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Background: The worldwide prevalence of suicide ideation, planning, attempt, and death is a major public health issue. The highest rates of suicide are seen in those aged 15 to 29, largely correlating to their time spent in higher education. Objectives: Identify the perception and experiences of medical students towards suicidal thoughts and attempts and explore some predictors. Methods: A cross-sectional study was conducted at Kafrelshiekh University in Egypt, included 554 university students using predesigned questionnaire that included sociodemographic characteristics, perception of students about suicide, and their experience with knowing a person who had suicide thoughts or attempts and if they themselves had suicidal thoughts or attempts. Results: Self-experience with suicidal thoughts was reported by 25.3% while 12.3% reported attempting suicide, and among those who attempted suicide the most frequent reason was feeling depressed (61.8) followed by educational pressures (54.4%) and feeling lonely (41.2%). Accepting the concept of suicide was the main predictor for having suicidal thoughts (OR = 7.784) followed by knowing a person who had suicidal attempt (OR = 2.234) or thoughts (OR = 4.609). Conclusion: Our results indicate the suicide ideation and behavior are prevalent among college undergraduates. Universities have the responsibility to educate students with effective life education as well as suicide prevention and intervention programs. [ABSTRACT FROM AUTHOR]

Introduction: Unhoused individuals have high rates of suicidal ideation (SI) and suicidal behaviors (SB), but few have studied the relative timing of homelessness and SI/SB. Our study examines the potential to use state‐wide electronic health record data from Rhode Island's health information exchange (HIE) to identify temporal relationships, service utilization, and associations of SI/SB among unhoused individuals. Methods: We use timestamped HIE data for 5368 unhoused patients to analyze service utilization and the relative timing of homelessness versus SI/SB onset. Multivariable models identified associations of SI/SB, hospitalization, and repeat acute care utilization within 30 days from clinical features representing 10,000+ diagnoses captured within the HIE. Results: The onset of SI typically precedes homelessness onset, while the onset of SB typically follows. Weekly rates of suicide‐related service utilization increased over 25 times the baseline rate during the week before and after homelessness onset. Over 50% of encounters involving SI/SB result in hospitalization. Of those engaging in acute care for suicide‐related reasons, we found high rates of repeat acute care encounters. Conclusion: HIEs are a particularly valuable resource for understudied populations. Our study demonstrates how longitudinal, multi‐institutional data from an HIE can be used to characterize temporal associations, service utilization, and clinical associations of SI and behaviors among a vulnerable population at scale. Increasing access to services that address co‐occurring SI/SB, mental health, and substance use is needed. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We explored the epidemiological characteristics of suicide attempts and identified suicide trends and associated factors. METHODS: This retrospective, cross-sectional, observational, and single-center study included consecutive 412 patients who were admitted to Emergency Department for follow-up and treatment after a suicide attempt between June 2019 and June 2022. We assessed patient demographics, suicidal behavior, previous suicide attempts, psychiatric disorders, drug use, visits to the psychiatry clinic within the past 6 months, the persistence of suicidal ideation, and clinical outcomes. RESULTS: The study population consisted of 259 females (62.86%) and 153 males (37.14%), with a mean age of 29.50±11.51 (range: 13-72) years. Females attempted suicide more often than males, but suicide completion was more common in males. Overall, 79.37% (n=327) of the suicide attempters were aged <40 years and most were 20-29 years old (n=147, 35.68%). Non-fatal suicide attempts were more common in single, unemployed, and poorly educated individuals, but this was not the case for suicide completers. However, there was no significant difference in marital status, education, and occupation among suicide completers. Drug poisoning was the major form of suicide attempt (n=345, 83.74%). Mental disorders, family or relationship conflicts, and separation from a partner were common causes of suicidal ideation. Patient numbers were particularly high in the autumn (i.e., September), and at night. CONCLUSION: Females, young adults, singletons, the unemployed, and individuals with psychiatric disorders and low education levels are more likely to attempt suicide, particularly during hours when they are likely to be alone. [ABSTRACT FROM AUTHOR]

Abstract Background Suicidal behaviors are prevalent among inpatients with severe mental conditions and may result in many dying by suicide. Few studies have focused on the burden of suicidal behaviors among these inpatients in low-income settings, despite suicide being consistently higher in lower-income countries such as Uganda. This study, therefore, provides the prevalence and associated factors of suicidal behaviors and suicide attempts among inpatients with severe mental conditions in Uganda. Method This was a retrospective chart review of all individuals admitted with severe mental conditions to a large psychiatry inpatient unit in Uganda for four years (2018–2021). Two separate logistic regressions were conducted to determine the factors associated with suicidal behaviors or suicidal attempts among the admitted individuals. Results The prevalence of suicidal behavior and suicidal attempts among 3104 (mean age = 33, Standard deviation [SD] = 14.0; 56% were males) were 6.12% and 3.45%, respectively. Having a diagnosis of depression increased the likelihood of both suicidal behaviors (adjusted odds ratio [aOR]: 5.36; 95% confidence interval [CI]: 2.14–13.37; p =0.001) and attempts (aOR: 10.73; 95% CI: 3.44–33.50; p

This study examines the relationship between patterns of adverse childhood experiences (ACEs) and suicidal behaviors. It investigates the role of depressive symptoms as an underlying mechanism between patterns of ACEs and suicidal behaviors in South Korea. Data came from the 2012 Korean General Social Survey (KGSS), a nationally representative sample in South Korea (N = 1,048). The dependent variables included two suicidal behaviors: suicidal thoughts and a suicide plan or attempt. The independent variable was the patterns of ACEs identified using ten binary indicators of childhood adversity. The mediating variable of depressive symptoms was measured using the Korean version of the Patient Health Questionnaire-9 (PHQ-9). Covariates were also included to control for socio-demographic characteristics: age, gender, education, and household income. This study conducted a latent class analysis (LCA) to classify different patterns of ACEs and then employed path analysis to examine mediating effects of depressive symptoms in the relationship between ACEs and suicidal behavior. Among the results, three latent classes of ACEs were identified— child maltreatment, child maltreatment and family dysfunction, and low ACEs. The child maltreatment and child maltreatment and family dysfunction classes were more likely to have suicidal thoughts and to plan or attempt suicide compared to the low ACEs class. Path analysis also showed significant indirect pathways from ACEs exposure to suicidal behaviors through depressive symptoms. This evidence corroborates previous research that shows family dysfunction and child maltreatment as detrimental factors leading to depressive symptoms and suicidal behaviors. Practitioners and policy-makers should therefore consider childhood life experiences when assessing suicidal behaviors in health prevention and intervention strategies. [ABSTRACT FROM AUTHOR]

Background: Suicide is a significant and growing concern in health systems worldwide. It is considered a crucial part of the comprehensive mental health action plan in every country. Kerman, one of the largest provinces of Iran with a relatively high population, has witnessed an increasing trend in this phenomenon, especially during the COVID-19 pandemic. Methods: This was a cross-sectional study conducted in urban and rural areas of Kerman. Suicide data for 2018-2021 were acquired from the Psychosocial Health and Addiction Prevention Group of the Deputy for Health at Kerman University of Medical Sciences. The burden resulting from suicide during these years was measured using the disability-adjusted life years (DALY) index. Findings: During these four years, 23701 suicide attempts were recorded in Kerman, with 59% and 41% of the suicide attempts made by men and women, respectively, and 668 (2.82%) attempts leading to death. The highest rate (68%) was observed in the 15-29 age range and the lowest rate (1.1%) was seen in people older than 60. Poisoning (89.3% of the attempts) was the most common suicide method. The suicide burden in Kerman in 2021 was 4417 according to the DALY index, which is 162.6 per 100 000 people; men and women endure 38% and 62% of this burden, respectively. The highest DALY rates were seen in the 15-29 and 30-44 age groups. Conclusion: The burden resulting from suicide highlights the necessity of taking immediate measures to prevent this behavior, especially among vulnerable groups. [ABSTRACT FROM AUTHOR]

