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Objective: West Virginia's (WV) suicide rate is 50% higher than the national average and is the highest in the Appalachian Region. Appalachia has several social factors that have contributed to greater socioeconomic deprivation, a known contributor of suicide. Given WV's high prevalence of suicide and poverty, the current study aims to examine the relationship between socioeconomic deprivation and suicide rates in WV., Methods: The Townsend Deprivation Index (TDI), Social Deprivation Index (SDI), and Social Vulnerability Index (SVI) measured socioeconomic deprivation. Negative binomial regression models assessed the relationship between socioeconomic deprivation scores, individual index items, and suicide rates. Model comparisons evaluated the indices' ability to assess suicide rates. A backward selection strategy identified additional key items for examining suicide rates., Results: There was a significant increase in suicide rates for every 10% increase in TDI (β = 0.04; p < 0.01), SDI (β = 0.03; p = 0.04), and SVI scores (β = 0.05; p < 0.01). Household overcrowding and unemployment had a positive linear relationship with suicide in TDI (β = 0.04, p = 0.02; β = 0.07, p = 0.01), SDI (β = 0.10, p = 0.02; β = 0.01, p<0.01), and the SVI (β = 0.10, p = 0.02; β = 0.03, p<0.01). The backwards selection strategy identified additional key items included by the SVI when assessing suicide., Conclusion: Greater socioeconomic deprivation, measured by the TDI, SDI, and SVI, was significantly associated with higher suicide rates. Expanding unemployment benefits and increasing the availability of affordable housing, especially in rural areas, may be useful in reducing suicide rates. Our results suggest racial and ethnic minorities and adults living with a disability may benefit from targeted suicide prevention strategies., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Caswell et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Depression and suicide attempts are reported to be high among medical students. It has also been reported that depression, suicide attempts, and autistic traits may be significantly related. The aim of this study was to determine the suicide probability and autistic traits of medical students with and without depression symptoms, and to examine the relationship between depression symptoms, suicide probability, and autistic traits together in these students. This cross-sectional study was conducted among 313 medical students, 206 female, and 107 male, who, according to the sociodemographic form, did not have any current psychiatric diagnosis, chronic medical or neurological disorders requiring treatment, or regular use of psychotropic medications, and who completed the forms in full. All the study participants completed a sociodemographic form, the Beck depression inventory (BDI), the suicide probability scale (SPS), and the autism spectrum quotient (ASQ).The entire study sample was divided into 2 groups: students with and without symptoms of depression, based on BDI scores. In the multivariate analysis, independent predictors of depression symptoms were examined using logistic regression analysis. The BDI total points (z = -13.99, P < .001), SPS total points (z = 10.61, P < .001), and subscale points of hopelessness (z = -9.28, P < .001), suicidal ideation (z = 8.48, P < .001), negative self-evaluation (z = -9.26, P < .001), and hostility (z = -8.10, P < .001), and the ASQ subscale points of communication (z = -5.05, P < .001), social skills (z = -6.05, P < .001), imagination (z = -3.27, P = .001), attention shifting (z = -4.35, P < .001), and ASQ total points (z = -6.64, P < .001) were significantly higher for the participants with BDI total points above the cutoff value compared to those with BDI total points below the cutoff value. Statistically significant positive correlations were found between BDI total points and SPS total points (R = 0.710, P < .001), ASQ total points (R = 0.451, P < .001), and between ASQ total points and SPS total points (R = 0.534, P < .001). The contribution of age, gender, ASQ, and SPS total points to explaining depression symptoms was evaluated using logistic regression analysis. This analysis showed that the SPS total points could be a significant predictor of depression symptoms (B = 0.112, P < .001). The findings of this study showed that the probability of suicide and the ASQ total and subscale points of communication, social skills, imagination, and attention shifting were significantly higher in medical students with symptoms of depression compared to those without depressive symptoms. Given the important relationship between symptoms of depression, suicidality, and autistic traits, it is crucial to raise awareness of these issues among medical education departments, health practitioners, medical students, and to provide the necessary guidance and clinical support for medical students to address these problems., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Suicide is a global health concern whose rates are soaring in many low-and-middle-income countries. Public awareness campaigns have been implemented in Brazil; however, their impact is uncertain., Methods: This was an ecological study using population data from DATA-SUS, a Brazilian official notification system, selecting only deaths that were voluntarily self-inflicted (CID-10 × 60-X84). We analyzed all available data from 2000 to 2019 to assess trends before and after the national Yellow September (YS) campaign started in 2015. Differences in trends were assessed by Joinpoint Analysis (JA) and Regression Discontinuity Analysis (RDD), unadjusted and adjusted for economic factors., Results: Overall, there was a progressive increase in the rate of relative (per 100,000 inhabitants) number of suicides over time between 2000 and 2019 (57 % increase). The JA detected a change in the slope of the curve representing an acceleration in suicides starting in the year 2015. Adjusted RDD revealed the year that Yellow September started significantly change the slope of the association between time and rates of suicide (p interaction  < 0.01), and marginal analysis detected the coefficient increased from 0.07 (95%CI 0.04-0.10) to 0.27 (95%CI -0.07-0.60) suicides/year per 100,000 inhabitants., Limitations: The ecological nature of the manuscript compromises causational implications., Conclusions: We found an increase in suicidal trends in Brazil, against the global trend that coincides with the beginning of a large national awareness campaign. Although we cannot attribute causality, our results reinforce the need of further studies to better understand the role of awareness campaigns in suicide reduction interventions, including potential unintended effects., Competing Interests: Declaration of competing interest Rodolfo Furlan Damiano: Declares no conflict of Interest Loren Beiram: Declares no conflict of Interest Bianca Besteti Fernandes: Declares no conflict of Interest Maurício Scopel Hoffmann: Declares no conflict of Interest Alexander Moreira-Almeida: Declares no conflict of Interest Christian Rück: Declares no conflict of Interest Hermano Tavares: Declares no conflict of Interest André R. Brunoni: Declares no conflict of Interest Euripedes Constantino Miguel: Declares no conflict of Interest Paulo Rossi Menezes: Declares no conflict of Interest Giovanni Abrahão Salum: Declares no conflict of InterestAcknowledgements We acknowledge Daniela Lopes Ângelo for helping to do the first statistical analysis., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: This study aimed to examine acute and chronic stressors, and perceived lack social support, and their associations with depression and suicidal ideation in adolescents during the COVID-19 pandemic., Methods: Deidentified data from (N = 270,153) U.S. adolescents aged 11 to 17 who completed the Patient Health Questionnaire 9-item tool (PHQ-9) in the years 2020 and 2021 were sourced from a collection of online screening tools that are free, confidential, anonymous, and scientifically validated. In addition to depression, the survey included questions about suicidality, past/chronic stressful events, and contributors to mental health problems and sociodemographic variables. SPSS software version 28 for descriptive analyses, and Mplus version 7.31 for confirmatory factor analysis (CFA) and structural equation modeling (SEM), were respectively used., Results: Participants were predominantly female, White, and heterosexual, and exhibited a high prevalence of severe depression and a significant frequency of suicidal thoughts. Significant associations were found between past/chronic stressful events, and lack of social support, with suicidality and depression. Mental health stress due to the COVID-19 pandemic itself presented no significant associations with depression and suicidality and was weakly and negatively associated with lack of social support and past/chronic stressors., Discussion: These findings reinforce the notion that prior traumatic events can create vulnerabilities in the face of acute stressors, while social support can enhance resilience in adolescents. Factors that increase resilience, such as preventing traumatic events, reducing social stressors, and increasing social support, can serve as valuable guidelines for clinical and public health interventions., Competing Interests: Declaration of competing interest Dr. Vidal receives funding from the NIDA/AACAP Physician Scientist Training Program in Substance Abuse Research, supported by NIDA Career Development Award (K12)., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Suicide is a leading cause of death globally and a serious public health concern. Childhood trauma has been found to be associated with adult suicide vulnerability. Recent research has turned attention to investigating the role of attachment in the context of the childhood trauma-adult suicide relationship. The current study investigated for the first time whether attachment influences and moderates the childhood trauma-suicidality relationship, using a daily diary design, in the general population., Methods: 481 participants completed questionnaires assessing experiences of childhood trauma, attachment patterns, and history of suicidality. 243 participants continued to a daily diary phase where measures of daily stress, defeat and entrapment were completed for 7 consecutive days., Results: Higher levels of childhood trauma were associated with a history of suicide ideation and attempt and also higher levels of daily defeat, entrapment and stress during the 7 day study. Similarly, higher levels of attachment anxiety and avoidance were associated with a history of suicide ideation and attempt together with higher levels of daily defeat, entrapment and stress. However, the effects of childhood trauma on suicide history and on daily suicide vulnerability factors were not moderated by attachment anxiety or avoidance., Limitations: The measure of childhood trauma was a retrospective self-report tool that may be influenced by memory biases., Conclusions: Childhood trauma and insecure attachment are implicated in adult suicide risk. Interventions aimed at mitigating the negative effects of childhood trauma and insecure attachment should also incorporate components that target modifiable risk factors such as defeat, entrapment and stress., Competing Interests: Declaration of competing interest The authors have no conflict of interests to declare., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: The phenomenon of suicide risk (SR) represents a psychiatric, social and environmental emergency. The acute psychiatric ward as the Italian Service for Psychiatric Diagnosis and Care (SPDC) represents the place where SR is high due to the acute and serious conditions of people hospitalized. The objective of this study was to evaluate the characteristics of subjects admitted to a SPDC over a 6-year period for SR represented by: suicidal ideation, attempted and failed suicide., Methods: With a retrospective single-center observational design, we collected hospitalizations from 01/01/2017 to 31/12/2022 in the SPDC of AUSL-Modena for SR, analyzed the modality of SR and compared the demographic and clinical variables of subjects with SR with those hospitalized for other clinical reasons in the same period. Data were statistically analyzed., Results: In the 6-year of study period, we collected 2,930 hospitalizations in the SPDC of AUSL- Modena and among them, 68% (n = 528) were carried out due to SR, which represented the second leading cause of hospitalization (18%), in particular among females (Pearson Chi2 = 17.41, p < 0.001). Individuals with SR were more frequently voluntary admitted (Pearson Chi2 = 215.41, p < 0.001) for a shorter period (7.36 ± 8.16 vs 11.66 ± 15.93, t = 6.03, t-test, p < 0.001) and less frequently repeated the hospitalization during the study period for the same reason (Pearson Chi2 = 6.0, p = 0.014). The most frequent psychiatric disorders associated with SR were depressive, personality and adjustment disorders, which represented the most common factor associated with SR (68%), followed by family/relationship problems (12%) and alcohol/substance abuse (8%). We highlighted three kinds of suicidal risk: suicidal ideation (40%), often associated with personality disorders and substance use disorders, drug ingestion (30%) concomitant with conflicting family relationships and use of violent means (30%) associated with depressive disorders (Pearson Chi2 = 42.83, p = 0.002)., Conclusions: Our study provides a real-world setting evaluation of subjects hospitalized for SR and, in accordance with literature, suggests that suicidal behavior is the product of many clinical and social factors' interaction, that occurred in a crucial moment of life in vulnerable individuals. The identification of subjects at SR represents the first step of preventive multi-professional interventions., Competing Interests: Declarations Ethics approval and consent to participate The study was approved by the Ethics Committee of the North Emilia Area Vasta (Prot. 306/2022/AOU) with subsequent amendment for extension of the period examined (Prot. 10826/2023) and authorized by the AUSL- Modena (Prot. no. 688; 27/4/2023). Consent for publication is not applicable. If the informed consent is waived, we would require full name of committee that waived the informed consent. As the study was conducted retrospectively, it was not possible to obtain written informed consent from the enrolled subjects, in accordance with the European GDPR 679/2016 and General Authorization n. 9/2016, extended by Provision n. 424/2018. Data access was granted to the study manager and collaborators, who were bound by confidentiality and data processing obligations under applicable regulations. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: In Japan, few studies have examined suicide risk for 5-year relative survival rates for cancer sites. Since 5-year relative survival rates differ by sex, we aim to examine suicide risk for patients with cancer separately for men and women., Methods: We estimated the risk of suicide among patients with cancer by sex in Japan compared to the general population, using standardized mortality ratios (SMRs). Patients with cancer diagnosed between January 1, 1985-December 31, 2013 and registered in the Osaka Cancer Registry were followed for up to 10 years. The outcome was suicide death. In addition, cancer sites were classified into three prognosis groups based on 5-year relative survival rates: good (>70%), moderate (40-70%), poor (<40%)., Results: Among 623,995 patients with cancer observed for 2,349,432 person-years, 1,210 patients died by suicide (867 men and 343 women). The SMRs were almost equal for men (1.66; 95% confidence interval [CI], 1.55-1.77) and women (1.65; 95% CI, 1.48-1.83). SMRs for cancer prognosis groups were 1.01 (95% CI, 0.84-1.22) for men and 1.47 (95% CI, 1.24-1.73) for women in the good group, 1.53 (95% CI, 1.39-1.68) for men and 1.74 (95% CI, 1.47-2.05) for women in the moderate group, and 2.54 (95% CI, 2.27-2.85) for men and 1.87 (95% CI, 1.43-2.46) for women in the poor group., Conclusion: In this population, both sexes had higher suicide risk with poor prognosis, but the difference in SMRs between the good and poor groups was smaller for women than men.

