Psychological Pain, Depression, and Suicide: Recent Evidences and Future Directions

Association between weekend catch-up sleep and depression of the United States population from 2017 to 2018: A cross-sectional study

Insufficient sleep on weekdays has become a societal norm, and studies have shown that sleep deprivation increases the risk of depression. Although individuals often resort to weekend catch-up sleep (CUS) as a compensatory measure, the present evidence supporting its efficacy in mitigating the risk of depression is limited. This article attempts to explore the relationship between CUS and depression. In this study, a total of 5510 participants were included, characterized into two groups: nondepressed (n = 5051) and depressed (n = 459), with data extracted from the National Health and Nutrition Examination Survey (NHANES). Compared with people without CUS, those practicing CUS exhibited a significantly lower risk of depression (OR = 0.81, P = 0.048). In subgroup analysis, this reduction effect was only observed in males (OR = 0.70, 95 % CI 0.05 to 0.99, P = 0.04), middle-aged (>40, ≤60) (OR: 0.57, 95 % CI: 0.40 to 0.81, P = 0.002), married or living with parents (OR: 0.61, 95 % CI: 0.44 to 0.86, P = 0.004), groups with three or more family members (OR: 0.69, 95 % CI: 0.52 to 0.93, P = 0.01), and individuals without alcohol intake (OR: 0.24,95 % CI: 0.09 to 0.67, P = 0.006). Therefore, in the realm of depression treatment, doctors may consider advising patients to get adequate sleep on weekends as part of their overall treatment plan. At the same time, individuals can also choose weekend sleep as a proactive strategy for regulating their psychological status.

Mental Health Treatment Use, Perceived Treatment Need, and Reasons for Non-Use Among U.S. Adults with Serious Suicidal Thoughts During the COVID-19 Pandemic

Analyzing the 2021 National Survey on Drug Use and Health data with generalized linear models, we examined: (1) COVID pandemic-related and other correlates of mental health treatment use and unmet perceived treatment need among U.S. adults who experienced serious suicidal thoughts (N = 3,177); and (2) correlates of self-reported reasons for not receiving treatment. We found that 61% used any mental health treatment, and 48% of users and 37% of nonusers reported perceived treatment need. Significant correlates of treatment use were demographic factors, insurance, major depressive disorder, and illicit drug use disorder. Significant correlates of perceived treatment need were age 18-34, some college education, and major depressive episode. Perceived negative effect of the COVID pandemic on mental health was a significant factor for both treatment use and perceived need. The most frequent reasons for not getting treatment were the cost of treatment or lack of insurance and stigma-related concerns.

A control study on pain characteristics and influencing factors in patients with depressive disorders-based on a 5-year follow-up report from the epidemiological survey of mental disorders in Shandong Province, China

BACKGROUND

This study extends from the 2015 Shandong Province Epidemiological Survey of Mental Disorders in adults aged 18 and above. Over five years, it investigates pain characteristics and influencing factors in individuals with depressive disorders in Shandong Province.

METHODS

The study encompasses 871 individuals who met DSM-IV criteria for depressive disorders in 2015. Using 1:1:1 matching by gender, age, and residence, 825 non-afflicted individuals were selected as high-risk controls, and 825 screening-negative individuals became low-risk controls. A follow-up study in 2020 involved 1848 participants. Survey tools included a general information questionnaire, General Health Questionnaire-12 (GHQ-12), SCID-I/P, Global Pain Scale (GPS), Quality of Life Questionnaire (QLQ), PSQI, MoCA, and clinical data questionnaire.

RESULTS

GPS scores in the current depressive group were higher than in non-current depressive group (Z = 14.36, P < 0.01). GPS scores in study group exceeded those in high-risk and low-risk control groups (H = 93.71, P < 0.01). GPS scores in non-remission group were higher than in the remission group (Z = 8.90, P < 0.01). Regression analysis revealed positive correlations between GPS scores and physical illnesses, current depression, incumbency, GHQ-12 total score, and PSQI total score. Negative correlations were observed with QLQ total score and MoCA total score.

LIMITATIONS

The study could not assess pain during the 2015 survey, limiting controlled pain analysis before and after five years.

CONCLUSION

Depression sufferers may experience prolonged heightened pain, potentially relieved when depression subsides. Individual pain is influenced by depression, physical illnesses, sleep quality, quality of life, cognitive function, gender, residence, and occupation.

Depression in older women who died by suicide: associations with other suicide contributors and suicide methods

Suicides among older women have received little research attention. In this study based on the 2017-2019 National Violent Death Reporting System data, we examined the prevalence of depression in older female suicide decedents (N = 3,061), associations between depression and other suicide precipitants, and the associations between suicide methods and depression. Descriptive statistics and generalized linear models (GLM) for a Poisson distribution with a log link were used to examine the research questions. Of the decedents, 15.0% had depressed mood without a reported diagnosis and 41.8% had a depression diagnosis. Nearly one-half of the decedents with reported depression were receiving mental health/substance use treatment at the time of injury. The likelihood of depression was lower among those who were age 85 and older compared to those were age 65-74, but higher among those who had anxiety disorder (IRR = 1.50, 95% CI = 1.33-1.69), history of suicidal ideation (IRR = 1.22, 95% CI = 1.10-1.35), history of suicide attempt (IRR = 1.27, 95% CI = 1.14-1.41), and bereavement problems (IRR = 1.45, 95% CI = 1.27-1.65). Those who had depression were less likely to have used firearms (IRR = 0.85, 95% CI = 0.75-0.97) but more likely to have used hanging/suffocation (IRR = 1.37, 95% CI = 1.13-1.67). The findings show that gun ownership was likely an important factor for firearm use. The high prevalence of depressed mood and/or depression diagnosis among older female suicide decedents at the time of their fatal injury underscores the importance of assessing depression and providing evidence-based depression treatment as an essential suicide prevention approach.

Association between thiamine intake and depression: A national cross-sectional study

BACKGROUND

Recent years have seen increasing attention to improving depressive symptoms through dietary intakes, yet the association between thiamine intake and depression remains unclear. The present study aimed to explore this association using data from an American cross-sectional study.

METHODS

We explored the association of covariates, exposure, and outcome with logistic regression equations. Multivariable regression models were performed to further exclude confounding factors. To investigate nonlinear relationships, we employed restricted cubic splines. Recursive algorithms were utilized to identify inflection points. Additionally, we conducted stratified analyses by age and sex to uncover differences among subgroups.

RESULTS

When all covariates were adjusted, the association between thiamine intake and depression was not statistically significant [0.93 (0.82, 1.07)]. In the linear trend test using Q1 as the reference, the ORs (95%CI) for Q2, Q3, and Q4 were 0.87 (0.73, 1.04), 0.83 (0.68, 1.00), and 0.92 (0.73, 1.16), which suggested that the association might be nonlinear. We then confirmed this nonlinear relationship with a restricted cubic spline, and the inflection point of 1.35 mg/day was calculated. Before the inflection point, the effect value of the relationship was 0.68 (0.53, 0.89). After the inflection point, no significant association was found [1.10 (0.92, 1.31)]. Stratified analyses revealed that this nonlinear relationship was consistent among women and individuals aged <60 years.

DISCUSSION

In this cross-sectional study among American general adults, we found a nonlinear association between thiamine intake and depression and further observed differences by age and sex.

Latent profile analysis of depression in US adults with obstructive sleep apnea hypopnea syndrome

Objective

This study used latent profile analysis to explore the level of depression among US adults with obstructive sleep apnea hypopnea syndrome (OSAHS) symptoms and to identify different latent categories of depression to gain insight into the characteristic differences between these categories.

Methods

The data of this study were obtained from the National Health and Nutrition Examination Survey (NHANES) database, and the subjects with OSAHS symptoms were aged 18 years and older. The latent profile analysis (LPA) method was used to fit the latent depression categories in subjects with OSAHS symptoms. The chi-square test, rank sum test, and binary logistic regression were used to analyze the influencing factors of depression subgroups in subjects with OSAHS symptoms.

Results

Three latent profiles were identified: low-level (83.7%), moderate-level (14.5%) and high-level (1.8%) depression. The scores of 9 items in the high-level depression group were higher than those in the other two groups. Among them, item 4 "feeling tired or lack of energy" had the highest score in all categories.

