Examination of the population attributable risk of different risk factor domains for suicidal thoughts and behaviors

Early-life risk factors for depression among young adults in the United States general population: Attributable risks and gender differences

BACKGROUND

This study adopts individual and societal-level approaches to examine the contribution of childhood risk factors to major depressive episodes (MDE) in 2526 American young adults.

METHODS

Nationally representative data from the 2017 U.S. Panel Study of Income Dynamics - Transition into Adulthood Supplement (PSID-TAS) were analyzed using multivariate methods to assess the impact of parental mental illness, childhood adversities, childhood mental disorders, and childhood physical conditions. Adjusted odds ratios and population attributable risk proportions (PARPs) are calculated to estimate the proportion of MDE cases related to risk factors.

RESULTS

The 12-month prevalence of positive screens for MDE was 25.4 %. Approximately 34 % of these were attributable to childhood mental disorders, 24 % to childhood physical conditions, 21 % to childhood adversities, and 16 % to parental mental illness. Childhood and parental depression were critical risk factors, both at the individual (odds ratio exceeding 2) and societal (PARP approximately 24 %) levels. Gender-specific risk factors were identified, with childhood physical abuse and childhood anxiety disorders constituting risk factors for females, and childhood externalizing disorders and childhood headaches as risk factors for males. Approximately 60 % of U.S. young adult MDE cases are attributable to risk factors before age 18.

LIMITATIONS

Possible over reporting of MDE may have biased the associations between predictors and depression.

CONCLUSIONS

Exposure to depression at a young age-one's own or parental depression-is a robust risk factor for both genders. Policies and interventions focused at alleviating the societal burden of depression should value its generational transmission.

Suicidal thoughts and behaviors in the Kingdom of Saudi Arabia

OBJECTIVE

Suicidal thoughts and behaviors (STB) constitute an escalating public health concern globally. Despite the growing burden of suicidal ideation, plan, and attempts, national information on the trends of STB is lacking in the Kingdom of Saudi Arabia (KSA). Therefore, we aim to report on the prevalence, correlates, and treatment-seeking behaviors associated with STB in the country using nationally representative information from The Saudi National Mental Health Survey (SNMHS).

METHODS

The SNMHS is a national household survey of Saudi citizens aged 15-65 (n = 4004). The adapted Composite International Diagnostic Interview (CIDI) 3.0 was administered to produce lifetime and 12-month prevalence and treatment estimates of STB in the KSA. Associated correlates were calculated using cross tabulations and logistic regressions.

RESULTS

Suicidal ideation, plan, and attempt had respective lifetime prevalence rates of 4.90 %, 1.78 %, and 1.46 %; 12-month prevalence rates of 1.82 %, 0.89 %, and 0.63 %. Significant correlates of STB include younger age, female gender, low education, urban rearing, and singe marital status. STB were also significantly associated with the presence of prior mental disorders, childhood adversities, and low treatment-seeking.

CONCLUSIONS

High unmet need and significant sociocultural and psychological risk factors have been identified in association with STB in the KSA. Given the community-based nature of the SNMHS and the limited national data on STB in the Middle East and North Africa region, our findings can extend to inform the necessary healthcare policies, treatment plans, and prevention strategies needed to alleviate the burdens of STB in the region.

Development and evaluation of a predictive algorithm and telehealth intervention to reduce suicidal behavior among university students

BACKGROUND

Suicidal behaviors are prevalent among college students; however, students remain reluctant to seek support. We developed a predictive algorithm to identify students at risk of suicidal behavior and used telehealth to reduce subsequent risk.

METHODS

Data come from several waves of a prospective cohort study (2016-2022) of college students (n = 5454). All first-year students were invited to participate as volunteers. (Response rates range: 16.00-19.93%). A stepped-care approach was implemented: (i) all students received a comprehensive list of services; (ii) those reporting past 12-month suicidal ideation were directed to a safety planning application; (iii) those identified as high risk of suicidal behavior by the algorithm or reporting 12-month suicide attempt were contacted via telephone within 24-h of survey completion. Intervention focused on support/safety-planning, and referral to services for this high-risk group.

