The Psychology and Neurobiology of Suicidal Behavior

Functional alterations of the suicidal brain: a coordinate-based meta-analysis of functional imaging studies

Altered brain activities in suicidal subjects have been reported in a number of neuroimaging studies. However, the activity aberrances were inconsistent in previous investigations. Thus, we aimed to address activity abnormalities in suicidal individuals. Databases were searched to perform a meta-analysis of whole-brain functional MRI studies of suicidal individuals through January 14, 2020. Meta-analyses were conducted using Seed-based d Mapping software. Based on a meta-analysis of 17 studies comprising 381 suicidal individuals and 642 controls, we mainly found that increased activity in the bilateral superior temporal gyrus, left middle temporal gyrus, and bilateral middle occipital gyrus, along with decreased activity in the right putamen and left insula, were detected in suicidal individuals compared with nonsuicidal subjects. To reduce methodological heterogeneity between the included studies, subanalyses of behavioral domains were conducted, and the right superior temporal gyrus was found to increase in all subanalyses of domains. In subanalyses of suicidal attempters and ideators, suicide attempters displayed hyperactivation in the bilateral superior temporal gyrus and left middle temporal gyrus and blunted responses in the left insula relative to controls. Suicidal ideators demonstrated elevated activation in the right middle occipital gyrus and reduced activity in the right putamen relative to controls. The bilateral superior temporal gyrus was the most robust finding, replicable in all data sets in the jackknife sensitive analysis. Moreover, increased activity in the right superior temporal gyrus, left middle temporal gyrus, and right middle occipital gyrus was found to be involved with higher suicide ideation scores. This study revealed several brain regions associated with suicidality. These findings may contribute to our understanding of the pathophysiology of suicide and have important implications for suicide prevention and interventions.

Relationship Between Recent Change of Anhedonia and Suicidal Ideation Taking Into Account the Severity and the Acuteness of Suicidal Ideation As Well As the Specific Roles of Loss of Pleasure and Loss of Interest in People: A Study on Medical Students

The aim of the study was to explore the relationships between recent changes of anhedonia or particular symptoms of recent changes of anhedonia and suicidal ideation taking into account the severity of suicidal ideations. In a group of 173 medical students, scores of the anhedonia subscale (ANH-BDI) of the BDI-II (i.e. 4 anhedonia items: loss of pleasure, loss of interest, loss of energy and loss of interest in sex) were compared between 95 subjects without suicidality, 24 subjects with life-time suicidal ideation, 28 subjects with recent suicidal ideation and 26 planners. Analyses of covariance (ANCOVA) were performed referring to groups as independent variables, the cognitive-affective subscale (CA-BDI) of the BDI-II as a covariate, the ANH-BDI and each of the four anhedonia items as dependent variables. High levels of loss of interest characterized planners when compared to the other three groups. Loss of interest could be associated with recent and severe suicidal ideation.

Aggression, Impulsivity and Suicidal Behavior in Depressive Disorders: A Comparison Study between New York City (US), Madrid (Spain) and Florence (Italy)

The association of aggression and impulsivity with suicidal behavior (SB) in depression may vary across countries. This study aimed (i) to compare aggression and impulsivity levels, measured with the Brown-Goodwin Scale (BGS) and the Barratt Impulsivity Scale (BIS), respectively, between New York City (NYC) (US), Madrid (Spain) and Florence (Italy) (ANOVA); and (ii) to investigate between-site differences in the association of aggression and impulsivity with previous SB (binary logistic regression). Aggression scores were higher in NYC, followed by Florence and Madrid. Impulsivity levels were higher in Florence than in Madrid or NYC. Aggression and impulsivity scores were higher in suicide attempters than in non-attempters in NYC and in Madrid. SB was associated with aggression in NYC (OR 1.12, 95% CI 1.07–1.16; p < 0.001) and in Florence (OR 1.11, 95% CI 1.01–1.22; p = 0.032). Impulsivity was linked with SB in NYC (OR 1.01, 95% CI 1.00–1.02; p < 0.001) and in Madrid (OR 1.03, 95% CI 1.02–1.05; p < 0.001). The higher suicide rates in NYC, compared to Madrid or Florence, may be, in part, explained by these cross-cultural differences in the contribution of aggression-impulsivity to SB, which should be considered by future research on SB prevention.

Incidence rate and risk factors for suicide death in patients with skin malignant melanoma: a Surveillance, Epidemiology, and End Results analysis

The purpose of this study was to use the Surveillance, Epidemiology, and End Results database to identify the incidence rate and risk factors for suicide death in patients with skin malignant melanoma (MM) in the USA. We screened cases of skin MM in the SEER database. The balance of covariates between the two groups was examined by the χ-test and Fisher's exact test. Logistic regression was used to identify independent risk factors for committing suicide. A propensity 1: 2 matched analysis was applied to minimize the risk of bias. In total, 103 500 patients with skin MM were included in the study, of whom 623 had died of suicide. The rate of suicide death did not differ significantly between different time intervals. In logistic regression before propensity score matching, age, being divorced, separated, or widowed, receiving radiation or chemotherapy, and the elapsed time since diagnosis were independently associated with an increased rate of suicide death. Only age (P  <  0.001) and being in the first year after a diagnosis (P  <  0.001) significantly increased the risk of suicide death after propensity score matching. In addition, after the propensity score matching, age was a risk factor for localized, regional, and unstaged, and being the first year after a diagnosis was only a risk factor for regional. It is important to identify and treat people at risk of suicide as early as possible. These results can help clinicians to understand suicidal patients and provide them with appropriate support.

The Perceived Stigma Reduction Expressed by Young Adults in Response to Suicide Prevention Videos

Evidence indicates that stigma impedes an individual’s chance of seeking professional help for a mental health crisis. Commonly reported aggregate-level results for stigma-reduction efforts obfuscate how much stigma reduction is needed to incur a practically meaningful change within an individual, defined here as an attitudinal shift and openness towards seeking mental health for oneself and/or support for others. When basing conclusions and recommendations about stigma-reducing interventions on aggregate scales, it is unclear how much stigma reduction is needed to incur meaningful change within an individual. We explored the impact of reductions in stigma of help-seeking scores in response to an online suicide prevention video among young adults in the United States, using online surveys to collect qualitative and quantitative data. We compared mean changes in the stigma scores from pre- to post-test (video exposure) of 371 young U.S. adults using standard t-tests and individual level analysis. A separate thematic analysis of free-text responses was also conducted from a smaller, randomly-selected subgroup, capturing individuals’ attitudes towards help-seeking for mental health problems. Great attention was given to participants to ensure that they were in a campus setting where counseling services were available. Four main themes emerged: (1) small changes in stigma scores were associated with individual reports of meaningful reductions in their attitudes towards professional counseling; (2) increased empathy towards victims of suicide and other mental health problems sometimes indicated increased empathy for victims of suicide and decreased openness in professional help; (3) empathy towards victims sometimes took the form of increased scores and grief or sadness, possibly thwarting the potential for help-seeking; and (4) self-reports of decreased stigma were not always associated with increased openness towards help-seeking. Results also indicated that small stigma score charges, not meeting statistical significance, were often associated with increased openness towards seeking help. These findings, discovered using mixed-methods, contribute to the body of literature regarding stigma towards suicide and help-seeking by demonstrating deficits in the aggregate-only analysis of stigma-reducing interventions specifically aimed at suicide prevention. Such individuation in stigma experiences indicates that public education on how to reduce the stigma of help-seeking for suicide prevention needs to consider individual-level analyses for improving target populations. Recommendations for future research include additional studies prior to releasing suicide prevention videos to public forums where they may be seen by individuals without access to help.