Prior research suggests sexual and gender minority (SGM) youth are profoundly impacted by levels of parental support. This study assessed mediating effects of generalized family acceptance and conflict on lifetime suicidal behaviors among a large diverse sample comprising both SGM and non-SGM youth in early adolescence, when intervention to optimize family dynamics may be critical. Using data from the first-year follow-up of the Adolescent Brain Cognitive Development Study based in the United States, mediation was tested using a binary logistic regression model fitted with a generalized structural equation. Models included SGM status as the independent variable, family acceptance or family conflict sum score as the mediator, and the presence of lifetime suicidal behaviors as the dependent variable. Models adjusted for age, birth-assigned sex (as reported by the parent/guardian), and race/ethnicity. Of 11,235 youths, lifetime suicidal behaviors were reported by 1.5% (n = 164). Youths with SGM identities reported 40% less parental acceptance and 47% greater family conflict, compared to non-SGM peers. Both parental acceptance and family conflict partially mediated associations between SGM identification and odds of lifetime suicidal behavior (ps =.001). Identification of modifiable risk factors for suicidality in this vulnerable population, including parental acceptance and family conflict, is critical to improving health outcomes. Clinicians should work with SGM youth and their families starting in childhood to optimize family dynamics and bolster acceptance to potentially reduce adverse health outcomes. Youths with SGM identity reported 40% less parental acceptance than non-SGM peers. Parental acceptance was associated with lower odds of lifetime suicidal behaviors. Family factors partially mediated associations between SGM status and suicidal behaviors. [ABSTRACT FROM AUTHOR]

Since 2015, there have been numerous reports, mostly unsubstantiated, of teen suicides associated with an online contest – the Blue Whale Challenge (BWC) in Russia, Europe and India. Recently, reports emerged of possible BWC cases in China. 7 Cases were selected from Chinese media reports by online searching. Multiple sources of information (e.g., published reports, social media entries) were searched and examined for detailed information about cases, to collect information on pre-game situations, game activities, and post-game conditions. Thematic analysis was used to determine themes in BWC victim antecedents, behaviors, and consequences. Two of seven cases were female. Ages ranged 11-19 years (M = 15.57, SD = 2.94). Thematic analysis of the seven Chinese cases revealed a predisposition phase (low mood, interpersonal problems, poor school performance) followed by a five-stage process of BWC involvement: 1) contact with a death-oriented game (BWC); 2) acceptance of the game's rules and the escalating challenges; 3) BWC incidents conclusion – a suicide attempt/completion; 4) discovery by others and/or game rejection, followed by 5) personal recovery. Analyses revealed interventions are required at each victim stage, and the necessity for increased online efforts. As most adolescent cases showed school problems (e.g., poor school performance, absenteeism), we recommend increased efforts at primary to tertiary schools to assess for and address personal difficulties of students demonstrating poor school performance. Results call for a new wave of revised suicide prevention methods led by digital natives but in collaboration with government, media and communities to address unique contemporary risks. [ABSTRACT FROM AUTHOR]

Background: This study examines how engagement with depression‐related social media content varies by teens who report suicidal ideation, suicide attempts, and nonsuicidal self‐injury (NSSI) versus those who had not experienced each behavior. Methods: Teens aged 15–17 years old (N = 93) were recruited from social media platforms from October 2016 to August 2018. Participants were asked three open‐ended questions about the advantages and disadvantages of networking about depression‐related content on social media. We conducted a qualitative analysis to capture themes in responses by question item. Univariate analyses were conducted to compare differences in the frequency of themes endorsed among the behavioral groups versus their counterparts. Results: Among participants (female, 73%; non‐White, 45%; sexual minority, 57%), most (93%, n = 87) endorsed depressive symptoms. Sixty‐five percent (n = 60) endorsed suicidal ideation within the past year, who were more likely to indicate unhelpful social interactions (p =.02) as a disadvantage of following depression content than peers who did not endorse suicidal ideation within the past year. Eighty percent (n = 74) endorsed lifetime experience of NSSI, who were more likely to indicate negative impact on relationships (p =.01) from posting depression content than peers who did not experience NSSI. Fifty‐eight percent (n = 54) endorsed a lifetime suicide attempt, who were more likely to mention offering solutions (p =.03) to someone posting concerning content than peers who did not endorse a lifetime suicide attempt. Conclusions: This study provides diverse and unique perspectives on how engagement with depression‐related social media varies by mental health behaviors and informs the use of social media for recruitment and outreach for teens. [ABSTRACT FROM AUTHOR]

Studies on suicide and the Internet emerged only a decade ago, and those on suicidal behaviors and social media are even more recent. Until today, all the benefits and harms related to the use of social networks and suicidal behaviors in adolescence are not fully known. However, the prevailing presence of social networks in youth life is promoting the development of strategies based on their use, for the intervention, detection, and prevention of suicide. The online presentation of suicidal behaviors is a sign of the importance of this phenomenon and the need to take care of it, considering that in the scientific literature there is little analysis of the relationship between suicidality and social networks. Therefore, it is necessary to explore all the possibilities offered by social networks to detect the factors involved in suicidal behavior. This work consists of an exploratory analysis of social discourse on Twitter based on three categories associated with suicidal behavior, for descriptive, preventive, and comparative purposes, between two samples of adolescents: Italian and Spanish. The extracted results show a greater number of both prosuicide and instigator tweets in the Italian sample, compared to the Spanish one, while the Spanish sample exceeds the Italian one in terms of anti-suicide tweets. It is suggested to keep on researching the useful responses to online communications from adolescents and into other possibilities offered by social media platforms in the analysis of youth suicide. [ABSTRACT FROM AUTHOR]

Purpose of Review: We review recent research on the epidemiology and etiology of suicide in the global context. We focus on data from low- and middle-income countries (LMIC), with the goal of highlighting findings from these under-researched, over-burdened settings. Recent Findings: Prevalence of suicide in LMIC adults varies across region and country income-level, but is, on average, lower than in high-income countries. Recent gains in suicide reduction, however, have been smaller in LMIC compared to global rates. LMIC youth have much higher rates of suicide attempts than youth from high-income countries. Females as well as people with psychiatric disorders, those living with HIV, those who are LGBTQ + , and those with poor socioeconomic status are highly vulnerable populations in LMIC. Summary: Limited and low-quality data from LMIC hinder clear interpretation and comparison of results. A greater body of more rigorous research is needed to understand and prevent suicide in these settings. [ABSTRACT FROM AUTHOR]

Previous research has identified mental health symptoms such as depression and aggression as contributing factors associated with suicidal ideation and attempts in adolescence. However, much of this work has focused on older adolescents (ages > 14) resulting in a dearth of knowledge about early adolescents under 12 years. Moreover, much less is known about school connectedness as a protective factor in the relationship between mental health symptoms and suicidal behaviors. This study examined the interaction effect between school connectedness and mental health symptoms on suicidal behaviors among early adolescents aged 9–12 years. Data were drawn from the Fragile Families and Child Wellbeing Study and yielded an analytic sample (n = 2826) that was majority male (52%), Black (53%), and with an average age of 9.3 years. Data were analyzed using multivariate logistic regression. Among participants, 2% experienced suicidal ideation, and 2% experienced suicide attempts. Black adolescents were more than five times more likely to experience a suicide attempt compared to their White peers (AOR = 5.37; 95% CI = 1.71–16.95; p =.004). There was a significant interaction effect between withdrawn depressed symptoms and school connectedness (AOR =.95; 95% CI =.91–98; p =.006), and between aggressive behavior and school connectedness (AOR = 1.02; 95% CI = 1.01–1.03; p =.001) on suicide attempts. School connectedness did not moderate the relationship between mental health symptoms and suicidal ideation. The findings have important practical implications, which are discussed. [ABSTRACT FROM AUTHOR]

Abstract Background Understanding the relationship between chronic pain conditions and suicidal behavior—suicide attempt, other intentional self-harm, and death by suicide—is imperative for suicide prevention efforts. Although chronic pain conditions are associated with suicidal behaviors, these associations might be attributed to unmeasured confounding or mediated via pain comorbidity. Methods We linked a population-based Swedish twin study (N=17,148 twins) with 10 years of longitudinal, nationwide records of suicidal behavior from health and mortality registers through 2016. To investigate whether pain comorbidity versus specific pain conditions were more important for later suicidal behavior, we modeled a general factor of pain and two independent specific pain factors (measuring pain-related somatic symptoms and neck-shoulder pain, respectively) based on 9 self-reported chronic pain conditions. To examine whether the pain-suicidal behavior associations were attributable to familial confounding, we applied a co-twin control model. Results Individuals scoring one standard deviation above the mean on the general pain factor had a 51% higher risk of experiencing suicidal behavior (odds ratio (OR), 1.51; 95% confidence interval (CI), 1.34–1.72). The specific factor of somatic pain was also associated with increased risk for suicidal behavior (OR, 1.80; 95% CI, 1.45–2.22]). However, after adjustment for familial confounding, the associations were greatly attenuated and not statistically significant within monozygotic twin pairs (general pain factor OR, 0.89; 95% CI, 0.59–1.33; somatic pain factor OR, 1.02; 95% CI, 0.49–2.11) Conclusion Clinicians might benefit from measuring not only specific types of pain, but also pain comorbidity; however, treating pain might not necessarily reduce future suicidal behavior, as the associations appeared attributable to familial confounding.

