The impact of intimate partner relationships on suicidal thoughts and behaviours: A systematic review

Dyadic Associations of Suicidal Risk Predicting Relationship Satisfaction in a Clinical Sample

This study investigated the prevalence of suicidal risk and associated trajectories of relational satisfaction in couples presenting for therapy using a national clinical data set, the Marriage and Family Therapy Practice Research Network (MFT-PRN). The sample assessed 296 different-sex couples attending couple therapy at sessions one, four, and eight. Nearly a quarter of couples indicated suicidal risk at session one. Dyadic latent growth models revealed that higher suicidal risk had a small but significant association with lower initial relationship satisfaction for men; thus, while the suicidal risk is associated with men's lower relationship satisfaction at intake, it may not continue to have impacts later in treatment. Alternative analyses of 27 same-sex couples revealed a quarter of couples with suicidal risk at session one and that suicidal risk was not associated with relationship satisfaction. Although suicide risk was not associated with changes in relational satisfaction over time, suicidal risk should be assessed for couples presenting to therapy.

Prevalence of suicidal ideation among married and cohabiting women in Sri Lanka: An analysis of the Sri Lanka Women's Well-being Survey 2019

This study utilized the 2019 Women's Wellbeing Survey conducted by the Department of Census and Statistics (DCS) in Sri Lanka to investigate the factors influencing suicidal ideation among married/cohabiting women. The study sample consists of secondary data from 1462 females, who were 15 years or older and currently married or living with a male partner, extracted from WWS 2019. Binary logistic regression was employed to analyze the association between suicidal ideation in married/cohabiting women and various independent variables. Among the respondents, 13.2% of married/cohabiting women reported having suicidal thoughts. Several factors were found to increase the likelihood of such ideation: a partner's extramarital affair, feelings of worthlessness and restlessness, partners consuming alcohol, experience of psychological violence and physical violence by the current partner, physical violence experienced since the age of 15, and childhood sexual violence. Conversely, lower odds of suicidal ideation were observed among women who married/cohabited between the ages of 20-29 compared to those in the 10-19 age category, and among unemployed women. This study emphasizes the urgency of addressing intimate partner violence, childhood sexual abuse, early marriages, and the mental well-being of vulnerable women, as these factors significantly impact their risk of life-threatening issues.

Associations among psychological health problems, intimate-relationship problems, and suicidal ideation among United States Air Force active-duty personnel

Linkages among psychological health problems, intimate relationship distress, and suicide risk have been widely studied, but less is known about how these factors interact, especially in military populations. With steady increases in suicide rates among active military and post-service members (SMs), it is critical to better understand the relation among known risk factors. The current study addresses this gap by testing a model hypothesizing that the association between intimate-relationship problems and suicidal ideation is mediated by individual mental health symptoms. We tested this model on a sample of 862 active-duty Air Force members in committed relationships. The sample consisted of 35.0% women and 64.8% men, with an average age of 21.9 years and a mean relationship length of 2.8 years. Findings supported the hypothesized statistical mediation model. Results indicated that relationship problems contribute to psychological health problems, which, in turn, are related to suicidal ideation. These findings may help direct suicide intervention and prevention protocols that consider intimate relationship distress as a significant risk factor. Limitations and further implications for policies regarding suicide prevention in the armed forces are discussed.

Cross-lagged relationships between exposure to intimate partner violence, depressive symptoms and suicidal thoughts among adolescent and young married women

BACKGROUND

High rates of depression and suicidal ideation are found in women experiencing intimate partner violence (IPV), but their temporal relationship is unclear. This study explores the bidirectional causality between IPV victimization, depressive symptoms, and suicidal thoughts among adolescent and young married women in India.

METHODS

Data sourced from the UDAYA longitudinal survey in India, comprising 3,965 women aged 15-22. Employing Pearson's correlation coefficient, we analyzed the relationship between variables. Additionally, a two-wave cross-lagged autoregressive panel model explored the bidirectional link between IPV, depressive symptoms, and suicidal ideation.

RESULTS

Approximately 25 % and 45 % of the participants reported some form of partner violence at baseline and at follow-up after three years, respectively. Exposure to IPV at baseline was significantly associated with depressive symptoms at follow-up [β = 0.10, p < 0.001], and the association between depressive symptoms at baseline and IPV at follow-up was statistically not significant [β = -0.02, 95 % CI: -0.06-0.02]. Similarly, exposure to IPV at baseline was significantly associated with suicidal thoughts at follow-up [β = 0.24, p < 0.001], and the association between suicidal thoughts at baseline and IPV at follow-up was statistically not significant [β = 0.003, 95 % CI: -0.001-006].

CONCLUSIONS

The findings suggest that exposure to IPV is consistently and strongly associated with depressive symptoms and suicidal thoughts in adolescent and young married women. However, the reciprocal relationships did not hold true in this study, implying that reducing IPV during adolescence could potentially minimize the prevalence of depressive symptoms and suicidal thoughts during young adulthood.

A novel framework for ketamine-assisted couple therapy

Intimate relationship distress is prevalent and is associated with poorer health, mental health, and mortality outcomes. Evidence-based couple therapies target cognitive, behavioral, and emotional processes that underlie relationship dysfunction. Increasing research and clinical evidence supports the efficacy of ketamine-assisted psychotherapy (KAP) for addressing clinical mental health concerns, including depression, anxiety disorders, posttraumatic stress disorder, and more. The purported mechanisms of KAP are also likely to improve psychosocial and relational functioning for patients and may be useful for supporting change mechanisms in couple therapy. This paper reviews the current evidence for therapeutic ketamine and KAP and outlines how the mechanisms of ketamine therapy may also augment the cognitive, behavioral, and emotional interventions in the most commonly used evidence-based couple therapies. Key mechanisms include increased neuroplasticity, changes in functional connectivity, adaptive dissociation, decreased inhibition, and reduced avoidance. Given the reciprocal interaction between relationship dysfunction and mental health problems, ketamine may also help alleviate relationship distress by directly treating clinical mental health symptoms. We then outline a proposed framework for ketamine-assisted couple therapy, addressing the application of KAP preparation, dosing, and integration to a dyadic intervention framework in a way that can be applied to different couple therapy modalities. This clinical framework for couples' KAP may be useful for clinicians and researchers working to improve the efficacy of couple therapy, particularly when one or both partners has accompanying mental health concerns.

Love Is Not All You Need: Understanding the Association Between Relationship Status and Relationship Dysfunction With Self-Directed Violence in Veterans

INTRODUCTION

Research indicates that being married is associated with reduced risk of suicide and self-directed violence (SDV) relative to being divorced. Simultaneously, difficulties within relationships predict poorer health outcomes. However, research on relationship status rarely examines relationship functioning, obfuscating the joint contribution of these variables for SDV risk.

METHOD

Veterans (N = 1,049) completed a survey that included assessment of relationship status, relationship functioning, and SDV history. Logistic regression models tested how (a) relationship status, (b) relationship dysfunction, and (c) being divorced compared to being in a low- or high-dysfunction relationship were associated with SDV, controlling for several intrapersonal risk factors.

RESULTS

Veterans in a relationship did not differ in SDV history compared to divorced/separated veterans. However, more dysfunction within relationships was associated with greater odds of a history of SDV and suicidal cognitions. Finally, SDV histories were more likely among veterans endorsing high-dysfunction relationships compared with (a) low-dysfunction relationships and (b) divorced veterans.

CONCLUSION

It may be insufficient to only consider relationship status when evaluating interpersonal risk factors for SDV. A single item assessing relationship dysfunction was associated with enacted SDV and suicidal cognitions over and above intrapersonal risk factors. Integrating such single-item measures into clinical practice could improve identification and subsequent tailored intervention for veterans at greater risk for SDV.

Decoding Suicide Decedent Profiles and Signs of Suicidal Intent Using Latent Class Analysis

Importance

Suicide rates in the US increased by 35.6% from 2001 to 2021. Given that most individuals die on their first attempt, earlier detection and intervention are crucial. Understanding modifiable risk factors is key to effective prevention strategies.

Objective

To identify distinct suicide profiles or classes, associated signs of suicidal intent, and patterns of modifiable risks for targeted prevention efforts.

Design, Setting, and Participants

This cross-sectional study used data from the 2003-2020 National Violent Death Reporting System Restricted Access Database for 306 800 suicide decedents. Statistical analysis was performed from July 2022 to June 2023.

Exposures

Suicide decedent profiles were determined using latent class analyses of available data on suicide circumstances, toxicology, and methods.

Main Outcomes and Measures

Disclosure of recent intent, suicide note presence, and known psychotropic usage.