Changes in depression and suicidal ideation under severe lockdown restrictions during the first wave of the COVID-19 pandemic in Spain: a longitudinal study in the general population

AIMS

To assess whether there is a change in the prevalence of depression and suicidal ideation after the strict lockdown measures due to the first wave of the COVID-19 pandemic in Spain; and to assess which are the factors associated with the incidence of a depressive episode or suicidal ideation during the lockdown.

METHODS

Data from a longitudinal adult population-based cohort from the provinces of Madrid and Barcelona were analysed (n = 1103). Structured face-to-face home-based interviews (pre-pandemic) and telephone interviews were performed. Both depression and suicidal ideation were assessed through an adaptation of the Composite International Diagnostic Interview (CIDI 3.0). A variety of validated instruments and sociodemographic variables including age, sex, educational level, occupational status, home quietness, screen time, resilience, loneliness, social support, physical activity, disability, economic situation and COVID-19-related information were also considered. Population prevalence estimates and multivariable logistic regressions were computed.

RESULTS

Overall, prevalence rates of depression and suicidal ideation did not change significantly from before to after the COVID-19 outbreak. However, the rates of depression among individuals aged 50+ years showed a significant decrease compared to before the pandemic (from 8.48 to 6.41%; p = 0.01). Younger individuals (odds ratio (OR) = 0.97 per year older; 95% confidence interval (CI) = 0.95-0.99) and those feeling loneliness (OR = 1.96; 95% CI = 1.42-2.70) during the lockdown were at an increased risk of developing depression during the confinement. Resilience showed a protective effect against the risk of depression (OR = 0.46; 95% CI = 0.32-0.66) and suicidal ideation (OR = 0.33; 95% CI = 0.16-0.68), whereas individuals perceiving social support were at a lower risk of developing suicidal thoughts (OR = 0.35; 95% CI = 0.18-0.69).

CONCLUSIONS

Continuous reinforcement of mental health preventive and intervening measures during and in the aftermath of the crisis is of global importance, particularly among vulnerable groups who are experiencing the most distress. Future research should strive to evaluate the long-term effects of the COVID-19 crisis on mental health.

Suicide and suicidality in contemporary serving and ex-serving Australian Defence Force personnel

OBJECTIVE

The risk of suicide in contemporary serving and ex-serving Australian Defence Force personnel is an area of significant concern, driving government-directed inquiries, community campaigns and most recently, the establishment of a permanent National Commissioner for Defence and Veteran Suicide Prevention. This concern is mirrored in international militaries and despite investment in prevention programmes, suicide is a leading cause of death in military populations. This review seeks to summarise recent findings from Australian research regarding the magnitude and factors associated with suicide and suicidality in contemporary serving and ex-serving Australian Defence Force populations and discusses research findings, implications and future opportunities.

METHODS

Initial review of the prevalence of suicide and suicidality in the general community and military populations is presented, followed by review of recent research findings pertaining to suicides and suicidal thoughts, plans and attempts in contemporary serving and ex-serving Australian Defence Force personnel. Key findings are presented from the 2010 Australian Defence Force Mental Health and Wellbeing Prevalence Study and the 2015 Transition and Wellbeing Research Programme.

RESULTS

Differences between serving and ex-serving Australian Defence Force cohorts were observed, with rates of completed suicide in ex-serving Australian Defence Force males more than double that of serving Australian Defence Force males, and increased risk for suicidality observed among those who had recently transitioned out of full-time Australian Defence Force service. Risk for increased suicidality and completed suicide is particularly evident for younger males of lower ranks, and those who have been medically discharged.

CONCLUSIONS

The findings provide insight into career phases and groups that should be followed-up and targeted for prevention and early intervention programmes, including prior to and several years following transition out of full-time military service. Further research to better understand the factors that influence those who develop suicidal ideation, and those who progress to plans and attempts, will inform a more sophisticated approach to suicide prevention programmes.

Volumetric MRI Analysis of Brain Structures in Patients with History of First and Repeated Suicide Attempts: A Cross Sectional Study

Structural brain changes are found in suicide attempters and in patients with mental disorders. It remains unclear whether the suicidal behaviors are related to atrophy of brain regions and how the morphology of specific brain areas is changing with each suicide attempt. The sample consisted of 56 patients hospitalized after first suicide attempt (first SA) (n = 29), more than one suicide attempt (SA > 1) (n = 27) and 54 healthy controls (HC). Brain volume was measured using FreeSurfer 6.0 automatic segmentation technique. In comparison to HC, patients with first SA had significantly lower cortical thickness of the superior and rostral middle frontal areas, the inferior, middle and superior temporal areas of the left hemisphere and superior frontal area of the right hemisphere. In comparison to HC, patients after SA > 1 had a significantly lower cortical thickness in ten areas of frontal cortex of the left hemisphere and seven areas of the right hemisphere. The comparison of hippocampus volume showed a significantly lower mean volume of left and right parts in patients with SA > 1, but not in patients with first SA. The atrophy of frontal, temporal cortex and hippocampus parts was significantly higher in repeated suicide attempters than in patients with first suicide attempt.

Abuse and suicide risk among college students in the United States: Findings from the 2019 Healthy Minds Study

BACKGROUND

Suicide has increased among American youth, and remains a concern on college campuses where students have reported increasing levels of psychological distress, alcohol use, social isolation, and loneliness. Abuse is known to be a risk factor for suicide, but more research is needed to understand whether current specific types of abuse and their co-occurrence are related to current suicidal thoughts and behaviors among young adults in college.

METHODS

We analyzed data from the 2019 wave of the Healthy Minds Study, a cross-sectional, web-based survey administered to undergraduate and graduate students. Using multivariable logistic regression, we examined the associations between abuse and suicidal thoughts and behaviors, adjusting for sociodemographic and mental health covariates.

RESULTS

In the past 12 months, 12.56% of the sample reported suicidal ideation, 5.70% reported making a suicide plan, and 1.28% reported making a suicide attempt. Over a third of the sample reported at least one type of abuse over the past 12 months. Emotional, physical, and sexual abuse were all associated with greater odds of all suicide outcomes, adjusting for sociodemographic characteristics and mental health. Endorsing multiple types of abuses was associated with greater odds of suicide outcomes in a dose-response fashion.

LIMITATIONS

Data were cross-sectional and the response rate for this survey was 16%.

CONCLUSIONS

Universities can implement a multi-pronged approach that covers screening for types of abuse, initiating awareness campaigns around abuse and suicide, and training faculty and staff to make appropriate referrals. Student services must also be equipped to address students who perpetrate abuse.

Low dose oral ketamine treatment in chronic suicidality: An open-label pilot study

Recently, low-dose ketamine has been proposed as a rapid-acting treatment option for suicidality. The majority of studies to date have utilised intravenous (IV) ketamine, however, this route of administration has limitations. On the other hand, oral ketamine can be administered in a range of settings, which is important in treating suicidality, although studies as to safety and feasibility are lacking. n = 32 adults (aged 22-72 years; 53% female) with chronic suicidal thoughts participated in the Oral Ketamine Trial on Suicidality (OKTOS), an open-label trial of sub-anaesthetic doses of oral ketamine over 6 weeks. Participants commenced with 0.5 mg/kg of ketamine, which was titrated to a maximum 3.0 mg/kg. Follow-up assessments occurred at 4 weeks after the final dose. The primary outcome measure was the Beck Scale for Suicide Ideation (BSS) and secondary measures included scales for suicidality and depressive symptoms, and measures of functioning and well-being. Mean BSS scores significantly reduced from a high level of suicidal ideation at the pre-ketamine (week 0) timepoint to below the clinical threshold at the post-ketamine (week 6) timepoint. The proportion of participants that achieved clinical improvement within the first 6 weeks was 69%, whereas 50% achieved a significant improvement by the follow-up (week 10) timepoint. Six weeks of oral ketamine treatment in participants with chronic suicidality led to significant reduction in suicidal ideation. The response observed in this study is consistent with IV ketamine trials, suggesting that oral administration is a feasible and tolerable alternative treatment for chronic suicidality.

