Risk factors for suicidality in Europe: results from the ESEMED study

Fish consumption and depression in Korean population: The Korea National Health and Nutrition Examination Survey, 2013-2021

BACKGROUND

Epidemiological studies in some populations showed that dietary intake of fish may be inversely associated with depression, but large studies in Korean population are limited. Thus, we investigated the association between fish consumption and depression, considering the serving size of fish, in Korean adults.

METHODS

This study was based on the data from the Korea National Health and Nutrition Examination Survey (2013-2021), which is a large nationally representative study of Korean population. Fish consumption was assessed with a 24-hour dietary recall, and physician-diagnosed depression status was assessed using questionnaires from the health interview survey. Multivariable logistic regression models adjusting for demographic, lifestyle, and dietary factors were used to calculate odds ratios (OR) and 95 % confidence intervals (CI) for depression.

RESULTS

A total of 31,632 adults aged 19-64 years were included in the analysis. After adjusting for covariates, highest fish consumption (≥4 servings/week) was significantly associated with 26 % lower odds of depression compared to the lowest fish consumption (<1 servings/week) (OR 0.74; 95 % CI, 0.60-0.92, P for trend = 0.007). A similar inverse association was found in female adults (OR 0.76; 95 % CI, 0.59-0.97, P for trend = 0.018), but no significant association was found in male adults (OR 0.75; 95 % CI, 0.49-1.15, P for trend = 0.223).

LIMITATIONS

Since KNHANES is a cross-sectional study, it is difficult to evaluate the causal relationship between fish consumption and depression risk.

CONCLUSIONS

This study results suggest that high fish consumption is associated with lower risk of depression in Korean adults, especially in female adults.

Predicting the Population Risk of Suicide Using Routinely Collected Health Administrative Data in Quebec, Canada: Model-Based Synthetic Estimation Study

BACKGROUND

Suicide is a significant public health issue. Many risk prediction tools have been developed to estimate an individual's risk of suicide. Risk prediction models can go beyond individual risk assessment; one important application of risk prediction models is population health planning. Suicide is a result of the interaction among the risk and protective factors at the individual, health care system, and community levels. Thus, policy and decision makers can play an important role in suicide prevention. However, few prediction models for the population risk of suicide have been developed.

OBJECTIVE

This study aims to develop and validate prediction models for the population risk of suicide using health administrative data, considering individual-, health system-, and community-level predictors.

METHODS

We used a case-control study design to develop sex-specific risk prediction models for suicide, using the health administrative data in Quebec, Canada. The training data included all suicide cases (n=8899) that occurred from January 1, 2002, to December 31, 2010. The control group was a 1% random sample of living individuals in each year between January 1, 2002, and December 31, 2010 (n=645,590). Logistic regression was used to develop the prediction models based on individual-, health care system-, and community-level predictors. The developed model was converted into synthetic estimation models, which concerted the individual-level predictors into community-level predictors. The synthetic estimation models were directly applied to the validation data from January 1, 2011, to December 31, 2019. We assessed the performance of the synthetic estimation models with four indicators: the agreement between predicted and observed proportions of suicide, mean average error, root mean square error, and the proportion of correctly identified high-risk regions.

RESULTS

The sex-specific models based on individual data had good discrimination (male model: C=0.79; female model: C=0.85) and calibration (Brier score for male model 0.01; Brier score for female model 0.005). With the regression-based synthetic models applied in the validation data, the absolute differences between the synthetic risk estimates and observed suicide risk ranged from 0% to 0.001%. The root mean square errors were under 0.2. The synthetic estimation model for males correctly predicted 4 of 5 high-risk regions in 8 years, and the model for females correctly predicted 4 of 5 high-risk regions in 5 years.

CONCLUSIONS

Using linked health administrative databases, this study demonstrated the feasibility and the validity of developing prediction models for the population risk of suicide, incorporating individual-, health system-, and community-level variables. Synthetic estimation models built on routinely collected health administrative data can accurately predict the population risk of suicide. This effort can be enhanced by timely access to other critical information at the population level.

Psychological dimensions in alcohol use disorder: comparing active drinkers and abstinent patients

Background

Alcohol use disorder (AUD) is a major public health concern due to its various physical, psychological, and social consequences. Despite regulatory differences, abstinence remains the primary treatment objective. Addressing the multifaceted nature of alcohol use disorder requires a comprehensive approach.

Methods

150 AUD patients (66%male) with a mean age of 54.10 ± 11.3 years were recruited for the study. Depression, impulsivity, alexithymia, and hopelessness were assessed to determine if there were significant differences in these dimensions between abstinent (N=72) and active drinkers (N=78).

Results

The study found significant differences in the psychological dimensions scores, active drinkers exhibited higher levels of depression, impulsivity, alexithymia, and hopelessness compared to abstinent patients.

Conclusion

Treatment outcomes for patients with AUD vary between regulatory agencies, but abstinence remains the safest and most preferred objective in managing AUD. Prioritizing abstinence-oriented interventions is crucial for achieving long term recovery and minimizing relapse risk. These results emphasize the intricate relationship between AUD and mental health issues, highlighting the need for comprehensive interventions addressing both alcohol consumption and associated psychological distress. Promoting abstinence (or at least reducing alcohol consumption) not only preserves mental health but also prevents life-threatening consequences such as suicide.

Risk factors for mortality after hospitalization for suicide attempt: results of 11-year follow-up study in Piedmont Region, Italy

PURPOSE

Suicide attempters are at high risk of premature death, both for suicide and for non-suicidal causes. The aim of this study is to investigate risk factors and temporal span for mortality in a cohort of cases admitted to hospital for suicide attempt.

METHODS

The cohort included 1489 patients resident in Piedmont Region, North West of Italy, who had been admitted to hospital or emergency department for suicide attempt between 2010 and 2020. Cox regression models were used to identify risk factors for death. The final multivariate model included gender, age, area deprivation index, family composition, psychiatric disorders, malignant neoplasms, neurological disorders, diabetes mellitus, cardiovascular diseases, chronic obstructive pulmonary disease, and intracranial injury or skull fracture.

RESULTS

During the observation period, 7.3% of patients died. The highest mortality was observed within the first 12 months after suicide attempt, and remained elevated for many years afterwards. Male gender, older age, high deprivation index of the census area, single-parent family, mood disorders, malignant neoplasms, diabetes mellitus and intracranial injuries or skull fracture were independent predictors of death. Risk factors for natural and unnatural causes of death were also identified.

CONCLUSIONS

The mortality risk of suicide attempters is very high, both in the months immediately following the attempt and afterwards. The identification of high-risk groups can help to plan outpatient care following the hospital discharge. Our findings urge the need to design strategies for the assistance and care of these patients at long term in order to reduce the unfavourable outcomes.

Prevalence of suicidal ideation in German psychotherapy outpatients: A large multicenter assessment

BACKGROUND

Suicidal ideation is a major concern in clinical practice. Yet, little is known about prevalence rates of suicidal ideation in patients undergoing outpatient psychotherapeutic treatment. Therefore, the aim of the current study is to assess the prevalence of suicidal ideation in a large sample of psychotherapy outpatients in Germany. The data analyzed in this study is taken from the KODAP-project on the coordination of data collection and analysis at German university-based research and training outpatient clinics for psychotherapy.

METHODS

A total of N = 10,357 adult outpatients (64.4 % female; age: M(SD) = 35.94 (13.54), range: 18-92 years of age) starting cognitive-behavioral therapy at one of 27 outpatient clinics in Germany were included in the current study. Prevalence of suicidal ideation was assessed with the Suicide Item (Item 9) of the Beck-Depression Inventory II.

RESULTS

Suicidal ideation was reported by 36.7 % (n = 3795) of the participants. Borderline Personality Disorder, Posttraumatic Stress Disorder, and recurrent Major Depression were the diagnoses most strongly associated with the presence and severity of suicidal ideation.

LIMITATION

Suicide ideation was assessed only with the respective item of the Beck Depression Inventory II.

CONCLUSION

Suicidal ideation is very common among adult patients who start psychotherapy in Germany. A well-founded knowledge of risk assessment in suicidal patients and suicide-specific treatment options is therefore highly relevant.

Recent Advances in the Treatment of Treatment-Resistant Depression: A Narrative Review of Literature Published from 2018 to 2023

PURPOSE OF REVIEW

We review recent advances in the treatment of treatment-resistant depression (TRD), a disorder with very limited treatment options until recently. We examine advances in psychotherapeutic, psychopharmacologic, and interventional psychiatry approaches to treatment of TRD. We also highlight various definitions of TRD in recent scientific literature.

RECENT FINDINGS

Recent evidence suggests some forms of psychotherapy can be effective as adjunctive treatments for TRD, but not as monotherapies alone. Little recent evidence supports the use of adjunctive non-antidepressant pharmacotherapies such as buprenorphine and antipsychotics for the treatment of TRD; side effects and increased medication discontinuation rates may outweigh the benefits of these adjunctive pharmacotherapies. Finally, a wealth of recent evidence supports the use of interventional approaches such as electroconvulsive therapy, ketamine/esketamine, and transcranial magnetic stimulation for TRD. Recent advances in our understanding of how to treat TRD have largely expanded our knowledge of best practices in, and efficacy of, interventional psychiatric approaches. Recent research has used a variety of TRD definitions for study inclusion criteria; research on TRD should adhere to inclusion criteria based on internationally defined guidelines for more meaningfully generalizable results.

