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Here we present the findings of the pilot phase of the SmartCrisis 2.0 Randomized Clinical Trial. This pilot study aimed to explore the feasibility and acceptability of a safety plan contained in a smartphone app. Our sample consisted patients with a history of recent suicidal behaviour who installed a smartphone-based safety plan. To explore the satisfaction with of the safety plan, two patient satisfaction surveys were conducted: one qualitative and one quantitative. To explore the objective use of the safety plan, we gained access to texts contained in the safety plans completed by the patients. Participation rate was 77%, while 48.9% patients completed both satisfaction surveys at the end of the pilot phase. N = 105 successfully installed the safety plan. In a scale from 1 to 10, users rated the usefulness of the security plan at 7.4, the usability at 8.9, the degree to which they would recommend it to others at 8.6 and the overall satisfaction with the project including evaluations at 9.6. The most widely completed tab was warning signs. Feeling sad or lonely was the warning sign most commonly reported by patients. The second most completed tab was internal coping strategies. Walking or practicing any other exercise was the strategy most commonly resorted to. Our smartphone-based safety plan appears to be a feasible intervention. Data obtained from this pilot study showed high participation rates and high acceptability by patients. This, together with the general satisfaction with the project, supports its implementation in the clinical practice., Competing Interests: Declaration of competing interest EBG has been a consultant to or has received honoraria or grants from Janssen Cilag, Lundbeck, Otsuka, Pziffer, Servier and Sanoffi. EBG and AAR designed the MEmind application. The other authors confirm they have no conflict of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

The COVID-19 pandemic had a significant impact on the mental health of the population. The lockdown period in Spain - from March 14 to June 21, 2020 - was particularly stressful. This study aims to examine the differences in visits to the emergency department for psychiatric reasons before and during the lockdown period in a hospital in the province of Lleida (Catalonia, Spain), which has a catchment area of 431,183 inhabitants. We hope that this study can contribute to the understanding of this difficult period in our recent history and help us to be prepared in case of new social emergencies that may affect the mental health of the general population. Background: This study aims to examine the differences in ER visits due to psychiatric reasons before and during the COVID-19 lockdown period in a province hospital in Spain. Aims: This study aims to examine the differences in ER visits due to psychiatric reasons before and during the COVID-19 lockdown period in a province hospital in Spain. Methods: We compared the n = 1,599 visits to the emergency room and their characteristics before (June 13 to March 13, 2020) and during (March 14 to June 21, 2020) the lockdown period in the province of Lerida, Spain. Data were obtained from the electronic health records. Information collected included sociodemographic variables, reason for consultation, previous diagnosis, and characteristics of suicidal ideation and attempts - including history of previous suicidal behavior, method, days spent in the ER, suicide reattempts at 6-month follow-up. Results: Before lockdown, there were an average of 11.2 psychiatric emergencies per day compared with 9.2 psychiatric emergencies per day during lockdown. Regarding suicidal behavior, before lockdown, there were an average of 0.9 suicide attempts before lockdown compared with 0.7 attempts per day during lockdown. Limitations: We observed a decrease in the number of visits to the ER in general, as well as a lower frequency of patients with suicidal behavior during the first and only lockdown period in Spain, which occurred during the initial months of the pandemic. This is consistent with previous studies showing a reduction of suicidal behavior during periods of social emergency. However, this decrease could be only temporary, and several authors predict an increase of suicidal behavior in the aftermath of the COVID-19 crisis. Ensuring access to mental healthcare during periods of crisis is crucial for the population.Conclusions: We observed a decrease in the number of visits to the ER in general, as well as a lower frequency of patients with suicidal behavior during the first and only lockdown period in Spain, which occurred during the initial months of the pandemic. This is consistent with previous studies showing a reduction of suicidal behavior during periods of social emergency. However, this decrease could be only temporary, and several authors predict an increase of suicidal behavior in the aftermath of the COVID-19 crisis. Ensuring access to mental healthcare during periods of crisis is crucial for the population.

Mental disorders are a major problem among young people. To identify early risk factors of self-injurious thoughts and behaviours (SITB) among young adults with mental health problems, this case-control study drew data from the Clinical Practice Research Datalink (CPRD), a primary care database covering 8% of the UK population. We explored the role of early factors (presenting at 8-14 years old) for suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI) in young adulthood (age 18-25 years) by performing logistic regressions. Our sample consisted of 219,581 participants, of which 6.51% had at least one SITB in young adulthood. Early risk factors for SITB included early NSSI, suicidal ideation, sexual abuse, behavioural problems, and mood and psychotic symptoms. Frequency of GP visits had a protective effect. Lack of access to mortality data, ethnicity, and socioeconomic status was a limitation of the current study. In conclusion, early symptoms in late childhood/early adolescence can be the start of long-standing problems going into adult life. The training of primary care providers in suicide risk assessment and proper co-ordination with child and adolescent mental health services are crucial for suicide prevention.

