Substance use and suicide

Exploration-Exploitation and Suicidal Behavior in Borderline Personality Disorder and Depression

Importance

Clinical theory and behavioral studies suggest that people experiencing suicidal crisis are often unable to find constructive solutions or incorporate useful information into their decisions, resulting in premature convergence on suicide and neglect of better alternatives. However, prior studies of suicidal behavior have not formally examined how individuals resolve the tradeoffs between exploiting familiar options and exploring potentially superior alternatives.

Objective

To investigate exploration and exploitation in suicidal behavior from the formal perspective of reinforcement learning.

Design, Setting, and Participants

Two case-control behavioral studies of exploration-exploitation of a large 1-dimensional continuous space and a 21-day prospective ambulatory study of suicidal ideation were conducted between April 2016 and March 2022. Participants were recruited from inpatient psychiatric units, outpatient clinics, and the community in Pittsburgh, Pennsylvania, and underwent laboratory and ambulatory assessments. Adults diagnosed with borderline personality disorder (BPD) and midlife and late-life major depressive disorder (MDD) were included, with each sample including demographically equated groups with a history of high-lethality suicide attempts, low-lethality suicide attempts, individuals with BPD or MDD but no suicide attempts, and control individuals without psychiatric disorders. The MDD sample also included a subgroup with serious suicidal ideation.

Main Outcomes and Measures

Behavioral (model-free and model-derived) indices of exploration and exploitation, suicide attempt lethality (Beck Lethality Scale), and prospectively assessed suicidal ideation.

Results

The BPD group included 171 adults (mean [SD] age, 30.55 [9.13] years; 135 [79%] female). The MDD group included 143 adults (mean [SD] age, 62.03 [6.82] years; 81 [57%] female). Across the BPD (χ23 = 50.68; P < .001) and MDD (χ24 = 36.34; P < .001) samples, individuals with high-lethality suicide attempts discovered fewer options than other groups as they were unable to shift away from unrewarded options. In contrast, those with low-lethality attempts were prone to excessive behavioral shifts after rewarded and unrewarded actions. No differences were seen in strategic early exploration or in exploitation. Among 84 participants with BPD in the ambulatory study, 56 reported suicidal ideation. Underexploration also predicted incident suicidal ideation (χ21 = 30.16; P < .001), validating the case-control results prospectively. The findings were robust to confounds, including medication exposure, affective state, and behavioral heterogeneity.

Conclusions and Relevance

The findings suggest that narrow exploration and inability to abandon inferior options are associated with serious suicidal behavior and chronic suicidal thoughts. By contrast, individuals in this study who engaged in low-lethality suicidal behavior displayed a low threshold for taking potentially disadvantageous actions.

Problematic substance use in depressed adolescents: Prevalence and clinical correlates

Background

Substance use among adolescents is common and associated with significant consequences, including depression. Adolescents can experience myriad problems related to early onset substance use and depression, making further understanding of this comorbidity necessary.

Method

Participants were a subset from a large-scale performance improvement project and consisted of adolescents aged 12-18 who screened positive for depression during their routine medical or psychiatric appointment and who then completed the substance use assessment Car, Relax, Alone, Forget, Friends, Trouble Version 2.1 (CRAFFT). Participants with problematic substance use had a CRAFFT score ≥2.

Results

A total of 621 participants were included in this study, and 105 (16.9%) reported problematic substance use. Compared with participants without problematic substance use, those with problematic use were more likely to have moderate to severe depression and anxiety, as well as significantly higher irritability, impulsivity, suicidal propensity, and suicidal thoughts scores. Controlling for age at screening, sex, race, and ethnicity, problematic substance use remained a significant predictor of depression severity, impulsivity, suicidal propensity, and suicidal thoughts.

Limitations

Participants were from a large, metropolitan area of the Southwest United States who must have screened positive for depression, so results may not generalize. Because all participants were underage, they may have been wary in responding to the substance use assessment accurately.

Conclusions

By using a large, diverse sample in a real-world clinical setting, findings strengthen the association between problematic substance use and depression and depression-associated symptoms among adolescents, highlighting the need for early detection and universal depression screening.

Substance use disorder and lifetime suicidal behaviour: A scoping review

BACKGROUND

Suicidal behaviours are prevalent in substance use disorder (SUD) patients. These behaviours have a negative impact on the psychopathological profile of these patients. However, few studies have evaluated suicide as a continuum (i.e. starting with ideation, followed by attempts and ending with death) and its evolution during treatment. The aim of this scoping review was to explore what is known about suicidal behaviour in individuals undergoing clinical treatment for SUD.

METHODS

The PsycINFO, Web of Science (Core Collection and MEDLINE), Scopus, and Cochrane Library databases were searched. After screening the records based on eligibility and exclusion criteria, 30 studies were ultimately selected for inclusion.

RESULTS

Most of the studies were conducted in the USA and Europe. Only three studies evaluated suicidal behaviour with a specific instrument. The prevalence of suicidal ideation (SI) in people being treated for SUD ranged from 20 % to 62.2 %, and the prevalence of suicide attempts (SA) ranged from 15.8 % to 52.1 %. Only one study reported death by suicide.

CONCLUSIONS

Despite the high prevalence of suicidal behaviours and their harmful consequences, the assessment of this phenomenon is scarce and heterogeneous. There is a need to assess suicidal behaviour with standardized criteria in order to develop tailored SUD treatment.

Differentiating the association between age of alcohol use initiation and conditional suicidal behaviors among adolescents

INTRODUCTION

Suicide and early alcohol use initiation are public health concerns. Previous studies have explored the associations between age of alcohol use initiation and suicidal behaviors, which progresses from ideation to action. Distinguishing between the various associations can help gain a deeper understanding of suicidal behaviors and aid in developing social suicide prevention strategies.