Objective: To evaluate the relationship between a predelivery history of concussion and risk of severe maternal mental illness., Methods: We conducted a population based cohort study of birthing people with a singleton livebirth accrued between 2007 and 2017 with follow-up to 2021 in Ontario, Canada. The primary outcome was severe maternal mental illness, defined as a psychiatric emergency department visit, psychiatric hospital admission, or self-harm or suicide in the 14 years after delivery. Cox proportional hazards regression generated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) comparing those with a history of a health care encounter for concussion between database inception and the index delivery date to those without a recorded health care encounter for concussion, adjusted for maternal age, parity, neighborhood income quintile, rural residence, immigration status, chronic conditions, history of interpersonal violence, and history of mental illness. Results were also stratified by history of mental illness., Results: There were n = 18,064 birthing people with a history of concussion and n = 736,689 without a history of concussion. Those with a history of concussion had an increased risk of severe maternal mental illness compared to those without this history (14.7 vs 7.9 per 1,000 person-years; aHR 1.25, 95% CI, 1.20-1.31). After stratification by predelivery history of mental illness, the association was strongest in individuals with no mental illness history (aHR 1.33, 95% CI, 1.23-1.44)., Conclusion: These findings indicate the need for early identification and screening of birthing people with a history of concussion, as well as ongoing long-term supports using trauma informed approaches to prevent adverse psychiatric outcomes., (© Copyright 2024 Physicians Postgraduate Press, Inc.)

Importance: The rising suicide rates in the US emphasize the need for effective prevention. While telehealth has transformed access to mental health care, the impact of telehealth on suicide outcomes is unknown., Objective: To evaluate the association of virtual mental health services with individual-level suicide-related events (SREs)., Design, Setting, and Participants: This retrospective cohort study using broadband access as an instrumental variable assessed a national sample of Veterans Health Administration patients who received mental health care between March 1, 2020, and December 31, 2021. Participants were recently separated (ie, discharged or released from active duty) veterans who completed their active duty service between March 1, 2019, and December 31, 2020, and who received at least 2 outpatient or inpatient diagnoses related to major depressive disorder, substance use disorder, or posttraumatic stress disorder within the year before their most recent separation date. Data were analyzed May 1 to October 31, 2023., Exposure: Percentage of a patient's total mental health visits that were conducted virtually by psychiatrists, psychologists, or social workers within a calendar month., Main Outcomes and Measures: Binary measure indicating whether the patient had experienced an SRE (defined as a nonfatal suicide attempt, intentional self-harm, or suicide death) in a specific month and year as evaluated an instrumental variable probit model., Results: The sample included 66 387 data points from 16 236 unique recently separated veterans. Among these entries, 44 766 were for male veterans (67.4%), the mean (SD) age across the sample was 32.9 (8.9) years, and the sample was representative of the US veteran population. There were 929 SREs (1.4%). Virtual mental health visits comprised a mean (SD) of 44.6% (46.1%) of all mental health visits. In instrumental variable probit analyses accounting for factors simultaneously associated with use of virtual mental health care and SRE risk, a 1% increase in the probability of virtual mental health visits was associated with a 2.5% decrease in SREs., Conclusions and Relevance: Findings from this cohort study using a retrospective quasi-experimental design found that an increase in virtual mental health visits relative to total visits was associated with a statistically significant decrease in SREs, suggesting that providing virtual mental health services may reduce suicide-related outcomes.

Aims: The aim of this 4-year follow-up study was to examine the predictive effects of demographics, three types of sexual stigma, three types of self-identity confusion, anxiety, depression, family support and problematic Internet use before the coronavirus disease 2019 (COVID-19) pandemic on new-onset suicide risk and persistent suicide risk in young adult lesbian, gay and bisexual individuals who experienced the COVID-19 pandemic in Taiwan., Methods: Baseline data were collected from 1,000 lesbian, gay and bisexual individuals in 2018 and 2019. Outcome data on suicide risk were collected again in 2023. The suicide module of the Mini International Neuropsychiatric Interview was used to assess suicide risk in terms of thoughts of death, desire to self-harm, thoughts of suicide, plans for suicide and suicide attempts in the preceding month at the initial and follow-up assessments. Baseline three types of sexual stigma, self-identity disturbance, depression, anxiety and problematic Internet use were used to examine their prediction of new-onset suicide risk and persistent suicide risk at follow-up., Results: In total, 673 individuals participated in the follow-up survey. Notably, 16.5% of the participants who had no suicide risk at baseline had new-onset suicide risk at follow-up; 46.4% of the participants who had suicide risk at baseline also had suicide risk at follow-up. Participants who were transgender ( p  = .003), who perceived greater levels of microaggression ( p  < .001), and who had greater levels of problematic Internet use at baseline ( p  = .024) were more likely to have new-onset suicide risk at follow-up. Participants who had greater levels of self-identity confusion were more likely to have persistent suicide risk at follow-up ( p  = .023)., Conclusion: Intervention strategies for reducing suicide risk in lesbian, gay and bisexual individuals should be developed with consideration of the predictors identified in this study.

Background: External causes of death, such as accidents, substance use, and suicide, contribute substantially to mortality during adolescence and early adulthood and show marked sex differences. Individuals born preterm are at increased risk of mental disorders, and impaired cognitive and executive functions, potentially increasing their vulnerability to death from external causes. We investigated sex-specific associations between gestational age at birth and mortality from external causes during late adolescence and early adulthood., Methods: Individual level data from national health registries in Denmark (1978-2001), Finland (1987-2003), Norway (1967-2002), and Sweden (1974-2001) were linked to form nationwide cohorts. In total, 6,924,697 participants were followed from age 15 years to a maximum of 50 years in 2016-2018. Gestational age was categorized as "very/moderately preterm" (23-33 weeks), "late preterm" (34-36 weeks), "early term" (37-38 weeks), "full term" (39-41 weeks), and "post term" (42-44 weeks). Outcomes were mortality from external causes overall and from the largest subgroups transport accidents, suicide, and drugs or alcohol. We estimated sex-specific hazard ratios (HRs), with full term as the reference, and pooled each country's estimates in meta-analyses., Results: Across gestational ages mortality was higher for males than females. Individuals born very/moderately preterm had higher mortality from external causes, with HRs 1.11 (95% confidence interval [CI] 0.99-1.24) for males and 1.55 (95% CI 1.28-1.88) for females. Corresponding estimates for late preterm born were 1.11 (95% CI 1.04-1.18) and 1.15 (95% CI 1.02-1.29), respectively. Those born very/moderately preterm had higher mortality from transport accidents, but precision was low. For females, suicide mortality was higher following very/moderately preterm birth (HR 1.76, 95% CI 1.34-2.32), but not for males. Mortality from drugs or alcohol was higher in very/moderately and late preterm born males (HRs 1.23 [95% CI 0.99-1.53] and 1.29 [95% CI 1.16-1.45], respectively) and females (HRs 1.53 [95% CI 0.97-2.41] and 1.35 [95% CI 1.07-1.71], respectively, with some heterogeneity across countries)., Conclusions: Mortality from external causes overall was higher in preterm than full term born among both males and females. A clear sex difference was seen for suicide, where preterm birth was a risk factor in females, but not in males., (© 2024. The Author(s).)

