Are we studying the right populations to understand suicide?

Rural Suicide: Demographics, Causes, and Treatment Implications

Suicide rates in rural areas are higher than urban areas and growing, with current treatment developments only exacerbating this discrepancy. Within individual factors, both age and gender relate to and intersect with personal values related to self-reliance and attitudes toward mental health difficulties and treatment to increase suicide risk. The lethality ubiquitous in rural environments and occupations is a leading factor in rural suicide rates, with other factors such as race alternately noted to be a key factor but with more mixed findings. The cultural values of rural communities as typically negative toward mental health disclosure and treatment contribute to the disengagement of rural communities from treatment that may otherwise prevent suicides, exacerbating the physical lack of treatment access many rural communities experience. Working within the primary care system alongside increased telehealth utilization are suggested to reduce rural suicide rates.

Prevalence and factors associated with suicidal ideation and attempts among war-affected internally displaced people in northwest Ethiopia, 2022

BACKGROUND

People who are forced to leave home often experience emotional suffering and may be disproportionately subjected to risk factors for suicide. Although it is a grave concern for the global public health community, it has not been understood in Ethiopia.

AIMS

This study aims to assess the prevalence and factors associated with suicidal ideation and attempts among war-affected internally displaced people in northwest Ethiopia, 2022.

METHOD

From 23 May to 22 June 2022, a cross-sectional study design was conducted, and a sample of 765 participants was selected through simple random sampling. A structured interview was employed to collect data. Suicidal ideation and attempts were assessed using the Composite International Diagnostic Interview.

RESULTS

Out of 751 interviewed participants with a response rate of 98.2%, the magnitude of suicidal ideation and attempt was 22.4% (95% CI: 19.5%, 25.4%) and 6.7% (95% CI: 5.1%, 8.7%), respectively. People of female gender, having depression, family with a history of mental illness, and poor social support were significantly associated with both suicidal ideation and attempts. Furthermore, post-traumatic stress symptoms and the death of a family member were significantly associated with suicide ideation and attempt, respectively.

CONCLUSION

At least one in five of the displaced people in this population had experienced suicide ideation, and one in fifteen had attempted suicide. Therefore, strengthening early detection and intervention for individuals is recommended, especially for females with depression, post-traumatic stress symptoms, family with a history of mental illness, poor social support and the death of family members.

Case fatality of repeated suicidal acts among suicide attempters in rural China: a retrospective cohort study

Background

Individuals presenting to hospital due to suicide attempt are at high risk for repeated suicidal act, yet there are meager data on the extent to which repeated suicidal acts result in death.

Methods

This retrospective cohort study was based on a general hospital self-harm register system in a rural county in China. Identified individuals who attempted suicide were contacted and followed up for up to 8 years. Main outcomes over follow-up were: 1) suicide death, 2) nonlethal suicide attempt, and 3) suicidal acts including suicide death and nonlethal attempt. Incidence densities, correlates, and case fatality of repeated suicidal acts were estimated.

Findings

A total of 1086 individuals (two-thirds females, mean age 40.6 years) with a suicide attempt presenting to hospital (index attempt) were identified and followed up, with most of the index attempts by pesticide ingestion (79%). Over follow-up, there were 116 suicidal acts carried out by 108 individuals (69 females, 39 males), including 34 suicide deaths (21 females, 13 males), yielding a high case-fatality of 29.3%. During follow-up, suicide death rates were also high overall and in the first year of follow-up (846.7 and 1787.2 per 100,000 person years). Over follow-up, pesticide was the most common method (47/116) of repeated suicidal act and yielded a higher case-fatality than other methods (46.8% vs 17.4%, χ2 = 11.68, P < 0.001). The incidence densities of repeated suicidal acts and nonlethal attempts were low compared to rates reported in previous literature.

Interpretation

Incidence densities of repeated suicidal acts in a rural China cohort were low compared to previous studies. However, rates of suicide deaths over follow-up were high, a result driven by the high case-fatality of suicidal acts and attributable to the common use of pesticides. Reducing suicidal acts with pesticides is a key target for suicide prevention in rural China.

Funding

Beijing Municipal High Rank Public Health Researcher Training Program, Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support, and Beijing Hospitals Authority's Ascent Plan.

Lower risk of hospitalisation for depression following hospitalisation for COVID-19 versus for another reason

INTRODUCTION

Although hospitalisation for COVID-19 is associated with a higher post-discharge risk of mood disorders, including major depressive disorder (MDD) and bipolar disorder (BD), this risk has not been compared to that following hospitalisation for a reason other than COVID-19.