RESULTS

5454 students ranging in age from 17-36 (s.d. = 5.346) participated; 65% female. The algorithm identified 77% of students reporting subsequent suicidal behavior in the top 15% of predicted probabilities (Sensitivity = 26.26 [95% CI 17.93-36.07]; Specificity = 97.46 [95% CI 96.21-98.38], PPV = 53.06 [95% CI 40.16-65.56]; AUC range: 0.895 [95% CIs 0.872-0.917] to 0.966 [95% CIs 0.939-0.994]). High-risk students in the Intervention Cohort showed a 41.7% reduction in probability of suicidal behavior at 12-month follow-up compared to high-risk students in the Control Cohort.

CONCLUSIONS

Predictive risk algorithms embedded into universal screening, coupled with telehealth intervention, offer significant potential as a suicide prevention approach for students.

The association between childhood maltreatment and suicidal intrusions: A cross-sectional study

Childhood maltreatment may play an important role in the transition from suicidal ideation to suicidal behavior. Recently, research has begun evaluating the association between childhood maltreatment and involuntary and distressing intrusions about one's own suicide, also called suicidal intrusions. This cross-sectional, multicenter study aimed to investigate the association between childhood maltreatment and the severity of suicidal intrusions using online questionnaires. Participants were suicidal outpatients currently receiving treatment at a Dutch mental health institution (N = 149). The Childhood Trauma Questionnaire-Short Form and Suicidal Intrusions Attributes Scale were administered online. A simple linear regression was performed followed by a multiple linear regression with backward selection to separate the predictors of childhood maltreatment subscales. Next, significant predictor variables were used to perform an additional regression analysis with gender, age, posttraumatic stress disorder (PTSD) diagnosis, and depressive symptoms as potential covariates. The results showed that childhood maltreatment was significantly associated with suicidal intrusion scores, B = .22, t(147) = 2.010, p = .046. A multiple linear regression analysis showed that the only specific form of childhood maltreatment associated with suicidal intrusions was sexual abuse; the association remained after controlling for age, gender, PTSD diagnosis and depressive symptoms, F(5, 143) = 11.15, p < .001. In summary, the present study confirms the link between childhood maltreatment, particularly childhood sexual abuse, and suicidal intrusions. This finding implies that in the treatment of suicidal intrusions and suicidality, childhood sexual abuse should be identified and targeted with evidence-based treatments for PTSD.

Mindfulness-Enhanced Computerized Cognitive Training for Depression: An Integrative Review and Proposed Model Targeting the Cognitive Control and Default-Mode Networks

Depression is often associated with co-occurring neurocognitive deficits in executive function (EF), processing speed (PS) and emotion regulation (ER), which impact treatment response. Cognitive training targeting these capacities results in improved cognitive function and mood, demonstrating the relationship between cognition and affect, and shedding light on novel targets for cognitive-focused interventions. Computerized cognitive training (CCT) is one such new intervention, with evidence suggesting it may be effective as an adjunct treatment for depression. Parallel research suggests that mindfulness training improves depression via enhanced ER and augmentation of self-referential processes. CCT and mindfulness training both act on anti-correlated neural networks involved in EF and ER that are often dysregulated in depression—the cognitive control network (CCN) and default-mode network (DMN). After practicing CCT or mindfulness, downregulation of DMN activity and upregulation of CCN activity have been observed, associated with improvements in depression and cognition. As CCT is posited to improve depression via enhanced cognitive function and mindfulness via enhanced ER ability, the combination of both forms of training into mindfulness-enhanced CCT (MCCT) may act to improve depression more rapidly. MCCT is a biologically plausible adjunct intervention and theoretical model with the potential to further elucidate and target the causal mechanisms implicated in depressive symptomatology. As the combination of CCT and mindfulness has not yet been fully explored, this is an intriguing new frontier. The aims of this integrative review article are four-fold: (1) to briefly review the current evidence supporting the efficacy of CCT and mindfulness in improving depression; (2) to discuss the interrelated neural networks involved in depression, CCT and mindfulness; (3) to present a theoretical model demonstrating how MCCT may act to target these neural mechanisms; (4) to propose and discuss future directions for MCCT research for depression.