Results

Among 306 800 suicide decedents (mean [SD] age, 46.3 [18.4] years; 239 627 males [78.1%] and 67 108 females [21.9%]), 5 profiles or classes were identified. The largest class, class 4 (97 175 [31.7%]), predominantly faced physical health challenges, followed by polysubstance problems in class 5 (58 803 [19.2%]), and crisis, alcohol-related, and intimate partner problems in class 3 (55 367 [18.0%]), mental health problems (class 2, 53 928 [17.6%]), and comorbid mental health and substance use disorders (class 1, 41 527 [13.5%]). Class 4 had the lowest rates of disclosing suicidal intent (13 952 [14.4%]) and leaving a suicide note (24 351 [25.1%]). Adjusting for covariates, compared with class 1, class 4 had the highest odds of not disclosing suicide intent (odds ratio [OR], 2.58; 95% CI, 2.51-2.66) and not leaving a suicide note (OR, 1.45; 95% CI, 1.41-1.49). Class 4 also had the lowest rates of all known psychiatric illnesses and psychotropic medications among all suicide profiles. Class 4 had more older adults (23 794 were aged 55-70 years [24.5%]; 20 100 aged ≥71 years [20.7%]), veterans (22 220 [22.9%]), widows (8633 [8.9%]), individuals with less than high school education (15 690 [16.1%]), and rural residents (23 966 [24.7%]).

Conclusions and Relevance

This study identified 5 distinct suicide profiles, highlighting a need for tailored prevention strategies. Improving the detection and treatment of coexisting mental health conditions, substance and alcohol use disorders, and physical illnesses is paramount. The implementation of means restriction strategies plays a vital role in reducing suicide risks across most of the profiles, reinforcing the need for a multifaceted approach to suicide prevention.

Factors associated with suicide attempt risk in adolescent inpatient psychiatric care: toward a practical model

Suicide is an important social and medical problem, particularly among children and adolescents. The aim of the study was to determine the association of the psychiatric diagnosis and selected psychosocial factors with the risk of suicide attempts among patients of an adolescent psychiatric unit. A retrospective analysis was performed on a database of consecutive N = 1311 patients aged 13-18 years of the adolescent psychiatric ward. A hierarchical logistic regression analysis was performed to assess the predictive value of the main psychiatric diagnosis, for factors selected from the database to determine their influence on the relative risk of a suicide attempt. Primary diagnoses of mood disorders and emotional and behavioral disorders were associated with an increased risk of a current admission after a suicidal attempt, a history of past suicidal attempts and non-suicidal self-harm (NSSI). History of NSSI was associated with a fourfold increase probability of a suicide attempt. Truancy, sexual abuse, heartbreak and frequent conflicts were related to a rise in suicidal attempt risk. Learning difficulties were found to be linked to increased probability of suicidal attempt, but only among women. The current study confirms that the primary diagnosis, NSSI and well-recognized psychosocial factors (including family- and school-related factors) may prove useful in the assessment of suicidal risk among adolescents admitted to a psychiatric ward.

Design of a randomized clinical trial of brief couple therapy for PTSD augmented with intranasal oxytocin

BACKGROUND

Leveraging military veterans' intimate relationships during treatment has the potential to concurrently improve posttraumatic stress disorder (PTSD) symptoms and relationship quality. Cognitive-Behavioral Conjoint Therapy (CBCT) and an 8-session Brief Cognitive-Behavioral Conjoint Therapy (bCBCT) are manualized treatments designed to simultaneously improve PTSD and relationship functioning for couples in which one partner has PTSD. Although efficacious in improving PTSD, the effects of CBCT on relationship satisfaction are small, especially among veterans. Intranasal oxytocin, which targets mechanisms of PTSD and relationship quality, may enhance the efficacy of bCBCT.

METHOD/DESIGN

The purpose of this 4-year clinical trial is to compare the outcomes of bCBCT augmented with intranasal oxytocin versus bCBCT plus placebo. We will also explore potential mechanisms of action: self-reported communication skills, empathy, and trust. We will recruit 120 dyads (i.e., veteran with PTSD and their intimate partner) from the VA San Diego Healthcare System. Veterans will be administered 40 international units of oxytocin (n = 60) or placebo (n = 60) 30 min before each of 8 bCBCT sessions delivered via telehealth. Clinical and functioning outcomes will be assessed at five timepoints (baseline, mid-treatment, post-treatment, and 3- and 6-month follow-up).

CONCLUSION

Study findings will reveal the efficacy of oxytocin-assisted brief couple therapy for PTSD, which could serve as highly scalable option for couples coping with PTSD, as well as provide preliminary evidence of interpersonal mechanisms of change.

CLINICALTRIALS

govIdentifier:NCT06194851.

Dynamic Associations Among Sleep, Emotion Dysregulation, and Desire to Live in a Perinatal Sample

OBJECTIVE

The present study prospectively examined dynamic associations among sleep, emotion dysregulation, and desire to live during the perinatal transition, as it was theorized that these factors may contribute to the emergence of postpartum suicide risk.

METHOD

Ninety-four women ( Mage = 29.2 years; 23.4% Latina) wore wrist actigraphs and completed twice daily surveys for 7 days during the third trimester of pregnancy, 6 weeks postpartum, and 4 months postpartum. Multilevel, change-as-outcome models were built to examine changes in attractor dynamics among sleep, emotion dysregulation, and desire to live, as well as if sleep-emotion dysregulation dynamics differed based on participants' desires to live.

RESULTS

From pregnancy to 6 weeks postpartum, emotion dysregulation ( B = -0.09, p = .032) and desire to live ( B = -0.16, p < .001) exhibited more stable temporal patterns around higher emotion dysregulation and lower desire to live. Compared to women who reported consistently high desires to live, those who experienced fluctuations in their desires to live exhibited lower, more stable sleep efficiency during pregnancy ( B = -0.90, p < .001). At 4 months postpartum, those with fluctuating desires to live exhibited a coupling dynamic whereby low sleep efficiency predicted increases in emotion dysregulation ( B = -0.16, p = .020).

CONCLUSIONS

This study was the first to examine nonlinear dynamics among risk factors for postpartum suicide, which may be evident as early as pregnancy and 6 weeks postpartum. Sleep health, in particular, warrants further exploration as a key susceptibility factor in the emergence of postpartum suicide risk.

PREREGISTRATION

Open Science Framework ( https://osf.io/qxb75/?view_only=799ffe5c048842dfb89d3ddfebaa420d ).

Starting a Romantic Relationship, Breakups, and Sleep: A Longitudinal Study of Chinese Adolescents

BACKGROUND

Epidemiological data on the association between romantic experiences and sleep in adolescents are limited. This study examined the associations of starting a romantic relationship (SRR) and romantic breakups with insomnia symptoms and sleep duration in adolescents.

METHODS

A total of 7,072 Chinese adolescents were surveyed in November-December 2015 and 1 year later. A self-administered questionnaire was used to assess SRR, romantic breakups, sleep duration, insomnia symptoms, depressive symptoms, substance use, and demographics.

RESULTS

The mean age of the sample was 14.58 (SD = 1.46) years and half were female. SRR only, breakups only, and both (SRR + breakups) in the past year were reported by 7.0%, 8.4%, and 15.4% of the sample, respectively. At the baseline and 1-year follow-up, 15.2% and 14.7% of the sample had insomnia symptoms and 47.7% and 42.1% reported short sleep duration (<7 h/night), respectively. After adjusting for depressive symptoms, substance use, and demographics, SRR and breakups were significantly associated with 35-45% increased odds of insomnia symptoms at baseline. SRR + breakups were significantly associated with short sleep duration (OR = 1.28, 95%CI = 1.05-1.56). SRR (OR = 1.61, 95%CI = 1.16-2.23) and breakups (OR = 1.43, 95%CI = 1.04-1.96) were significantly associated with increased odds of incident insomnia symptoms at 1-year follow-up. These associations were stronger in younger adolescents (<15 years) than in older adolescents (≥15 years), especially in girls.

CONCLUSIONS

The findings suggest that SRR and breakups are associated with insomnia symptoms and short sleep duration, underscoring the importance of romantic relationships education and management of romantic stress for healthy sleep especially in early adolescent girls.

Understanding complex causes of suicidal behaviour among graduates in Bangladesh

This study utilizes both fieldwork and desk-based discourse analysis of newspaper reports to investigate the concerning number of suicides among graduates in Bangladesh. According to some reports, a majority of suicide cases involve young adults who are either currently studying at university or have recently completed their degree (between the ages of 20 and 32). This research contends that patriarchal social expectations in Bangladesh place significant pressure on young adults to secure well-paying jobs to support their families and uphold their family's status, which can have a negative impact on their mental health. Furthermore, this article identifies additional risk factors that contribute to the high suicide rates among graduates in Bangladesh. These factors include unemployment, poverty, relationship problems, drug addiction, political marginalization, and the stigma of shame, all of which can cause low self-esteem and suicidal thoughts. Moreover, the research suggests that families in Bangladesh have not been providing adequate support to their young members when facing challenges in life. On the contrary, families have added to the pressure on young adults, which can be attributed to joiner's theory of the effect of industrialization on family norms and values.

Suicide from intimate partner and other relationship conflicts: demographic and clinical correlates'

BACKGROUND

A significant portion of suicides are precipitated by interpersonal relationship problems.

AIMS

To examine demographic and clinical correlates of any intimate partner conflicts (IPC) and other interpersonal conflicts (OPC) as suicide precipitants.

METHODS

We analyzed data on 92,805 (72,628 male; 20,177 female) adult suicide decedents from the 2017 to 2019 U.S. National Violent Death Reporting System, using multinomial and binary logistic regression models. We included case examples from coroners/medical examiner (CME) and law enforcement (LE) agency reports.