Conclusion

Depression in subjects with OSAHS symptoms can be divided into low-level, moderate-level and high-level depression. There are significant differences among different levels of depression in gender, marital status, PIR, BMI, smoking, general health condition, sleep duration and OSAHS symptom severity.

Identifying suicide attempter in major depressive disorder through machine learning: the importance of pain avoidance, event-related potential features of affective processing

How to achieve a high-precision suicide attempt classifier based on the three-dimensional psychological pain model is a valuable issue in suicide research. The aim of the present study is to explore the importance of pain avoidance and its related neural features in suicide attempt classification models among patients with major depressive disorder. By recursive feature elimination with cross-validation and support-vector-machine algorithms, scores from the measurements and the task-based EEG signals were chosen to achieve a suicide attempt classification model. In the multimodal suicide attempt classifier with an accuracy of 83.91% and an area under the curve of 0.90, pain avoidance ranked as the top one in the optimal feature set. Theta (reward positive feedback minus neutral positive feedback) was the shared neural representation ranking as the top one of event-related potential features in pain avoidance and suicide attempt classifiers. In conclusion, the suicide attempt classifier based on pain avoidance and its related affective processing neural features has excellent accuracy among patients with major depressive disorder. Pain avoidance is a stable and strong indicator for identifying suicide risks in both traditional analyses and machine-learning approaches. A novel methodology is needed to clarify the relationship between cognitive and affective processing evoked by punishment stimuli and pain avoidance.

The relationship between chronotype, psychological pain, problematic social media use, and suicidality among university students in Turkey

Chronotype has been extensively linked to various psychological outcomes, including suicide, which significantly impacts the mortality rate among young adults worldwide. Research on the extent of these links is still ongoing. This cross-sectional study aimed to explore the complex relationships between chronotype, internet addiction, problematic social media use (PSMU), psychological pain, and suicidality in a student population. A total of 571 Turkish students (65.3% female, mean age 20.3 ± 1.63 years) completed the following scales: the Suicide Probability Scale (SPS), the Mee-Bunney Psychological Pain Assessment Scale (MBPPAS), the Social Media Disorder Scale (SMDS), the Internet Addiction Test (IAT), the Morningness - Eveningness Questionnaire (MEQ), and the Hospital Anxiety and Depression Scale (HADS). The results showed that the relationship between chronotype and suicidality was partially mediated by SMDS and MBPPAS but not by anxiety, depression, or IAT. These findings suggest that psychological pain and PSMU may be important factors that contribute to suicidality in evening-type individuals. These findings have significant implications for the development of interventions aimed at reducing suicidality among evening-type individuals. By addressing the underlying factors of psychological pain and PSMU, it may be possible to mitigate the increased risk of suicidality among this population.

Suicidal ideation in female individuals with fibromyalgia and comorbid obesity: prevalence and association with clinical, pain-related, and psychological factors

OBJECTIVE

Individuals with fibromyalgia report alarming levels of suicidal ideation, and comorbidity with other chronic health conditions such as obesity-a risk factor for suicidal ideation per se-could further complicate the clinical picture. The aim of this study is to determine, in a sample of women with fibromyalgia and comorbid obesity, the prevalence of suicidal ideation and to evaluate clinical, pain-related and psychological factors associated with suicidal ideation.

METHODS

In total, 156 female individuals with fibromyalgia and obesity were recruited and completed a series of self-report measures that assessed (i) the level of pain intensity, (ii) depressive symptomatology, (iii) sleep quality, and (iv) pain catastrophizing. Suicidal ideation was evaluated by item #9 of the Beck Depression Inventory. In addition, information regarding previous suicide attempts and current opioid use was collected.

RESULTS

3n sum, 7.8% of participants reported presence of suicidal ideation. According to the results of the multiple logistic regression, depressive symptomatology, sleep quality, and pain catastrophizing were associated with the presence of suicidal ideation.

DISCUSSION

The presence of suicidal ideation in our sample was significantly associated with depressive symptomatology, sleep quality, and pain catastrophizing. Our findings are the first to suggest a unique (ie, independent of depressive symptomatology, and sleep quality) association between pain catastrophizing and suicidal ideation in the context of fibromyalgia and comorbid obesity. In order to prevent and reduce suicidal ideation, these factors should be assessed and targeted in interventions for pain management. Future research should investigate the extent to which addressing depressive symptoms, sleep quality, and pain catastrophizing reduces suicidal ideation.

Assessing the association of coffee consumption on the relationship of chronic pain with depression and anxiety

BACKGROUND

A bidirectional relationship between chronic pain (CP) and mental disorders has been reported, and coffee was believed to be associated with both. However, the association of coffee in this bidirectional relationship remains unclear. We aim to analyze the association of coffee consumption on the relationship of CP with depression and anxiety.

METHODS

A total of 376,813 participants from UK Biobank were included. We collected data on anxiety, depression and CP from objects of our study population. The association of coffee consumption on the relationship of CP with depression and anxiety was assessed through logistic/linear regression models. Moreover, seemingly unrelated estimation test (SUEST) was used to compare whether the coefficients differed in two different groups.

RESULTS

We observed significant associations of coffee consumption in the interaction of CP with depression and anxiety, such as the association of multisite chronic pain (MCP) on self-reported depression (βcoffee = 0.421, βnon-coffee = 0.488, PSUEST = 0.001), and the association of MCP on generalized anxiety disorder-7 (GAD-7) scores (βcoffee = 0.561, βnon-coffee = 0.678, PSUEST = 0.004) were significantly different between coffee drinking and non-coffee drinking groups. Furthermore, in analysis stratified by gender, we found headache (βmale = 0.392, βfemale = 0.214, PSUEST = 0.022) and hip pain (βmale = 0.480, βfemale = 0.191, PSUEST = 0.021) had significant associations with self-reported depression between males and females groups in coffee drinkers.

CONCLUSIONS

Our results suggested that coffee consumption has a significant association on the relationship of CP with depression and anxiety.

Multitask Learning for Mental Health: Depression, Anxiety, Stress (DAS) Using Wearables

This study investigates the prediction of mental well-being factors-depression, stress, and anxiety-using the NetHealth dataset from college students. The research addresses four key questions, exploring the impact of digital biomarkers on these factors, their alignment with conventional psychology literature, the time-based performance of applied methods, and potential enhancements through multitask learning. The findings reveal modality rankings aligned with psychology literature, validated against paper-based studies. Improved predictions are noted with temporal considerations, and further enhanced by multitasking. Mental health multitask prediction results show aligned baseline and multitask performances, with notable enhancements using temporal aspects, particularly with the random forest (RF) classifier. Multitask learning improves outcomes for depression and stress but not anxiety using RF and XGBoost.

Psychiatric profiles in suicidal attempters: Relationships with suicide behaviour features

BACKGROUND

Suicide constitutes a major health concern worldwide, being a significant contributor of death, globally. The diagnosis of a mental disorder has been extensively linked to the varying forms of suicidal ideation and behaviour. The aim of our study was to identify the varying diagnostic profiles in a sample of suicide attempters.

METHODS

A sample of 683 adults (71.3% females, 40.10±15.74 years) admitted at a hospital emergency department due to a suicide attempt was recruited. Latent class analysis was used to identify diagnostic profiles and logistic regression to study the relationship between comorbidity profile membership and sociodemographic and clinical variables.

RESULTS

Two comorbidity profiles were identified (Class I: low comorbidity class, 71.3% of attempters; Class II: high comorbidity class, 28.7% of attempters). Class I members were featured by the diagnosis of depression and general anxiety disorder, and low comorbidity; by contrast, the high comorbidity profile was characterized by a higher probability of presenting two or more coexisting psychiatric disorders. Class II included more females, younger, with more depressive symptoms and with higher impulsivity levels. Moreover, Class II members showed more severe suicidal ideation, higher number of suicide behaviours and a greater number of previous suicide attempts (p<.01, for all the outcomes), compared to Class I members.

CONCLUSIONS

Psychiatric profiles may be considered for treatment provision and personalized psychiatric treatment in suicidal attempters as well as tackle suicide risk.

