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Identifying patients at risk for a suicide attempt (SA) is critical in adolescents with mental disorders. The current study aimed to 1) examine whether personality dysfunction (PD) is associated with previous SA, 2) explore the incremental utility of PD over psychiatric disorders in modeling previous SA. The sample comprised of n = 498 adolescent patients (mean age = 15.41 years, 79.12 % females, inpatient 48.8 %, outpatient 51.2 %). SA in the past year, PD according to the alternative DSM-5 model for personality disorders, and psychiatric diagnoses were assessed using semi-structured interviews. Logistic regression and principal component analysis examining the associations and specific patterns of PD and SA in the past year were conducted. Hierarchical (stepwise) logistic regression was applied to investigate the incremental utility of PD over that of psychiatric diagnoses to identify individuals with SA in the past year. Including all facets of PD revealed a significant model with SA in the past year as outcome (χ 2 (12) = 106.65, McFaddens Pseudo- R 2 = 0.17, p < 0.01). Adding PD to the model explained a significant amount of variance in past SA over that of psychiatric diagnoses (Pseudo- R 2 = 0.18, Wald χ 2 = 43.05, p < 0.01). As we only studied past SA and due to the cross-sectional design, no conclusion regarding the prediction of future SA can be drawn. PD should routinely be assessed in adolescent patients since individuals with PD are more likely to have attempted suicide even when controlling for comorbid psychiatric disorders. PD may represent an important target for intervention in those with suicidal thoughts and behaviors. • Personality dysfunction and past suicide attempts in adolescent patients were studied. • Personality dysfunction predicted past suicide attempts above psychiatric diagnosis. • Impaired self-functioning was associated with higher odds for past suicide attempts. • In teens at risk for suicide attempts personality dysfunction should be assessed. • Future studies should address implications for the prevention of suicide attempts. [ABSTRACT FROM AUTHOR]

Childhood maltreatment (CM) is prevalent among patients with mood disorders and considered an important risk factor for suicide in the general population. Despite mood disorders being implicated in up to 60 % of completed suicides, the predictive role of CM on suicide attempt (SA) among early mood disorder patients remains poorly understood. We enrolled 480 participants diagnosed with early-onset major depressive disorder (MDD), bipolar I disorder (BD I), and bipolar II disorder (BD II). Over an average of 60 weeks, participants underwent follow-up assessments at 12-week intervals. Using multivariate logistic regression, we examined the association between CM and SA history at baseline. Further, the Cox proportional hazard model assessed the predictive role of childhood maltreatment in SA during follow-up. At baseline, 38 % of the total participants reported SA history, with a follow-up prevalence of 10 %. Childhood maltreatment was significantly associated with past SAs and was a robust predictor of future SA, adjusting for relevant clinical risk factors. Emotional abuse and sexual abuse related to SA history, and physical abuse increased future SA risk. Potential biases in reporting SA and childhood maltreatment, along with unexplored factors such as additional environmental and familial risks, may affect the study's findings. Childhood maltreatment emerged as a robust predictor of SA among early-onset mood disorder patients. Systematic evaluation of CM early in the clinical process may be crucial for effective risk management. Additionally, our findings highlight the importance of implementing proactive interventions for CM to prevent the onset of adverse psychological trajectories. • Childhood maltreatment is a key predictor of suicide attempts over 60 weeks of follow-up in early-onset mood disorders. • Childhood maltreatment remains a significant risk factor for suicide, even when accounting for relevant clinical risk factors. • Findings highlight the need for early detection and interventions to mitigate childhood maltreatment's impact on mood disorders. [ABSTRACT FROM AUTHOR]

A more in-depth understanding of the relationship between depressive symptoms, neurocognition and suicidal behavior could provide insights into the prognosis and treatment of major depressive disorder (MDD) and suicide. We conducted a network analysis among depressed patients examining associations between history of suicide attempt (HSA), core emotional major depression disorder, and key neurocognitive domains. Depressed patients (n = 120) aged 18–65 years were recruited from a larger randomized clinical trial conducted at the Douglas Institute in Montreal, Canada. They were randomly assigned to receive one of two antidepressant treatments (i.e., escitalopram or desvenlafaxine) for 8 weeks. Core emotional MDD and key neurocognitive domains were assessed pre-post treatment. At baseline, an association between history of suicide attempt (HSA) and phonemic verbal fluency (PVF) suggested that HSA patients reported lower levels of the latter. After 8 weeks of antidepressant treatment, HSA became conditionally independent from PVF. Similar results were found for both the HAM-D and the QIDS-SR core emotional MDD/neurocognitive networks. Network analysis revealed a pre-treatment relationship between a HSA and decreased phonemic VF among depressed patients, which was no longer present after 8 weeks of antidepressant treatment. • Core emotional MDD and key neurocognitive domains pre-post treatment associated with a history of suicide attempt. • Similar results for both the HAM-D and the QIDS-SR core emotional MDD/neurocognitive networks. • Network analysis revealed a pre-treatment relationship between a HSA and decreased phonemic VF among depressed patients. • Relationship between a HSA and decreased phonemic VF disappeared after 8 weeks of antidepressant treatment. [ABSTRACT FROM AUTHOR]

BackgroundMethodsResultsConclusionsSuicidality in individuals with intellectual disability is a critical but under-researched area. This systematic review aims to synthesize existing literature on the prevalence, risk factors, and interventions for suicidality among individuals with intellectual disability.Adhering to the PRISMA guidelines, a comprehensive review of databases was conducted for empirical studies on suicidality in intellectual disability. Data were extracted on sample characteristics, methodologies, and key findings.Nineteen studies met the inclusion criteria. Consistent risk factors, notably comorbid psychiatric disorders, emerged. Passive suicide methods predominated with a positive correlation between higher intellectual functioning and increased suicidal behaviors.The increased vulnerability to suicide in this population highlights the need for targeted interventions and comprehensive risk assessments. Much future research is required in the face of paucity of data with the priority on developing specific suicide prevention tools while addressing cultural stigmas to enhance support for this population. [ABSTRACT FROM AUTHOR]