RESULTS

Of all decedents, 23.6% had IPC and 8.0% had OPC as a suicide precipitant. Compared to those without any relationship conflict, those who had IPC or OPC were younger and more likely to have had previous suicide attempt(s), alcohol/other substance use problems, and job/finance/housing and legal problems. Compared to those with OPC, those with IPC were more likely to be male and Hispanic and had higher odds of previous suicide attempt, depression diagnosis, alcohol problems, and more acute crises. CME/LE reports showed distress of divorce/break-up, other life stressors, prior suicide attempt(s), alcohol/other substance involvement, and/or loss of family support.

CONCLUSIONS

Access to behavioral health treatment for those at risk of suicide in the face of IPC or OPC is essential for suicide prevention.

Association between love breakup and suicidal ideation in Peruvian medical students: a cross-sectional study during the COVID-19 pandemic

Objective

We aimed to determine the association between a major romantic breakup and suicidal ideation in medical students from three universities in Peru.

Methods

A cross-sectional study was conducted during the first pandemic wave in 2021 on medical students from three universities in northern Peru. The outcome was suicidal ideation, measured with question nine of the Patient Health Questionnaire-9 (PHQ-9). Generalized Anxiety Disorder Scale-7 (GAD-7) and Insomnia Severity Index (ISI) were also used to assess mental health symptoms. The exposure was the experience of a major love breakup during the pandemic. In addition, its association with other covariates (age, sex, family members infected with COVID-19, deceased family members with COVID-19, insomnia, and anxiety, among others) was examined.

Results and discussions

Out of 370 students, 19.5% reported a major love breakup during the pandemic (95%CI: 15.5-23.8), and 34.3% had suicidal ideation (95%CI: 29.4-39.4). Having a major love breakup was associated with a higher prevalence of suicidal ideation (PR: 1.49, 95%CI: 1.32-1.67, p < 0.001). Moderate insomnia (PR: 2.56, 95%CI: 1.70-3.87, p < 0.001) and anxiety symptoms (PR: 1.94, 1.10-3.44, p = 0.023) were also associated with suicidal ideation.

Conclusion

Our study provides evidence of a significant association between a major love breakup and suicidal ideation. This finding emphasizes the need for further research to better understand this association and inform the development of effective suicide prevention policies in medical education.

Understanding suicidal transitions in Australian adults: protocol for the LifeTrack prospective longitudinal cohort study

BACKGROUND

The factors that influence transition from suicidal ideation to a suicide attempt or remission of suicidal thoughts are poorly understood. Despite an abundance of research on risk factors for suicidal ideation, no large-scale longitudinal population-based studies have specifically recruited people with suicidal ideation to examine the mechanisms underlying critical transitions to either suicide attempt or recovery from suicidal ideation. Without longitudinal data on the psychological, behavioural, and social determinants of suicide attempt and the remission of suicidal ideation, we are unlikely to see major gains in the prevention of suicide.

AIM

The LifeTrack Project is a population-based longitudinal cohort study that aims to identify key modifiable risk and protective factors that predict the transition from suicidal ideation to suicide attempt or remission of suicidal ideation. We will assess theory-informed risk and protective factors using validated and efficient measures to identify distinct trajectories reflecting changes in severity of suicidal ideation and transition to suicide attempt over three years.

METHODS

A three-year prospective population-based longitudinal cohort study will be conducted with adults from the general Australian population who initially report suicidal ideation (n = 842). Eligibility criteria include recent suicidal ideation (past 30 days), aged 18 years or older, living in Australia and fluent in English. Those with a suicide attempt in past 30 days or who are unable to participate in a long-term study will be excluded. Participants will be asked to complete online assessments related to psychopathology, cognition, psychological factors, social factors, mental health treatment use, and environmental exposures at baseline and every six months during this three-year period. One week of daily measurement bursts (ecological momentary assessments) at yearly intervals will also capture short-term fluctuations in suicidal ideation, perceived burdensomeness, thwarted belongingness, capability for suicide, and distress.

CONCLUSION

This study is intended to identify potential targets for novel and tailored therapies for people experiencing suicidal ideation and improve targeting of suicide prevention programs. Even modest improvements in current treatments may lead to important reductions in suicide attempts and deaths.

STUDY REGISTRATION

Australian New Zealand Clinical Trials Registry identifier: ACTRN12623000433606.

Working with men in the context of distressed and disrupted intimate partner relationships: A qualitative study

OBJECTIVE

To describe key considerations for working with men experiencing distressed and disrupted intimate partner relationships.

METHODS

Individual Zoom interviews were conducted with help-seeking men (n = 25) who had experienced an intimate partnership break-up, and health service providers (n = 30) working with men in the relationships space. Interpretive Description methodology was used to generate considerations for working with men in distressed and disrupted relationships.

RESULTS

Three thematic findings were inductively derived; 1) A whole life approach for deconstructing relationships, wherein men engaged in discussions about their broader experiences and circumstances within the context of intimate partnerships; 2) Affirming men's relationship emotions and vulnerabilities as normative and changeable, comprising coaching for embodying transformative masculinities; and 3) Tangible 'to do's' in and after a relationship, outlining men's present and prospective self-work with action-oriented strategies.

CONCLUSION

Strategies tailored to men's receptivity and needs can increase connection with professional services and providers to bolster the mental health of men in and after disrupted intimate partner relationships.

PRACTICE IMPLICATIONS

With men increasingly accessing professional mental health services, the present study offers key considerations and recommendations regarding assessment, communication, and treatment for health service providers working with men in the relationships space.

Brief relationship support as a selective suicide prevention intervention: Piloting the Relationship Checkup in veteran couples with relationship and mental health concerns

INTRODUCTION

Close relationship problems play a key role in many contemporary theories of suicide. However, the potential of relationship support in suicide prevention is understudied. This study explores the feasibility, safety, acceptability, and promise of utilizing the 3-session Relationship Checkup (RC) in veterans with mental health and romantic relationship concerns.

METHODS

We conducted a single-arm pilot of telehealth RC in veterans with a positive mental health screen and their romantic partners. Couples completed baseline and post-treatment assessments of study outcomes.

RESULTS

Feasibility analyses showed we were able to recruit an elevated-risk sample (30% history of attempts or interrupted attempts), take them through the service (90% treatment completion), and had minimal harm events (no suicidal behavior, no physical harm in arguments). Multimethod acceptability analyses suggested high satisfaction with the program, though some desired more intensive services. Couples reported improvements in relationship functioning, emotional intimacy, thwarted belongingness, depression, and posttraumatic stress. Perceived burdensomeness only improved for identified patients and drinking did not change for either partner.

CONCLUSION

The RC is a feasible, safe, and acceptable strategy for providing relationship support to couples at elevated risk. Although further randomized trials are needed, RC shows promise to reduce relationship-level and individual-level suicide risk factors.

Characteristics of and Circumstances Associated With Female Intimate Partner Problem-Included Suicides: Analysis of Data From the National Violent Death Reporting System (2003-2019)

Intimate partner problems (IPP)-which include divorce, breakups, arguments, jealousy, conflict, discord, and violence-have been robust precipitating factors associated with an increased risk for suicidal thoughts and behaviors. Although research on suicide related to IPP is growing, efforts to explore the circumstances surrounding suicidality among female victims struggling with IPP remain insufficient. To address this gap, this exploratory study sought to understand the circumstances surrounding female IPP-related suicide in the United States. We conducted a secondary analysis of data from the U.S. National Violent Death Reporting System (NVDRS, 2003-2019) which includes 43 states, the District of Columbia, and Puerto Rico. Of the final analytical sample of 58,545 female suicide cases in the United States, we delineated IPP-included suicide cases (13,496, 23.1%) and non-IPP-included suicide cases (45,049, 76.9%). Two-sided Pearson chi-square tests and standardized difference (SD) tests identified significant differences in the surrounding circumstances between IPP-included suicide and non-IPP-included suicide. IPP-included female suicide was more common among younger women, those involved in an intimate relationship, and women who were pregnant or postpartum (p < .001; SD > .10). IPP-included suicide victims were more likely to have experienced depression, substance abuse, and previous interpersonal trauma than non-IPP-included suicide victims (p < .001; SD > .10). Compared to non-IPP-included suicide, IPP-included suicide was more likely to occur at the victim's house or apartment during evening and nighttime by firearm or hanging (p < .001; SD > .10). Our findings also showed that IPP-included suicide victims had previous suicidal thoughts and were more likely to have disclosed their suicidal ideation with others before committing suicide than non-IPP-included suicide victims (p < .001; SD > .10). Findings identified unique circumstances and characteristics possibly associated with IPP-included female suicide. Our understanding of suicide may be enhanced by exploring the causal pathway behind these relationships.

Precipitating Circumstances Associated With Intimate Partner Problem-Related Suicides

INTRODUCTION

In 2020, suicide was the 12th leading cause of death among adults in the U.S. Previous research has shown that one common precipitating circumstance among adult suicide decedents is experiencing intimate partner problems (IPPs), such as divorce, separation, romantic break-ups, arguments, conflicts, and intimate partner violence. This study examines how precipitating factors differ between IPP- and non-IPP-related suicides.

