on treatment settings. Patients enrolled in psychological/psychotherapeutic treatment (N = 150) were involved in the study and asked to describe a specific segment of a session with their clinician. We then collected both patients’ and independent raters’ assessments of in-session dominance and hostility (interpersonal behavior), to quantify the discrepancy between patients’ and consensual perceptions of interpersonal behavior. Furthermore, we assessed patients’ traits of pathological narcissism, to investigate their role in predicting patient-rater discrepancies in interpersonal perceptions. Contrary to our expectations, pathological narcissism was not related to patient-rater discrepancies in the way clinicians were perceived. However, patients’ grandiose narcissism was related to distinctively perceiving oneself as more dominant, while patients’ vulnerable narcissism to distinctively perceiving oneself as more hostile. The former association (but not the latter) also held after incorporating additional raters’ assessments in post-hoc procedures. Self-enhancement may explain the “excess” of self-dominance in patients’ self-ratings, while covert hostility and self-concealment may account for the link between vulnerable narcissism and construal in self-hostility. Clinicians need to detect these defensive processes for effective treatment of narcissism-related themes.

Objective. Adolescence is a crucial period for the development and consolidation of personality. As adolescents deal with changes related to both body and neurophysiological development, they also face psychological changes in the perception of their self and interpersonal functioning. According to the object relations theoretical framework, this contribution aims at presenting data on the development of the Adolescent Personality Questionnaire (APS-Q) an agile but reliable measure to evaluate pathological personality functioning in adolescence. Indeed, there is a lack of self-report instruments to assess pathological personality functioning in adolescence directly aimed for the adolescent population and shaped according to the core aspects of (mal)adaptive personality acknowledging features related to self (identity) and interpersonal (object relations) dimensions and affect regulation. Methods. The study involved overall 1557 participants, recruited from middle and secondary schools in Northern Italy. A first sample compiled a pilot version of the APS-Q to run Principal Component Analysis (PCS) and test for construct and test-retest validity. A second sample compiled the final version of the APS-Q to run Confirmatory Factor Analysis (CFA) and check for relationships with borderline and narcissistic traits as also for psychological problems. Results. Data suggest a strong factorial structure for the APS-Q, encompassing seven dimensions of personality functioning related to self and interpersonal aspects as well as affect regulation. Furthermore, impairments in personality functioning measured with the APS-Q were significantly associated with specific pathological personality traits and psychological problems. Conclusions. Our results suggest that the APS-Q is a quick and reliable measure to assess emerging personality functioning in adolescence. Moreover, significant relations with maladaptive features (i.e., personality traits and internalizing/externalizing problems) indicate the possibility to efficiently use this instrument in larger batteries to assess crucial dimensions of impairment in adolescence.

Objectives. Adolescence is a crucial phase for the development and consolidation of personality, as youths face critical psychological changes in the perception of their self in relations with family members and peers, as well as with evolving romantic and sexual relations. Significant deviations in personality structuring can result in the emergence of pathological personality features. In this contribution, we investigated the relationship between emerging personality structure in adolescence and borderline and narcissistic personality aspects. Specifically, we aimed at underlining which dimensions of emerging personality structure were related to borderline and narcissistic characteristics. Methods. A community sample of 709 adolescents (age 13-19) was tested for personality dimensions (Self, Self-acceptance, Relationship with Family and Friends, Aggression, Sexuality, Investments and goals) using the Adolescent Personality Structure Questionnaire (APS-Q) and for borderline (Borderline Personality Features Scale for Children – BPFSC-11) and narcissistic features (Pathological Narcissism Inventory – PNI). Results. Data suggest significant associations between specific personality dimensions and pathological personality features. In particular, results showed strong associations between borderline features and impairments in self and interpersonal related personality dimensions as well as with difficulties in aggression regulation. Likewise, data indicated significant relations between vulnerable narcissistic features and self-related aspects of personality. Finally, results showed impairments in Self, Self-acceptance dimensions, difficulties in aggression regulation and sexuality, related to more severe grandiose narcissistic characteristics. Discussions. These preliminary data suggest that impairments in specific dimensions of emerging personality structure in adolescence might be related explicitly to borderline and narcissistic features. In particular, both emerging identity and the ability to regulate aggression might play an essential role in this relationship. Also, identifying crucial impaired dimensions of emerging personality structure might benefit clinical purposes and practice.