The prevalence of alcohol consumption and its related factors in adolescents: Findings from Global School-based Student Health Survey

BACKGROUND

Alcohol consumption has become very common among adolescents in recent years and its prevalence varies in different countries. This study aimed to investigate the prevalence of alcohol consumption and related factors in adolescents aged 11 to 16 years.

METHODS

This descriptive cross-sectional study was performed on 288385 adolescents (girls, 53.9% of total) aged 11 to 16 years. In the present study, the GSHS data (2003-2018) available to public on the websites of the US Centers for Disease Control and Prevention (CDC) and WHO was used. To investigate the factors affecting alcohol consumption, univariate and multivariate logistics models with 95% confidence limits were used.

RESULTS

The overall prevalence of alcohol consumption in adolescents was 25.2%, which was 28.3% and 22.4% in boys and girls, respectively. Among the surveyed countries, the highest prevalence was in Seychelles (57.9%) and the lowest in Tajikistan (0.7). Multivariate analysis showed that the Age for 16 and more than 16 years old (OR = 3.08,95%CI: 2.54-3.74), truancy for more than 10 days (OR = 1.24, 95%CI: 1.08-1.43), loneliness at sometimes of the times (OR = 1.04, 95%CI: 1.01-1.07), insomnia at most of the times (OR = 1.85, 95%CI: 1.70-2.01), daily activity (OR = 1.03, 95%CI: 1.00-1.07), bullied for 1-9 Days in a month (OR = 1.24, 95%CI: 1.09-1.40), cigarette (OR = 4.01, 95%CI: 3.86-4.17), used marijuana for more than 10 days in a month (OR = 5.58, 95%CI: 4.59-7.78), had sex (OR = 2.76, 95%CI: 2.68-2.84), and suicide plan (OR = 1.48, 95%CI: 1.42-1.54) were important factors affecting drinking alcohol. (Table 4). In this study, the sensitivity, specificity, positive predictive value, and negative predictive value were 42.79%, 93.96%, 70.80%, and 82.75.

CONCLUSIONS

According to the results of the present study, the prevalence of alcohol consumption among teenagers was high. Therefore, it is suggested that demographic, family, and psychological factors should be taken into consideration in health programs for the prevention and treatment of alcohol consumption in adolescents.

Comprehensive bioinformatics analysis of co-expressed genes of post-traumatic stress disorder and major depressive disorder

BACKGROUND

Post-traumatic stress disorder (PTSD) is one of the most serious sequelae of trauma with serious impact worldwide. Studies have suggested an association between PTSD and major depressive disorder (MDD), but the underlying common mechanisms remain unclear. This study aimed to further explore the molecular mechanism between PTSD and MDD via comprehensive bioinformatics analysis.

METHODS

The microarray data of PTSD and MDD were downloaded from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) analysis and weighted gene co-expression network analysis (WGCNA) were performed to identify the co-expressed genes associated with PTSD and MDD. Gene Set Enrichment Analysis (GSEA), enrichment analyses based on Disease Ontology (DO), Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were performed using R software. Then, R software was used for single-sample gene set enrichment analysis (ssGSEA) and immune infiltration analysis on the co-expressed genes in the two datasets., Therefore, a logistic regression model was constructed to predict PTSD and MDD using the R language. Ultimately, this study employed PTSD and MDD models to assess alterations in the expression of target genes within the mouse hippocampus.

RESULTS

Four core genes (GNAQ, DPEP3, ICAM2, PACSIN2) were obtained through different analyses, and these genes had predictive validity for PTSD and MDD, playing an important role in the common mechanism of PTSD and MDD. The study findings reveal decreased expression levels of DPEP3, GNAQ, and PACDIN2 in PTSD samples, accompanied by an increased expression of ICAM2. In MDD samples, the expression of DPEP3 and ICAM2 is reduced, whereas GNAQ and PACDIN2 show an increase in expression.

CONCLUSIONS

This study provides a new perspective on the common molecular mechanisms of PTSD and MDD. These common pathways and core genes may provide promising clues for further experimental studies.

Income inequality and deaths of despair risk in Canada, identifying possible mechanisms

BACKGROUND

Declines in life expectancy in developed countries have been attributed to increases in drug-related overdose, suicide, and liver cirrhosis, collectively referred to as deaths of despair. Income inequality is proposed to be partly responsible for increases in deaths of despair rates. This study investigated the associations between income inequality, deaths of despair risk in Canada, and potential mechanisms (stress, social cohesion, and access to health services).

METHODS

We obtained data from the Canadian Community Health Survey and the Canadian Vital Statistics Database from 2007 to 2017. A total of 504,825 Canadians were included in the analyses. We used multilevel survival analyses, as measured by the Gini coefficient, to examine the relationships between income inequality and mortality attributed to drug overdose, suicide, death of despair, and all-cause. We then used multilevel path analyses to investigate whether each mediator (stress, social cohesion, and access to mental health professionals), which were investigated using separate mediation models, influenced the relationship between income inequality and drug overdose, suicide, deaths of despair, and all-cause death.

RESULTS

Adjusted multilevel survival analyses demonstrated significant relationships between a one-SD increase in Gini coefficient was associated with an increased hazard for drug overdose (HRadj. = 1.28; 95 CI = 1.05, 1.55), suicide (HRadj. = 1.24; 95 CI = 1.06, 1.46), deaths of despair (HRadj. = 1.26; 95 CI = 1.12, 1.40), and all-cause death (HRadj. = 1.04; 95 CI = 1.02, 1.07). Adjusted path analyses indicated that stress, social cohesion, and access to mental health professionals significantly mediated the association between income inequality and mortality outcomes.

CONCLUSION

Income inequality is associated with deaths of despair and this relationship is mediated by stress, social cohesion, and access to mental health professionals. Findings should be applied to develop programs to address income inequality in Canada.

Clinical predictive factors and trajectories of suicidal remission over 6 weeks following intravenous ketamine for suicidal ideation

BACKGROUND

Ketamine is efficient for short-term reduction of suicidal ideas. Predictive factors and outcome trajectories are poorly characterized.

METHODS

Secondary analyses were conducted on the KETIS study (Abbar et al. BMJ 2022): 156 suicidal patients were randomized to two intravenous infusions of racemic ketamine (0.5 mg/kg) or placebo. Response or remission was assessed over six weeks based on the Beck Scale for Suicidal Ideation (SSI). We calculated i) predictive values of 12 baseline variables on remission ii) outcome courses, and iii) positive (PPV) and negative predictive values.

RESULTS

In multivariate analyses, bipolar disorder, lower patient-rated suicidal ideas, and higher physical pain were predictive of suicidal remission at day 3. No clinical factor predicted remission at week 6. Twenty and 24 different clinical courses were identified in early (day 3) and later (week 6) follow-up, respectively, including around 40 % sustained remission, 50 % fluctuating course and 10 % no response. Suicidal remissions at day 1 and day 3 were highly predictive of remissions at day 3 and week 6 (PPV = 96.8 and 92.6 %).

LIMITATIONS

SSI may not be adapted for rapid variations and repeated measures.

CONCLUSIONS

Clinical factors were poorly predictive of remission. Fluctuations in suicidal ideas were frequent, even after ketamine (although less than placebo), necessitating vigilance and multimodal care. Remission at day 1 after one infusion was highly predictive of future remission. The benefits of a second infusion will have to be tested.

Sexual Orientation and Age-Related Patterns of Suicidal Ideation Among U.S. Adults

Purpose: We aimed to explore whether and how suicidal ideation differs according to specific sexual orientations (i.e., heterosexual, gay/lesbian, bisexual orientation) and age groups in gender-stratified analyses. Methods: We identified state health departments from nine U.S. states that collected Behavioral Risk Factor Surveillance System data on both sexual orientation and suicidal ideation from 2011 to 2018 for adults aged 18 and older (n = 113,337). Logistic regression and average marginal effects (AME) were used to examine the likelihood of suicidal ideation by sexual orientation, gender, and age. Results: We found that after important sociodemographic and socioeconomic controls, sexual minority adult men and women experienced significantly higher odds of suicidal ideation than their same-gender heterosexual counterparts. After all adjustments, lesbian women had more than three times higher odds and bisexual women had almost four times higher odds than heterosexual women. Compared with heterosexual men, gay men reported twice higher odds and bisexual men exhibited 3.67 times higher odds of suicidal ideation. Analysis of the AME revealed age-specific disparities. The likelihood of suicidal ideation for bisexual men aged 18-24 years was significantly higher than that for gay and heterosexual men of the same age. Among women, bisexual women closer to middle age (35-44 years) experienced a higher likelihood of suicidal ideation than heterosexual or lesbian women of the same age. Conclusion: The elevated risk of suicidal ideation among sexual minority people throughout different stages of adulthood has important implications for policies and support services.

Prevalence of Suicidal Behavior Among Students in South-East Asia: A Systematic Review and Meta-Analysis

OBJECTIVES

Estimation of rates of suicidal behaviors (ideation, plan, and attempt) would help to understand the burden and prioritize prevention strategies. However, no attempt to assess suicidal behavior among students was identified in South-East Asia (SEA). We aimed to assess the prevalence of suicidal behavior (ideation, plan, and attempt) among students in SEA.

METHODS

We followed PRISMA 2020 guidelines and registered the protocol in PROSPERO (CRD42022353438). We searched in Medline, Embase, and PsycINFO and performed meta-analyses to pool the lifetime, 1-year, and point prevalence rates for suicidal ideation, plans, and attempts. We considered the duration of a month for point prevalence.