METHODS

The study utilized the Youth Risk Behavior Survey to investigate this association. A total of 17 209 students were finally included in the study. Conditional suicidal behaviors included no suicidal behavior (NS), suicidal ideation without a plan or attempt (SINPA), suicide plan without an attempt (SPNA) and suicide attempt (SA).

RESULTS

Among 17 209 students, the prevalence of suicidal ideation, suicide plan, and suicide attempt were 21.4%, 17.3%, and 11.1%, respectively. Moreover, 15.2% of the students used alcohol before age 13, whereas 31.7% of students used alcohol at age 13 or older. Compared to NS, students using alcohol showed significant associations with SA (OR = 2.34, p < .001; OR = 1.29, p < .01), SPNA (OR = 1.68, p < .001; OR = 1.19, p < .05) and SINPA (OR = 1.55, p < .001; OR = 1.40, p < .001). Comparing with SINPA and SNPA, students using alcohol before age 13 were associated with SA (OR = 1.61, p < .001; OR = 1.46, p < .001), whereas those using alcohol at or after the age 13 were not associated with SA (OR = 0.98, p > .05; OR = 1.09, p > .05).

DISCUSSION

This study demonstrated that early alcohol use initiation was significantly associated with suicide attempts among students with suicidal ideations or plans.

Suicide Rates and Risks Across U.S. Industries: A 29-Year Population-Based Survey

OBJECTIVE

Suicide rates in the working-age U.S. population have increased by over 40% in the last two decades. Although suicide may be linked with characteristics of workplaces and their industries, few studies have reported industry-level suicide rates. No study has reported suicide rates by industry using nationally representative data. This study estimates suicide risks across industries in the U.S. working population.

METHODS

Industry-level estimates of suicide risks require substantial data; we combined 29 years of U.S. suicide data using the National Health Interview Survey (NHIS)-Mortality Linked data from 1986 through 2014, with mortality follow-up through 2015. We conducted survey-weighted Poisson regression analyses to estimate suicide mortality rates and rate ratios across all populations and stratified by gender. All analyses were adjusted first for age, and then for age, employment status, marital status, race/ethnicity, and rurality/urbanicity (demographic-adjusted). Rate ratios compared results for workers in each industry to those for all industries, accounting for the NHIS survey design.

RESULTS

A total of 1,943 suicide deaths were recorded. Age-adjusted suicide rates per 100,000 were highest in the furniture, lumber, and wood industry group (29.3), the fabricated metal industry (26.3), and mining (25.8). Demographic-adjusted rates were higher among men than women in most industries. Demographic-adjusted rate ratios were significantly elevated in the furniture, lumber, and wood industries (Rate Ratio, RR = 1.60, 95% confidence interval, CI = 1.18-2.18); chemicals and allied products (RR = 1.49, 95%CI = 1.04-2.13); and construction (RR = 1.21, 95% CI = 1.03-1.41).

CONCLUSION

Several industries had significantly high suicide rates. Suicide prevention efforts may be particularly useful for workers in those industries.

Healthcare Utilization 12 Months Prior to Fatal and Non-fatal Suicidal Behaviour in Cape Town, South Africa

The purpose of this study was to characterize healthcare use for general care and mental health one year before suicidal behavior among individuals with fatal and non-fatal suicidal behavior (NFSB) in Cape Town, South Africa. We linked electronic health records of 484 participants from a case series of 93 completed suicides on whom forensic autopsies were performed at a mortuary in Cape Town, between August 2014 and January 2016; and 391 patients admitted to hospital following NFSB between June 2014 and March 2015, and between August 2015 and August 2017. Time from last healthcare visit to date of suicidal behavior (fatal or non-fatal) was calculated, and Kaplan Meier curves were used to compare the differences by psychiatric diagnoses and study group. Overall, 64.5% of completed suicides and 65.9% of NFSB patients sought general healthcare in the year before suicidal behavior. Most of these visits occurred at hospital outpatient clinics (40.8%) and primary healthcare facilities (31.3%). The prevalence of preexisting psychiatric diagnoses and the use of mental healthcare services was lower for individuals who completed suicide compared to NFSB patients. Common reasons for a healthcare visit among individuals who completed suicide were chronic disease and assault; and psychiatric illness (depression, bipolar, and/or substance use disorders), chronic disease and HIV among NFSB patients. A large proportion of individuals with fatal and NFSB interacted with the healthcare system before suicidal behavior. These findings suggest opportunities for suicide prevention at primary healthcare facilities, antiretroviral treatment centers and emergency departments.HIGHLIGHTSHealthcare access is common among individuals with fatal and NFSB in the year before suicidal behavior.The prevalence of mental disorder diagnoses is higher among NFSB patients than among individuals who completed suicide.A greater proportion of NFSB patients accessed mental healthcare services compared to individuals who completed suicide.

Differentiating the associations between alcohol use, cigarette smoking, and conditional suicidal behaviors among adolescents

BACKGROUND

Both alcohol use and cigarette smoking have been identified as risk factors for suicidal behaviors. However, suicide is a process from ideation to action, and some evidence have implied us that alcohol use and cigarette smoking may play different roles in the different process of suicidal behaviors.

METHODS

Data was derived from the 2019 Youth Risk Behavior Survey (YRBS), and a total of 12, 487 valid samples were analyzed in the study. To distinguish the different situation of suicidal behaviors, participants were divided into general people without any suicidal behavior (GNS), suicidal ideators without plan or attempt (SINPA), suicide planners without attempt (SPNA), and suicide attempters (SA).1 RESULTS: The prevalence of suicidal ideation, plan, and attempt were 19.4 %, 15.9 %, and 7.7 %, respectively. Comparing to GNS, alcohol use and cigarette smoking were associated with SINPA (OR = 1.27, P < 0.05; OR = 1.47, P < 0.001), SPNA (OR = 1.29, P < 0.01; OR = 1.26, P < 0.01), and SA (OR = 1.31, P < 0.01; OR = 2.11, P < 0.001). However, alcohol use was not associated with SA comparing to SINPA (OR = 1.05, P > 0.05) and SPNA (OR = 1.03, P > 0.05), while cigarette smoking was associated with SA (OR = 1.40, P < 0.01; OR = 1.74, P < 0.001).