Suicide remains a leading cause of death in the United States, and recent data suggest suicide deaths involving opioids are increasing. Given unprecedented increases in drug-poisoning deaths, suicidality, and suicide deaths in recent years, an updated examination of the trends in suicide deaths involving opioids is warranted. In this descriptive epidemiologic analysis, we leverage final and provisional mortality data from the US Centers for Disease Control and Prevention's WONDER database to examine trends in suicide deaths involving opioid poisoning from 1999 to 2021 by biological sex. Results reveal complex changes over time: the number and age-adjusted rate of suicide deaths involving opioid poisoning among male and female residents tended to track together, and both increased through 2010, but then diverged, with the number and rate of suicide deaths involving opioid poisoning among female residents outpacing that of male residents. However, the number and rate of suicide deaths involving opioid poisoning among male residents then began to stabilize, while that of female residents declined, closing the sex-based gap. Across all years of data, the proportion of suicide deaths that involved opioid poisoning was consistently higher among female decedents (5.8%-11.0%) compared with male decedents (1.4%-2.8%). Findings have implications for improved suicide prevention and harm reduction efforts. This article is part of a Special Collection on Mental Health., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: Sexual- and gender-diverse youth face unique stressors that negatively impact their health. The objective of this study was to use National Fatality Review-Case Reporting System data to epidemiologically describe fatalities among identified sexual- and gender-diverse youth to inform future prevention efforts., Methods: We used 2015 to 2020 data from the National Fatality Review-Case Reporting System to identify deaths among sexual- and gender-diverse youth and compare their characteristics to a matched sample of youth from these same data who were not known to be sexual- and gender-diverse. Demographic, injury, death, history, and life stressor characteristics were analyzed using descriptive statistics., Results: During the study period, 176 fatalities were identified among sexual- and gender-diverse youth. Decedents' mean age was 15.3 years. A greater proportion of deaths was attributed to suicide among sexual- and gender-diverse youth (81%) compared with nonsexual- and gender-diverse youth (54%). Receiving prior (69%) and/or current (49%) mental health services was more common among sexual- and gender-diverse youth, compared with nonsexual- and gender-diverse youth (50% and 31%, respectively). Sexual- and gender-diverse youth were significantly more likely to experience problems in school or be victims of bullying, compared with nonsexual- and gender-diverse youth (63% versus 47% and 28% versus 15%, respectively)., Conclusions: Suicide was the most common manner of death for sexual- and gender-diverse youth, despite many decedents receiving current or prior mental health services. These findings indicate the need to improve and diversify interventions to prevent these deaths., Competing Interests: CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2024 by the American Academy of Pediatrics.)

Background: Limited research exists on suicide among children aged 5 to 9 years. The objective of this study was to examine characteristics of suicide in children younger than 10 years., Methods: Data are from the National Fatality Review-Case Reporting System (NFR-CRS) for years 2006 through 2021 for children aged 6 to 9 years who died by suicide. No suicide deaths were reported in NFR-CRS for children aged ≤ 5 years. Descriptive analyses by demographics and circumstances were conducted. A thematic analysis of prevention recommendations made by child death review teams was performed., Results: From 2006 to 2021, NFR-CRS identified 78 suicide decedents aged 6 to 9 years. The largest share were aged 9 years (72%), male (74%), non-Hispanic Black (42%), and died by hanging (86%) at home (91%). School-related problems (39%), history of child maltreatment (36%), history of mental health services (30%), argument with parents (23%), and familial discord (19%) were common circumstances. Key suicide prevention themes included education for caregivers and school staff, improved behavioral health services, and implementation of school policies and programs., Conclusions: Results provide a more complete picture of suicide among younger children, improving understanding of their unique characteristics. It is recommended that program planners consider both age-appropriateness and the impacts of social (eg, racism) and structural inequities in their approaches to prevention, encompassing both community and school-based strategies. For pediatricians, results emphasize the importance of lethal means counseling, safety planning, and educating parents and caregivers on the distinct warning signs of suicide for younger children., Competing Interests: CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no conflicts of interest relevant to this article to disclose., (Copyright © 2024 by the American Academy of Pediatrics.)

Aims : While there is substantial literature on gender and research productivity, bearing mixed results, no study is available for suicidology. The present investigation fills this gap and focuses on an influential elite. Methods : Data are taken from the Web of Science (WoS). They refer to the most prolific suicidologists ( N = 116) with 70 or more works on the subject of suicide cited in WoS. Measures of research productivity include the number of works on suicide, citations to these works, and the h-index. The link between gender and the measures of research productivity is adjusted for years of experience, membership in a local research cluster, and region of the world. Results : Adjusting for the other predictors, males had more publications than females. However, gender did not predict either measure of quality of research (citations, h-index). Years of experience, as well as membership in a research cluster, predicted research productivity in most analyses. Region was unrelated to research productivity. Limitations : Further work on productivity might assess additional potential predictors including marital status, grant funding, and presence of young children. Conclusion : There is no significant difference between the genders in research quality. Similar results have been noted in previous work on prolific scientists.

Suicide is a leading cause of death. Suicide rates are particularly elevated among Department of Veterans Affairs (VA) patients. While VA has made impactful suicide prevention advances, efforts primarily target high-risk patients with documented suicide risk. This high-risk population accounts for less than 10% of VA patient suicide deaths. We previously evaluated epidemiological patterns among VA patients that had lower classified suicide risk and derived moderate- and low-risk groupings. Expanding upon VA's leading suicide prediction model, this study uses national VA data to refine high-, moderate-, and low-risk specific suicide prediction methods. We selected all VA patients who died by suicide in 2017 or 2018 (n = 4584), matching each case with five controls who remained alive during treatment year and shared suicide risk percentiles. We extracted all sample unstructured electronic health record notes, analyzed them using natural language processing, and applied machine-learning classification algorithms to develop risk-tier-specific predictive models. We calculated area under the curve (AUC) and suicide risk concentration to evaluate predictive accuracy and analyzed derived words. RESULTS: Our high-risk model (AUC = 0.621 (95% CI: 0.55-0.68)), moderate-risk (AUC = 0.669 (95% CI: 0.64-0.71)), and low-risk (AUC = 0.673 (95% CI: 0.63-0.72)) models offered significant predictive accuracy over VA's leading suicide prediction algorithm. Derived words varied considerably, the high-risk model including chronic condition service words, moderate-risk model including outpatient care, and low-risk model including acute condition care. Study suggests benefit of leveraging unstructured electronic health records and expands prediction resources for non-high-risk suicide decedents, an historically underserved population., Competing Interests: Declaration of competing interest The authors have no conflicts of interests. They have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript., (Published by Elsevier Ltd.)

Objective: With increased utilization of virtual care in mental health, examining its appropriateness in various clinical scenarios is warranted. This study aimed to compare the risk of adverse psychiatric outcomes following virtual versus in-person mental health follow-up care after a psychiatric emergency department (ED) visit., Methods: Using population-based health administrative data in Ontario (2021), we identified 28,232 adults discharged from a psychiatric ED visit who had a follow-up mental health visit within 14 days postdischarge. We compared those whose first follow-up visit was virtual (telephone or video) versus in-person on their risk for experiencing either a repeat psychiatric ED visit, psychiatric hospitalization, intentional self-injury, or suicide in the 15-90 days post-ED visit. Cox proportional hazard models generated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs), adjusted for age, income quintile, psychiatric hospitalization, and intentional self-injury in the 2 years prior to ED visit. We stratified by sex and diagnosis at index ED visits based on the International Classification of Diseases and Related Health Problems, 10th Revision, Canada (ICD-10-CA) coding., Results: About 65% ( n  = 18,354) of first follow-up visits were virtual, while 35% ( n  = 9,878) were in-person. About 13.9% and 14.6% of the virtual and in-person groups, respectively, experienced the composite outcome, corresponding to incidence rates of 60.9 versus 74.2 per 1000 person-years (aHR 0.95, 95% CI 0.89 to 1.01). Results were similar for individual elements of the composite outcome, when stratifying by sex and index psychiatric diagnosis, when varying exposure (7 days) and outcome periods (60 and 30 days), and comparing "only" virtual versus "any" in-person follow-up during the 14-day follow-up., Conclusions and Relevance: These results support virtual care as a modality to increase access to follow-up after an acute care psychiatric encounter across a wide range of diagnoses. Prospective trials to discern whether this is due to the comparable efficacy of virtual and in-person care, or due solely to appropriate patient selection may be warranted., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Importance: Changes in suicide rates after a nationwide trauma may be different from changes in psychiatric symptoms or general distress after such events. However, very few studies have examined short-term suicide-related reactions after such an event., Objective: To evaluate the short-term outcome of the events in Israel on October 7, 2023, a large-scale terror attack and unfolding war, on changes in suicidality as reflected in percentages of suicide-related calls in relation to all calls to a national mental health first aid helpline, the Israeli Association for Emotional First Aid (ERAN)., Design, Setting and Participants: The data included all interactions via the various ERAN helpline services between January 1, 2022, and December 31, 2023., Exposures: The October 7, 2023, terror attack on Israel., Mean Outcomes and Measures: Changes in the numbers of overall calls and suicide-related calls to the ERAN helpline using an interrupted time-series analysis., Results: A total of 602 323 calls were received by the ERAN helpline. The number of calls reflecting psychological distress in the 3 months before October 7, 2023, was 67 555 compared with 89 445 calls in the 3 months after. Analysis indicated that overall calls increased significantly on October 7 (β = 2089.16; 95% CI, 1918.97-2259.35). In addition, the daily trajectory of all calls changed significantly after October 7 (β = -22.77; 95% CI, -33.37 to -12.16), such that there was a decrease in the number of calls per day (β = -11.34; SE = 1.213; t = -9.35; P < .001). The number of suicide-related calls in the 3 months before October 7 was 1887, whereas 1663 suicide-related calls were registered in the 3 months after. Analysis showed that there were no changes in the daily number of suicide-related calls from before October 7 (β = -0.001; 95% CI, -0.005 to 0.03) or on October 7 (β = -0.22; 95% CI, -3.69 to 3.25). Therefore, the percentage of suicide-related calls decreased significantly on October 7 (β = -1.42; 95% CI, -1.92 to -0.92) and gradually increased in the following period (β = 0.016; 95% CI, 0.006-0.026)., Conclusions and Relevance: The findings of this cohort study suggest that although short-term emotional distress increased after national trauma, the percentage of suicide-related calls decreased. These results support previous studies suggesting that suicidality is not one of the immediate reactions to such traumas.