Objective: Psychoanalytic theories describe narcissists as characterized by a grandiose self, but underlying feelings of shame. However, empirical findings show inconsistent associations between narcissism and shame, also because most studies focused mainly on grandiose overt narcissism, neglecting vulnerable narcissism. Shame experiences usually result from a stable negative evaluation of the self, which has shown to be often associated with vulnerable but not with grandiose narcissism. The aim of the present study is to investigate the relationship between both grandiose and vulnerable narcissistic traits with shame feelings. In particular, we tested whether explicit agentic and communal self-views might explain such relationship. Methods: A community sample of adults (N = 367, Mage = 33.67, SD = 13.62) completed the Personal Feelings Questionnaire-2 for the assessment of shame-proneness, the Five-Factor Nacisssism Inventory – Short Form for the assessment of grandiose and vulnerable narcissistic traits, and an adjective-based measure of explicit self-view in both agentic and communal domains, adapted from Campbell, Bosson, Goheen, Lakey, & Kernis (2007). A mediation model was conducted to test whether narcissistic traits were associated with shame-proneness, and whether self-views in agentic and communal domains mediated this association. Analyses were run controlling for gender and guilt-proneness. Results: Results showed that vulnerable narcissistic traits were positively related to shame-proneness, and negatively related to both agentic and communal self-views. Moreover, the relationship between vulnerable narcissistic traits and shame-proneness was partially mediated by agentic self-view, but not by communal self-view. The higher vulnerable narcissism the less agentic self-view, and the less agentic self-view the higher shame proneness. Finally, grandiose narcissistic traits showed to be positively associated with agentic self-view, and no significant association was found with shame-proneness. Conclusions: Individuals high in vulnerable narcissism, but not individuals high in grandiose narcissism, may be particularly prone to feel ashamed because of their negative agentic self-views.

Objective: Research globally supports the association between narcissism and externalizing problems, such as aggression, whereas the connection between narcissism and internalizing problems, such as depression or anxiety, is more controversial. Studies have been predominantly conducted on adult samples. Moreover, they usually neglected the vulnerable manifestations of narcissism, concentrating on grandiose overt aspects. The aim of the present study is to investigate the association of grandiose and vulnerable narcissistic traits with internalizing and externalizing problems in a sample of adolescents, considering gender as a potential moderator. Method: A sample of 635 youths (208 males; Mage = 15.81, SD = 1.31, age range = 13-19) completed the Pathological Narcissism Inventory for the assessment of narcissistic grandiosity and vulnerability, and the Youth Self-Report for the assessment of internalizing and externalizing problems. Analyses were conducted to investigate the association between narcissistic grandiosity and both internalizing and externalizing problems respectively, testing the moderating role of gender, and controlling for narcissistic vulnerability. Results: Gender was associated with both internalizing and externalizing problems, with males displaying more externalizing features and females more internalizing ones. Grandiose narcissism was negatively associated with internalizing problems, and unrelated to externalizing. However, a marginally significant interaction with gender emerged in predicting externalizing tendencies, indicating that grandiose traits were positively associated with externalization in females, but not in males. Vulnerable narcissism was positively associated with both internalizing and externalizing problems. Conclusions: Vulnerable narcissistic traits are associated with increased problems, both internalizing and externalizing. Moreover, an effect of grandiose narcissism on externalization is only detectable when differentiating by gender: externalizing tendencies in male adolescents may be high, regardless of their narcissistic traits.

Narcissistic pathology is a topic of great interest for both researchers and clinicians nowadays. A growing body of research has investigated pathological narcissism to understand its nature and to reach a comprehensive definition of such personality pathology. We revised empirical and theoretical literature on pathological narcissism to show how its conceptualizations have changed over time. Also, we presented which objectives have been reached by experts in narcissism in the attempt to univocally define the phenomenon in recent times. Finally, we highlighted which aspects of the definition of narcissistic pathology are still not clear and remain the subject of debates at present.

Even if shame has been conceptualized as a clinically relevant affect for narcissistic functioning, empirical associations with narcissism are inconsistent thoroughout research. This may be due to the tendency to assess narcissism in terms of overt and grandiose themes only. Moreover, shame is usually associated with guilt, but the role of guilt in narcissism is not equally emphasized by clinicians. A nonclinical sample of adults (N = 367, Mage = 33.67, SD = 13.62) completed the Personal Feelings Questionnaire-2 for the assessment of shame- and guilt-proneness, and the Pathological Narcissism Inventory for the assessment of both narcisssistic grandiosity and narcissistic vulnerability. Two multiple linear regressions were conducted to evaluate the associations between narcissistic traits and shame- and guilt-proneness. Analyses were conducted controlling for gender, and for guilt- and shame-proneness respectively. Results showed that while narcissistic grandiosity was negatively associated with shame-proneness, narcissistic vulnerability was positively associated with it. On the other hand, no association emerged between vulnerable or grandiose narcissism with guilt-proneness, after controlling for shame-proneness. Shame-proneness seems to be more relevant than guilt-proneness for narcissistic functioning. Moreover, individuals high in narcissistic grandiosity may be less likely to consciously experience and report feelings of shame.