METHODS

Using data from France's National Health Data System (SNDS) database, we compared patients hospitalised for mood disorders in the 12 months following COVID-19/another reason hospitalisation.

RESULTS

96,313 adult individuals were hospitalised for COVID-19, and 2,979,775 were hospitalised for another reason. In the 12 months post-discharge, 110,976 (3.83 %) patients were hospitalised for mood disorders. In unadjusted analyses, patients initially hospitalised for COVID-19 (versus another reason) were more likely to be subsequently hospitalised for a mood disorder (4.27 % versus 3.82 % versus, respectively, p < 0.0001). These patients were also more likely to have a history of mood disorders, especially depressive disorders (6.45 % versus 5.77 %, respectively, p < 0.0001). Women, older age, lower social deprivation, a history of mood disorders, longer initial hospitalisation (COVID-19 or other), and a higher level of clinical care during initial hospitalisation were all significantly associated with the risk of subsequent hospitalisation for MDD and BD. In contrast, after adjusting for all these factors, persons initially hospitalised for COVID-19 were less likely to be subsequently hospitalised for MDD (OR = 0.902 [0.870-0.935]; p < 0.0001). No difference between both groups was observed for BD.

LIMITATIONS

Other reasons were not separately studied.

CONCLUSIONS

After adjusting for confounding factors, initial hospitalisation for COVID-19 versus for another reason was associated with a lower risk of hospitalisation for a mood disorder.

Prevalence of suicidality and associated factors of suicide risk in a representative community sample of families in three East African refugee camps

PURPOSE

To assess the prevalence of suicidality and associated factors of suicide risk in a sample of Burundian refugee families living in three refugee camps in Tanzania.

METHODS

Children (n = 230) and their parents (n = 460) were randomly selected and interviewed about suicidality (suicidal ideation, plans, and attempts) and a range of sociodemographic, psychological, and environmental factors. Multinomial logistic regression analyses were conducted to examine factors associated with children and parents' lower and moderate or high current suicide risk.

RESULTS

Past-month prevalence of suicidal ideation, plans, and attempts were 11.3%, 0.9% and 0.9%, respectively, among children; 37.4%, 7.4% and 5.2%, respectively, among mothers; and 29.6%, 4.8% and 1.7%, respectively, among fathers. Older age in years (aORlower = 2.20, 95% CI 1.38-3.51; aORmoderate/high = 3.03, 95% CI 1.15-7.99) and higher levels of posttraumatic stress disorder symptoms (aORlower = 1.64, 95% CI 1.05-2.57; aORmoderate/high = 2.30, 95% CI: 1.02-5.16), internalizing (aORmoderate/high = 2.88, 95% CI 1.33-6.26) and externalizing problems (aORlower = 1.56, 95% CI: 1.06-2.31; aORmoderate/high = 3.03, 95% CI 1.42-6.49) were significantly positively associated with children's current suicide risk. For mothers, higher perceived instrumental social support (aORmoderate/high = 0.05, 95% CI < 0.01-0.58) was significantly negatively related to suicide risk, whereas exposure to community violence (aORlower = 1.97, 95% CI 1.30-2.99; aORmoderate/high = 1.59, 95% CI 1.00-2.52), living in larger households (aORlower = 1.74, 95% CI 1.17-2.57), and higher psychological distress (aORmoderate/high = 1.67, 95% CI 1.05-2.67) were significantly positively associated with suicide risk. For fathers, higher perceived instrumental social support (aORmoderate/high = 0.04, 95% CI < 0.01-0.44) and having more years of formal education (aORmoderate/high = 0.58, 95% CI 0.34-0.98) were significantly negatively and exposure to war-related trauma (aORmoderate/high = 1.81, 95% CI 1.03-3.19) was significantly positively associated with suicide risk.

CONCLUSION

Prevention programs should target psychopathology, community violence and social support to mitigate children and parents' current suicide risk.