Introduction: Suicide is a leading cause of death globally. People with psychosis are at increased risk of suicide death and up to half experience suicidal thoughts and/or engage in suicidal behaviors in their lifetime. Talking therapies can be effective in alleviating suicidal experiences. However, research is yet to be translated into practice, demonstrating a gap in service provision. The barriers and facilitators in therapy implementation require a thorough investigation including the perspectives of different stakeholders such as service users and mental health professionals. This study aimed to investigate stakeholders' (health professionals and service users) perspectives of implementing a suicide-focused psychological therapy for people experiencing psychosis in mental health services. Methods: Face-to-face, semi-structured interviews with 20 healthcare professionals and 18 service users were conducted. Interviews were audio recorded and transcribed verbatim. Data were analyzed and managed using reflexive thematic analysis and NVivo software. Results: For suicide-focused therapy to be successfully implemented in services for people with psychosis, there are four key aspects that need to be considered: (i) Creating safe spaces to be understood; (ii) Gaining a voice; (iii) Accessing therapy at the right time; and (iv) Ensuring a straightforward pathway to accessing therapy. Discussion: Whilst all stakeholders viewed a suicide-focused therapy as valuable for people experiencing psychosis, they also recognize that enabling successful implementation of such interventions will require additional training, flexibility, and resources to existing services. [ABSTRACT FROM AUTHOR]

Background: Suicidal behaviors are prevalent among inpatients with severe mental conditions and may result in many dying by suicide. Few studies have focused on the burden of suicidal behaviors among these inpatients in low-income settings, despite suicide being consistently higher in lower-income countries such as Uganda. This study, therefore, provides the prevalence and associated factors of suicidal behaviors and suicide attempts among inpatients with severe mental conditions in Uganda. Method: This was a retrospective chart review of all individuals admitted with severe mental conditions to a large psychiatry inpatient unit in Uganda for four years (2018–2021). Two separate logistic regressions were conducted to determine the factors associated with suicidal behaviors or suicidal attempts among the admitted individuals. Results: The prevalence of suicidal behavior and suicidal attempts among 3104 (mean age = 33, Standard deviation [SD] = 14.0; 56% were males) were 6.12% and 3.45%, respectively. Having a diagnosis of depression increased the likelihood of both suicidal behaviors (adjusted odds ratio [aOR]: 5.36; 95% confidence interval [CI]: 2.14–13.37; p =0.001) and attempts (aOR: 10.73; 95% CI: 3.44–33.50; p < 0.001). However, a diagnosis of substance-related disorder increased the likelihood of having attempted suicide (aOR: 4.14; 95% CI: 1.21–14.15; p = 0.023). The likelihood of having suicidal behavior decreased as one increased in age (aOR: 0.97; 95% CI: 0.94–0.99; p = 0.006) and increased among individuals reporting stress from financial constraints (aOR: 2.26; 95% CI: 1.05–4.86; p = 0.036). Conclusion: Suicidal behaviors are common among inpatients managed for severe mental health conditions in Uganda, especially those with substance use and depressive disorders. In addition, financial stressors are a main predictor in this low-income country. Therefore, regular screening for suicide behaviors is warranted, especially among individuals with depression, and substance use, among those who are young, and among those reporting financial constraints/stress. [ABSTRACT FROM AUTHOR]

Suicidal behaviors have been a crucial public health issue among young men who have sex with men (YMSM). Adverse childhood experiences (ACEs) and depression are important predictors of suicidal behaviors. Few studies have examined the underlying mechanisms. This study aims to examine the mediation mechanism from ACEs to depression and further to suicidal ideation based on a prospective cohort study of YMSM. Study data were derived from 499 YMSM recruited from three cities (Wuhan, Changsha and Nanchang) of China from September in 2017 to January in 2018. ACEs (abuse, neglect and household challenges), depressive symptoms and suicidal behaviors (suicidal ideation, suicidal plan and suicidal attempt) were measured at the baseline, the first wave and second wave follow-up survey, respectively. Mediation modeling analysis was used for data analysis only for suicidal ideation due to the low frequency of suicidal plan and attempt. An estimated 17.86% of YMSM reported suicidal ideation, 2.27% ever made a suicidal plan and 0.65% of YMSM had a suicidal attempt in the past six months. The effect of ACEs on suicidal ideation was fully mediated through depressive symptoms (indirect effect [95%CI] = 0.011 [0.004,0.022]). Among the three subconstructs of ACEs, childhood abuse and neglect could increase the risk of suicidal ideation in adulthood by increasing depressive symptoms (indirect effect = 0.020 [0.007,0.042] for childhood abuse, and 0.043 [0.018,0.083] for neglect), but not for household challenges (indirect effect = 0.003 [-0.011,0.018]). ACEs could affect suicidal ideation through depression, particularly for childhood abuse and neglect. Preventive strategies may focus on the treatment of depression and psychological counseling, especially for YMSM who ever experienced negative experiences in childhood. [ABSTRACT FROM AUTHOR]

The ubiquity of Internet gaming as part of the younger generation's (11-35 year-olds) lifestyle to-day warrants a deeper understanding of its impact on their mental health. In particular, there has been scant research investigating the link between Internet Gaming Disorder (IGD) and suicidal behaviors in this demographic group, even though several mental health symptoms of the former are known risk factors for the latter. This paper aims to establish the presence or absence of association between IGD and each of suicidal ideation, self-harm, and suicide attempt among the younger generation. A large-scale online survey on Internet gamers in Hong Kong was conducted in February 2019. 3430 respondents were recruited through purposive sampling. Study samples were stratified into distinct age groups and multiple logistic regression was conducted for each measured suicidal behavior in each age group. After controlling for sociodemographics, Internet usage, self-reported bullying perpetration and bullying victimization, social withdrawal, and self-reported psychiatric diagnoses such as depression and psychosis, analyses revealed that adolescent (11-17 year-old) gamers with IGD were more likely than their peers who had no IGD to have had suicidal ideation, self-harm, and suicide attempt in their lifetime. These associations did not hold for 18-35 year-old gamers. Findings suggest that it may be prudent to recognize IGD as a growing public mental health priority for the young populace, particularly adolescents. Existing suicide prevention efforts can be complemented through screening adolescents for IGD, and could be expanded to online gaming platforms to reach more hidden at-risk individuals. • Adolescent gamers with IGD had higher odds of lifetime suicidal ideation compared to their peers with no IGD. • Adolescent gamers with IGD had higher odds of lifetime self-harm compared to their peers with no IGD. • Adolescent gamers with IGD had higher odds of lifetime suicide attempt compared to their peers with no IGD. • IGD was not associated with lifetime suicidal behaviors among gamers aged 18–35 years old. • Suicide prevention efforts may be enhanced by screening individuals for IGD and expanding efforts to online game platforms. [ABSTRACT FROM AUTHOR]