RESULTS

The search identified 40 separate populations from which 46 were included in the analyses, as some studies included samples from multiple countries. The pooled prevalence of suicidal ideation was 17.4% (confidence interval [95% CI], 12.4%-23.9%) for lifetime, 9.33% (95% CI, 7.2%-12%) for the past year, and 4.8% (95% CI, 3.6%-6.4%) for the present time. The pooled prevalence of suicide plans was 9% (95% CI, 6.2%-12.9%) for lifetime, 7.3% (95% CI, 5.1%-10.3%) for the past year, and 2.3% (95% CI, 0.8%-6.7%) for the present time. The pooled prevalence of suicide attempts was 5.2% (95% CI, 3.5%-7.8%) for lifetime and 4.5% (95% CI, 3.4%-5.8%) for the past year. Higher rates of suicide attempts in the lifetime were noted in Nepal (10%) and Bangladesh (9%), while lower rates were reported in India (4%) and Indonesia (5%).

CONCLUSIONS

Suicidal behaviors are a common phenomenon among students in the SEA region. These findings call for integrated, multisectoral efforts to prevent suicidal behaviors in this group.

Childhood adversities and suicidal behavior in the general population. The cross-sectional PEGASUS-Murcia Project

INTRODUCTION

The aim of the present study is to estimate the lifetime prevalence of suicidal ideation, plans, and attempts in a regional representative sample and the association of these outcomes with sociodemographic factors, prior mental disorders, and childhood adversities.

MATERIAL AND METHODS

The PEGASUS-Murcia project is a cross-sectional survey of a representative sample of adults in Murcia that is part of the WHO World Mental Health Survey Initiative. The Composite International Diagnostic Interview (CIDI 3.0) was administered face-to-face to 2621 participants (67.4% response rate). The main outcomes were suicidal ideation, plans, and attempts. Lifetime prevalence, age of onset, and risk factors (sociodemographic variables, mental disorders, and childhood adversities) were examined using multiple discrete-time survival models.

RESULTS

Lifetime prevalence of suicidal ideation, plans and attempts were 8.0% (standard error, SE: 1.1), 2.1% (SE: 0.3), and 1.2% (SE: 1.1), respectively. Prevalence of any childhood adversities was 22.1% (SE: 1.3) in the total sample and, even higher, among those with suicide related outcomes (ranging between 36.8% and 53.7%). Female sex, younger age, prior (to onset of the outcome) lifetime prevalence of mood disorders, number of mental disorders, and exposure to childhood adversity were associated with significantly increased odds of suicidal ideation and plans.

CONCLUSIONS

Lifetime prevalence estimates of suicidality are similar to those in community epidemiological surveys. Childhood adversities and mental disorders, especially mood disorders, are important risk factors for suicidality. Early detection of these adversities and disorders should be targeted in suicide prevention programs.

The relationship of negative life events, trait-anxiety and depression among Chinese university students: A moderated effect of self-esteem

BACKGROUND

Negative life events are major triggers for depression. How individual physical qualities and psychological resources affect the relationship between negative life events and depression in college students remains to be studied. Therefore, we constructed a structural equation model to explore the mediating effect of trait anxiety and the moderating effect of self-esteem in the relationship between negative life events and depression among college students.

METHODS

A total of 6224 Chinese college students (aged 16-25) in Jiangxi Province in the central area of China completed the online survey. A moderated mediation model was tested to verify the hypothesis.

RESULTS

The mediation analysis showed a significant indirect effect of negative life events on depression through trait-anxiety. Mediation was moderated by self-esteem, which significantly interacted with negative life events to reduce their effect on both anxiety and depression.

LIMITATIONS

All measures were self-reported. The cross-sectional design only provides evidence of correlation.

CONCLUSIONS

The results in this study revealed that self-esteem as a component of psychological defense mechanism to reduce the harm of environmental threats to individuals. Low self-esteem college students are more likely to have adverse effects when experiencing low-level life events. University mental health education reduces the effects of negative life events on trait anxiety and depression of college students by raising their self-esteem levels.

Blending Video Therapy and Digital Self-Help for Individuals With Suicidal Ideation: Intervention Design and a Qualitative Study Within the Development Process

BACKGROUND

Digital formats have the potential to enhance accessibility to care for individuals with suicidal ideation. However, digital self-help interventions have faced limitations, including small effect sizes in reducing suicidal ideation, low adherence, and safety concerns.

OBJECTIVE

Therefore, we aimed to develop a remote blended cognitive behavioral therapy intervention that specifically targets suicidal ideation by blending video therapy with web-based self-help modules. The objective of this paper is to describe the collaborative development process and the resulting intervention and treatment rationale.

METHODS

First, we compiled intervention components from established treatment manuals designed for people with suicidal ideation or behavior, resulting in the development of 11 drafts of web-based modules. Second, we conducted a qualitative study, involving 5 licensed psychotherapists and 3 lay counselors specialized in individuals with suicidal ideation who reviewed these module drafts. Data were collected using the think-aloud method and semistructured interviews, and a qualitative content analysis was performed. The 4 a priori main categories of interest were blended care for individuals with suicidal ideation, contents of web-based modules, usability of modules, and layout. Subcategories emerged inductively from the interview transcripts. Finally, informed by previous treatment manuals and qualitative findings, we developed the remote blended treatment program.

RESULTS

The participants suggested that therapists should thoroughly prepare the web-based therapy with patients to tailor the therapy to each individual's needs. Participants emphasized that the web-based modules should explain concepts in a simple manner, convey empathy and validation, and include reminders for the safety plan. In addition, participants highlighted the need for a simple navigation and layout. Taking these recommendations into account, we developed a fully remote blended cognitive behavioral therapy intervention comprising 12 video therapy sessions and up to 31 web-based modules. The treatment involves collaboratively developing a personalized treatment plan to address individual suicidal drivers.

CONCLUSIONS

This remote treatment takes advantage of the high accessibility of digital formats while incorporating full sessions with a therapist. In a subsequent pilot trial, we will seek input from individuals with lived experience and therapists to test the feasibility of the treatment.

Validation of the Farsi version of the Suicide Ideation and Behavior Scale

Objective

Suicide ideation and suicide attempts are prevalent in Farsi speaking populations. The present study aimed at validating the Farsi version of the Suicide Ideation and Behavior Scale (SIBS).

Methods

Reliability and validity of the Farsi version of the SIBS were established in a highly burdened Afghan student sample (N = 279). Internal consistency, convergent and discriminant validity were investigated, and confirmatory factor analysis was conducted.

Results

The Farsi version of the SIBS was shown to have a unidimensional structure with excellent internal consistency, as well as good convergent and divergent validity.

Discussion

The results suggest that the SIBS is a brief, reliable, and valid measure of current suicidal ideation and behavior that can be used in Farsi speaking populations.

Epidemiology and Clinical-Demographic Characteristics of Suicide Attempts in Alcohol Use Disorders in an Italian Population

Suicide is a leading cause of morbidity worldwide. Among the known risk factors, alcohol use disorders (AUDs) are particularly relevant, but data on the epidemiology and characteristics of suicide attempts (SA) in this group are lacking. We used electronic health records of national health services to identify individuals who received a diagnosis of AUD in the Metropolitan area of Bologna from 2009 to 2019. In this cohort we identified accesses to Emergency Departments for SA from 2009 to 2020. The Crude Suicide Rate (CSR) for 1,000 Person Years was 2.93, higher than the general population. The CSR was higher in females, within one year from receiving the diagnosis of AUD, in patients with psychiatric comorbidities, concomitant abuse of cannabis or benzodiazepines. As for Covid-19 pandemic, the risk ratio of SA was significantly higher in 2020 compared to 2019 in females. Our results are relevant to identify clinical risk factors for SA in patients with AUDs, which are strongly associated with suicide risk but with scarce data in the previous literature and paucity of evidence-based therapeutic interventions.

Effects of resistance exercise training on depressive symptoms among young adults: A randomized controlled trial

Evidence supports the antidepressant effects of resistance exercise training (RET); however, findings among young adults at-risk for elevated depressive symptoms are limited. This randomized controlled trial examined the effects of eight weeks of ecologically-valid, guidelines-based RET, compared to a wait-list control, on depressive symptoms among 55 young adults (26±5y; 36 female) with and without subclinical, or analogue, Generalized Anxiety Disorder (AGAD; Psychiatric Diagnostic Screening Questionnaire GAD subscale ≥6 and Penn State Worry Questionnaire ≥45) and Major Depressive Disorder (AMDD). Following a three-week familiarization period, participants completed one-on-one, twice-weekly RET sessions. The 16-item, self-reported Quick Inventory of Depressive Symptomatology (QIDS) assessed depressive symptoms. RM-ANCOVAs examined between-group differences, and significant interactions were decomposed with simple effects analysis. Hedges' d effect sizes (95%CI) quantified the magnitude of differences in change between groups across time. Stratified analyses were conducted among subsamples with AMDD and AGAD. There were no baseline depressive symptom differences between groups. Attendance was 83%, and compliance was 80%. RET induced statistically significant, clinically-meaningful, large-magnitude reductions in depressive symptoms from baseline to week eight in the total (d = 1.01; [95%CI: 0.44-1.57]), AMDD (d = 1.71; [95%CI: 0.96-2.46]), and AGAD (d = 1.39; [95%CI: 0.55-2.24]) samples. These findings support guidelines-based RET as a promising treatment for mild depression.