Longitudinal trajectories of suicidal ideation and attempts in adolescents with psychiatric disorders in Chile: study protocol

INTRODUCTION

Adolescent suicide is a worldwide public health problem, being the second and the third leading cause of death in the 15-29 and the 15-19 age groups, respectively. Among adolescents, it is estimated that for every suicide, there are 100-200 suicide attempts. Although 79% of suicides in the world occur in low/middle-income countries, most of scientific evidence comes from high-income and low-risk countries. In recent years, adolescent suicide rates have steadily increased in Chile. Deaths caused by self-harm increased by 220% in the population aged 10-19 years between 2000 and 2015. The Maule Region is one of the regions of Chile with the highest levels of suicide among those aged 15 and 19 years old. The objective of this study is to evaluate the trajectories of ideation and suicidal attempts in adolescents with psychiatric disorders treated within the public health system of the Maule Region, Chile, based on different clinical, psychological and neuropsychological factors.

METHOD

A prospective naturalistic study of a clinical sample of adolescents under psychiatric treatment in the Maule Region, Chile. Adolescents will be evaluated using a thorough protocol that includes suicide-related clinical variables. The study seeks to establish patterns of change in the trajectories of ideation and suicide attempts among adolescents.

ETHICS AND DISSEMINATION

Ethical approval was granted by the Scientific Ethics Committee of the Universidad Católica del Maule in Chile. This protocol was registered in ClinicalTrials.gov. The results of this study will be disseminated to health centres through executive reports and feedback sessions. In addition, the most relevant findings will be presented in scientific articles, conferences and seminars open to the community.

TRIAL REGISTRATION NUMBER

NCT04635163.

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.

Community-based participatory research: Suicide prevention for youth at highest risk in Guyana

Studied mostly in developed countries, the increased prevalence of suicide among youth, worldwide, is a preventable public health concern. Guyana, a developing country in South America, has the highest rate of youth death by suicide. Based on the diathesis-stress model, this community-based study aimed to identify both psychiatric and biological factors associated with repeated suicide attempts among high-risk youth.

OBJECTIVE

We measured psychiatric symptoms, childhood traumas, and cortisol to identify correlates with recurrent suicide attempts.

METHOD

Poisson regression tested the association between psychiatric symptoms, trauma, and cortisol levels on number of suicide attempts among 50 youths from three child welfare orphanages in Guyana. Sixty-six percent were female, and the average age was 14 years. DSM-5 symptom measure was administered and saliva samples collected.

RESULTS

Fifty percent of the youth endorsed suicide attempt. Within this subsample, a minimum of one and maximum of five suicide attempts were self-reported. Participants' number of suicide attempts was positively associated with number of past traumas, psychosis, and depression symptoms.

CONCLUSION

Suicide prevention screening among at-risk youth should target severity of psychosis and depression reports and number of traumatic life experiences.

Predictive factors for the medical hospitalisation of patients who visited the emergency department with suicide attempt

BACKGROUND

Suicide is a significant public health problem. Individuals are estimated to make up to 20 suicide attempts before suicide. The emergency department (ED) is the first location where individuals are brought after a suicide attempt. This study investigated the factors related to delays in the medical hospitalisation of patients who attempted suicide and aimed to provide criteria for hospitalisation decisions by physicians.

METHODS

This study included patients who had deliberately self-harmed (age ≥ 19 years) and presented at the EDs of two tertiary teaching hospitals between March 2017 and April 2020. Those for whom relevant demographic and clinical information were unavailable and those admitted to the psychiatric wards were excluded.

RESULTS

This study included 414 patients in the hospitalisation group and 1346 in the discharged group. The mean patient age was 50.3 ± 20.0 years and 40.7 ± 17.0 years in the hospitalised and discharged groups (p < 0.001), respectively. The mean ED length of stay (LOS) was 4.2 ± 12.3 and 11.4 ± 18.8 h in the hospitalised and discharged groups, respectively. In the hospitalised group, the odds ratio and confidence interval for aged 35 ~ 64 (2.222, 1.343-3.678), aged over 65 (2.788, 1.416-5.492), sex -male (2.041, 1.302-3.119), and consciousness (1.840, 1.253-2.466). The Risk-Rescue Ratio Scale (RRRS) was (1.298, 1.255-1.343). A receiver operating characteristics analysis of RRRS for the decision to hospitalise patients who attempted suicide showed a cut-off value of 42, with sensitivity, specificity, and area under the curve being 85.7, 85.5%, and 0.924, respectively.

CONCLUSION

The level of consciousness and the RRRS of patients who attempted suicide can be the factors to decide medical hospitalisation and reduce ED LOS and crowding.

Sex, Gender, and Suicidal Behavior

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

Suicide and suicide attempts in adults: exploring suicide risk 24 months after a psychiatric emergency room visit

Objective:

Suicide risk (including attempted and completed suicide) should be measured over short periods of time after contacting health services. The objective of this study was to identify the patterns of attempted and completed suicides within 24-months of a psychiatric emergency department visit, as well as to investigate predictive risk factors, including sociodemographic and clinical variables, previous suicidal behavior, and service utilization.