To examine the independent and interactive associations of being bullied and non-suicidal self-injury (NSSI) with suicidal behaviors (suicidal ideation, suicidal plan, and suicidal attempt) among junior and senior high school students in China. A cross-sectional study was conducted in 4 cities from November 2017 to January 2018 and a total of 18,900 students were enrolled in this study. Being bullied, NSSI and suicidal behaviors were measured by self-reported questionnaires. Analyses were conducted with Chi-square tests, multivariable logistic regression, and additive interaction models. Results showed that the prevalence of suicidal ideation, suicidal plan, and suicidal attempt was 26.4%, 13.2% and 5.2%, respectively. Being bullied was significantly associated with suicidal ideation (OR = 2.35, 95% CI: 2.17–2.55), suicidal plan (OR = 2.25, 95% CI: 2.03–2.48) and suicidal attempt (OR = 2.27, 95% CI: 1.96–2.62). NSSI was significantly positively correlated with suicidal ideation (OR = 3.92, 95% CI: 3.64–4.21), suicidal plan (OR = 3.72, 95% CI: 3.39–4.08) and suicidal attempt (OR = 3.29, 95% CI: 2.86–3.79). Additive interaction models indicated that NSSI was associated with an increase in the risk of suicidal behaviors among adolescents being bullied than those not being bullied. Namely, additive interactions of NSSI and being bullied on suicidal behaviors were found. The NSSI and being bullied have synergistic effects, and co-victimization, rather than single. Meanwhile, considering the perpetrator is critical to intervening suicidal behaviors in adolescence. Ideally, intervention programs should take action from multiple aspects according to different types of factors, including individual level, social environment and institution. [ABSTRACT FROM AUTHOR]

This study aimed to identify predictors of emergency department (ED) use for suicide ideation or suicide attempt compared with other reasons among 14,158 patients with substance-related disorders (SRD) in Quebec (Canada). Longitudinal data on clinical, sociodemographic, and service use variables for patients who used addiction treatment centers in 2012–13 were extracted from Quebec administrative databases. A multinomial logistic regression was produced, comparing predictors of suicide ideation or attempts to other reasons for ED use in 2015–16. Patients using ED for both suicide ideation and attempt were more likely to have bipolar or personality disorders, problems related to the social environment, 4+ previous yearly outpatient consultations with their usual psychiatrist, high prior ED use, and dropout from SRD programs in addiction treatment centers in the previous 7 years, compared with those using ED for other reasons. Patients with alcohol- or drug-related disorders other than cannabis and living in the least materially deprived areas, urban territories, and university healthcare regions made more suicide attempts than those using ED for other reasons. Patients with common mental disorders, 1–3 previous yearly outpatient consultations with their usual psychiatrist, one previous treatment episode in addiction treatment centers, and those using at least one SRD program experienced more suicide ideation than patients using ED for other reasons. Clinical variables most strongly predicted suicidal behaviors, whereas completion of SRD programs may help to reduce them. SRD services and outreach strategies should be reinforced, particularly for patients with complex issues living in more advantaged urban areas. Over 10% of ED visits were for suicidal behaviors among patients with SRD. ED use for suicidal behaviors was mainly associated with clinical variables. Addiction treatment centers may help reduce ED use for suicidal behaviors. [ABSTRACT FROM AUTHOR]

This study employed network analysis to characterize central autism spectrum disorder (ASD) traits and suicide symptoms within an active duty military sample as well as to identify symptoms that may bridge between ASD traits and suicidality (i.e., suicidal ideation and behaviors). Participants were active duty U.S. military service members (N = 287). Autism spectrum traits, suicidality, depression, and suicide related constructs were assessed online via self-report. Within the combined ASD trait-suicidality network, suicide rumination, suicide behaviors, and depression had the highest strength centrality. The most central bridge symptoms between ASD and suicidality were thwarted belongingness, social skills deficits, and depressive symptoms. Social skills deficits and thwarted belongingness may function as a meaningful bridge between ASD symptoms and suicidality within active duty members. Individuals with ASD symptoms who additionally present with high levels of thwarted belongingness and/or considerable social skills deficits may be at increased risk for suicidality. Within an ASD-suicidality network, social skills deficits, low belonging, and depression had the greatest bridge strength. Although low belonging emerged as a bridge symptom, perceived burdensomeness did not. Suicide rumination, suicide behaviors, and depression were the most central symptom in an ASD-suicidality network. Symptoms related to social skills deficits may connect ASD traits and suicidality. [ABSTRACT FROM AUTHOR]

Introduction: Intentional self-harm in adolescents and young people, including both suicidal behaviors and non-suicidal self-injury (NSSI), is a serious issue in mental health systems. However, the majority of studies on self-harm in adolescents and young people focused on a quantitative methodology which might have limitations in explaining this complex phenomenon of intentional self-harm. Therefore, this study aimed to describe the subjective experiences of adolescents and young people who presented with intentional self-harm in order to provide a better understanding of this behavioral phenomenon. Methods: This is an exploratory qualitative study that uses phenomenological processes and thematic analysis. Twenty subjects aged 13-29 years were included in this study. Results: The results revealed six themes regarding predisposing child-rearing environments and nine themes regarding factors related to the cessation of intentional self-harm. Moreover, it demonstrated the important functions of self- harm as an intrapersonal strategy for emotional regulation. Discussion: In conclusion, this study underscored the importance of understanding the developmental and cessation pathways of these complex behaviors. [ABSTRACT FROM AUTHOR]

Mental health issues are prominent among gender minorities; however, research examining these issues among college campuses is limited, and has often overlooked individuals who identify outside of transgender or cisgender identities. Our findings indicated that transgender participants reported the highest rates and frequencies of non-suicidal self injury, suicidal thoughts, and suicide attempt compared to cisgender peers; followed closely by gender-expansive participants. Gender minority participants reported higher rates of family distress and social anxiety. [ABSTRACT FROM AUTHOR]

BackgroundThe prevalence of mental distress is common for medical students in China due to factors such as the long duration of schooling, stressful doctor-patient relationship, numerous patient population, and limited medical resources. However, previous studies have failed to provide a comprehensive prevalence of these mental disorders in this population. This meta-analysis aimed to estimate the prevalence of common mental disorders (CMDs), including depression, anxiety, and suicidal behaviors, among medical students in China.MethodsWe conducted a systematic search for empirical studies on the prevalence of depression, anxiety, suicide attempt, suicide ideation, and suicide plan in Chinese medical students published from January 2000 to December 2020. All data were collected pre-COVID-19. The prevalence and heterogeneity estimations were computed by using a random-effects model and univariate meta-regression analyses.ResultsA total of 197 studies conducted in 23 provinces in China were included in the final meta-analysis. The prevalence data of depression, anxiety, suicide attempt, suicide ideation, and suicide plan were extracted from 129, 80, 21, 53, and 14 studies, respectively. The overall pooled crude prevalence for depression was 29% [38,309/132,343; 95% confidence interval (CI): 26%−32%]; anxiety, 18% (19,479/105,397; 95% CI: 15%−20%); suicide ideation, 13% (15,546/119,069; 95% CI: 11%−15%); suicide attempt, 3% (1,730/69,786; 95% CI: 1%−4%); and suicide plan, 4% (1,188/27,025; 95% CI: 3%−6%).ConclusionThis meta-analysis demonstrated the high prevalence of CMDs among Chinese medical students. Further research is needed to identify targeted strategies to improve the mental health of this population.