Practitioner Experiences Responding to Suicide Risk for Survivors of Human Trafficking in the Philippines

Human trafficking survivors experience elevated suicide risk in comparison to the general population. Anti-trafficking service providers in the Philippines have identified capacity building in suicide prevention as a critical priority given the insufficient number of trained mental health professionals and lack of culturally adapted evidence-based interventions in the Philippines. We conducted a focused ethnography exploring the experiences of non-mental health professionals working in the anti-human trafficking sector in the Philippines in responding to suicidality among survivors of human trafficking (n = 20). Themes included: emotional burden on service providers, manifestations of stigma regarding suicide, lack of clarity regarding risk assessment, lack of mental health services and support systems, transferring responsibility to other providers, and the need for training, supervision, and organizational systems. We discuss implications for training service providers in the anti-human trafficking sector, as well as cultural adaptation of suicide prevention interventions with human trafficking survivors in the Philippines.

Genetic and Psychosocial Risk Factors Associated with Suicide Among Community Veterans: Implications for Screening, Treatment and Precision Medicine

Introduction

Since veteran suicide is a concern and our knowledge of predictive factors is still limited, our objective was to assess risk factors for suicide, including genetic factors, among deployed veterans.

Methods

For this study, we surveyed 1730 veterans who were outpatients in a multi-hospital system in Pennsylvania. Altogether, 1041 veterans (60%) provided a DNA sample. The genetic risk variants investigated were within loci previously associated with PTSD and substance misuse, including CRHR1, CHRNA5, RORA, and FKBP5 genetic variations, which were used to calculate a polygenic risk score (range=0–8, mean=3.6, SD=1.4).

Results

Most veterans (56.2%) were deployed to Vietnam while significant numbers were deployed to Iraq, Afghanistan, and other post-Vietnam conflicts. Overall, 95.1% of the veterans were male, their mean age was 56.2 (SD=12), and 95.6% were Caucasian. Among the veterans, 24% had high combat exposure. The prevalence of lifetime suicidal thoughts was 11.3%. Additionally, 5.7% ever developed a suicide plan or attempted suicide in their lifetimes. Among those with a history of a lifetime suicide attempt or suicide plan, the PTSD genetic risk score was significantly higher (OR=3.96 vs 3.55, p=0.033), but for suicidal thoughts, this association was not significant (p=0.717). In multivariable analysis (MVA) logistic regression, significant predictors of attempting suicide or having a suicide plan were history of depression (OR=5.04, p<0.001), PTSD genetic risk score (OR=1.25, p=0.036), history of childhood abuse/neglect (OR=2.24, p=0.009), and lifetime marijuana use (OR= 1.56, p=0.020). Conversely, rural residence was protective for suicide risk (OR=0.49; p=0.031). For suicidal thoughts, in the MVA genetic risk score was not significant (p=0.697), but history of child abuse/neglect (p<0.001), history of depression (p>0.001), low psychological resilience (p=0.004), and lifetime marijuana use (p=0.022) were significant.

Discussion

In this study, we identified genetic risk variants and other predictors for suicide among veterans that may have implications for future screening and clinical care. Further research is advised.

Arrest and non-fatal suicide attempts among men: analysis of survey data from the National Survey on Drug Use and Health

BACKGROUND

Studies have found an association between recent arrest and suicide attempts, but the population-level significance of this link has not been reported. We estimated the population attributable risk percent (PAR%) of self-reported non-fatal suicide attempts based on recent arrest in a national sample of adult men.