Domains of the autism phenotype, cognitive control, and rumination as transdiagnostic predictors of DSM-5 suicide risk

Suicide is a global health problem affecting both normative and clinical populations. Theoretical models that examine mechanisms underlying suicide risk across heterogeneous samples are needed. The present study explored core characteristics associated with autism spectrum disorder (ASD), a sub-population at high risk of suicide, as well as two dimensional cognitive constructs, as potential transdiagnostic predictors of suicidal ideation in a clinically diverse sample. Participants (n = 1851, 62% female) aged 18 to 89 years completed online questionnaires assessing: social communication difficulties; insistence on sameness; cognitive control; and rumination. Forty-three percent of participants reported the presence of at least one neurodevelopmental or neuropsychiatric disorder. One third of the sample reported some suicidal ideation (SI), and 40 percent met the threshold for concern for depression. All hypothesized constructs were associated with SI and depression and, with the exception of rumination, contributed significantly to SI. Participants reporting SI returned significantly higher social communication difficulties and insistence on sameness, and lower levels of cognitive control than those reporting no-SI. The study was limited by the use of a cross-sectional sample assessed with self-report measures. All diagnoses were self-reported and the study was additionally limited by the use of a single item indicator of suicidal ideation. These findings support a role for constructs associated with the ASD phenotype and associated broad cognitive domains as potential risk factors underlying suicidal ideation in a large clinically diverse sample. Our findings suggest directions for future longitudinal research studies, along with specific targets for suicide prevention and clinical practice.

Psychometric properties of the Italian version of the Interpersonal Needs Questionnaire-15 (INQ-15-I)

OBJECTIVE

The Interpersonal Needs Questionnaire (INQ-15) is a self-report measure of thwarted belongingness and perceived burdensomeness, two constructs associated with suicidal ideation. The objective of the current study was to translate the INQ-15 from English to Italian (INQ-15-I) and to test its factor structure, reliability, and validity in Italian samples.

METHOD

We examined (a) whether the components of the hypothesized two-factor measurement model are invariant across a community sample (N = 510) and a clinical sample (N = 259); (b) the relations between the INQ-15-I factors and measures of depression (Beck Depression Inventory-II), hopelessness (Beck Hopelessness Scale), and suicidal ideation (Beck Scale for Suicide Ideation); (c) the reliability and psychometric properties of the INQ-15-I.

RESULTS

Results from multigroup confirmatory factor analyses supported the adequacy of the two-factor model to represent thwarted belongingness and perceived burdensomeness. The model is invariant across community and clinical groups, showing excellent fit. The two INQ-15-I scales measure highly intercorrelated constructs. Both significantly correlate with depression, hopelessness, and suicidal ideation, and correlations are high in the clinical sample.

CONCLUSION

The INQ-15-I is a valid and reliable measure of thwarted belongingness and perceived burdensomeness. Implications for research, assessment, and intervention in suicidal ideation are discussed.

Suicidal Ideation Mediates the Relationship Between Affect and Suicide Attempt in Adolescents

Suicide, as one of the leading causes of death for the adolescent population, both in Chile and globally, remains a complex and elusive phenomenon. This research studies the association between positive and negative affect in relation with suicidal ideation and suicidal attempt, given that affectivity is a fundamental basis on which people make evaluations on their satisfaction with life. First, it examines the reliability, structure, and validity of Watson's positive and negative affect scale (PANAS) scale in a representative random sample of Chilean high school students (N = 4,568). The scale evidences strong reliability coefficients and a confirmatory factor analysis, excluding one positive (excited) and one negative (nervous) item. The scale shows a satisfactory goodness of fit. Secondly, it investigates the association of PANAS positive and negative affect scores with suicidal ideation as well as reported attempt in adolescents, controlling for the potential effect of age and sex (N = 420 high school students). Low positive and high negative affect, but not sex and age, show a significant association with suicidal ideation. Suicidal ideation totally mediates the association of affect with suicide attempt, as expected. Results are discussed regarding prevention and it considers how positive and negative affect can be relevant as indicators for prevention and treatment using widely available technology.

Psychological distress, anxiety, family violence, suicidality, and wellbeing in New Zealand during the COVID-19 lockdown: A cross-sectional study

New Zealand's early response to the novel coronavirus pandemic included a strict lockdown which eliminated community transmission of COVID-19. However, this success was not without cost, both economic and social. In our study, we examined the psychological wellbeing of New Zealanders during the COVID-19 lockdown when restrictions reduced social contact, limited recreation opportunities, and resulted in job losses and financial insecurity. We conducted an online panel survey of a demographically representative sample of 2010 adult New Zealanders in April 2020. The survey contained three standardised measures-the Kessler Psychological Distress Scale (K10), the GAD-7, and the Well-Being Index (WHO-5)-as well as questions designed specifically to measure family violence, suicidal ideation, and alcohol consumption. It also included items assessing positive aspects of the lockdown. Thirty percent of respondents reported moderate to severe psychological distress (K10), 16% moderate to high levels of anxiety, and 39% low wellbeing; well above baseline measures. Poorer outcomes were seen among young people and those who had lost jobs or had less work, those with poor health status, and who had past diagnoses of mental illness. Suicidal ideation was reported by 6%, with 2% reporting making plans for suicide and 2% reporting suicide attempts. Suicidality was highest in those aged 18-34. Just under 10% of participants had directly experienced some form of family harm over the lockdown period. However, not all consequences of the lockdown were negative, with 62% reporting 'silver linings', which included enjoying working from home, spending more time with family, and a quieter, less polluted environment. New Zealand's lockdown successfully eliminated COVID-19 from the community, but our results show this achievement brought a significant psychological toll. Although much of the debate about lockdown measures has focused on their economic effects, our findings emphasise the need to pay equal attention to their effects on psychological wellbeing.

Mental Pain as a Transdiagnostic Patient-Reported Outcome Measure

Patient-reported outcomes (PROs) refer to any report coming directly from patients about how they function or feel in relation to a health condition or its therapy. PROs have been applied in medicine for the assessment of the impact of clinical phenomena. Self-report scales and procedures for assessing physical pain in adults have been developed and used in clinical trials. However, insufficient attention has been dedicated to the assessment of mental pain. The aim of this paper is to outline the implications that assessment of mental pain may entail in psychiatry and medicine, with particular reference to a clinimetric index. A simple 10-item self-rating questionnaire, the Mental Pain Questionnaire (MPQ), encompasses the specific clinical features of mental pain and shows good clinimetric properties (i.e., sensitivity, discriminant and incremental validity). The preliminary data suggest that the MPQ may qualify as a PRO measure to be included in clinical trials. Assessment of mental pain may have important clinical implications in intervention research, both in psychopharmacology and psychotherapy. The transdiagnostic features of mental pain are supported by its association with a number of psychiatric disorders, such as depression, anxiety, eating disorders, as well as borderline personality disorder. Further, addressing mental pain may be an important pathway to prevent and diminish the opioid epidemic. The data summarized here indicate that mental pain can be incorporated into current psychiatric assessment and included as a PRO measure in treatment outcome studies.