Purpose of Review: We aimed to examine the factors that differentiate single and multiple suicide attempters in adult population. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to conduct this review and meta-analysis. The review protocol was registered in PROSPERO. We carried out a systematic literature search in three databases to identify original studies that explored the differences between single and multiple suicide attempters among adult population., Recent Findings: There might be meaningful differences between those individuals that attempt suicide once in their lifespan and those who make multiple attempts in terms of sociodemographic and clinical characteristics. There are no previous meta-analysis addressing this topic in the adult population. A total of 75 studies were included in the review and 69 were included in the meta-analysis. Multiple attempters were more likely to present certain disorders such as mood and psychotic disorders, as well as personality or substance use disorders. Higher suicide ideation and suicide intent scores also characterized this group. Childhood trauma experiences, stressful life events, and higher rates of hopelessness were statistically significant in multiple attempters. Identifying the factors predicting multiple suicide attempts helps to delineate a high-risk suicidal profile that should be taken into account in the clinical and suicide prevention scenario., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Suicide is a major global public health issue that is becoming increasingly common despite preventive efforts. Though current methods for predicting suicide risk are not sufficiently accurate, technological advances provide invaluable tools with which we may evolve toward a personalized, predictive approach., Objective: We aim to predict the short-term (1-week) risk of suicide by identifying changes in behavioral patterns characterized through real-time smartphone monitoring in a cohort of patients with suicidal ideation., Methods: We recruited 225 patients between February 2018 and March 2020 with a history of suicidal thoughts and behavior as part of the multicenter SmartCrisis study. Throughout 6 months of follow-up, we collected information on the risk of suicide or mental health crises. All participants underwent voluntary passive monitoring using data generated by their own smartphones, including distance walked and steps taken, time spent at home, and app usage. The algorithm constructs daily activity profiles for each patient according to these data and detects changes in the distribution of these profiles over time. Such changes are considered critical periods, and their relationship with suicide-risk events was tested., Results: During follow-up, 18 (8%) participants attempted suicide, and 14 (6.2%) presented to the emergency department for psychiatric care. The behavioral changes identified by the algorithm predicted suicide risk in a time frame of 1 week with an area under the curve of 0.78, indicating good accuracy., Conclusions: We describe an innovative method to identify mental health crises based on passively collected information from patients' smartphones. This technology could be applied to homogeneous groups of patients to identify different types of crises., (©Maria Luisa Barrigon, Lorena Romero-Medrano, Pablo Moreno-Muñoz, Alejandro Porras-Segovia, Jorge Lopez-Castroman, Philippe Courtet, Antonio Artés-Rodríguez, Enrique Baca-Garcia. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 01.09.2023.)

Background: This study explores factors associated with transitioning from recent suicidal ideation (SI) to suicide attempt (SA) in depressed outpatients., Methods: This is a case-control study nested in two cohorts (LUEUR and GENESE) of depressed adult outpatients recruited in France and followed up for six weeks. SI, depression, anxiety, insomnia, impulsivity, and hopelessness were assessed with validated scales. Differences between patients with SI who attempted suicide during follow up and those who did not were explored using logistic regressions., Results: There was a slight majority of females in both cohorts. Mean age was 47.2 years in LUEUR and 49.4 years in GENESE. Of the 3785 participants in the LUEUR cohort, 72 (2.1 %) attempted suicide within the 6-week period vs. 19 of the 2698 participants (0.7 %) in the GENESE cohort. In LUEUR, factors associated with SA within the 6-week period were lifetime history of SA (OR = 5.35, 95 % CI = 3.30-8.66), high SI at baseline (OR = 3.87, 95 % CI = 2.4-6.24), associated treatments (OR = 3.28, 95 % CI = 2.00-5.38), and less improvement over follow-up in the following symptoms: SI (OR = 3.64, 95 % CI = 1.89-7.02), depression (OR = 3.66, 95 % CI = 1.76-7.62), and anxiety (OR = 3.26, 95 % CI = 1.46-7.27). In GENESE, associated factors were lifetime history of SAs (OR = 9.93, 95 % CI = 3.83-25.80), and less improvement in SI (OR = 9.20, 95 % CI = 3.61-23.44)., Limitations: Heterogeneity of cohorts prevented from performing a pooled analysis with a greater sample size., Conclusions: In depressed outpatients, lack of improvement was strongly associated with a short-term SA, particularly in patients with a history of previous SAs. Fast acting treatment on SI and depression may help prevent SAs., Competing Interests: Declaration of competing interest None., (Copyright © 2023. Published by Elsevier B.V.)