Objective: Preliminary evidence (Dawood et al., 2017) suggests that narcissism is related to lifetime presence of Non-Suicidal Self-injury (NSSI). Nevertheless, no study has investigated the relationship between narcissistic traits and functions of NSSI, although understanding functions may be relevant to better predict frequency and maintenance of NSSI. The aim of the present study was to test whether and how narcissistic traits were associated with functions of NSSI, controlling for borderline traits. Methods: The study involved 297 Italian nonclinical adult participants, with a mean age of 26.93 (SD = 9.11; range = 18 – 60). Hierarchical multiple linear regressions were conducted to evaluate the association of narcissistic traits with intrapersonal and interpersonal functions of NSSI among self-injurers (N=102). Results: Results showed that facets of narcissistic vulnerability, but not of narcissistic grandiosity, were associated with intrapersonal functions of NSSI, including reasons such as reducing aversing internal states or punishing the self. In particular, vulnerable narcissistic traits of entitlement rage were negatively related to the engagement of NSSI for intrapersonal purposes. On the other hand, vulnerable narcissistic traits of contingent self-esteem were positively associated with intrapersonal functions of NSSI. Finally, interpersonal functions of NSSI, which include reasons such as seeking help or gaining attention from others, were not significantly associated with narcissistic traits. Conclusions: The present study suggests that clinicians and researchers need to go beyond the effect of borderline traits when studying and treating NSSI, focusing attention also on narcissistic traits.

Objective The aim of the present study is to investigate the reliability and validity of the Level of Personality Functioning Scale (LPFS; APA, 2013) rated by inexperienced individuals from the Structured Interview of Personality Organization (STIPO; Clarkin et al., 2004). Methods Forty clinically inexperienced undergraduate students were asked to assess personality functioning of 8 female inpatients using the LPFS from audiotaped STIPO. Intraclass correlation analyses (ICC) were conducted to test the interrater reliability of the LPFS dimensions (Self- Functioning and Interpersonal-Functioning) and sub- dimensions (Identity, Self-direction, Empathy, Intimacy). Linear Mixed-Effect Models were implemented to investigate associations between the LPFS dimensions and external measures such as personality disorders diagnoses and structural features of personality functioning. Results Results showed good Intraclass correlation coefficients for both Self-functioning (ICC= .97) and Interpersonal- functioning (ICC= .98). Again, good interrater reliability indexes were found for the LPFS sub-dimensions, ranging from .95 to .98. Finally, regression models confirmed the validity of LPFS scores (as rated by our sample) in predicting features of personality pathology. Conclusion Findings from the present study confirmed that untrained raters can reliably assess personality pathology by rating the LPFS based on material from the STIPO. Implications related to the use of the STIPO as a tool for the assessment of personality pathology according to the DSM-5 Alternative model are discussed.

Introduction: Adolescence is a crucial developmental stage in which the need to upgrade and integrate personality aspects such as identity integration, interpersonal relations and affect regulation emerges. Within this context, research, in order to understand the steps that lead to the development of personality disorders (PDs), highlights the significance of personality traits for psychological development as well as how impairment in identity integration resulted predictive of PDs in adults. In particular, given that during adolescence it is crucial to integrate changes of self-image related both to mental and bodily experiences, few studies have explored the relationship between identity integration in adolescence and the presence of somatic symptoms. Method: Up to now, in a sample of 80 adolescents we measured personality traits (Personality Inventory for DSM-5, PID-5), personality functioning (Severity Indices of Personality Problems-118, SIPP-118), psychological distress and somatic symptoms (Symptom Checklist 90-R, SCL-90-R). Results: Results suggest that personality traits are related to somatic symptoms. Furthermore, identity functioning seems to play a crucial role in this association. Conclusions: This study emphasizes the importance to strengthen our understanding of the complex relationship between the severity of personality functioning and somatic symptoms manifestations during adolescence.