Social exclusion and suicide intention in Chinese college students: a moderated mediation model

Given the growing incidence rates of suicide among college students and the potential lifelong consequences of suicide, it is imperative to better understand the factors that reduce the rates at which college students in a clinical sample engage in suicide. This study examines the relationship between social exclusion and suicide intention, the mediating effect of depression, and the moderating effect of meaning in life. Two hundred and ninety-nine Chinese college students, aged from 18 to 22 years (56.86% female, M age = 20.14, SD = 1.27) completed questionnaires assessing their social exclusion, suicide intention, depression, and meaning in life. The result revealed that social exclusion was positively associated with suicide intention, and depression mediated this relationship. In addition, this mediating effect of depression was moderated by meaning in life. That is, the mediation effect was stronger for students with a higher level of meaning in life. These findings provide educational suggestions for preventing and intervening in suicide intention among college students.

Inhibition of spinal Rac1 attenuates chronic inflammatory pain by regulating the activation of astrocytes

BACKGROUND

Spinal astrocyte-mediated neuroinflammation is an important mechanism for the maintenance of chronic inflammatory pain. Previous studies have investigated that Ras-related C3 botulinum toxin substrate 1 (Rac1) is closely related to astrocyte activation after central nervous system injury. However, the role of Rac1 in astrocyte activation in chronic inflammatory pain has not been reported.

METHODS

Complete Freund's adjuvant (CFA)-induced chronic inflammatory pain model and LPS-stimulated astrocytes were used to investigate the role of Rac1 in astrocyte activation and the underlying mechanism. Rac1-interfering adeno-associated virus (AAV) targeting astrocytes was delivered to spinal astrocytes by intrathecal administration and a Rac1 specific inhibitor, NSC23766, was used to block cultured astrocytes. The glial fibrillary acidic protein (GFAP), proinflammatory cytokines, p-NF-κB, and nod-like receptor thermal protein domain associated protein 3 (NLRP3) inflammasome were detected by RT-qPCR, Western blotting, and immunofluorescence to investigate the activation of astrocytes.

RESULTS

CFA induced spinal astrocyte activation and increased the expression of active Rac1 in spinal astrocytes. Knockdown of astrocyte Rac1 alleviated chronic inflammatory pain and inhibited astrocyte activation. Inhibition of Rac1 activation in cultured astrocytes decreased the expression of GFAP and proinflammatory cytokines. Knockdown of Rac1 inhibited the increase of expression of NLRP3 inflammasome and phosphorylation of NF-κB in the spinal lumbar enlargement after CFA injection. Similarly, the inhibition of Rac1 suppressed the increase of NLRP3 inflammasome and p-NF-κB protein level after LPS stimulation.

CONCLUSION

Knockdown of astrocyte Rac1 attenuated CFA-induced hyperalgesia and astrocyte activation possibly by blocking the expression of NLRP3 inflammasome and phosphorylation of NF-κB.

The role of CD38 in inflammation-induced depression-like behavior and the antidepressant effect of (R)-ketamine

CD38 is involved in immune responses, cell proliferation, and has been identified in the brain, where it is implicated in inflammation processes and psychiatric disorders. We hypothesized that dysfunctional CD38 activity in the brain may contribute to the pathogenesis of depression. To investigate the underlying mechanisms, we used a lipopolysaccharide (LPS)-induced depression-like model and conducted behavioral tests, molecular and morphological methods, along with optogenetic techniques. We microinjected adeno-associated virus into the hippocampal CA3 region with stereotaxic instrumentation. Our results showed a marked increase in CD38 expression in both the hippocampus and cortex of LPS-treated mice. Additionally, pharmacological inhibition and genetic knockout of CD38 effectively alleviated neuroinflammation, microglia activation, synaptic defects, and Sirt1/STAT3 signaling, subsequently improving depression-like behaviors. Moreover, optogenetic activation of glutamatergic neurons of hippocampal CA3 reduced the susceptibility of mice to depression-like behaviors, accompanied by reduced CD38 expression. We also found that (R)-ketamine, which displayed antidepressant effects, was linked to its anti-inflammatory properties by suppressing increased CD38 expression and reversing synaptic defects. In conclusion, hippocampal CD38 is closely linked to depression-like behaviors in an inflammation model, highlighting its potential as a therapeutic target for antidepressant development.

Characteristics of gut microbiota and metabolic phenotype in patients with major depressive disorder based on multi-omics analysis

Depression is a chronic, relapsing mental illness, often accompanied by loss of appetite, increased fatigue, insomnia and poor concentration. Here, we performed serum and urine metabolomics and fecal 16S rDNA sequencing studies on 57 unmedicated patients with major depressive disorder (MDD) and 57 healthy controls to characterize the metabolic and flora profile of MDD patients. We observed significant differences in serum and urinary metabolome between MDD patients and healthy individuals. Specifically, glycerophospholipid metabolism, primary bile acid biosynthesis and linoleic acid metabolism were significantly disordered in serum, and aminoacyl-tRNA biosynthesis, arginine biosynthesis, purine metabolism, phenylalanine metabolism, alanine, aspartate and glutamate metabolism, and pyrimidine metabolism were significantly impaired in urine. On this basis, we identified four potential diagnostic biomarkers for carnitine and four fatty acid classes in serum and urine, respectively. In addition, we observed significant disturbances of the gut microbiota in MDD patients. Spearman correlation analysis showed that imbalances in the gut microbiota were associated with metabolic disturbances, suggesting an important role of the gut microbiota in the pathogenesis of MDD. Our study provides a theoretical basis for further understanding of the pathogenesis of depression and for future clinical diagnosis and screening, as well as a basis for targeting the gut flora to optimize its structure for the prevention and treatment of depression.

Health-related quality of life of Korean older adults according to age, sex, and living arrangements: a cross-sectional study

Introduction

The number and proportion of older adults living alone is a significant issue. While the number of the oldest old people is also expected to increase, their health characteristics are poorly understood. This study aims to evaluate the health-related quality of life (HRQoL) of the oldest old people according to age, sex, and living arrangements.

Methods

This study is based on the Korea Community Health Survey 2021. Among the survey's 229,242 observations, 73,617 observations aged 65 or higher were used for the analysis. The study participants were divided into 5-year age intervals (from 65-69 to 90+), sex, and living arrangements. The outcome variables are the EuroQol 5 Dimensions (EQ-5D) index score and the problem reporting rates of the five dimensions of EQ-5D.

Results

The mean EQ-5D index scores were 0.896 at 65-69 and 0.741 at 90+. The mean EQ-5D index score decreased more rapidly as age increased. Women showed consistently lower mean EQ-5D index scores than men in all age intervals. The proportion of older adults living alone increased from 18.1% at 65-69 to 43.6% at 90+. The odds of reporting problems with anxiety/depression among older men living alone were estimated to be significantly higher than older men living with someone (aOR 1.22 95% CI 1.05-1.43). The odds of reporting problems in self-care and usual activity among older women living alone were estimated to be significantly lower than older women living with someone (aOR 0.88 95% CI 0.70-0.83 and aOR 0.88 95% CI 0.82-0.94).

Conclusion

This study showed that older adults' HRQoL deteriorates as their age increases. Moreover, living alone may lead to different effects on older adults' HRQoL according to sex. More comprehensive studies and collaborative attention are needed to identify and provide customized care for older adults.

Mental Pain Correlates with Mind Wandering, Self-Reflection, and Insight in Individuals with Psychotic Disorders: A Cross-Sectional Study

Understanding the cognitive processes that contribute to mental pain in individuals with psychotic disorders is important for refining therapeutic strategies and improving patient outcomes. This study investigated the potential relationship between mental pain, mind wandering, and self-reflection and insight in individuals diagnosed with psychotic disorders. We included individuals diagnosed with a 'schizophrenia spectrum disorder' according to DSM-5 criteria. Patients in the study were between 18 and 65 years old, clinically stable, and able to provide informed consent. A total of 34 participants, comprising 25 males and 9 females with an average age of 41.5 years (SD 11.5) were evaluated. The Psychache Scale (PAS), the Mind Wandering Deliberate and Spontaneous Scale (MWDS), and the Self-Reflection and Insight Scale (SRIS) were administered. Statistical analyses involved Spearman's rho correlations, controlled for potential confounders with partial correlations, and mediation and moderation analyses to understand the indirect effects of MWDS and SRIS on PAS and their potential interplay. Key findings revealed direct correlations between PAS and MWDS and inverse correlations between PAS and SRIS. The mediation effects on the relationship between the predictors and PAS ranged from 9.22% to 49.8%. The largest statistically significant mediation effect was observed with the SRIS-I subscale, suggesting that the self-reflection and insight component may play a role in the impact of mind wandering on mental pain. No evidence was found to suggest that any of the variables could function as relationship moderators for PAS. The results underscore the likely benefits of interventions aimed at reducing mind wandering and enhancing self-reflection in psychotic patients (e.g., metacognitive therapy, mindfulness). Further research will be essential to elucidate the underlying mechanisms.