Background: Physical exercise is an underutilized tool for the management of mental disorders. New technologies have made a breakthrough in health care, and one of its possible applications (apps) could be that of customizing exercise programs for special populations, such as patients with mental disorders. However, the app of the so-called e-health to mental health care is still limited., Aim: To know the efficacy of apps to promote physical activity in patients with mental disorders., Methods: We conducted a systematic review of the PubMed and Embase databases with the aim of exploring the use of new technologies for the enhancement of physical exercise in patients with a psychiatric illness. Following the selection process, 10 articles were included in the review., Results: The most commonly used devices in this type of intervention are wearable devices and web platforms. Good results in terms of effectiveness and acceptability were obtained in most of the studies., Conclusion: Our findings suggest that the use of new technologies in mental health represents a feasible strategy with great potential in clinical practice., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Objective: In this study, we combined ecological momentary assessment (EMA) with traditional clinical follow-up to explore correlates of suicidal relapse in patients with a history of suicidal behavior., Methods: Over 6 months, we followed up with 393 patients who completed baseline and follow-up interviews and were monitored through smartphone-based EMA via the MEmind app. Recruitment was conducted between February 2018 and March 2020. We recorded the occurrence of clinical suicidal events and EMA suicidal events, the latter defined as extreme scores on questions on passive suicide ideation., Results: Fifteen percent of participants had a new clinical suicidal event during follow-up (9.2% suicide attempt [SA]; 5.9% emergency referral for suicidal ideation [SI]). Of the 319 participants who installed the MEmind app, 20.7% presented with EMA suicidal events. EMA suicidal events were statistically significantly associated with clinical suicidal events at 2-month follow-up but not at 6-month follow-up. In the Cox multivariate regression model, 5 factors were independently associated with clinical suicidal events: number of previous SAs, SA in the past year, SA in the past month (risk factors), female gender, and age (protective factors)., Conclusions: Our study confirms some of the risk factors classically associated with risk of suicide reattempt, such as history of suicidal behavior, while questioning others, such as female gender. Risk factors associated with EMA events differed from risk factors associated with traditional clinical suicide events, supporting the existence of distinct suicidal phenotypes., (© Copyright 2022 Physicians Postgraduate Press, Inc.)