Objectives: In recent years, there has been an increase in suicide rates in Brazil. From 2015 to 2019, a 34% increase in self-inflicted deaths was observed. The aim of this study was to analyse population data to determine whether some subgroups of the population, specifically the elderly population with Alzheimer's disease, are at a greater risk of suicide., Study Design: An analysis of population data was carried out., Methods: Population data from the state of São Paulo, Brazil, were obtained from two platforms: the Brazilian Institute of Geography and Statistics (IBGE); and the Brazilian Ministry of Health (DataSUS). Data were measured and compared in 2010 and 2022 using the two most recent censuses., Results: Between 2010 and 2022, the number of registered deaths of patients with Alzheimer's increased by 21.93%. In addition, there was a 100.37% increase in suicides among the elderly population compared to a 37.78% increase in the general population., Conclusions: In recent years, there has been a notable increase in both suicides among the elderly and mortality rates attributed to Alzheimer's disease within São Paulo state, Brazil. However, it is not possible to conclude that the increase in suicide among the elderly is directly linked to Alzheimer's disease. To determine a correlation between suicide and Alzheimer's disease, further studies are required., Competing Interests: Competing interests The authors declare no conflicts of interest., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Objective: Literature on temporal patterns of suicidality among youths during the COVID-19 pandemic is growing. The present work proposes a Bayesian approach to assess temporal patterns of suicide-related behaviours among inpatient adolescents during the COVID-19 pandemic., Methodology: Data referred to the first hospital discharge record with ICD9-CM codes related to suicide-related behaviour and/or suicidal ideation among adolescents aged 13-19 between 1 January 2017 and 31 March 2021 were collected in the Piedmont region, Italy (n = 334; median age: 15 years, IQR: 14-16; 80% girls). A Poisson Bayesian regression model performed on pre-COVID-19 data (2017-2020), adjusted by seasonality and stratified by sex, was adopted to provide the probability that the predicted counts exceed the observed ones in each pandemic year quarter., Results: A declining trend of suicidality was observed in April-June 2020 among both sex groups. Among females, an increasing pattern of suicidality was registered in early 2021 (January-March) compared to the pre-pandemic period., Conclusion: The present findings contributed to a growing literature on the COVID-19 pandemic's impact on adolescents' suicide-related behaviours from a gender perspective and encouraged wider adoption of Bayesian approaches as valuable tools to explore rare events and deeply enlighten open public health issues., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Importance: Concerns have been raised regarding a link between use of glucagon-like peptide-1 (GLP-1) receptor agonists and increased risk of suicidality and self-harm., Objective: To assess the association between use of GLP-1 receptor agonists and the risk of suicide death in routine clinical practice., Design, Setting, and Participants: This active-comparator new-user cohort study used nationwide register data from Sweden and Denmark from 2013 to 2021. Adults 18 to 84 years old who initiated treatment with GLP-1 receptor agonists or the comparator sodium-glucose cotransporter-2 (SGLT2) inhibitors were included. Data were analyzed from March to June 2024., Exposure: Initiation of treatment with a GLP-1 receptor agonist or SGLT2 inhibitor., Main Outcomes and Measures: The primary outcome was suicide death recorded in the cause of death registers. Secondary outcomes were the composite of suicide death and nonfatal self-harm and the composite of incident depression and anxiety-related disorders. Using propensity score weighting, hazard ratios (HRs) with 95% CIs were calculated separately in the 2 countries and pooled in a meta-analysis., Results: In total, 124 517 adults initiated a GLP-1 receptor agonist and 174 036 initiated an SGLT2 inhibitor; among GLP-1 receptor agonist users, the mean (SD) age was 60 (13) years, and 45% were women. During a mean (SD) follow-up of 2.5 (1.7) years, 77 suicide deaths occurred among users of GLP-1 receptor agonists and 71 suicide deaths occurred among users of SGLT2 inhibitors: weighted incidences were 0.23 vs 0.18 events per 1000 person-years (HR, 1.25; 95% CI, 0.83-1.88), with an absolute difference of 0.05 (95% CI, -0.03 to 0.16) events per 1000 person-years. The HR was 0.83 (95% CI, 0.70-0.97) for suicide death and nonfatal self-harm, and the HR was 1.01 (95% CI, 0.97-1.06) for incident depression and anxiety-related disorders., Conclusions and Relevance: This cohort study, including mostly patients with type 2 diabetes, does not show an association between use of GLP-1 receptor agonists and an increased risk of suicide death, self-harm, or incident depression and anxiety-related disorders. Suicide death among GLP-1 receptor agonist users was rare, and the upper limit of the confidence interval was compatible with an absolute risk increase of no more than 0.16 events per 1000 person-years.

We aimed to quantify the risk, mortality, and burden of suicide among autistic persons. We searched PubMed, Embase, and PsycINFO on 5 th April 2023 for sources reporting the relative risk (RR) of suicide or suicide attempt among autistic persons (PROSPERO registration: CRD42021265313). Autism spectrum prevalence and suicide mortality and years of life lost (YLLs), were sourced from the Global Burden of Disease Study 2021. RRs pooled via meta-regression and health metrics estimates were used to estimate the excess suicide mortality and YLLs among autistic persons. We sourced 983 unique studies of which ten studies met inclusion criteria, consisting of 10.4 million persons. The pooled RR for suicide for autistic persons was 2·85 (95% UI: 2·05-4·03), which was significantly higher for autistic females than autistic males. No evidence of publication bias was detected via inspection of funnel plot and Egger's test. Globally, we estimated 13 400 excess suicide deaths among autistic persons in 2021, equating to 1·8% of all suicide deaths and 621 000 excess YLLs. Studies were limited in number and geographical coverage. Effective suicide prevention strategies for autistic persons may substantially reduce the fatal burden of suicides globally and reduce the health burden experienced within this population., Competing Interests: Declaration of competing interest All authors declare that they have no conflict of interests, (Copyright © 2024. Published by Elsevier B.V.)

