Perspectives on Self-Harm and Suicidal Ideation in Nigeria: A Mixed-Methods Study of Patients, Family Caregivers, Clinicians, and the Public

BACKGROUND

Suicide and self-harm are global disease burden that contributes significantly to years of lost life and mortality. Despite the increasing rates of suicide and self-harm in Nigeria, this topic is understudied.

METHODS

A mixed-methods design was adopted. Study 1 interviewed n = 18 participants (n = 11 clinicians; n = 5 patients with a history of self-harm and suicide ideation; and n = 2 caregivers). All interviews were audio-recorded, transcribed verbatim, and analyzed using IPA. Study 2 surveyed n = 562 non-clinical sample about their tolerance toward self-harm and the data was analyzed using One-way ANOVA in SPSS.

RESULTS

Study 1 qualitative findings showed substance use, perceived rejection and social isolation were considered predisposing factors for suicide and self-harm. Cultural and religious beliefs shaped help-seeking behaviours. Although Study 2 found no significant differences in demographic characteristics concerning public tolerance toward persons with a history of self-harm, 64% believed that individuals who died by suicide would face punishment after death; 51% believed that victims of attempted suicide are a source of shame to their families; and 33.8% agreed that dying by suicide is the correct behaviour.

CONCLUSIONS

Patients with a history of self-harm and suicidal ideation consider family members and close friends as valuable sources of support. Due to the potential clinical implication of cultural and religious beliefs, as shown in the present study's findings, the authors recommend a co-development of culturally appropriate psychological intervention for persons with a history of self-harm and suicidal ideation to be tested in randomized control trials.

Deep learning for identifying personal and family history of suicidal thoughts and behaviors from EHRs

Personal and family history of suicidal thoughts and behaviors (PSH and FSH, respectively) are significant risk factors associated with suicides. Research is limited in automatic identification of such data from clinical notes in Electronic Health Records. This study developed deep learning (DL) tools utilizing transformer models (Bio_ClinicalBERT and GatorTron) to detect PSH and FSH in clinical notes derived from three academic medical centers, and compared their performance with a rule-based natural language processing tool. For detecting PSH, the rule-based approach obtained an F1-score of 0.75 ± 0.07, while the Bio_ClinicalBERT and GatorTron DL tools scored 0.83 ± 0.09 and 0.84 ± 0.07, respectively. For detecting FSH, the rule-based approach achieved an F1-score of 0.69 ± 0.11, compared to 0.89 ± 0.10 for Bio_ClinicalBERT and 0.92 ± 0.07 for GatorTron. Across sites, the DL tools identified more than 80% of patients at elevated risk for suicide who remain undiagnosed and untreated.

A Narrative Review of Compassion Focused Therapy on Positive Mental Health Outcomes

BACKGROUND

Compassion-focused therapy (CFT) has been attracting attention in mental health practice and research. CFT is effective in reducing a variety of negative mental health symptoms. Positive mental health (PMH) focuses on an individual's functioning, quality of life, and well-being, aiming to achieve fulfilment. A need for PMH has been increasingly recognised such as national policies incorporating recovery-oriented approaches. However, how effective CFT is for PMH outcomes remains to be investigated. This narrative review aimed to identify the literature that reports evidence on CFT used against PMH outcomes.

METHODS

Our research questions (RQs) were as follows: RQ1. What PMH outcomes are targeted in CFT intervention research? RQ2. Is CFT effective for PMH?" Medline, Embase, and PsycINFO were searched on the Ovid platform. All studies that mentioned "compassion focused therapy" and "compassion-focused therapy" were searched.

RESULTS

Sixteen RCTs were included published since 2012. Nine studies were from Europe, four from Asia, two from Northern America, and one from Australia and New Zealand. CFT was used for diverse PMH outcomes, and the effects were overall positive. Self-compassion and compassion were the most frequently evaluated outcomes.

CONCLUSIONS

The mechanism of action for CFT on PMH needs to be evaluated. CFT can be used as part of personal recovery in mental health. More evidence from non-WEIRD countries including LMICs is needed.

Technology-based suicide prevention: An umbrella review

Background

The objective is to summarize evidence from systematic reviews, scoping reviews, and meta-analyses evaluating the effects of any format of Internet-based, mobile-, or telephone-based intervention as a technology-based intervention in suicide prevention.

Materials and Methods

This is an umbrella review, that followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement guidelines. An electronic search was done on September 29, 2022. Data were extracted by reviewers and then methodological quality and risk of bias were assessed by A Measurement Tool to Assess Systematic Reviews-2. Statistical analysis was done by STATA version 17. Standard mean difference was extracted from these studies and by random effect model, the overall pooled effect size (ES) was calculated. I2 statistic was used to assess the heterogeneity between studies. For publication bias, the Egger test was used.

Results

Six reviews were included in our study, all with moderate quality. The overall sample size was 24631. The ES for standard mean differences of the studies is calculated as - 0.20 with a confidence interval of (-0.26, -0.14). The heterogeneity is found as 58.14%, indicating a moderate-to-substantial one. The Egger test shows publication bias.

Conclusion

Our results show that technology-based interventions are effective. We propose more rigorous randomized controlled trials with different control groups to assess the effectiveness of these interventions.

Understanding suicidal ideation disparity between sexual minority and heterosexual Chinese young men: a multiple mediation model of social support sources, self-esteem, and depressive symptoms

Objectives

Although sexual minorities have reported higher levels of suicidal ideation than heterosexuals across cultures, the role of various psychosocial factors underlying this disparity among young men has been understudied, particularly in China. This study examined the multiple mediating effects of psychosocial factors between sexual orientation and suicidal ideation in Chinese sexual minority and heterosexual young men.

Methods

302 Chinese cisgender men who identified as gay or bisexual, and 250 cisgender heterosexual men (n=552, aged 18-39 years) completed an online questionnaire measuring perceived social support, self-esteem, depressive symptoms, and suicidal ideation.

Results

Young sexual minority men reported significantly higher suicidal ideation and lower social support than their heterosexual peers. Structural equation modelling revealed two multiple indirect pathways. One pathway indicated that sexual orientation was indirectly related to suicidal ideation via family support and depressive symptoms. Another pathway indicated that sexual orientation was indirectly related to suicidal ideation via support from friends, self-esteem, and depressive symptoms.

Conclusions

This study is among the first to examine the potentially cascading relationships between sexual orientation and psychosocial factors with suicidal ideation in a Chinese sample of young men. The findings highlight several promising psychosocial targets (i.e., improving family/friend support and increasing self-esteem) for suicide interventions among sexual minority males in China.

Early Risk Factors for Self-Injurious Thoughts and Behaviours: A UK Population-Based Study of 219,581 People

Mental disorders are a major problem among young people. To identify early risk factors of self-injurious thoughts and behaviours (SITB) among young adults with mental health problems, this case-control study drew data from the Clinical Practice Research Datalink (CPRD), a primary care database covering 8% of the UK population. We explored the role of early factors (presenting at 8-14 years old) for suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI) in young adulthood (age 18-25 years) by performing logistic regressions. Our sample consisted of 219,581 participants, of which 6.51% had at least one SITB in young adulthood. Early risk factors for SITB included early NSSI, suicidal ideation, sexual abuse, behavioural problems, and mood and psychotic symptoms. Frequency of GP visits had a protective effect. Lack of access to mortality data, ethnicity, and socioeconomic status was a limitation of the current study. In conclusion, early symptoms in late childhood/early adolescence can be the start of long-standing problems going into adult life. The training of primary care providers in suicide risk assessment and proper co-ordination with child and adolescent mental health services are crucial for suicide prevention.