Introduction: Suicide is one of the leading public health issues worldwide. Mobile health can help us to combat suicide through monitoring and treatment. The SmartCrisis V.2.0 randomised clinical trial aims to evaluate the effectiveness of a smartphone-based Ecological Momentary Intervention to prevent suicidal thoughts and behaviour., Methods and Analysis: The SmartCrisis V.2.0 study is a randomised clinical trial with two parallel groups, conducted among patients with a history of suicidal behaviour treated at five sites in France and Spain. The intervention group will be monitored using Ecological Momentary Assessment (EMA) and will receive an Ecological Momentary Intervention called 'SmartSafe' in addition to their treatment as usual (TAU). TAU will consist of mental health follow-up of the patient (scheduled appointments with a psychiatrist) in an outpatient Suicide Prevention programme, with predetermined clinical appointments according to the Brief Intervention Contact recommendations (1, 2, 4, 7 and 11 weeks and 4, 6, 9 and 12 months). The control group would receive TAU and be monitored using EMA., Ethics and Dissemination: This study has been approved by the Ethics Committee of the University Hospital Fundación Jiménez Díaz. It is expected that, in the near future, our mobile health intervention and monitoring system can be implemented in routine clinical practice. Results will be disseminated through peer-reviewed journals and psychiatric congresses. Reference number EC005-21_FJD. Participants gave informed consent to participate in the study before taking part., Trial Registration Number: NCT04775160., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Childhood maltreatment is a known risk factor for the development of suicidal behavior. Possible mediators of the association between childhood maltreatment and suicide have been analyzed. Some studies have considered impulsivity as one of these mediators, but there are no previous reviews on this topic. We, therefore, present a systematic review and mediation meta-analysis of the literature summarizing the evidence on impulsivity as a mediator of the relationship between childhood maltreatment and lifetime suicidal behavior. This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The review was registered in the PROSPERO database. We searched PubMed, PsycINFO, WebOfScience, and EMBASE databases up to February 2021 to identify studies exploring the association between childhood maltreatment and suicide through impulsivity. Fourteen articles met the selection criteria and were included in the review. Seven articles could be included in the mediation meta-analysis. Impulsivity was a significant mediator of the relationship between childhood maltreatment and suicidal behavior in ten of the fourteen included studies. This result was confirmed using mediation meta-analysis (β = .06, 95% CI 0.03-0.10). Studies suggest that exposure to traumatic situations in childhood affects the proper neurobiological, cognitive, and affective development of individuals. This may increase impulsivity, which in turn would be related to an increased risk of suicide. The effects of childhood maltreatment and impulsivity may be both therapeutic targets of interest to reduce suicide rates., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Active and passive Ecological Momentary Assessment of suicide risk is crucial for suicide prevention. We aimed to assess the feasibility and acceptability of active and passive smartphone-based EMA in real-world conditions in patients at high risk for suicide. We followed 393 patients at high risk for suicide for six months using two mobile health applications: the MEmind (active) and the eB2 (passive). Retention with active EMA was 79.3% after 1 month and 22.6% after 6 months. Retention with passive EMA was 87.8% after 1 month and 46.6% after 6 months. Satisfaction with the MEmind app, uninstalling the eB2 app and diagnosis of eating disorders were independently associated with stopping active EMA. Satisfaction with the eB2 app and uninstalling the MEmind app were independently associated with stopping passive EMA. Smartphone-based active and passive EMA are feasible and may increase accessibility to mental healthcare., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Patients with delusional disorder (DD) are at an increased risk for the development of depressive symptoms. We aimed to examine the literature dealing with assessment tools to assess depressive symptoms in DD. A systematic review was performed by searching PubMed, Scopus and clinicaltrials.gov databases from inception until June 2021 (PRISMA guidelines). From 1863 initial retrieved records, 11 studies were included (N = 715 DD patients). Depressive comorbidity ranged from 20.9% to 53.5%. Seven studies used semistructured/structured interviews: OPCRIT 4.0 (n = 1), Manual for Assessment and Documentation of Psychopathology in Psychiatry (AMDP System) (n = 2), the MINI interview (n = 1), DSM-IV (n = 1), ICD-10 (n = 1); and the Diagnostic Interview Schedule (DIS-R) (n = 1). Seven studies used at least one observer-rated scale: Positive and Negative Syndrome Scale (PANSS)-depressive component (n = 2), Hamilton Rating Scale for Depression (HRSD, n = 3), Montgomery-Asberg Depression Rating Scale (MADRS, n = 1), Clinical Global Impression Scale (CGI, n = 1) and the Bipolar Affective Disorder Dimension Scale (BADDS, n = 1). Assessment scales administered in depressive disorders and schizophrenia are applied to DD. This is the first systematic review exploring the use of assessment tools for depressive symptoms in DD. The use of the MADRS to assess depressive symptoms can be recommended in combination with other clinical scales, for instance, the CGI., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Schizophrenia is a prevalent and serious disorder. Video games have shown potential as an aid in health care for people who suffer from schizophrenia. Although video games may contribute benefit in the treatment of schizophrenia, reviews on this topic are scarce. In this article, we systematically review the evidence concerning video game-based therapeutic interventions for people diagnosed with schizophrenia., Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review protocol was registered in the PROSPERO database. We searched 4 databases-PubMed, Web of Science, EMBASE, and clinicaltrials.gov-to identify original studies exploring video game-based therapeutic interventions for people with schizophrenia., Results: After initial screening, full-text review, and study selection, 11 articles were included in the review. Most studies used video consoles as the platform, with a minority using a personal computer. Video game-based therapeutic interventions were well accepted and generally effective in improving cognitive areas., Conclusions: Cognitive training could be one of the main mechanisms underlying the usefulness and effectiveness of video game-based therapeutic interventions. Software optimization and greater collaboration between developers and health care professionals are some of the priorities for future research in this area., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: This study reviews the evidence on ecological momentary interventions (EMIs) for managing and preventing suicidal thoughts and behaviors., Methods: This review follows the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Its protocol was registered in the PROSPERO database. We conducted a systematic literature search of five databases: PubMed, EMBASE, Web of Science, PsycInfo, and Cochrane library. The most recent search date was 10 September 2021., Results: After screening and full-text review, 27 studies were included, totaling 19 different interventions. Many of the available interventions have not yet been clinically tested. Those that have undergone effectiveness evaluation (10 interventions) showed good rates of effectiveness and feasibility, with some exceptions. The most widely used intervention model is the safety plan, which allows the user to implement coping and distracting strategies in case of suicidal ideation., Conclusions: Ecological momentary interventions provide certain advantages, such as their wide availability, versatility, and potential for customization. These interventions can be useful complements to traditional care, especially in situations in which face-to-face care is not possible. Evidence on the effectiveness of such interventions is still scarce. Furthermore, barriers limiting implementation in clinical practice remain. The constant advance of technology means that these interventions have great potential for improvement in the coming years., (Copyright © 2022 President and Fellows of Harvard College.)