Warning signs for suicide attempts in psychiatric inpatients: Patient and informant perspectives

OBJECTIVE

Warning signs can help prevent suicide attempts and death. It is important to develop an evidence base for warning signs that considers both self-perspectives (i.e., those at risk for suicide) and informant-perspectives (i.e., those who observe individuals at risk for suicide).

METHODS

A questionnaire assessing a diverse set of 80 potential warning signs ("present in the minutes, hours, or days before the suicide attempts") was developed based on literature searches, lived experience consultations, and the American Association of Suicidology (AAS) expert consensus list. This questionnaire was administered to two samples: psychiatric inpatients who had attempted suicide (n = 476), and informants identified as friends, family, or caretakers of patients (n = 120).

RESULTS

Hopelessness, anxiousness, and unbearable pain were each endorsed as warning signs by >80% of inpatients and informants. Warning signs were similar across patient and informant perspectives, and across sociodemographic and clinical characteristics. Some AAS warning signs were endorsed by few patients and informants (risky behaviors, alcohol or drug use, seeking revenge) and may warrant re-evaluation.

CONCLUSIONS

Findings are consistent with models of suicide risk emphasizing pain, hopelessness, and anxiousness. Existing lists of warning signs may benefit from revision as the evidence base continues to develop.

The occupational burnout among medical staff with high workloads after the COVID-19 and its association with anxiety and depression

Objective

After the end of COVID-19, medical staff were immediately faced with a high workload, leading to widespread occupational burnout. This study aims to explore the level and influencing factors of burnout among medical staff during this period, as well as its relationship with anxiety and depression.

Methods

The participants' levels of burnout were assessed using Maslach Burnout Inventory-Human Services Survey (MBI-HSS), and the reliability and validity of the questionnaire were evaluated through Cronbach's α and Confirmatory Factor Analysis (CFA). Independent sample t-test, chi-square test, and Pearson analysis were employed to determine the correlation between two sets of variables. Univariate and multivariate logistic regression analyses were conducted to identify significant factors influencing burnout. Finally, nomograms were used to predict the probability of burnout occurrence.

Results

This study collected a total of 1,550 questionnaires, and after excluding 45 questionnaires that were duplicates or incomplete, a sample of 1,505 (97.1%) participants were included in the final statistical analysis. Both Cronbach's α and the fit indices of CFA demonstrated excellent adaptability of the Chinese version of MBI-HSS in this study. The overall prevalence rates for emotional exhaustion (EE), depersonalization (DP), and diminished personal accomplishment (PA) were 52.4, 55.3, and 30.6%, respectively. Obtaining psychological support, health condition, relationship with family members, and insufficient sleep were identified as common contributing factors to burnout among medical staff. Additionally, age and promotion pressure were also associated with burnout among doctors, and exceeding legal working hours was an important factor for nurse burnout. The C-index for the nomograms predicting burnout among doctors and nurses was 0.832 and 0.843, respectively. Furthermore, burnout exhibited a significant linear correlation with anxiety and depression.

Conclusion

After the end of COVID-19, medical staff in high workload environments were facing severe burnout, which might lead to anxiety and depression. The occupational burnout of medical staff needed to be taken seriously and actively intervened.

Study on relationship between self-recognition of voice disorder and mental health status: Korea National Health and Nutrition Examination Survey

BACKGROUND

The voice has been thought to be associated with emotions, but conducting large-scale research on this relationship has some limitations. To overcome these limitations, questionnaires have been utilized as a research tool.

METHODS

A population-based cross-sectional study was done. A total of 15,977 participants completed questionnaires regarding self-recognition of voice disorder (SRVD), and mental health status.

RESULTS

1053(6.6 %) participants answered that they had SRVD. In the multivariate Cox proportional hazard model, psychological stress (Hazard ratio (HR) = 1.371, 95 % confidence interval (CI) = 1.154-1.629), depressive symptoms (HR = 1.626, 95 % CI = 1.323-1.997), suicidal ideation (HR = 1.739, 95 % CI = 1.418-2.133), and suicide attempt (HR =2.206, 95 % CI = 1.067-4.56) were all associated with SRVD. In SRVD lasting over three weeks, psychological stress (HR = 1.604, 95 % CI = 1.278-2.014), depressive symptoms (HR = 1.807, 95 % CI = 1.384-2.36), and suicidal ideation (HR = 2.073, 95 % CI = 1.587-2.709) were also significant factors. As the number of mental health problems increased, the odds ratio of both SRVD (OR = 2.49, 95 % CI = 1.839-3.37) and SRVD lasting over three weeks (OR = 3.254, 95 % CI = 2.242-4.725) increased, respectively.

LIMITATIONS

SRVD and mental health status were judged only by simple questionnaires. Cross-sectional design and retrospective data could not draw causal relationships.

CONCLUSIONS

SRVD and SRVD lasting over three weeks had a significant relationship with mental health status, including psychological stress, depressive symptoms, and suicidal ideation. There is a need to consider psychiatric treatment for individuals who visit hospitals with voice disorders.

Influencing factors of psychological pain among older people in China: A cross-sectional study

Limited research has focused on the psychological pain among older people and factors associated with psychological distress in older adults also remain to be evaluated. This study aims to examine the status and correlates of psychological pain among older people from urban and rural areas in China. This cross-sectional study analyzed data from 4312 samples which extracted from the dataset of China's Health-Related Quality of Life Survey for Older Adults 2018. Psychological pain was assessed by the Chinese version of the Psychache Scale (PAS). Multiple linear regression models were established to examine the associations between demographic characteristics and psychological pain. The average score of PAS among older people was 41.79 ± 14.52, and the average score of PAS among urban older people was higher than rural ones in this study. For rural older people, age (B ≥ 80 = 2.55), gender (B Female = 1.27), educational level (B Primary school = 1.63; B ≥ Middle school = 0.27), smoking (B yes = 0.83), number of chronic diseases (B ≥ 2 = 3.19) and personal social capital (B BRC = 0.27) were positively related to psychological pain, while family per-capita annual income (B15,000-30,000 = -2.52; B > 30,000 = -3.44), living arrangement (B With spouse = -3.40; B With children = -2.89; B Others = -3.82) and personal social capital (B BOC = -0.36) were negatively associated with psychological pain (p < 0.05). Moreover, for urban older people, gender (B Female = 0.98), current occupation (B With occupation = 1.13) and smoking (B yes = 2.14) were positively related to psychological pain, whereas age (B ≥ 80 = -1.45), family per-capita annual income (B > 30,000 = -3.63), living arrangement (B With spouse = -1.31), BMI (Bnormal = -2.62) and personal social capital (B BOC = -0.16) were negatively associated with psychological pain (p < 0.05). The present study sheds light on the worrying state of psychological pain experienced by Chinese older people. The results suggest that targeted interventions and social support, should be taken to alleviate the psychological pain among older people, especially urban older people.

Potential neuropsychological mechanism involved in the transition from suicide ideation to action - a resting-state fMRI study implicating the insula

BACKGROUND

Understanding the neural mechanism underlying the transition from suicidal ideation to action is crucial but remains unclear. To explore this mechanism, we combined resting-state functional connectivity (rsFC) and computational modeling to investigate differences between those who attempted suicide(SA) and those who hold only high levels of suicidal ideation(HSI).

METHODS

A total of 120 MDD patients were categorized into SA group (n=47) and HSI group (n=73). All participants completed a resting-state functional MRI scan, with three subregions of the insula and the dorsal anterior cingulate cortex (dACC) being chosen as the region of interest (ROI) in seed-to-voxel analyses. Additionally, 86 participants completed the balloon analogue risk task (BART), and a five-parameter Bayesian modeling of BART was estimated.

