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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.)

Traditional research methods have shown low predictive value for suicidal risk assessments and limitations to be applied in clinical practice. The authors sought to evaluate natural language processing as a new tool for assessing self-injurious thoughts and behaviors and emotions related. We used MEmind project to assess 2838 psychiatric outpatients. Anonymous unstructured responses to the open-ended question "how are you feeling today?" were collected according to their emotional state. Natural language processing was used to process the patients' writings. The texts were automatically represented (corpus) and analyzed to determine their emotional content and degree of suicidal risk. Authors compared the patients' texts with a question used to assess lack of desire to live, as a suicidal risk assessment tool. Corpus consists of 5,489 short free-text documents containing 12,256 tokenized or unique words. The natural language processing showed an ROC-AUC score of 0.9638 when compared with the responses to lack of a desire to live question. Natural language processing shows encouraging results for classifying subjects according to their desire not to live as a measure of suicidal risk using patients' free texts. It is also easily applicable to clinical practice and facilitates real-time communication with patients, allowing better intervention strategies to be designed., Competing Interests: Declaration of Competing Interest Enrique Baca-Garcia has designed MEmind., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Suicidal behavior (SB) is common in first-episode psychosis (FEP), and cognitive impairment has also been described in psychosis. Despite well-established risk factors for SB in psychosis, the role of cognition and insight remains unclear. This study aimed to explore the relationship between history of SB and cognition in recent-onset FEP, distinguishing between neurocognition, social cognition, and metacognition, and including cognitive insight (CI) as a metacognitive variable. The sample consisted of 190 participants with recent-onset FEP recruited from two multicentric studies. Two groups were formed based on presence/absence of a history of SB. Demographic, clinical, and cognitive data were compared by group, including significance level adjustments and size effect calculation. No differences were found regarding demographic, clinical, neurocognitive, social cognition, and metacognitive variables except for CI (18.18 ± 4.87; t = -3.16; p = 0.0020; d = -0.635), which showed a medium effect size. Small to medium effect size were found for attributional style (externalizing bias) (1.15 ± 3.94; t = 2.07; d = 0.482), theory of mind (ToM) (1.73 ± 0.22; t = 2.04; d = -0.403), jumping to conclusions bias (JTC) (23.3 %; X 2  = 0.94; V = 0.178). In recent-onset psychosis, neurocognitive functioning was not related to the history of SB. As novelty, individuals with previous SB showed higher CI. Also, regarding social cognition and metacognition, individuals with prior SB tended to present extremely low externalizing bias, better ToM, and presence of JTC., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

The Dimensional Anhedonia Rating Scale (DARS) is a novel questionnaire to assess anhedonia of recent validation. In this work, we aim to study the equivalence between the traditional paper-and-pencil and the digital format of DARS. Sixty-nine patients filled the DARS in a paper-based and digital versions. We assessed differences between formats (Wilcoxon test), validity of the scales [Kappa and intraclass correlation coefficients (ICCs)], and reliability (Cronbach's alpha and Guttman's coefficient). We calculated the comparative fit index and the root mean squared error (RMSE) associated with the proposed one-factor structure. Total scores were higher for paper-based format. Significant differences between both formats were found for three items. The weighted Kappa coefficient was approximately 0.40 for most of the items. Internal consistency was greater than 0.94, and the ICC for the digital version was 0.95 and 0.94 for the paper-and-pencil version ( F = 16.7, p < 0.001). Comparative Adjustment Index was 0.97 for the digital DARS and 0.97 for the paper-and-pencil DARS, and RMSE was 0.11 for the digital DARS and 0.10 for the paper-and-pencil DARS. We concluded that the digital DARS is consistent in many respects with the paper-and-pencil questionnaire, but equivalence with this format cannot be assumed without caution.

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&#95;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.)

Introduction: Impulsivity is present in a range of mental disorders and has been associated with suicide. Traditional measures of impulsivity have certain limitations, such as the lack of ecological validity. Virtual reality (VR) may overcome these issues. This study aims to validate the VR assessment tool 'Spheres & Shield Maze Task' and speech analysis by comparing them with traditional measures. We hypothesise that these innovative tools will be reliable and acceptable by patients, potentially improving the simultaneous assessment of impulsivity and decision-making., Methods and Analysis: This study will be carried out at the University Hospital Fundación Jiménez Díaz (Madrid, Spain). Our sample will consist of adults divided into three groups: psychiatric outpatients with a history of suicidal thoughts and/or behaviours, psychiatric outpatients without such a history and healthy volunteers. The target sample size was established at 300 participants (100 per group). Participants will complete the Barratt Impulsiveness Scale 11; the Urgency, Premeditation, Perseverance, Sensation Seeking, Positive Urgency, Impulsive Behaviour Scale; Iowa Gambling Task; Continuous Performance Test; Stop signal Task, and Go/no-go task, three questions of emotional affect, the Spheres & Shield Maze Task and two satisfaction surveys. During these tasks, participant speech will be recorded. Construct validity of the VR environment will be calculated. We will also explore the association between VR-assessed impulsivity and history of suicidal thoughts and/or behaviour, and the association between speech and impulsivity and decision-making., Ethics and Dissemination: This study was approved by the Ethics Committee of the University Hospital Fundación Jiménez Díaz (PIC128-21&#95;FJD). Participants will be required to provide written informed consent. The findings will be presented in a series of manuscripts that will be submitted to peer-reviewed journals for publication., Trial Registration Number: NCT05109845; Pre-results., 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.)