Objectives: The aim of this study was to explore sex-specific disparities in rates of deaths of despair across 183 countries from 2000 to 2019., Study Design: Secondary analysis of cross-sectional population-level data., Methods: Data were obtained from the World Health Organization Health Inequality Data Repository. We analysed data on mortality due to alcohol, drug-use disorders, and self-harm (as a proxy for suicide). We calculated the average rate of deaths of despair by year and sex, trends in these rates, and cause-specific mortality trends. We then fitted mixed-effect generalised linear models to compare mortality rates by sex and country., Results: Analyses revealed significant disparities by sex, with a 3.3-fold higher rate among men than among women globally (95% confidence interval: 3.1-3.5, P < 0.001). There was a significant decline in deaths of despair globally and among both sexes during the assessed period (5% per 5 years). Lesotho, Belarus, the US, the Russian Federation, Guyana, and Slovenia ranked among the top 10 countries out of 183 with the highest mortality rates for both sexes. Canada, the Republic of Korea, Belgium, and Finland were countries with the highest mortality rates among women, whereas Ukraine, Lithuania, Mongolia, and Eswatini have the highest rates among men. In the US, 5-year mortality rates increased by 35% for women and 21% for men: drug-use mortality showed a significant increase over time, whereas suicide rates decreased for both sexes in the given country. Additionally, mortality rates from alcohol use decreased among women., Conclusions: This global analysis shed light on health disparities by sex in deaths of despair, especially concerning trends in the US. It identified countries and groups in need of targeted mental health and substance-use programs. Moreover, the disparities by sex revealed in this analysis suggest that mental health and substance-use interventions and programs may need to be more attentive to sex and/or gender, such as inequitable social norms and restrictive forms of masculinities, which have been shown to be contributing factors to deaths of despair., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Physician burnout and poor mental health are highly prevalent issues within the surgical community. Authenticity, defined as the degree to which individuals align their actions with their true selves, has been identified as a potential factor facilitating positive mental health. This study explores the impact of authenticity on burnout, depression, and suicide among surgeons., Study Design: Members of the department of surgery at a large academic medical center were sent an anonymous survey between April and May 2023. The survey evaluated authenticity using Authenticity Scale, depression using Patient Health Questionnaire, burnout using Copenhagen Burnout Inventory, and suicidality using Ask-Suicide Screening Questions (ASQ) tool., Results: Of the 170 surgeons, 94 (55.3%) completed the survey. Higher Authentic Living Scores correlated with reduced burnout (r = -0.21, p = 0.047) and depression (r = -0.37, p = 0.0002). Conversely, higher Accepting External Influence (AEI) scores were associated with increased depression (r = 0.23, p = 0.023), and higher Authenticity Self-Alienation (ASA) scores were associated with increased burnout (r = 0.43, p < 0.0001) and depression (r = 0.48, p < 0.0001). Although authenticity domain scores were not significantly associated with ASQ, specific AEI and ASA questions indicated an elevated odds ratio (p = 0.029 and p = 0.010, respectively) of a positive ASQ. Authentic Living Score increased with advancement in professional rank (p = 0.007), whereas AEI (p = 0.0001), ASA (p = 0.003), depression (p = 0.014), and ASQ (p = 0.02) decreased., Conclusions: In this study, higher authenticity was associated with a lower likelihood of burnout and depression among surgeons. This study contributes valuable insights into the development of targeted intervention and support mechanisms aimed at promoting authenticity and mental health within the surgical profession., (Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: To assess all-cause mortality and suicides after pediatric traumatic brain injury (pTBI)., Study Design: We conducted population-based historical cohort study using three nationwide registers from 1998 to 2018 in Finland. All patients that were the age of 0-17 at the time of the pTBI were included. The reference group consisted of children with ankle or wrist fractures. We used Kaplan-Meier and restricted mean survival time (RMST) analysis with 95% confidence intervals (CI) to compare all-cause mortality and suicides between groups., Results: After 20 years of follow-up, there were 479 deaths in the pTBI group (0.67% of 71,963) and 306 deaths in the reference group (0.47% of 64,848). In the pTBI group, 28.6% of the deaths occurred after the first follow-up year, compared to 2.6% in the reference group. In all-cause mortality, survival time was slightly less in the pTBI group with age and gender adjustment throughout the follow-up period [20-year RMST ratio: 0.995; CI (0.994-0.996)]. The leading manners of death were suicides (pTBI group = 28.4%; reference group = 45.5%) and traffic collisions (pTBI group = 37.4%; reference group = 20.8%). Age and gender-adjusted survival time was slightly less for those with suicide as a manner of death in the pTBI group [10-year RMST ratio: 0.999; CI (0.999-0.999); 20-year RMST ratio: 0.999; CI (0.998-0.999)]., Conclusions: Children and adolescents who sustained a TBI have slightly lower long-term survival time for all-cause mortality, most of which occurs during the first year following injury. There is no clinically meaningful difference in deaths by suicide between the two injury groups., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: Previous studies have reported that levels of rurality and deprivation are factors associated with suicide risk. Reports on the association between rurality, deprivation and suicide incidence during the COVID-19 pandemic are scarce. The study aims to investigate how suicide rates evolved in areas with different levels of rurality and deprivation among Japanese adults aged 20 years or older between 2009 and 2022., Methods: This study used population density in 2020 as an indicator of rurality and per capita prefectural income in 2019 as a proxy for deprivation in Japan's 47 prefectures. Joinpoint regression analysis was performed to analyze secular trends in suicide rates by rurality and deprivation., Results: Suicide rates for both men and women at different levels of rurality and deprivation remained roughly parallel during the research period. Suicide rates for men and women at all levels of rurality and deprivation were on a downward trend until around 2019, just before the onset of the pandemic. Following this, suicide rates in women showed a clear upward trend, while the trend in suicide rates for men also changed around 2019, with a slightly increasing or flat trend thereafter. Changes in suicide rates were greater among women and those aged 20-59 years., Conclusions: In Japan, time trends in suicide rates for both men and women have changed before and after the pandemic, but levels of rurality and deprivation across the 47 prefectures do not appear to have contributed much to these changes., (© 2024. The Author(s).)

Objectives: Indigenous people experience poorer mental health compared to the general population. Socioeconomic gaps partly explain these disparities. However, there is variability between populations and French overseas territories are understudied. This study examines the prevalence of mental health problems among Indigenous people in New Caledonia and French Polynesia, describing and comparing it with that of their counterparts while considering associated factors., Methods: We used the data from the cross-sectional Mental Health in the General Population survey in the only 3 sites for which information on indigenous status was available: Noumea (2006) and the 'Bush' (2008) in New Caledonia, and French Polynesia (2015-2017). Current mental health issues were screened using the Mini-International Neuropsychiatric Interview . In multivariable analyses, we considered the following factors: gender, age, education level, marital status, occupational activity and monthly income., Results: Overall, 2294 participants were analysed. Among the 1379 indigenous participants, 52.3% had at least one mental health issue. The prevalence of depressive disorder (18.0% vs 11.7%), alcohol use disorder (16.7% vs 11.7%) and suicide risk (22.3% vs 16.7%) were higher among indigenous participants compared to non-indigenous participants. After adjustment, the association between indigenous status and these mental health issues did not persist, except for alcohol use disorder., Conclusion: We found higher prevalence of depressive disorder, alcohol use disorder and suicide risk among indigenous people of French Polynesia and New Caledonia compared to their counterparts. These differences seemed largely explained by socioeconomic disparities. Future studies could explore the use of and access to healthcare by indigenous populations., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Background: Prevention strategies for suicide emphasize restrictions on firearm access. These restrictions may lose efficacy if individuals substitute other lethal suicide methods. Aims: The objective of this study is to determine the extent to which individuals who die by suicide in the United States substitute hanging for firearm injury. Methods: This study is a repeated cross-sectional analysis of suicide deaths in the United States from 2003 to 2021. Multiple regression was used to estimate the effect of firearm access proxies on individual suicide methods (hanging vs. firearm injury). Results: The probability of death by hanging was significantly and negatively associated with proxies of firearm access. Limitations: This study does not compare crude rates of suicide by state, which rise on average with rates of firearm ownership. The National Violent Death Reporting System expanded over the sample period, so early years have incomplete ascertainment. Rates of gun ownership and gun safety law scales are measured as proxies. Conclusions: Although means restriction around firearm access is a critical tool for suicide prevention, complementary strategies for prevention around hanging merit further study.

Aim: Adolescents and young adults are vulnerable to suicidality, especially those at high risk such as young people who use drugs (YPUD). This study aimed to assess the prevalence and related factors of suicide risk among this population., Methods: We conducted a descriptive, cross-sectional study on YPUD aged 16-24 in the community in Hanoi, Vietnam. Data on socio-demographic characteristics, drug use, and adverse childhood experiences were collected using face-to-face questionnaires by research assistants. YPUD were screened by psychiatrists for depression, psychotic symptoms, and suicide risk, using the MINI questionnaire., Results: Three hundred-seven YPUD (250 males, 57 females) participated in the study; of those, 86 (28.0%) were at risk of suicide. Gender (female), adverse childhood experiences, depression, and psychosis were relevant factors., Conclusion: The prevalence of suicide risk among young people using drugs was high. Therefore, suicide risk should be screened and monitored in the clinical assessment of this population. In addition, the intervention efforts to detect and intervene in adverse events during childhood may be one way to prevent mental health and suicide in later life., (© 2024 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Previous epidemiological studies have reported a short-term association between ambient temperature and suicide risk. To gain a clearer understanding of this association, it is essential to differentiate the risk factors for intentional self-harm (ISH) from those specifically associated with suicide deaths. Therefore, this study aims to examine whether the association between daily temperature and ISH or suicide deaths differs by age and sex. Between 2014 and 2019, cases of emergency room visits related to ISH and suicide deaths in Seoul were identified. A time-stratified case-crossover design was used to adjust for temporal trends and seasonal variation. A distributed lag nonlinear model was used to analyze the nonlinear and time-delayed effect of ambient temperature on ISH and suicide deaths. Positive associations were observed between temperature and both ISH and suicide deaths. For ISH, the relative risk (RR) was high at 1.17 (95% confidence interval (CI): 1.03, 1.34) for a temperature of 25.7 °C compared with 14.8 °C. The RR for suicide death was higher than those for ISH, at 1.43 (95% CI: 1.03, 2.00) for a temperature of 33.7 °C. These associations varied by age and sex, with males and females aged 35-64 years showing increased susceptibility to suicide deaths. This study provides detailed evidence that unusually high temperatures, both anomalous and out of season, may trigger suicidal behaviors, including both ISH and suicide deaths., (© 2024. The Author(s).)

Objective: To investigate the mediating role of depressive symptoms in the relationship between negative life events (NLEs) and suicidality, as well as to test the moderating effect of self-esteem in the mediation model., Methods: A total of 3,003 adolescents from Han, Tibetan, and Yi ethnic groups living in Western China were included in this study. Utilizing the structural equation model, a mediation model and a moderated mediation model were constructed., Results: The presence of NLEs was positively associated with suicidality (β = 0.17, p < 0.001). Depressive symptoms partially mediated the relationship between NLEs and suicidality (indirect effect β = 0.19, p < 0.001). Self-esteem moderated both the antecedent and subsequent segments of the mediating paths of "NLEs → depressive symptoms → suicidality" and the direct relationship between NLEs and suicidality. Among adolescents with a low level of self-esteem, the mediating effect coefficient of depressive symptoms was higher at 0.18 (95% confidence interval (CI): 0.14-0.23), in contrast to adolescents with a high level of self-esteem, where the mediating effect coefficient of depressive symptoms was 0.04 (95% CI: 0.02-0.07)., Conclusion: NLEs are directly associated with an increased risk of suicidality and indirectly related to suicidality by increasing the risk of depressive symptoms among adolescents. Self-esteem can moderate the mediating effect of depressive symptoms and the relationship between NLEs and suicidality. The intervention strategy for preventing suicidality among adolescents who have experienced NLEs should focus on reducing depressive symptoms and improving self-esteem., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Purpose: The effects of the COVID-19 pandemic on mental health issues such as depression and anxiety are well-documented in the literature, but its influence on suicidal patterns shows divergent results. We aim to comprehensively synthesize evidence on potential changes or stability of suicide rates during the COVID-19 pandemic worldwide., Methods: A comprehensive search of studies reporting suicide rates before and during the COVID-19 pandemic was conducted. Eligible studies reported incidences of confirmed suicides (suspected in special cases) for two time periods, before (until February 2020) and during (from March 2020 to June 2021) the COVID-19 pandemic. A meta-analysis of proportions using a random-effect model was performed to estimate the pre- and during-pandemic incidence rates of suicide with 95% confidence intervals. Differences in pre- and during-pandemic rates were formally tested using a heterogeneity test., Results: A total of 34 studies were included in the review capturing suicide data from over 40 countries and regions. The meta-analysis outputs did not indicate a significant change in suicide rates during the COVID-19 pandemic. The pooled suicide rate in the studied period before the pandemic was 11.38 per 100,000 (95% CI 9.35-13.42) and in the period during the pandemic was 10.65 per 100,000 (95% CI 8.61-12.68)., Conclusion: No significant change in suicide rates was observed during the COVID pandemic from a global perspective for the periods examined. A longer follow-up can provide additional insights into such suicide trends globally. Improvements in data reporting, specifically with implementation of real-time surveillance, is imperative to provide adequate suicide prevention and support., (© 2024. The Author(s).)