RESULTS

In the SA group, the FC between the ventral anterior insula (vAI) and the superior/middle frontal gyrus (vAI-SFG, vAI-MFG), as well as the FC between posterior insula (pI) and MFG (pI-MFG), were lower than those in HSI group. The correlation analysis showed a negative correlation between the FC of vAI-SFG and psychological pain avoidance in SA group, whereas a positive correlation in HSI group. Furthermore, the FC of vAI-MFG displayed a negative correlation with loss aversion in SA group, while a positive correlation was found with psychological pain avoidance in HSI group.

CONCLUSION

In current study, two distinct neural mechanisms were identified in the insula which involving in the progression from suicidal ideation to action. Dysfunction in vAI FCs may gradually stabilize as individuals experience heightened psychological pain, and a shift from positive to negative correlation patterns of vAI-MFC may indicate a transition from state to trait impairment. Additionally, the dysfunction in PI FC may lead to a lowered threshold for suicide by blunting the perception of physical harm.

Evaluation of common prescription analgesics and adjuvant analgesics as markers of suicide risk: a longitudinal population-based study in England

Background

Analgesics prescriptions may provide a marker for identifying individuals at higher risk of suicide. In particular, awareness of which analgesics are implicated may help clinicians assess and modify risk.

Method

A case-control study in England using the Clinical Practice Research Datalink (for primary care records) linked with hospital and national mortality electronic registries. We included patients aged ≥15 who died by suicide between 2001 and 2019 (N = 14,515), to whom we individually matched 580,159 controls by suicide date and general practice (N = 594,674). Odds ratios (ORs) for suicide, controlled for age and sex, were assessed using conditional logistic regression.

Findings

Suicide risks were highest in those prescribed adjuvant analgesics (pregabalin, gabapentin and carbamazepine) (adjusted OR 4.07; 95% confidence intervals CI: 3.62-4.57), followed by those prescribed opioids (adjusted OR 2.01; 95% CI: 1.88-2.15) and those prescribed non-opioid analgesics (adjusted OR 1.48; 95% CI: 1.39-1.58) compared to those not prescribed these medications. By individual analgesic, the highest suicide risks were seen in patients prescribed oxycodone (adjusted OR 6.70; 95% CI: 4.49-9.37); pregabalin (adjusted OR 6.50; 95% CI: 5.41-7.81); morphine (adjusted OR 4.54; 95% CI: 3.73-5.52); and gabapentin (adjusted OR 3.12; 95% CI: 2.59-3.75). Suicide risk increased linearly with the number of analgesic prescriptions in the final year (p < 0.01 based on the likelihood ratio test), and the more different analgesics categories were prescribed in the final year (p < 0.01 based on the likelihood ratio test).

Interpretation

Analgesic prescribing was associated with higher suicide risk. This is a particular issue with regard to adjuvant non-opiate analgesics.

Funding

There was no funding for this study.

The mediating effects of dysfunctional attitudes and moderating effect of sex between stressful life events and depressive symptoms among Chinese college students

Stressful life events (SLEs) closely correlates with depressive symptoms. Although vulnerability-stress model suggests SLEs interacted with dysfunctional attitudes (DA) to predict depression, the mediation role of DA is poorly understood. Therefore, this study intended to investigate the mediating role of DA and the moderating role of sex between SLEs and self-reported depression. A cross-sectional survey was conducted with a sample of 7769 Chinese college students. Participants were assessed in terms of self-reported SLEs, DA and depression variables. Results showed that there were significant sex differences in both SLE and DA. DA mediated the association between SLE and self-reported depression. The moderated mediation model analysis showed that the interaction of SLEs and sex significantly predicted DA in mediator variable model and self-reported depression in dependent variable model. Results indicated that DA partially mediated the association between SLEs and self-reported depression, and sex moderates the association between SLEs and both DA and self-reported depression, which females have bigger changes of DA and depressive symptoms across low and high levels of SLEs than males.

Internet addiction and depression among Chinese adolescents: anxiety as a mediator and social support as a moderator

This study constructed a moderated mediation model to investigate the mediating effect of anxiety and the moderating effect of social support between Internet addiction and depression. A sample of 17 058 middle school students in one district of Chengdu were selected. The Internet Addiction Test (IAT), Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), and Social Support Scale for adolescents were used to investigate their Internet addiction, anxiety, depression and social support. The descriptive statistics and Spearman correlation analysis were performed with SPSS 25.0. An SPSS macro process was used to analyze the data from complex models that contained mediators and moderators. The results show that adolescents with Internet addiction are more likely to suffer from depression. Anxiety partially mediated the relations between Internet addiction and depression. Social support moderated both direct and indirect pathways leading from Internet addiction to depression, and these two effects were stronger for adolescents with low social support than for those with high social support. It will be possible for researchers to gain a better understanding of the conditions, pathways, and effects of Internet addiction on depression in adolescents through the results of this study.

Exploring psychological and psychosocial correlates of non-suicidal self-injury and suicide in college students using network analysis

BACKGROUND

Non-suicidal self-injury (NSSI) and suicide are a serious health concern in young people. Remarkable progress has been made in understanding the correlates and risk factors for suicidality. However, it remains unclear the complex interplay between different factors and which factors are most saliently associated with NSSI and suicide risk and should be targeted for interventions.

METHODS

This study utilized network analysis to examine the interrelationship between NSSI, suicide and a variety of psychological (e.g., depression, psychotic-like experiences) and psychosocial (e.g., childhood maltreatment, family dysfunction, being bullied and social support) correlates in a sample of Chinese first year college students (n = 2328).

RESULTS

The severity of depressive symptoms was the only factor connected to both NSSI and suicide. Other psychiatric factors like psychotic experiences could only act in an indirect way via the bridging effect of depression. Emotional abuse, compared with other forms of childhood adversities, was found to be the most influential maltreatment form associated with suicidal ideation and attempts. Finally, social support showed the potential to lower the risk of self-injury and suicide in young people.

LIMITATIONS

Only a subset of risk and resilience factors of NSSI and suicide were included. Causal inference was impossible due to the cross-sectional design.

CONCLUSIONS

Our findings highlighted the importance of identifying risk groups with mental illnesses or negative childhood events, and providing additional support during the key time of transitioning into higher education.

Agomelatine's antiglycoxidative action-In vitro and in silico research and systematic literature review

Introduction

Agomelatine is an atypical antidepressant drug enhancing norepinephrine and dopamine liberation; nevertheless, additional mechanisms are considered for the drug's pharmacological action. Since protein glycoxidation plays a crucial role in depression pathogenesis, agomelatine's impact on carbonyl/oxidative stress was the research purpose.

Methods

Reactive oxygen species scavenging (hydroxyl radical, hydrogen peroxide, and nitrogen oxide) and antioxidant capacity (2,2-diphenyl-1-picrylhydrazyl radical and ferrous ion chelating assays) of agomelatine were marked. Agomelatine's antiglycoxidation properties were assayed in sugars (glucose, fructose, and galactose) and aldehydes- (glyoxal and methylglyoxal) glycated bovine serum albumin (BSA). Aminoguanidine and α-lipoic acid were used as standard glycation/oxidation inhibitors.

Results

Agomelatine did not show meaningful scavenging/antioxidant capacity vs. standards. Sugars/aldehydes increased glycation (↑kynurenine, ↑N-formylkynurenine, ↑dityrosine, ↑advanced glycation end products, and ↑β-amyloid) and oxidation (↑protein carbonyls and ↑advanced oxidation protein products) parameters in addition to BSA. Standards restored BSA baselines of glycation and oxidation markers, unlike agomelatine which sometimes even intensifies glycation above BSA + glycators levels. Molecular docking analysis of agomelatine in BSA demonstrated its very weak binding affinity.

Discussion

Agomelatine's very low affinity to the BSA could proclaim non-specific bonding and simplify attachment of glycation factors. Thereby, the drug may stimulate brain adaptation to carbonyl/oxidative stress as the systematic review indicates. Moreover, the drug's active metabolites could exert an antiglycoxidative effect.

Gender-based differences in interaction effects between childhood maltreatment and problematic mobile phone use on college students' depression and anxiety symptoms

BACKGROUND

Childhood maltreatment and problematic mobile phone use are risk factors for depression and anxiety symptoms among college students. However, how the interaction between the two factors affects depression and anxiety has yet to be validated. This study aimed to investigate the independent and interaction effects of childhood maltreatment and problematic mobile phone use on depression and anxiety among college students and explored gender-based differences in these associations.