Acute appendicitis (AA) is among the most common causes of acute lower abdominal pain leading patients to the emergency department. Significant debate remains on whether AA should be operated or not. A propensity score-matched analysis was performed in seven Italian Hospitals, with the aim to assess safety and feasibility both nonoperative management with antibiotics (AT) and surgical therapy with appendectomy (ST) for patients with AA. Data regarding all patients discharged from the participating centers with a diagnosis of appendicitis from January 1st, 2014 to December 31st, 2014 were collected retrospectively. Follow-up data were collected from January 1st, 2015 to December 31st, 2016. The complication-free treatment success of AT (53.7%) was significantly inferior to that of ST (86.4%) (P

The study aims to compare psychometric properties and clinical utility of Kennedy Axis V (K Axis) and 12-items version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), a comparable version of the 36-items one included in DSM-5, comparing them with other significant instruments for the assessment of personality. A sample of 25 clinical inpatients of a therapeutic community in Northern Italy was assessed with different tools: K Axis, WHODAS 2.0, IPO, SCL-90-R and SIPP-118. K Axis showed low internal consistency, unlike WHODAS 2.0. Moreover, significant correlations were found between both WHODAS 2.0 and K Axis and IPO and SIPP-118. However, no significant correlations emerged between K Axis and WHODAS 2.0. Even if further investigation will be needed, such as the increase of the sample and the update of the WHODAS version, K Axis and WHODAS 2.0 has proven to be useful tools for the evaluation of global functioning; however, while WHODAS is more consistent from a psychometric point of view, K Axis presents a multidimensional view of the functioning of the patient.

Background: The COVID-19 pandemic has been postulated to account for inflated rates of either suicides or homicides. Nonetheless, results are discordant, in particular concerning suicide. We aimed to perform a retrospective analysis of suicides and homicides in the region of Lombardy, Northern Italy (districts of Milan and Monza Brianza), the Italian region most seriously impacted by the pandemic outbreak. Methods: Data were collected during the autopsies performed at the Institute of Forensic Medicine in Milan. We presented suicides and homicides in the years 2015-2021 and compared the year 2021 to 2019, a pre-COVID-19 year. Results: Data may allow us to cautiously hypothesize a normalization of trends ("regression" to the mean effect) as time passes from the COVID-19 outbreak. Limitations: Limited number of events, in particular, homicides. Conclusions: Recording historical reports from the same region is warranted besides the comparisons across different countries.

The “Healthcare workers’ wellbeing [Benessere Operatori]” project is an exploratory longitudinal study assessing healthcare workers’ mental health at three different time points over a 14-month period during the COVID-19 pandemic. We collected socio-demographic and work-related information and assessed the perceived social support, coping strategies, and levels of depression, anxiety, insomnia, anger, burnout, and PTSD symptoms. In total, 325 Italian healthcare workers (i.e. physicians, nurses, other healthcare workers, and clerks) participated in the first initial survey and either the second or third subsequent survey. Participants reported subclinical levels of psychiatric symptoms that remained mostly unchanged across time, except for an increase in stress, depression, state anger, and emotional exhaustion symptoms. Despite subclinical levels, healthcare workers’ distress can adversely affect the quality of care, patient satisfaction, and medical error rates. Therefore, implementing interventions to improve healthcare workers’ wellbeing is required.

Introduction: Both variable- and person-centered approaches identify grandiose and vulnerable themes in pathological narcissism (PN). However, person-centered results rely on cross-sectional data, preventing identification of subtypes of individuals through transitory self-states. Methods: We perform a cluster analysis on the joint trajectory of daily ratings of grandiose (GN) and vulnerable narcissism (GN), collected during a 28-day experience sampling (N = 196 participants). Results: The best partition – identified by multiple criteria – includes three clusters: a “low PN” cluster displays below-average levels of both daily GN and VN; a “high VN” cluster displays average daily GN and above-average levels of daily VN; a “high GN” cluster shows above-average levels of daily GN and below-average levels of daily VN. Significant inter-cluster differences emerge on both daily and trait measures of narcissism, and on trait measures of self-esteem and shame, but less sharply on impairment in personality structure. There is no inter-cluster difference on the variability and instability of daily narcissism. Discussion: We conclude that the constructs of daily GN and VN define corresponding groups of individuals with either high GN or VN, the latter group being more distressed. Yet, this group is also less “pure” in its narcissistic characterization, showing at least some levels of trait and state GN.