Impaired decision-making (DM) is well-known in suicidal behavior (SB). We aimed to review the evidence on DM and its mediating factors in SB and perform a meta-analysis on DM assessed using the Iowa Gambling Task (IGT). We conducted a search on databases of papers published on DM and SB up to 2020: 46 studies were included in the systematic review, and 18 in the meta-analysis. For meta-analysis, we compared DM performance between suicide attempters (SAs) and patients (PCs) or healthy controls (HCs). The systematic review showed that SAs have greater difficulties in all DM domains. The meta-analysis found worse IGT performance among SAs in comparison with PCs and HCs. A meta-regression did not find differences for age, gender, psychiatric disorder, and clinical status. Our findings indicate that SAs exhibited deficits in DM under conditions of risk though not ambiguity. Worse DM was independent of age, gender, psychiatric disorder, and suggested that DM impairment could be considered a cognitive trait of suicidal vulnerability, a risk factor and an attribute of SAs., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Metacognitive training (MCT) is a promising treatment for improving cognitive insight associated with delusional beliefs in individuals with psychotic disorders. The aim of this study was to examine potential moderators of cognitive insight in individuals with first-episode psychosis (FEP) who received either MCT or psychoeducation. The present study was based on data from a randomized control trial comparing MCT to psychoeducation. Baseline sociodemographic and clinical characteristics in a sample of 122 patients with FEP were examined as potential moderators of the self-reflectiveness and self-certainty dimensions of cognitive insight using the SPSS PROCESS macro. The only variable that moderated self-reflectiveness at the post-treatment evaluation was age of onset (b = -0.27, p = .025). The effect of MCT in reducing self-certainty was stronger in women (b = -3.26, p = .018) and in individuals with average or above average baseline self-esteem (b = -0.30, p = .007). Overall, our findings support the generalization of MCT to a variety of sociodemographic and clinical profiles. While some patient profiles may require targeted interventions such as MCT to improve cognitive insight, others may do equally as well with less demanding interventions such as a psychoeducational group., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

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.

Introduction: Mental disorders represent the second cause of years lived with disability worldwide. Suicide mortality has been targeted as a key public health concern by the WHO. Smartphone technology provides a huge potential to develop massive and fast surveys. Given the vast cultural diversity of Mexico and its abrupt orography, smartphone-based resources are invaluable in order to adequately manage resources, services and preventive measures in the population. The objective of this study is to conduct a universal suicide risk screening in a rural area of Mexico, measuring also other mental health outcomes such as depression, anxiety and alcohol and substance use disorders., Methods and Analysis: A population-based cross-sectional study with a temporary sampling space of 9 months will be performed between September 2019 and June 2020. We expect to recruit a large percentage of the target population (at least 70%) in a short-term survey of Milpa Alta Delegation, which accounts for 137 927 inhabitants in a territorial extension of 288 km 2 .They will be recruited via an institutional call and a massive public campaign to fill in an online questionnaire through mobile-assisted or computer-assisted web app. This questionnaire will include data on general health, validated questionnaires including Well-being Index 5, Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale 2, Alcohol Use Disorders Identification Test, selected questions of the Drug Abuse Screening Test and Columbia-Suicide Severity Rating Scales and Diagnostic and statistical manual of mental disorders (DSM-5) questions about self-harm.We will take into account information regarding time to mobile app response and geo-spatial location, and aggregated data on social, demographical and environmental variables. Traditional regression modelling, multilevel mixed methods and data-driven machine learning approaches will be used to test hypotheses regarding suicide risk factors at the individual and the population level., Ethics and Dissemination: Ethical approval (002/2019) was granted by the Ethics Review Board of the Hospital Psiquiátrico Yucatán, Yucatán (Mexico). This protocol has been registered in ClinicalTrials.gov. The starting date of the study is 3 September 2019. Results will serve for the planning and healthcare of groups with greater mental health needs and will be disseminated via publications in peer-reviewed journal and presented at relevant mental health conferences., Trial Registration Number: NCT04067063., Competing Interests: Competing interests: EBG designed the MeMind application., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