LIMITATIONS

Firstly, using the secondary data was possibly limited. Next, this was a cross-sectional study, the casual relationship was unsure. Lastly, the amount of alcohol consumption and cigarette smoking status were not considered.

CONCLUSION

Both alcohol use and cigarette smoking are risk factors for any suicidal behaviors. However, controlling alcohol use may be a limited method to prevent the further suicidal behaviors for ideators and planners. Managing cigarette smoking should be considered.

Predicting suicide attempts among Norwegian adolescents without using suicide-related items: a machine learning approach

Introduction

Research on the classification models of suicide attempts has predominantly depended on the collection of sensitive data related to suicide. Gathering this type of information at the population level can be challenging, especially when it pertains to adolescents. We addressed two main objectives: (1) the feasibility of classifying adolescents at high risk of attempting suicide without relying on specific suicide-related survey items such as history of suicide attempts, suicide plan, or suicide ideation, and (2) identifying the most important predictors of suicide attempts among adolescents.

Methods

Nationwide survey data from 173,664 Norwegian adolescents (ages 13-18) were utilized to train a binary classification model, using 169 questionnaire items. The Extreme Gradient Boosting (XGBoost) algorithm was fine-tuned to classify adolescent suicide attempts, and the most important predictors were identified.

Results

XGBoost achieved a sensitivity of 77% with a specificity of 90%, and an AUC of 92.1% and an AUPRC of 47.1%. A coherent set of predictors in the domains of internalizing problems, substance use, interpersonal relationships, and victimization were pinpointed as the most important items related to recent suicide attempts.

Conclusion

This study underscores the potential of machine learning for screening adolescent suicide attempts on a population scale without requiring sensitive suicide-related survey items. Future research investigating the etiology of suicidal behavior may direct particular attention to internalizing problems, interpersonal relationships, victimization, and substance use.

Factors associated with suicide in people who use drugs: a scoping review

BACKGROUND

Suicide is a significant contributor to global mortality. People who use drugs (PWUD) are at increased risk of death by suicide relative to the general population, but there is a lack of information on associated candidate factors for suicide in this group. The aim of this study was to provide a comprehensive overview of existing evidence on potential factors for death by suicide in PWUD.

METHODS

A scoping review was conducted according to the Arksey and O'Malley framework. Articles were identified using Medline, CINAHL, PsycINFO, SOCIndex, the Cochrane Database of Systematic Reviews and the Campbell Collaboration Database of Systematic Reviews; supplemented by grey literature, technical reports, and consultation with experts. No limitations were placed on study design. Publications in English from January 2000 to December 2021 were included. Two reviewers independently screened full-text publications for inclusion. Extracted data were collated using tables and accompanying narrative descriptive summaries. The review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines.

RESULTS

The initial search identified 12,389 individual publications, of which 53 met the inclusion criteria. The majority (87%) of included publications were primary research, with an uncontrolled, retrospective study design. The most common data sources were drug treatment databases or national death indexes. Eleven potential factors associated with death by suicide among PWUD were identified: sex; mental health conditions; periods of heightened vulnerability; age profile; use of stimulants, cannabis, or new psychoactive substances; specific medical conditions; lack of dual diagnosis service provision; homelessness; incarceration; intravenous drug use; and race or ethnicity. Opioids, followed by cannabis and stimulant drugs were the most prevalent drugs of use in PWUD who died by suicide. A large proportion of evidence was related to opioid use; therefore, more primary research on suicide and explicit risk factors is required.

CONCLUSIONS

The majority of studies exploring factors associated with death by suicide among PWUD involved descriptive epidemiological data, with limited in-depth analyses of explicit risk factors. To prevent suicide in PWUD, it is important to consider potential risk factors and type of drug use, and to tailor policies and practices accordingly.

Association between unmet healthcare needs and suicidal behaviors among the Korean population

OBJECTIVE

Suicide is an important public health concern. In South Korea, suicide rates have steadily risen over the past two decades. Unfortunately, there is a dearth of literature on the effects of unmet healthcare needs on suicide. Therefore, this study aimed to analyze the relationship between unmet healthcare needs and suicidal behaviors (suicidal ideation, plans, and attempts).

METHOD

This study analyzed data from 27,498 participants assessed by the Korea National Health and Nutrition Examination Survey conducted between 2016 and 2020. Logistic regression was used to evaluate the relationship between unmet healthcare needs and suicidal behaviors, while controlling for age, sex, education, household income, occupation, smoking, obesity, and alcohol consumption.

RESULTS

Adjusted odds ratios (95% confidence interval) were significantly higher in participants who experienced unmet healthcare needs [suicidal ideation: 2.31 (1.84-2.90); suicidal planning: 2.23 (1.75-2.85); and suicidal attempts: 1.92 (1.27-2.87)]. After stratifying for sex and depression, this trend was maintained in male participants and those without a depression diagnosis.

CONCLUSIONS

This study analyzed the relationship between unmet healthcare needs and suicidal behavior. Further studies using data sources that include more detailed information on suicide and somatic symptoms are required.

State Gun Regulations and Reduced Gun Ownership are Associated with Fewer Firearm-Related Suicides Among Both Juveniles and Adults in the USA

BACKGROUND

Few studies have investigated the relationship between specific gun regulations and gun ownership with the firearm-related suicide rate among juveniles and adults across U.S. states. Therefore, this study seeks to determine if gun ownership rates and gun restrictions are related to the firearm-related suicide rate in both the pediatric and adult populations.