Prevalence and clinical correlates of psychotic symptoms in first-episode untreated female chinese patients with major depressive disorder

BACKGROUND

Recent studies have reported that psychotic symptoms are common in patients with major depressive disorder (MDD). However, few studies have reported the relationship between thyroid function, lipid metabolism and clinical profiles in female MDD patients. Thus, this study aimed to investigate the prevalence of psychotic depression (PD) and its risk factors in first-episode and drug naive (FEDN) depression among the female population in China.

METHODS

This was a cross-sectional study involving a representative probability sample of 1,130 FEDN female outpatients with MDD (aged 18 years or older) in China. We collected information relating to socio-demographic characteristics, clinical data and blood samples. The Hamilton Depression Rating Scale 17-item version (HAMD-17), Hamilton Anxiety Rating Scale 14-item version (HAMA-14), and Positive and Negative Syndrome Scale (PANSS) were used to evaluate depressive, anxiety, and psychotic symptoms.

RESULTS

The prevalence of psychotic symptoms in female MDD patients was 10.97%. The findings revealed significant differences between MDD female patients with psychotic symptoms and non-PD female patients in the following areas: higher HAMD scores, higher HAMA scores, more severe anxiety and an increased risk of suicide attempts. Further logistic regression analysis showed that psychotic symptoms were associated with higher thyroid-stimulating hormone (TSH) levels and an odds ratio of 1.168.

CONCLUSIONS

Our findings supported the hypothesis that higher TSH levels were correlated with psychotic symptoms in female MDD patients. Therefore, serum TSH levels may be a potential biomarker of PD in female MDD patients. In addition, we found that PD was closely associated with suicide attempts and lipid levels, but did not reach statistical significance.

Diurnal symptoms of sleepiness and dysfunction predict future suicidal ideation in a French cohort of outpatients (FACE-DR) with treatment resistant depression: A 1-year prospective study about sleep markers

BACKGROUND

Patients suffering from treatment-resistant depression (TRD) are at risk of suicide. Sleep and circadian rhythm alterations are widely recognized as core symptoms of major depressive disorder and are associated with suicidal ideation. Thus, sleep and circadian rhythm alterations may be targeted to prevent suicide.

METHODS

Patients were recruited from a prospective cohort of the French network of TRD expert centers. Mood, sleep and circadian rhythms were assessed at baseline; suicidal risk was assessed both at baseline and during a one-year follow-up with standardized subjective questionnaires.

RESULTS

Excessive daytime sleepiness (adjusted odds ratio aOR = 1.7(1-3.3), p = 0.04) and daytime dysfunction (aOR = 1.81(1.16-2.81), p = 0.0085) increased the risk of suicidal thoughts over the one-year follow-up period in patients with TRD after adjustment on age, gender, depression, trauma, anxiety, impulsivity, current daily tobacco smoking and body mass index. Hypnotics intake is associated with a reduced risk of suicidal ideation at one-year follow-up after the same adjustments (OR = 0.73(0.56-0.95), p = 0.019). Other associations between sleep quality or circadian rhythms and suicidal ideations at either baseline or one year did not remain significant in multivariate analyses after the same adjustments.

LIMITATIONS

Sleep assessments were based on self-reported questionnaires rather than objective measures.

CONCLUSIONS

Daytime sleepiness and dysfunction are predictors of suicidal ideations, whereas hypnotics intake is associated with a reduced risk of suicidal ideations. Diurnal symptoms of sleep disturbances are therefore red flags to target for preventing suicide in depressed patients, and hypnotics seem efficient in preventing suicide for patients with TRD.

Pharmacological Mechanism of Ketamine in Suicidal Behavior Based on Animal Models of Aggressiveness and Impulsivity: A Narrative Review

Around 700,000 people die from suicide each year in the world. Approximately 90% of suicides have a history of mental illness, and more than two-thirds occur during a major depressive episode. Specific therapeutic options to manage the suicidal crisis are limited and measures to prevent acting out also remain limited. Drugs shown to reduce the risk of suicide (antidepressants, lithium, or clozapine) necessitate a long delay of onset. To date, no treatment is indicated for the treatment of suicidality. Ketamine, a glutamate NMDA receptor antagonist, is a fast-acting antidepressant with significant effects on suicidal ideation in the short term, while its effects on suicidal acts still need to be demonstrated. In the present article, we reviewed the literature on preclinical studies in order to identify the potential anti-suicidal pharmacological targets of ketamine. Impulsive-aggressive traits are one of the vulnerability factors common to suicide in patients with unipolar and bipolar depression. Preclinical studies in rodent models with impulsivity, aggressiveness, and anhedonia may help to analyze, at least in part, suicide neurobiology, as well as the beneficial effects of ketamine/esketamine on reducing suicidal ideations and preventing suicidal acts. The present review focuses on disruptions in the serotonergic system (5-HT_B receptor, MAO-A enzyme), neuroinflammation, and/or the HPA axis in rodent models with an impulsive/aggressive phenotype, because these traits are critical risk factors for suicide in humans. Ketamine can modulate these endophenotypes of suicide in human as well as in animal models. The main pharmacological properties of ketamine are then summarized. Finally, numerous questions arose regarding the mechanisms by which ketamine may prevent an impulsive-aggressive phenotype in rodents and suicidal ideations in humans. Animal models of anxiety/depression are important tools to better understand the pathophysiology of depressed patients, and in helping develop novel and fast antidepressant drugs with anti-suicidal properties and clinical utility.

Dissecting the causal association between inflammation and post-traumatic stress disorder: A bidirectional Mendelian randomization study

BACKGROUND

Accumulating evidence showed a bidirectional association between post-traumatic stress disorder and inflammation. However, whether the association is causal remains unclear. We aimed to evaluate the causal relationships between inflammatory cytokines and post-traumatic stress disorder using two-sample bi-directional Mendelian randomization analysis.

METHODS

Single nucleotide polymorphism from genome-wide association studies of inflammatory cytokines, C-reactive protein, and post-traumatic stress disorder (23,212 patients and 151,447 controls) was selected as instrumental variables. The causal associations were estimated by inverse variance weighting with sensitivity analyses using weighted median, MR-Egger, and MR-PRESSO methods.

RESULTS

We observed suggestive associations of genetically predicted interleukin-17 (IL-17) and RANTES with post-traumatic stress disorder. One standard deviation (SD) increase in genetically predicted level of IL-17 lowered the risk of post-traumatic stress disorder with an odds ratio (OR) of 0.902 (95 % CI = 0.828, 0.984, P = 0.02). One SD higher genetically predicted RANTES (CCL5) concentration increased post-traumatic stress disorder risk (OR = 1.067, 95 % CI = 1.005, 1.133, P = 0.032). However, we found no evidence of causal associations of post-traumatic stress disorder with the selected inflammatory cytokines and biomarkers. We observed no evidence supporting the presence of pleiotropy. The results of sensitivity analyses demonstrated the same directions and similar effect sizes as the primary findings.

LIMITATIONS

Potential pleiotropy, possible weak instruments, and low statistical power limited our findings.

CONCLUSION

Inflammation was suggestively causally associated with the risk of post-traumatic stress disorder, and inflammatory cytokines had no downstream effect on post-traumatic stress disorder. Further studies are needed to explain the mechanisms of systemic inflammation and neuroinflammation in post-traumatic stress disorder.

Unintended Consequences of COVID-19 Non-Pharmaceutical Interventions (NPIs) for Population Health and Health Inequalities

Since the start of the COVID-19 pandemic in early 2020, governments around the world have adopted an array of measures intended to control the transmission of the SARS-CoV-2 virus, using both pharmaceutical and non-pharmaceutical interventions (NPIs). NPIs are public health interventions that do not rely on vaccines or medicines and include policies such as lockdowns, stay-at-home orders, school closures, and travel restrictions. Although the intention was to slow viral transmission, emerging research indicates that these NPIs have also had unintended consequences for other aspects of public health. Hence, we conducted a narrative review of studies investigating these unintended consequences of NPIs, with a particular emphasis on mental health and on lifestyle risk factors for non-communicable diseases (NCD): physical activity (PA), overweight and obesity, alcohol consumption, and tobacco smoking. We reviewed the scientific literature using combinations of search terms such as 'COVID-19', 'pandemic', 'lockdowns', 'mental health', 'physical activity', and 'obesity'. NPIs were found to have considerable adverse consequences for mental health, physical activity, and overweight and obesity. The impacts on alcohol and tobacco consumption varied greatly within and between studies. The variability in consequences for different groups implies increased health inequalities by age, sex/gender, socioeconomic status, pre-existing lifestyle, and place of residence. In conclusion, a proper assessment of the use of NPIs in attempts to control the spread of the pandemic should be weighed against the potential adverse impacts on other aspects of public health. Our findings should also be of relevance for future pandemic preparedness and pandemic response teams.

Predicting suicide attempts among people with diabetes using a large multicenter electronic health records dataset

OBJECTIVE

People with diabetes have a higher risk of suicidal behaviors than the general population. However, few studies have focused on understanding this relationship. We investigated risk factors and predicted suicide attempts in people with diabetes using the Least Absolute Shrinkage and Selection Operator (LASSO) regression.

METHOD

Data was retrieved from Cerner Real-World Data™ and included over 3 million diabetes patients in the study. Least absolute shrinkage and selection operator regression was applied to identify associated factors. Gender-, diabetes-type-, and depression-specific LASSO regression models were analyzed.