An exploratory qualitative study of the psychological effects of HIV diagnosis; the need for early involvement of mental health professionals to improve linkage to care

BACKGROUND

Diagnosing a life-threatening disease like the human immunodeficiency virus (HIV) can be unbearable to the individual, which has implications for their subsequent care-seeking decision-making. However, an essential element of HIV testing is identifying infected individuals and linking them with adequate care services, thus contributing to the UNAIDS 95-95-95 targets. The attainment of these targets has been particularly challenging for lower and middle-income countries (LMIC). This study explored the psychological reactions to a positive HIV status in a hospital treatment centre to provide insight into mental health interventions' role in improving HIV screening and early antiretroviral therapy (ART) initiation to enhance the quality of life.

METHODS

An exploratory qualitative study was investigated among adults who were diagnosed as HIV positive. Participants were purposively recruited from an HIV Treatment Centre. Data were collected with semi-structured interviews that explored the interpretations and psychological reactions to their positive HIV status. Overall, 18 participants were interviewed to reach saturation. Data were transcribed verbatim and analysed thematically to produce findings that address the study's objective.

RESULTS

Following analysis of participants' interpretations, understanding and implications of their HIV-positive diagnosis, two major themes emerged: (1) anxiety regarding the impact of the disease on self, family and society was overwhelming. Participants were anxious because of the stigma, fear, worry, shock, and shame they faced. (2) Participants expressed hopelessness and could not see meaning or purpose in life. Suicidal ideation, suicide plans and self-harm characterised hopelessness.

CONCLUSIONS

The initial reaction to the diagnosis of HIV in this LMIC context has the potential to impact linkage to care negatively and, thus, the attainment of the global 95-95-95 targets. It is, therefore, essential that mental health and psychological support services are integrated with testing services to manage the initial reactions and support individuals to improve early linkage to care and thus improve overall outcomes for the infected individual and society.

Validation and application of the Chinese version of the Columbia-Suicide Severity Rating Scale: Suicidality and cognitive deficits in patients with major depressive disorder

BACKGROUND

Depression is a significant risk factor for death by suicide. Additionally, patients with depression who have neurocognitive dysfunction are at a higher risk of exhibiting suicidal behaviors. We aimed to validate the Chinese version of the Columbia Suicide Severity Rating Scale (C-SSRS) and then employ it to examine the association between suicidality and cognitive deficits in patients with Major Depressive Disorder (MDD).

METHODS

Data from 456 patients with MDD who underwent baseline assessment and 3-month follow-up were used for psychometric validation of the C-SSRS. 430 patients were divided into a mild cognitive impairment group (N = 390) and a severe cognitive impairment group (N = 40) using cluster analysis and compared with healthy controls. The relationship between C-SSRS scores and the degree of cognitive impairment was analyzed.

RESULTS

1) The Chinese version of C-SSRS demonstrated good internal consistency (Cronbach's alpha = 0.884/0.842), convergent and divergent validity. 2) The severity of suicidal ideation (SI), the intensity of SI, and the lifetime history of suicide attempts were significant independent predictors of short-term suicide attempts. 3) Higher worst-point lifetime SI severity and intensity scores in patients with MDD were significantly associated with severe cognitive impairment.

LIMITATIONS

The analysis of cognition and suicide was based on cross-sectional studies. Hence, changes in SI and cognitive function over time could not be analyzed.

CONCLUSIONS

The Chinese C-SSRS is a reliable and valid assessment tool for suicidal ideation and behavior in patients with depression. Suicidal ideation in patients with MDD is associated with cognitive dysfunction. These findings provide a reference for suicide prevention in patients with depression.

A Proposed Pastoral Response to the Increase in the Number of Suicide Cases in the Philippines During the COVID-19 Pandemic

This paper aims to provide a pastoral response to the increase in the number of suicides in the Philippines during the COVID-19 pandemic. This paper will look into the reasons and statistics related to suicide since there was a sudden spike in number during the pandemic. The See-Discern-Act method is used in this study so that the current social issue will be viewed from the teachings of the Church. First, we will discuss the reports on the cases of mental health issues. This issue has alarmed several professionals that focus on protecting one's mental health. Second, we will discuss key concepts from the Catechism of the Catholic Church to present the view on suicide. Also, John Paul II's Evangelium Vitae will be cited to provide a perspective on the value of human life. The Compendium of the Social Doctrine of the Church will also be tackled to explain the Church's view on mental health and well-being. Third, we will attempt to unearth the mental well-being of some Filipinos concerning suicide cases in the Philippines in light of the Church's teachings. Hence, our goal is to provide a perspective on this problem using the teachings of the Church on human life so that we may draw a proposed pastoral theological response. Hence, we propose that the Church must provide plans for prevention, intervention, and postvention when it comes to people involved in any suicide case as these actions are aligned with the goal of the Church to take care of those who suffer from mental illness and emphasize the value of human life.

Changing trends in the global burden of mental disorders from 1990 to 2019 and predicted levels in 25 years

AIMS

The burden of mental disorders is increasing worldwide, thus, affecting society and healthcare systems. This study investigated the independent influences of age, period and cohort on the global prevalence of mental disorders from 1990 to 2019; compared them by sex; and predicted the future burden of mental disorders in the next 25 years.

METHODS

The age-specific and sex-specific incidence of mental disorders worldwide was analysed according to the general analysis strategy used in the Global Burden of Disease Study in 2019. The incidence and mortality trends of mental disorders from 1990 to 2019 were evaluated through joinpoint regression analysis. The influences of age, period and cohort on the incidence of mental disorders were evaluated with an age-period-cohort model.

RESULTS

From 1990 to 2019, the sex-specific age-standardized incidence and disability-adjusted life years (DALY) rate decreased slightly. Joinpoint regression analysis from 1990 to 2019 indicated four turning points in the male DALY rate and five turning points in the female DALY rate. In analysis of age effects, the relative risk (RR) of incidence and the DALY rate in mental disorders in men and women generally showed an inverted U-shaped pattern with increasing age. In analysis of period effects, the incidence of mental disorders increased gradually over time, and showed a sub-peak in 2004 (RR, 1.006 for males; 95% CI, 1.000-1.012; 1.002 for women, 0.997-1.008). Analysis of cohort effects showed that the incidence and DALY rate decreased in successive birth cohorts. The incidence of mental disorders is expected to decline slightly over the next 25 years, but the number of cases is expected to increase.

CONCLUSIONS

Although the age-standardized burden of mental disorders has declined in the past 30 years, the number of new cases and deaths of mental disorders worldwide has increased, and will continue to increase in the near future. Therefore, relevant policies should be used to promote the prevention and management of known risk factors and strengthen the understanding of risk profiles and incidence modes of mental disorders, to help guide future research on control and prevention strategies.