Incidence of and sociological risk factors for suicide death in patients with leukemia: A population-based study

OBJECTIVES

Suicide is closely related to sociological factors, but sociological analyses of suicide risk in leukemia are lacking. This study is the first to use the Surveillance, Epidemiology, and End Results Program (SEER) database to analyze sociological risk factors for suicide death in leukemia patients.

METHODS

A retrospective search of the SEER database was conducted. Logistic regression was used to identify independent risk factors for suicide death. Variables significant in the univariate logistic regression models were subsequently analyzed using multivariate regression.

RESULTS

The death rate was highest in California (1.73%). Suicide mortality was more common during the 1970s and 1980s, after which it trended downward. Young age at diagnosis (18-34 vs. >64 years: odds ratio [OR] = 1.537, 95% confidence interval [CI] = 1.007-2.347; 35-64 vs. >64 years: OR = 1.610, 95% CI = 1.309-1.979), being male (OR = 1.518, 95% CI = 1.230-1.873), and living where a high proportion of people have at least a bachelor's degree (>50% vs. <20%: OR = 8.115, 95% CI = 5.053-13.034) significantly increased suicide death risk.

CONCLUSION

Our findings could increase clinician awareness of and appropriate support for leukemia patients at risk of death by suicide.

Clinical and personality profile of depressed suicide attempters: A preliminary study at the open-door policy Mood Disorder Unit of San Raffaele Hospital

Suicidal behavior is a complex phenomenon with high rates among psychiatric inpatients. Mood disorders and personality dysfunctions represent relevant risk factors for suicides attempts and suicidal ideation. Our study aims to investigate the role of the co-occurrence of clinical variables (duration of depressive state, previous suicide attempts), socio-demographic variables (gender, employment and civil status) and narcissistic personality features in the suicide risk of admitted psychiatric patients affected by a mood disorder. The sample was composed of 93 patients consecutively admitted in an open ward psychiatric Unit. Forty-eight participants had a positive history of previous suicide attempts: the suicide attempters (SA) were mostly female, unemployed and married. The SA group were observed to have suffered from a depressive episode with a longer duration; moreover in the SA group, the presence of active suicidal ideation was significantly related to a higher number of previous suicide attempts. In the whole sample, suicidal ideation was significantly related to narcissistic vulnerability personality features. Using a multidimensional approach, the present study allows a preliminary profiling of patients at risk for suicidal behavior during hospitalization.

Alterations in functional brain networks in depressed patients with a suicide attempt history

Suicide is a major challenge in public health and is strongly associated with major depressive disorder (MDD). Despite recent neuroimaging developments, the neural correlates of suicide behavior in patients with MDD remain unclear. Independent component analysis (ICA) for neuroimaging data allows the identification of functional brain networks without prior regions of interest and may help to identify neurobiological markers of specific disorders. Using ICA, we investigated the differences in resting-state brain networks in patients with MDD who had or did not have a history of suicide attempts and in healthy controls (HCs). Suicidal depressed (SD) patients, non-suicidal depressed (NSD) patients, and HCs significantly differed from each other in the pattern of connectivity of multiple functional networks, network synchronization, and functional network connectivity (FNC). The patient groups had a decreased network synchronization in the insular, cerebellum, basal ganglia, thalamus, operculum, frontoparietal cortices, and sensory cortices relative to the HCs. The decreased FNC between these networks (insular-default mode network and insular-cerebellum) was found in the SD group compared to the NSD and HC groups. These differences were not related to illness duration and medication status differences between SD and NSD. Furthermore, the degree of FNC in these networks was associated with the suicide ideation and stress level. Our results demonstrated that widespread but discrete network changes in brain networks and their interconnectivity was associated with suicide attempts in patients with MDD. Our results suggest that the neural basis underlying the psychopathology of attempted suicide in patients with MDD involves multiple brain networks and their interaction.

Suicide in Belgian psychiatric inpatients. A matched case-control study in a Belgian teaching hospital

BACKGROUND AND OBJECTIVES

Patients admitted to a psychiatric hospital show an increased risk for suicide but specific risk factors are not well understood.

METHODS

In this case-control study we describe suicides (n = 37) that took place during admission in a Flemish psychiatric teaching hospital between 2007 and 2015 and investigate predictive factors for suicide.

RESULTS

Inpatient suicide is a rare condition (37 patients among 20,442 admission periods between 2007 and 2015). Most inpatients who completed suicide were diagnosed with a mood disorder (68%); 38% committed suicide in the first month of hospitalization and 19% in the first week following admission. The majority of suicides took place just before or during the weekend (57%), with hanging as the prominent method (41%). Multivariate analysis showed that hopelessness was the only significant risk factor for inpatient suicide.

CONCLUSIONS

Inpatient suicide remains a very rare event in inpatient care. Enquiring and managing hopelessness is essential in inpatient treatment of psychiatric patients.

Comparison of the Sleep Problems Among Adolescents Who Attempted Suicide and Healthy Adolescents

The aim of this study was to compare sleep problems among adolescents who attempted suicide and healthy adolescents who never attempted suicide. Adolescents who attempted suicide (study group, n = 103) and healthy adolescents (control group, n = 59) completed a questionnaire prepared by researchers including demographic factors. In addition, the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) were administered to both groups. The median age was 16 years and 73% were girls, in both groups. The study group had lower rate of attending to school (88.3% vs. 100%; p = 0.001), academic achievement (45.7% vs. 83.1%; p = 0.001), higher rate of smoking (37.9% vs. 13.8%; p = 0.001), socializing problems (31.1% vs. 3.4%; p = 0.001), and appetite changes (57.3% vs. 39.7%; p = 0.032) than controls. The rate of those with PSQI scores 6 or higher was 53.4% in the attempted suicide group and 37.3% in the control group (p = 0.048). Adolescents, classified as sleepy according to the ESS, did not differ significantly between the groups (p = 0.214). Adolescents who attempted suicide had poor sleep quality. It is crucial to examine the kinds of sleep problems adolescents who have attempted suicide have experienced. Among adolescents attending outpatient clinics with poor sleep quality, PSQI can be a useful screening tool. Those with high scores should be evaluated for suicide risk.

Association between suicidal ideation and acoustic parameters of university students' voice and speech: a pilot study

PURPOSE

At a worldwide level, suicide is a public health problem that, despite displaying downward trends in several areas of the world, in many countries these rates have increased. One of the elements that contributes to its prevention is an early and dynamic evaluation. Due to this, the objective is to determine the association between acoustic parameters of voice and speech (F0, F1, F2, F3, dB, and Jitter) and suicidal ideation arousal amongst some university students from the city of Temuco, Chile.

METHODS

Attending to this issue, a cross-sectional design study was conducted through a non-probabilistic sampling of sixty 18- and 19-year-old adolescents from the city of Temuco, that went through an acoustic evaluation of their voice and speech after taking a test to determine suicidal ideation. Afterwards, data were analyzed through IBM SPSS version 23.0 software (IBM SPSS Statistics, Armonk, NY), by means of exploratory, descriptive, and inferential statistics taking the variable's levels of measurements and the types of distributions into account.

RESULTS

The results point out that 30% of the adolescents, from both genders, displayed suicidal ideation. Taking into account the acoustic results of their voice, it is possible to recognize that the fundamental frequency (F0), the formants (F1, F2), and Jitter, are the ones that majorly link to the presence of suicidal ideation, both in women and men (p < .05). The characteristics that describe F3 were only linked to the presence of suicidal ideation in men (p < .05).

CONCLUSIONS

It is concluded that the acoustic parameters of voice and speech differ in adolescents with suicidal behavior, opening the possibility of representing a useful tool in the diagnosis of suicide.