Introduction: Few studies have examined county-level hotspots of veteran suicide and associated place-based contributors, limiting development of targeted community-level prevention strategies. The objectives of this national spatial analysis of all veteran suicides were to identify areas of the United States with higher-than-expected veteran suicide rates and determine county-level social and economic characteristics associated with areas of higher risk., Methods: Using Bayesian hierarchical modeling, county-level standardized mortality ratios for veteran suicide deaths were estimated for time periods 2011-2018, 2011-2014, and 2015-2018. Adjusted relative risk, accounting for community characteristics, for each county was then estimated and associations between community characteristics and veteran suicide risk were examined. Analyses were conducted in 2023-2024., Results: Risk of veteran suicide is predominantly concentrated in the Mountain West and West. Significant predictors of risk across all time periods were per capita number of firearm retailers (2011-2018 relative risk [RR]=1.065 [95% credible interval [CI] 1.030-1.102]), the proportion of residents who moved in the past year (2011-2018 RR=1.060 [95% CI 1.039-1.081]), the proportion of residents who live alone (2011-2018 RR=1.067 [95% CI 1.046-1.089]), the proportion of residents in rental housing (2011-2018 RR=1.041 [95% CI 1.018-1.065]), and the proportion of married residents (2011-2018 RR=0.915 [95% CI 0.890-0.941])., Conclusions: This study contributes to a comprehensive public health approach to veteran suicide prevention by identifying where resources are needed most, and which place-based intervention targets have the largest potential for impact. Findings suggest that public health efforts to address suicide among veterans should address community-level firearm access and identify ways to alleviate deleterious effects of social fragmentation., (Published by Elsevier Inc.)

Aim: To evaluate the potential association between suicidality and glucagon-like peptide-1 receptor agonists (GLP-1RAs), as well as other medications used for obesity and diabetes, using comprehensive global data., Materials and Methods: This study utilized the World Health Organization's pharmacovigilance database, encompassing adverse drug reaction reports from 1967 to 2023, from 170 countries (total reports, N = 131 255 418). We present the reported odds ratios (RORs) with 95% confidence intervals (CIs) and information component (IC) with IC 025 regarding the association between GLP-1RA use and suicidality., Results: Although reports of GLP-1RA-associated suicidality increased gradually from 2005 to 2023 (n = 332), no evidence of an association was observed (ROR 0.15 [95% CI 0.13 to 0.16]; IC -2.77 [IC 025 -2.95]). The lack of evidence of an association persisted regardless of whether GLP-1RAs were used for diabetes treatment (ROR 0.13 [95% CI 0.11 to 0.14]; IC -2.95 [IC 025 -3.14]) or obesity treatment (ROR 0.44 [95% CI 0.34 to 0.58]; IC -1.16 [IC 025 -1.62]). However, an association was found between suicidality and other diabetes medications excluding GLP-1RAs (ROR 1.13 [95% CI 1.10 to 1.15]; IC 0.17 [IC 025 0.13]). Similarly, the potential association with suicidality was observed in medications used to treat obesity excluding GLP-1RAs (ROR 1.08 [95% CI 1.01 to 1.14]; IC 0.10 [IC 025 0.01])., Conclusions: The suspected association between GLP-1RA use and suicidality, as raised by the European Medicines Agency, was not found in our global analysis. This indicates that the sporadic reports of GLP-1RA-associated suicidality are likely influenced by factors such as comorbidities present in the GLP-1RA user population., (© 2024 John Wiley & Sons Ltd.)

Introduction: Suicide is a major public health concern in low- and middle-income countries (LMICs) due to its substantial psychological, social, and economic impact. There is little synthesized evidence to estimate the economic burden of suicide and suicide attempts in such economies. The present systematic literature review aims to examine existing evidence on the cost of illness (COI) in the case of suicides and suicide attempts and assess their quality., Methods: A systematic review was carried out using electronic databases, such as Medline, EMBASE, EconLit, PsycINFO, and CINAHL using keywords like 'suicide and suicide attempts,' 'cost of illness,' and economic burden." The quality assessment of studies was conducted along with the per-person cost estimation to understand the variation of methods followed across the studies., Result: 14 studies qualified for final data extraction and synthesis out of 4,164 studies. The studies showed heterogeneity across objectives, settings, and methods, with cost estimates reflecting a wide range of costings per person in suicide and suicide attempts., Conclusion: It is challenging to determine and compare the economic estimates of suicide. Intensive research is warranted with standardized cost assessment techniques and wider perspectives to understand the true economic burden of suicide., Registration: PROSPERO Registration No- CRD42022294080.

Objective: The authors evaluated associations between employment at discharge from Veterans Health Administration Vocational Rehabilitation Service (VR) programs and suicide and other causes of death., Methods: For veterans receiving VR between October 1, 2005, and September 30, 2014 (N=78,293), proportional hazards analyses were used to test associations of employment with suicide, drug overdose, and external and natural cause mortality rates over 1 and 5 years postdischarge and through December 31, 2019. The analyses were adjusted for clinical and sociodemographic characteristics and propensity for employment., Results: Of the veterans, 94.1% had a psychiatric diagnosis, and 35.5% were employed at VR discharge. In proportional hazards analyses, employment was associated with lower mortality rates through 1 year (suicide, hazard ratio [HR]=0.54; overdose, HR=0.70; external causes, HR=0.62; and natural causes, HR=0.51) and 5 years postdischarge (overdose, HR=0.72; external causes, HR=0.81; and natural causes, HR=0.72). Through December 31, 2019, employment was associated with lower risks for overdose (HR=0.80) and death by external (HR=0.81) and natural (HR=0.80) causes., Conclusions: Employment at VR discharge was associated with lower mortality risk among veterans with psychiatric diagnoses., Competing Interests: The authors report no financial relationships with commercial interests.

Purpose: Suicide is a leading cause of death in prison and the suicide rates are several times higher in the prison population than in the general population in most countries. Of the studies that have investigated risk factors for suicide in prison, few have controlled for possible confounding factors. The aim of this study is to identify risk factors of suicide among people in French prisons, over a four-year period., Methods: All incarcerations that occurred in France during 2017-2020 were eligible. Sociodemographic, criminal and prison characteristics were collected for each incarceration from data of the National Prison Service. Survival univariate and multivariate analyses were performed with a Cox regression model., Results: 358,522 incarcerations were included, of which 449 ended in suicide during the follow-up. The median length of prison stay was 5.1 months. The median age at prison entry was 30 years and 95.8% of incarcerations involved men. The overall suicide rate was 173 [157-189] per 100,000 person-years. Factors associated with suicide in the multivariate model (p < 0.05) were the early stage of incarceration and in particular the first week (HR = 7.6 [5.4-10.8]), violent offences and in particular homicide (HR = 3.0 [2.1-4.2]), French (HR = 1.7 [1.2-2.4]) and other European nationalities (HR = 2.1 [1.4-3.3]), age above 40 (HR = 2.0 [1.5-2.6]), pre-trial incarceration (HR = 1.8 [1.4-2.3]), being separated (HR = 1.6 [1.1-2.3] and having a high school diploma (HR = 1.4 [1.0-1.8])., Conclusions: Factors associated with suicide in prison are complex and involve individuals' criminal history as well as conditions of incarceration. These characteristics may be relevant to focus suicide prevention efforts., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background: Decreasing suicide mortality has become an overarching goal for societies worldwide. Suicide registers and other monitoring systems are a valuable source of information that can be used for addressing the suicide phenomenon and evaluating preventative interventions., Aims: This scoping review provides an overview of literature published in the last decade that has focussed on the operations (functioning) and characteristics of suicide registers and other suicide monitoring systems., Methods: Four electronic databases were searched in 2020 for identifying published material from January 2010 to October 2020. The searches were updated in October 2023 to include material from 2020 to date. Grey literature through Google searches and mental health commissions websites and the reference lists of selected documents were also searched., Results: Twenty-five articles were included in this review. Nearly half the articles were from the United States, followed by Australia. Nine countries were identified as having used suicide registers or suicide-specific monitoring systems to inform suicide prevention. Monitoring mechanisms varied across the countries examined. No article provided evidence that definitively linked suicide registers or other monitoring systems for suicide with the prevention of suicide or reduction in suicide rates. However, a variety of benefits of suicide monitoring for preventative and public health interventions were identified., Conclusions: The number of nations with surveillance systems for suicide prevention is low. Further, there is a lack of consistency in the systematic collection, analysis and interpretation of suicide-related information across the countries examined. Efforts to establish high-quality suicide surveillance systems that can be accessed in a timely and easy manner are needed to inform tailored strategies for suicide prevention.