Introduction Suicidal ideation and attempts are considered to be graduated risks for suicide, yet they remain under studied. Suicide is among the leading causes of death in the U.S. for all individuals between the ages of 10 and 64 years. Suicide is a critical problem in the U.S. Military. The U.S. Army suicide rates surpassed civilian rates in 2008 and continue to climb steadily; with U.S. Army soldiers at more than twice the risk than U.S. civilians, and enlisted personnel at more than twice the risk of officers. Suicidal ideation and attempts are routinely reported within U.S. Army brigades using suicide-related serious incident reports (SR-SIRs). These reports could form a useful source of information for prevention planning, but to date there have been no efforts to summary these reports. This paper analyzes SR-SIRs among enlisted personnel for a 4-year period for 1 Army brigade, to test the usefulness of this information and to explore whether risk factors for attempts compared to ideation can be identified. Materials and Methods This report analyzes 130 de-identified reports of suicidal ideation (n  = 102) and suicide attempts (n  = 28) reported as SR-SIRs from August 2018 to June 2022 among enlisted personnel in an airborne infantry brigade combat team (BCT) outside the continental U.S. Analysis of de-identified data was not considered research by brigade and university human subject/IRB authorities. Fourteen soldier characteristics and context factors were examined to determine if they differentiate the two types of incidents, suicidal ideations and suicide attempts. Results Unit location and alcohol use at the time of the incident were strongly associated with suicide attempts compared to ideation. Attempts occurred disproportionately during off duty hours, and attempters were more likely to have had prior contact with behavioral health services than ideators; however, these differences did not attain conventional statistical significance. Conclusions The study can help inform unit-specific suicide prevention and intervention strategies. Off duty hours and alcohol use are risk factors for attempts, particularly among soldiers who have sought behavioral health care. Plans to engage and support soldiers who have sought behavioral health care during off duty hours, and information regarding the risks of alcohol use, could meaningfully reduce their risk. This is the first known attempt to examine active duty U.S. Army brigade combat team SR-SIRs, and they are a potentially valuable source of health and mental health-related information. [ABSTRACT FROM AUTHOR]

This study assessed the direct and indirect effects (via depressive symptoms) of lifetime use of a broad range of substances on suicide risk among US adolescents. This was a cross-sectional study. Data from the 2021 Youth Risk Behavior Survey were used (N = 12,303, 48.7% female). Associations between five types of substance use (cigarette, e-cigarette, alcohol, marijuana, and prescription pain medicine) and three dimensions of suicide risk (suicidal ideation, suicide plan, and suicide attempt) were measured by multivariate logistic regression models. The role of depressive symptoms was further examined by structural equation modeling. Almost three in five (57.5%) adolescents had used one or more substances in their lifetime (18.1% one type, 12.2% two types, 13.1% three types, 10.2% four types, and 3.8% five types). Adolescents using five substances were up to 16 times more likely to experience suicidal ideation and behaviors. Depressive symptoms significantly linked the pathway from substance use to suicide risk, resulting in much stronger indirect effects than the direct effects. Collectively, the five substance use behaviors and depressive symptoms explained about 60.4% of variance in suicidal ideation, 53.6% of variance in suicide plan, and 55.0% of variance in suicide attempt. Lifetime use of multiple substances is significantly correlated with suicidal ideation and behaviors among adolescents via the pathway of depressive symptoms. Routine screening for a broad range of substance use behaviors is needed to identify adolescents at risk for suicide and accessible mental health services could potentially attenuate the linkage between substance use and suicide risk. [ABSTRACT FROM AUTHOR]

Cognitive impairment is recognized as a risk factor for suicide in schizophrenia (SZ) patients. Despite empathy being an important aspect of social cognition, the association between suicidal behavior and empathy has received little attention. We aimed to compare empathy and neurocognition in SZ patients with and without suicide attempts (SAs), and to explore the relationship between empathy, neurocognition, and clinical symptoms in SZ patients with and without SAs. Data on SAs and socio-demographic characteristics were collected from 628 chronic SZ patients. The patients' symptomatology was measured by the Positive and Negative Syndrome Scale (PANSS). Empathy and neurocognition were assessed with the Interpersonal Reactivity Index (IRI) and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), respectively. Patients with SAs performed better on all IRI domains (except for Perspective Taking) and total scores. Regression results showed that negative symptoms, positive symptoms, and duration of illness were independently associated with IRI total score in patients without SAs (adjusted R2 = 0.048). In patients without SAs, negative symptoms, general psychopathology, education, age, and sex were independently associated with RBANS total score (adjusted R2 = 0.265), while in patients with SAs, education, PANSS total score, and age at onset were independently associated with RBANS total score (adjusted R2 = 0.456). Our results show that SZ patients with SAs may have better empathic performance than patients without SAs. In chronic SZ patients, negative and positive symptoms may have different effects on cognition in the SAs and non-SAs groups. [ABSTRACT FROM AUTHOR]

Introduction: Young people living in gosiwons could be at high risk for suicide owing to inadequate living conditions and the social stigma towards them. However, this topic has not received adequate academic attention. Gosiwon is a type of small residence consisting of several tiny rooms densely packed together and usually does not meet minimum housing standards. However, gosiwons are favored by low-income groups, especially young people, because they are cheaper than other residences. This study aimed to examine the factors that increase the risk of suicidal ideation and attempt among young people living in gosiwons. Methods: A sample of 300 young people aged 19–34 years living in gosiwons for over 6 months was analyzed. A set of multinomial logistic regression was conducted to examine the factors that differentiate the suicidal ideation and attempt group from the no-suicidal risk group. Results: Approximately 30% of the study participants experienced suicidal ideation or attempted suicide. Among several risk factors, social exclusion and depressive symptoms distinguished the group with suicidal ideation from the no-risk group. Depressive symptoms were the only factor that differentiated the group with suicide attempts history from the no-risk group. Conclusion: The results emphasize the need to focus on social exclusion and depressive symptoms among young people living in poor housing conditions. Interventions to address social exclusion and depressive symptoms may help prevent suicide risk among young people exposed to housing exclusion. [ABSTRACT FROM AUTHOR]