Background Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally. Methods We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age-and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation. Findings We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries' COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries' income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well. Interpretation Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue. Copyright (C) 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

The authors investigate whether and how borderline and pathological narcissistic traits differ in their associations with trait and state rejection sensitivity, and with affective reactions to experiences of social rejection occurring in daily life. Community adults (N = 189) completed baseline measures of rejection sensitivity, borderline personality, and pathological narcissism, and daily measures of perceived social rejection and affective states for 7 days. Vulnerable narcissism was the main driver of negative anticipated emotions for social rejection. Borderline personality made people prone to experiencing social rejection in daily life. Moreover, borderline personality traits predicted greater self-directed aggressive impulses when experiencing social rejection. Grandiose narcissism showed only a negative association with anticipatory anxiety for rejection. These findings highlight that sensitivity to social rejection is crucial in both borderline personality and pathological narcissism.

Introduction This work represents the continuation of the studies presented in two e-posters during the EPA 2021 conference (De Filippi et al., 2021; Rignanese et al., 2021), which addressed the physical pain-suicidality association (k=44 studies). Objectives The aim of this meta-analysis is to provide an update of those studies, integrating data relating to adolescents, adults, and olders. Methods We started with the analysis of three papers, in particular a meta-analysis (Calati et al., 2015) and two systematic reviews (Hinze et al., 2019; Santos et al., 2019). After searching on Pubmed (until September 2020), data were extracted from articles comparing the rates of current and lifetime suicidal thoughts and behaviours (death wish, suicidal ideation, suicidal planning, suicide attempt and suicide death: DW, SI, SP, SA, and SD) in adolescents, adults, and olders with any type of physical pain and in individuals who did not report this condition. Data were analysed using Comprehensive Meta-Analysis Software (CMA) version 2. Results 67 studies were included, of which 16 on adolescents, 29 on adults, 16 on olders, and 6 on mixed ages. Although quite high between-study heterogeneity was detected in most analyses, results suggested that individuals with physical pain are more likely to report any form of suicidal outcome if compared to those not affected by pain. Conclusions Collected data are therefore in line with previous literature on this topic, which considered physical pain an extremely predictive risk factor for suicidal thoughts and behaviours. However, further research on this topic would be extremely useful. Disclosure No significant relationships.

Adolescence is a crucial period for the development of personality and its dysfunctions. In this regard, it is essential to evaluate the nature and degree of maladaptive personality functioning. However, measures currently available present some limitations, mainly being adaptations from adult’s tailored instruments and length. Moreover, no instrument considers the crucial dimensions related to body development and sexuality. This contribution presents data on the Adolescent Personality Structure Questionnaire (APS-Q) development, a self-report measure to capture core aspects of personality functioning in adolescence while being agile and reliable. On two large samples of adolescents (total N = 1,664), we investigated the psychometric properties of the APS-Q. We explored its factor structure and construct and incremental validity in the first sample, testing specific associations with existing measures of severity of personality pathology, maladaptive personality traits, and psychological distress. In the second sample, we confirmed its factor structure, assessing gender and age invariance. Overall, our findings support the APS-Q’s validity as a reliable and useful measure to assess personality functioning. Moreover, the APS-Q highlighted developmentally vital dimensions such as self-functioning (encompassing mental and bodily changes and considering the dimension of sexuality), interpersonal functioning (discriminating the dimensions of family and peers), and emotion regulation.

Introduction: Among the most investigated theories explaining suicidal behavior there are the interpersonal-psychological theory of suicide (IPTS) by Thomas E. Joiner and the one focused on the construct of psychological pain (or psychache, or mental pain). Objective: Since it remains unclear whether these two different theories correlate with each other in the explanation of suicidal risk, we used a network analysis approach to investigate the complex interplay between both IPTS and psychological pain theories and history of suicidal planning and/or suicide attempt (SP/SA). Methods: A sample of 1,586 university students from various Italian universities was recruited between April 24th, 2020 and February 23rd, 2021, hence during the COVID-19 pandemic. To be included subjects should have been university students and aged between 18 and 35 years old. Results: Within a network that included the core factors from both models (IPTS and psychological pain), higher fearlessness about death (Acquired Capability for Suicide Scale-Fearlessness About Death, ACSS-FAD) and higher psychological pain (Psychache Scale) were the variables most strongly associated with history of SP/SA. Conclusions: Considering a large number of variables, history of SP/SA was explained in particular by fearlessness about death and psychological pain in university students. Hence these aspects should be targeted in the treatment for suicide prevention.