Method:

A convenience sample (n=147), recruited at a general hospital’s psychiatric emergency room, included patients with suicidal ideation, suicidal plans or previous suicide attempts. These patients were followed for 24 months, focusing on two main outcomes: attempted and completed suicides.

Results:

After six months there were no completed suicides and 36 suicide attempts, while after 24 months there were seven completed suicides and 69 suicide attempts. A final logistic regression model for suicide attempts at 24 months identified somatic pathology and the number of previous psychiatric hospitalizations as predictive factors, with a good area under the receiver operating characteristic curve.

Conclusions:

The findings showed distinct patterns of attempted and completed suicides over time, indicating the importance of a systematic multidisciplinary suicide risk evaluation in psychiatric emergency rooms.

Why Are Suicide Rates Increasing in the United States? Towards a Multilevel Reimagination of Suicide Prevention

Suicide, a major public health concern, takes around 800,000 lives globally every year and is the second leading cause of death among adolescents and young adults. Despite substantial prevention efforts, between 1999 and 2017, suicide and nonfatal self-injury rates have experienced unprecedented increases across the United States - as well as in many other countries in the world. This chapter reviews the existing evidence on the causes behind increased suicide rates and critically evaluates the impact of a range of innovative approaches to suicide prevention. First, we briefly describe current trends in suicide and suicidal behaviors and relate them to recent time trends in relevant suicide risk markers. Then, we review the existing evidence in suicide prevention at the individual and the population levels, including new approaches that are currently under development. Finally, we advocate for a new generation of suicide research that examines causal factors beyond the proximal and clinical and fosters a socially conscious reimagining of suicidal prevention. To this end, we emphasize the need for the conceptualization of suicide and suicidal behaviors as complex phenomena with causes at several levels of organization. Future interdisciplinary research and interventions should be developed within a multilevel causal framework that can better capture the social, economic, and political settings where suicide, as a process, unfolds across the life course.

Barriers for the Research, Prevention, and Treatment of Suicidal Behavior

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

An Emergency Department-Initiated Intervention to Lower Relapse Risk after Attempted Suicide

OBJECTIVE

According to randomized trials, contact after a suicide attempt lowers relapse risk. However, effectiveness studies based on real clinical data can provide additional external validity.

METHOD

We conducted an observational study to determine if an emergency department (ED)-initiated intervention for suicide attempt risk reduction, consisting on scheduling a single added appointment within 7 days after discharge following a suicide attempt, can reduce the risk of relapse. The study included 1,775 patients who had been treated at a general hospital ED due to a suicide attempt. The principal outcome measure was ED return after a new attempt. We obtained Kaplan-Meier survival functions and used Cox proportional hazard regression models to estimate unadjusted and adjusted risks of relapse by treatment phase. Covariates included: age, gender, history of suicide attempts, history of psychiatric disorders, concurrent alcohol/drug abuse, number of attempts during follow-up, admission as an inpatient and family support.

RESULTS

A total of 497 (22.5%) attempts were followed by a relapse. Subjects exposed to the studied intervention had a lower risk of relapse after a suicide attempt, with a 24% adjusted risk reduction estimate.

CONCLUSION

Our real-world results suggest that an additional early appointment, scheduled before discharging suicide attempters, reduces suicide reattempt risk.

Risk of suicide in households threatened with eviction: the role of banks and social support

Background

One of the greatest effects of the financial crisis in Spain has been the enormous increase in the number of evictions. Several studies have shown the association of evictions with different aspects of the physical and mental health. Furthermore, evictions have been associated with an increased risk of suicide. Our objective was to evaluate the risk of suicide among victims of eviction and investigate whether it is associated with specific characteristics of households and interviewees, the eviction process and social support, and health needs.

Methods

A total of 205 participants from households threatened with eviction in Granada, Spain, and 673 being the total number of members of these households, were interviewed in one-on-one sessions between April 2013 and May 2014. Through a questionnaire, information was obtained on physical and mental health, characteristics of their eviction process and support networks, and the use of health services.