Introduction: Suicide risk assessment based on self-report questionnaires is considered as problematic because risk states are dynamic and at-risk individuals may conceal suicidal intentions for several reasons. Therefore, recent research efforts increasingly focus on implicit risk markers such as the suicide attentional bias (SAB) measured with the Suicide Stroop Task (SST). However, most SST studies failed to demonstrate a SAB in individuals with suicide risk and repeatedly demonstrated insufficient psychometrics of the SST. This study aimed to investigate a SAB using a modified SST (M-SST) and to test its psychometric properties. Method: We compared n = 61 healthy controls and a high-risk inpatient sample of n = 40 suicide ideators and n = 40 suicide attempters regarding interference scores of positive, negative and suicide-related words. Interference scores were calculated by subtracting the mean reaction time (mean RT) of the neutral words from the mean RT of the suicide-related words (mean RT Suicide-mean RT Neutral), resulting in a suicide-specific interference score. Similarly, interference scores were calculated for the positive and negative words by subtracting the mean RT of neutral words from the mean RT of positive and negative words. Results: A Group x Interference ANOVA showed a significant interaction effect (p <.001, ηp2 = .09), indicating that group effects significantly vary across interference type. Post hoc comparisons revealed that both ideators and attempters demonstrated greater interferences only for suicide-related words compared to healthy controls, indicating a SAB in patients, while a difference between ideators and attempters was lacking. The suicide interference score classified with an AUC = 0.73, 95% CI [0.65 - 0.82], p <.001, between controls and patients with STBs. The M-SST demonstrated good internal consistency and convergent validity. Discussion: The study adds evidence to the assumptions of the Cognitive Model of Suicide, viewing a SAB as a cognitive marker of suicide vulnerability independently of the engagement in suicidal behavior. The results' clinical implications are discussed in the context of recommended intervention strategies during an acute suicidal state. Future studies with the M-SST should include non-suicidal patient controls to investigate whether a SAB is uniquely related to suicidality. [ABSTRACT FROM AUTHOR]

AbstractBackground: The linkage between substance use and youth suicidality is less developed due to the predominant focus on certain types of substances (e.g., alcohol consumption, prescription opioid misuse). This study examines polysubstance use and its mutual impact on suicidal thoughts and behaviors among US adolescents. Methods: Data from 2019 Youth Risk Behavior Survey were utilized. Associations between the concurrent use of five substances (cigarette, e-cigarette, alcohol, marijuana, and prescription opioid) and suicidality (suicidal thoughts, suicide plans, and suicide attempts) were measured by logistic regression models. The combined effect of polysubstance use on suicidality was further assessed by structural equation modeling. Results: About two in five (42.1%) adolescents used at least one type of substances in the past month and one in seven (13.5%) used three or more types concurrently (polysubstance use). Adolescents with polysubstance use behaviors were three to five times more likely to experience suicidal thoughts (OR=3.8, p < 0.05), make a suicide plan (OR=3.5, p < 0.05), or attempt suicide (OR=4.6, p < 0.05) than non-users. In the final structural model, polysubstance use and suicidality were significantly correlated with each other (β=0.37, p < 0.05). Collectively, polysubstance use explained about 14% of variance in youth suicidality. Conclusions: Polysubstance use shows a significant impact on youth suicidality. School-based health centers and educational programs are recommended to reduce substance use and suicidal behaviors among adolescents. Accessible mental health services and targeted treatments are needed for polysubstance users to mitigate their risk of suicide. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to evaluate the applications to the Emergency Departments in …. province between 2019 and 2023 due to suicide attempts and to provide guidance for social preventive programs. Material and Method: This cross-sectional study was conducted with the approval of the …. University Non-Interventional Research Ethics Committee, dated 21 September 2023 and numbered 176-176- 09. The study examined The archive of the …. Provincial Health Directorate was consulted to obtain records of cases of suicide attempts among individuals aged 13 years and over between the years 2019-2023. These records were examined between 1 November-31 December 2023. Results: A total of 947 patients participated in the study, 635 of whom were women. The majority of suicide attempts (43.2%) occurred between the ages of 13 and 24 years. The highest number of suicide attempts occurred between 18:00 and 23:59 (40.5%) and in summer (29.8%). The highest number of suicide attempts occurred in August (10.5%). The majority of those who attempted suicide were primary school graduates (47.0%) and unemployed (39.4%). The suicide attempt rate of farmers (42.9%) was significantly higher than other occupational groups (p=0.009). Family problems (31.3%) were the most common reason for suicide attempt. The most common method of suicide attempt was drug-toxic substance use (92.6%). Among the study participants, 21.1% had attempted suicide previously. Among those who attempted suicide, 24.2% had a previous psychiatric diagnosis. Medication (activated charcoal) was administered to 60.4% of the suicide attempters while psychiatric consultation was requested for 11.5%. A total of 69.5% of the suicide attempts resulted in a single interview. Conclusion: Most of the suicide attempters were adolescent and young age group, female, illiterate, primary school graduate and unemployed. According to our study, the most common causes and methods of suicide attempts were familial problems and drug-toxic substance use. It is recommended that regulations should be implemented to ensure psychiatric consultation for all suicide attempters and that the follow-up and treatment of suicide attempters should be carried out by a team consisting of family physicians, psychiatrists, psychologists and social workers. [ABSTRACT FROM AUTHOR]