IntroductionInternet addiction (IA) is common among adolescents and may have severe consequences. This study aimed to investigate the prevalence and factors associated with IA among middle school students of Hunan Province, China. Relevance between IA and childhood trauma was also explored.MethodsOne thousand six hundred ten students were enrolled in this cross-sectional study. Data collected included demographics; internet addiction (revised-Chen internet addiction scale); childhood trauma (CTQ-SF); depression, anxiety, and stress symptoms (DASS-21); suicidal behaviors, as well as non-suicidal self-injury (NSSI). Cramer’s V analysis, univariable logistic regression and multivariable logistic regression were used for associations and identifying independent relevance of IA, respectively.ResultsThe prevalence of IA was 12.8%. Cramer’s V analysis showed that IA was associated with emotional abuse, emotional and physical neglect, NSSI, suicidal behaviors, stress, anxiety and depressive symptoms, physical disorder history. Regression analysis showed that IA was independently associated with emotional neglect (OR = 3.062, 95% CI: 2.083, 4.501, p

Background/purpose: Suicide is a huge global health burden. High suicide rates with a low prevalence of major depressive disorder were reported in East Asia. This study aimed to investigate the prevalence of suicidal behaviors in relation to the demographic characteristics and major depressive disorder in Taiwan. Methods: This study was based on the Taiwan Psychiatric Morbidity Survey, conducted between 2003 and 2005, a survey of common psychiatric disorders in a nationally representative sample of non-institutionalized civilians aged 18 or above. Demographic data, major depressive disorder, and suicidal behaviors were ascertained by a face-to-face interview using the paper version of the World Mental Health Survey Composite International Diagnostic Interview. Results: According to the total sample of 10,135 participants, the lifetime prevalence of suicidal ideation, plans and attempts was 7.52% (S.E = 0.46%), 1.31% (S.E. = 0.16%) and 1.29% (S.E. = 0.16%), respectively. Among suicide ideators, the conditional probability of making a suicide plan was 17.39% (S.E. = 1.92%), and a suicide attempt 17.16% (S.E. = 2.15%). Age ≤ 40, female sex, and major depressive disorder were related to a higher risk of suicidal behaviors in the general population; the former two were associated with further developing suicide attempts and the latter one developing plans among ideators. Conclusion: Despite low prevalence, major depressive disorder remained a significant risk factor for suicidal behaviors in Taiwan.

Background. Suicide is recognized as a public health issue in Malekan County through a health community assessment. A community-based suicide prevention program was conducted during 2014-2017. Methods. This health system research was conducted in seven steps, including conducting systematic reviews, gathering expert opinions, improving the coverage of suicide attempt records, conducting research to identify regional risk factors, conducting follow ups and managing the individuals attempting suicide, training health gatekeepers, and launching public awareness campaigns. Our goal was to lower the rates of suicide, and suicide attempt by 15% and 20%, respectively. Multiple logistic regression was calculated to estimate the adjusted odds ratios and the 95% confidence intervals. Result. 821 suicide attempts and 32 suicides had been recorded in the county. 70% of the suicides had been committed by men while the majority of attempters were females (64%). Most of the suicides (18cases-56.25%) had occurred in the spring while the majority of suicide attempts (288cases-35.8%) had been recorded in the summer. The common methods (62%) suiciders used were hanging and poisoning, which increased death risk significantly (OR: 8.5, 95% CI: 2.9–76.99). The incidence rates of suicide and suicide attempts reduced from 11.22, and 203 per 100,000 in 2013 to 2.63, and 157 in 2017, respectively. Suicide re-attempts also diminished from 12% in 2013 to 6.7% in 2017. Conclusion. Suicide, SA, and re-attempt were lowered by 75%, 22%, and 42%, respectively. Practical Implications. The practical framework that emerged out of the present study can be used for generating future suicide prevention strategies. Furthermore, our study highlights the need to consider a wide range of contextual factors when developing suicide prevention programs.

IntroductionSuicide is a leading cause of death globally. People with psychosis are at increased risk of suicide death and up to half experience suicidal thoughts and/or engage in suicidal behaviors in their lifetime. Talking therapies can be effective in alleviating suicidal experiences. However, research is yet to be translated into practice, demonstrating a gap in service provision. The barriers and facilitators in therapy implementation require a thorough investigation including the perspectives of different stakeholders such as service users and mental health professionals. This study aimed to investigate stakeholders’ (health professionals and service users) perspectives of implementing a suicide-focused psychological therapy for people experiencing psychosis in mental health services.MethodsFace-to-face, semi-structured interviews with 20 healthcare professionals and 18 service users were conducted. Interviews were audio recorded and transcribed verbatim. Data were analyzed and managed using reflexive thematic analysis and NVivo software.ResultsFor suicide-focused therapy to be successfully implemented in services for people with psychosis, there are four key aspects that need to be considered: (i) Creating safe spaces to be understood; (ii) Gaining a voice; (iii) Accessing therapy at the right time; and (iv) Ensuring a straightforward pathway to accessing therapy.DiscussionWhilst all stakeholders viewed a suicide-focused therapy as valuable for people experiencing psychosis, they also recognize that enabling successful implementation of such interventions will require additional training, flexibility, and resources to existing services.

IntroductionIntentional self-harm in adolescents and young people, including both suicidal behaviors and non-suicidal self-injury (NSSI), is a serious issue in mental health systems. However, the majority of studies on self-harm in adolescents and young people focused on a quantitative methodology which might have limitations in explaining this complex phenomenon of intentional self-harm. Therefore, this study aimed to describe the subjective experiences of adolescents and young people who presented with intentional self-harm in order to provide a better understanding of this behavioral phenomenon.MethodsThis is an exploratory qualitative study that uses phenomenological processes and thematic analysis. Twenty subjects aged 13–29 years were included in this study.ResultsThe results revealed six themes regarding predisposing child-rearing environments and nine themes regarding factors related to the cessation of intentional self-harm. Moreover, it demonstrated the important functions of self-harm as an intrapersonal strategy for emotional regulation.DiscussionIn conclusion, this study underscored the importance of understanding the developmental and cessation pathways of these complex behaviors.

Suicide is one of the most common causes of death in the population of children and adolescents. Available data show the continuous growth of this phenomenon and the ineffectiveness of prevention programs. Additionally, the COVID-19 pandemic significantly affected young people's mental health, including an increased risk of suicidal behaviors due to limited direct contact with the school and peer groups in favor of the home environment. Therefore, the aim of this narrative review was to consider the risk factors and protective factors for suicidal behavior in the under-18 population, with a particular focus on the importance of belonging to a social group and building identification with it as a phenomenon protecting against suicidal behavior. Additionally, in this review, we evaluate how the COVID-19 pandemic affected these relationships. The PubMed database was used in the search with the following keywords: suicide, suicide behaviors, child and adolescent suicide behaviors, group affiliation, family affiliation, ethnicity, religious affiliation, and the COVID-19 pandemic, with articles published between 2002 and 2022 analyzed. Research conducted to date indicates that both sustained and stable family and peer relationships, as well as a sense of identification and belonging, noticeably reduce the risk of suicidal behavior. Ethnic or cultural affiliation seems to have been particularly important during the isolation in the home environment caused by the COVID-19 pandemic. Additionally, it has been shown that while in lockdown, contact through social media with individuals' identification groups was associated with a reduced chance of emotional crises. Furthermore, regardless of cultural background, attachment to a particular group correlates with enhanced psychiatric state of children and adolescents. Thus, available data highlight the need for building and maintaining affiliations with suitable groups as a protective factor against suicidal behaviors. [ABSTRACT FROM AUTHOR]

Objective: Family conflict is a risk factor for suicidal behaviors among adolescents. However, few longitudinal studies have investigated this association and explored the mediation effect of behavioral and emotional problems. This study aimed to examine the longitudinal association between family conflict, internalizing and externalizing problems, and suicidal behaviors in a large sample of Chinese adolescents.Method: This longitudinal study of 7,072 adolescents was based on the Shandong Adolescent Behavior & Health Cohort (SABHC). Participants completed a self-administrated questionnaire to assess family conflict, internalizing and externalizing problems, suicidal behaviors, and family demographics at baseline. Excluding adolescents with any suicidal behavior at baseline (N = 839), others (N = 6,233) were allowed to report their internalizing and externalizing problems and suicidal behaviors one-year later. Path analyses were conducted to examine the mediation relationship of internalizing and externalizing problems between family conflict and suicidal behaviors.Results: Of 6,233 participants, mean age was 14.52 at baseline and 51.2% were males. Adolescents with subsequent suicidal behaviors reported higher scores in family conflict, internalizing and externalizing problems (Ps < 0.01). Path analyses showed that internalizing and externalizing problems played a significant mediating role in the associations of family conflict with suicidal behaviors after adjusting for covariates.Conclusions: Family conflict is associated with suicidal behaviors in adolescents, which is partially mediated by internalizing and externalizing problems. Internalizing problems is the major mediator between family conflict and suicidal thought or suicide plan; however, internalizing and externalizing problems play similar mediating roles in the family conflict-suicide attempt link. [ABSTRACT FROM AUTHOR]