Results

Almost half of the sample (46.7%) were at low (11.8%), moderate (16.9%), or high suicide risk (17.9%). Household and interviewee features had a limited association with suicide risk. On the contrary, the risk of suicide is greater with a longer exposure to the eviction process. In addition, threatening phone calls from banks increased significantly the risk of suicide, especially among men. Suicide risk was also associated with low social support, especially among women. Interviewees at risk of suicide received more help from nongovernmental organizations than those who were not at risk. In interviewees at risk, the main unmet needs were emotional and psychological help, especially in men. A high percentage of those at risk of suicide declare having large unmeet health needs. Finally, there was a tendency among the evicted at risk of suicide to visit emergency room and primary care more often than those not at risk, especially among women.

Conclusions

To our knowledge, this is the first study showing that when banks adopt a threatening attitude, suicide risk increases among the evicted. As hypothesized, when the evicted felt socially supported, suicide risk decreased. Emotional help was the main mediator of suicide risk and the main unmet need, especially among men.

Domestic violence and suicide attempts among married women: A case-control study

AIMS AND OBJECTIVES

To investigate the impact of domestic violence-related factors on suicide attempt in married women.

BACKGROUND

Suicide is a global public health concern that poses significant burden on individuals, families and communities. There is limited research on factors predicting suicide attempt in women.

DESIGN

A retrospective case-control design was adopted.

METHODS

Using a convenience sampling method, 610 participants, admitted to a teaching referral hospital in Northwest of Iran, were recruited to the study and assigned to case or control groups based on whether or not they had attempted suicide. The participants in two groups were matched in the terms of important demographic characteristics. Domestic violence-related factors were considered as independent variables and suicide attempt as dependent variable. Descriptive statistics, and simple and multivariate logistic regression analysis were used to analyse the data. Odds ratios (OR) of domestic violence-related factors were compared between the groups. We used STROBE checklist as an EQUATOR in this study.

RESULTS

The mean age of participants in the case and control groups was 28.4 and 29.45 years, respectively. The infidelity was the strongest predictor of suicide attempt in women (OR 44.57, 95%CI 6.08-326. 63, p < 0.001), followed by being threatened to physical assault by husband (OR 37.01, 95%CI 11.54-118.67, p < 0.001), jealousy of husband (OR 23.46, 95%CI 11.63-47.30, p < 0.001), and previous attempts to divorce (OR 16.55, 95%CI 5.91-46.31, p < 0.001). Suicide attempt was significantly lower in women who reported a sense of peace in life or lived with their mother or father-in-law (p < 0.001).

CONCLUSIONS

To reduce the risk of suicide in women, violence against women should be condemned and appropriate prevention measures be taken by health professionals.

RELEVANCE TO CLINICAL PRACTICE

Recognising risk, assessment and referral of victims of domestic violence should be an integral part of healthcare systems.

Clinical risk factors among youth at high risk for suicide in South Africa and Guyana

INTRODUCTION

Suicide is the second leading cause of death among youth worldwide, but low- and middle-income countries (LMICs) account for 78% of all suicides. The LMICs South Africa and Guyana rank high in the global suicide rates. To better understand and prevent suicide among the youth, the present study targets youths at high risk for suicide, in an LMIC, to contextually and representatively identify clinical risk factors for suicide.

METHODS

One hundred-ninety youths, aged 11-21, separated from biological parents at the time of assessment, in South Africa and Guyana, were administered the Child Behavior Checklist and Behavior Assessment System for Children to assess clinical symptoms. The youths were asked about current suicide ideation and previous attempt(s). Self-report responses to clinical items yielded scale scores for depression, social stress, atypicality, somatization, anxiety, and ADHD. Using an integrative data analytic technique, clinical scale scores were standardized and used to predict suicidal behaviors in a binary logistic regression analysis.

RESULTS

Approximately 22% of Black South African youths and 60% of Guyanese youths endorsed suicide ideation and attempt or suicide attempt only. In fully adjusted analyses, the odds of atypicality and somatization were 1.96 and 1.67 times greater among the youths who endorsed suicidal ideation when compared with those who did not (p < .04). Youth social stress was significantly associated with the suicide attempt, controlling for model covariates (odds ratio [OR], 1.88, p = .05). Gender moderated the effect of somatization on youth suicide.

CONCLUSION

Our results contextualize how social stress, atypicality, and somatization relate to LMIC youth suicide. Further study on high-risk samples will contribute to generalizable suicide-prevention models.

Annual Research Review: Suicide among youth - epidemiology, (potential) etiology, and treatment

BACKGROUND

Suicide is a leading cause of death and a complex clinical outcome. Here, we summarize the current state of research pertaining to suicidal thoughts and behaviors in youth. We review their definitions/measurement and phenomenology, epidemiology, potential etiological mechanisms, and psychological treatment and prevention efforts.