Mental health of South Korean adolescents in the COVID-19 Era: Web-based survey focused on suicide-related factors

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has negatively impacted many aspects of life. Measures for preventing the spread of COVID-19 (e.g., school lockdowns, remote and hybrid classes, group and outdoor activity restrictions, and social distancing in the classroom and meal time) could have led to adolescents to experience anxiety and depressive symptoms. Such mental health impacts could increase the risk of suicidal ideation in this population. Moreover, according to a report by the Organization for Economic Co-operation and Development, although the total number of suicide deaths in South Korea decreased in 2021, the suicide rate of those aged 10-29 years increased. One factor affecting the result is adolescent mental health by COVID-19. This study examines the mental health status of South Korean adolescents amid the prolonged COVID-19 pandemic, and identifies and analyzes predictors of suicidal ideation, suicide planning, and suicide attempts.

METHODS

The study used data from 54,948 adolescents who participated in the 2020 Korea Youth Risk Behavior Web-based Survey. Based on their responses to suicide-related questions, the sample was divided into a healthy group, suicide-ideation group, suicide-planning group, and suicide-attempt group. The descriptive statistics of these groups were then analyzed. An analysis of covariance, post-hoc tests, and multiple logistic regression analysis were performed on the four groups.

RESULTS

Overall, 6.9% of the participants reported suicidal ideation, 2.2% reported planning suicide, and 1.9% reported attempting suicide in the previous 12 months.

CONCLUSIONS

During the prolonged COVID-19 pandemic, there is a strong need for various individualized programs that identify and intervene to support adolescents at risk of suicide by accurately assessing their mental health risk factors, such as stress, sadness and despair, loneliness, and generalized anxiety disorder. Accordingly, it is necessary to develop and distribute a mental health and well-being curriculum, strengthen suicide prevention programs and support services, expand mental health diagnostic tests, and school-based mental health programs.

Factors Associated With Suicide in Four West African Countries Among Adolescent Students: An Analysis Using the Global School-Based Student Health Survey

PURPOSE

Globally, suicide is a leading cause of death among adolescents, with the highest burden of suicide occurring in Africa. Despite this, little is known about the epidemiology of suicide among adolescents in West Africa. In this study, we explore suicidality among West African adolescents.

METHODS

Using pooled data from the Global School-Based Student Health Survey in four West African countries (Ghana, Benin, Liberia, and Sierra Leone), we investigated the prevalence of suicidal ideation and suicide attempt and examined associations with 15 covariates using univariate and multivariable logistic regression.

RESULTS

Overall, 18.6% of adolescents in the pooled sample (N = 9,726) had considered suicide, while 24.7% reported attempting suicide. Significant correlates of suicide attempt included older age (16+ years; odds ratio [OR]: 1.70, confidence interval [CI]: 1.09-2.63), difficulty sleeping due to worry (OR: 1.27, CI: 1.04-1.56), loneliness (OR: 1.65, CI: 1.39-1.96), truancy (OR: 1.38. CI: 1.05-1.82), being a target of bullying (OR: 1.53, CI: 1.26-1.85), getting physically attacked (OR: 1.73, CI: 1.42-2.11), physical fighting (OR: 1.47, CI: 1.21-1.79), current cigarette use (OR: 2.71, CI: 1.88-3.89), and initiation of drug use (OR: 2.19, CI: 1.71-2.81). Conversely, having close friends was associated with lower odds of suicide attempt (OR: 0.67, CI: 0.48-0.93). Several covariates were also significantly associated with suicidal ideation.

DISCUSSION

Suicidal ideation and attempts are highly prevalent among school-going adolescents in these West African countries. Multiple modifiable risk and protective factors were identified. Programs, interventions, and policies aimed at addressing these factors may play a significant role in preventing suicides in these countries.

The Trends of Suicidality Over the Past 10 Years (1999-2022) in the Ethiopian General Population and the Way Forward in Tackling It

Suicide is defined as a death caused by willful acts of taking one's own life. It might be a way for people to get away from suffering or anguish. Globally, an estimated a million people individuals lose their life due to suicide annually. Before the age of 50 years old more than half (58%) of all suicide deaths occur. This commentary aims to highlight the Ethiopian context, feasible preventive measures, and the way forward in tackling suicidal behavior. Worldwide in adolescent age groups between the ages of 15 and 29, suicide is the fourth leading cause of death. Even though suicide occurs everywhere in the world, according to data in 2019, 77% of all suicides that occurred in the world reside in developing countries. Due to the numerous psychosocial pressures present in Ethiopia, one in four citizens suffers from a mental disorder. According to Ethiopian national data figures, suicide ideation affects 9%, 5-16% of people, whereas suicidal attempt affects 4%, 1-8%. Even though, there is a variation of prevalence over the years based on the variation in design, settings, and sample size. There is an increment in the prevalence's suicidal ideation and attempts in the past 10 years. The country's Ministry of Health needs to act to address and prevent this urgent public health situation. The prevention of suicide should be a top concern, and working with numerous stakeholders is an efficient and practical approach.

Assisted Suicide and Euthanasia in Mental Disorders: Ethical Positions in the Debate between Proportionality, Dignity, and the Right to Die

The admission of people suffering from psychiatric and neurocognitive disorders to euthanasia and physician-assisted suicide (E/PAS) in some European and non-European countries represents a controversial issue. In some countries, the initial limitation of E/PAS to cases of severe physical illness with poor prognosis in the short term has been overcome, as it was considered discriminatory; thus, E/PAS has also been made available to subjects suffering from mental disorders. This decision has raised significant ethical questions regarding the capacity and freedom of self-determination; the family, social, and economic contexts; the social consideration of the sense of dignity and the pressure on the judgment of one's personal value; the contextual therapeutic possibilities; the identification of figures involved in the validation and application; as well as the epistemological definitions of the clinical conditions in question. To these issues must be added the situation of legislative vacuum peculiar to different countries and the widespread lack of effective evaluation and control systems. Nonetheless, pessimistic indicators on global health status, availability of care and assistance, aging demographics, and socioeconomic levels suggest that there may be further pressure toward the expansion of such requests. The present paper aims to trace an international overview with the aim of providing ethical support to the debate on the matter. Precisely, the goal is the delimitation of foundations for clinical practice in the complex field of psychiatry between the recognition of the irreversibility of the disease, assessment of the state of physical and mental suffering, as well as the possibility of adopting free and informed choices.

Disclosure of Mental Health Problems or Suicidality at Work: A Systematic Review

Many adults experience mental health problems or suicidality. Mental health and suicidality are associated with stigma and discrimination. Little is known about disclosure of mental health or suicidality problems in workplaces and the role of stigma and discrimination in affecting disclosure. To address this gap, we conducted a systematic review following the PRISMA guidelines. Searches for peer-reviewed articles in MedLINE, CINAHL, Embase and PsycINFO identified 26 studies, including sixteen qualitative, seven quantitative and three mixed-methods studies. No studies were excluded based on quality assessment. All studies reported on mental health disclosure; none reported on disclosure of suicidal thoughts or behaviours. The narrative synthesis identified four overarching themes relating to disclosure of mental health problems in workplaces. Themes included beliefs about stigma and discrimination, workplace factors (including supports and accommodation), identity factors (including professional and personal identity, gender and intersectionality) and factors relating to the disclosure process (including timing and recipients), with all influencing disclosure decision making. Significantly, this review found that there is a gap in the existing literature relating to suicidality disclosure in workplaces, with none of the included studies investigating disclosure of suicidal thoughts and behaviours.