Background: Understanding the relationship between chronic pain conditions and suicidal behavior—suicide attempt, other intentional self-harm, and death by suicide—is imperative for suicide prevention efforts. Although chronic pain conditions are associated with suicidal behaviors, these associations might be attributed to unmeasured confounding or mediated via pain comorbidity. Methods: We linked a population-based Swedish twin study (N=17,148 twins) with 10 years of longitudinal, nationwide records of suicidal behavior from health and mortality registers through 2016. To investigate whether pain comorbidity versus specific pain conditions were more important for later suicidal behavior, we modeled a general factor of pain and two independent specific pain factors (measuring pain-related somatic symptoms and neck-shoulder pain, respectively) based on 9 self-reported chronic pain conditions. To examine whether the pain-suicidal behavior associations were attributable to familial confounding, we applied a co-twin control model. Results: Individuals scoring one standard deviation above the mean on the general pain factor had a 51% higher risk of experiencing suicidal behavior (odds ratio (OR), 1.51; 95% confidence interval (CI), 1.34–1.72). The specific factor of somatic pain was also associated with increased risk for suicidal behavior (OR, 1.80; 95% CI, 1.45–2.22]). However, after adjustment for familial confounding, the associations were greatly attenuated and not statistically significant within monozygotic twin pairs (general pain factor OR, 0.89; 95% CI, 0.59–1.33; somatic pain factor OR, 1.02; 95% CI, 0.49–2.11) Conclusion: Clinicians might benefit from measuring not only specific types of pain, but also pain comorbidity; however, treating pain might not necessarily reduce future suicidal behavior, as the associations appeared attributable to familial confounding. [ABSTRACT FROM AUTHOR]

Suicide ideation and behaviors are major health issues in the field of mental health. Several psychological and psychosocial factors have been taken into account as possible predictors of suicidality. Only recently affective temperaments have been considered as possible factors linked to suicide. This study aims to investigate the relationship between affective temperaments and suicidality, including the lifetime onset of suicide ideation, lifetime presence of suicide attempts and the total number of lifetime suicide attempts. This is a naturalistic multicentric observational study, involving outpatient units of seven University sites in Italy. Patients were administered with the short version of TEMPS-M and the Columbia Suicide Severity Rating Scale. A total of 653 participants were recruited, with a diagnosis of bipolar (55.7%), unipolar (35.8%) and cyclothymic disorder (8.4%). Regression models showed that the presence of lifetime suicide behaviors was increased in patients presenting trait related impulsivity (p < 0.0001), poor free-interval functioning (p < 0.05), higher number of affective episodes (p < 0.01), higher number of hospitalizations (p < 0.0001), cyclothymic and irritable affective temperaments (p < 0.05 and p < 0.05, respectively). Conversely, the presence of hyperthymic affective disposition reduced the likelihood of having suicidal behaviors (p < 0.01). Lifetime suicidal ideation was associated with trait-related impulsivity (p < 0.001), poor free-interval functioning (p < 0.05), higher number of affective episodes (p < 0.001) and of hospitalizations (p < 0.001). Depressive temperaments increased the likelihood of presenting suicidal ideation (p < 0.05), along with irritable temperaments (p < 0.01), contrary to hyperthymic affective (p < 0.05). Results of the present study confirm that affective disposition has a significant impact on the onset of suicidal ideation and behaviors, and that affective dispositions should be assessed in clinical settings to identify people at risk of suicide. Moreover, a wider clinical evaluation, including different clinical psychopathological dimensions, should be taken into consideration to develop effective preventive interventions. [ABSTRACT FROM AUTHOR]

Background and Objective: Suicide is a serious, yet preventable global mental health problem for people of all ages and countries. It is the third leading cause of death in 15-19-year-olds. There is paucity of systematic studies and official statistics on child & adolescent suicides in Pakistan. In the absence of other means, newspaper coverage of adolescent suicides may serve as a useful source to understand the phenomena. Our objective was to report pattern of suicide deaths in children and adolescents across Pakistan and to determine the predominant methods of suicide precipitating events and associated factors Methods: This study used content analysis to analyze newspaper reports of adolescent suicide in four leading newspapers of Pakistan from January 1st, 2019, through December 31st, 2020. Search yielded 289 child and adolescent (ages<18) suicide reports. Data about various sociodemographic characteristics, methods of suicide, possible motives, and associated features (e.g., any suicide notes) was extracted and analyzed. Results: Total 289 suicides in children and adolescents in Pakistan were reported in selected newspapers during two years among both genders (51.5 % boys and 48.5% girls) with high incidence in late adolescence (66%). The predominant method of suicide in this group was ingestion of poisonous substances (50%) followed by hanging (35%) and use of firearms (7%). The behavior usually takes place within or near the adolescent’s home environment. The act was often attributed to domestic conflicts including arguments with parents of the deceased and relationship problems. Conclusion: To develop effective suicide prevention strategies for a population, it must be studied within its own socio-cultural context. Study results emphasize adolescent suicide being a reality in Pakistan. There is urgent need for further culture specific research in this area in the country. [ABSTRACT FROM AUTHOR]

Background: Previous research has found increasing evidence of adverse childhood experiences (ACEs) leading to non-suicidal self-injury (NSSI) and suicidal behaviors. Most studies have focused on a certain type or timing of ACEs or the patterns of multiple types; however, few of them have examined the patterns of ACEs combined types and timing and the gender differences in the association between ACEs and self-harming behaviors.Methods: A cross-sectional survey was conducted in three Chinese cities from November 2020 to May 2021. We asked 16,853 middle school students to anonymously complete a questionnaire to provide the details of their own ACEs and NSSI or suicidal behaviors.Results: Latent class analysis identified four classes: high ACEs (10 %), high abuse/neglect (20.3 %), moderate ACEs (26.7 %) and low ACEs (43 %). Logistic regression models demonstrated that students in the high ACEs, high abuse/neglect and moderate ACEs subgroups were more likely to engage in NSSI and suicidal behaviors than students with low ACEs. Compared with boys, girls had a higher probability of engaging in NSSI and suicidal behaviors when exposed to the same level of ACEs.Conclusion: Co-occurrence of ACEs is associated with high risk of NSSI and suicidal behaviors. Our findings recognized the most dangerous patterns and latent class membership, which supply the evidence for policy makers to adopt preventive measures to protect high-risk individuals. Strategies to relieve the impact of ACEs, especially on girls, need to be considered comprehensively.Limitations: The study was limited by cross-sectional design, as causality could not be confirmed. In addition, because our survey was retrospective, potential recall bias can not be ignored. [ABSTRACT FROM AUTHOR]

Background: Suicide is a major public health concern, especially among adolescents and young adults. Although research has begun to explore the developmental trajectories of suicide-related outcomes, most have thus far focused on children and adolescents. The current study extends existing literature by identifying subgroup trajectories and related factors of college students over a two-year period.Methods: The data used in this study was obtained from an ongoing longitudinal study in Guangdong, China. A total of 3871 students participated in assessments performed at three time points at one-year assessment intervals. Growth mixture modeling (GMM) was used to estimate trajectory classes for suicidal behaviors, followed by multivariable logistic regression to explore the association between predictive factors and classes.Results: GMM analyses extracted two distinct trajectories of suicidal behaviors: a low-decreasing group (n = 3669, 94.8 %) and a high-increasing group (n = 202, 5.2 %). Multivariate logistic regression analyses revealed that depressive symptoms, non-suicidal self-injury, hopelessness, and childhood emotional abuse served as risk factors for the high-increasing group, while reasons for living served as protective factors.Conclusions: Psychological interventions aimed at reducing the influence of risk factors and bolstering reasons to live may help to decrease the risk of suicide behaviors in college students. [ABSTRACT FROM AUTHOR]