Hopelessness and its correlates with clinical outcomes in an outpatient setting

INTRODUCTION

This study examined whether patients with hopelessness and those without may significantly differ regarding their main presentations and clinical course in a large Italian population.

METHODS

The recruited sample included 583 currently euthymic outpatients with major affective disorders. The Beck Hopelessness Scale (BHS) assessed hopelessness using a cutoff score of 9 or higher. Participants were categorized based on the presence/absence of hopelessness. A binary logistic regression analysis -accounting for age and gender and considering history of psychotherapy, emotional/physical abuse, depressive symptoms, Toronto Alexithymia Scale (TAS) total score, difficulties identifying and communicating feelings as potential predictors- was carried out in order to detect the variables associated with hopelessness.

RESULTS

Individuals with hopelessness, compared to those without, were more likely to be older (p=0.005), females (p=0.01), to have a unipolar depressive disorder (p≤0.05), be prescribed antidepressants and psychotherapy in the past (p=0.001 and p≤0.05). Moreover, individuals with hopelessness scored higher on the Montgomery-Asberg Depression Rating Scale (p≤0.05) and on the emotional (p=<0.001), physical abuse (p≤0.01) and physical neglect (p≤0.05) subscales of the Childhood Trauma Questionnaire - Short form, and reported more difficulties identifying (p≤0.001) and communicating feelings (p≤0.001) than those without hopelessness. The multivariate analysis showed that having difficulties identifying feelings is independently associated with hopelessness.

DISCUSSION

These findings indicate that individuals with difficulties identifying feelings are at higher risk of hopelessness and of negative outcomes. Further studies need to explore the impact of alexithymia on hopelessness and clinical outcomes in the lifetime illness course.

Differential effects of state and trait social anhedonia on suicidal ideation at 3-months follow up

BACKGROUND

Recent work suggests that the social component of anhedonia is more associated with suicide ideation than the other component of pleasure. The present study investigated the differential effects of state and trait social anhedonia on suicidal ideation across two undergraduate samples based on the Interpersonal Theory and Three-Step Theory of Suicide.

METHODS

State social anhedonia was assessed with a single item (Loss of Interest in People) extracted from the Beck Depression Inventory, while trait social anhedonia was assessed using the Anticipatory and Consummatory Interpersonal Pleasure Scale. Suicidal ideation was re-administered at a 3-month follow-up.

RESULTS

In Study 1, higher state social anhedonia was associated with greater levels of suicidal ideation, while trait social anhedonia moderated the relationship between thwarted belongingness, perceived burdensomeness and suicidal ideation. In Study 2, state social anhedonia was margin significant predictor of suicidal ideation, while trait social anhedonia moderated the relationship between psychological pain and suicidal ideation.

CONCLUSIONS

These findings confirmed the presence of two different effects on suicidal ideation in state and trait social anhedonia: state social anhedonia directly was associated with suicidal ideation, while trait social anhedonia was indirectly related through their effects on other risk factors of suicidality.

Does treatment method matter? A meta-analysis of the past 20 years of research on therapeutic interventions for self-harm and suicidal ideation in adolescents

BACKGROUND

Self-harm is a clinically relevant and prevalent behaviour which peaks in adolescence. Given the high prevalence of self-harm, the high levels of psychiatric comorbidity, and its role as a risk factor for suicide, delivering evidence-based care is critical.

METHODS

We conducted a systematic review and meta-analysis of the literature on treating self-harm in adolescents (12-19 years) published in the last 20 years, identifying 25 randomised controlled trials. We calculated the effect of treatment interventions relative to active control conditions in reducing self-harm, suicidal ideation and depressive symptoms.

RESULTS

Overall, treatment interventions fared slightly better than active controls in decreasing self-harm (d = 0.13, 95% CI 0.04-0.22, p = .004), suicidal ideation (d = 0.31, 95% CI 0.12-0.50, p = .001) and depressive symptoms (d = 0.22, 95% CI 0.07-0.38, p = .006). Subgroup analysis of specific therapies revealed moderate effects of DBT-A in reducing self-harm (d = 0.51, 95% CI 0.18-0.85, p = .002) and suicidal ideation (d = 0.48, 95% CI 0.17-0.80, p = .003), as well as moderate effects of family-centred therapy in the treating suicidal ideation (d = 0.58, 95% CI 0.01-1.15, p = .049).

CONCLUSIONS

The findings of our meta-analysis indicate that, overall, currently available treatments are effective in treating self-harm, suicidal ideation, and depressive symptoms in adolescence. Although the treatment intervention conditions showed only small to moderate effects in comparison to active controls, these differences were statistically significant and are clinically important. Further research is needed to understand the reduction in self-harm within active controls, which may arise due to the natural course of self-harm, or the potential efficacy of treatment as usual and enhanced usual care. Given the significant reduction of self-harm in active control conditions, delivering effective care to a large number of adolescents with self-harm may require developing stepped-care models in clinical practice. Expensive and poorly available treatments should be targeted at young people who most need them.

A multi factorial model of self-harm behaviors in Anorexia-nervosa and Bulimia-nervosa

BACKGROUND

Co-existence of eating disorders and NSSI, suicide attempts and ideations is well established yet much is not known about the personality traits and behavioral tendencies that maintain this relationship. To this date no empirical work has been produced that offers a multifactorial view on the contributing variables to the occurrence of self-harm behaviors in EDs.

METHOD

Binge eating, depression, impulsivity, ruminations and loss aversion were assessed in a sample of 93 patients diagnosed with Anorexia-Nervosa and Bulimia-Nervosa and other EDs with a history of NSSI and suicide attempts.

RESULTS

Binge eating was found to be a predictor of depression, which in turn was found to be related to NSSI frequency, suicide attempts and suicide ideations. Ruminations were found to mediate a relationship between depression and suicide ideations. Trait impulsivity predicted suicide attempts, while the attentional construct of impulsivity was associated to suicide ideations as well as attempts. Higher loss aversion was positively associated with NSSI frequency and suicide ideations.

CONCLUSION

Our findings suggest that trait and state aspects of impulsivity are related to different self-harm behaviors in EDs. Exploring these differences is potentially of great value in understanding the process of transition from suicidal ideation to suicide attempt and the process of NSSI and may assist clinicians formulate better interventions for patients with EDs at risk. Ways in which individual findings in our model correspond with previous research and future implications are discussed.

The Fear of Losing-Nonsuicidal Self-Injury as a Protective Mechanism in Eating Disorders

Background: This study examined the moderating role of loss aversion (LA) on the relationship between impulsivity, nonsuicidal self-injury (NSSI), suicidal attempts, and ideations among Eating Disorder (ED) patients. Methods: Data was collected on 81 ED patients and 37 healthy controls. ED patients were divided into 2 groups: 25 AN-Rs, 56 AN-BPs and BNs. Measurements of trait impulsivity, LA, NSSI, suicide attempts, and suicide ideations were collected. Results: The rate of attempting suicide was highest in the AN-BP/BN (34.8%), lower in the AN-Rs (8%), and the lowest in the controls (2.7%). Suicide ideation was also higher in AN-BP/BN compared to both AN-R and controls. NSSI was higher in the AN-BP/BN group compared to both AN-R and control groups. LA scores were lower among participants with EDs compared to controls. BMI and depression were positively associated with suicide ideation and NSSI. Impulsivity was associated to suicide attempt and suicide ideation. Contrary to our hypothesis, LA scores were positively correlated with NSSI and SI. A stepwise regression revealed that contradictory to our hypothesis, higher LA predicted NSSI prevalence severity of NSSI and suicide ideation. Limitations: (1) Cross-sectional design; (2) Relatively small sample size of clinical subjects and only female participants; (3) Heterogeneity of treatment status. Conclusions: EDs are associated with lower levels of LA compared to general population. Although high LA is considered a protective factor against "high damage" decisions, it may serve as a facilitator of lower risk decisions which help the individual soothe and communicate his or her own suffering such as NSSI.