RESULTS

There were 7764 subjects diagnosed with suicide attempts with an average age of 45. We found risk factors for suicide attempts in diabetes patients, such as being an American Indian or Alaska Native (β = 0.637), atypical agents (β = 0.704), benzodiazepines (β = 0.784), and antihistamines (β = 0.528). Amyotrophy had a negative coefficient for suicide attempts in males with diabetes (β = -2.025); in contrast, it had a positive coefficient in females with diabetes (β = 3.339). Using MAOI had a negative coefficient for suicide attempts in T1DM patients (β = -7.304). Aged less than 20 had a positive coefficient for suicide attempts in depressed (β = 2.093) and non-depressed patients with diabetes (β = 1.497). The LASSO model had 94.4% AUC and 87.4% F1 score.

CONCLUSIONS

To our knowledge, this is the first study using LASSO regression to identify risk factors for suicide attempts and diabetes. The shrinkage technique successfully reduced the number of variables in the model to improve overfitting. Further research is needed to study cause-and-effect relationships. The results may help providers identify high-risk groups of suicide attempters among diabetes patients.

Cause-specific mortality after hospital discharge for suicide attempt or suicidal ideation: A cohort study in Piedmont Region, Italy

BACKGROUND

Suicide attempters are at higher risk of death than the general population. The present study aims to investigate the excess of all-cause mortality and cause-specific mortality in a cohort of patients who have attempted suicide or had suicidal ideation compared with the general population.

METHOD

The cohort included 826 patients residing in the Piedmont Region of Northwest Italy who were admitted to a hospital or emergency department for suicide attempts or suicidal ideation between 2010 and 2016. Mortality excesses of the study population compared to the general population were estimated by applying indirect standardization. Standardized Mortality Ratios and 95% Confidence Intervals were calculated for all-cause, and cause-specific, natural, and unnatural causes of death by gender and age.

RESULTS

During the 7 years of follow-up, 8.2% of the study sample died. The mortality of suicide attempters and ideators was significantly higher than that of the general population. Mortality was about twice than expected from natural causes, and 30 times than expected from unnatural causes. The mortality due to suicide was 85 times higher than that of the general population, with an excess of 126 times for females. The SMRs for all-cause mortality decreased with increasing age.

CONCLUSIONS

Patients who access hospitals or emergency departments for suicide attempts or suicidal ideation are a frail group at high risk of dying from natural or unnatural causes. Clinicians should pay special attention to the care of these patients, and public health and prevention professionals should develop and implement appropriate interventions to timely identify individuals at higher risk for suicide attempts and suicidal ideation and provide standardized care and support services.

A case-control study on predicting population risk of suicide using health administrative data: a research protocol

INTRODUCTION

Suicide has a complex aetiology and is a result of the interaction among the risk and protective factors at the individual, healthcare system and population levels. Therefore, policy and decision makers and mental health service planners can play an important role in suicide prevention. Although a number of suicide risk predictive tools have been developed, these tools were designed to be used by clinicians for assessing individual risk of suicide. There have been no risk predictive models to be used by policy and decision makers for predicting population risk of suicide at the national, provincial and regional levels. This paper aimed to describe the rationale and methodology for developing risk predictive models for population risk of suicide.

METHODS AND ANALYSIS

A case-control study design will be used to develop sex-specific risk predictive models for population risk of suicide, using statistical regression and machine learning techniques. Routinely collected health administrative data in Quebec, Canada, and community-level social deprivation and marginalisation data will be used. The developed models will be transformed into the models that can be readily used by policy and decision makers. Two rounds of qualitative interviews with end-users and other stakeholders were proposed to understand their views about the developed models and potential systematic, social and ethical issues for implementation; the first round of qualitative interviews has been completed. We included 9440 suicide cases (7234 males and 2206 females) and 661 780 controls for model development. Three hundred and forty-seven variables at individual, healthcare system and community levels have been identified and will be included in least absolute shrinkage and selection operator regression for feature selection.

ETHICS AND DISSEMINATION

This study is approved by the Health Research Ethnics Committee of Dalhousie University, Canada. This study takes an integrated knowledge translation approach, involving knowledge users from the beginning of the process.

Associations between binge drinking experience, depressive mood, and suicidality in adolescents: Based on the 2021 Korea Youth Risk Behavior Web-based Survey

BACKGROUND

This study aimed to investigate the associations between binge drinking experience (BDE), depressive mood, and suicidality among Korean adolescents.

METHODS

We analyzed the 17th population-based and cross-sectional data from the Korean Youth Risk Behavior Web-based Survey. Multiple logistic regression analysis was performed to compare BDE, depressive mood, and suicidality by sex.

RESULTS

In 54,848 adolescents, the prevalence of BDE was 5.3 % in boys and 4.4 % in girls. The prevalence of suicidal ideation, plans, and attempts among girls was 7.8 %, 2.4 %, and 1.4 %, respectively. The prevalence of suicide attempts among girls with both BDE and depressive moods was higher than that among boys. Boys with both BDE and depressive mood had 12.60 times and 14.50 times higher adjusted odds ratio (aOR) of suicide ideation and plan, respectively, compared with the non-drinking/non-depressed group. Girls with both BDE and depressive mood had 22.06 times higher aOR of suicide attempts than the non-drinking/non-depressed group.

LIMITATIONS

The study has few limitations including the use of self-report questionnaires, participants' response bias, and lack of diagnosis by mental health professionals.

CONCLUSIONS

These findings represent the prevalence of suicidality among South Korean adolescents with BDE or depressive mood. Since adolescents with both BDE and depressive mood showed particularly high suicidality, it is necessary to establish mental health services, such as proper prevention strategies and targeted interventions.

Apparent Lack of Benefit of Combining Repetitive Transcranial Magnetic Stimulation with Internet-Delivered Cognitive Behavior Therapy for the Treatment of Resistant Depression: Patient-Centered Randomized Controlled Pilot Trial

Background: Treatment-resistant depression (TRD) is considered one of the major clinical challenges in the field of psychiatry. An estimated 44% of patients with major depressive disorder (MDD) do not respond to two consecutive antidepressant therapies, and 33% do not respond to up to four antidepressants. Over 15% of all patients with MDD remain refractory to any treatment intervention. rTMS is considered a treatment option for patients with TRD. Likewise, iCBT is evidence-based, symptom-focused psychotherapy recommended for the treatment of TRD. Objective: This study aimed to evaluate the initial comparative clinical effectiveness of rTMS treatment with and without iCBT as an innovative intervention for the treatment of participants diagnosed with TRD. Methods: This study is a prospective two-arm randomized controlled trial. Overall, 78 participants diagnosed with TRD were randomized to one of two treatment interventions: rTMS sessions alone and rTMS sessions plus iCBT. Participants in each group were made to complete evaluation measures at baseline, and 6 weeks (discharge) from treatment. The primary outcome measure was baseline to six weeks change in mean score for the 17-item Hamilton depression rating scale (HAMD-17). Secondary outcomes included mean baseline to six-week changes in the Columbia suicide severity rating scale (CSSRS) for the rate of suicidal ideations, the QIDS-SR16 for subjective depression, and the EQ-5D-5L to assess the quality of health in participants. Results: A majority of the participants were females 50 (64.1%), aged ≥ 40 39 (50.0%), and had college/university education 54 (73.0%). After adjusting for the baseline scores, the study failed to find a significant difference in the changes in mean scores for participants from baseline to six weeks between the two interventions under study on the HAMD-17 scale: F (1, 53) = 0.15, p = 0.70, partial eta squared = 0.003, CSSRS; F (1, 56) = 0.04 p = 0.85, partial eta squared = 0.001, QIDS-SR16 scale; F (1, 53) = 0.04 p = 0.61, partial eta squared = 0.005, and EQ-5D-VAS; F (1, 51) = 0.46 p = 0.50, and partial eta squared = 0.009. However, there was a significant reduction in means scores at week six compared to baseline scores for the combined study population on the HAMD-17 scale (42%), CSSRS (41%), QIDS-SR16 scale (35%), and EQ-VAS scale (62%). Conclusion: This study did not find that combined treatment of TRD with rTMS + iCBT (unguided) was superior to treatment with rTMS alone. Our findings do not support the use of combined treatment of rTMS + iCBT for the management of TRD disorders.

Metabolic parameters and thyroid hormones in relation to suicide attempts in patients with first-episode and drug-naive major depressive disorder with comorbid glucose disturbances: a large cross-sectional study

The factors associated with suicide attempts in major depressive disorder (MDD) patients with comorbid glucose disturbances remain unclear. To the best of our knowledge, this is the first study with a large sample size to examine risk factors of suicide attempts in first-episode drug-naïve (FEDN) MDD patients with comorbid glucose disturbances, including clinically relevant factors, metabolic parameters, and thyroid hormone levels. A total of 1718 FEDN MDD patients were enrolled. The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and Positive and Negative Syndrome Scale (PANSS) were used to assess the clinical symptoms of patients. Fasting blood glucose, metabolic parameters, and thyroid hormone levels were measured. After controlling for HAMA and HAMD scores, the suicide attempt rate was 1.88 times higher in MDD patients with glucose disturbances than in MDD patients without glucose disturbances. Compared to non-suicide attempters, suicide attempters among the MDD patients with glucose disturbances had higher scores on HAMD and HAMA, PANSS positive symptoms, as well as higher levels of systolic and diastolic blood pressure, TC, LDL-C, thyroid stimulating hormone (TSH), TgAb, and thyroid peroxidases antibody (TPOAb). The combination of positive symptom score, HDL-C, systolic blood pressure, and marital status distinguished suicide attempters from non-suicide attempters. In addition, HAMA score, HAMD score, and TPOAb were associated with the number of suicide attempts in MDD patients with comorbid glucose disturbances. Our results suggest a high incidence of suicide attempts in MDD patients with comorbid glucose disturbances. Several clinically relevant factors, metabolic parameters, and thyroid hormone function have an impact on suicide attempts in MDD patients with comorbid glucose disturbances.