Introduction Background: Existing evidence poses low self-esteem as a risk factor for both suicidal ideation (SI) and suicide attempts (SAs) in the general population. Objectives The present study assesses the relationship between self-esteem level and SI/SA, considering across the lifespan. Two separate meta-analyses, one for SI and the other for SA are herein reported since they substantially overlap in terms of eligibility procedures and search strategies. Methods Eligible studies documented at least one suicidal, and a non-suicidal group. Data were analyzed using the Cochrane Collaboration Review Manager Software (RevMan, version 5.4.1) under the random-effects models. Values were standardized owing to the anticipated heterogeneity of self-esteem rating tools. Sensitivity analyses were performed to control for heterogeneity. Results Out of 3,310 initial hits, 24 studies were deemed eligible for inclusion. The meta-analyses showed that individuals with lower levels of self-esteem, compared to those with higher levels, were more likely to endorse both SI and SA. SI reached a standardized mean difference of -0.43 (CI: -0.81, -0.05), while SA reduced by -0.89 (CI: -1.02, -0.76), overall. Limitations: The herein presented results rely on standardized mean differences rather than odds of either SI or SA since the original studies failed to systematically fetch rates of the events. Conclusions Lower levels of self-esteem represent a risk factor for both SI and SA across the lifespan. Forthcoming studies should systematically account for multiple moderators to allow meta-analytic synthesis including sub-group and meta-regression analyses assuming high-heterogeneity would still be concerned. Disclosure No significant relationships.

IntroductionPrevalence of suicidal thoughts and behaviours is higher among patients with borderline personality disorder than the general population. However, evidence concerning the role of specific borderline symptoms for predicting suicide-related outcomes is lacking and no systematic review/meta-analysis (SR/MA) investigated this topic. Our aim will be to investigate the relationship between any borderline symptom (except criterion 5) and suicide-related outcomes both through an SR/MA and an individual patient data meta-analysis (IPD-MA).MethodsWe will search PubMed/MEDLINE, Scopus, Web of Science, Embase, PsycINFO, CINAHL and Cochrane Library databases from 1974 until September 2021. Both published and unpublished studies showing the association between any borderline symptom (except criterion 5) and suicide-related outcomes (death wish, suicidal ideation, suicidal plan, non-suicidal self-injury, deliberate self-harm, suicide attempt, suicidal behaviour disorder, suicide) will be included. Two team members will independently perform the selection of the studies and data extraction, with the supervision of two other members in case of discrepancies; and assess each study with study quality assessment tools by National Institutes of Health and Grading of Recommendations Assessment, Development and Evaluation. Each author will be contacted. If possible, we will perform both random-effect meta-analyses on the collected data (odds, risk, rate ratios or correlations) and an IPD-MA on collected databases.Ethics and disseminationThis study does not require an ethical approval. Results will be publicly disseminated, included in research presentations and published in peer-review journals.PROSPERO registration numberCRD42018078696.

Background Suicide outcomes in cancer patients represent a major public health concern. We performed an umbrella review (UR) including all meta-analyses (MAs) and systematic reviews (SRs) published on the association between cancer and suicide outcomes. Methods Eligible studies were searched in the main scientific databases up to January 23rd, 2021. Eligible MAs/SRs focused on all suicide phenotypes among cancer patients. Evidence of the association was extracted; the credibility and quality of the included studies were evaluated using ad-hoc tools, including “A MeaSurement Tool to Assess systematic Reviews-2-Revised” (AMSTAR-2-R). Results Six MAs and 6 SRs were included. The standardized mortality ratio of suicide in cancer patients was 1.5 to 1.7-fold higher than in the general population. Risk factors for suicide outcomes among cancer patients were male sex and older age, a cancer diagnosis within the prior year, and some specific cancer sites. Among 107 associations, 90 (84.1%) were supported by high credibility of evidence (class II). However, all studies reported a large heterogeneity (I2> 50%) and the majority of them reported considerable heterogeneity (I2> 75%). All MAs used random-effects measures. All MAs but one assessed publication bias and only one disclosed it. The majority of MAs/SRs showed critically low quality based on AMSTAR-2-R. Limitations We could not perform additional analyses due to the limited number of MAs. Conclusions This UR underlines the inflated risk for suicide among cancer patients. Upcoming, well-designed studies are needed to account for a broader set of variables. Several methodological issues likewise warrant attention.