Suicide and suicide risk

Although recent years have seen large decreases in the overall global rate of suicide fatalities, this trend is not reflected everywhere. Suicide and suicidal behaviour continue to present key challenges for public policy and health services, with increasing suicide deaths in some countries such as the USA. The development of suicide risk is complex, involving contributions from biological (including genetics), psychological (such as certain personality traits), clinical (such as comorbid psychiatric illness), social and environmental factors. The involvement of multiple risk factors in conveying risk of suicide means that determining an individual's risk of suicide is challenging. Improving risk assessment, for example, by using computer testing and genetic screening, is an area of ongoing research. Prevention is key to reduce the number of suicide deaths and prevention efforts include universal, selective and indicated interventions, although these interventions are often delivered in combination. These interventions, combined with psychological (such as cognitive behavioural therapy, caring contacts and safety planning) and pharmacological treatments (for example, clozapine and ketamine) along with coordinated social and public health initiatives, should continue to improve the management of individuals who are suicidal and decrease suicide-associated morbidity.

Self-injuring adolescent girls exhibit insular cortex volumetric abnormalities that are similar to those seen in adults with borderline personality disorder

Self-inflicted injury (SII) in adolescence is a serious public health concern that portends prospective vulnerability to internalizing and externalizing psychopathology, borderline personality development, suicide attempts, and suicide. To date, however, our understanding of neurobiological vulnerabilities to SII is limited. Behaviorally, affect dysregulation is common among those who self-injure. This suggests ineffective cortical modulation of emotion, as observed among adults with borderline personality disorder. In borderline samples, structural and functional abnormalities are observed in several frontal regions that subserve emotion regulation (e.g., anterior cingulate, insula, dorsolateral prefrontal cortex). However, no volumetric analyses of cortical brain regions have been conducted among self-injuring adolescents. We used voxel-based morphometry to compare cortical gray matter volumes between self-injuring adolescent girls, ages 13-19 years (n = 20), and controls (n = 20). Whole-brain analyses revealed reduced gray matter volumes among self-injurers in the insular cortex bilaterally, and in the right inferior frontal gyrus, an adjacent neural structure also implicated in emotion and self-regulation. Insular and inferior frontal gyrus gray matter volumes correlated inversely with self-reported emotion dysregulation, over-and-above effects of psychopathology. Findings are consistent with an emotion dysregulation construal of SII, and indicate structural abnormalities in some but not all cortical brain regions implicated in borderline personality disorder among adults.

A Psycholinguistic Analysis of Responses to Live-Stream Suicides on Social Media

Live-stream suicide has become an emerging public health problem in many countries. Regular users are often the first to witness and respond to such suicides, emphasizing their impact on the success of crisis intervention. In order to reduce the likelihood of suicide deaths, this paper aims to use psycholinguistic analysis methods to facilitate automatic detection of negative expressions in responses to live-stream suicides on social media. In this paper, a total of 7212 comments posted on suicide-related messages were collected and analyzed. First, a content analysis was performed to investigate the nature of each comment (negative or not). Second, the simplified Chinese version of the LIWC software was used to extract 75 psycholinguistic features from each comment. Third, based on 19 selected key features, four classification models were established to differentiate between comments with and without negative expressions. Results showed that 19.55% of 7212 comments were recognized as "making negative responses". Among the four classification models, the highest values of Precision, Recall, F-Measure, and Screening Efficacy reached 69.8%, 85.9%, 72.9%, and 47.1%, respectively. This paper confirms the need for campaigns to reduce negative responses to live-stream suicides and support the use of psycholinguistic analysis methods to improve suicide prevention efforts.

Expressive suppression mediates the relation between disordered eating and suicidal ideation

OBJECTIVE

Although disordered eating is robustly associated with suicidal thoughts, it is not well understood why these conditions relate to each other. Emotion dysregulation is a shared risk factor for disordered eating and suicidal thoughts. Individuals with dysregulated emotions struggle to select appropriate strategies to modulate emotions and the strategies they use might explain some of the shared variances. Thus, we examined whether emotion regulation strategies mediated the relationship between disordered eating and suicidal ideation.

METHOD

Adult participants (N = 230) completed questionnaires on current disordered eating symptoms, emotion regulation strategies, and current suicidal ideation.

RESULTS

Disordered eating symptoms positively associated with suicidal ideation. In addition, expressive suppression mediated the relation between disordered eating symptoms and current suicidal ideation. No relation was found for cognitive reappraisal.

CONCLUSIONS

The use of expressive suppression as an emotion regulation strategy may be related to increased suicidal ideation in individuals who express concerns about eating.

Scale of psychological pain: Spanish adaptation of the Psychache Scale in young adults

INTRODUCTION

Psychological pain is understood as an intolerable and disturbing mental state characterized by an internal experience of negative emotions. This study was aimed at making a Spanish adaptation of the Psychache Scale by Holden and colleagues in a sample of young adults.

MATERIAL AND METHODS

The scale evaluates psychological pain as a subjective experience. It is composed of 13 items with a Likert-type response format. Following the guidelines of the International Tests Commission for the adaptation of the test, we obtained a version conceptually and linguistically equivalent to the original scale. Through an online questionnaire, participants completed the psychological pain scale along with other scales to measure depression (BDI-II), hopelessness (Beck's scale of hopelessness) and suicide risk (Plutchik suicide risk scale). The participants were 234 people (94 men, 137 women and three people who identified as a different sex) from 18 to 35 years old.

RESULTS

The EFA showed a one-factor solution, and the FCA revealed adequate indexes of adjustment to the unifactorial model. It also showed good reliability of the test scores. The evidence of validity of the scale in relation to the other variables showed high, positive and statistically significant correlations with depression, hopelessness, suicidal ideation and suicidal risk.

CONCLUSION

In summary, this Spanish adaptation of the Psychache Scale could contribute to improving the evaluation of both the patient with suicide risk and the effectiveness of psychological therapy, as well as suicidal behaviour prevention and intervention.

Effect of Altitude on Veteran Suicide Rates

Aims: Suicide rates in the general population in the United States are correlated with altitude. To explore factors contributing to suicide among military veterans, we examined the relationship between veteran state-level suicide rates and altitude for 2014, including firearm-related and nonfirearm-related rates. Methods: Pearson's coefficients were calculated for altitude and each outcome. Mixed linear models were used to determine the association between suicide and altitude while adjusting for demographic confounds. Results: State mean altitude was significantly correlated with total veteran suicide rate (r = 0.678, p < 0.0001), veteran firearm-related suicide rate (r = 0.578, p < 0.0001), and veteran nonfirearm suicide rate (r = 0.609, p < 0.0001). In mixed models, altitude was significantly correlated with total veteran suicide rate (β = 0.331, p < 0.05), veteran firearm suicides (β = 0.282, p < 0.05), and veteran nonfirearm suicides (β = 0.393, p < 0.05). Conclusion: This study adds to evidence linking altitude and suicide rates, arguing for additional research into the relationship between altitude and suicide among veterans.