METHODS

Fourteen measures of state gun law restrictions and gun ownership were collected. These included Giffords Center ranking, gun ownership percentages, and 12 specific firearm laws. Unadjusted linear regressions modeled the relationship between each individual variable and the rate of firearm-related suicides for adults and children across states. This was repeated using a multivariable linear regression adjusting for poverty, poor mental health, race, gun ownership, and divorce rates by state. P values of <0.004 were considered significant.

RESULTS

In the unadjusted linear regression, 9 of 14 firearm-related measures were statistically associated with fewer firearm-related suicides in adults. Similarly, 9 of 14 measures were found to be associated with fewer firearm-related suicides in the pediatric population. In the multivariable regression, 6 of 14 vs. 5 of 14 measures were statistically associated with fewer firearm-related suicides in the adult and pediatric populations, respectively.

CONCLUSIONS

Ultimately, this study found that increased state gun restrictions and lower gun ownership rates were associated with fewer firearm related suicides among juveniles and adults in the US. This paper provides objective data to help lawmakers as they create gun control legislation that can potentially decrease the rate of fire-arm related suicide.

LEVELS OF EVIDENCE

II.

Suicidal thoughts and behaviours among military veterans: protocol for a prospective, observational, neuroimaging study

INTRODUCTION

This study's overarching goal is to examine the relationship between brain circuits and suicidal thoughts and behaviours (STBs) in a transdiagnostic sample of US military veterans. Because STBs have been linked with maladaptive decision-making and disorders linked to impulsivity, this investigation focuses on valence and inhibitory control circuits.

METHODS AND ANALYSIS

In this prospective, observational study, we will collect functional MRI (fMRI), cognitive and clinical data from 136 veterans (target sample size) recruited from the Providence VA Health System (PVAHS): 68 with STBs and 68 matched controls. Behavioural data will be collected using standardised measures of STBs, psychiatric symptoms, cognition, functioning and medical history. Neuroimaging data will include structural, task and resting fMRI. We will conduct follow-up interviews and assessments at 6, 12 and 24 months post-enrolment. Primary analyses will compare data from veterans with and without STBs and will also evaluate whether activation and connectivity within circuits of valence and inhibition covary with historical and prospective patterns of suicidal ideation and behaviour.

ETHICS AND DISSEMINATION

The PVAHS Institutional Review Board approved this study (2018-051). Written informed consent will be obtained from all participants. Findings from this study will be published in peer-reviewed journals and presented at local, regional, national and international conferences.Nauder Namaky, Ph.D.* nauder_namaky@brown.edu.

The psychological autopsy: An overview of its utility and methodology

Objectives

The objective of this study is to provide an overview of the psychological autopsy (PA) research method, including its methodology, uses, limitations, and ethical considerations.

Materials and Methods

The study conducted a PA investigation on 35 cases of suicide. Information was collected from multiple sources and reliable informants, including family members, friends, medical and mental health professionals, and other relevant individuals. Qualitative and quantitative research methods were used to analyze the collected information.

Results

The results indicated that several factors were associated with suicide, including mental health problems, life stressors, interpersonal conflicts, substance abuse, and history of previous suicide attempts. The findings have important implications for suicide prevention strategies, emphasizing the significance of addressing mental health issues and providing social support.

Conclusion

The PA is a valuable research method for investigating and understanding suicide. Despite challenges such as recall biases and methodological limitations, it provides insights into the psychological factors associated with suicide and informs suicide prevention strategies. However, conducting psychological autopsies requires careful consideration of ethical issues. Further research is needed to replicate and extend the findings of this study.

Predictors of suicide ideation among South Korean adolescents: A machine learning approach

BACKGROUND

The current study developed a predictive model for suicide ideation among South Korean (Korean) adolescents using a comprehensive set of factors across demographic, physical and mental health, academic, social, and behavioral domains. The aim of this study was to address the pressing public health concerns of adolescent suicide in Korea and the methodological limitations of suicidal research.

METHODS

This study used machine learning methods (decision tree, logistic regression, naive Bayes classifier) to improve the accuracy of predicting suicidal ideation and related factors among a nationally representative sample of Korean middle school students (N = 6666).

RESULTS

Factors within all domains, including demographic characteristics, physical and mental health, and academic, social, and behavioral, were important in predicting suicidal thoughts among Korean adolescents, with mental health being the most important factor.

LIMITATIONS

The predictive model of the current research does not infer causality, and there may have been some loss of information due to measurement issues.

CONCLUSIONS

Study results provide insights for taking a multidimensional approach when identifying adolescents at risk of suicide, which may be used to further address their needs through intervention programs within the school setting. Considering the cultural stigma attached to disclosing suicidal ideation and behavior, the current study proposes the need for a preventive screening process based on the observation and assessment of adolescents' general characteristics and experiences in everyday life.

Examining associations between suicidal desire, implicit fearlessness about death, and lifetime frequency of suicide attempts

INTRODUCTION

Suicide models propose that the capability for suicide, such as fearlessness about death (FAD), is necessary for the transition from suicidal desire to a suicide attempt. Most studies have relied on self-report methods to assess FAD. However, this research has produced equivocal results. As individuals may have limited awareness of learned or pre-existing associations between fearlessness and death, implicit measures of FAD hold promise. This study used a novel implicit association test (IAT), the IAT-FAD, to examine associations between suicidal desire, implicit FAD, and lifetime suicide attempt frequency.

METHODS

Patients in residential substance use treatment (N = 75), a population with increased suicide risk and exposure to painful and provocative events, completed the IAT-FAD and assessments of suicidal desire and past suicide attempts.