RESULTS

We identify key patterns and gaps in knowledge that should guide future work. Regarding epidemiology, the prevalence of suicidal thoughts and behaviors among youth varies across countries and sociodemographic populations. Despite this, studies are rarely conducted cross-nationally and do not uniformly account for high-risk populations. Regarding etiology, the majority of risk factors have been identified within the realm of environmental and psychological factors (notably negative affect-related processes), and most frequently using self-report measures. Little research has spanned across additional units of analyses including behavior, physiology, molecules, cells, and genes. Finally, there has been growing evidence in support of select psychotherapeutic treatment and prevention strategies, and preliminary evidence for technology-based interventions.

CONCLUSIONS

There is much work to be done to better understand suicidal thoughts and behaviors among youth. We strongly encourage future research to: (1) continue improving the conceptualization and operationalization of suicidal thoughts and behaviors; (2) improve etiological understanding by focusing on individual (preferably malleable) mechanisms; (3) improve etiological understanding also by integrating findings across multiple units of analyses and developing short-term prediction models; (4) demonstrate greater developmental sensitivity overall; and (5) account for diverse high-risk populations via sampling and reporting of sample characteristics. These serve as initial steps to improve the scientific approach, knowledge base, and ultimately prevention of suicidal thoughts and behaviors among youth.

Psychiatrists' experiences of suicide assessment

BACKGROUND

Clinical guidelines for suicide prevention often stress the identification of risk and protective factors as well as the evaluation of suicidal intent. However, we know very little about what psychiatrists actually do when they make these assessments. The aim was to investigate psychiatrists' own accounts of suicide assessment consultations, with a focus on their behaviors, attitudes and emotions.

METHOD

Semi-structured in depth interviews were carried out with a purposive selection of 15 psychiatrists.

RESULTS

Thematic analysis revealed three main themes: understanding the patient in a precarious situation, understanding one's own reactions, and understanding how the doctor-patient relationship impacted on risk assessment and management decisions. Emotional contact and credibility issues were common subthemes that arose when the respondents talked about trying to understand the patient. The psychiatrists stressed the semi-intuitive nature of their assessments. Problems related to the use of risk factor assessments and rating scales were apparent. Assessment consultations could evoke physical and emotional symptoms of anxiety, and concerns about responsibility could lead to repressive management decisions. In situations of mutual trust, however, the assessment consultation could kick-start a therapeutic process.

CONCLUSION

This study highlights psychiatrists' experiences in clinical suicide assessment situations. Findings have implications for professional development as well as for service delivery.

Cognitive, Emotional, Temperament, and Personality Trait Correlates of Suicidal Behavior

Suicide is one of the leading causes of violent death in many countries and its prevention is included in worldwide health objectives. Currently, the DSM-5 considers suicidal behavior as an entity that requires further study. Among the three validators required for considering a psychiatric disorder, there is one based on psychological correlates, biological markers, and patterns of comorbidity. This review includes the most important and recent studies on psychological factors: cognitive, emotional, temperament, and personality correlates (unrelated to diagnostic criteria). We included classic factors related to suicidal behavior such as cognitive, inflexibility, problem-solving, coping, rumination, thought suppression, decision-making, autobiographical memory, working memory, language fluency, burdensomeness, belongingness, fearless, pain insensitivity, impulsiveness, aggressiveness, and hopelessness. The personality correlates reported are mainly based on the personality theories of Cloninger, Costa and McCrae, and Eysenck. Moreover, it explores conceptual links to other new pathways in psychological factors, emptiness, and psychological pain as a possible origin and common end path for a portion of suicidal behaviors.

Sociodemographic Antecedent Validators of Suicidal Behavior: A Review of Recent Literature

Suicidal behavior and its prevention constitute a major public health issue. Etiology of suicidal behavior is multifactorial. Whereas current research is mostly focused on clinical and biological risk factors, the sociodemographic risk factors for suicidal behavior, first highlighted by Durkheim, have received less attention. Besides the well-known impact of age and gender, sociodemographic variables such as marital and parental status, education, occupation, income, employment status, religion, migration or minority status, and sexual orientation are repeatedly reported to play an important role in suicidal behavior. This narrative review aimed to summarize recent research on sociodemographic risk factors for suicidal behavior and to elicit possible implications for suicide prevention.