METHODS

This study included men aged ≥18 who completed the 2008-2019 National Surveys on Drug Use and Health. The outcome measure was any non-fatal suicide attempts in the past year. The primary independent variable was any arrest in the past year. Major depression and substance use disorders were also included as independent variables for comparison. Descriptive statistics and multivariate logistic regression with postestimation marginal effects ascertained the PAR% of non-fatal suicide attempts for arrest, major depression, and substance use disorders, while controlling for sociodemographic covariates. All analyses applied survey weights. We disaggregated analyses by race/ethnicity.

RESULTS

In the sample of 220,261 men, arrest accounted for 8.9% (99% CI 5.1 to 12.6%, p < 0.001) of non-fatal suicide attempts, while major depression accounted for 40.3% (99% CI 35.0 to 45.1%. p < 0.001) and substance use disorders for 24.1% (99% CI 17.6 to 30.2%, p < 0.001). After disaggregating by race/ethnicity, arrest accounted for 9.5% (99% CI 4.5 to 14.3%, p < 0.001) of suicide attempts among Non-Hispanic White men and fell short of statistical significance for Non-Hispanic Black men (10.2, 99% CI - 3.0 to 21.6%, p = 0.043) and Hispanic men (8.1, 99% CI - 0.5 to 15.9%, p = 0.016).

CONCLUSIONS

Arrest accounted for nearly one in eleven non-fatal suicide attempts in a national sample of American men, which is by extension about 50,000 suicide attempts per year. Results were similar for Non-Hispanic White, Non-Hispanic Black, and Hispanic men, although there were differences in prevalence of arrest and suicide attempts. Unlike major depression, arrest is an easily identifiable event, and the period after arrest might provide an opportunity to support mental health and coping.

Prevalence of Suicidality in the European General Population: A Systematic Review and Meta-Analysis

OBJECTIVE

To conduct a systematic review and meta-analysis of the prevalence and variability in suicidality in the general adult population of Europe between 2008 and 2017.

METHODS

Studies containing original data on suicidality were identified in five electronic databases. Point, 12-month and lifetime prevalences were calculated for various types of suicidality. Pooled prevalence rates were calculated using a random effects model. Subgroup analysis and multivariate meta-regression were also performed.

RESULTS

We identified 24 papers containing original data, which provided 97 prevalence rates for suicidality. The pooled point prevalence rate was 3.96% (2.37-5.56), pooled 12-month prevalence 2.9% (1.49-4.32), and pooled lifetime prevalence 5.55% (4.31-6.79). The subgroup analysis showed that lifetime prevalence figures for wishing to be dead and suicidal ideation were higher in areas with a population of less than 3,849 inhabitants and in Eastern Europe. Finally, the multivariate meta-regression showed differences with respect to the period and type of suicidality, lower and upper age thresholds, population size, and study area.

CONCLUSION

Our data showed that approximately 21% of European individuals have wished to be dead at some point during their lifetime. Studies like this are necessary to highlight the need for efforts to prevent and intervene in suicidality.

Suicidality among healthcare professionals during the first COVID19 wave

BACKGROUND

Prevalence estimates of suicidal thoughts and behaviours (STB) among clinically active healthcare professionals during the first wave of COVID19 pandemic are non-existing. The main aim of this study was to investigate the 30-day prevalence of STB and associated risk factors.

METHODS

As part of the Recovering Emotionally from COVID study (RECOVID), 30-day STB among healthcare professionals (N = 6,409) was assessed in an e-survey in healthcare settings in Belgium. The prevalence of STB and associated risk factors were estimated in multivariable models with individual-level and society-level measures of association. We used post-stratification weights to make the data representative for the entire clinical workforce in Belgium.

RESULTS

Prevalence was 3.6% death wish, 1.5% suicide ideation, 1.0% suicide plan, and 0.0% suicide attempt. Thirty-day STB was (a) increased among respondents with lifetime and current mental disorders (mostly depression) and those hospitalized for COVID19 infection, (b) decreased among respondents with social support, and (c) unrelated to work environment.

LIMITATIONS

This is an explorative cross-sectional study using multivariate models that generates specific hypotheses on the prevalence of and risk factors for STB during the COVID19 pandemic rather than testing specific pathways that lead to STB onset.