Adolescence is a critical period for early identification and intervention of borderline personality disorder (BPD). Risk-taking and self-harm behaviors (RSB) have been identified as promising early markers of BPD and correlates of depression in school-based samples. The present study aimed, first, to examine the association between RSB and BPD in a clinical sample of adolescents and, second, to examine whether RSB are also linked to depression. N = 405 participants (82.7% female) were recruited from an outpatient clinic for adolescents with RSB. RSB assessed included truancy, excessive media use, alcohol, tobacco, and illicit drug use, sexual risk-taking, and self-harm behavior. Regression analyses and generalized linear models were performed to examine the associations between individual RSB or patterns of RSB (identified using latent class analysis, LCA) and a diagnosis and severity of BPD or depression. All RSB (except excessive media use) were positively associated with BPD diagnosis and severity. In contrast, only non-suicidal self-injury (NSSI) and suicide attempts were positively associated with depression diagnosis and severity, while illicit drug use was negatively associated with depression severity. The LCA yielded two classes differing in the occurrence of RSB. The high RSB class was more likely to have a BPD diagnosis and greater BPD severity than the low RSB class. Classes did not differ regarding depression diagnosis or severity. As NSSI and suicide attempts were associated with both BPD and depression, the presence of additional RSB, besides self-harm behavior, may represent a specific risk marker for BPD in adolescents. [ABSTRACT FROM AUTHOR]

Behavioral warning signs (WS) are near-term changes within individuals, which aid in determining imminent risk for suicide attempts. However, those who attempt suicide differ in their engagement of WS, and it is unclear if these differences relate to future risk of suicidal behavior. Using a sample of 132 adults presenting to a hospital following a suicide attempt, the current study sought to determine if differences in engagement in WS for the index attempt prospectively predicted suicide attempt, frequency of ideation, and intensity of suicide ideation 12 months post discharge. Latent class analyses (LCAs) conducted on 6 behaviors (i.e., alcohol use, nightmares, interpersonal negative life events, suicide communication, risky behavior, low sleep, and high sleep) found a 5-class solution optimally fit the data. One identified class, characterized by engagement in risky behaviors the hours before an attempt differed from other identified classes in terms of risk for future suicidal ideation and behaviors. More specifically, participants in "High Risky Behavior" class had higher rates of 12-month suicide reattempt, significantly more frequent suicide ideation, and significantly worse intensity of suicide ideation during the 12 months following their index attempt compared to participants endorsing typical patterns of WS. These results held when adjusting for various traditional baseline covariates (e.g., depressive symptoms). The current study demonstrates that patterns of behavioral WS may be utilized as their own prognostic indicator of future suicidal ideation and behaviors among high-risk individuals reporting a recent suicide attempt, which can inform post-discharge clinical intervention and prevention efforts. • There are distinguishable profiles of behavioral warning signs for suicide attempt. • Profiles of warning signs for an index attempt can predict risk for reattempt. • High Risky Behavior Class predicted future worst suicidal ideation and reattempt. [ABSTRACT FROM AUTHOR]

Suicide is considered one of the major public health problems worldwide, being the second leading cause of death in the 15–29 age group. It is estimated that every 40s someone in the world commits suicide. The social taboo surrounding this phenomenon as well as the fact that suicide prevention measures currently fail to avoid deaths from this cause, means that more research is needed to understand its mechanisms. The present narrative review on suicide tries to point out several important aspects, such as risk factors or the dynamics of suicide, as well as the current findings in the field of physiology that could offer advances in the understanding of suicide. Subjective measures of risk such as scales and questionnaires are not effective alone, whereas the objective measures can be addressed from physiology. Thus, an increased neuroinflammation in people who take their own lives has been found, with an increase in inflammatory markers such as interleukin-6 and other cytokines in plasma or cerebrospinal fluid. Also, the hyperactivity of the hypothalamic–pituitary–adrenal axis and a decrease in serotonin or in vitamin D levels seems to also be involved. In conclusion, this review could help to understand which factors can trigger an increased risk of dying by suicide, as well as pointing out those alterations that occur in the body when someone attempt to commit suicide or succeeds in taking their own life. There is a need for more multidisciplinary approaches that address suicide to help to raise awareness of the relevance of this problem that causes the death of thousands of people every year. [ABSTRACT FROM AUTHOR]

Summary: Glucagon‐like‐peptide 1 receptor agonists (GLP‐1RA) have transformed type 2 diabetes (T2D) and obesity management. Multiple regulatory agencies are investigating reported associations between GLP1‐RA and increased suicide attempts (SA), but observational data may be prone to confounding. Randomised control trials (RCT) of GLP‐1RA were largely undertaken in people at lower risk of SA. Real‐world data suggest semaglutide use associates with reduced suicidal ideation and depression but was under‐powered to statistically assess risk of SA. Mendelian randomisation (MR) leverages genetic instrument(s) to infer potential causal association between an exposure and an outcome. We undertook MR using missense variants in the gene encoding GLP1R that improve glycemia, lower T2D risk and/or lower BMI, to investigate potential causal association between GLP‐1RA and SA. In people of European ancestry, MR did not find evidence genetically proxied GLP1RA increased SA in a general population cohort: (rs10305492, exposure: HbA1c, odds ratio [OR] and 95% confidence interval [CI]: 1.38, 0.41–4.62, p =.60), (rs10305492, exposure: FG, OR 1.27, 0.52–3.13, p =.60) and (rs1042044, exposure BMI, OR 0.30, 0.06–1.48) with concordant results in a multi‐ancestry SA case–control cohort. In conclusion, we did not find MR evidence that increased GLP‐1RA impacts SA. This awaits confirmation with RCT and real‐world data. [ABSTRACT FROM AUTHOR]