METHOD

A cross-sectional study was conducted from October to December 2019. We collected data from 7623 students at two colleges in Hefei and Anqing cities in Anhui Province, China. Multinomial logistic regression models were performed to explore the associations of childhood maltreatment and problematic mobile phone use with depression and anxiety symptoms and their interaction effects on depression and anxiety symptoms.

RESULTS

Childhood maltreatment and problematic mobile phone use were significantly associated with increased risk of depression and anxiety symptoms (P < 0.001). Moreover, following adjustments for covariates, there was a multiplicative interaction between childhood maltreatment and problematic mobile phone use on depression and anxiety symptoms (P < 0.001). Gender-based differences were also observed in the associations. For instance, depression was more common in males and male students with childhood maltreatment were at higher risk of depression-only symptoms.

CONCLUSION

Focusing on childhood maltreatment and problematic mobile phone use could facilitate a reduction in the occurrence of depression and anxiety symptoms in college students. Furthermore, it is necessary to develop gender-targeted intervention strategies.

Multifaceted risk for non-suicidal self-injury only versus suicide attempt in a population-based cohort of adults

BACKGROUND

Non-suicidal self-injury and suicide attempt represent significant public health concerns. While these outcomes are related, there is prior evidence that their etiology does not entirely overlap. Efforts to directly differentiate risk across outcomes are uncommon, particularly among older, population-based cohorts.

METHODS

This research has been conducted using the UK Biobank. Data on individuals' self-reported history of non-suicidal self-injury only versus suicide attempt (maximum N = 6643) were analyzed. Applying LASSO and standard logistic regression, participants reporting one of these outcomes were assessed for differences across a range of sociodemographic, behavioral, and environmental features.

RESULTS

Sociodemographic features most strongly differentiated between the outcomes of non-suicidal self-injury only versus suicide attempt. Specifically, Black individuals were more likely to report a suicide attempt, as were those of mixed race, those endorsing higher levels of depressive symptoms or trauma history, and those who had experienced financial problems (odds ratios 1.02-3.92). Those more likely to engage in non-suicidal self-injury only were younger, female, had higher levels of education, those who resided with a partner, and those who had a recently injured relative.

LIMITATIONS

Differences in timing across correlates and outcomes preclude the ability to establish causal pathways.

CONCLUSIONS

The factors identified in the current study as differentially associated with non-suicidal self-injury only versus suicide attempt provide further evidence of at least partially distinct correlates, and warrant follow-up in independent samples to investigate causality.

Gender differences in the predictive effect of depression and aggression on suicide risk among first-year college students

BACKGROUND

Depression and aggression are related to the risk of suicide. Previous studies have associated different characteristics with depression and aggression in separate gender groups. The main aim of this study was to investigate the gender differences in the predictive effect of depression and aggression on suicide risk among first-year college students.

METHODS

A total of 2004 first-year undergraduates (80.5 % female, mean age = 19.4 ± 0.8 years) were surveyed by a battery of questionnaires that contained the Chinese version of the Beck scale for Suicide Ideation, the Chinese version of the 12-item Aggression Questionnaire, and the Center for Epidemiologic Studies Depression scale.

RESULTS

(1) Depression severity was significantly associated with the suicidality risk (r = 0.090, p < 0.01). (2) Suicide risk correlated positively with physical aggression, verbal aggression, anger, and hostility in the aggression questionnaire (r = 0.308, 0.227, 0.284, 0.277, p < 0.01). (3) A possible gender difference was noted for suicide risk in that depression degree was a significant risk factor for females but not males (R2 = 0.095, F = 41.554, p < 0.01), whereas anger was a significant predictor of suicide risk for males but not for females (R2 = 0.21, F = 25.75, p < 0.01).

CONCLUSIONS

Gender differences exist in the predictive effect of depression and aggression on suicide risk among first-year college students.

A randomized controlled trial of a nurse-led psychological pain solution-focused intervention for depressed inpatients: study protocol

BACKGROUND

Depressed patients commonly experience psychological pain. Research pointed to positive psychological interventions as an effective means of ameliorating psychological pain, although the exact effect is unclear. Based on the hope theory and solution-focused brief therapy (SFBT), this study combines hope theory with solution-focused brief therapy to develop a nurse-led psychological pain solution-focused (PPSF) intervention in depressed patients.

METHODS

This is an assessor-blinded randomized controlled trial following the SPIRIT guidance. A total of 84 depressed patients will be recruited from the inpatient wards of a psychiatric hospital and randomly assigned to the control and experimental groups. Patients in the control group will be treated as usual. In contrast, patients in the experimental group will receive 6 sessions of the PPSF intervention for two weeks on top of the routine care. Primary outcomes are psychological pain, hope, cognitive distortions. Secondary outcomes are depression and suicidal ideation. Data will be collected at 5-time points: baseline, 1 and 2 weeks (post-intervention), 1 month (follow up), and 6 months after baseline. Generalized equation evaluation will be used to assess the effectiveness of the PPSF intervention.

DISCUSSION

From a positive psychology perspective, there remains much room for developing psychological pain interventions in depressed patients. SFBT and hope theory are both based on positive psychology. With hope theory as the general framework and SFBT questions as the practical guide, the PPSF intervention program is designed that nursing staff can implement. If the intervention is effective, it will advance the development of psychological pain interventions for patients with depression.

TRIAL REGISTRATION

ChiCTR2100048223.

Symptoms of internet gaming disorder and depression in Chinese adolescents: A network analysis

The current study aimed to investigate comorbidity among symptoms of depression and internet gaming disorder (IGD) utilizing symptom network analysis in a sample of Chinese adolescents. A total of 1,362 Chinese adolescents (Mean age = 15.19 ± 1.67; range 13-21; 39.79% female, 56.02% male, 4.19% not disclosed) were recruited from 11 local secondary schools between June and July 2020. Symptoms of depression and IGD were assessed by the 7-item DASS-21 depression subscale and the 9-item Internet Gaming Disorder Scale. We conducted network analysis to estimate network models and the most central symptoms of depression and IGD and computed a combined network model of both depression and IGD symptoms to find bridge symptoms and illustrate the comorbidity between depression and IGD. We found that feeling 'Worthless', 'Meaningless', and 'Down-hearted' were identified as the most central symptoms of depression, whereas 'Preoccupation' and 'Tolerance' were the two most central symptoms of IGD. The bridge symptoms in the combined network model were 'Gaming for escape or mood relief' from the IGD cluster and 'No initiative' and 'Down-hearted" from the depression cluster. The current study was the first to investigate the relationship between depression and IGD symptoms among adolescents utilizing a symptom network perspective. Also, it highlighted key bridge symptoms in understanding how IGD and depression contribute to each other.

Latent profile analysis of depression among older adults living alone in China

BACKGROUND

The number of older adults living alone has increased significantly. Depression is one of the significant mental health problems they face; classifying depressive conditions into homogeneous subgroups can help discover hidden information.

METHODS

The data comes from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Latent profile analysis (LPA) was used to identify depression subgroups among elderly living alone, Chi-square tests and Kruskal-Wallis tests were used to univariate analysis, multinomial logistic regression was used to analyze the related factors.

RESULTS

1831 older adults living alone were identified and classified as low-level (30.4 %), moderate-level (55.3 %) and high-level (14.4 %). All variables, except age, were significant in the univariate analysis. Multinomial logistic regression showed that not participating in exercise, sometimes interacting with friends, anxiety symptoms, and impaired IADL were associated with the moderate- and high-level of depression in older adults living alone; good or fair self-rated health and life satisfaction were associated with the low-level of depression in older adults living alone. Anxiety symptoms were associated with high-level of depression in older adults living alone compared to moderate-level; good or fair self-rated health and life satisfaction were associated with moderate-level of depression in older adults living alone.

LIMITATIONS

The CES-D-10 cannot fully determine the presence of depression in elderly people living alone at high-level.

CONCLUSIONS

In future primary health care, it would be more meaningful to provide targeted interventions for different subgroups of depression in older adults living alone.