Posttraumatic stress disorder and risk of suicidal behavior: A systematic review and meta-analysis

INTRODUCTION

This study conducted a systematic review and meta-analysis of the association between posttraumatic stress disorder (PTSD) and (i) death by suicide, (ii) attempted suicide (AS), and (iii) suicidal ideation (SI).

METHODS

The systematic review identified seven studies on PTSD and suicide, 33 studies for AS, and 20 studies for SI. A series of stratified meta-analyses were conducted to estimate pooled effects, in addition to meta-regression to investigate sources of heterogeneity.

RESULTS

A higher relative risk of suicide was evident among those diagnosed with PTSD (RR = 2.09 [95% confidence interval (CI): 1.11-3.94]), with strongest associations among combat veterans (RR = 3.97, 95% CI 2.22-7.10). A lower relative risk of suicide among those with PTSD and co-morbid psychiatric conditions was evident (RR = 0.74, 95% CI 0.63-0.86). A strong association between PTSD and attempted suicide (RR = 4.05, 95% CI 3.14-5.23) and suicidal ideation (RR = 2.91, 95% CI 2.22-3.82) was also found, with a consistently strong association among those with co-morbid psychiatric conditions and non-clinical cohorts.

CONCLUSION

This review found a strong association between PTSD and death by suicide, attempted suicide, and suicidal ideation, and also suicide among veteran populations. Early identification and treatment of PTSD across both clinical and non-clinical cohorts should be a priority for suicide prevention.

Polygenic Contributions to Suicidal Thoughts and Behaviors in a Sample Ascertained for Alcohol Use Disorders

Introduction

Suicidal thoughts and behaviors have partially distinct genetic etiologies.

Methods

We used PRS-CS to create polygenic risk scores (PRSs) from GWAS of non-suicidal self-injury, broad-sense self-harm ideation, nonfatal suicide attempt, death by suicide, and depression. Using mixed-effect models, we estimated whether these PRSs were associated with a range of suicidal thoughts and behaviors in the Collaborative Study on the Genetics of Alcoholism (N = 7,526).

Results

All PRSs were significantly associated with suicidal ideation and suicide attempt (betas = 0.08-0.44, false discovery rate [FDR] <0.023). All PRSs except non-suicidal self-injury PRS were associated with active suicidal ideation (betas = 0.14-0.22, FDR <0.003). Several associations remained significant in models where all significant PRSs were included as simultaneous predictors, and when all PRSs predicted suicide attempt, the PRS together explained 6.2% of the variance in suicide attempt. Significant associations were also observed between some PRSs and persistent suicidal ideation, non-suicidal self-injury, compounded suicide attempt, and desire to die.

Conclusion

Our findings suggest that PRS for depression does not explain the entirety of the variance in suicidal thoughts and behaviors, with PRS specifically for suicidal thoughts and behaviors making additional and sometimes unique contributions.

Social Group Identification as a Predictor of Pretreatment Suicidal Ideation and Intent in those Receiving cCBT: Evidence from a Scottish Primary Care Sample

Suicidal ideation and intent are strongly linked with suicidal attempts and completions; however, no study to date has explored the predictors of ideation and intent within a sample receiving computerized cognitive behavioral therapy (cCBT) as an intervention for mild to moderate depression. The current study investigates the impact of social group identification and socioeconomic deprivation, together with a number of important clinical and demographic factors, on suicidal ideation and intent within a Scottish primary care sample. Participants (N = 1062) were recruited from referrals to a cCBT program, "Beating the Blues" (BtB), over a 33-month period. Participants completed three versions of the group identifications scale (GIS), one for each of three groups: family, community, and a social group of choice. Single-item questions on suicidal ideation and intent were delivered through the BtB program, and demographic and clinical information were collected on commencing BtB. More severe psychological distress, fewer group identifications, younger age, and being male, all significantly predicted the presence of suicidal ideations, however only greater severity of psychological distress was associated with more serious suicidal intent. These results provide valuable insight into factors associated with suicidal ideation and intent within a clinical population from a psychosocial, psychopharmacological, and demographic perspective.

Associations between anxiety, depression, and risk of suicidal behaviors in Chinese medical college students

Background

Previous studies have established a strong association between depression and suicidal behaviors, yet the relationship between anxiety and suicidal behaviors remains unclear. This study examines whether anxiety and depression are independent risk factors for suicidal behaviors in medical college students, and further, whether anxiety may increase the greater risk of suicidal behaviors (SB) in participants with depression.

Methods

This cross-sectional study was conducted among 4,882 medical students. Demographic information, anxiety, and depression data were collected using online questionnaires or through a widely used social media app named WeChat.

Results

Anxiety and depression were independent risk factors for suicidal behaviors, and levels of risk correlated positively with the severity of both anxiety and depressive symptoms. A dose-response relationship was identified between the severity of anxiety and the risk of SB, as well as the severity of depression and SB. Furthermore, anxiety increased the risk of suicidal behaviors in participants with depression, with a dose-response relationship between the severity of anxiety symptoms and the risk of SB.

Conclusion

The findings highlight the importance of screening for anxiety and depressive symptoms in medical college students, as well as reducing anxiety in addition to depressive symptoms in treatment. This study provides valuable data as a reference for clinicians for suicide risk assessments.

Observational study to characterize treatment-resistant depression in Germany, France and the United Kingdom: analysis of real-world data collected through a survey of healthcare professionals

OBJECTIVE

This study describes treatment patterns, productivity, healthcare resource utilization and previous episodes of depression for patients with treatment-resistant depression (TRD).

METHODS

In this cross-sectional study, a quantitative survey was administered to 225 healthcare providers (HCPs) distributed evenly across Germany, France and the UK from July to August 2021. Each HCP was asked to answer based on medical records of five patients with TRD, defined as patients failing to respond to two or more treatments of adequate dose and duration in the same episode of major depressive disorder (MDD), which provided a sample size of 1125 patients.

RESULTS

Of the 1125 patients with TRD, 73.2% had two or more previous episodes of MDD, 46.3% had a history of suicidal ideation and 24.8% had attempted suicide. Only 26.8% of patients were employed either full-time or part-time. During the most recent/current TRD episode, 45.5% of patients received five or more lines of treatment, and 46.0% remained on monotherapy. For multiple pharmacological treatments, too many distinct combinations were used to discern trends. Overall, 60.6% of patients had at least one mental health-related hospitalization in the last 12 months; 35.0% had two or more hospitalizations. Half of TRD patients saw a doctor five or more times per year for their depression.

CONCLUSIONS

This study addresses the knowledge gap about treatment patterns and healthcare utilization in real-world practice for TRD patients in three European countries. It provides data that potentially could inform treatment guideline development and optimize patient-perceived benefits from the treatment of TRD.

Personalised depression forecasting using mobile sensor data and ecological momentary assessment

INTRODUCTION

Digital health interventions are an effective way to treat depression, but it is still largely unclear how patients' individual symptoms evolve dynamically during such treatments. Data-driven forecasts of depressive symptoms would allow to greatly improve the personalisation of treatments. In current forecasting approaches, models are often trained on an entire population, resulting in a general model that works overall, but does not translate well to each individual in clinically heterogeneous, real-world populations. Model fairness across patient subgroups is also frequently overlooked. Personalised models tailored to the individual patient may therefore be promising.

METHODS

We investigate different personalisation strategies using transfer learning, subgroup models, as well as subject-dependent standardisation on a newly-collected, longitudinal dataset of depression patients undergoing treatment with a digital intervention ( N = 65 patients recruited). Both passive mobile sensor data as well as ecological momentary assessments were available for modelling. We evaluated the models' ability to predict symptoms of depression (Patient Health Questionnaire-2; PHQ-2) at the end of each day, and to forecast symptoms of the next day.

RESULTS

In our experiments, we achieve a best mean-absolute-error (MAE) of 0.801 (25% improvement) for predicting PHQ-2 values at the end of the day with subject-dependent standardisation compared to a non-personalised baseline ( MAE = 1.062 ). For one day ahead-forecasting, we can improve the baseline of 1.539 by 12 % to a MAE of 1.349 using a transfer learning approach with shared common layers. In addition, personalisation leads to fairer models at group-level.

DISCUSSION

Our results suggest that personalisation using subject-dependent standardisation and transfer learning can improve predictions and forecasts, respectively, of depressive symptoms in participants of a digital depression intervention. We discuss technical and clinical limitations of this approach, avenues for future investigations, and how personalised machine learning architectures may be implemented to improve existing digital interventions for depression.

Insecure adult attachment and reflective functioning as mechanisms of the relationship between traumatic life events and suicidal ideation: A path analysis

The relationship between traumatic life events and increased suicide risk has been well reported in literature. However, the complex nature of suicidality phenomena still hinders our ability to comprehend the mediation mechanism underlying this association. In this study, we examined the mediating role of adult attachment and reflective functioning in the relationship between traumatic life events and suicidal ideation. Nine hundred and fifty Italian adults completed an online survey evaluating traumatic life events, adult attachment, reflective functioning and suicidal ideation. The path analysis showed that the positive relationship between traumatic life events and suicidal ideation was partially mediated by attachment anxiety and reflective functioning. From a clinical point of view, these results support the relevance of evaluating and improving patients’ ability to mentalize as a part of psychotherapeutic intervention aimed at reducing suicidality in people with a history of traumatic experiences and attachment anxiety.