To examine recent 12-year trends in prevalence of suicidal ideation and behaviors (SIBs) among US adults experiencing a past-year treatment-resistant depression (TRD). Using data from the National Survey of Drug Use and Health, we estimated the annual percentage of individuals aged ≥18 with TRD who reported past-year SIBs, and estimated linear trends adjusting for potentially confounding factors from 2009 to 2020. Of estimated 237.5 million US adults, 7.1 % met diagnostic criteria for a past-year major depressive episode (MDE) between 2009 and 2020. Of these, 9.7 % met criteria for TRD. The proportion reporting past-year suicidal ideation in TRD ranged from 39.5 % (95 % confidence interval [CI], 32.1–47.3 %) in 2009–2010 to 43.4 % (95 % CI, 36.7–503 %) in 2019–2020, with an average annual percent change (AAPC) of 1.3 % (95 % CI, −0.7 % to 3.3 %). The prevalence of past-year suicide attempts in TRD was 7.3 % across the study period (AAPC, 0.1 %; 95 % CI, −4.3 % to 4.7 %). Past-year SIBs were significantly associated with an increased likelihood of meeting criteria for TRD among adults with MDE (adjusted odds ratio [AOR], 1.53; 95 % CI, 1.35–1.75 for suicidal ideation; AOR, 2.17; 95 % CI, 1.79–2.62 for suicide attempts). No significant differences were observed between 2019 and 2020, reflecting the COVID-19 pandemic. Among individuals with TRD, proportions of SIBs are high. These findings underscore an urgent need for suicide prevention efforts in this high-risk population, including preventive services across diverse settings and accessibility to evidence-based pharmacological and non-pharmacological interventions. • This study examined recent 12-year trends in prevalence of suicidal ideation and behaviors (SIBs) among US adults experiencing a past-year treatment-resistant depression (TRD) from 2009 to 2020. • One in 10 US adults with TRD reported having past-year suicidal ideation. • About 7.3 % of US adults with TRD reported having a past-year suicide attempt. • Among individuals with TRD, proportions of SIBs are high. • These findings underscore an urgent need for suicide prevention efforts in this high-risk population. [ABSTRACT FROM AUTHOR]

The Psychological-Physical-Pain Visual Analogue Scale (PPP-VAS) was thought to probably help in identifying patients at risk of suicide. However, no data on its validity to measure psychological pain was available. Our main aim was to investigate the convergent validity of the PPP-VAS using two well-validated scales of psychological pain, the Orbach and Mikulincer Mental Pain scale (OMMP) and the Holden et al. Psychache Scale. This multicentre study recruited a total of 1618 adult psychiatric inpatients and outpatients in Italy. Psychological pain was evaluated using the OMMP, Holden et al., and PPP-VAS scales. Psychiatric status, suicidal status, physical pain, depression, and hopelessness were also assessed. A structural equation model (SEM) using the items of psychological pain from the PPP-VAS showed that items loaded significantly on the psychological pain factor and showed good fit. Similarly, a second SEM model using the three scales of psychological pain showed acceptable fit and converged into a psychological pain construct. Correlations between the PPP-VAS and depression, hopelessness, and physical pain showed moderate correlations (r = 0.43 to r = 0.67). Finally, psychological pain evaluated with the PPP-VAS was significantly related with recent suicidal ideation in all patients (OR [95 % CI] = 1.07 [1.05, 1.09]) and recent suicide attempts in moderately to severely depressed patients, OR [95 % CI] = 1.01 [1.02, 1.03]. The PPP-VAS showed good psychometric properties in evaluating psychological pain. The characteristics of the PPP-VAS makes this scale a great option for its use in clinical practice to detect patients at risk of suicide. • Validity of psychological and physical pain visual analogue scale (PPP-VAS) was investigated. • PPP-VAS showed convergent validity with the Orbach and the Holden psychological pain scales. • PPP-VAS showed discriminant validity with depression, hopelessness and physical pain. • PPP-VAS was related with recent suicidal ideation and suicide attempt. • PPP-VAS is an easy to use scale useful to evaluate suicidal risk in clinical settings. [ABSTRACT FROM AUTHOR]

Suicide is a major public health concern, and anxiety is a prevalent developmental challenge in adolescents closely linked to suicidal behavior. This study aimed to assess the association between anxiety in adolescents and subsequent risk of suicidal behavior through a meta-analysis, offering crucial insights for suicide prevention. Six bibliographic databases were comprehensively searched to clarify the association between adolescents anxiety and subsequent risk of suicidal behavior. We used a fixed-effects model to determine the total pooled effect size estimate and reported odds ratios and the corresponding 95 % confidence intervals. Subgroup analysis, sensitivity analysis and publication bias analysis were conducted with Stata version 15.1. The findings revealed a significant association between anxiety in adolescents and subsequent suicidal behavior (OR = 2.33, 95 % CI [2.00, 2.71]). Subgroup analyses indicated differences in mean effect size estimates based on clinical diagnoses and self-reported measures used to assess anxiety. The correlation strength between adolescent anxiety and subsequent suicidal behavior increased with a longer follow-up period. Furthermore, adolescents anxiety was associated with increased risk of subsequent suicidal ideation (OR = 1.97, 95 % CI [1.72, 2.25]) and attempts (OR = 3.56, 95 % CI [2.49, 5.07]). Finally, boys (OR = 2.41, 95 % CI [1.67, 3.47]) with anxiety had a greater risk of subsequent suicidal behavior than girls (OR = 2.02, 95 % CI [1.47, 2.78]). This study revealed that adolescents anxiety increases the risk of suicidal behavior, including suicidal ideation and attempts. Consequently, there is a critical need for timely interventions tailored to adolescents with anxiety to prevent future instances of suicide. • Anxiety in adolescents can increase the risk of subsequent suicide behavior. • Anxiety teens face an elevated risk of subsequent suicide with longer follow-up. • The study provides important insights into reducing suicide rates in the population. [ABSTRACT FROM AUTHOR]