CONCLUSIONS

Across age, gender, professional discipline, and exposure to COVID, lifetime and current mental disorders were highly associated with STB. These factors could guide governments and healthcare organizations in taking up responsibilities in preventing emotional problems and developing resilience among healthcare professionals during, but probably beyond, the current COVID19 pandemic.

Testing the Mechanism of Action of Computerized Cognitive Training in Young Adults with Depression: Protocol for a Blinded, Randomized, Controlled Treatment Trial

Background:

Depression is associated with a broad range of cognitive deficits, including processing speed (PS) and executive functioning (EF). Cognitive symptoms commonly persist with the resolution of affective symptoms and increase risk of relapse and recurrence. The cognitive control network is comprised of brain areas implicated in EF and mood regulatory functions. Prior research has demonstrated the effectiveness of computerized cognitive training (CCT) focused on PS and EF in mitigating both cognitive and affective symptoms of depression.

Methods:

Ninety participants aged 18–29 with a current diagnosis of major depressive disorder or persistent depressive disorder, or a Hamilton Depression Rating Scale score ≥12, will be randomized to either PS/EF CCT, verbal CCT, or waitlist control. Participants in the active groups will complete 15 min of training 5 days/week for 8 weeks. Clinical and neuropsychological assessments will be completed at baseline, week 4, week 8, and 3-month follow-up. Structural and functional magnetic resonance imaging (fMRI) will be completed at baseline and week 8. We will compare changes in mood, cognition, daily functioning, and fMRI data. We will explore cognitive control network functioning using resting-state and task-based fMRI.

Results:

Recruitment began in October 2019; we expect to finish recruitment by April 2022 and subsequently begin data analysis.

Conclusions:

This study is innovative in that it will include both active and waitlist control conditions and will explore changes in neural activation. Identifying the neural networks associated with improvements following CCT will allow for the development of more precise and effective interventions.

Trial Registration:

ClinicalTrials.govNCT03869463; https://clinicaltrials.gov/ct2/show/NCT03869463.

Determinants of Suicidality in the European General Population: A Systematic Review and Meta-Analysis

Close to one million people commit suicide each year, with suicidal attempts being the main risk factor for suicide. The aim of this systematic review and meta-analysis is to achieve a greater understanding of suicidality in the general population of Europe by studying associated factors and their statistical significance with suicidality, as well as the effect of the temporal moment in which suicidality is observed in a relationship. A search strategy was carried out in electronic databases: Proquest's Psychology Database, Scopus, PsycINFO, Medline and Embase. Odds ratios (ORs), publication bias, influential studies on heterogeneity and analysis moderators were calculated. Twenty-six studies were included after meeting the inclusion criteria. Factors statistically associated with suicidality are female gender, age over 65 years, unemployment, low social support, adulthood adversity, childhood adversity, family history of mental disorder, any affective disorder, major depression, anxiety/stress/somatoform disorders, tobacco and substance use, any mental disorder and body mass index. As a limitation, a high heterogeneity between studies was found. Factors associated with suicidality in the general population are relevant for understanding the suicidal phenomenon.

Prevalence and correlates of suicidality in Andalusia (Spain): Results of the epidemiological study PISMA-ep

BACKGROUND

Suicidality is an important public health problem. Hence, the aims of this study are to report prevalence rates and correlates of suicidality in Andalusia (Southern Spain).

METHODS

This is a cross-sectional household survey conducted on a representative sample of adults living in Andalusia. 4507 subjects were interviewed using the Mini International Neuropsychiatric Interview (MINI) to assess suicidality and standardized instruments were employed to evaluate associated variables. A multivariate logistic regression analysis was used to explore independent associations with suicidality.

RESULTS

Current prevalence of suicidality was 6.4%, 4.4% showed death wish, 1.4% had ideas of self-harm, 2.4% had suicidal thoughts, 1.1% had a suicidal plan, 0.6% had attempted suicide during the month prior to the interview, and, lastly, 2.6% reported to have had any sort of suicide attempt during his/her previous life. Independent factors associated with suicidality were being female, older age, not having a stable couple, lower levels of social support, having had physical childhood abuse experience, having experienced an increasing number of stressful life events, higher neuroticism scores, having a family history of mental disorder and nicotine or drugs dependence.