METHODS

In 2022, this study analyzed National Violent Death Reporting System data from adult suicide decedents in 48 states and 2 territories between 2003 and 2020. Multivariable logistic regression models were used to compare precipitating circumstances between IPP- and non-IPP-related suicides, controlling for sociodemographic characteristics.

RESULTS

Of the 402,391 suicides, 20% (n=80,717) were known to be IPP-related. Circumstances that significantly increased the odds of IPP-related suicides included a history of suicidal thoughts and attempts and mental health problems (depressed mood, alcohol problem, mental health diagnosis), life stressors (interpersonal violence perpetration and victimization, arguments, financial problems, job problems, family problems), and recent legal problems. Non-IPP-related suicides were more likely to occur among older individuals and to be precipitated by a physical health problem or crime.

CONCLUSIONS

The findings can inform prevention strategies that build resiliency and problem-solving skills, strengthen economic support, and identify and assist people at risk for IPP-related suicides. The Centers for Disease Control and Prevention's Suicide Resource for Action and Intimate Partner Violence Prevention resource packages highlight the best available evidence for policies, programs, and practices related to preventing suicides and IPP.

Suicidal ideation, attempts and its determinants among young adults in Meghalaya: a cross sectional study

OBJECTIVES

Suicide is a major health issue in India. With the advent of the COVID-19 pandemic, people have experienced loss on a tremendous scale. The impact of these losses on the youth will be massive leading to a rise in depression cases, suicidal ideation and ultimately suicidal attempts. Hence there is a need to determine the prevalence of suicidal ideation, suicide attempts and the predictors for both suicidal ideation and attempts among the young adults in Meghalaya.

METHODS

This cross-sectional study was conducted among the students aged 18-25 years in NEIGRIHMS and Synod College in Shillong between March to April 2022. Data was collected by using questionnaire method.

RESULTS

The prevalence of suicidal ideation and suicidal attempts was found to be 15.9 % (12.3-20.3) and 5.8 % (3.7-8.9) respectively. There was a strong relationship for suicidal ideation with urban students, with less family members, those who had unhealthy relationship with their parents, stress, complicated relationship/loss of loved ones and also those with experience of violence/abuse and behavioural problems. However, the attempts were found to be associated only with the loss of the loved ones.

CONCLUSIONS

The prevalence, though smaller is a serious concern considering the fact that the burden of suicides is on a rise and hence regular mental health counselling along with the management of the stress is needed at the educational institutional level which could prove to be beneficial to the students.

Association between Love Breakup and Suicidal Ideation in Peruvian Medical Students: A Cross-Sectional Study during the COVID-19 Pandemic

Objective

We aimed to determine the association between a major romantic breakup and suicidal ideation in medical students from three universities in Peru.

Methods

A cross-sectional study was conducted during the first pandemic wave in 2021 on medical students from three universities in northern Peru. The outcome was suicidal ideation, measured with question nine of the PHQ-9. The exposure was the experience of a major love breakup during the pandemic. In addition, its association with other covariates (age, sex, family members infected with COVID-19, deceased family members with COVID-19, insomnia, and anxiety, among others) was examined.

Results and discussions

Out of 370 students, 19.5% reported a major love breakup during the pandemic (95%CI: 15.5-23.8), and 34.3% had suicidal ideation (95%CI: 29.4-39.4). Having a major love breakup was associated with a higher prevalence of suicidal ideation (PR: 1.49, 95%CI: 1.32-1.67). Moderate insomnia (PR: 2.56, 95%CI: 1.70-3.87) and anxiety symptoms (PR: 1.94, 1.10-3.44) were also associated with suicidal ideation.

Conclusion

Our study provides evidence of a significant association between a major love breakup and suicidal ideation. This finding emphasizes the need for further research to better understand this association and inform the development of effective suicide prevention policies in medical education.

"I Don't Feel at Home in This World" Sexual and Gender Minority Emerging Adults' Self-Perceived Links Between Their Suicidal Thoughts and Sexual Orientation or Gender Identity

OBJECTIVES

To examine whether sexual and gender minority (SGM) emerging adults perceived their SGM status was linked to suicidal ideation, and to explore if their responses fell within tenets of the minority stress framework.

METHOD

Open text (survey) responses of Dutch and Flemish SGM emerging adults (n  =  187) were thematically analysed using the constant comparative comparison method for qualitative analysis.

RESULTS

We identified 8 themes in our qualitative analysis. Two themes fell within the scope of the minority stress framework that has received little attention: (1) concerns about relationships and family planning and (2) feeling different (internal stressor). Two additional themes emerged largely beyond the scope of existing minority stress framework studies on suicidality: (3) SGM-related questioning; (4) negativity in LGBT communities. Four established minority stress framework themes emerged: (5) gender identity stress; (6) victimization; (7) coming-out stress; (8) psychological difficulties linked to SGM status.

CONCLUSION

Suicide prevention needs to focus on supporting SGM emerging adults who worry about feeling "different", or who have concerns over their romantic and family life, on reducing gender minority stress, as well as on caring for those who are victimized due to their sexual or gender identity.

Sociodemographic characteristics of women who died by suicide in India from 2014 to 2020: findings from surveillance data

BACKGROUND

Women in India have twice the suicide death rate (SDR) compared with the global average for women. The aim of this study is to present a systematic understanding of sociodemographic risk factors, reasons for suicide deaths, and methods of suicide among women in India at the state level over time.

METHODS

Administrative data on suicide deaths among women by education level, marital status, and occupation, and reason for and method of suicide were extracted from the National Crimes Record Bureau reports for years 2014 to 2020. We extrapolated SDR at the population level for Indian women by education, marital status, and occupation to understand the sociodemography of these suicide deaths for India and its states. We reported the reasons for and methods of suicide deaths among Indian women at the state level over this period.

FINDINGS

SDR was higher among women with education of class 6 or more (10·2; 95% CI 10·1-10·4) than those with no education (3·8; 3·7-3·9) or education until class 5 (5·4; 5·2-5·5) in India in 2020, with similar patterns in most states. SDR declined between 2014 and 2020 for women with education until class 5. Women currently married accounted for 28 085 (63·1%) of 44 498 suicide deaths in India, 8336 (56·2%) of 14 840 in less developed states, and 19 661 (66·9%) of 29 407 in more developed states in 2020. For India, women currently married had a significantly higher SDR (8·1; 8·0-8·2) than those never married in 2014. However, women who never married had a significantly higher SDR (8·4; 8·2-8·5) in 2020 than those who were currently married. Many individual states in 2020 had similar SDR for women who never married and those who are currently married. Housewife as an occupation accounted for 50% or more of suicide deaths from 2014 to 2020 in India and its states. Family problems was the most common reason for suicide from 2014 to 2020, accounting for 16 140 (36·3%) of 44 498 suicide deaths in India, 5268 (35·5%) of 14 840 in less developed states, and 10 803 (36·7%) of 29 407 in more developed states in 2020. Hanging was the leading mean of suicide from 2014 to 2020. Insecticide or poison consumption was the second leading cause of suicide, accounting for 2228 (15·0%) of all 14 840 suicide deaths in less developed states and 5753 (19·6%) of 29 407 in more developed states, with a near 70·0% increase in the use of this method from 2014 to 2020.

INTERPRETATION

The higher SDR among women who have received an education, similar SDR between women currently married and never married, and variations in the reasons for and means of suicide at the state level highlight the need to incorporate sociological insights into how the external social environment can matter for women to better understand the complexity of suicide and determine how to effectively intervene.

FUNDING

Bill & Melinda Gates Foundation.

Detecting intimate partner violence circumstance for suicide: development and validation of a tool using natural language processing and supervised machine learning in the National Violent Death Reporting System

BACKGROUND

Intimate partner violence (IPV) victims and perpetrators often report suicidal ideation, yet there is no comprehensive national dataset that allows for an assessment of the connection between IPV and suicide. The National Violent Death Reporting System (NVDRS) captures IPV circumstances for homicide-suicides (<2% of suicides), but not single suicides (suicide unconnected to other violent deaths; >98% of suicides).

OBJECTIVE

To facilitate a more comprehensive understanding of the co-occurrence of IPV and suicide, we developed and validated a tool that detects mentions of IPV circumstances (yes/no) for single suicides in NVDRS death narratives.

METHODS

We used 10 000 hand-labelled single suicide cases from NVDRS (2010-2018) to train (n=8500) and validate (n=1500) a classification model using supervised machine learning. We used natural language processing to extract relevant information from the death narratives within a concept normalisation framework. We tested numerous models and present performance metrics for the best approach.

RESULTS

Our final model had robust sensitivity (0.70), specificity (0.98), precision (0.72) and kappa values (0.69). False positives mostly described other family violence. False negatives used vague and heterogeneous language to describe IPV, and often included abusive suicide threats.

IMPLICATIONS

It is possible to detect IPV circumstances among singles suicides in NVDRS, although vague language in death narratives limited our tool's sensitivity. More attention to the role of IPV in suicide is merited both during the initial death investigation processes and subsequent NVDRS reporting. This tool can support future research to inform targeted prevention.