Tinnitus and risk of attempted suicide: A one year follow-up study

BACKGROUND

Tinnitus causes emotional stress that can be extreme, bringing on anxiety, depression, or sleep disorders. We used a nationwide, population-based database to study the risk of attempted suicide among adults with tinnitus.

METHODS

Data for this retrospective cohort study were extracted from the Taiwan National Health Insurance Research Database, on 386,055 patients with tinnitus and propensity score-matched controls. We performed Cox proportional hazards regression analysis to calculate the one-year hazard of a suicide attempt and 95 % confidence intervals (CI) following a first-time diagnosis of tinnitus.

RESULTS

The results shows that the incidence of attempted suicide was 0.253 (95 % CI = 0.237-0.269) and 0.123 (95 % CI = 0.113-0.135) for the study cohort and comparison cohort, respectively. The log-rank test suggested that the study cohort had significantly lower suicide attempt-free survival at one year than the comparison cohort (p < 0.001). Cox proportional analysis shows that the hazard ratio of attempted suicide within the one-year follow-up period was 2.04 (95 % CI = 1.83-2.28) for patients with tinnitus than those in the comparison cohort after adjusting for the patients' age, sex, monthly income, geographic region, urbanization level of the patient's residence, hyperlipidemia, diabetes, coronary heart disease, and hypertension.

LIMITATIONS

The database lacks information on socioeconomic problems, specific personal characteristics or traits, marital status, or other factors associated with attempts to commit suicide. Notably, our study addressed suicide attempts as detected from claims-based ICD codes which do not cover suicidal ideation or suicidal death.

CONCLUSIONS

We found increased likelihood of attempted suicide among patients with tinnitus.

The Collaborative Assessment and Management of Suicidality compared to enhanced treatment as usual for inpatients who are suicidal: A randomized controlled trial

Background

Although use of inpatient crisis hospital intervention for suicide risk is common, the evidence for inpatient treatments that reduce suicidal thoughts and behaviors is remarkably limited. To address this need, this novel feasibility pilot randomized controlled trial compared the use of the Collaborative Assessment and Management of Suicidality (CAMS) to enhanced treatment as usual (E-TAU) within a standard acute inpatient mental health care setting.

Objectives

We hypothesized that CAMS would be more effective than E-TAU in reducing suicidal thoughts and behaviors. As secondary outcomes we also investigated depressive symptoms, general symptom burden, reasons for living, and quality of the therapeutic relationship.

Methods

All patients were admitted due to acute suicidal thoughts or behaviors. They were randomly assigned to CAMS (n = 43) or E-TAU (n = 45) and assessed at four time points (admission, discharge, 1 month and 5 months after discharge). We used mixed-effects models, effect sizes, and reliable change analyses to compare improvements across and between treatment groups over time.

Results

Intent-to-treat analyses of 88 participants [mean age 32.1, SD = 13.5; n = 47 (53%) females] showed that both groups improved over time across all outcome measures with no significant between-group differences in terms of change in suicidal ideation, depression, reasons for living, and distress. However, CAMS showed larger effect sizes across all measures; for treatment completers CAMS patients showed significant improvement in suicidal ideation (p = 0.01) in comparison to control patients. CAMS patients rated the therapeutic relationship significantly better (p = 0.02) than E-TAU patients and were less likely to attempt suicide within 4 weeks after discharge (p = 0.05).

Conclusions

CAMS and E-TAU were both effective in reducing suicidal thoughts and symptom distress. Within this feasibility RCT the pattern of results was generally supportive of CAMS suggesting that inpatient use of CAMS is both feasible and promising. However, our preliminary results need further replication within well-powered multi-site randomized controlled trials.

Trial registration

DRKS-ID/ICTRP-ID: DRKS00013727. The trial was retrospectively registered in the German Clinical Trials Register, registration code/ DRKS-ID: DRKS00013727 on 12.01.2018 and also in the International Clinical Trials Registry Platform of the World Health Organization (identical registration code).

Validity and reliability of a Chinese language suicide screening questionnaire-observer rating (CL-SSQ-OR) assessment for children/adolescents

Background

A Suicide Screening Questionnaire-Observer Rating (SSQ-OR) has been used to assess risk of suicide among individuals and to help clinicians identify and rescue individuals attempting suicide. To prevent the risk of suicide in China, a Chinese language SSQ-OR (CL-SSQ-OR) needs to be introduced.

Objective

To test the validity and reliability of a CL-SSQ-OR.

Method

A total of 250 individuals were enrolled in this study. Each completed a CL-SSQ-OR assessment, Patient Health Questionnaire-9, and the Beck Scale for Suicide Ideation. Confirmatory factor analysis (CFA) was adopted to determine structural validity. Spearman correlation coefficients were adopted to determine criterion validity. An internal correlation coefficient (ICC) was used to test inter-consistency and Cronbach's α coefficient was used to test split-half reliability.

Results

CFA was conducted with use of the maximum variance method to evaluate the item results. All of the items received scores >0.40. In addition, good model fit indices were observed for the two-factor structure RMSEA = 0.046, TLI = 0.965, CFI = 0.977. The items' factor loading of the CL-SSQ-OR in the first factor ranged from 0.443 to 0.878. The items' factor loading of the CL-SSQ-OR in the second factor ranged from 0.400 to 0.810. The ICC of the total CL-SSQ-OR was 0.855. Cronbach's α was 0.873.

Conclusion

The CL-SSQ-OR described here demonstrates ideal psychometric properties and is found to be a suitable tool for screening Chinese children/adolescents who are at risk of suicide.

Encouraging help-seeking and engagement in a mental health app: What young people want

Although many young people evince a preference for digital mental health support over face to face, engagement with smartphone apps for mental health remains relatively low, particularly in young people not accessing professional support services. While some of this can be attributed to stigma or embarrassment, there is also a need for developers and researchers to investigate features which promote long-term usage. MoodyTunes is a music-based smartphone app that has been co-designed with young people to help them develop effective self-management strategies for mood through music listening. Four focus groups with young people (N = 24, aged 13-25) were conducted to workshop how MoodyTunes could promote help-seeking behaviours and long-term engagement with the app. Online discussions following a broad topic guide were held in groups of 4-7 in which participants explored topics including the use of social features, promoting help-seeking behaviour, gamification and mood tracking. Participants also viewed visual materials and offered ideas about visual design both verbally and on paper. A general inductive approach was taken to analysis of qualitative data. Three primary themes were identified in the data: privacy; user empowerment; and engagement vs. achievement. Participants voiced a strong desire to remain anonymous and to feel empowered to make their own decisions about accessing professional help. Sensitive use of language was noted as critical, with some participants noting that the use of more directive language could have a negative impact on their mental health and that motivational features should focus on engagement with the primary aim of the app rather than rewarding achievement. Findings highlight the benefits of a co-design approach and provide key insights into how mental health apps may be able to improve long-term user engagement with young people.