RESULTS

Implicit FAD moderated the association between suicidal desire and lifetime frequency of suicide attempts associated with an intent to die and requiring medical attention (although not ambivalent suicide attempts). Suicidal desire related to medically attended suicide attempts only at high implicit FAD levels, and to suicide attempts with a clear intent to die only at high or mean implicit FAD levels.

CONCLUSION

Results provide initial support for the relevance of implicit measures of FAD for understanding suicide risk.

Analiza przypadków samobójstw w materiale sekcyjnym Katedry Medycyny Sądowej Collegium Medicum w Bydgoszczy Uniwersytetu Mikołaja Kopernika w Toruniu w latach 2011-2020

Cel pracy: Analiza samobójstw na podstawie sądowo-lekarskich sekcji zwłok przeprowadzonych w Katedrze Medycyny Sądowej w Bydgoszczy w porównaniu z danymi z lat wcześniejszych i innych ośrodków. Materiał i metody: Ocenie poddano 6564 opinii sądowo-lekarskich z przeprowadzonych badań pośmiertnych z lat 2011-2020, wśród których wyodrębniono 1073 przypadki samobójstw, uwzględniając płeć i wiek pokrzywdzonych, miejsce w którym dokonano czynu samobójczego, wpływ alkoholu lub innych środków odurzających, sposoby popełniania samobójstw oraz data (miesiąc i rok). Wyniki: Samobójstwa stanowiły 16,34% wszystkich badań pośmiertnych. Najczęstszą metodą samobójstwa było powieszenie – 73%. Drugim co do częstości sposobem odebrania sobie życia był upadek z wysokości –8%. Najliczniejszą grupą wiekową wśród popełniających samobójstwo stanowią osoby pomiędzy 51, a 60 rokiem życia. W większości przypadków samobójcy byli trzeźwi. Widoczna jest istotna różnica pomiędzy stanem trzeźwości, a płcią ofiary. Zdecydowanie częściej pod wpływem alkoholu w trakcie dokonania samobójstwa były ofiary płci męskiej. 14% ogółu samobójstw popełniły kobiety, zaś 86% mężczyźni. Nieco częściej zgon w wyniku samobójstwa miał miejsce w granicach dużych aglomeracji miejskich, niż na terenie miasteczek i wsi. Wnioski: Badania wykazały wzrost odsetka samobójstw w stosunku do lat poprzednich. Powieszenie nadal jest najczęstszym sposobem samobójstwa. Odnotowano wzrost liczby samobójstw osób w wieku podeszłym oraz zwiększenie liczby tzw. samobójstw kombinowanych. Słowa kluczowe: samobójstwa, sekcja zwłok Analysis of suicide cases in the autopsy material of the Department of Forensic Medicine Collegium Medicum in Bydgoszcz, University of Nicolaus Copernicus in Toruń in 2011-2020 Aim of the study: Analysis of suicides on the basis of forensic post mortem examinations conducted at the Department of Forensic Medicine in Bydgoszcz in comparison with data from previous years and other centers. Material and methods: The assessment included 6,564 forensic medical opinions from the post mortem examinations carried out in 2011–2020, including 1,073 cases of suicide, taking into account the sex and age of the victims, the place where the suicide was committed, the influence of alcohol or other intoxicants, methods of committing suicides and date (month and year). Results: Suicides accounted for 16.34% of all post mortem examinations. The most common method of suicide was hanging – 73%. The second most common way to take your own life was fall from height – 8%. The most numerous age group among those committing suicide are people between 51 and 60 years of age. In most cases, the suicide victims were sober. There is a significant difference between the state of sobriety and the gender of the victim. Male victims were much more often under the influence of alcohol during the suicide. 14% of all suicides were committed by women, and 86% by men. Death as a result of suicide took place somewhat more often within the boundaries of large urban agglomerations than in towns and villages. Conclusions: The research showed an increase in the suicide rate compared to the previous years. Hanging is still the most common form of suicide. There has been an increase in the number of suicides in the elderly and an increase in the number of so-called combined suicides.

Risk of non-fatal suicide attempt in individuals with substance use disorder: the roles of aggregate genetic liability and environmental exposures in a Swedish population-based cohort

BACKGROUND AND AIMS

Substance use disorder (SUD) is related to widespread adverse consequences, including higher suicidality. Shared genetic liability has been demonstrated between SUD and suicidality. Here, we measured the factors that contribute to increased risk of non-fatal suicide attempt among individuals with SUD by focusing upon aggregate genetic risks and both childhood and past-year environmental factors.

DESIGN

Longitudinal study. Family genetic risk scores and environmental factors (childhood, aged from 0 to 15 years, and the year preceding SUD registration) were used to predict the relative risk of non-fatal suicide attempt using Cox proportional hazards models. Additional analyses employed a co-relative design, accounting for genetic factors and shared familial environment, to test for potential causality.

SETTING AND PARTICIPANTS

Based on longitudinal Swedish registry data, 228 617 individuals with SUD registrations from 1991 to 2015 were included.

MEASUREMENTS

SUD and suicide attempts were identified using medical records (International Classification of Diseases codes). SUD was also identified using pharmacy and criminal registries.

FINDINGS

In multivariable analyses that jointly accounted for all the selected potential predictors, individuals with SUD were at higher risk for non-fatal suicide attempt if they had experienced a parental death [hazard ratio (HR) = 1.58; 95% confidence interval (CI) = 1.30, 1.93], were female (HR = 1.53, 95% CI = 1.49, 1.57), had low educational attainment (HR = 1.50, 95% CI = 1.46, 1.55), received social welfare (HR = 1.21, 95% CI = 1.17, 1.25) or had lived in a non-intact family (HR = 1.11, 95% CI = 1.08, 1.14). In co-relative analyses, low education was supported as a possible causal factor for suicide attempt. Aggregate genetic risks interacted with low education and being raised in a non-intact family, with increased prevalence of suicide attempt in people with high genetic risks and unfavorable environmental exposures.