Purpose of Review: Suicide risk assessment is a challenge in clinical practice. Implicit measures may present with advantages with respect to explicit methods, and therefore may be useful for the assessment of suicide risk. We conducted a systematic review of 2 databases (PubMed and EMBASE) about implicit tests that measure suicide risk to explore their validity and reliability., Recent Findings: Initial research revealed 321 articles. After the selection process, 31 articles were included in the review. The most death-related implicit cognition test used was the Death/Suicide Implicit association test (D/S IAT), followed by the Suicide Stroop Task. The Suicide Affect Misattribution Procedure (S-AMP) and the Death version of the Implicit Relational Assessment Procedure (D-IRAP) were also used. We found that the measures reviewed were generally valid for the assessment of past and future suicidal thoughts and behaviors, with statistically significant results regarding retrospective and prospective associations., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent and serious disorder among children. Video games have shown potential for aiding in child healthcare. Video games could contribute to the assessment and management of ADHD, but there are no previous reviews on this topic. Here, we systematically review the evidence about video game-based assessment tools and interventions for children diagnosed with ADHD. This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The review protocol was registered in PROSPERO database. We searched four databases-PubMed, PsycInfo, Embase and clinicaltrials.gov-to identify original studies exploring either video game-based interventions or video game-based assessment tools in children with ADHD. After initial screening, full text revision and study selection, 22 articles were finally included in the review. Most studies used PC as platform, with a minority using a video console, pad, or 3D device. Video game-based assessment tools were generally effective in discriminating ADHD cases from controls, and in discriminating between ADHD subtypes. Video game-based therapeutic interventions were well accepted and generally effective in improving cognitive areas and decreasing ADHD symptoms. Gamification and cognitive training could be the main mechanisms underlying the usefulness and effectiveness of video game-based assessment tools and interventions. Software optimization and greater collaboration between developers and healthcare professionals are some of the priorities for future research in this area., (© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.)

Video games are a promising area of intervention for children diagnosed with Autism Spectrum Disorders (ASD). However, reviews on this topic are scarce. This review on studies exploring video games for the treatment of ASD followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and its protocol was registered in PROSPERO. PubMed, PsycInfo, Embase, WebOfScience and clinicaltrials.gov databases were searched. Twenty-four articles were included in the review. Video game-based interventions were effective for alleviating ASD symptoms, albeit with small effect sizes. High rates of acceptability and adherence to treatment were obtained. Conclusion: Video games are a promising area for improving the treatment of children with ASD. Exploring commercial video games is one of the lines for future research., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.)

Purpose of Review: To review the evidence about video game-based therapeutic intervention for people diagnosed with depressive disorders., Recent Findings: Psychotherapy has been proved to reduce depressive symptoms and is a key element in the treatment of depressive disorders. However, geographical, economical and stigmatized concerns are barriers to access to psychotherapy. New technologies and videos games can overcome some of these barriers by providing teleconferencing evidence-based therapy as time as they may offer an interactive entertainment. Overall, video game-based interventions were useful and effective in reducing symptoms of depressive disorders. Seven of the studies were published in the last 5 years, which reflects the increased research interest in video game-based interventions for depression. Overall, when adherence was reported, rates of acceptability and feasibility were high., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: Ecological momentary assessment (EMA) is a recently introduced approach to patient evaluation that consists of asking patients questions in real time and in their usual habitat. This method seeks to contribute to suicide prevention by providing psychiatrists with detailed information about suicidal thoughts and behavior, how these fluctuate over short periods of time, and the short-term risk factors presented by patients. We conducted a systematic review of published research using EMA to study suicidal thoughts and behavior., Recent Findings: Several systematic reviews of EMA in mental health have been conducted to date, and the literature contains numerous theoretical papers and compilations on EMA and suicide phenomena. To date, however, no systematic reviews have explored the use of this tool to study suicidal thoughts and behavior. We performed a systematic review of five databases (i.e., PubMed, Embase, Scopus, Web of Science, and PsycINFO) to identify studies on EMA and suicidal thoughts and behavior. An initial search revealed 544 articles. Following the study selection process, 35 studies were included in the review. Almost three-quarters of the studies were published in the last 4 years. The studies reviewed concluded that EMA was generally feasible and well accepted. EMA findings correlated well with the results of a retrospective assessment, though tended to over-represent symptom severity. Our review points to important aspects of suicidal thoughts and behavior, such as its wide fluctuation over short periods of time. Negative affect and disturbed sleep, among others, emerged as short-term predictors of suicidal thoughts and behavior. Therefore, EMA is a potentially useful tool in clinical practice, although not without drawbacks, such as participant fatigue with questionnaires and ethical concerns.