Introduction: Resting heart rate has been distinctly related to both internalizing (high pulse) and externalizing (low pulse) disorders. We aimed to explore the associations between resting heart rate and suicidal behavior (nonfatal suicide attempt [SA] and suicide death [SD]) and evaluate if such associations exist beyond the effects of internalizing/externalizing symptomatology. Method: We used Cox proportional hazards models to evaluate the associations between resting heart rate (age 19) and later SA/SD in 357,290 Swedish men. Models were controlled for internalizing disorders, externalizing disorders, and resilience (the ability to deal with adversity). Co‐relative analysis (comparing pairs of different genetic relatedness) was used to control for unmeasured family confounders and improve causal inference. Results: In baseline models, low resting heart rate was associated with SA (HR = 0.96; 95% CI: 0.95,0.98) and high resting heart rate with SD (HR = 1.04; 95% CI: 1.002,1.07). The association with SA remained after adjustment for all confounders (HR = 0.98). However, the association with SD did not persist after controlling for covariates. Co‐relative analysis did not support causal associations. Conclusions: Our findings raise interesting etiological questions for the understanding of suicidal behaviors but do not support the usefulness of resting heart rate in suicide prediction. [ABSTRACT FROM AUTHOR]

Background and Aims: Suicide attempts are a fundamental problem in health care systems and are known for their complex and multifaceted nature. This study aimed to explore the reasons for suicide attempts and to identify associated factors in western Iran. Methods: In Asadabad, western Iran, a cross‐sectional study was carried out between April 2020 and March 2021. A nonrandom sampling method was used to select 110 participants, ages 15–35. Structured questionnaires such as the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI‐II), and the Suicide Motivation Scale (IMSA) were used to gather the data. Multiple linear regression, one‐way analysis of variance, Pearson's correlation coefficient, and independent t tests were all used in the data analysis. Results: The majority of participants (59.1%) were female, with a mean age of 25.78 years. The most common reason for suicide attempts (43.6%) was family issues, and the most popular means (66.4%) were pills and medication. Eighty‐nine percent of participants had symptoms of depression. The mean scores were calculated for motivation for suicide attempts (32.46 ± 16.11), depression (34.60 ± 20.50), and anxiety (34.14 ± 15.69). The analysis showed that the motivation for suicide attempts and anxiety was greater in single persons than in married and divorced persons (p < 0.05). Motivation for suicide attempts was also greater in low‐ to middle‐income individuals with a history of divorce (p < 0.05). The multiple regression model showed that anxiety, sex, education, and medical history significantly influenced the motivation for suicide attempts (p < 0.001). Conclusion: The results showed that a wide range of social, economic, and cultural factors and psychiatric disorders, including anxiety and depression, are involved in suicide attempts. This study aimed to design interventions and strategies to prioritize mental health, improve life skills to control stressful events, and focus on high‐risk groups (women, married people, people with low education levels, and those with a history of physical and mental illnesses) for suicide prevention in health promotion programs. [ABSTRACT FROM AUTHOR]

Aim Design Methods Results Conclusion Implications for the Profession and/or Patient Care Reporting Method Patient or Public Contribution To assess the proportions and associated factors of different post‐discharge referrals among adolescents treated in the emergency department after a suicide attempt.Observational, cross‐sectional retrospective study.We conducted a study using the medical records of 140 adolescents treated for a suicide attempt between January 2015 and May 2023 in a Brazilian emergency department, focusing on post‐discharge referrals, defined as discharge without referral, unaddressed referral and referral addressed to the network. Associations between the outcomes and other variables were analysed using a Poisson regression model.Discharges without referrals prevailed, followed by addressed and unaddressed referrals. Regression models showed associations between post‐discharge and age, prior continuous use of psychotropic medications, location of care, continued suicidal ideation at discharge and evaluation by a multi‐professional team.A high number of adolescents were discharged from emergency departments without co‐ordination with the mental health network, and the involvement of the multi‐professional team was positively associated with addressed referrals.This study informs healthcare professionals by raising awareness of their practices in discharging adolescents after suicide attempts in emergency departments, with the possibility of improving care quality and reducing the likelihood of readmission.STrengthening the Reporting of OBservational studies in Epidemiology (STROBE).No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Child maltreatment is associated with a higher probability of mental disorders and suicidal behavior in adolescence. Therefore, accurate psychometric instruments are essential to assess this. Objective: To validate the Spanish version of the Childhood Trauma Questionnaire-Short Form (CTQ-SF) in adolescents with suicide attempts. Methods: Multisite cohort study of 208 adolescents with suicide attempts using data from the following scales: Mini International Neuropsychiatric Interview (MINI), Columbia Suicide Severity Rating Scale (C-SSRS), Patient Health Questionnaire (PHQ-9), and CTQ-SF. Statistical analysis: CTQ-SF scores analyzed by descriptive statistics. Internal consistency: McDonald's omega and Cronbach's alpha. Concurrent validity with PHQ-9 and C-SSRS scores: Spearman correlation coefficient. Structural validity: Confirmatory factor analysis. Results: Floor and ceiling effects: Physical abuse and neglect as well as sexual abuse demonstrated high floor effects (50.0, 35.1, and 61.1% of adolescents, respectively). No ceiling effects were found. The CTQ-SF had excellent internal consistency (McDonald's omega = 0.94), as did the majority of its subscales (Cronbach's alpha 0.925-0.831) except for physical neglect (0.624). Its concurrent validity was modest, and the emotional neglect subscale had the lowest Spearman correlation coefficients (0.067-0.244). Confirmatory factor analysis: Compared with alternative factor structures, the original CTQ-SF model (correlated 5-factor) exhibited a better fit [S-B χ² = 676.653, p < 0; RMSEA (90% CI = 0.076-0.097) = 0.087; SRMR = 0.078; CFI = 0.980; TLI = 0.978]. Conclusion: The Spanish CTQ-SF is a reliable, valid instrument for assessing traumatic experiences in adolescents at high risk of suicide. It appears appropriate for use in routine clinical practice to monitor maltreatment in this group. [ABSTRACT FROM AUTHOR]