Introduction: Over 40,000 people die by suicide annually in the U.S., and firearms are the most lethal suicide method. There is limited evidence on the effectiveness of many state-level policies on reducing firearm suicide. The objective of this study was to identify public policies that best predict state-level firearm suicide rates., Methods: Data from the Centers for Disease Control and Prevention's WONDER system and the State Firearm Law Database, a longitudinal catalog of 134 firearm safety laws, were analyzed. The analysis included 1,450 observations from 50 states spanning 1991-2019. An ElasticNet regression technique was used to analyze the relationship between the policy variables and firearm suicide rates. Nested cross-validation was performed to tune the model hyperparameters. The study data were collected and analyzed in 2023 and 2024., Results: The optimized ElasticNet approach had a mean squared error of 2.07, which was superior to nonregularized and dummy regressor models. The most influential policies for predicting the firearm suicide rate on average included laws requiring firearm dealers that sell handguns to have a state license and laws requiring individuals to obtain a permit to purchase a firearm through an approval process that includes law enforcement, among others., Conclusions: On average, firearm suicide rates were lower in state-years that had each influential policy active. Notably, these analyses were ecological and noncausal. However, this study was able to use a supervised machine learning approach with inherent feature selection and many policy types to make predictions using unseen data (i.e., balancing Lasso and Ridge regularization penalties)., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Real-time suicide registers are being established in many countries and enable regular monitoring of suspected suicides over time. The use of these data to monitor for suicide clusters is in its infancy. Aims: We sought to test the feasibility of using real-time suicide register data to detect spatiotemporal suicide clusters. Method: Using the Victorian Suicide Register and SaTScan's spatiotemporal scan statistic, we simulated a monthly search for clusters from January 2015 to June 2022 using rolling 2-year windows of data in each search. Monthly scans were performed at three different levels of geographic granularity and for all-ages and under-25 populations. Results: Our results indicated the rapid identification of possible suicide clusters and demonstrated a practical approach to combining real-time suicide data and scanning algorithms. We developed new model outputs that showed cluster timelines. Limitations: The main limitations are that the computational burden of fitting multiple models meant we were unable to scan for ellipses and other irregular shapes and we were unable to consider space-time permutation models. Conclusions: Using data from a real-time suicide register, we were able to scan for space-time suicide clusters simulating the situation where the data are updated monthly with new updates.

Objective: The suicide crisis syndrome (SCS), an acute negative affect state predictive of near-term suicidal behavior, is currently under review for inclusion as a suicide-specific diagnosis in the Diagnostic and Statistical Manual of Mental Disorders ( DSM ). While the SCS has ample psychometric validation, it is critical to test its utility as a clinical tool within a real-world clinical setting. The present study investigates patterns of emergency department (ED) readmissions following implementation of an SCS-based risk assessment tool into the ED of a large, urban hospital system., Methods: Patterns of readmission rates to the ED in the 3 months following initial ED visit were evaluated for patients diagnosed with the SCS, after controlling for suicidal ideation (SI), self-harm behavior (SHB), and psychosis in the initial ED visit. All diagnoses were extracted from the electronic medical record. SCS diagnosis was based on the Abbreviated SCS Checklist (A-SCS-C), a clinician administered rating scale., Results: Analysis of the SCS was performed on 213 patients consecutively admitted to the ED 9 months post-implementation of the A-SCS-C. Over one third (79; 37%) of patients were diagnosed with the SCS, over half 111 (52.1%) presented with SI and 8 (3.8%) with suicide attempt. After controlling for covariates, SCS diagnosis reduced readmission risk by approximately 72% (AOR = 0.281) for any reason and almost 75% (AOR = 0.257) for suicidal presentations, while SI and SHB upon initial ED visit either increased readmission risk or were noncontributory. The protective effect of the SCS was consistent across levels of severity of both SI and SHB., Conclusion: Use of the SCS appears to improve clinical outcome with suicidal patients presenting to the ED., (© Copyright 2024 Physicians Postgraduate Press, Inc.)

Objectives: To assess the short term temporal variations in suicide risk related to the day of the week and national holidays in multiple countries., Design: Multicountry, two stage, time series design., Setting: Data from 740 locations in 26 countries and territories, with overlapping periods between 1971 and 2019, collected from the Multi-city Multi-country Collaborative Research Network database., Participants: All suicides were registered in these locations during the study period (overall 1 701  286 cases)., Main Outcome Measures: Daily suicide mortality., Results: Mondays had peak suicide risk during weekdays (Monday-Friday) across all countries, with relative risks (reference: Wednesday) ranging from 1.02 (95% confidence interval (CI) 0.95 to 1.10) in Costa Rica to 1.17 (1.09 to 1.25) in Chile. Suicide risks were lowest on Saturdays or Sundays in many countries in North America, Asia, and Europe. However, the risk increased during weekends in South and Central American countries, Finland, and South Africa. Additionally, evidence suggested strong increases in suicide risk on New Year's day in most countries with relative risks ranging from 0.93 (95% CI 0.75 to 1.14) in Japan to 1.93 (1.31 to 2.85) in Chile, whereas the evidence on Christmas day was weak. Suicide risk was associated with a weak decrease on other national holidays, except for Central and South American countries, where the risk generally increased one or two days after these holidays., Conclusions: Suicide risk was highest on Mondays and increased on New Year's day in most countries. However, the risk of suicide on weekends and Christmas varied by country and territory. The results of this study can help to better understand the short term variations in suicide risks and define suicide prevention action plans and awareness campaigns., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at URL www.icmje.org/disclosure-of-interest/ and declare no support for the present study; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. This study did not include plans to recruit participants and only used pre-existing datasets. All data used in this study were pre-recorded and completely de-identified., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims: Venlafaxine is used to treat depression worldwide. Previous reviews have demonstrated that venlafaxine lowers scores on depression rating scales, producing statistically significant results but the relevance to patients remains uncertain. Knowledge of the incidence of the adverse effects associated with venlafaxine has previously been based on the results of non-randomised studies. Our primary objective was to assess the risks of adverse events with venlafaxine in the treatment of adults with major depressive disorder in randomised trials., Methods: We searched relevant databases and other sources from inception to 7 March 2024 for randomised clinical trials comparing venlafaxine versus placebo or no intervention in adults with major depressive disorder. Data were synthesised using meta-analysis and Trial Sequential Analysis. The primary outcomes were suicides or suicide attempts, serious adverse events and non-serious adverse events., Results: We included 28 trials randomising 6,253 participants to venlafaxine versus placebo. All results were at high risk of bias, and the certainty of the evidence was very low. All trials assessed outcomes at a maximum of 12 weeks after randomisation. Meta-analysis and Trial Sequential Analysis showed insufficient information to assess the effects of venlafaxine on the risks of suicides or suicide attempts. Meta-analysis showed evidence of harm of venlafaxine versus placebo on serious adverse events (risk ratio: 2.66; 95% confidence interval: 1.67-4.25; p < 0.01; 22 trials), mainly due to a higher risk of sexual dysfunction and anorexia. Meta-analysis showed that venlafaxine also increased the risk of several non-serious adverse events: nausea, dry mouth, dizziness, sweating, somnolence, constipation, nervousness, insomnia, asthenia, tremor and decreased appetite., Conclusions: Short-term results show that venlafaxine has uncertain effects on the risks of suicides but increases the risks of serious adverse events (especially sexual dysfunction and anorexia) and many non-serious adverse events. The long-term effects of venlafaxine for major depressive disorder are unknown. It is a particular cause for concern that there are no data on the long-term adverse effects of venlafaxine given that so many people use these drugs for several years.

Background: Suicide is the leading cause of death among children and adolescents in Japan. Internet search volume may be useful in detecting suicide risk. However, few studies have shown an association between suicides attempted by children and adolescents and their internet search volume., Objective: This study aimed to examine the relationship between the number of suicides and the volume of school-related internet searches to identify the search terms that could serve as the leading indicators of suicide prevention among children and adolescents., Methods: We used data on weekly suicides attempted by elementary, middle, and high school students in Japan from 2016 to 2020, provided by the National Police Agency. Internet search volume was weekly data for 20 school-related terms obtained from Google Trends. Granger causality and cross-correlation analysis were performed to estimate the temporal back-and-forth and lag between suicide deaths and search volume for the related terms., Results: The search queries "I do not want to go to school" and "study" showed Granger causality with suicide incidences. The cross-correlation analysis showed significant positive correlations in the range of -2 to 2 for "I do not want to go to school" (highest value at time lag 0, r=0.28), and -1 to 2 for "study" (highest value at time lag -1, r=0.18), indicating that the search volume increased as the number of suicides increased. Furthermore, during the COVID-19 pandemic period (January-December 2020), the search trend for "I do not want to go to school," unlike "study," was highly associated with suicide frequency., Conclusions: Monitoring the volume of internet searches for "I do not want to go to school" could be useful for the early detection of suicide risk among children and adolescents and for optimizing web-based helpline displays., (©Takahiro Arai, Hiroe Tsubaki, Ayako Wakano, Yasuyuki Shimizu. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 21.10.2024.)