Suicidal behaviors and irritability in children and adolescents: a systematic review of the nature and mechanisms of the association

While many psychiatric disorders are associated with an increased risk for suicidal behaviors (SB) in children and adolescents, a few studies have explored the role of clinical symptoms based on a dimensional approach. Irritability is seen as a marker, a general psychopathology, and a symptom of both externalizing and internalizing disorders. In this review, we are interested in determining whether and how irritability can predict SB in youth. First, we reviewed consistencies and variation in the literature linking irritability to suicidal ideation (SI) and suicide attempt (SA). Second, based on the available models, we proposed specific mechanistic pathways, whereby irritability may modulate the risk for SB. Irritability has been found associated with SB both in cross-sectional and in longitudinal studies. The relation is consistent in different settings (i.e., general population and clinical settings) and across psychiatric disorders. The association is reduced but persists after adjusting for psychiatric disorder, including depression. On one hand, irritability constitutes a risk factor for SI via the onset of internalized disorder. On the other hand, irritable youth may be more prone to attempt suicide when experiencing SI. The measures for irritability were heterogeneous. A limited number of studies were designed to explore the role of mediators and/or moderators. Recognizing irritability in children and adolescents is a key issue with regards to suicide prevention.

More than just statics: temporal dynamics of intrinsic brain activity predicts the suicidal ideation in depressed patients

BACKGROUND

Major depressive disorder (MDD) is associated with high risk of suicide. Conventional neuroimaging works showed abnormalities of static brain activity and connectivity in MDD with suicidal ideation (SI). However, little is known regarding alterations of brain dynamics. More broadly, it remains unclear whether temporal dynamics of the brain activity could predict the prognosis of SI.

METHODS

We included MDD patients (n = 48) with and without SI and age-, gender-, and education-matched healthy controls (n = 30) who underwent resting-state functional magnetic resonance imaging. We first assessed dynamic amplitude of low-frequency fluctuation (dALFF) - a proxy for intrinsic brain activity (iBA) - using sliding-window analysis. Furthermore, the temporal variability (dynamics) of iBA was quantified as the variance of dALFF over time. In addition, the prediction of the severity of SI from temporal variability was conducted using a general linear model.

RESULTS

Compared with MDD without SI, the SI group showed decreased brain dynamics (less temporal variability) in the dorsal anterior cingulate cortex, the left orbital frontal cortex, the left inferior temporal gyrus, and the left hippocampus. Importantly, these temporal variabilities could be used to predict the severity of SI (r = 0.43, p = 0.03), whereas static ALFF could not in the current data set.

CONCLUSIONS

These findings suggest that alterations of temporal variability in regions involved in executive and emotional processing are associated with SI in MDD patients. This novel predictive model using the dynamics of iBA could be useful in developing neuromarkers for clinical applications.

Predicting status along the continuum of suicidal thoughts and behavior among those with a history of nonsuicidal self-injury

Nonsuicidal self-injury (NSSI) and suicidal thoughts and behavior often co-occur, representing a growing public health concern. Despite extensive research examining suicidal thoughts and behavior among those who engage in NSSI, there is a lack of research investigating factors that, when considered together, can differentiate individuals along the continuum of suicidal thoughts and behavior (no history, suicidal ideation, suicide plan, suicide attempt). This study sought to address this question using a sample of 1178 college students with NSSI history (68.70% female). Discriminant function analysis was conducted including the following predictors: NSSI characteristics, negative affect difficulties, and behavioral and demographic risk factors for suicidal thoughts and behavior. Results suggest that self-disclosure of suicidal ideation, number of lifetime NSSI methods, NSSI frequency, depressive symptoms, and age most parsimoniously differentiate study groups. Those who use a greater number of NSSI methods and acts, paired with higher depressive symptoms and repeated self-disclosure of suicidal ideation are most likely to have a suicide attempt history; decreases in these variables suggest membership within less severe groups. Furthermore, older age may be related to greater suicidality. Findings suggest that the evaluation and co-occurrence of these variables may contribute to a more accurate suicide risk assessment.

Socio-demographic and psychological risk factors for suicidal behavior among individuals with anorexia and bulimia nervosa: A systematic review

OBJECTIVE

Suicide is the second leading cause of death among individuals with anorexia nervosa (AN) and is also elevated in bulimia nervosa (BN). We carried out a systematic review in which we analyzed the relationship between AN and/or BN and suicidality (i.e. suicidal ideation or attempted and/or death by suicide) and the major risk factors for suicidal behavior among AN and BN patients by synthesizing the qualitative data from relevant studies.

EVIDENCE ACQUISITION

According to PRISMA guidelines, we conducted a systematic search of the literature on PsycNET, PubMed, Google Scholar, and ScienceDirect. Search terms were "eating disorders" "OR" "anorexia" "OR" "bulimia" combined with the Boolean "AND" operator with "suicide."

EVIDENCE SYNTHESIS

The initial search identified 8,590 records, of which 38 research reports met the predefined inclusion criteria and were analyzed. Eating disorders (EDs) were found to be associated with a marked increase in suicidal behaviors and ideation. ED type, impulsivity, and specific interpersonal features were associated with suicidal behavior.

CONCLUSIONS

Our findings highlight the importance of the combined role of socio-demographic and psychological factors to the co-occurrence of EDs and suicidal behavior. It is imperative that a thorough suicide assessment be conducted routinely for individuals with past and current EDs, and that clinicians be aware that this risk may be ongoing and occur throughout treatment, even after ED symptoms appear to be remitting.

LIMITATIONS

Study limitations include diagnostic definitions of and criteria for EDs, and the different terminology used by researchers to define suicide, including non-suicidal behaviors, which weakens the ability to draw conclusions regarding actual suicidal behaviors versus other self-harm behaviors.

Mediators of childhood trauma and suicidality in a cohort of socio-economically deprived Scottish men

BACKGROUND

There is little research investigating the relationship between childhood abuse, including neglect, and suicidality in adult men, despite epidemiological data suggesting that they are most at risk for suicide.

OBJECTIVE

To investigate the relationship between childhood abuse and neglect and suicidality, and the possible mediating roles of affect dysregulation and social inhibition.

PARTICIPANTS AND SETTING

a cohort of eighty-six socio-economically deprived male Caucasian participants previously identified as suicidal, attending a non-clinical community group.

METHODS

Participants completed self-report measures on childhood trauma, emotion regulation, interpersonal difficulties and suicidal behavior.

RESULTS

Mediation analysis indicated that emotion dysregulation and interpersonal difficulties significantly mediated the relationship between childhood trauma and suicidality with a medium effect size (R² = .41, p < .001).

CONCLUSIONS

Study results suggest that early childhood abuse and neglect results in dysfunctional emotion regulation, which leads to suicidality in the context of impoverished social environments. The provision of psychological interventions aimed at improving social and emotional functioning may help to safeguard men who are most at risk of suicide.

A Look at Culture and Stigma of Suicide: Textual Analysis of Community Theatre Performances

Stigma against suicidal ideation and help-seeking is a significant barrier to prevention. Little detail is provided on what types of stigma interfere with help-seeking, how stigma is expressed, and how to reduce it. Five groups of two ethnically diverse community theatre programs were formed to analyze differences in Eastern Montana Caucasian and Native American adolescents and young adults’ experiences with stigma about mental illness and mental health treatment that affect help-seeking for suicidal thoughts and experiences. Over a ten-week period, a grassroots theatre project was used to recruit members from the same population as the audience to write and perform a play on suicide and depression (n = 33; 10 males, 23 females; 12 Native American, 21 Caucasian, ages 14–24). Using textual analysis, the community- and campus-based performance scripts were coded for themes related to stigma. Both ethnic groups reported that stigma is a barrier to expressing emotional vulnerability, seeking help, and acknowledging mental illness. We found that Caucasians’ experiences were more individually oriented and Native Americans’ experiences were more collectively oriented. Understanding the cultural bases of experiences with stigma related to mental health treatment for suicide is necessary to create educational programs to reduce stigma for diverse groups of adolescents and young adults.