Limited research exists on suicidal behaviors among women with disabilities. This study examined disability, suicidal behaviors, and associated health determinants among non-pregnant women of reproductive age. Data from the 2015–2019 National Survey on Drug Use and Health (n = 76,750) were used to estimate associations between disability and suicidal behaviors and evaluate the effects of health determinants on suicidal behaviors among non-pregnant women of reproductive age with disabilities. Approximately 22% of non-pregnant women of reproductive age with disabilities reported suicidal behaviors compared to only 4.3% of women without disabilities. Women with disabilities had greater adjusted odds of past-year suicidal behaviors (AOR 1.73; 95% CI 1.60–1.87) than those without disabilities. Psychological distress (OR 3.66; 95% CI 2.98–4.49), major depressive episode (OR 3.22; 95% CI 2.82–3.67), unmet perceived mental health need (OR 2.29; 95% CI 1.98–2.65), age 18–25 years (OR 1.65; 95% CI 1.43–1.92), and illicit drug use (OR 1.40; 95% CI 1.20–1.64) were significantly associated with higher odds of suicidal behaviors, and specifically suicidal ideation, among women with disabilities. Non-pregnant women of reproductive age with disabilities are at increased risk for exhibiting suicidal behaviors. Better understanding of suicidal behaviors among women with disabilities can assist public health officials and medical professionals in developing meaningful prevention, detection, and intervention programs. [ABSTRACT FROM AUTHOR]

Background: Although previous studies have examined many predictors of suicidal behaviors. However, little is known for childhood physical abuse (CPA) and aggression, which are prevalent among adolescents. This study aimed to explore association between CPA and suicidal behaviors, and the potential mediating role of aggression.Method: A total of 16,111 students graded 7 to 12 were recruited using a stratified cluster sampling across five representative provinces in China. Conflict Tactics Scale-Parents to Child (CTS-PC) and Buss and Warren's Aggression Questionnaire (BWAQ) were used to measure CPA and aggression, respectively.Results: During the last year, 16.0 % of adolescents reported suicidal behaviors. Specifically, 7.9 % were suicide ideators, 4.6 % were planners, and 3.5 % were attempters. The prevalence of CPA in mild, moderate, and severe was 15.7 %, 26.9 %, and 4.4 %, respectively. Multinomial logistic regression indicated that moderate and severe CPA and overall aggression were associated with suicide ideators, planners, and attempters. In five sub-types of aggression, only hostility was significantly associated with all three suicidal behaviors. Structural equation modelling showed that aggression partially mediate the relationship between CPA and suicidal behaviors. The mediation proportion of overall aggression, physical aggression, verbal aggression, anger, hostility, and indirect aggression were 27.2 %, 22.4 %, 5.2 %, 14.2 %, 23.5 %, and 12.1 %, respectively.Limitations: Cross-sectional design, self-reported questionnaire, and no other forms of childhood maltreatment.Conclusions: CPA is a critical risk factor of suicidal behaviors among Chinese adolescents and aggression is a mediator between CPA and suicidal behaviors. Targeted suicide prevention should focus on those adolescents who report CPA and aggression, especially for hostility. [ABSTRACT FROM AUTHOR]

Abstract Background Qatar is a high-income country with 90% of the population being economic migrants from low income countries. Due to this unique population composition, it has been suggested that Qatar may not follow suicide trends of high-income countries. Additionally, there is paucity of information on suicidal trends and rates due to social and cultural reasons. The Covid-19 pandemic has additionally impacted mental health of migrants differently form native Qataris. Objectives This study explores suicidal behavior trends among individuals attending the main Emergency Department in the state of Qatar for mental health emergencies. The study also compared these trends for pre-pandemic period to early post pandemic period. Methods A cross-sectional study of individuals attending the main emergency department of the country from 1st December 2019 to 30th June 2020 was carried out using a composite data collection form. This identified 799 individuals presenting with mental health emergencies. Suicidal behaviors, relevant sociodemographic data, along with factors known to be associated with suicidal behaviors were collected for this group. Results 24.9% (n = 199) of the sample presented with suicidal behaviors. Younger age (31.16 ± 9.497), current hopelessness (70; 54.7%), history of suicidal thoughts (50; 47.2%), history of suicidal attempts (43; 34.7%), history of self-harm thoughts (35; 39.3%), history of self-harm attempts (41; 37.6%) were highly significantly associated with suicidal behavior (p

Suicidal behaviors are relatively common among children, yet literature concerning the associated risks remains limited. Using a cumulative risk model, this study examined the effects of disability status, suspensions/expulsions, school disconnectedness, and negative peer relationships on suicidal behaviors. Data used were from The Future of Families and Child Wellbeing Study, which yielded an analytic sample (N = 2,463) that was majority male (52%), Black and Hispanic (81%), and with an average age of 9.3 years. Using multivariate logistic regression with subgroup analysis, negative peer relationships and being male were associated with suicidal ideation in children without a history of suspension/expulsion. On the contrary, children with a history of suspension/expulsion and a disability status had three times higher odds of suicidal ideation in comparison to children with no disability status. These findings have important research and practical implications, which are discussed. [ABSTRACT FROM AUTHOR]

Background: Bullying victimization has been found to be associated with suicidal behaviors among adolescents. However, there is a lack of studies examining the mediating pathways. Purpose: This study aims to investigate psychological distress as a candidate mediator to the association between bullying victimization and suicidal behaviors. Methods: This was a cross-sectional study involving 10,883 records of school-going adolescents, retrieved from the 2015 Indonesia Global School-based Student Health Survey (IGSHS). The primary independent variable was the experience of being bullied in the last 30 days. In contrast, the dependent variable was any suicidal behaviors (i.e., suicidal ideation, planning, or attempt) reported in the last 12 months. Psychological distress as a candidate mediator was measured as loneliness, anxiety-induced sleep disturbance (in the past 12 months), and a combination of both measures – psychological distress. Causal mediation analysis with single mediation models was used to investigate the mediation using psychological distress measures by adjusting for potential confounders. Results: This study found conceivable pathways linking bullying victimization to suicidal behaviors through all measures of psychological distress with statistically significant Natural Indirect Effect (NIE): loneliness (aOR=1.17; 95%CI=1.11-1.27), anxiety-induced sleep disturbance (aOR=1.16; 95%CI=1.10-1.27), and psychological distress (aOR=1.21; 95%CI=1.15-1.31). The proportions mediated by loneliness, anxiety-induced sleep disturbance, and psychological distress accounted for 24.58%, 23.03%, 29.27%, respectively. Findings also suggest that the mediation by all measures of psychological distress persisted among both genders, with higher proportions mediated reported among boys. Conclusion: Psychological distress mediated the associations between bullying victimization and suicidal behaviors among Indonesian adolescents.

Emergency Department (ED) is an important site for assessing people presenting with self-harm or suicidal behaviors. Digital mental health services (DMHS) offer evidence-based interventions for mental health issues, but are often under-utilised, and information about them is rarely provided in ED. This feasibility study explored whether offering information about a DMHS to individuals presenting to ED with self-harm/suicidal behaviors resulted in self-enrolment in DMHS interventions for anxiety, depression and/or chronic pain. Methods : all individuals aged 18+ presenting with self-harm/suicidal behaviors to a metropolitan ED were screened for symptoms of anxiety, depression and/or chronic pain. Those with these symptoms were invited to participate in a study investigating enrolment with a DMHS. Study participants were provided with information about DMHS and followed up at one month. Results: 260 individuals presented with self-harm/suicidal behaviors over the 6-month study period. Many reported low mood (73.5%, n = 191) anxiety (67.2%, n = 174) and/or chronic pain (18.5%, n = 48). Half of those eligible for DMHS agreed at point of ED discharge to be contacted about participation in the DMHS study (51.4%, n = 108). One-third of these participated in the study (35.2%, n = 38). Rates of past-month high-risk SB (65.8%, n = 25), depression (92.1%, n = 35), anxiety (78.9%, n = 30) and chronic pain (57.9%, n = 22) were very high. Of these, 39.5% (n = 15) self-enrolled with the DMHS; almost all (80.0%, n = 13) engaged with an online intervention. Conclusions: A subset of people presenting to emergency department with suicidal behaviors will engage with DMHS. Better understanding is needed of factors contributing to uptake of DMHS in this group. • Digital mental health services (DMHS) are increasingly acceptable following COVID-19. • DMHS provide evidence-based interventions for anxiety, depression and chronic pain. • A subset of people presenting to ED with suicidal behaviors will engage with DMHS. • Better understanding is needed of factors contributing to low uptake of DMHS in this group. [ABSTRACT FROM AUTHOR]