Mental health and suicidality in Afghan students after the Taliban takeover in 2021

BACKGROUND

On the 15th of August 2021, Kabul was captured by the Taliban, leading to the fall of the Islamic Republic of Afghanistan. The present study investigated PTSD symptoms, depression, suicide risk and facets of positive mental health in the immediate aftermath of the Taliban take-over.

METHODS

A total of 214 Afghan university students (73.7% women; age in years: M(SD) = 23.92 (5.77)) took part in this cross-sectional study between August and November 2021. Self-report measures of PTSD, depression, suicide ideation/behavior, positive mental health, social support, and posttraumatic growth were used.

RESULTS

Severe posttraumatic stress disorders symptoms were reported by 70%, clinically relevant depression symptoms were reported by 69.7% and significant suicide ideation/behavior was reported by 38.6% of the sample. Posttraumatic growth moderated the impact of depression on suicide risk. No interaction effects were found for positive mental health and social support.

LIMITATION

The study focused on a specific group of highly educated and predominantly female Afghan students limiting the generalizability of the findings.

CONCLUSION

PTSD symptoms, depression and suicidality show an alarmingly high prevalence in this specific sample of Afghan students. Various protective factors seem to be insufficient to buffer the association between PTSD, depression and suicide risk.

Relationship Between Affective Temperaments and Suicide Risk in Patients With First-Onset Major Depressive Disorder

Background

People may endorse suicidal behavior during a major depressive episode. Affective temperaments may play a role in this risk. We explored the relationship between affective temperaments and suicide and identified some traits that can predict suicide risk in depression.

Materials and Methods

We analyzed the results of the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A) in 284 participants recruited from a psychiatric clinic and the community in Beijing and compared the subscale scores (temperaments of cyclothymic, dysthymic, anxious, irritable, and hyperthymic) among major depressive disorders (MDDs) vs. the general population as well as depressive patients with vs. without suicide risk, using Student's test, chi-square test, rank-sum test, and multivariable regression modeling.

Results

The incidence of suicidal risk in depressive subjects was 47.62% (80/168). Being unmarried (p < 0.001), unemployed (p = 0.007), and temperaments of dysthymic, cyclothymic, anxious, and irritable scores (all p < 0.001) were significantly more prevalent in patients with depression than in the general population. Young age (p < 0.001), female sex (p = 0.037), unmarried (p = 0.001), more severe depression (p < 0.001), and dysthymic, anxious, and cyclothymic temperament (all p < 0.05) were significantly more prevalent in patients with depressive disorder than those without suicide risk. The logistic regression analysis showed that younger age (odds ratio [OR] = 0.937, 95% CI 0.905∼0.970), female sex (OR = 2.606, 95% CI 1.142∼5.948), more severe depression (OR = 1.145, 95% CI 1.063∼1.234), cyclothymic temperament (OR = 1.275, 95% CI 1.102∼1.475), and dysthymic temperament (OR = 1.265, 95% CI 1.037∼1.542) were all independently associated with high suicidal risk in patients with first-onset major depression (p < 0.05).

Conclusion

Temperament traits differ between the general population and people suffering from MDD. Subjects with MDD who have much more severe depressive symptoms and a cyclothymic or dysthymic temperament were at a high risk of suicide.

Psychoactive Drugs in the Management of Post Traumatic Stress Disorder: A Promising New Horizon

Post-traumatic stress disorder (PTSD) is an anxiety disorder that often presents after exposure to a traumatic, life-threatening event. Experiencing a traumatic event is not rare, with inciting incidents ranging from being burglarized to politically motivated genocide. While traditional psychopharmacology and psychotherapy are the mainstays of the treatment of PTSD currently, psychoactive drugs (otherwise known as psychedelics) are being explored for their novel role in the treatment of PTSD patients. Psychoactive drugs such as MDMA, ketamine, and psilocybin have been shown to specifically target and decrease fear and anxiety pathways in the brain. These unique properties hold the potential to be utilized in addressing symptoms of trauma in those with refractory or treatment-resistant PTSD. Historically, federal and state laws have restricted research into how psychoactive drugs can be used to treat mental illness due to the widespread belief that these drugs present more harm than benefit. However, the current shift in public opinion on psychedelics has propelled research to look into the benefits of these drugs for patients with mental illness. This article aims to discuss the mechanisms of how MDMA, ketamine, and psilocybin work in the PTSD brain, as well as their beneficial role in treatment.

[Can you See and Hear How Bad I Feel Right Now? - Self-Injury and Suicidal Communication in Borderline Personality Disorder - A Secondary Analysis]

Non-suicidal self-injurious behavior (NSSV) and suicide attempts are well-known features of borderline personality disorder; communicative behavior is poorly studied. Differences between patients with and without NSSV as well as differences in current suicide attempts regarding suicidal communication and NSSV were investigated.In a secondary analysis, data on current and anamnestic NSSV, suicide attempts, suicidal communication, and clinical symptomatology of 87 inpatients were studied.Patients with and without current NSSV did not differ in anamnestic but did differ in current suicide attempts and suicidal communication. In regard to the current inpatient stay, it was observed that patients with and without suicide attempts differed considerably in the variables NSSV (100 vs. 32.5 %) and suicidal communication (71.4 vs. 7.5 %).Current self-injury and suicidal communication are highly significant for risk assessment of current suicidality.

Posttraumatic stress disorder symptoms and suicidal ideation/behavior: The moderating effects of positive mental health and social support among Iranian and German students

Suicidal ideation and behavior are common in those suffering from Posttraumatic Stress Disorder (PTSD). The present study investigated factors buffering the association between PTSD symptoms and suicidal ideation/behavior. A total of 571 Iranian students and 421 German students took part in the investigation. Social support and positive mental health (PMH) were considered as resilience factors moderating the association between PTSD symptoms and suicide ideation/behavior within both samples. PMH moderated the impact of PTSD symptoms on suicidal ideation/behavior in Iranian and German students. Social support moderated the impact of PTSD symptoms on suicidal ideation/behavior in Iranian students only. Positive mental health and perceived social support seem to confer resilience and should be taken into account, when assessing individuals for suicide risk.

Sociocultural perspectives on suicidal behaviour at the Coast Region of Kenya: an exploratory qualitative study

OBJECTIVES

To explore perceived sociocultural factors that may influence suicidality from key informants residing in coastal Kenya.

DESIGN

We used an exploratory qualitative study design.

SETTING

Mombasa and Kilifi Counties of Coastal Kenya.

PARTICIPANTS

25 key informants including community leaders, professionals and community members directly and indirectly affected by suicidality.

METHODS

We conducted in-depth interviews with purposively selected key informants to collect data on sociocultural perspectives of suicide. Thematic analysis was used to identify key themes using both inductive and deductive processes.

RESULTS

Four key themes were identified from the inductive content analysis of 25 in-depth interviews as being important for understanding cultural perspectives related to suicidality: (1) the stigma of suicidal behaviour, with suicidal victims perceived as weak or crazy, and suicidal act as evil and illegal; (2) the attribution of supernatural causality to suicide, for example, due to sorcery or inherited curses; (3) the convoluted pathway to care, specifically, delayed access to biomedical care and preference for informal healers; and (4) gender and age differences influencing suicide motivation, method of suicide and care seeking behaviour for suicidality.

CONCLUSIONS

This study provides an in depth understanding of cultural factors attributed to suicide in this rural community that may engender stigma, discrimination and poor access to mental healthcare in this community. We recommend multipronged and multilevel suicide prevention interventions targeted at changing stigmatising attitudes, beliefs and behaviours, and improving access to mental healthcare in the community.

Association of real-time assessed mood, affect and suicidal ideation in psychiatric inpatients with unipolar depression

Previous research provided preliminary support of a potential reinforcing effect of suicidal ideation demonstrating reduced negative affect and increased positive affect after thinking about suicide. The present study therefore sought to investigate the role of mood and affect as a proximal risk factor of suicidal ideation in a high-risk sample. Seventy-four psychiatric inpatients (72% female) with unipolar depression and current and/or lifetime suicidal ideation aged 18 to 85 years (M = 37.6, SD = 14.3) took part in an ecological momentary assessment (EMA) over 6 days. Multilevel analyses were calculated. Analyses revealed negative valence of mood and low positive affect to be predictors of subsequent intensity of suicidal ideation (active, passive) as well as predictors of change in suicidal ideation (active, passive) since the last measurement. High negative affect only predicted intensity of passive suicidal ideation. Suicidal ideation (active, passive) was prospectively associated with subsequent negative valence of mood and lower positive affect as well as with higher intensity of negative affect. Suicidal ideation (active, passive) also predicted the change in valence of mood, positive affect and negative affect since the last measurement. Mood and affect should be taken into account as important proximal risk factors of active and passive suicidal ideation. The results do not support the idea of a reinforcing effect of suicidal ideation. In fact, they show a pattern of reduced subsequent positive affect, negative valence of mood and increased negative affect. Replication studies with larger samples and longer EMA follow-ups are needed.