Evaluating the Effectiveness of Components of National Suicide Prevention Strategies

Background: National suicide prevention strategies support development of suicide prevention activities and their evaluation. Aims: To describe components included in national suicide prevention strategies and analyze the potential contribution of individual components to reduce suicide rates. Method: We conducted a narrative review and statistical analysis of national suicide prevention strategies. The narrative review was based on a framework of 12 components and included 29 countries (14 lower middle-income countries [LMICs] and 15 high-income countries [HICs]) with a national suicide prevention strategy. The statistical analyses covered suicide mortality data for 24 countries with a national strategy (9 LMICs and 15 HICs). Results: The number of components adopted in national strategies ranged from 4 to 11, and training and education were included in 96.5% of strategies. Estimated period effects for total suicide rates in individual countries ranged from a significant decrease in the yearly suicide rate (RR = 0.80; 95% CI 0.69-0.93) to a significant increase (RR = 1.12; 95% CI 1.05-1.19). There were no changes in suicide mortality associated with individual components of national strategies. Limitations: The limitations of existing suicide mortality data apply to our study. Conclusion: Further detailed evaluations will help identify the specific contribution of individual components to the impact national strategies. Until then, countries should be encouraged to implement and evaluate comprehensive national suicide prevention strategies.

The efficacy and safety of esketamine in the treatment of major depressive disorder with suicidal ideation: study protocol for a randomized controlled trial

BACKGROUND

Major depressive disorder (MDD) is a high risk factor for suicide, with up to 20% of MDD patients attempting suicide during their lifetime. Current treatments for MDD are slow onset of action, low efficiency, and the inability to control suicidal behaviors quickly and effectively. Intravenous ketamine has been shown to have a rapid but transient antidepressant effect, but there is still lack evidence on the efficacy and safety of intravenous esketamine in reducing suicidal ideation and depressive symptoms in MDD patients with suicidal ideation. We designed a study to investigate the effect of short-term repeated intravenous infusion of esketamine three times in MDD patients with suicidal ideation.

METHODS

This study features a randomized, double-blind, placebo-controlled trial (RCT) comparing short-term repeated intravenous infusions of esketamine with placebo as a supplement to conventional antidepressants with an intervention period of 6 days and one infusion every other day, followed by 4 weeks of follow-up. These methods support the examination of the efficacy, safety, tolerability, and mechanism of action of short-term repeated intravenous infusions of esketamine in MDD patients with suicidal ideation.

DISCUSSION

This is the first RCT to explore the efficacy and safety of short-term repeated infusion of esketamine on suicidal ideation and depressive symptoms in MDD patients with suicidal ideation. If proven effective and tolerated, it will provide evidence for rapid and effective treatment of suicidal ideation and depressive symptoms in MDD individuals with suicidal ideation.

TRIAL REGISTRATION

Chinese Clinical Trial Register, ChiCTR2000041232 . Registered 22 December 2020.

Gender differences in suicidal ideation, suicide attempts, and suicide death among people living with HIV : A systematic review and meta‐analysis

OBJECTIVE

Although excess mortality, especially suicide, is a critical trait in people living with HIV, consensus about gender differences in these areas is lacking. We conducted meta-analyses to examine gender differences in suicidal ideation, suicide attempts, and suicide death among people living with HIV.

METHODS

We systematically searched PubMed and Web of Science for studies written in English. In this review, suicide among people living with HIV includes suicide death, suicidal ideation, and suicide attempts. Studies reporting the suicide prevalence among males and females living with HIV were eligible for inclusion in our review. Odds ratios (ORs) and 95% confidence intervals (CIs) served as the effect size index. Fixed-effects or random-effects meta-analyses were chosen based on the size of the heterogeneity.

RESULTS

A total of 27 studies comprising 801 017 participants from 11 countries were included in the meta-analysis. The overall prevalence of suicidal ideation was 18.0% (95% CI 13.3%-22.8%) in males and 20.8% (95% CI 16.4%-25.1%) in females, and there was a statistically significant higher risk of suicidal ideation in females living with HIV (OR 1.30; 95% CI 1.09-1.56; p < 0.05). The overall prevalence of suicide attempts was 16.8% (95% CI 9.0%-24.5%) in males and 24.7% (95% CI 12.4%-37.1%) in females, and there was a statistically significant higher risk of suicide attempts in females living with HIV (OR 1.34; 95% CI 1.02-1.75; p < 0.05). The pooled prevalence of suicide death was 1.2% (95% CI 0.5%-1.9%) among males and 0.2% (95% CI 0.1%-0.3%) among females, and the risk of suicide death between genders was not statistically significant (OR 0.78; 95% CI 0.50-1.24; p = 0.298).

CONCLUSIONS

There were gender differences in suicidal ideation and suicide attempts among people living with HIV. Females living with HIV were more likely to experience suicidal ideation and make suicide attempts, but there were no statistically significant gender differences in suicide death. Appropriate initiatives to optimize the recognition, treatment, and management suicide behaviours of males and females living with HIV may narrow this gender gap.

Suicide Risk in Military Personnel during the COVID-19 Health Emergency in a Peruvian Region: A Cross-Sectional Study

Military personnel represent a frontline group exposed to multiple stressors. These factors have increased during the COVID-19 pandemic, predisposing to the development of suicidal risk (SR). Given the few studies conducted in this population, we evaluated the prevalence of SR and its associated factors during the health emergency. A cross-sectional survey study was conducted in person among 514 participants in Lambayeque, Peru in 2021. The outcome was SR, and the exposures were depression (PHQ-9), anxiety (GAD-7), PTSD (PCL-C), and other sociodemographic variables. The prevalence of SR was 14.0% (95% CI: 11.12-17.31%) and was significantly higher in people with a family history of mental health (PR: 2.16; 95% CI: 1.13-4.15) and in those with moderate clinical insomnia (PR: 2.21; 95% CI: 1.19-4.12). Military personnel with high resilience had a lower prevalence of SR (PR: 0.54, CI: 0.31-0.95). Anxiety was associated with a higher prevalence of SR (PR: 3.27; 95% CI: 1.76-6.10). Our findings show that at least 1 out of 10 military personnel are at risk of suicide. Special attention should be paid to the associated factors to develop interventions and reverse their consequences. These results may be useful in policy implementation and general statistics of SR in the local and regional context.

Piloting of a suicide first aid gatekeeper training (online) for children and young people in conflict affected areas in Syria

Suicide among internally displaced people remains an under-researched public health issue especially in conflict affected countries. Given the limited and sometimes inaccessible mental health services, there is a need for scalable evidence-based suicide prevention programmes that could be delivered by trained and supervised non-specialists. The Suicide First Aid Guidelines approach aims to support humanitarian workers who deal directly with children and families with the appropriate knowledge and skills to identify and support those at risk of suicide until they can access further specialized support services or until the crisis passes.This paper presents the findings of an online pilot training of 56 humanitarian workers from different sectors (e.g. Child Protection, Nutrition and Mental Health and Psychosocial Support) in conflict affected areas in Syria. The quantitative and qualitative evaluations were based on pre- and post-training questionnaires and revision journals completed between training sessions. Suggestions and examples provided in the journals and during the trainings were incorporated into the succeeding trainings. This was to contextualize and modify the gatekeeper training to fit the Syrian context and provide adaptations for future research and suicide prevention guidelines. Overall, the evaluation indicated that the pilot training raised awareness and improved participants' knowledge on how to assist a suicidal person, including warning signs. It also contributed to a positive change in attitude or beliefs towards suicide. Although the pilot training was considered adequate for the Syrian context some improvements were suggested.