CONCLUSIONS

Aggregate genetic liability, childhood environmental experiences and specific socio-economic indicators are important risk factors for non-fatal suicide attempt among individuals with substance use disorder.

Suicide Risk in Survivors of Acute Respiratory Distress Syndrome: A Nationwide Cohort Study in South Korea

OBJECTIVE

We aimed to examine the prevalence and risk factors of suicide among patients with acute respiratory distress syndrome (ARDS).

METHODS

Data were extracted from the National Health Insurance Service database in South Korea. This study included all adults admitted to intensive care units with a diagnosis of ARDS from January 1, 2010 to December 31, 2019, who survived ≥365. The primary endpoint in this study was suicide within 1 year of an ARDS diagnosis, which was determined as death by a suicide attempt or self-harm.

RESULTS

Analysis included 9,928 patients identified as ARDS survivors. One-year all-cause mortality occurred in 5,021 patients, 186 (1.9%) of which died by suicide. In multivariable Cox regression, older age, continuous renal replacement therapy, cardiopulmonary resuscitation incidence, history of self-harm or attempted suicide and concurrent substance abuse were associated with a higher risk of death by suicide among ARDS survivors.

CONCLUSION

During the 1-year follow-up period, 1.9% of ARDS survivors died by suicide in South Korea, and some factors were identified as potential risk factors for death by suicide. Knowledge of the factors associated with suicide might allow for earlier intervention to potentially reduce the death by suicide among ARDS survivors.

Suicide ideation and/or attempt with substance use and associated factors among the youth in northwest Ethiopia, community-based

BACKGROUND

Substance use is referring to the use of psychoactive substances like chat, cigarettes, alcohol, and others. The use of substances particularly (alcohol, chat, and cigarette) is a major mental health burden in developing countries including Ethiopia among youth. Suicide ideation and an attempt are thinking or trying to kill oneself that facilitates the act of a person intentionally causing his or her death. Suicide is one of the most serious mental health problems and has a great social impact in the world as it is currently the third leading cause of death for youth. Youth is defined as the period of life between childhood and maturity with an age interval of (15-25).

METHOD

A cross-sectional study design was used to assess the prevalence of suicidal ideation and attempts with substance use among youth in northwest Ethiopia. Multi-stage sampling techniques of stratified with simple random sample ware used. In the first stage, substance users are selected then as the second stage among substance users the burden of suicide behavior is assessed. ASIST, DASS-21, and other tools were used to assess suicidal behavior with substance use and associated factors. Data were edited, purified, and entered into Epi-data version 4.6 before being exported to the statistical package for social sciences version 20 for analysis of bi-variables to see the associations' p-value < 0.2 and multi-variables to identify the associated variables with a p-value of < 0.05 AOR and CI also done.

RESULTS

From a total of 372 substance user participants over all prevalence of suicidal ideation and attempt among youth was 54(14.5%) with 95% CI of (11.0,18.0) and 37(9.9%) with 95% CI (7.0, 13.0) respectively. Being female [AOR =2.36;95% CI:(1.19, 4.68)], poor social support [AOR =3.03; 95% CI: (1.11, 8.25)], and anxiety [AOR = 3.82: 95% CI; (1.96, 7.46)].

CONCLUSION AND RECOMMENDATIONS

The prevalence of suicidal ideation and attempt among substance users was 14.5 and 9.9% respectively therefore, immediate interventional actions needed to be administered to decrease the burden of suicide by reducing substance use and other associated factors.

Evaluation of forensic autopsy cases with substance use detected in Izmir, Turkey

Using postmortem toxicological analyses, we aimed to determine the origin and cause of death and type of substance used in substance use-related deaths. A total of 7475 autopsies were performed between January 2015 and December 2017 in İzmir, Turkey. In our retrospective analysis, substance use was detected in 449 (6.0%) autopsies. The majority (96.4%) were male. The most frequent deaths (18.5%) occurred in the 25-29 age group. Of the 55.2% of the cases that died of unnatural causes, accident-related events (22.9%) were most frequent. Trauma/injury caused death in 37.0% of cases and substance intoxication in 24.7%. Cannabis use was detected in 34.3% of the samples, and multiple substance use in 25.4%. Accordingly, It is thought that a multidisciplinary approach can be successful in preventing substance use and related problems.

Prevalence and Correlates of Illicit Substance Use Among Young Adults Experiencing Homelessness in Seven Cities Across the United States

Background

Young adults experiencing homelessness (YAEH) engage in substantially higher substance use rates than housed young adults. This current study builds on previous research by investigating the prevalence of and salient correlates of illicit substance use across a seven-city sample.

Methods

This study used the Homeless Youth Risk and Resiliency Survey (HYRRS) dataset, n=1426 Young adults experiencing homelessness to study patterns and correlates of illicit substance use.

Results

Multivariate logistic regression analyses were used to assess correlates of substance use. Study site, age, gender identity, sexual orientation, history of suicidal ideation, use of specific substances, and trading sex for drugs were associated with five types of illicit substance use (ecstasy, cocaine, crack, methamphetamine, and injection drug use).

Conclusion

Findings indicate that substance use interventions for YAEH must be multifaceted, addressing illicit and multiple substance use, along with the myriad factors associated with substance use among this at-risk group.

A Brief Intervention on E-Cigarette, Regular Cigarette, and Marijuana Use Results in Generalization Effects: Lateral Attitude Change among College Students

OBJECTIVE

We hypothesized (1) perceived harm beliefs and intention to use e-cigarette attitudes will become more negative post-exposure to the intervention (2) this change will generalize to more negative beliefs and intention toward regular cigarettes and marijuana.