Background: Smartphone monitoring could contribute to the elucidation of the correlates of suicidal thoughts and behaviors (STB). In this study, we employ smartphone monitoring and machine learning techniques to explore the association of wish to die (passive suicidal ideation) with disturbed sleep, altered appetite and negative feelings., Methods: This is a prospective cohort study carried out among adult psychiatric outpatients with a history of STB. A daily questionnaire was administered through the MEmind smartphone application. Participants were followed-up for a median of 89.8 days, resulting in 9,878 person-days. Data analysis employed a machine learning technique called Indian Buffet Process., Results: 165 patients were recruited, 139 had the MEmind mobile application installed on their smartphone, and 110 answered questions regularly enough to be included in the final analysis. We found that the combination of wish to die and sleep problems was one of the most relevant latent features found across the sample, showing that these variables tend to be present during the same time frame (96 hours)., Conclusions: Disturbed sleep emerges as a potential clinical marker for passive suicidal ideation. Our findings stress the importance of evaluating sleep as part of the screening for suicidal behavior. Compared to previous smartphone monitoring studies on suicidal behavior, this study includes a long follow-up period and a large sample., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Suicide is one of the main challenges worldwide. Every year 800,000 people die by suicide. There is evidence that life stressful events are associated to suicidal behaviour. Our aim in this case-control study is to explore their role as triggers of suicidal behaviour.

Objective: Psychomotor abnormalities are relevant symptoms in the clinical presentation of schizophrenia, and assessing them could facilitate monitoring. New technologies can measure psychomotor activity objectively and continuously, but evidence on the topic is scarce. Our aim is to systematically review the existing evidence about eHealth tools for assessing psychomotor activity in patients diagnosed with schizophrenia., Method: We performed a systematic search of the PubMed and Embase databases and identified 15 relevant articles on eHealth tools for assessing psychomotor activity in schizophrenia., Results: eHealth devices accurately assessed psychomotor activity and were well accepted. Abnormalities in psychomotor activity helped differentiate between different subtypes of schizophrenia. Abnormal increases in psychomotor activity were correlated with acute presentations, while lower activity was associated with relapses, deterioration, and negative symptoms., Conclusion: Actigraphy is still the preferred eHealth device in research settings, but mobile applications have great potential. Further studies are needed to explore the possibilities of psychomotor monitoring and mobile health applications for preventing relapses in schizophrenia. eHealth could be useful for monitoring psychomotor activity, which might help prevent relapses.

Objectives: Major depressive disorder (MDD) is one of the most disabling mental illnesses and it has a significant impact on society. This review aims to provide updated scientific evidence about the epidemiology of MDD., Methods: A systematic literature review of the PubMed and MEDLINE databases was performed to identify articles on the prevalence of MDD and its correlates. The search was restricted to manuscripts published between January 2001 and December 2018., Results: Sixty-three articles were included in the review. The lifetime prevalence of MDD ranged from 2 to 21%, with the highest rates found in some European countries and the lowest in some Asian countries. The main sociodemographic correlates were separated/divorced marital status and female gender. Child abuse, intimate partner violence, and comorbidity with other physical and mental disorders also were consistently associated with MDD across the reviewed studies., Conclusions: MDD is a highly prevalent condition worldwide. There are remarkable interregional differences in the disorder's prevalence, as well as in certain sociodemographic correlates. MDD is also highly comorbid with physical and mental health problems.

Background: Smartphone-based ecological momentary assessment (EMA) is a promising methodology for mental health research. The objective of this study is to determine the feasibility of smartphone-based active and passive EMA in psychiatric outpatients and student controls., Methods: Two smartphone applications -MEmind and eB 2 - were developed for behavioral active and passive monitoring. The applications were tested in psychiatric patients with a history of suicidal thoughts and/or behaviors (STB), psychiatric patients without a history of STB, and student controls. Main outcome was feasibility, measured as response to recruitment, retention, and EMA compliance. Secondary outcomes were patterns of smartphone usage., Results: Response rate was 87.3% in patients with a history of STB, 85.1% in patients without a history of STB, and 75.0% in student controls. 457 participants installed the MEmind app (120 patients with a history of STB and 337 controls) and 1,708 installed the eB 2 app (139 patients with a history of STB, 1,224 patients with no history of STB and 346 controls). For the MEmind app, participants were followed-up for a median of 49.5, resulting in 22,622 person-days. For the eB 2 application, participants were followed-up for a median of 48.9 days, resulting in 83,521 person-days. EMA compliance rate was 65.00% in suicidal patients and 75.21% in student controls. At the end of the follow-up, over 60% of participants remained in the study., Limitations: Cases and controls were not matched by age and sex. Cases were patients who were receiving adequate psychopharmacological treatment and attending their appointments, which may result in an overstatement of clinical compliance., Conclusions: Smartphone-based active and passive monitoring are feasible methods in psychiatric patients in real-world settings. The development of applications with friendly interfaces and directly useful features can help increase engagement without using incentives. The MEmind and eB 2 applications are promising clinical tools that could contribute to the management of mental disorders. In the near future, these applications could serve as risk monitoring devices in the clinical practice., Competing Interests: Declaration of Competing Interest All the authors confirm they have no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Purpose of Review: To summarize the latest evidence about mobile phone applications for the management of depression., Recent Findings: Depression apps are very heterogeneous, given the absence of standards for their development, description, and evaluation. Randomized clinical trials show the effectiveness of some of these applications in reducing depressive symptoms. Attrition is an important issue whose evaluation is limited by the frequent use of incentives in the studies. The number of mobile applications for depression far exceeds the number of studies evaluating their efficacy and feasibility. Despite the limitations of the digital market, there are a small number of apps that have demonstrated sufficient effectiveness and tolerability to think of short-term clinical use. However, there are still barriers at different levels that may delay the implementation of these interventions in daily clinical practice.