Epidemiological changes, demographic drivers, and global years of life lost from suicide over the period 1990-2019

OBJECTIVE

To quantify the contributions of epidemiological changes (age- and gender-specific suicide rates) and demographic forces (population growth and aging) to global changes in years of life lost (YLLs) from suicide over the last 30 years.

METHOD

A decomposition analysis was used to assess the impacts of population growth, population aging, and suicide prevalence on global changes in YLLs from suicide between 1990 and 2019.

RESULTS

From 1990 to 2019, global YLLs from suicide reduced by 2,073,714 years (5.9%), from 35,246,316 years to 33,172,602 years. This was mainly due to the decline in age-specific suicide rates, which reduced the overall YLLs from suicide by 20,185,691 years (973.4%). However, this decline was offset by the impacts of population growth and population aging, which increased global YLLs from suicide by 14,949,110 years (-720.9%) and 3,442,074 years (-166.0%), respectively. The combined effects of epidemiological and demographic drivers were also reflected in different trends in YLLs from suicide across genders and World Bank income level regions, with particularly notable increases in low- income and lower-middle income countries and the aging population.

CONCLUSIONS

With the significant effects of epidemiological and demographic drivers, global and regional YLLs from suicide may be expected to change greatly in the future. Efforts to reduce the burden of suicide require appropriate allocation of resources for suicide-prevention strategies and further consideration of demographic factors.

Fatores de risco e prevenção do suicídio na Atenção Primária à Saúde em tempos de pandemia por COVID-19

Introdução: O suicídio constitui-se em uma das principais causas de morte evitáveis. A pandemia da COVID-19 pode contribuir para reforçar os fatores de risco e a ideação suicida em razão da diminuição da capacidade de enfrentamento emocional ante a crise sanitária mundial. Ao mesmo tempo, os serviços de Atenção Primária à Saúde (APS) foram demandados a construir uma resposta rápida a questões relacionadas à saúde mental. Objetivo: Refletir sobre os fatores de risco e as possíveis intervenções para a prevenção do suicídio na atenção primária no contexto da pandemia da COVID-19. Métodos: Trata-se de uma revisão integrativa pautada na construção de uma análise crítica da literatura internacional sobre os fatores de risco e a prevenção do suicídio na APS durante a pandemia do novo coronavírus. Esta revisão foi construída por meio do levantamento de evidências na literatura internacional, feito pelo acesso às bases de dados científicas Web of Science, Science Direct e Scopus usando os descritores suicide AND prevention AND COVID-19 AND Primary Health Care. Foram incluídos artigos científicos disponibilizados entre dezembro de 2019 e setembro de 2020 e publicados em português, inglês e espanhol. Resultados: O corpus de análise foi composto de 15 artigos, com predominância da descrição de fatores de risco, da implementação e das adaptações de estratégias de intervenções específicas mediadas por recursos de tecnologia da informação e comunicação para oferecer cuidados de saúde mental. Conclusões: Os cuidados colaborativos pautados pelos atributos essenciais da APS destacaram-se como estratégias prioritárias para ofertar cuidados contínuos e longitudinais no contexto da pandemia.

Suicidal Behaviours During Covid-19 Pandemic: A Review

Objective

Novel COVID-19 disease has become a major concern worldwide, and a recent line of research warned that the context of the COVID-19 pandemic may be a major risk factor for developing severe suicidal behaviors. A broad systematic review is needed to cover the studies that have already assessed the potential underlying factors for suicidal behaviors in the context of the COVID-19 outbreak.

Method

A total of 52 studies met the inclusion criteria, and data were then described according to the subsequent categories: (1) countries where the studies were carried out; (2) factors impacting suicidal behaviors during the COVID-19 outbreak; and (3) examination of the observed populations.

Results

Findings of the current systematic review suggest that there is a certain amount of heterogeneity in factors impacting suicidal behaviors during the COVID-19 outbreak, with economic downturn, psychiatric vulnerability, isolation and quarantine, health concerns, and relational difficulties being the most prominent reasons for developing suicidal behaviors during the COVID-19 outbreak.

Conclusions

Timely interventions are needed to prevent suicidal behaviors in both the clinical and general populations, and in this regard, the creation of standard procedures may speed up the process.

Suicide Mortality Rate as a Sustainable Development Goal (SDG): A Bibliometric Analysis

Suicidal behaviors are a serious but potentially preventable cause of premature death. Increased awareness of the importance of mental health for global health has led to new initiatives, supported by the World Health Organization (WHO) and the United Nations (UN). The suicide mortality rate is one of the indicators covered in the UN's Sustainable Development Goal (SDG) 3. The aim of this study is to identify the scientific production and its temporal evolution related to the suicide mortality rate indicator in the context of mental disorders and as one of the SDG. A bibliometric analysis was performed in Scopus to assess the related research on suicide mortality rate, including on the context of the third SDG, from inception to September 2, 2020. The set of articles were analyzed for bibliometric measures. A total of 3126 documents about mental health and suicide mortality rate on the context of SDG were collected. Articles were the predominant type of literature on this area (78.3%), with significant expression on the last years, more evident around 2015, the year of adoption of SDGs. Despite a large volume of evidence, the debate about suicide mortality rate as an indicator of SDG is still very sparse suggesting a need for better consensus on its evaluation methods. This study presents useful characteristics for the formulation of new studies and provides specific targets for the construction or improvement of public policies on the context of the SDGs for further discussion on this strategy proposed by the UN.

"I Want to Be Stepping in More" - Professional Online Forum Moderators' Experiences of Supporting Individuals in a Suicide Crisis

INTRODUCTION

Individuals experiencing suicidal crises increasingly turn to online mental health forums for support. Support can come from peers but also from online moderators, many of whom are trained health professionals. Much is known about users' forum experiences; however, the experiences of professional moderators who work to keep users safe has been overlooked. The beneficial nature of online forums cannot be fully realized until there is a clearer understanding of both parties' participation. This study explored the experiences of professional online forum moderators engaged in suicide prevention.

MATERIALS AND METHODS

A purposive sample of professionally qualified moderators was recruited from three online mental health organizations. In-depth semi-structured, video-recorded interviews were conducted with 15 moderators (3 male, 12 female), to explore their experiences and perceptions of working in online suicide prevention spaces. Data was analyzed using inductive thematic analysis.

RESULTS

Five themes were identified related to the experiences and challenges for moderators. These were the sense of the unknown, the scope of the role, limitations of the written word, volume of tasks, and balancing individual vs. community needs.

DISCUSSION

Findings indicate that the professionally qualified moderator role is complex and multifaceted, with organizations failing to recognize these aspects. Organizations restrict moderators from using their full therapeutic skill set, limiting them to only identifying and re-directing at-risk users to crisis services. The benefits of moderated online forums could be enhanced by allowing moderators to use more of their skills. To facilitate this, in-situ research is needed that examines how moderators use their skills to identify at-risk users.