LIMITATIONS

The instrument employed to measure suicidality is a screening tool rather than a more in-depth diagnostic measure. We have not included all potential correlates of suicidality. This is a cross-sectional study which cannot establish causal relationships between exposures and outcomes.

CONCLUSIONS

This is the first epidemiological study in Andalusia on suicidality offering important results of clinical interest for suicide prevention.

Specific traumatic events elevate the risk of a suicide attempt in a 10-year longitudinal community study on adolescents and young adults

Traumatic events (TEs) have been associated with suicide attempts (SAs). However, the empirical status of some TEs is inconclusive. This also concerns community adolescents and young adults, known to be a high-risk group for SAs. We examined associations between (a) a range of prior TEs (physical attack, rape/sexual abuse, serious accident, and witnessing somebody else experiencing a TE) and a subsequent SA, and (b) the number of prior TEs and an SA, and (c) we estimated attributable proportions of SAs, in relation to each TE. Over a 10-year period, the Early Developmental Stages of Psychopathology (EDSP) study prospectively assessed community members, aged 14-24 years at baseline. Starting with 3021 subjects, each individual was assessed up to four times. Assessment was based on the Munich-Composite International Diagnostic Interview. Temporal associations were estimated using the Cox model with time-dependent covariates. Attributable proportions were based on the results of the Cox models. All four TEs elevated the risk for a subsequent SA, adjusting for confounders. Highest risk was found for the combined TE rape/sexual abuse. Results showed that 56-90% of SAs could be attributed to TEs in the exposed group; on the population level, attributable proportions ranged between 6.9% and 23.5%. Different TEs have been shown to elevate the risk of an SA in a young community sample. Our results suggest that both health professionals and health policy decision-makers consider specific TEs and the number of prior TEs as risk factors for SAs.

Mental disorders and the risk for the subsequent first suicide attempt: results of a community study on adolescents and young adults

Adolescents and young adults represent the high-risk group for first onset of both DSM-IV mental disorders and lifetime suicide attempt (SA). Yet few studies have evaluated the temporal association of prior mental disorders and subsequent first SA in a young community sample. We examined (a) such associations using a broad range of specific DSM-IV mental disorders, (b) the risk of experiencing the outcome due to prior comorbidity, and (c) the proportion of SAs that could be attributed to prior disorders. During a 10-year prospective study, data were gathered from 3021 community subjects, 14-24 years of age at baseline. DSM-IV disorders and SA were assessed with the Munich-Composite International Diagnostic Interview. Cox models with time-dependent covariates were used to estimate the temporal associations of prior mental disorders with subsequent first SA. Most prior mental disorders showed elevated risk for subsequent first SA. Highest risks were associated with posttraumatic stress disorder (PTSD), dysthymia, and nicotine dependence. Comorbidity elevated the risk for subsequent first SA, and the more disorders a subject had, the higher the risk for first SA. More than 90% of SAs in the exposed group could be attributed to PTSD, and over 30% of SAs in the total sample could be attributed to specific phobia. Several DSM-IV disorders increase the risk for first SA in adolescents and young adults. Several promising early intervention targets were observed, e.g., specific phobia, nicotine dependence, dysthymia, and whether a young person is burdened with comorbid mental disorders.

Preventing Depression in Final Year Secondary Students: School-Based Randomized Controlled Trial

Background

Depression often emerges for the first time during adolescence. There is accumulating evidence that universal depression prevention programs may have the capacity to reduce the impact of depression when delivered in the school environment.

Objective

This trial investigated the effectiveness of SPARX-R, a gamified online cognitive behavior therapy intervention for the prevention of depression relative to an attention-matched control intervention delivered to students prior to facing a significant stressor—final secondary school exams. It was hypothesized that delivering a prevention intervention in advance of a stressor would reduce depressive symptoms relative to the control group.