Identification of Risk Factors for Suicide and Insights for Developing Suicide Prevention Technologies: A Systematic Review and Meta-Analysis

Suicide is a termite that engulfs close to seven hundred thousand people worldwide each year. Existing work on risk factors that predict suicide lacks statistical associations, does not consider most countries, and has a wide range of risk factor domains. The goal of this systematic review and meta-analysis is to enhance our current understanding of suicidality by identifying risk factors that are most strongly associated with suicide and their impact on developing technological interventions for suicide prevention. A search strategy was carried out on four databases: (1) PsycINFO, (2) IEEE Xplore, (3) the ACM Digital Library, and (4) PubMed, and twenty-five studies were included based on the inclusion criteria. Factors statistically associated with suicide are any diagnosed mental disorder, adverse life events, past suicide attempts, low education level, loneliness or high levels of isolation, bipolar disorder, depression, multiple chronic health conditions, family history of suicide, sexual trauma, and being female. Domain-wise, comorbid disorders, and behavior-related risk factors are most strongly associated with suicide. We present a new hierarchical model of risk factors for suicide that advances our understanding of suicide and its causes. Finally, we present open research directions and considerations for developing suicide prevention technologies.

Pilot test of intranasal oxytocin as an enhancer of brief couples therapy for posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) negatively impacts military veterans and their intimate partners. Cognitive-Behavioral Conjoint Therapy (CBCT) was developed to address both PTSD and relationship satisfaction among couples. Although efficacious in improving PTSD, the effects of CBCT and the 8-session brief CBCT (bCBCT) on relationship satisfaction among veteran patients with PTSD are modest. Pharmacological augmentation with the neuropeptide oxytocin is promising for enhancing bCBCT's potency due to its effects on mechanisms of trauma recovery (e.g., extinction learning) and relationship functioning (e.g., trust, communication). The goal of this pilot uncontrolled clinical trial was to examine the feasibility and preliminary efficacy of bCBCT augmented with intranasal oxytocin for improving PTSD and relationship satisfaction among 10 U.S. veterans with PTSD and their intimate partners. Veterans self-administered 40 international units of intranasal oxytocin 30 min before each bCBCT session delivered to the couple via telehealth. Both partners completed pre-assessment, weekly, post, and 3-month follow-up assessments of PTSD symptoms and relationship satisfaction. Couples also provided qualitative feedback related to feasibility and engagement. Nine dyads completed the treatment. There were no serious adverse events. Veterans and partners reported moderate to large effect size improvements in relationship satisfaction (Hedge's g = 0.55 and 1.01, respectively). Veterans reported large effect size reductions in PTSD severity (Hedge's g = 1.87). These results suggest that virtual oxytocin-assisted bCBCT is feasible, scalable, potentially efficacious, and should be tested with a placebo-controlled randomized controlled trial.

Love and Infidelity: Causes and Consequences

This is a narrative review addressing the topic of romantic infidelity, its causes and its consequences. Love is commonly a source of much pleasure and fulfillment. However, as this review points out, it can also cause stress, heartache and may even be traumatic in some circumstances. Infidelity, which is relatively common in Western culture, can damage a loving, romantic relationship to the point of its demise. However, by highlighting this phenomenon, its causes and its consequences, we hope to provide useful insight for both researchers and clinicians who may be assisting couples facing these issues. We begin by defining infidelity and illustrating the various ways in which one may become unfaithful to their partner. We explore the personal and relational factors that enhance an individual's tendency to betray their partner, the various reactions related to a discovered affair and the challenges related to the nosological categorization of infidelity-based trauma, and conclude by reviewing the effects of COVID-19 on unfaithful behavior, as well as clinical implications related to infidelity-based treatment. Ultimately, we hope to provide a road map, for academicians and clinicians alike, of what some couples may experience in their relationships and how can they be helped.

Suicidal intent disclosure among adult suicide decedents: Four age group comparisons

Research on who does/does not disclose suicidal intent (SI) and related factors has important implications for suicide risk management. In this paper based on the 2017-2019 National Violent Death Reporting System, we compared four age groups (18-24, 25-44, 45-64, and 65+ years) of suicide decedents with respect to associations between SI disclosure and (1) suicide contributing/precipitating factors, and (2) suicide means. The results shows that those age 18-44 were more likely to disclose SI than those age> =45, especially among those with relationship problems. Physical health problems and death/suicide of family/friend increased the likelihood of SI disclosure in the 65+ age group.

Three leading suicide methods in the United States, 2017-2019: Associations with decedents' demographic and clinical characteristics

Background and aims

The U.S. suicide data show that use of lethal methods, specifically firearms and hanging/suffocation, has been increasing among young and middle-aged adults of both sexes over the past decades. In this study, we examined demographic and clinical correlates of use of firearms, hanging/suffocation, and poisoning as suicide methods among suicide decedents age 18+.

Methods

Data came from the 2017-2019 National Violent Death Reporting System (NVDRS; N = 94,454, age ≥ 18 at the time of suicide; 74,042 men and 20,412 women). We fit generalized linear models (GLMs) for a Poisson distribution with a log link to examine (1) changes in four suicide methods (firearms, hanging/suffocation, poisoning, and other) during the study period, controlling for sex and age group; and (2) correlates of firearms, hanging/suffocation, and poisoning use.

Results

In all age groups, 55% of men and 30% of women used firearms; 28% of men and 29% of women hanging/suffocation; 9% of men and 32% of women poisoning, and 8% of men and 9% of women "other" methods. Men age < 45 had higher likelihood of firearm and/or hanging/suffocation use than those age 45-64. Women age<45 also had higher likelihood of hanging/suffocation than those age 45-64. Prior suicide attempt history was associated with higher likelihood of poisoning in both sexes and hanging/suffocation in men; mental disorders/SUD were associated with higher likelihood of hanging/suffocation and poisoning in both sexes; physical health problems were associated with higher likelihood poisoning in both sexes and firearm use in men; relationship problems were associated with higher likelihood of firearm use; legal problems and job/financial/housing problems were associated with higher likelihood of hanging/suffocation in both sexes; and more crises were associated with higher likelihood of firearm use in both sexes.

Implications

The findings call for the following suicide prevention strategies: (1) restricted access to firearms; (2) improved access to mental health/substance use treatment; (3) improved long-term and palliative care services for those (mostly older adults) with physical health problems; (4) financial/housing support policies to mitigate economic hardship; and (5) more research to identify effective strategies to curtail the increasing use of firearm and hanging/suffocation among young and middle-aged adults.

Multi-layer relationships between psychological symptoms and life adaptation among humidifier disinfectant survivors

In April 2011, the Korea Centers for Disease Control and Prevention (CDC) announced the results of an epidemiological investigation that an unknown cause of lung disease that occurred throughout Korea was caused by humidifier disinfectants. The unprecedented social catastrophe caused by humidifier disinfectants, a household chemical, has so far reported 1,784 deaths and 5,984 survivors in South Korea. This study was designed to investigate the multi-layer relationships between psychological symptoms and adaptive functioning in survivors of the Humidifier disinfectants in South Korea caused by chemical toxic substances. Specifically, this study aimed to explore how psychological symptoms affect actual interpersonal relationships and job adjustment with two variable sets, six internalizing and externalizing subscales, and three adaptation subscales. A total of 224 survivors recruited from a program to support humidifier disinfectant survivors by the government participated in this study. This research was approved by the Institutional Review Board of one of the Universities in South Korea. The age range of the participants was 18–73 years (M = 42.23, SD = 10.90), 37.1% (n = 83) were male, and 62.9% (n = 141) were female. The participants responded to the Adult Self-Report (ASR) of the Achenbach System of Empirically Based Assessment (ASEBA). A Canonical Correlation Analysis (CCA) generated three unique patterns in the relationships between psychological symptoms and adaptive functions. Humidifier disinfectant survivors in the first pattern were more vulnerable to psychological symptoms and showed maladaptive functioning in life. Survivors in the second pattern showed intrusive behaviors and appeared to be adaptive in relationships with friends. Finally, survivors in the third pattern showed aggressive behaviors and reported poor partner relationships while showing good relationships with friends. The practical implications of the interventions are also discussed.

Exposure to violence and the presence of suicidal and self-harm behaviour predominantly in Asian females: scoping review

Background

Exposure to violence is associated with psychological distress, mental disorders such as depression, and suicidal behaviour. Most of the studies are conducted in the West, with limited publications from Asia. Thus, we conducted a scoping review of studies investigating the association between experiences of violence and later suicidal ideation/attempts from Asia in the twenty-first century.

Results

Many studies focused on domestic violence toward women in the Southeast Asian region. Sociocultural factors such as family disputes, public shaming, dowry, lack of education opportunities, and marriage life perceptions mediated the association. Many women exposed to violence and attempted suicide suffered from mental disorders such as depression, anxiety, and post-traumatic stress. The small number of suitable studies and the possible effect of confounders on participants were limitations in the review. Future studies would have to focus on specific types of violence and ethnoreligious beliefs.

Conclusion

Women in Asia exposed to violence appear to have an increased risk of suicidal behaviour and mental disorders. The early screening of psychological distress with culturally validated tools is essential for preventing suicides in Asian victims of violence.