Altitude and risk of depression and anxiety: findings from the intern health study

Multiple studies suggest that the risks of depression and suicide increase with increasing altitude of residence, but no studies have assessed whether changing altitude changes these risks. To address this gap, this study used data from the Intern Health Study, which follows students from the end of medical school through the first year of residency, recording depression via the 9-item Patient Health Questionnaire (PHQ-9), anxiety via the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7), and multiple risk factors for these symptoms. Data from 3764 medical students representing 46 schools and 282 residencies were available. Odds ratios (OR) representing the effects of altitude on psychiatric symptoms were estimated using generalized linear models. After excluding participants with missing altitude data, 3731 medical students were analyzed. High altitude residence (> 900 m) was significantly associated with PHQ-9 total score (OR = 1.32, 95% CI = 1.001-1.75, p < 0.05), and PHQ-9 suicidal ideation (OR = 1.79, 95% CI = 1.08-0.02, p = 0.02). Moving from low to high altitude was significantly associated with PHQ-9 total score (OR = 1.47, 95% CI = 1.087-1.98, p = 0.01), GAD-7 total score (OR = 1.40, 95% CI = 1.0040-1.95, p < 0.05), and PHQ-9 suicidal ideation (OR = 1.10, 95% CI = 1.01-1.19, p = 0.02). The data suggest that moving from low to high altitude is associated with increasing symptoms of depression, anxiety, and suicidal ideation.

Association between completed suicide and bipolar disorder: A systematic review of the literature

BACKGROUND

Completed suicide is a major cause of death in bipolar disorder (BD) patients.

OBJECTIVE

The aim of this paper is to provide an overall review of the existing literature of completed suicide in BD patients, including clinical and genetic data DATA SOURCES: We performed a systematic review of English and non-English articles published on MEDLINE/PubMed, PsycInfo and Cochrane database (1970-2017). Additional studies were identified by contacting clinical experts, searching bibliographies, major textbooks and website of World Health Organization. Initially we did a broad search for the association of bipolar disorder and suicide and we were narrowing the search in terms included "bipolar disorder" and "completed suicide".

STUDY SELECTION

Inclusion criteria were articles about completed suicide in patients with BD. Articles exclusively focusing on suicide attempts and suicidal behaviour have been excluded. We used PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) consensus for drafting this systematic review.

RESULTS

The initial search generated 2806 articles and a total of 61 meeting our inclusion criteria. We reviewed epidemiological data, genetic factors, risk factors and treatment of completed suicide in BD. Suicide rates in BD vary between studies but our analyses show that they are approximately 20-30-fold greater than in general population. The highest risk of successful suicide was observed in BD-II subjects. The heritability of completed suicide is about 40% and some genes related to major neurotransmitter systems have been associated with suicide. Lithium is the only treatment that has shown anti-suicide potential.

LIMITATIONS

The most important limitation of the present review is the limited existing literature on completed suicide in BD.

CONCLUSIONS

BD patients are at high risk for suicide. It is possible to identify some factors related to completed suicide, such as early onset, family history of suicide among first-degree relatives, previous attempted suicides, comorbidities and treatment. However it is necessary to promote research on this serious health problem.

Personal Technology Use and Thwarted Belongingness Among Suicidal Active-Duty Military Personnel

This study (a) provides descriptive information about the personal technology use of a suicide sample of active-duty military personnel and (b) uses a traditional and a technology-based measure of social connectedness to examine their relation to suicide ideation and behaviors. Higher thwarted belongingness, and therefore lower perceived social connectedness, was associated with higher current and worst suicide ideation and a greater lifetime self-directed violence regardless of intent to die. Higher social connectedness based on personal technology usage was associated with higher current suicide ideation and a higher number of lifetime self-directed violence and suicide attempts.

Biological and Behavioral Mechanisms of Identity Pathology Development: An Integrative Review

Although identity disturbance is a transdiagnostic mental health problem, modern explanatory models for its emergence are limited. To date, the social, developmental, clinical, and neuropsychological literatures exploring identity processes are also largely disconnected. Existing theories have laid the foundation for understanding important components of identity pathology, yet many overlook biological, behavioral, and interactive processes by which these difficulties may emerge. In this integrative review, we explore how broad transdiagnostic vulnerabilities for psychopathology and more specific risky behavioral processes may reciprocally interact and be refined over time into an identity disturbance profile. Our primary purpose is to review behavioral and biosocial theories and derive a testable conceptual framework for how identity disturbance emerges over the course of development. We aim to describe and integrate several disparate lines of theory and research in order to illuminate potential etiological pathways to identity pathology.

The rate of reply and nature of responses to suicide-related posts on Twitter

The social media platform Twitter has been used by individuals to communicate suicidal thoughts and intentions. Currently, the nature and rate of reply to this type of Twitter content is unknown. This brief report aimed to understand how Twitter users respond to suicide-related content as compared to non-suicide related content. Using a dataset of suicide and non-suicide related posts, replies, retweets and likes were analysed and compared. The content of the first replies to suicide-related posts were also reviewed. When compared to non-suicide related posts, those that were suicide-related received a significantly greater number of replies, with fewer retweets and likes. The rate of reply to the suicide-related posts was also significantly faster than that of the non-suicide related posts, with the average reply occurring within 1 h. Thematic analysis revealed that 62% of the first replies to suicidal posts were of a potentially helpful nature (e.g. discouraging suicide, caring, or clarifying), while 23% were dismissive or encouraging of the suicide. These findings indicate that Twitter users respond differently to suicidal content. Further research is needed to determine the effects of the replies on suicidal intentions or ideations, and whether this platform can be used to intervene, increase help-seeking, or provide anti-stigma campaigns.

Interest of neuroimaging of social exclusion in suicide

With one million deaths worldwide, suicide is a major health issue. The frequency of life events preceding suicidal act is high and raises the question of their role in suicidal process. At biological level, dysfunctional neural processing of social exclusion may participate in suicidal risk through an increased perception of social adversity in vulnerable subjects. The purpose of this narrative review is to discuss neuroimaging findings related to social exclusion and loneliness, and to open new perspectives to investigate sensitivity to social stress in suicide.

The (Suicidal-) Depressive Position: A Scientifically Informed Reformulation

Despite considerable progress in depression research and treatment, the disorder continues to pose daunting challenges to scientists and practitioners alike. This article presents a novel conceptualization of the psychological dynamics of depression which draws from Melanie Klein's notion of the positions, reformulated using social-cognitive terms. Specifically, Klein's notion of position, consisting of anxieties (persecutory vs. "depressive"), defense mechanisms ("primitive"/split based vs. neurotic/repression based), and object relations (part vs. whole) is reformulated to include (1) affect, broadly defined, (2) affect regulatory strategies (defense mechanisms, coping strategies, and motivation regulation), and (3) mental representations of self-with-others, all pertaining to the past, present, and future. I reformulate the depressive position to include-beyond sadness, anxiety, and anhedonia-also anger/agitation, shame, disgust, and contempt, all of which are down-regulated via diverse mechanisms. In the depressive position, the self is experienced as wronged and others as punitive, albeit seductive. Attempts to appease internal others (objects) are projected into the future, only to be thwarted by awkward and inept interpersonal behavior. This might propel the use of counter-phobic, counter-dependent, and "manic" affect regulatory mechanisms, potentially leading to suicidal depression.