Methods

A cluster randomized controlled trial was conducted in 10 government schools in Sydney, Australia. Participants were 540 final year secondary students (mean 16.7 [SD 0.51] years), and clusters at the school level were randomly allocated to SPARX-R or the control intervention. Interventions were delivered weekly in 7 modules, each taking approximately 20 to 30 minutes to complete. The primary outcome was symptoms of depression as measured by the Major Depression Inventory. Intention-to-treat analyses were performed.

Results

Compared to controls, participants in the SPARX-R condition (n=242) showed significantly reduced depression symptoms relative to the control (n=298) at post-intervention (Cohen d=0.29) and 6 months post-baseline (d=0.21) but not at 18 months post-baseline (d=0.33).

Conclusions

This is the first trial to demonstrate a preventive effect on depressive symptoms prior to a significant and universal stressor in adolescents. It demonstrates that an online intervention delivered in advance of a stressful experience can reduce the impact of such an event on the potential development or exacerbation of depression.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12614000316606; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365986 (Archived by WebCite at http://www.webcitation.org/ 6u7ou1aI9)

Childhood trauma and suicide attempt: A meta-analysis of longitudinal studies from the last decade

Childhood trauma (CT) is a modifiable risk factor for lifetime suicide attempts (SA). However, the extent to which each type of CT increases SA risk is unclear. This study aimed to conduct a meta-analysis of longitudinal studies published in the last 10 years about the relationship between CT and lifetime SA risk. The PUBMED, PsycINFO, ISI, and EMBASE databases were searched for cohort studies that reported AS during follow-up and included an assessment of CT. A meta-analysis was conducted to identify potential effects of each type of CT on SA. Seven unique studies were included for review. Sexual (n=6, OR=3.73, 95%CI 2.94-4.75, p<0.001), physical (n=6, OR=4.11, 95%CI 2.30-7.33, p<0.001), and emotional abuse (n=3, OR=3.98, 95%CI 2.89-5.64, p<0.001), as well as physical neglect (n=2, OR=3.42, 95%CI 2.09-5.59, p<0.001), were associated with SA. Emotional neglect and a broken home were not significantly associated with further SA. The modes of CT that most contribute to SA in later life are physical, emotional, and sexual abuse and physical neglect, in descending order.

Understanding Suicide Risk within the Research Domain Criteria (RDoC) Framework: Insights, Challenges, and Future Research Considerations

Suicide is a leading cause of death worldwide. Prior research has focused primarily on sociodemographic and psychiatric risk factors with little improvement in the prediction or prevention of suicidal behavior over time. The Research Domain Criteria (RDoC) may be an especially useful framework for advancing research in this area. This paper provides a brief and broad overview of research on suicidal behavior relating to each of the RDoC domains-highlighting the RDoC construct(s) where research has focused, construct(s) where research is lacking, and suggestions for future research directions. We also discuss major challenges for suicide research within the RDoC framework, including the intersection of RDoC domains, interaction of domains with the environment, incorporation of developmental stage, integration of distal and proximal processes, and inclusion of suicide-specific constructs. We conclude by underscoring important considerations for future research aimed at using the RDoC framework to study suicidal behavior and other forms of psychopathology.

Risk Factors for Malnutrition among Older Adults in the Emergency Department: A Multicenter Study

BACKGROUND

Among older adults, malnutrition is common, often missed by healthcare providers, and influences recovery from illness or injury.

OBJECTIVE

To identify modifiable risk factors associated with malnutrition in older patients.

DESIGN

Prospective cross-sectional multicenter study.

SETTING

3 EDs in the South, Northeast, and Midwest.

PARTICIPANTS

Non-critically ill, English-speaking adults aged ≥65 years.

MEASUREMENTS

Random time block sampling was used to enroll patients. The ED interview assessed malnutrition using the Mini Nutritional Assessment Short-Form. Food insecurity and poor oral health were assessed using validated measures. Other risk factors examined included depressive symptoms, limited mobility, lack of transportation, loneliness, and medication side effects, qualified by whether the patient reported the risk factor affected their diet. The population attributable risk proportion (PARP) for malnutrition was estimated for each risk factor.