Intimate partner violence, suicidality, and self-harm: a probability sample survey of the general population in England

BACKGROUND

Intimate partner violence (IPV) is a recognised risk factor for psychiatric disorders. There is little current evidence on IPV and self-harm and suicidality, and we therefore aimed to investigate the associations between experience of lifetime and past-year IPV with suicidal thoughts, suicide attempt, and self-harm in the past year.

METHODS

We analysed the 2014 Adult Psychiatric Morbidity Survey, a cross-sectional survey of 7058 adults (aged ≥16 years) in England, which used a multistage random probability sampling design and involved face-to-face interviews. Participants were asked about experience of physical violence and sexual, economic, and emotional abuse from a current or former partner, and about suicidal thoughts, suicide attempts, and self-harm. Other adversities were recorded through an adapted version of the List of Threatening Experiences. Multivariable logistic regression models quantified associations between different indicators of lifetime and past-year IPV, with past-year non-suicidal self-harm, suicidal thoughts, and suicide attempts. All analyses were weighted.

FINDINGS

Using weighted percentages, we found that a fifth (21·4%) of 7058 adults reported lifetime experience of IPV, and that 27·2% of women and 15·3% of men had experienced IPV. Among women, 19·6% had ever experienced emotional IPV, 18·7% physical IPV, 8·5% economic IPV, and 3·7% sexual IPV, which was higher than in men (8·6%, 9·3%, 3·6%, and 0·3%, respectively). Findings for ethnicity were unclear. Lifetime prevalence of IPV was higher in those living in rented accommodation or deprived neighbourhoods. Among people who had attempted suicide in the past year, 49·7% had ever experienced IPV and 23·1% had experienced IPV in the past year (including 34·8% of women and 9·4% of men). After adjusting for demographics, socioeconomics, and lifetime experience of adversities, the odds ratio of a past-year suicide attempt were 2·82 (95% CI 1·54-5·17) times higher in those who have ever experienced IPV, compared with those who had not. Fully adjusted odds ratios for past-year self-harm (2·20, 95% CI 1·37-3·53) and suicidal thoughts (1·85, 1·39-2·46) were also raised in those who had ever experienced IPV.

INTERPRETATION

IPV is common in England, especially among women, and is strongly associated with self-harm and suicidality. People presenting to services in suicidal distress or after self-harm should be asked about IPV. Interventions designed to reduce the prevalence and duration of IPV might protect and improve the lives of people at risk of self-harm and suicide.

FUNDING

UK Prevention Research Partnership.

Intimate partner violence victimization and perpetration as precursors to suicide

It remains unclear how often and under what circumstances intimate partner violence (IPV) precedes suicide. Available research on IPV and suicide focuses largely on homicide-suicide, which is a rare event (<2% of suicides). We focus instead on single suicides (i.e., suicides unconnected to other violent deaths), which are the most common type of fatal violence in the US.

Unfortunately, information about IPV circumstances is often unavailable for suicides. To address this gap, we sought to identify the proportion of single suicides that were preceded by IPV in North Carolina (NC), to describe the prevalence of IPV victimization and perpetration as precursors to suicide, and to explore how IPV-related suicides differ from other suicides. We used data from the NC Violent Death Reporting System (2010–2017, n = 9682 single suicides) and hand-reviewed textual data for a subset of cases (n = 2440) to document IPV circumstances.

We had robust inter-rater reliability (Kappa: 0.73) and identified n = 439 IPV-related suicides. Most were males who had perpetrated nonfatal IPV (n = 319, 72.7%) prior to dying by suicide. Our findings suggest that IPV was a precursor for at least 4.5% of single suicides.

Next, we conducted logistic regression analyses by sex comparing IPV-related suicides to other suicides. For both men and women, IPV was more common when the person who died by suicide had recently disclosed suicidal intent, was younger, used a firearm, and was involved with the criminal legal system, even after controlling for covariates. We also found sex-specific correlates for IPV circumstances in suicide.

Combined with homicide-suicide data (reported elsewhere), IPV is likely associated with 6.1% or more of suicides overall. Results suggest clear missed opportunities to intervene for this unique subpopulation, such as suicide screening and referral in IPV settings (e.g., batterer intervention programs, Family Justice Centers) that is tailored by sex.

•

Intimate partner violence is a precipitating factor for 4.5% of single suicides.

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Most IPV-related single suicides were of men who perpetrated nonfatal IPV.

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Decedents in IPV-related suicides often used a firearm and disclosed intent.

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Integrated prevention strategies to target both IPV and suicide may be appropriate.

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When combined with homicide-suicide data, IPV influences 6.1% of suicides overall.

Romantic Relationships and Mental Health During the COVID-19 Pandemic in Austria: A Population-Based Cross-Sectional Survey

Background

Previous studies suggest that romantic relationships can be beneficial to mental health, but may also be a major stressor depending on specific relationship characteristics. Studies examining the role of romantic relationship in mental health are scarce. This study aimed to investigate differences in mental health with regards to relationship characteristics.

Methods

We assessed individuals’ mental health, i.e., suicidal ideation (via Beck Scale for Suicidal Ideation, BSS), depression (via Patient Health Questionnaire, PHQ-9), anxiety (Hospital Anxiety and Depression Scale, HADS), experience of psychological and physical violence, including changes in suicidal ideation and anxiety compared to before the pandemic, and relationship characteristics (i.e., relationship status, satisfaction, and commitment as well as family structure) with online questionnaires in a population-based cross-sectional study with 3,012 respondents in Austria during the COVID-19 pandemic.

Results

There were small to medium–sized group differences with regards to relationship status and satisfaction (η_p²: 0.011–0.056). Most mental health outcomes were less favorable in singles than in individuals in happy relationships, but scores for anxiety (p < 0.001), psychological (p < 0.001) and physical violence (p < 0.001), and the probability of experiencing an increase in anxiety compared to before the pandemic (p < 0.01) were lower in singles as compared to those with low relationship satisfaction. Furthermore, scores for suicidal ideation (p > 0.001) and psychological (p > 0.01) and physical violence (p > 0.01) were highest in individuals in relationships with low commitment and with a child living in the same household, but effect sizes were small (η_p²: 0.004–0.015).

Conclusion

During the COVID-19 pandemic, as compared to singles, mental health appeared worse in individuals with low relationship satisfaction and those in a relationship with low commitment and with a child in the household. Living in a happy relationship was associated with somewhat better mental health.

Burden, Belonging, and Homelessness: Disclosure and Social Network Differences among LGBTQ Youth Recruited from a Suicide Crisis Service Provider

Among LGBTQ youth, suicidality and homelessness occur at heightened rates. Using the Interpersonal Theory of Suicide (ITS), this study seeks to explore the associations of having a parent, family member, friend, or romantic partner in one's social network and not being "out" to specific network members (lack of disclosure) with ITS constructs (perceived burdensomeness and thwarted belonging), considering homelessness history. Data include 462 youth aged 12-24 who contacted an LGBTQ youth-focused suicide crisis provider from 2015 to 2017. Disclosure status and network composition differed by homelessness experience. Homeless youth were more likely to disclose to their parents and less likely to disclose to other family members. Youth who had not disclosed to their parents reported higher perceived burdensomeness and thwarted belonging whereas having more family members and peers in one's network was associated with lower scores on ITS constructs. Implications for prevention approaches with youth who may be at increased risk for suicide are discussed.

Effects of the COVID-19 pandemic on suicidal ideation in a representative Australian population sample-Longitudinal cohort study

OBJECTIVE

The direct and indirect mental health impacts of the COVID-19 pandemic are considerable. However, it is unclear how suicidal ideation was affected in communities during the acute lockdown phase of the pandemic, and over the longer-term. This study provides longitudinal data on the prevalence of, and risk factors for, suicidal ideation in the Australian national population, during the pandemic.

METHOD

The Australian National COVID-19 Mental Health and Risk Communication Survey assessed a nationally representative sample of Australian adults (N = 1296) fortnightly for 12 weeks from late-March to June 2020 (7 waves), and again in March 2021 (wave 8). Cox proportional hazards models examined demographic and pandemic-related risk factors for suicidal ideation over time.

RESULTS

Prevalence of suicidal ideation was high but steady at ∼18% across the acute lockdown phase of the pandemic, and 16.2% in March 2021. People who had direct experience with COVID-19 (tested, diagnosed, or contact with someone who was diagnosed) had increased risk for suicidal ideation. Higher pandemic-related work and social impairment, recent adversity, loneliness, and being younger were also associated with increased risk of suicidal ideation over time.

CONCLUSION

Both the direct and indirect impacts of COVID-19 were associated with increased risk for suicidal ideation over time, although prevalence did not vary over time. The high prevalence of suicidal ideation in our sample flags a critical need for accessible mental health support, and findings provide insights into the factors placing people at risk during the pandemic.