METHODS

MANOVAs of students' perceptions of harm beliefs and intention toward the use of e-cigarettes and regular cigarettes, and marijuana were performed to ascertain change in harm beliefs before (t₁) to after the intervention (t₂) for 188 nonwhite Hispanic and White college students who viewed educational material (informational text + video), the intervention, during an online experimental survey.

RESULTS

The first MANOVA yielded main effect with significant differences for substances, Wilks' Lambda (Λ) = 0.254, F = 234.920 (2, 160), p < 0.001, η_p² =0.746 and by time (Λ = 0.740, F = 56.684 (1, 161), p < 0.001, η_p² = 0.260). E-cigarettes, regular cigarettes, and marijuana were perceived more harmful for one's health and for the health of others at t₂. The MANOVA on peer influence and intention to use (Λ = 0.277, F = 222.890 (2, 171), p < 0.001), η_p² = 0.723) and by time (Λ = 0.922, F = 14.514 (1, 172), p < 0.001), η_p² = 0.078) was significant. Respondents were less likely to use any of the substances if their best friend offered at t_2. Intent for future use was also reduced at t₂.

CONCLUSION

A brief intervention potentiated favorable change in harm beliefs and intention to focal object (e-cigarettes) and lateral objects (regular cigarettes and marijuana).

Jordanian University Students' Lived Experience of Misusing Amphetamine (Captagon): A Qualitative Study

BACKGROUND

Substance misuse is a growing problem among Jordanian university students.

PURPOSE

The aim of this study was to explore the lived experiences of university students who misuse Captagon (amphetamines).

METHODS

The interpretative phenomenological analysis methodology was used. In-depth face-to-face interviews were conducted with 10 Jordanian university students, aged 17-22 years, who were using Captagon (amphetamines) for the last 6 months.

RESULTS

Three major themes detailed participants' experiences with Captagon: (a) causes for use, (b) effects of taking amphetamines, and (c) seeking help behaviors and support. Participants who experienced academic and personal stress sought help from friends, who provided them with Captagon pills as a way to overcome their life challenges. Initially, taking Captagon provided participants with a sense of control, but it did not solve their problems. Later or as the days passed by, they experienced increased level of stress, felt disorganized in a way that they missed classes, and were being socially isolated. Participants finally sought community help for their problem, but this was difficult because of stigmatizing attitudes in their community toward substance misuse.

CONCLUSIONS

Increasing university students' knowledge about the negative consequences of substance misuse and raising awareness of strategies to address the problem will help young people to make more informed choices, because today's young generation are tomorrow's citizens.

Decision-making and cognitive control in adolescent suicidal behaviors: a qualitative systematic review of the literature

Suicide and suicidal behaviors represent a leading cause of morbidity and mortality during adolescence. While several lines of evidence suggest that suicidal behaviors are associated with risky decisions and deficient cognitive control in laboratory tasks in adults, comparatively less is known about adolescents. Here, we systematically reviewed the literature on the association between these neurocognitive variables and adolescent suicidal behaviors. The online search strategy identified 17 neurocognitive studies examining either cognitive control or decision-making processes in adolescents with past suicidal behaviors. Several studies have reported that adolescents with a history of suicidal behaviors present neuropsychological differences in the cognitive control (using Go/NoGo, suicide Stroop Test, continuous performance test, suicide/death Implicit Association Test), and decision-making (Iowa Gambling Task, Cambridge Gambling Task, cost computation, delay discounting, loss aversion tasks) domains. Due to a lack of replication or conflicting findings, our systematic review suggests that no firm conclusion can be drawn as to whether altered decision-making or poor cognitive control contribute to adolescent suicidal behaviors. However, these results collectively suggest that further research is warranted. Limitations included scarcity of longitudinal studies and a lack of homogeneity in study designs, which precluded quantitative analysis. We propose remediating ways to continue neuropsychological investigations of suicide risk in adolescence, which could lead to the identification of novel therapeutic targets and predictive markers, enabling early intervention in suicidal youth.

The early impact of COVID-19 on the incidence, prevalence, and severity of alcohol use and other drugs: A systematic review

BACKGROUND

The aim of this paper was to examine the early impact of COVID-19 on substance use to assess implications for planning substance use treatment and support systems.

METHOD

A systematic review of literature published up to March 2021 was conducted to summarize changes in prevalence, incidence, and severity of substance use associated with COVID-19 and the accompanying public health measures, including lockdown, stay-at-home orders, and social distancing.

RESULTS

We identified 53 papers describing changes to substance use at the population level. The majority of papers described changes related to alcohol use and most relied on self-reported measures of consumption during the COVID-19 pandemic, compared with pre-pandemic use. There was less evidence to support changes in non-alcohol substance use. In general, risky pre-pandemic alcohol use, caregiving responsibilities, stress, depression, anxiety, and current treatment for a mental disorder were found to be associated with increased substance use.

CONCLUSION

This review provides preliminary data on changes in substance use, indicating that certain segments of the population increased their alcohol use early on in the COVID-19 pandemic and may be at greater risk of harm and in need of additional services. There is a need for additional population-level information on substance use to inform evidence-based rapid responses from a treatment system perspective.