Efforts in research, prevention, and treatment of suicidal behavior have produced mixed results. One of the main barriers to combating suicidal behavior lies in the very conceptualization of suicide, a phenomenon that is at once sociological, psychiatric, and even philosophical, and one that has not always been included in the field of health care. There are also many barriers at the social level, ranging from stigma against people with suicidal behavior to stigma towards psychiatric care, as well as the controversial role of the media. The media plays an important role in society and depending on its attitude it can be either beneficial or harmful in our fight against suicidal behavior. Differences between countries - in the provision of resources, in the way of understanding the phenomenon or in the manner of providing official figures - pose an additional challenge to suicide prevention on a global level. In the field of research, predicting suicidal behavior by identifying effective risk markers is severely hampered by the low occurrence of suicide in the population, which limits the statistical power of studies. The authors recommend combining various risk factors to build predictive models. This, in addition to employing increasingly precise machine learning techniques, is a step in the right direction, although there is still a long way to go before the expected results can be obtained. Finally, adequate training of health professionals, both specialized and non-specialized, as well as gatekeeper training, is crucial for implementing suicide prevention strategies in the population.

Background: Life expectancy of people with depression is on average 15 years less than that of the general population. This excess of mortality is largely attributed to a deteriorated physical health. Evidence about the association between major depressive disorder (MDD) and physical health is still lacking in some areas. The aim of this study was to explore the association between MDD and physical health-related variables in southern Spain., Methods: The PISMA-ep is a cross-sectional study based on community-dwelling adult population. Our main outcome was current prevalence of MDD. Independent variables explored were: lifetime prevalence of twenty-one chronic physical conditions (CPCs), anthropometric measures (height, weight, body max index, and hip and waist circumferences), general health status, and medication use., Results: MDD was significantly associated with any CPC (OR = 2.60; 95% CI: 2.01-3.35; p < 0.001). Increases in BMI were associated with MDD in women (OR=1.08; 95% CI: 1.05-1.11; p < 0.001), but not in men (OR=0.99; 95% CI: 0.95-1.05; p = 0.916). Variables associated with MDD in the multivariate model were: female gender, obesity, general health status, cancer, peptic ulcer, tinnitus and vertigo. 21.4% of participants with MDD received antidepressant treatment., Conclusions: MDD is associated with CPCs, obesity, and increased use of medication. The high rates of comorbidity between MDD and CPCs call for a more holistic management of patients in the clinical practice. The low rate of antidepressant use may be indicating underdiagnosis. Anthropometric variables were differently associated with MDD depending on gender, suggesting a strong influence of psychosocial factors., (Copyright © 2019. Published by Elsevier Masson SAS.)