This study sought to establish if models involving the specific combinations of identifiable behavioral warning signs (WS; i.e., alcohol use, suicidal communications, preparation of personal affairs, experiencing negative interpersonal life events) for a suicide attempt outperformed a simpler count model of WS to distinguish an acute risk period (the six hours prior to a suicide attempt) from a control period (a matched six-hour period the day prior). Generalized linear mixed models tested all logical combinations of four behavioral WS in addition to a count variable of the number of behavioral warning signs. For the count variable, receiver operating characteristic curve analysis was utilized to determine the optimal cut point for the number of endorsed WS. Area under the curve (AUC) compared classification across all models, with the count model demonstrating similar classification performance to the best multivariate model (AUCs of 0.72 and 0.73, respectively), with an optimal cut point of endorsing one or more WS. Although determinations of acute risk should be informed by multiple sources of information, this study suggests a relatively simple count-based approach that considers the presence of one (or more) behavioral WS may be used as a potential indication of increased acute risk for suicide attempt. [ABSTRACT FROM AUTHOR]

Background: Suicide attempts have increased in the young population, becoming a public health problem with individual, family, and social implications. The objective of the present study was to explore the relationship between cultural variables and family functioning in young people with and without a history of suicide attempts in Ecuador. Methods: It was a cross-sectional analytical study of cases and controls. Measurement involved the following instruments: International Neuropsychiatric Interview for adolescents and adults, Pierce Suicidal Intention Scale, Battery of Multidimensional Cultural Variables Questionnaires, FACE III, and FF-SIL. All scales were culturally adapted and validated to the Ecuadorian context. A U-Mann Whitney comparison established differences between the two groups, as well as a Spearman-Rho correlation coefficient. Results: Significant differences resulted in the "cultural independence" variable between cases and controls (p> 0,05). Concerning family functioning, young people who attempted suicide belong to dysfunctional families. Discussion: Cultural patterns influence suicide attempts in young people and family functioning characterized by difficulties in adaptation and poor cohesion remain serious risk factors. [ABSTRACT FROM AUTHOR]

A history of attempted suicide is the most significant predictor of suicidal death. Several brief interventions aimed at tertiary suicide prevention have been investigated in clinical trials. However, suicide attempt survivors' experiences of such interventions have rarely been reported. To explore how suicide attempt survivors perceive the impact of the Attempted Suicide Short Intervention Program (ASSIP). We interviewed 14 Finnish adults who had received ASSIP as an adjunct to treatment as usual. Semi-structured interviews took place 4–10 weeks after the last ASSIP session. A conventional content analysis of the interview data is presented. Three core categories depicting ASSIP's perceived impact were identified. The core category life-affirming change comprised subcategories of feeling better, thinking differently, acting differently, and having new resources. The core category collateral effects comprised difficult feelings and cognitive overload. The core category incompleteness of change comprised lack of desired change, gains as incomplete, need for sustenance, and unrealized potential. Clients perceived ASSIP as effectively facilitating life-affirming change but agreed that further support was necessary to retain and build on these gains. Identified needs for improvement included more predictable post-ASSIP service paths and more support for involving affected loved ones. [ABSTRACT FROM AUTHOR]

The Attempted Suicude Short Intervention Program (ASSIP) provides an effective and cost-effective treatment option for people who have attempted suicide. Studies suggest that longer treatment latency is associated with poorer response to therapy, more severe symptomatology, and more suicide attempts This study examined the influence of treatment latency (time between suicide attempt and initiation of therapy) on the number of suicide attempts over the long-term course of ASSIP and the influence of treatment relationship on the extent of suicidal ideation. Survival and regression analyses were performed on 60 participants who had recently attempted suicide and received ASSIP at an outpatient psychiatric clinic. 60% were women and 40% were men. The results found no significant association between treatment outcome in ASSIP and treatment latency (HR = 1.06; 95% CI: 0.92- 1.21, p =.44). Treatment relationship significantly influenced suicidal ideation at time t4 (B = −.35, t(55) = −3.21, p =.002), but treatment latency was not significantly associated with suicidal ideation (B =.02, t(55) = 0.87, p =.39). No relationship between treatment latency and treatment outcome could be found, suggesting that ASSIP can be implemented at any time after the last suicide attempt. In contrast, the treatment relationship plays a central role in ASSIP. [ABSTRACT FROM AUTHOR]

An estimated 41,000 lives are lost to suicide each year in World Health Organization Eastern Mediterranean Region Office (WHO EMRO) countries. The objective of this study was to conduct a situation analysis for suicide and self-harm in the WHO EMRO region. Data on suicide were obtained from the WHO Global Health Estimates for the years 2000–2019. Information on risk groups efforts to prevent self-harm and suicide in the EMRO region were retrieved through scientific studies, grey literature, and public websites. During 2000–2019, the age-standardized suicide rate was 6.7 per 100,000 inhabitants, albeit there are concerns regarding data quality. Self-harm and suicide remain criminal acts in more than half of the countries. Few countries have a national plan for prevention of suicide. Toxic agents, such as pesticides and black henna, are easily available and frequently used for suicide in some areas, as are firearms and self-immolation. Successful prevention measures include means restriction and psychosocial interventions after self-harm. Many WHO EMRO countries remain underserved in terms of mental health care. Decriminalization of suicide and means restriction might be further promoted. Online-based tools for mental health literacy and psychosocial therapy are other options to explore. Suicidal behavior remains a criminal act in more than half of the WHO EMRO countries. Easily available toxic agents, such as pesticides and black henna, and firearms are common methods used for suicidal behavior in the WHO EMRO countries. Access to mental health care is limited in many of the WHO EMRO countries. Online-based psychoeducation and psychosocial intervention programs might be further explored as preventive efforts. [ABSTRACT FROM AUTHOR]