Objectives: This study identified profiles of patients with suicidal behaviors, their sociodemographic and clinical correlates, and assessed the risk of death within a 12‐month follow‐up period. Methods: Based on administrative databases, this 5‐year study analyzed data on 5064 patients in Quebec who used emergency departments (ED) or were hospitalized for suicidal behaviors over a 2‐year period. Latent class analysis was used for patient profiles, bivariate analysis for patient correlates over 2 years, and survival analysis for risk of death within a 12‐month follow‐up. Results: Four profiles were identified: high suicidal behaviors and high service use (Profile 1: 23%); low suicidal behaviors and moderate service use (Profile 2: 46%); low suicidal behaviors and low service use (Profile 3: 25%); and high suicidal behaviors and high acute care, but low outpatient care (Profile 4: 6%). Profiles 1 and 4 patients had more serious conditions, with a higher risk of death in Profile 1 versus Profiles 2 and 3. Profile 2 patients had relatively more common mental disorders, and Profile 3 patients had less severe conditions. Profiles 3 and 4 included more men and younger patients. Conclusion: Programs better adapted to patient profiles should be deployed after ED use and hospitalization in coordination with outpatient services. [ABSTRACT FROM AUTHOR]

Background: Alexithymia is an emotion regulation problem that may be rela - ted to suicidality, especially in patients with SUD. The study aimed at estimating the prevalence of alexithymia in Moroccan psychoactive substances users, and to establish the links between alexithymia and suicidal ideation and behaviors, anxiety and depression in drug-dependent patients. We also aimed to elucidate if alexithymia predicts suicidal thoughts and behaviors in these consumers. Material/Methods: The study included 451 consecutively admitted patients with substance use. Consumers were examined with the Toronto alexi - thymia scale (TAS-20), State and Trait Anxiety Inventory (STAIY), Beck Depression Inventory (BDI) and The Columbia-Suicide Severity Rating Scale (C-SSRS). Results: Among substance-dependent individuals, 72.7% was identified as a group with alexithymia. Current age and age at first substance use were lower in the alexithymic group (p<0.01). The mean STAI-Y state and C-SSRS scores were higher in the group with alexithymia (p<0.01). There was a statistically significant difference between the groups in terms of mean scores for anxiety traits (p<0.05) and no significant difference in terms of mean scores for depression. All of the scores correlated significantly with. Conclusions: Addicted patients with alexithymia could be targeted at preventing the onset of suicidal thoughts and behaviour. The present study also evokes that whenever an emotional regulation disor - der is observed, the possibility of anxio-depressive symptomatology and suicidality (ideation and behavior) needs to be assessed. [ABSTRACT FROM AUTHOR]

Substance use has been recognized as increasing risk for concomitant infectious and non-communicable diseases (NCDs), which has contributed to poor treatment outcomes and a social burden, particularly in low-middle income countries. This study aimed at investigating effects of comorbid substance use and infectious and NCDs on psychological, suicidal behaviors and cognitive assessments. In a cross-sectional study, 141 participants were recruited from six wards in one rehabilitation center and data consisting of demographic and personal characteristics and three self-administered instruments were obtained. Descriptive statistics, Mann–Whitney U test and binary logistic regression were used for data analysis. Findings showed that participants' age and reasons for hospitalization were significantly related to comorbid substance use, χ2(48) = 97.348, p <.05, and χ2(60) = 84.790, p <.05, respectively. Compared with methamphetamine dependence, participants with concomitant methamphetamine psychosis were five times more likely to develop severe anxiety disorders (OR = 5.00, 95% CI = 1.16–21.45) but there were no significant differences for suicidal behaviors and cognitive impairment. Because of severe anxiety symptoms, treatment for users with comorbid methamphetamine and psychosis should be closely monitored to increase therapeutic effects. [ABSTRACT FROM AUTHOR]

Opioid and other drug-related overdoses and suicides are leading causes of injury death and represent a significant public health threat in the United States (U.S.). This study examined clinical factors of three patient groups from two inpatient addiction treatment facilities in Appalachian West Virginia (n = 66). Patients were classified as having: 1) unintentional overdose(s) (OD), 2) suicidal ideation or suicide attempt(s) (SI/SA), and 3) suicidal ideation or suicide attempt, and unintentional overdose (SI/SA/OD). Multinomial logistic regression models were used to determine whether adverse childhood experiences, self-injurious behaviors, substance use history, overdose history, and past year stressful life events were differentially associated with history of SI/SA/OD. Participants in the OD group were more likely to have used heroin in the 24-h preceding their most recent overdose compared to either the SI/SA or SI/SA/OD groups. The multivariable model found participants with history of SI/SA had higher adverse childhood experience scores and more participants with history of SI/SA endorsed childhood physical abuse and teen dating violence. Overall, there are characteristics that distinguish unintentional overdose from suicidal ideation and attempt. Patients with SI/SA/OD appear to have greater clinical severity. More thorough evaluation of drugs involved in overdose and history of self-injury may help distinguish future risk and inform treatment planning. [ABSTRACT FROM AUTHOR]

Background: Real-time monitoring captures information about suicidal thoughts and behaviors (STBs) as they occur and offers great promise to learn about STBs. However, this approach also introduces questions about how to monitor and respond to real-time information about STBs. Given the increasing use of real-time monitoring, there is a need for novel, effective, and scalable tools for responding to suicide risk in real time., Objective: The goal of this study was to develop and test an automated tool (ResourceBot) that promotes the use of crisis services (eg, 988) in real time through a rule-based (ie, if-then) brief barrier reduction intervention., Methods: ResourceBot was tested in a 2-week real-time monitoring study of 74 adults with recent suicidal thoughts., Results: ResourceBot was deployed 221 times to 36 participants. There was high engagement with ResourceBot (ie, 87% of the time ResourceBot was deployed, a participant opened the tool and submitted a response to it), but zero participants reported using crisis services after engaging with ResourceBot. The most reported reasons for not using crisis services were beliefs that the resources would not help, wanting to handle things on one's own, and the resources requiring too much time or effort. At the end of the study, participants rated ResourceBot with good usability (mean of 75.6 out of 100) and satisfaction (mean of 20.8 out of 32)., Conclusions: This study highlights both the possibilities and challenges of developing effective real-time interventions for suicide risk and areas for refinement in future work., (©Daniel DL Coppersmith, Kate H Bentley, Evan M Kleiman, Adam C Jaroszewski, Merryn Daniel, Matthew K Nock. Originally published in JMIR Mental Health (https://mental.jmir.org), 31.10.2024.)

Background: East Asia has high suicide rates but low prevalence of mental disorders. We examined the associations between prior lifetime mental disorders (mood disorders, anxiety disorders, substance use disorders, and impulse control disorders) and subsequent suicidal behaviors (suicidal ideation and attempts in the general population and suicide plans, planned attempts, and unplanned attempts in suicidal ideators) in Taiwan. Methods: This survey applied the World Mental Health Survey Composite International Diagnostic Interview to a population representative sample of noninstitutionalized adults between 2003 and 2005. Odds ratios (ORs) obtained using discrete-time survival analysis were used to estimate population attributable fractions (PAFs) of suicidal behaviors due to lifetime mental disorders. Results: Lifetime mental illness was a significant risk factor for subsequent suicidal behaviors (except unplanned attempts among ideators) despite the relatively low prevalence of mental disorders in people with suicidality (16.1%–35.0%). Each diagnosis increased the odds of suicidal ideation. In terms of acting on suicidal ideation, mood disorders were most strongly associated with having plans (OR = 10.0; 95% confidence interval, CI 4.3–21.1), whereas substance use disorders most strongly with either planned (OR = 27.3; 95% CI 6.3–118.5) or unplanned attempts (OR = 14.5; 95% CI 1.7–121.5). PAFs of all mental disorders on suicidality lay between 20 and 30% (except 11% of unplanned attempts among ideators). Mood, anxiety, and substance use disorders had higher PAFs than impulse control disorders. Conclusions: In addition to mood disorders, considering anxiety and substance use disorders is essential in devising population-based suicide prevention strategies. [ABSTRACT FROM AUTHOR]