Perceived rather than objective weight status is associated with suicidal behaviors among Chinese adolescents: a school-based study

BACKGROUND

We aimed to explore the relationship between body mass index (BMI) and body weight perception (BWP) with suicidal behaviors among mainland Chinese adolescents.

METHODS

A nationally representative sample (N = 10 110) of Chinese adolescents was assessed in this study. Suicidal behaviors (ideation, plan and attempt) were evaluated by four self-reported questions. Generalized linear mixed model was used to estimate the adjusted odds ratios (ORs) for the association between BWP/BMI with suicidal behaviors.

RESULTS

The prevalence of suicidal ideation, suicidal plan and suicidal attempt was 12, 5 and 2.1%, respectively. After adjusting potential covariates, perceiving oneself as obese was significantly associated with increased risks of suicidal ideation (OR: 2.4, 95% confidence intervals, CI: 1.6-4.0, P = 0.001), suicidal plan (OR: 3.1, 95% CI: 1.5-6.3, P = 0.002) and suicidal attempt (OR: 3.7, 95% CI: 1.5-9.1, P = 0.001) compared with perceiving as normal weight among male adolescents; the effect attenuated to null among female adolescents. Perceiving oneself as underweight and overweight both exhibited significant adverse effect on suicidal behaviors (only suicidal ideation and suicidal plan) compared with perceiving oneself as normal weight among male adolescents, but not among female adolescents. The actual measured BMI was not significantly associated with suicidal behaviors among neither gender.

CONCLUSIONS

Self-perception of their body image rather than actual measured weight may have a gender-specific adverse effect on suicidal behaviors among Chinese adolescents.

Significantly elevated phosphatidylethanol levels in recent suicide attempters, but not in depressed controls and healthy volunteers

INTRODUCTION

Suicide is a complex transdiagnostic phenomenon. It is strongly associated with, but not exclusive to major depressive disorder (MDD). Hazardous alcohol drinking has also been linked to an increased risk of suicidal behaviours, however, it is often underreported. The study aimed to evaluate whether an objective measure of chronic alcohol use, phosphatidylethanol (PEth) could be useful as a biomarker in clinical practice.

METHOD

ology. The present case-control multi-centric study recruited 156 participants into three study groups: 52 patients treated for major depressive disorder (MDD), 51 individuals immediately following a suicide attempt (SA), and 53 volunteers. Sociodemographic data, medical history, and laboratory data, including PEth concentrations and C-reactive protein levels, were collected from study participants.

RESULTS

PEth concentrations were the highest in suicide attempters (232,54 ± 394,01 ng/ml), followed by patients with MDD (58,39 ± 135,82 ng/ml), and the control group (24,45 ± 70,83 ng/ml) (Kruskall Wallis χ2 = 12.23, df = 2, p = .002). In a multinomial logistic regression model with adjustments, PEth concentration was able to predict belonging to suicide attempters' group, but not to depression group (p = .01). Suicide attempters were also more likely to underreport their recent alcohol consumption.

LIMITATIONS

We did not analyze SA methods, psychiatric comorbidity and several other factors that might be associated with PEth levels, such as body mass index, race, and haemoglobin levels. Sample recruited in hospital settings may not be representative of the whole population. The results of this adult-only study cannot be generalized to adolescents.

CONCLUSIONS

PEth levels in recent suicide attempters significantly exceeded those of patients with MDD and controls. Suicide attempters also were more likely to underreport their alcohol consumption when questioned about their consuption. PEth might be an interesting biomarker to evaluate individuals at risk of SA.

Research progress on rheumatoid arthritis-associated depression

Depression is an independent mood disorder and one of the most common comorbidities of rheumatoid arthritis (RA). Growing evidence suggests that there is two-way regulation between RA and depression, resulting in a vicious cycle of RA, depression, poor outcomes, and disease burden. The rising prevalence of RA-associated depression warrants a re-examination of the relationships between them. Here we provide an overview of the etiology and pathological mechanisms of RA-associated depression, and recent advances in treatment with biologics, which will facilitate the development of new and effective prevention and treatment strategies.

Suicide and Neurotrophin Factors: A Systematic Review of the Correlation between BDNF and GDNF and Self-Killing

According to WHO data, suicide is a public health priority. In particular, suicide is the fourth-leading cause of death in young people. Many risk factors of suicide are described, including individual-, relationship-, community-, and societal-linked ones. The leading factor is the diagnosis of mental illness. Nevertheless, not all people who attempt suicide are psychiatric patients; these characteristics help define high-risk populations. There are currently no useful biomarkers to indicate the risk of suicide. In recent years, neurotrophic factors have increasingly become of scientific interest. This review aims to summarize the current scientific knowledge on the correlation between BDNF and GDNF and suicide, to theorize whether neurotrophins could be a reliable marker for an early diagnosis of suicidal risk. The authors conducted a systematic review following PRISMA criteria. They found eight research papers in agreement with the inclusion criteria. According to the results of these studies, there may be a connection between BDNF brain levels and complete suicide, although there are discrepancies. A lack of interest in GDNF may suggest less involvement in the suicidal dynamic. Further studies may provide helpful information to researchers.

Racial Differences in the Relationship Between Pain and Suicide Desire in Older Adults

Older adults are reported to die by suicide at higher rates than the general population. Suicide desire among older adults is associated with pain, and pain experiences have been found to differ based on race. To investigate the relationship between pain and suicidal desire, 437 racially diverse older adults who receive home-based services (home-delivered meals) in the Southeastern region of the United States completed standardized measures of psychological pain, chronic physical pain, and suicidal desire. Results identified race moderated the relationship between pain and suicidal desire, indicating a stronger relationship between pain and suicidal desire among Black older adults than White older adults. Chronic physical pain (i.e., emotional burden) interacted with race to predict Perceived Burdensomeness ( p = .011) and Thwarted Belongingness ( p = .032). Greater attention to pain experiences among Black older adults is warranted, considering the impact of COVID-19 on racial/ethnic minorities’ mental health.

Scrutinizing the Profile and Risk Factors of Suicide: A Perspective from a Case-Control Study Focused on a Northern Region of Spain

Suicide is a major public health problem the prevention of which has become a priority, and, to this end, knowledge of its risk factors is essential. This study aims to evaluate the impact of some social, medico-legal, and clinical issues on suicide deaths. A total of 135 cases were identified as suicides that occurred in a region of northern Spain between 2018 and 2020. Controls (three for each case) were matched by age, sex, and urban-rural areas. The information was collected retrospectively through electronic health record systems. A binary logistic regression analysis was performed to study the association between individual risk factors and suicide. Being male (78.5%), between 40 and 60 years of age, unmarried (70.9%), and unemployed (85%) were associated with suicide deaths. Although the existence of a previous self-harm attempt is presented as the most robust risk factor (OR 22.121 [8.997-54.389]), the presence of a psychiatric diagnosis (OR 12.583 [7.686-20.601]) and cancer (OR 3.729 [1.845-7.536]) also showed a significant relationship with suicide (p < 0.05). Defining and knowing the risk factors for suicide helps to better understand the profiles of those individuals who are vulnerable, and enables prevention actions to be taken in both social and medical spheres.

A protocol for a type 1 effectiveness-implementation randomized controlled trial of the WHO digital mental health intervention Step-by-Step to address depression among Chinese young adults in Macao (SAR), China

BACKGROUND

Among Chinese college students, the burden of depression is considerably high, affecting up to 30 % of the population. Despite this burden, few Chinese students seek mental health treatment. In addition, depression is highly comorbid with other mental health disorders, such as anxiety. Scalable, transdiagnostic, evidence-based interventions are needed for this population.

OBJECTIVE

The study will evaluate the effectiveness of a World Health Organization transdiagnostic digital mental health intervention, Step-by-Step, to reduce depressive and anxiety symptoms and improve well-being compared with enhanced care as usual and its implementation in a Chinese university community.

METHODS

A type 1 effectiveness-implementation two-arm, parallel, randomized controlled trial will be conducted. The two conditions are 1) the 5-session Step-by-Step program with minimal guidance by trained peer-helpers and 2) psychoeducational information on depression and anxiety and referrals to local community services. A total of 334 Chinese university students will be randomized with a 1:1 ratio to either of the two groups. Depression, anxiety, wellbeing, and client defined problems will be assessed at pre-intervention, post-intervention, and 3-month follow-up. Endline qualitative interviews and focus group discussions will be conducted to explore SbS implementation among service users, university staff, and stakeholders. Data will be analysed based on the intent-to-treat principle.