This chapter reviews gender differences in suicide, commonly known as the gender paradox in suicide. While men are more likely to complete suicide, suicide attempts are more frequent in women. Although there are exceptions, this paradox occurs in most countries over the world, and it is partially explained by the preference of men for more lethal methods. Nevertheless, there are differences in the known risk factors for suicide between men and women, and this chapter summarizes the more relevant findings for the gender paradox. Apart from previous attempts, which still is the strongest predictor of death by suicide, with a higher rate in males than in females, we will emphasize in the role of male depression. It is commonly recognized that over 90% of people who die by suicide had a psychiatric diagnosis, mostly depression, and male depression seems to be a distinct clinical phenotype challenging to recognize, which might contribute to the gender paradox. Finally, in light of all the information reviewed, some recommendations on prevention of suicide from a gender perspective in the clinical setting will be made.

Purpose of Review: A better understanding of suicide phenomena is needed, and precision medicine is a promising approach toward this aim. In this manuscript, we review recent advances in the field, with particular focus on the role of digital health., Recent Findings: Technological advances such as smartphone-based ecological momentary assessment and passive collection of information from sensors provide a detailed description of suicidal behavior and thoughts. Further, we review more traditional approaches in the field of genetics. We first highlight the need for precision medicine in suicidology. Then, in light of recent and promising research, we examine the role of smartphone-based information collection using explicit (active) and implicit (passive) means to construct a digital phenotype, which should be integrated with genetic and epigenetic data to develop tailored therapeutic and preventive approaches for suicide.

This paper presents a novel method for predicting suicidal ideation from electronic health records (EHR) and ecological momentary assessment (EMA) data using deep sequential models. Both EHR longitudinal data and EMA question forms are defined by asynchronous, variable length, randomly sampled data sequences. In our method, we model each of them with a recurrent neural network, and both sequences are aligned by concatenating the hidden state of each of them using temporal marks. Furthermore, we incorporate attention schemes to improve performance in long sequences and time-independent pre-trained schemes to cope with very short sequences. Using a database of 1023 patients, our experimental results show that the addition of EMA records boosts the system recall to predict the suicidal ideation diagnosis from 48.13% obtained exclusively from EHR-based state-of-the-art methods to 67.78%. Additionally, our method provides interpretability through the t-distributed stochastic neighbor embedding (t-SNE) representation of the latent space. Furthermore, the most relevant input features are identified and interpreted medically.

Ecological momentary assessment is an excellent tool for the measurement of different day-to-day domains in patients and capturing real-world and real-time data. The purpose of this review is to evaluate feasibility in current ecological momentary assessment studies on emotional and behavioral functioning, functional impairments, and quality of life patients with an attention-deficit/hyperactivity disorder diagnosis. This systematic review follows the recommendation of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines selecting articles published from January 1, 1990, up to the latest access on May 2018, identifying a pool of 23 eligible studies. Twenty-three studies demonstrate the validity of ecological momentary assessment methodology in evaluating different aspects of patients with attention-deficit/hyperactivity disorder. Fifteen studies focus on the child's or adolescent's daily behavior, while eight studies only focus on adults. The studies presented in this review monitored patients and their families over a maximum period of 28 days. We can conclude that ecological momentary assessment can be successfully implemented with attention-deficit/hyperactivity disorder patients to evaluate diverse backgrounds. However, more studies are needed with a longer monitoring period, especially in adolescents, to determine the effectiveness of ecological momentary assessment on patients with attention-deficit/hyperactivity disorder.

Objectives:: Brain maturation differs depending on the area of the brain and sex. Girls show an earlier peak in maturation of the prefrontal cortex. Although differences between adult females and males with schizophrenia have been widely studied, there has been less research in girls and boys with psychosis. The purpose of this study was to examine differences in verbal and visual memory, verbal working memory, auditory attention, processing speed, and cognitive flexibility between boys and girls., Methods:: We compared a group of 80 boys and girls with first-episode psychosis to a group of controls., Results:: We found interactions between group and sex in verbal working memory (p = 0.04) and auditory attention (p = 0.01). The female controls showed better working memory (p = 0.01) and auditory attention (p = 0.001) than males. However, we did not find any sex differences in working memory (p = 0.91) or auditory attention (p = 0.93) in the psychosis group., Conclusions:: These results are consistent with the presence of sex-modulated cognitive profiles at first presentation of early-onset psychosis.