Aims: We aimed to report an overview of trends in suicide mortality and years of life lost (YLLs) among adolescents and young adults aged 10-24 years by sex, age group, Socio-demographic Index (SDI), region and country from 1990 to 2021 as well as the suicide mortality with age, period and birth cohort effects., Methods: Estimates and 95% uncertainty intervals for suicide mortality and YLLs were extracted from the Global Burden of Diseases Study 2021. Joinpoint analysis was used to calculate the annual percentage change (APC) and average annual percentage change (AAPC) to describe the mortality and rate of YLLs trends. Age, period and cohort model was utilized to disentangle age, period and birth cohort effects on suicide mortality trends., Results: Globally, suicide mortality and the rate of YLLs among adolescents and young adults both declined from 1990 to 2021 (AAPC: -1.6 [-2.1 to -1.2]). In 2021, the global number of suicide death cases was 112.9 thousand [103.9-122.2 thousand] and led to 7.9 million [7.2-8.6 million] YLLs. A significant reduction in suicide mortality was observed in all sexes and age groups. By SDI quintiles, the high SDI region (AAPC: -0.3 [-0.6 to 0.0]) had the slowest decline trend, and low-middle SDI region remained the highest suicide mortality till 2021 (7.8 per 100,000 population [6.9-8.6]). Most SDI regions showed generally lower period and cohort effects during the study period, whereas high SDI region showed more unfavourable risks, especially period and cohort effects in females. Regionally, Central Latin America (AAPC: 1.7 [1.1-2.3]), Tropical Latin America (AAPC: 1.5 [0.9-2.0]), High-income Asia Pacific (AAPC: 1.2 [0.7-1.7]) and Southern sub-Saharan Africa (AAPC: 0.8 [0.4-1.2]) had the significance increase in suicide mortality. In 2021, Southern sub-Saharan Africa had the highest mortality (10.5 per 100,000 population [8.6-12.5]). Nationally, a total of 29 countries had a significant upward trend in suicide mortality and rate of YLLs over the past three decades, and certain countries in low-middle and middle regions exhibited an extremely higher burden of suicide., Conclusions: Global suicide mortality and the rate of YLLs among adolescents and young adults both declined from 1990 to 2021, but obvious variability was observed across regions and countries. Earlier mental health education and targeted management are urgently required for adolescents and young adults in certain areas.

Background: Associations between violent victimisation and psychiatric disorders are hypothesised to be bidirectional, but the role of violent victimisation in the aetiologies of psychiatric disorders and other adverse outcomes remains unclear. We aimed to estimate associations between violent victimisation and subsequent common psychiatric disorders, suicidal behaviours, and premature mortality while accounting for unmeasured familial confounders., Methods and Findings: Using nationwide registers, we identified a total of 127,628 individuals born in Finland (1987 to 2004) and Sweden (1973 to 2004) who had experienced violent victimisation, defined as either hospital admissions or secondary care outpatient visits for assault-related injuries. These were age- and sex-matched with up to 10 individuals in the general population (n = 1,276,215). Additionally, we matched those who had experienced violent victimisation with their unaffected siblings (n = 132,408). Outcomes included depression, anxiety, personality disorders, alcohol use disorders, drug use disorders, suicidal behaviours, and premature mortality. Participants were followed from the victimisation date until the date of the outcome, emigration, death, or December 31, 2020, whichever occurred first. Country-specific associations were estimated using stratified Cox regression models, which also accounted for unmeasured familial confounders via sibling comparisons. The country-specific associations were then pooled using meta-analytic models. Among 127,628 patients (69.0% male) who had experienced violent victimisation, the median age at first violent victimisation was 21 (interquartile range: 18 to 26) years. Incidence of all outcomes was larger in those who were exposed to violent victimisation compared to population controls, ranging from 2.3 (95% confidence interval (CI) [2.2; 2.4]) per 1,000 person-years for premature mortality (compared with 0.6, 95% CI [0.6; 0.6], in controls) to 22.5 (95% CI [22.3; 22.8]) per 1,000 person-years for anxiety (compared with 7.3, 95% CI [7.3; 7.4], in controls). In adjusted models, people who had experienced violent victimisation were between 2 to 3 times as likely as their siblings to develop any of the outcomes, ranging from adjusted hazard ratio [aHR] 1.7 (95% CI [1.7; 1.8]) for depression to 3.0 (95% CI [2.9; 3.1]) for drug use disorders. Risks remained elevated 2 years post-victimisation, ranging from aHR 1.4 (95% CI [1.3; 1.5]) for depression to 2.3 (95% CI [2.2; 2.4]) for drug use disorders. Our reliance on secondary care data likely excluded individuals with milder assault-related injuries and less severe psychiatric symptoms, thus suggesting that our estimates may be conservative. Another limitation is the possibility of residual genetic confounding, as full siblings share on average about half of their co-segregating genes. However, the associations remained robust even after adjusting for both measured and unmeasured familial confounders., Conclusions: In this longitudinal cross-national cohort study, we observed that those who had experienced violent victimisation were at least twice as likely as their unaffected siblings to develop common psychiatric disorders (i.e., depression, anxiety, personality disorder, and alcohol and drug use disorders), engage in suicidal behaviours, and to die prematurely. Importantly, these risk elevations remained 2 years after the first victimisation event. Improving clinical assessment, management, and aftercare psychosocial support could therefore potentially reduce rates of common psychiatric disorders, suicidality, and premature mortality in individuals experiencing violent victimisation., Competing Interests: SF is an Academic Editor on PLOS Medicine’s editorial board. HL reports receiving grants from Shire Pharmaceuticals; personal fees from and serving as a speaker for Medice, Shire/Takeda Pharmaceuticals and Evolan Pharma AB; all outside the submitted work. HL is the editor-in-chief of JCPP Advances. Shire/Takeda and Evolan were not involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review or approval of the manuscript., (Copyright: © 2024 Sariaslan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Aim: Acute alcohol use (AAU) can increase suicide risk. It is unknown if this effect differs by population sub-group in New Zealand, and what characteristics are associated with alcohol being coded as contributory to death, when AAU is identified. This study aimed to answer: 1) are the characteristics associated with suicide involving AAU different between females and males, and 2) among suicides that involved AAU, what factors are associated with alcohol being coded as a contributory factor?, Method: Secondary analysis was conducted of suicide data from 2007-2020, from the National Coronial Information System. Binomial regression models for females and males were used to estimate sex-specific differences in risk of suicide involving AAU. Poisson regression modelling was used to estimate the relative risk of alcohol being coded as contributory where AAU was identified., Results: Suicide was more likely to involve AAU among Māori females (adjusted risk ratio [ARR] 1.35, 95% confidence interval [CI] 1.08-1.68) and Pacific females (ARR 1.75, 95% CI 1.22-2.51), compared to European females. Compared to males who were employed, all other employment statuses had significantly lower risk of suicide that involved AAU. Those who died by hanging (ARR 0.75, 95% CI 0.62-0.92) or firearms (ARR 0.55, 95% CI 0.38-0.90) were less likely to have alcohol coded as contributory, compared to those who died by poisoning., Conclusion: Targeted public health interventions designed by and for specific demographic groups (particularly Māori and Pacific females) are needed, alongside universal interventions that address social and structural determinants. Data systems and coding must accurately reflect the association between AAU and suicide in New Zealand., Competing Interests: Nil., (© PMA.)

Standardized suicide mortality rates per 100,000 (SMRs) in Japan consistently decreased from 2009 to 2019 but increased from 2020. The causes of these temporal SMR fluctuations remain to be clarified. Therefore, this study was conducted to identify the causalities underlying the recently transformed fluctuations of suicide mortality in Japan. Monthly suicide numbers disaggregated by sex and social standing, and political uncertainty indices, such as economic policy uncertainty (EPU) and government management instability (AENROP), were obtained from Japanese government databases. Interrupted time-series analysis was performed to analyze temporal fluctuations of SMRs disaggregated by sex/social standing associated with the three General Principles of Suicide Prevention Policy (GPSPP) periods and the COVID-19 pandemic. Panel data and vector autoregressive analyses were conducted to investigate causalities from political uncertainties to SMRs. During the first and second GPSPPs (2009-2017), all SMRs disaggregated by sex and social standing decreased, whereas those of unemployed females did not change. During the third GPSPP (2017-2022), decreasing trends in all SMRs were attenuated compared to previous periods. All female SMRs, except unemployed females, showed sharp increases synchronized with the pandemic outbreak. No male SMRs showed sharply increasing at the pandemic outbreak. SMRs of unemployed males/females drastically increased in the later periods of the pandemic, while SMRs of employed and multiple-person/single-person household males did not increase during the pandemic. SMR of unemployed males was positively related to AENROP but not EPU. Other male SMRs were positively related to EPU/AENROP. On the contrary, not all female SMRs were related to EPU/AENROP. Increasing AENROP generally contributed to increasing male SMRs throughout the observation period; however, susceptibility to AENROP and/or political information might have unexpectedly contributed to suppressing the sharply increasing male SMRs induced by large-scale social shocks (the COVID-19 pandemic outbreak) in Japan.

Background: Schizophrenia is associated with a high mortality rate due to the high risk of suicide. However, there is still a lack of evidence on the gender-specific risk factors for suicide among people with schizophrenia. In this study, we aimed to measure the sociodemographic and clinical correlates of suicide deaths in different genders among people with schizophrenia., Methods: Data on patients with schizophrenia from 2013 to 2021 in Guangzhou, China were obtained from the National Information System for Psychosis (NISP), involving a total of 33,080 patients. Cox regression and Fine-Gray models were used to explore the sociodemographic and clinical risk factors for suicide mortality in different genders., Results: The overall age-standardized mortality rates due to suicide were 133.89 (95% CI: 124.31-143.47) per 100,000 person-years for females and 163.25 (95% CI: 152.92-173.59) per 100,000 person-years for males. To be specific, lack of medical insurance, history of non-treatment, and history of suicidal behavior was associated with a higher risk for suicide mortality for females, while an age of 35-54, being hospitalized once, and the age of onset being > 28 years were linked to lower risk for suicide mortality for males. For both genders, a lower risk for suicide mortality was observed in patients at an older age (≥ 55 years) and with a history of hospitalization more than once, and a higher suicide mortality risk was found in married patients and those residing in rural areas., Conclusion: The present study found that gender differences should be taken into account in the development of suicide prevention programs for people with schizophrenia, and future research is still required to verify our preliminary results., (© 2024. The Author(s).)

Searches for "pro-suicide" websites in the United States peaked during the week a high-profile news story was published and remained elevated for 6 months afterward, highlighting the need to avoid mentioning specific sources of explicit suicide instructions in media publications., (©Nora Clancy Kelsall, Catherine Gimbrone, Mark Olfson, Madelyn Gould, Jeffrey Shaman, Katherine Keyes. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 15.10.2024.)