DISCUSSION

Step-by-Step is an innovative approach to address common mental health problems in populations with sufficient digital literacy. It is a promising intervention that can be embedded to scale mental health services within a university setting. It is anticipated that after successful evaluation of the program and its implementation in the type 1 hybrid design RCT study, Step-by-Step can be scaled and maintained as a low-intensity treatment in universities, and potentially extended to other populations within the Chinese community.

TRIAL REGISTRATION

ChiCTR2100050214.

The influence of college students' academic stressors on mental health during COVID-19: The mediating effect of social support, social well-being, and self-identity

COVID-19 caused harmful mental consequences to the public, and mental health problems were very common among college students during the outbreak of COVID-19. Academic stressors were the main stress for college students, and social support, social well-being, and self-identity were widely known as protective factors for mental health. Therefore, the study aimed to investigate the influence of academic stressors on mental health and the mediating effect of social support, social well-being, and self-identity among college students during the outbreak of COVID-19. With 900 college students as subjects, using the college students' academic stressors questionnaire, social support questionnaire, social well-being scale, self-identity scale, and depression anxiety stress scales (DASS-21), the results showed that: (1) academic stressors had a significantly negative correlation with social support, social well-being, and self-identity while having a significantly positive correlation with mental health; (2) academic stressors could positively predict mental health; (3) this effect was mediated by social support, social well-being, and self-identity; (4) work stressor was an important stressor during COVID-19, and had the same role as academic stressors in the structural equation model. The results of this study suggested that adjusting the academic stressors or work stressors of college students and enhancing social support could improve social well-being and self-identity, and might effectively protect their mental health under the COVID-19 pandemic environment.

Design, synthesis, and biological evaluation of low-toxic lappaconitine derivatives as potential analgesics

The C₁₈-diterpenoid alkaloid lappaconitine (LA) is a non-addictive analgesic used in China. The toxicity (LD₅₀ = 11.7 mg/kg) limits its application. Two series of LA derivatives, including amides and sulfonamides (1-93), were designed and synthesized by modification on their C4 acetamidobenzoate side chains in this work. In vivo analgesic activity and toxicity of all derivatives were evaluated, and the structure-activity relationship was summarized. Six lead compounds (35, 36, 39, 49, 70, and 89) exhibited approximate analgesic activity to LA but with significantly reduced toxicity. The therapeutic index of these compounds is 14-30 times that of LA. In vivo metabolism study of the lead compounds 39, 49, 70, and 89 were conducted by UPLC-MS^E, indicating the reason for the low toxicity of the potential derivatives might be they are difficult to metabolize to toxic metabolite N-deacetyllappaconitine compared to LA. The effects of lead compounds on sodium channels and hERG channels were also studied by ion channel reader (ICR) which further revealed their analgesic and toxicity-attenuating mechanisms. Sodium channel assay revealed that the analgesic mechanism of these lead compounds was inhibiting the Na_v 1.7 channels. Taken together, compound 39 was provided as a new analgesic lead compound with significantly low toxicity and comparable activity to LA.

Exploring the Suicide Mechanism Path of High-Suicide-Risk Adolescents-Based on Weibo Text Analysis

BACKGROUND

Adolescent suicide can have serious consequences for individuals, families and society, so we should pay attention to it. As social media becomes a platform for adolescents to share their daily lives and express their emotions, online identification and intervention of adolescent suicide problems become possible. In order to find the suicide mechanism path of high-suicide-risk adolescents, we explore the factors that influence is, especially the relations between psychological pain, hopelessness and suicide stages.

METHODS

We identified high-suicide-risk adolescents through machine learning model identification and manual identification, and used the Weibo text analysis method to explore the suicide mechanism path of high-suicide-risk adolescents.

RESULTS

Qualitative analysis showed that 36.2% of high-suicide-risk adolescents suffered from mental illness, and depression accounted for 76.3% of all mental illnesses. The mediating effect analysis showed that hopelessness played a complete mediating role between psychological pain and suicide stages. In addition, hopelessness was significantly negatively correlated with suicide stages.

CONCLUSION

mental illness (especially depression) in high-suicide-risk adolescents is closely related to suicide stages, the later the suicide stage, the higher the diagnosis rate of mental illness. The suicide mechanism path in high-suicide-risk adolescents is: psychological pain→ hopelessness → suicide stages, indicating that psychological pain mainly affects suicide risk through hopelessness. Adolescents who are later in the suicide stages have fewer expressions of hopelessness in the traditional sense.

Social Exclusion and Depression among undergraduate students: the mediating roles of rejection sensitivity and social self-efficacy

Nowadays, depression has been a prominent mental health problem throughout the world. A common but negative social experience, social exclusion (also known as ostracism) is a great risk factor for individuals' health and adaptation. Undergraduate students are in a development period of challenges and transitions, so they are vulnerable to suffering from depression and negative social experiences. Against this background, the present study aimed to examine the association between social exclusion and undergraduate students' depression as well as the underlying mechanism - the mediating roles of rejection sensitivity and social self-efficacy. Seven hundred sixty-two undergraduate students were recruited to participate in this study, who were asked to complete a set of questionnaires measuring social exclusion, depression, rejection sensitivity, and social self-efficacy. After controlling for gender, social exclusion was positively associated with undergraduate students' depression. And rejection sensitivity and social self-efficacy could significantly mediate this relation through three mediating paths - the separate mediating effects of rejection sensitivity and social self-efficacy, as well as the serial mediating effect of rejection sensitivity and social self-efficacy. These results could not only deepen our understanding of this theme, but also have several practical implications for the intervention of depression, for example, relevant social skill training and cognitive therapy could be adopted to intervene the rejection sensitivity and social self-efficacy.

The mediating roles of depression, anxiety, and psychological pain in the relationship between chronotype and suicide in patients with depressive disorder

The evening chronotype has been associated with depressive symptoms and suicidality; however, the underlying mechanisms are still under investigation. Research has shown that psychological pain, or feelings of suffering, is closely related to suicidality. Therefore, the aim of the study is to determine whether psychological pain, anxiety, and depressive symptoms mediate the association between chronotype and depressive symptoms in patients with depression and in healthy controls. A total of 118 patients with depressive disorder and 85 healthy controls completed the Morningness-Eveningness Questionnaire, the Hospital Anxiety and Depression Scale, the Suicide Probability Scale, and the Mee-Bunney Psychological Pain Assessment Scale. Mediation analysis revealed that the relationship between eveningness and suicidality was fully mediated by depression and psychological pain and not by anxiety. These findings highlight that psychological pain is an important psychological dimension in the relationship between eveningness and suicidality.

Childhood trauma increases vulnerability to attempt suicide in adulthood through avoidant attachment

BACKGROUND

Childhood trauma and affective disorders are known risk factors for adult suicidal behavior. Studies have shown a mediating effect of insecure attachment on the effect of childhood trauma and suicidal behavior but so far it is not clear whether this effect is related to an attachment dimension (anxiety, avoidance).

AIM

The present study sought to examine the mediating effect of attachment anxiety and avoidance on suicidal behavior.

METHODS

We analyzed data on childhood trauma, attachment style, depression severity, presence of prior suicide attempts and current suicide ideation from 96 patients diagnosed with an affective disorder. Two mediation analyses were conducted to assess the effect of childhood trauma on 1) prior suicide attempts and 2) current suicidal ideation through its effect on attachment.

RESULTS

We found that childhood trauma had a complete mediated effect on the presence of prior suicide attempts through its effect on avoidant attachment (a1b1 = 0.0120, 95%-CI [0.0031, 0.0276]). However, only emotional abuse had a direct influence on suicidal ideation (c' = 0.0273, p < 0.01) without any indirect effect of anxious or avoidant attachment.

LIMITATIONS

Variables were not assessed in a prospective way and sample size was small.

CONCLUSIONS

Our findings suggest that individuals with avoidant attachment and childhood trauma are likely to present a high suicide risk. Since avoidant attachment is associated with altered perceptions and eventual rejection of social support, we recommend to screen for attachment early and to engage patients in therapeutical approaches focusing on the client-therapist alliance.