Language, culture, gender, and intersectionalities in suicide theory, research, and prevention: Challenges and changes

Over the decades suicidology has experienced many challenges and changes. Language, culture, gender, and intersectionalities of experience have been domains of challenge and change. In this article I document my contributions to suicidology's transformation in these domains. These contributions include challenging stigmatizing and biased suicide-language (e.g., expressions like "successful" and "failed" suicide); questioning gender myths of suicidal behaviors (e.g., the myth that women and men are opposites in terms of suicide motives); the gender-paradox-of-suicide idea; and suicide-scripts theory and research. I then describe the evolution of suicide-scripts theory. Suicide-scripts theory builds on evidence that in each culture there are unique situations when suicidal behavior is expected from specific people, using specific methods, and with specific social consequences. The theory posits that these scripts contribute to variations in suicidality across cultures, and within cultures, across sociodemographic groups, intersectionally. Studies using a diversity of methodologies and focusing on a diversity of sociodemographic groups and cultures point to the role of suicide scripts in suicidality. The article concludes with a discussion of the implications, for suicide prevention, of suicide-scripts theory and evidence.

Utilizing the couple relationship to prevent suicide: A preliminary examination of Treatment for Relationships and Safety Together

OBJECTIVE

To evaluate the feasibility, preliminary effects, and acceptability of the first comprehensive couple-based treatment for suicide, called Treatment for Relationships and Safety Together (TR&ST).

METHOD

In a preliminary examination, five couples (N = 10) participated in 10 weekly sessions of TR&ST. All couples included a veteran who reported active suicidal ideation at baseline and their partner. Couples completed measures of relationship functioning, perceived burdensomeness, thwarted belonging, and suicidal ideation at baseline, mid-treatment, and posttreatment.

RESULTS

TR&ST was feasible to deliver. Veteran and partner relationship functioning improved and veteran perceived burdensomeness, thwarted belonging, and suicidal ideation decreased. There were no suicide related behaviors, hospitalizations, or crisis line calls during the study. TR&ST seemed acceptable to couples (100% retention and high satisfaction ratings).

CONCLUSION

Couple-based suicide prevention may provide an additional avenue for suicide prevention in veterans.

Suicide in rural Australia: A retrospective study of mental health problems, health-seeking and service utilisation

BACKGROUND

Suicide rates are higher in rural Australia than in major cities, although the factors contributing to this are not well understood. This study highlights trends in suicide and examines the prevalence of mental health problems and service utilisation of non-Indigenous Australians by geographic remoteness in rural Australia.

METHODS

A retrospective study of National Coronial Information System data of intentional self-harm deaths in rural New South Wales, Queensland, South Australia and Tasmania for 2010-2015 from the National Coronial Information System.

RESULTS

There were 3163 closed cases of intentional self-harm deaths by non-Indigenous Australians for the period 2010-2015. The suicide rate of 12.7 deaths per 100,000 persons was 11% higher than the national Australian rate and increased with remoteness. Among people who died by suicide, up to 56% had a diagnosed mental illness, and a further 24% had undiagnosed symptoms. Reported diagnoses of mental illness decreased with remoteness, as did treatment for mental illness, particularly in men. The most reported diagnoses were mood disorders (70%), psychotic disorders (9%) and anxiety disorders (8%). In the six weeks before suicide, 22% of cases had visited any type of health service at least once, and 6% had visited two or more services. Medication alone accounted for 76% of all cases treated.

CONCLUSIONS

Higher suicide rates in rural areas, which increase with remoteness, may be attributable to decreasing diagnosis and treatment of mental disorders, particularly in men. Less availability of mental health specialists coupled with socio-demographic factors within more remote areas may contribute to lower mental health diagnoses and treatment. Despite an emphasis on improving health-seeking and service accessibility in rural Australia, research is needed to determine factors related to the under-utilisation of services and treatment by specific groups vulnerable to death by suicide.

Mental health symptoms and suicidality in Iranian gay men

BACKGROUND

No published data is currently available on mental health symptoms and suicidality in Iranian gay men - a population facing serious legal threats including capital punishment.

METHODS

The present study provides initial data on this topic by assessing mental health symptoms (SCL-90) and suicidality (BSSI) in N = 213 gay men in Tehran, Iran.

RESULTS

Last-week mental health symptoms were severe in 4.2% of gay men, moderate in 7.5%, minor in 27.7%, and absent in 61.6% of Iranian gay men. Regarding last-week suicidality: 1.9% were highly likely to attempt suicide, 7.5% reported having threatened to commit suicide, 19.7% reported suicidal ideation, and 80.28% revealed no suicidality. Last-week mental health symptoms and last-week suicidality were correlated in gay men to a high degree.

CONCLUSIONS

When descriptively comparing the SCL-90 and BSSI scores with those in the general Iranian population reported in previous studies, gay men reported more serious mental health symptoms, and more suicidal ideation, threats, and attempts. The decriminalization of same-sex sexual encounters and accepting social attitudes towards gay men are needed in Iran to help improve this population's mental health and reduce their suicidality.

Men building better relationships: A scoping review

ISSUE ADDRESSED

Health outcomes linked to men's relationships have the potential to both promote and risk the well-being of males and their families. The current scoping review provides a synthesis of men's relationship programs (excluding criminal court mandated services) in Australia, Canada and the United Kingdom to distil predominant program designs, access points, delivery modes and evaluative strategies.

METHODS

Databases CINAHL, Medline, PsycInfo and Web of Science were searched for eligible articles published January 2010 and June 2020. The inclusion criteria consisted of empirical studies focussed on relationship programs for men.

RESULTS

The review identified 21 articles comprising eight focussed on Fathering Identities as the Catalyst for Relationship Building and 13 targeting Men's Behaviour Change in Partner Relationships. Findings highlight the prevalence of group-based, in-person programs which men accessed via third party or self-referrals. Fathering programs highlighted the impact of men's violence on their children in appealing to attendees to strategise behavioural adjustments. Men's partner relationship programs emphasised self-control amid building strategies for proactively dealing with distress and conflict. Program evaluations consistently reported attendee feedback to gauge the acceptability and usefulness of services.

CONCLUSIONS

That most men attending fathering and partner relationship programs were referred as a result of domestic violence and/or intimate partner violence underscores men's reticence for proactively seeking help as well as the absence of upstream relationship programs. There are likely enormous gains to be made by norming boys and men's relationship programs to prevent rather than correct violent and/or abusive behaviours.

Psychosocial impact of the COVID-19 pandemic: a cross-sectional study of online help-seeking Canadian men

Purpose: The COVID-19 pandemic has had a profound impact on the lives of men. The present study investigated psychosocial impacts of the COVID-19 pandemic on a help-seeking sample of Canadian men, focusing on diverse aspects of their psychosocial well-being.Methods: A cross-sectional, open survey study design was used. Canadian adult men who were visiting an eHealth depression resource (HeadsUpGuys.org) were recruited to complete an online survey. Descriptive statistics, including means and standard deviations for continuous variables and frequency and percentages for categorical variables, were used to summarize survey responses. Regression analysis was utilized to identify factors associated with various mental health indicators (anxiety, depression, fear of COVID-19, suicidality). The Patient Health Questionnaire-4, Fear of COVID-19 Scale, and item 9 (suicidality item) from the Patient Health Questionnaire-9 were used to assess the mental health indicators.Results: A total of 434 men completed the study. Most respondents (79.3%; N = 344) indicated that their mental health was negatively affected by COVID-19, and two-thirds (65.5%; N = 284) conveyed that government-imposed physical distancing measures had negatively affected their mental health. Half the sample (51.2%; N = 222) reported at least moderate financial stress due to COVID-19. Nearly a third of respondents (31.1%; N = 135) reported that their current living situation has had a considerable or severe negative impact on their mental health since COVID-19. About two-fifths (37.7%; N = 94) of men felt that COVID-19 has had a negative impact on their relationship with their intimate partner. Nearly a third of respondents who were in a relationship (30.9%; N = 77) reported that they engaged in some type of abuse (primarily verbal abuse, 22.9%; N = 57) toward their intimate partner during COVID-19, and more than a quarter (27.3%; N = 68) reported being abused by their intimate partner (also primarily verbal abuse, 22.5%; N = 56). Just under half (42.2%; N = 183) of the respondents indicated experiencing suicidal ideation.Conclusion: These findings can help inform providers of health services to Canadian men, as well as policies that will be implemented during subsequent waves of COVID-19 or during future infectious outbreaks.

Racial/Ethnic Differences in Preceding Circumstances of Suicide and Potential Suicide Misclassification Among US Adolescents

PURPOSE

There is a paucity of research on racial/ethnic differences in preceding circumstances of suicide among adolescents aged 10-19 years and consequential potential misclassification of suicide deaths (i.e., manner of death classified as injury of undetermined intent). This study (1) examined preceding circumstances of suicide among non-Hispanic White, non-Hispanic Black, non-Hispanic Asian/Pacific Islander (A/PI), non-Hispanic American Indian/Alaskan Native (AI/AN), and Hispanic adolescent decedents; and (2) investigated potential suicide misclassification of racial/ethnic minority decedents.

METHODS

We used data from the 2006-2015 National Violent Death Reporting System Restricted Access Database. Multivariable logistic regression analyses examined differences in depressed mood, mental health problem and treatment, crisis in the past 2 weeks, problems with school, intimate partner, family relationship, and other relationships (e.g., friend) among racial/ethnic minority decedents compared to White decedents. A separate logistic regression analysis assessed potential suicide misclassification of racial/ethnic minority decedents relative to White counterparts.