Prevalence of and risk factors for depressive and anxiety symptoms in a large sample of Chinese adolescents in the post-COVID-19 era

BACKGROUND

Depressive and anxiety symptoms are widespread among adolescents today, creating a large social problem. However, few previous studies have addressed depression and anxiety among adolescents in Chinese cohorts. The aim of this study was to evaluate the prevalence of and risk factors for depressive and anxiety symptoms among Chinese middle school adolescent students in the post-COVID-19 era.

METHODS

A total of 22,380 middle school students from Jiangsu Province were surveyed online, and their general demographic data were collected. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms, and the seven-item Generalized Anxiety Disorder (GAD-7) scale was used to measure anxiety symptoms.

RESULTS

Of these participants (aged 12-17 years), 25.6% had depressive symptoms, 26.9% had anxiety symptoms, and 20.6% had a combination of depression and anxiety symptoms. The prevalence of depressive symptoms was higher in female adolescents (27.6%) than in male adolescents (23.7%; χ² = 45.479, P = 0.000), and the proportion with anxiety symptoms was higher among female adolescents (28.6%) than among male adolescents (25.4%; χ² = 29.390, P = 0.000). Furthermore, binary logistic regression analysis showed that gender, region, and parental relationship were significantly associated with depressive symptoms among adolescents, while age, gender, region, and parental relationship were significantly associated with anxiety symptoms.

CONCLUSIONS

Our findings demonstrated that the prevalence of reported depressive and anxiety symptoms in Chinese adolescents are high. Female gender, urban region, and poor parental relationship may be risk factors for depressive and anxiety symptoms. Furthermore, policy makers, schools, and families need to pay more attention to the psychological health of adolescents, develop response plans and take early intervention measures to reduce the prevalence of adolescent depression and anxiety.

Effect of repetitive transcranial magnetic stimulation on patients with severe depression: a study protocol for systematic review and meta-analysis of randomised clinical trials

INTRODUCTION

Depression is characterised by easy recurrence, high disability and high burden, and antidepressant therapy is the standard treatment. However, its treatment effect on patients with severe depressive disorder has been unsatisfactory. Previous studies have shown that repetitive transcranial magnetic stimulation (rTMS), as a neurotherapy, can effectively mitigate the severity of depressive symptoms. Yet, more evidence is still required for TMS to treat severe depression. This study will be the first systematic review of the efficacy and tolerability of TMS for treating severe depression. We expect it to guide future clinical practice of TMS for the treatment of psychiatric disorders.

METHODS AND ANALYSIS

We will search for the randomised controlled trial (RCT) involving rTMS for treating depression in eight electronic databases, including PubMed, Web of Science, EMBASE, the Cochrane Library and Wanfang Database, from publication up to September 2021. We will define Improvement in depressive symptoms, the difference between pretreatment (baseline) and post-treatment as the primary outcomes. The difference between pretreatment and post-treatment changes in resting state fMRI will be regarded as the secondary outcomes. Quality assessment of the included articles will be independently performed according to the Cochrane Risk of Bias tool.

ETHICS AND DISSEMINATION

Ethical approval is not essential because there is no need to collect individual patient data. And this study will be published in a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

CRD42020211460.

Relationship Between the Early Initiation of Substance Use and Attempted Suicide Among in-School Adolescents in Seven Low- or Middle-Income African Countries: An Analysis of the Global School-Based Student Health Survey Data

Background: Preventing suicide among adolescents is an urgent global public-health challenge, especially in Africa. Accordingly, the aim of this study was to examine the relationship between the early initiation (< 12 years old) of substance use (cigarette smoking, alcohol use, and drug use) and attempted suicide among in-school adolescents in seven African countries.

Methods: Data on the early initiation of substance use and on attempted suicide among in-school adolescents over the previous 12 months in Benin, Liberia, Mauritius, Mozambique, Namibia, Seychelles, and the United Republic of Tanzania were collected from Global School-based Student Health Surveys and were pooled to determine the overall prevalence of these behaviors in adolescents. Univariate and multivariate logistic regressions were then performed to evaluate country-specific associations between the early initiation of substance use and attempted suicide in these adolescents, followed by meta-analyses to evaluate overall pooled associations.

Results: In the abovementioned seven African low- or middle-income countries (LMICs), overall weighted prevalences of attempted suicide and early initiation of cigarette smoking, alcohol use, and drug use among in-school adolescents were 16.05, 7.76, 17.68, and 3.48%, respectively. Multivariate logistic regression analyses revealed that relative to non-smoking, the early initiation of smoking was significantly associated with attempted suicide in these adolescents [OR (95% CI) = 1.783 (1.219–2.348)]. Additionally, the relationship between early initiation of cigarette smoking and attempted suicide is mostly driven by a higher association in girls [OR (95% CI) = 1.867 (1.031–2.703)] than boys [OR (95% CI) = 1.392 (0.995−1.789)]. Moreover, relative to not using other drugs, the early and later initiation of other drug use were also significantly associated with attempted suicide in these adolescents [ORs (95% CIs) = 2.455 (1.701–3.208) and 1.548 (1.198–1.898)].

Conclusion: Programs that can eliminate or decrease the early initiation of substance use among adolescents should be implemented in African LMICs to prevent subsequent suicide attempts, especially among adolescent girls.

Secular Trends of Suicide in the City of São Paulo, 1904-2017

Background: Few reports from developing countries have described long-term trends in suicide. Aims: To investigate the age-, sex-, and method-specific trends in suicide over the period 1904-2017 in São Paulo. Method: Mortality data were obtained from SEADE, DATASUS, and PRO-AIM. Results: Suicide peaked in the mid-1910s and mid-1950s, being higher among men. There was an upward trend from the 1920s for men and from the 1930s for women. Suicide rates have declined since the mid-1950s, reaching lower rates in the past 40 years. Men aged 60+ had higher rates at the beginning and a decreasing trend. Suicide rates among men aged 20-39 and 40-59 peaked in the mid-1950s and declined until the late 1970s, thereafter remaining stable. Women aged 20-39 years had the highest rates with decreasing trends from the mid-1950s. No trends were detected for the age group 40-59, and women aged 60+ presented a decreasing trend. Rates among women aged 0-19 declined after the late 1970s. Suicide by poisoning peaked in the 1950s, and there was a downward trend for firearms and an upward trend for hanging. Conclusion: Suicide trends vary by sex, age group, and method. Accurate monitoring of these trends is an important task for suicide prevention and public health agencies and personnel.