RESULTS

In our sample (n = 252), the prevalence of malnutrition was 12%. Patient characteristics associated with malnutrition included not having a college degree, being admitted to the hospital, and residence in an assisted living facility. Of the risk factors examined, the PARPs for malnutrition were highest for poor oral health (54%; 95% CI 16%, 78%), food insecurity (14%; 95% CI 3%, 31%), and lack of transportation affecting diet (12%; 95% CI 3%, 28%).

CONCLUSION

Results of this observational study identify multiple modifiable factors associated with the problem of malnutrition in older adults.

First onset of suicidal thoughts and behaviours in college

BACKGROUND

College students are a worldwide increasing group of young people at risk for suicidal thoughts and behaviours (STB). However, no previous studies have prospectively investigated the first onset of STB during the college period.

METHODS

Using longitudinal data from the Leuven College Surveys, 2337 (response rate [RR]=66.6%) incoming freshmen provided baseline data on STB, parental psychopathology, childhood-adolescent traumatic experiences, 12-month risk for mental disorders, and 12-month stressful experiences. A total of 1253 baseline respondents provided data on 12-month STB in a two-year annual follow-up survey (conditional RR=53.6%; college dropout adjusted conditional RR=70.2%).

RESULTS

One-year incidence of first-onset STB was 4.8-6.4%. Effect sizes of the included risk factors varied considerably whether viewed from individual-level (ORs=1.91-17.58) or population-level perspective (PARPs=3.4-34.3%). Dating violence prior to the age of 17, physical abuse prior to the age of 17, and 12-month betrayal by someone else than the partner were most strong predictors for first-onset suicidal ideation (ORs=4.23-12.25; PARPs=8.7-27.1%) and plans (ORs=6.57-17.58; PARPs=15.2-34.3%). Multivariate prediction (AUC=0.84-0.91) revealed that 50.7-65.7% of first-onset STB cases were concentrated in the 10% at highest predicted risk.

LIMITATIONS

As this is a first investigation of STB onset in college, future studies should use validation samples to test the accuracy of our multivariate prediction model.

CONCLUSIONS

The first onset of STB in college appears to be higher than in the general population. Screening at college entrance is a promising strategy to identify those students at highest prospective risk, enabling the cost-efficient clinical assessment of young adults in college.

Exploring the risk factors of suicidal ideation among the seniors in Shandong, China: A path analysis

BACKGROUND

Suicide is a global public health problem that has a significant negative influence on individuals, families and the society. The objective of this study is to explore the risk factors associated with suicidal ideation among the elderly in Shandong Province, China.

METHOD

A total of 3313 participants (60+) of Shandong Province, China were included in this study. Suicidal ideation was assessed by using questions from the NCS (National Comorbidity Survey). Multiple logistic regression analysis was performed to examine the factors associated with suicidal ideation. Path analysis was conducted to test the direct and indirect association between factors and suicidal ideation.

RESULTS

The prevalence of suicidal ideation among the seniors in Shandong, China was 4.2%. Depression had the strongest direct (β=0.303, p-value<0.05) and total effect (β=0.303), life satisfaction (β=-0.103, p-value<0.05; β=-0.136, p-value<0.05), economic status (β=-0.046, p-value<0.05; β=-0.040, p-value<0.05) had both direct and indirect impacts on suicidal ideation. Social support (β=-0.040, p-value<0.05) had indirect influence on suicidal ideation. Depression was a mediator between life satisfaction, economic status, social support and suicidal ideation.

LIMITATIONS

The data used in this study was cross-sectional, and the relationship between identified factors and suicidal ideation cannot be interpreted as cause-effect.

CONCLUSIONS

Depression was the strongest influencing factor of suicidal ideation among the elderly, followed by life satisfaction, economic status. Active intervention measures focusing on the depression screening and treatment both in urban and rural communities should be taken to prevent suicide.