RESULTS

Adjusting for sex and suicide history and circumstances, all racial/ethnic minority decedents had significantly lower odds of documented mental health problem and treatment compared to White decedents. Racial/ethnic differences in relationship problems were also identified. Black decedents had significantly higher odds of manner-of-death classification as undetermined intent than did White decedents, suggesting greater likelihood of suicide misclassification.

CONCLUSIONS

Circumstances contributing to suicide among adolescents differ by race/ethnicity, indicating the need for culturally tailored suicide prevention efforts.

Sociodemographic and Clinical Characteristics Associated with Suicidal Behaviour and Relationship with a Nurse-Led Suicide Prevention Programme

Suicidal behaviour is a major public health problem that needs to be tackled by all health agents including mental health nurses. Aims: The purpose of this study was to analyse the relationship between demographic and clinical characteristics and different kinds of suicidal behaviour with a nurse-led suicide prevention programme. Methods: The design was a cross-sectional study, performed in the region of Osona (Catalonia) in the five-year period 2013–2017. Suicidal behaviour was classified as suicidal ideation, interrupted self-directed violence, suicide attempt or completed suicide. Results: The sample included 753 patients (of whom 53 completed suicide) who experienced 931 suicidal behaviour episodes. Men represented only 38.4% of the sample but 81.1% of completed suicides. Mental disorders were associated with suicidal behaviour in 75.4% of the sample. Two thirds (66.4%) of the individuals (0.8% (n = 4) of whom completed suicide) were participants in a nurse-led suicidal behaviour case management programme. Conclusion: The main risk factors were being a woman for suicidal behaviour and being a man and being older for completed suicide. Mental disorders, widowhood and retirement were also associated with completed suicide. The completed suicide rate was lower among participants in the nurse-led programme.

The Case for Studying Implicit Social Cognition in Close Relationships

This review offers close relationships as a fruitful avenue to address long-lasting questions and current controversies in implicit social cognition research. Close relationships provide a unique opportunity to study strong attitudes that are formed and updated through ongoing contact with significant others and appear to have important downstream consequences. Therefore, close relationship contexts enable researchers to apply fine-grained, dyadic, longitudinal methodologies to provide unique insights regarding whether and how automatic attitudes relate to personal experience, change meaningfully and reliably over time, and predict consequential judgments and behaviors. Further, given that close relationships are critical to people's well-being and health, applying implicit social cognition theories to close relationships may also offer practical benefits regarding real-world issues related to relationship decay. In this regard, we provide guidance for future research by highlighting how continuing to refine our understanding of implicit social cognition in close relationships can inform interventions and reliably benefit society

Intimate Partnerships, Suicidal Ideation and Suicide-Related Hospitalization Among Young Kenyan Men

The first study focused on a three-month chart review containing information on suicide attempts (n = 34) admitted to a local mission hospital in Meru County, Kenya. The second study utilized a cross-sectional survey administered to men 18-34 years old (n = 532) residing in rural Kenya. Data posit intimate partnership discord as salient to suicide ideation and behavior. Men who reported their partner status was "divorced" had four-times the odds of reporting suicide ideation than other partnership states, an association significantly mediated by loneliness. Violent conflict tactics predicted suicidal ideation, mediated by loneliness and decreased marital satisfaction.

Effects of emotion regulation and perpetrator-victim roles in intimate partner violence on mental health problems among men who have sex with men in China

AIMS

This study assessed the relationships between different perpetrator-victim roles in intimate partner violence (IPV), emotion regulation (ER) and mental health problems among men who have sex with men (MSM) in China.

METHODS

From April to June 2019, 1233 participants were approached via gay-friendly non-governmental organisations in 15 cities across mainland China.

RESULTS

Of the total, 578 eligible participants completed an anonymous online survey. All participants provided informed consent and information about their violent perpetrator-victim role and mental health status. The results revealed a high prevalence of IPV in this study sample, with 32.7% of participants reporting IPV victimisation and 32.5% of participants reporting IPV perpetration during their lifetime. A total of 81 (14.0%) participants were suicidal, 309 (53.5%) participants reported poor general mental health and 208 (36.0%) had significant depressive symptoms. Adjusted logistic regression models revealed that both physical victimisation (adjusted odds ratio [ORa] = 3.22, 95% confidence interval [CI] = 1.11-9.32) and sexual victimisation (ORa = 2.90, 95% CI = 1.39-6.05) had positive associations with suicidality, and unidirectional and bidirectional psychological perpetration were associated with poor general mental health and significant depressive symptoms. Although high cognitive reappraisal showed a negative association with poor general mental health (ORa = 0.89，95% CI = 0.86-0.92), the correlation with victims of IPV was weaker than it was with non-victims.

CONCLUSIONS

This study revealed that different perpetrator-victim roles in different IPV situations should be considered comprehensively in research, prevention and intervention. ER is not enough to buffer the effects of IPV on the mental health of MSM victims.

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.

Factors associated with engagement in online self-help programs among people with suicidal thoughts

BACKGROUND

The effectiveness of internet-based self-help programs for mental health may be limited by low engagement. Identifying factors associated with engagement in online interventions assists in developing strategies to improve efficacy through greater engagement. The aim of the current study was to identify factors associated with engagement among people with suicidal thoughts who completed an online program.

METHOD

418 adults with suicidal ideation were recruited online into a randomized controlled trial of a 6-week internet-based self-help program. Program usage for the intervention and active control conditions was measured as the number of logins and modules accessed. Predictors of program usage and between-group differences were examined, including sociodemographic variables, user preferences and mental health status.

RESULTS

Both the control group and the intervention group accessed approximately three modules (M = 3.1, SD = 2.0 v. M = 2.8, SD = 2.1, respectively), although participants in the intervention group had a significantly higher number of logins (17.3 vs 9.7, p < 0.001). Across both conditions, individuals with more severe suicidal thoughts had better engagement with their respective program. More logins for both programs were also associated with being female, married or in a de-facto relationship, not employed, less severe depression and less willingness to seek help from informal sources.

LIMITATIONS

Metrics of adherence may not directly reflect engagement with the program. There may be additional unmeasured factors associated with engagement.

CONCLUSIONS

The findings suggest that different engagement strategies may be required depending on sociodemographic and clinical characteristics. Tailoring interventions to at-risk subgroups may optimise health and functional outcomes.

Discrete Survival Time Constructions for Studying Marital Formation and Dissolution in Rural South Africa

Introduction: Marriage formation and dissolution are important life-course events which impact psychological well-being and health of adults and children experiencing the events. Family studies have usually concentrated on analyzing single transitions including Never Married to Married and Married to Divorced. This does not allow understanding and interrogation of dynamics of these life changing events and their effects on individuals and their families. The objective of this study was to assess determinants associated with transitions between and within marital states in South Africa.

Methods: The population-based data available for this study consists of over 55, 000 subjects representing over 340, 000 person-years exposure from the Africa Health Research Institute (AHRI) in rural KwaZulu-Natal, South Africa. It was collected from 1 January 2004 to 31 December 2016. Multilevel multinomial, binary and competing risks regression models were used to model marital state occupation, transitions between marital states as well as investigate determinants of marital dissolution, respectively.

Results: Between the years 2006 and 2007, a subject was more likely to be married than never married when compared to years 2004 − 2005. After 2007, subjects were less likely to be married than never married and the trend reduced over the years up to 2016 [with OR=0.86, CI=(0.78; 0.94), OR=0.71, CI=(0.64; 0.78), OR=0.60, CI=(0.54; 0.67), OR=0.50, CI=(0.44; 0.56), and OR = 0.43, CI = (0.38; 0.48)] for periods 2008 − 2009, 2010 − 2011, 2012 − 2013, 2014 − 2015, and 2016, respectively. In 2008 − 2009, subjects were more likely to experience a marital dissolution than in the period 2004 − 2005 and the trend slightly reduces from 2010 until 2013 [OR=24.49, CI=(5.53; 108.37)]. Raising age at first sexual debut was found to be inversely associated with a marital dissolution [OR = 0.97;CI = (0.95; 0.99)]. Highly educated subjects were more likely to stay in one marital state than those who never went to school [OR=6.43, CI=(4.89; 8.47), OR=18.86, CI=(1.14; 53.31), and OR=2.96, CI=(1.96; 4.46) for being married, separated and widowed, respectively, among subjects with tertiary education]. As the age at first marriage increased, subjects became less likely to experience a marital separation [OR = 0.06, CI = (0.00; 1.11), OR = 0.05, CI = (0.00; 0.91), and OR = 0.04, CI = (0.00; 0.76) for subjects who entered a first marriage at ages 18 − 22, 23 − 29, and 30 − 40, respectively].

Conclusion: The study found that marrying at later ages is associated with a lower rate of marital dissolution while more educated subjects tend to stay longer in one marital state. Sexual debut at later ages was associated with a lower likelihood of experiencing a marital dissolution. There could, however, be some factors that are not accounted for in the model that may lead to heterogeneity in these dynamics in our model specification which are captured by the random effects in the model. Nonetheless, we may postulate that existing programs that encourage delay in onset of sexual activity for HIV risk reduction for example, may also have a positive impact on lowering rates of marital dissolution, thus ultimately improving psychological and physical health.