The Convergence Model of Brain Reward Circuitry: Implications for Relief of Treatment-Resistant Depression by Deep-Brain Stimulation of the Medial Forebrain Bundle

Deep-brain stimulation of the medial forebrain bundle (MFB) can provide effective, enduring relief of treatment-resistant depression. Panksepp provided an explanatory framework: the MFB constitutes the core of the neural circuitry subserving the anticipation and pursuit of rewards: the “SEEKING” system. On that view, the SEEKING system is hypoactive in depressed individuals; background electrical stimulation of the MFB alleviates symptoms by normalizing activity. Panksepp attributed intracranial self-stimulation to excitation of the SEEKING system in which the ascending projections of midbrain dopamine neurons are an essential component. In parallel with Panksepp’s qualitative work, intracranial self-stimulation has long been studied quantitatively by psychophysical means. That work argues that the predominant directly stimulated substrate for MFB self-stimulation are myelinated, non-dopaminergic fibers, more readily excited by brief electrical current pulses than the thin, unmyelinated axons of the midbrain dopamine neurons. The series-circuit hypothesis reconciles this view with the evidence implicating dopamine in MFB self-stimulation as follows: direct activation of myelinated MFB fibers is rewarding due to their trans-synaptic activation of midbrain dopamine neurons. A recent study in which rats worked for optogenetic stimulation of midbrain dopamine neurons challenges the series-circuit hypothesis and provides a new model of intracranial self-stimulation in which the myelinated non-dopaminergic neurons and the midbrain dopamine projections access the behavioral final common path for reward seeking via separate, converging routes. We explore the potential implications of this convergence model for the interpretation of the antidepressant effect of MFB stimulation. We also discuss the consistent finding that psychomotor stimulants, which boost dopaminergic neurotransmission, fail to provide a monotherapy for depression. We propose that non-dopaminergic MFB components may contribute to the therapeutic effect in parallel to, in synergy with, or even instead of, a dopaminergic component.

Does Nonsuicidal Self-Injury Predict Later Suicidal Attempts? A Review of Studies

Co-occurrence of nonsuicidal self-injury (NSSI) and suicide attempts (SA) might occur because they share common risk factors, or alternatively because one leads to the other. Using search terms salient to NSSI and SA, we screened 555 studies to identify 17 that presented temporal data about NSSI and SA. Much of the evidence indicates that NSSI predates SA, especially among females and individuals with depressive symptoms, or diagnosed with borderline personality disorder or mood disorders. However, in some studies, associated risk factors likely accounted for the effect. Greater NSSI frequency to a threshold increases risk for later SA. Findings suggest that the behaviors have common predisposing factors, but that there is also a potent gateway effect whereby NSSI precedes SA.

Suicide rate and social environment characteristics in South Korea: the roles of socioeconomic, demographic, urbanicity, general health behaviors, and other environmental factors on suicide rate

BACKGROUND

Suicide is a serious worldwide public health concern, and South Korea has shown the highest suicide rate among Organisation for Economic Co-operation and Development (OECD) countries since 2003. Nevertheless, most previous Korean studies on suicide had limitations in investigating various social environment factors using long-term nationwide data. Thus, this study examined how various social environment characteristics are related to the suicide rate at the district-level, using nationwide longitudinal data over 11 years.

METHODS

We used the district-level age-standardized suicide rate and a total of 12 annual social environment characteristics that represented socioeconomic, demographic, urbanicity, general health behaviors, and other environmental characteristics from 229 administrative districts in South Korea. A Bayesian hierarchical model with integrated Laplace approximations (INLA) was used to examine the spatiotemporal association between the rate of suicide and the social environment indicators selected for the study.

RESULTS

In the total population, the indicators "% of population aged 65 and older eligible for the basic pension", "% vacant houses in the area", "% divorce", "% single elderly households", "% detached houses", "% current smokers", and "% of population with obesity" showed positive associations with the suicide rate. In contrast, "% of people who regularly participated in religious activities" showed negative associations with suicide rate. The associations between these social environment characteristics and suicide rate were generally more statistically significant in males and more urbanized areas, than in females and less urbanized areas; however, associations differed amongst age groups, depending on the social environment characteristic variable under study.

CONCLUSIONS

This study investigated the complex role of social environments on suicide rate in South Korea and revealed that higher suicide rates were associated with lower values of socioeconomic status, physical exercise, and religious activities, and with higher social isolation and smoking practice. Our results can be used in the development of targeted suicide prevention policies.

Measurement of Post-Treatment Changes in Brain Metabolites in Patients with Generalized Anxiety Disorder using Magnetic Resonance Spectroscopy

BACKGROUND

From previous studies, we know the correlations of some brain metabolites with a generalized anxiety disorder (GAD) and its symptoms. The response of GAD patients to various treatments is not the same and finding the best treatment option for each patient takes a long period of time.

OBJECTIVE

In this study, we try to examine if there is any relationship between a special treatment option and GAD patients' response and brain metabolite correlation with anxiety level change.

MATERIAL AND METHODS

This study is a clinical trial type of studies. We have used proton MRS (1H-MRS) with field strength of 3 Tesla to assess whether a different treatment option makes different responses based on metabolite changes. We chose 16 patients based on Hamilton's anxiety rate and a psychiatrist diagnosis. Patients were divided into two groups randomly. Each group took different treatments. Before treatment started, patients underwent MRS imaging and 8 weeks after treatment as well. Our study lacked a control group, and the results were analyzed by comparing the measured values of metabolites and clinical scores before and after treatment.

RESULTS

The NAA and Cho concentration increased after treatments and Cr concentration remained constant in both groups. Both groups showed improvements in their symptoms of anxiety and also in their clinical score rates. Sertraline group showed a more increase in NAA concentration than CBT and also a more decrease in HAMA and HAMD-17 scores.

CONCLUSION

A simultaneously increase in NAA and Cho in both groups and a decrease in clinical anxiety levels demonstrate that NAA and Cho concentration are associated negatively with anxiety levels. In addition, both CBT and sertraline are effective in the improvement of anxiety symptoms.

Suicide Attempts Among Adult Eritrean Refugees in Tigray, Ethiopia: Prevalence and Associated Factors

Purpose

The present study assessed the prevalence of and factors associated with suicide attempts among adult Eritrean refugees in Tigray, Ethiopia.

Methods

A community-based cross-sectional study was carried out among adult refugees from February 2020 to April 2020. The exposure variables included socio-demographic, clinically related, and psychosocial characteristics, and substance use-related factors. We included 400 participants and recruited them via a systematic random sampling technique. The study participants were between 18 and 60 years old. Data were collected using a structured interviewer-administered questionnaire. We applied bivariable and multivariable logistic regression to determine predictors for suicide attempts. Multicollinearity was checked to test correlations among predictor variables, and the Hosmer and Lemeshow test (p>0.2) was conducted to check the fitness of the model. Odds ratios and p-values were determined to check the associations between variables, and a p-value <0.05 was considered as a cut-off for statistical significance.

Results

The prevalence of suicide attempts was 7.3% (95% CI: 4.8%, 9.8%). Having current symptoms of trauma (AOR=5.6, 95% CI: 2.1, 14.9), a family history of mental disorder (AOR=3.02, 95% CI: 1.01, 9.07), a history of post-traumatic stress disorder (PTSD) (AOR=2.7, 95% CI: 1.01, 7.4), and severe hopelessness (AOR=3.9, 95% CI: 1.3, 12.7) were significantly associated with suicide attempts.

Conclusion

This study showed that during the stay in the refugee camp, there was a high prevalence of suicide attempts compared to the prevalence of suicide attempts among the general populations of Ethiopia, Europe, and China, and the lifetime pooled prevalence across 17 countries. Current symptoms of trauma, PTSD, a family history of mental illness, and hopelessness were the factors statistically associated with the suicide attempt. Early screening, detection, and management of suicidal behavior, as well as appropriate mental healthcare, are warranted in refugee camps to reduce the number of suicide attempts.

Glucocorticoid-glucocorticoid receptor-HCN1 channels reduce neuronal excitability in dorsal hippocampal CA1 neurons

While chronic stress increases hyperpolarization-activated current (I_h) in dorsal hippocampal CA1 neurons, the underlying molecular mechanisms are entirely unknown. Following chronic social defeat stress (CSDS), susceptible mice displayed social avoidance and impaired spatial working memory, which were linked to decreased neuronal excitability, increased perisomatic hyperpolarization-activated cyclic nucleotide-gated (HCN) 1 protein expression, and elevated I_h in dorsal but not ventral CA1 neurons. In control mice, bath application of corticosterone reduced neuronal excitability, increased tetratricopeptide repeat-containing Rab8b-interacting protein (TRIP8b) and HCN1 protein expression, and elevated I_h in dorsal but not ventral CA1 region/neurons. Corticosterone-induced upregulation of functional I_h was mediated by the glucocorticoid receptor (GR), HCN channels, and the protein kinase A (PKA) but not the calcium/calmodulin-dependent protein kinase II (CaMKII) pathway. Three months after the end of CSDS, susceptible mice displayed persistent social avoidance when exposed to a novel aggressor. The sustained behavioral deficit was associated with lower neuronal excitability and higher functional I_h in dorsal CA1 neurons, both of which were unaffected by corticosterone treatment. Our findings show that corticosterone treatment mimics the pathophysiological effects of dorsal CA1 neurons/region found in susceptible mice. The aberrant expression of HCN1 protein along the somatodendritic axis of the dorsal hippocampal CA1 region might be the molecular mechanism driving susceptibility to social avoidance.