Suicide is one of the leading causes of death worldwide (WHO, 2021). Depression is a common precursor to suicide and suicidality; however, individuals' experience of depression and the meaning of suicide differs depending on one's cultural background (Colucci, 2013 ; Goodmann et al., 2021; Kleinman, 2004). The current study explores the relationship between suicide and depression among six broad cultural groups in a large sample (N = 17,015) of adults representing six broad cultural groups (Latin America, South Asia, former Soviet Bloc, Western English-speakers, Chinese, and Arab World). Participants were recruited to a multilingual depression and suicide screening study via Google Ads (Leykin et al., 2012; Gross et al., 2014). As expected, the presence of depression was associated with suicide attempts. However, cultural group moderated this association, with Chinese participants being most likely to report suicide attempts while screening negative for depression. Although depression remains an important predictor of suicidality, it appears that certain cultural groups may be at higher risk even when depression is not present. Clinicians should consider using culturally adapted assessments for depression and suicidality. • 17,015 individuals completed an online screener of depression and suicidality. • Participants represented six broad cultural groups. • Chinese group was far more likely to attempt suicide with negative depression screen. • Cultural differences remained when controlling for common predictors of suicidality. [ABSTRACT FROM AUTHOR]

History of suicide attempt (SA) is the strongest predictor of a new SA and suicide. It is primordial to identify additional risk factors of suicide re-attempt. The aim of this study was to identify risk factors of suicide re-attempt in patients with recent SA followed for 2 years. In this multicentric cohort of adult inpatients, the median of the index SA before inclusion was 10 days. Clinicians assessed a large panel of psychological dimensions using validated tools. Occurrence of a new SA or death by suicide during the follow-up was recorded. A cluster analysis was used to identify the dimensions that best characterized the population and a variable "number of personality traits" was created that included the three most representative traits: anxiety, anger, and anxious lability. Risk factors of re-attempt were assessed with adjusted Cox regression models. Among the 379 patients included, 100 (26.4 %) re-attempted suicide and 6 (1.6 %) died by suicide. The two major risk factors of suicide re-attempt were no history of violent SA and presenting two or three personality traits among trait anxiety, anger and anxious lability. It was impossible to know if treatment change during follow-up occur before or after the re-attempt. One of the most important predictors of re-attempt in suicide attempters with mood disorders, was the presence of three personality traits (anger, anxiety, and anxious lability). Clinicians should provide close monitoring to patients presenting these traits and proposed treatments specifically targeting these dimensions, especially anxiety. • Main personality traits of suicidal patients: anxiety, anger, and anxious lability. • There is an additive effect of these personality traits on risk of re-attempt. • Trait anxiety and anxious lability should be specifically targeted in these patients. • History of deliberate self-poisoning is a major risk factor of re-attempt. • Restrict access to all medications with weekly fractioned delivery should be done. [ABSTRACT FROM AUTHOR]

Background: Considering the limited information on suicide determinants, especially in low- and middle-income countries, the establishment and promotion of a suicide registration system are among the prominent strategies for suicide prevention programs around the world. The multicenter suicide registry is designed to collect standardized data from the two provinces of Iran according to the latest World Health Organization (WHO) guidelines. Methods: The Suicidal Behavior Registration Program is a multicenter study designed in five stages, including literature review, infrastructure establishment, database design, training, data analysis, and examining opportunities and challenges. The research samples cases of suicide attempts and self-harm from hospitals in the provinces of Tehran and Ilam. Results: The multicenter suicide registration program was carried out for 8 months in the two provinces of Tehran and Ilam. During the study period, data of 1382 people were registered, of which 7 cases in Ilam resulted in death. The study uncovered significant differences in socio-demographic, psychological status, and suicide characteristics in the two provinces. Conclusion: The design and implementation of the suicide registration program help researchers and policymakers make more innovative and effective interventions to prevent suicide by creating a comprehensive database of suicidal behavior determinants. [ABSTRACT FROM AUTHOR]

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Introduction People living with HIV are at increased risk of suicidal behaviors. It is critical to assess risk factors in resource-poor settings. Our study aimed to quantitatively assess the prevalence, pattern, and risk factors for suicidal behaviors among HIV-positive adults. Material and methods Facility-based cross-sectional study among 412 HIV-positive adults over nine months was conducted. Data on participants’ characteristics, prevalence and pattern of suicidal idea­tion, plan and attempt, and risk factors for suicidal behaviors using structured interviews with closed-ended questionnaires were obtained. Crude and specific prevalence, 95% confidence intervals of suicidal behaviors, and risk factors were computed. Subsequently, we conducted bivariate analyses and binary logistic analysis to assess relevant associations, with statistical significance at 5%. Results About two out of every three (68.4%) participants were women. The crude prevalence of suicide behaviors was 7.3%, 6.1%, and 5.8% for suicide ideation, suicide planning, and suicide attempt, respectively. Several risk factors for suicide behaviors were common, such as perception of suicide as a crime (59.7%), lack of access to healthcare (44.7%), social isolation (34.7%), anxiety (32.8%), psychological distress (32.3%), separation or divorce (29.4%), widowhood (23.3%), intimate partner violence (15.5%), and co-existing major medical conditions (14.8). Suicidal behaviors were associated (p < 0.05) with an­xiety, alcohol consumption, co-existing major medical conditions, rape, and lack of access to healthcare. Conclusions Suicidal behaviors and their risk factors are common among people living with HIV. It is critical to prioritize screening for suicide behaviors and their risk factors in HIV care.