Suicide and Associations with Air Pollution and Ambient Temperature: A Systematic Review and Meta-Analysis

Given health threats of climate change, a comprehensive review of the impacts of ambient temperature and ar pollution on suicide is needed. We performed systematic literature review and meta-analysis of suicide risks associated with short-term exposure to ambient temperature and air pollution. Pubmed, Scopus, and Web of Science were searched for English-language publications using relevant keywords. Observational studies assessing risks of daily suicide and suicide attempts associated with temperature, particulate matter with aerodynamic diameter ≤10 μm (PM₁₀) and ≤2.5 mm (PM_2.5), ozone (O₃), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), and carbon monoxide (CO) were included. Data extraction was independently performed in duplicate. Random-effect meta-analysis was applied to pool risk ratios (RRs) for increases in daily suicide per interquartile range (IQR) increase in exposure. Meta-regression analysis was applied to examine effect modification by income level based on gross national income (GNI) per capita, national suicide rates, and average level of exposure factors. In total 2274 articles were screened, with 18 studies meeting inclusion criteria for air pollution and 32 studies for temperature. RRs of suicide per 7.1 °C temperature was 1.09 (95% CI: 1.06, 1.13). RRs of suicide per IQR increase in PM_2.5, PM₁₀, and NO₂ were 1.02 (95% CI: 1.00, 1.05), 1.01 (95% CI: 1.00, 1.03), and 1.03 (95% CI: 1.00, 1.07). O₃, SO₂, and CO were not associated with suicide. RR of suicide was significantly higher in higher-income than lower-income countries (1.09, 95% CI: 1.07, 1.11 and 1.20, 95% CI: 1.14, 1.26 per 7.1 °C increased temperature, respectively). Suicide risks associated with air pollution did not significantly differ by income level, national suicide rates, or average exposure levels. Research gaps were found for interactions between air pollution and temperature on suicide risks.

Quantitation of six steroid hormones by ultra-performance liquid chromatography-tandem mass spectrometry in plasma and prefrontal cortex samples from rats with chronic unpredictable mild stress-induced depression

Steroid hormones such as glucocorticoids and their metabolites are closely related to mental diseases and neuroendocrine diseases. Quantitative analysis of these substances will help in understanding their roles in related research fields. In this study, an ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method was developed to detect the concentration of corticosterone (CORT) and its metabolites, progesterone (PROG) and testosterone in rat plasma and prefrontal cortex (PFC), and was applied to investigate the changes in hormones in rats with depression induced by chronic unpredictable mild stress (CUMS). The method was shown to be linear in the quantitation range for all analytes. Intra- and inter-day accuracy and precision were between 80% and 120%. Furthermore, we found that the level of CORT in plasma and PFC increased, whereas that of 11-dehydrocorticosterone (11-DHCORT) as well as the ratio of 11-DHCORT and CORT declined in rats with CUMS-induced depression. The trends of these changes in central PFC and peripheral plasma were consistent. In conclusion, this study successfully established an UPLC-MS/MS method for simultaneous measurement of CORT and its metabolites, PROG and testosterone in rat plasma and PFC, and applied it to rats with depression. The method could be further applied to the research of depression and diseases related to these steroid hormones.

Trends in suicide rates and the case-fatality of pesticide self-poisoning in an agricultural county in china, 2009 to 2014

BACKGROUND

Suicide rates in China have declined substantially in the last two decades, however, the correlates of the decreases are still unclear.

METHODS

Using hospital-based suicidal acts registry system in Meixian county, we reviewed all episodes of suicidal behaviors presented at hospitals from 2009 to 2014. The data was combined with the suicides reported in the same period by the county's Center for Disease Prevention and Control. Stratified by gender and method, age-standardized incidences of suicide death, suicide attempts, suicidal acts, as well as the case-fatalities of suicidal acts, were calculated. Joinpoint regression analysis was applied to test the time trends changes of the annual incidences and case-fatalities. Correlation coefficients between suicide rates and case-fatality were estimated.

RESULTS

Age-standardized suicide rates among females declined by 20.4% per year, meanwhile, overall suicide rates were characterized by downward trend without statistical significance. The annual proportions of suicide deaths by pesticide self-poisoning ranged from 57.1% to 82.6%. There were positive or marginally positive correlations between suicide rates and case-fatalities of suicidal acts in gender- and method-specific groups (r values range from 0.77 to 0.89).

LIMITATIONS

Underreporting in the hospital-based registry system and misclassification in the death reporting system. Changes in other related factors are not yet accessible.

CONCLUSION

Suicide rates in females declined prominently in Meixian from 2009 to 2014, even though overall suicide rates remained steady. Pesticide ingestion were most common suicide method. Restriction of pesticide and reduction in the case-fatality are critical targets of suicide prevention in rural China.

Serum Lipid Levels and Suicide Attempts Within 2 Weeks in Patients With Major Depressive Disorder: Is There a Relationship?

The potential correlation between serum lipid profiles and suicidal tendencies has been previously reported, however, it is unclear whether serum lipid profiles have definite relevance to recently attempted suicides in individuals suffering from major depressive disorder (MDD). In this study, the relationship between blood lipids and suicide attempts in first-episode MDD patients in research were used to examine whether there is a connection. The cross-sectional study recruited 580 patients at the time of their first episode, measuring up to the diagnostic standard of MDD. Baseline demographic, clinical data, and blood lipid level data were collected. Depression severity was measured with the Hamilton Depression Rating Scale (HAMD). Our results revealed that the level of TC may be identified as a promising and effective biomarker for first-episode MDD suicide risk, suggesting that screening of serum lipid profiles in depressive patients is essential for suicide prevention.

A Mobile Health Intervention (LifeBuoy App) to Help Young People Manage Suicidal Thoughts: Protocol for a Mixed-Methods Randomized Controlled Trial

BACKGROUND

Self-help smartphone apps offer a new opportunity to address youth suicide prevention by improving access to support and by providing potentially high fidelity and cost-effective treatment. However, there have been very few smartphone apps providing evidence-based support for suicide prevention in this population. To address this gap, we developed the LifeBuoy app, a self-help smartphone app informed by dialectical behavior therapy (DBT), to help young people manage suicidal thoughts in their daily life.

OBJECTIVE

This study describes the protocol for a randomized controlled trial to evaluate the efficacy of the LifeBuoy app for reducing suicidal thoughts and behaviors, depression, anxiety, and psychological distress, and improving general mental well-being in young adults aged 18 to 25 years.

METHODS

This is a randomized controlled trial recruiting 378 young adults aged between 18 and 25 years and comparing the LifeBuoy app with a matched attention control (a placebo app with the same display but no DBT components). The primary outcome is suicidal thoughts measured by the Suicidal Ideation Attributes Scale (SIDAS). The secondary outcomes are suicidal behavior, depression, anxiety, psychological distress, and general mental well-being. The changes in the levels of insomnia, rumination, suicide cognitions, distress tolerance, loneliness, and help seeking before and after using the app are evaluated in this study. The study also addresses risk factors and responses to the intervention. A series of items assessing COVID-19 experiences is included in the trial to capture the potential impact of the pandemic on this study. Assessments will occur on the following three occasions: baseline, postintervention, and follow-up at 3 months postintervention. A qualitative interview about user experience with the LifeBuoy app will take place within 4 weeks of the final assessment. Using linear mixed models, the primary analysis will compare the changes in suicidal thoughts in the intervention condition relative to the control condition. To minimize risks, participants will receive a call from the team clinical psychologist by clicking a help button in the app or responding to an automated email sent by the system when they are assessed with elevated suicide risks at the baseline, postintervention, and 3-month follow-up surveys.

RESULTS

The trial recruitment started in May 2020. Data collection is currently ongoing.

CONCLUSIONS

This is the first trial examining the efficacy of a DBT-informed smartphone app delivered to community-living young adults reporting suicidal thoughts. This trial will extend knowledge about the efficacy and acceptability of app-based support for suicidal thoughts in young people.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12619001671156; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378366.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/23655.