Background: Major Depressive Disorder (MDD) is one of the most prevalent and disabling mental disorders. Sedentarism and obesity are recognized risk factors for MDD. Physical exercise has shown beneficial effects on mental health and there is an increasing awareness of its potential as a therapeutic and preventive tool for depression. No epidemiological studies have explored the role of physical activity and obesity as potential correlates of MDD in the Spanish population. The aim of this study was to explore whether MDD was associated with two strongly linked variables: physical exercise and body mass index., Methods: The PISMA-ep is a cross-sectional community-based study carried out in Andalusia, southern Spain. Main outcome was current prevalence of MDD, measured through face-to-face interviews using the Mini-International Neuropsychiatric Interview (MINI). Independent variables explored were physical exercise and its intensity, Body Mass Index (BMI), BMI categories (underweight, normal weight, overweight and obesity), hip and waist circumferences, general health status measured with the SF12 questionnaire, and sociodemographic factors., Results: Physical exercise was inversely associated with MDD, acting as a protective factor. Higher intensity of exercise strengthened this association. Four variables were independently associated with MDD in the multivariate association model: female sex, physical exercise, general health status and BMI., Conclusion: MDD was associated with poorer health status, higher BMI and reduced physical activity. Physical exercise should be considered as a potential intervention for the treatment and prevention of MDD in clinical and public health settings., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Sleep disturbances and suicidal behaviour are highly prevalent phenomena, representing with a significant burden to society. Sleep has been acknowledged as a potential biomarker for suicidal behaviour. Over the past decade several studies have explored the association between sleep problems and suicidal behaviour. This area has attracted a growing research interest, hence updated information is needed. We therefore present a wide-scope review of the literature summarizing the most relevant studies on epidemiological and theoretical issues underlying this association. Implications of these findings for clinical practice and future research are discussed. We performed a systematic search of PubMed and Embase databases up to October 2018 to identify studies exploring the association between sleep and suicide. Sixty-five articles met the selection criteria, thus they were included in the review. There was a significant and independent association between sleep disturbances and suicide risk. Psychiatric disorders, sleep deprivation-induced neurocognitive deficits, emotional dysregulation, alterations in circadian rhythms, and negative feelings, among other factors, contributed to this relationship. Sleep loss may lead to higher levels of impulsivity, thus increasing unplanned suicidal behaviour. Sleep disturbances may therefore predict suicidal behaviour, hence becoming a potential therapeutic target., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Suicide prevention is one of the greatest challenges in mental health policies. Since a previous suicide attempt is the main predictor of future suicidal behaviour, clinical management of suicide attempters is vital for lowering mortality. Psychopharmacological interventions are still nonspecific, and their effectiveness have often been questioned. In this study, we aim to identify predictors of suicide re-attempt in a cohort of suicide attempters, with particular focus on different aspects of psychopharmacological treatment., Methods: This is a prospective study. Adults presenting with a suicide attempt were approached to take part in our study, resulting in a final sample of 371 participants. Participants were followed from inclusion to next suicide attempt, death by other causes, loss of the patient, or after a maximum of two years. We conducted Kaplan-Meier survival analyses and a multivariate Cox regression model for several exposure variables., Results: During the study period, 70 participants (18,9%) re-attempted. 60% of re-attempts occurred within the first 6 months. Three factors were independently associated with risk of re-attempt in the Multivariate Cox regression model: diagnosis of a Cluster B personality disorder, good treatment compliance, and at least one previous suicide attempt prior to the index event., Limitations: Indication bias precludes a clear interpretation of our results regarding psychopharmacological treatment. Poor adherence may also be a consequence of relapse rather than just one of its causes., Conclusions: A correct psychopharmacological treatment is insufficient to prevent re-attempts in populations at risk. Strategies to increase compliance should be taken into account as part of prevention programs., (Copyright © 2018 Elsevier B.V. All rights reserved.)

This is a cross-sectional study of participants from a population census living in the province of Granada (Spain). A total of 1176 persons were contacted, 367 (31%) refused and 54 (6.7%) needed substitution. A final sample of 809 participants (response rate, 69.3%) were screened for mental disorder (MD) using the MINI International Neuropsychiatric Interview, a comprehensive interview validated to generate diagnoses compatible with ICD-10/DSM-4 criteria. Current (1-month) prevalence for any MD was 11.3% (95% confidence interval [CI], 9.7%-13.4%; affective 8.2%, anxiety 9.6%, psychotic 2.1%, addiction 1.8%, personality disorder 3.6%). Lifetime MD prevalence was 24.6% (95% CI, 21.6-27.6; affective 14.9%, anxiety 15.5%, psychotic 3.4%, addiction 4.4%, personality disorder 3.6%). Female sex was associated with MD, but this appeared partially due to higher levels of neuroticism among women. MD also correlated significantly with cannabis use, family history of MD, higher social adversity, higher suicide risk, poorer physical health, poorer cognitive performance, and personality problems.

Background: Schizophrenia has a 1% prevalence in the population; 30% of these patients are treatment refractory. Clozapine is the only drug licensed to treat treatment refractory psychosis, but concerns about potential adverse effects result in only a proportion of eligible patients being treated. Although a well-documented neutropenia risk is mitigated by routine blood testing, cardiac toxicity is a commonly cited reason to discontinue clozapine treatment. However, there is little data on the real-life cardiac outcomes in those receiving clozapine treatment., Methods: Retrospective review of electrocardiogram, echocardiogram, and clinical outcomes in 39 inpatients with treatment-refractory schizophrenia, treated with clozapine and other antipsychotic medication, referred for cardiology opinion., Results: Commonest reasons for referral were development of left ventricular (LV) impairment or sinus tachycardia with normal LV function. Patients were reviewed by a range of cardiologists, receiving varied interventions.Median LV ejection fraction in the clozapine group was normal (52%). Serial echocardiograms demonstrated that clozapine-treated patients with LV impairment had no change in LV ejection fraction over a 4-month follow-up. Left ventricular ejection fraction did not differ between patients treated with clozapine and other antipsychotics. However, over an 11-year follow-up period, 48% of patients had discontinued clozapine treatment., Conclusions: This naturalistic study demonstrates that clozapine is not associated with significant cardiac mortality or morbidity. There is a real need for multidisciplinary working between specialist cardiologists and psychiatrists caring for these complex patients to facilitate optimal long-term physical and mental health outcomes.