Suicide prevention in psychiatric patients

An increased risk of suicide has been reported for psychiatric patients. In several world regions, an underlying psychiatric disorder is reported in up to 90% of people who die from suicide, though this rate seems to be considerably lower in low- and middle-income countries. Major psychiatric conditions associated with suicidality are mood disorders, alcohol and substance use disorders, borderline personality disorder, and schizophrenia. Comorbidity between different disorders is frequently associated with a higher suicide risk. A history of suicide attempts, feelings of hopelessness, impulsivity and aggression, adverse childhood experiences, severe psychopathology, and somatic disorders are common risk factors for suicide among psychiatric patients. Stressful life events and interpersonal problems, including interpersonal violence, are often triggers. A comprehensive and repeated suicide risk assessment represents the first step for effective suicide prevention. Particular attention should be paid during and after hospitalization, with the first days and weeks after discharge representing the most critical period. Pharmacological treatment of mood disorders and schizophrenia has been shown to have an anti-suicidal effect. A significant reduction of suicidal thoughts and behavior has been reported for cognitive behavioral therapy and dialectical behavior therapy. Brief interventions, including psychoeducation and follow-ups, are associated with a decrease in suicide deaths. Further development of suicide prevention in psychiatric patients will require a better understanding of additional risk and protective factors, such as the role of a person's decision-making capacity and social support, the role of spiritual and religious interventions, and the reduction of the treatment gap in mental health care.

Substance use and suicide outcomes among self-injured trauma patients

BACKGROUND

Research indicates alcohol (AUD) or substance (SUD) use disorders and acute alcohol or drug use serve as risk factors for suicidal behaviors and death both distally and proximally to a suicidal event. However, limited research has investigated these relationships among medically serious suicide attempters at the time of injury without relying on cohorts of substance users only or by examining suicide decedent characteristics.

METHODS

Data were collected from the National Trauma Data Bank (NTDB) for 2017. The sample comprised patients who engaged in suicidal and self-injurious acts that were medically serious enough to require trauma admission and were tested for alcohol (N = 9,196) or drug (N = 8,121) exposure upon admission. Logistic regression determined relationships between acute alcohol/substance use, presence of AUDs and SUDs and suicide mortality risk, while linear regression evaluated substance conditions and injury severity and length of stay (LOS).

RESULTS

AUDs (OR = 0.59[0.42-0.83]) and SUDs (OR = 0.66[0.48-0.90]) had reduced odds of death but increased LOS (β = 1.7, p < .001; β = 0.82, p = .024). Blood alcohol concentration (BAC) was positively associated with reduced odds of death (OR = 0.20[0.06-0.61]), injury severity (β = -5.3, p < .001), and LOS (β = -7.5, p < .001). Presence of cocaine (β = -0.80, p = .044) and opioids (β = -1.4, p < .001) were associated lower injury severity, while MDMA (β = 3.6, p = .016) and methamphetamine (β = 1.5, p = .025) were associated with increased injury severity.

CONCLUSIONS

While higher BAC may be associated with lower odds of mortality during a single high-risk suicide event, substance users may be at increased risk for worse outcomes over time. Targeted interventions should be considered to interrupt and develop healthy alternatives for survivors with substance use conditions.

Recognizing Adolescent Depression with Parent- and Youth-Report Screens in Pediatric Primary Care

OBJECTIVES

To compare the use of the parent-report Pediatric Symptom Checklist (PSC-17P) and youth-report Patient Health Questionnaire-9 Modified for Teens (PHQ-9M) in compliance with recent quality standards for adolescent depression screening.

STUDY DESIGN

Parents of 5411 pediatric outpatients (11.0-17.9 years old) completed the PSC-17P, which contains scales that assign categorical risk for overall (PSC-17P-OVR), internalizing (PSC-17P-INT), externalizing (PSC-17P-EXT), and attention (PSC-17P-ATT) problems. Adolescents completed the PHQ-9M, which assesses depressive symptoms. Both forms were completed online within 24 hours of each other before pediatric well-child visits.

RESULTS

A total of 9.9% of patients (n = 535) were at risk on the PSC-17P-OVR, 14.3% (n = 775) were at risk on the PSC-17P-INT, and 17.0% (n = 992) were at risk on either or both scales (PSC-17P-OVR and/or PSC-17P-INT). Using the PHQ-9M cut-off score of 10 (moderate-very severe depression), an additional 2.4% (n = 131) were classified as at risk, with 66.8% (n = 263) of all PHQ-9M positives (n = 394) also coded as at risk by the PSC-17P-OVR and/or PSC-17P-INT scales. Using a PHQ-9M cut-off score of 15 (severe-very severe depression), only 29 patients (21.8% of the PHQ-9M positives) not identified by the PSC-17P-OVR and/or PSC-17P-INT were classified as being at risk.

CONCLUSIONS

The combined PSC-17P-OVR and/or PSC-17P-INT scales identified 17% of adolescents as at risk for depression, including about two-thirds to three-quarters of adolescents classified as at risk on the PHQ-9M. These findings support using the PSC-17P to meet quality standards for depression as well as overall screening in pediatrics. Primary care clinicians can add the PHQ-9M to identify additional adolescents who may self-report depressive symptoms.

Search for solutions, learning, simulation, and choice processes in suicidal behavior

Suicide may be viewed as an unfortunate outcome of failures in decision processes. Such failures occur when the demands of a crisis exceed a person's capacity to (i) search for options, (ii) learn and simulate possible futures, and (iii) make advantageous value‐based choices. Can individual‐level decision deficits and biases drive the progression of the suicidal crisis? Our overview of the evidence on this question is informed by clinical theory and grounded in reinforcement learning and behavioral economics. Cohort and case–control studies provide strong evidence that limited cognitive capacity and particularly impaired cognitive control are associated with suicidal behavior, imposing cognitive constraints on decision‐making. We conceptualize suicidal ideation as an element of impoverished consideration sets resulting from a search for solutions under cognitive constraints and mood‐congruent Pavlovian influences, a view supported by mostly indirect evidence. More compelling is the evidence of impaired learning in people with a history of suicidal behavior. We speculate that an inability to simulate alternative futures using one's model of the world may undermine alternative solutions in a suicidal crisis. The hypothesis supported by the strongest evidence is that the selection of suicide over alternatives is facilitated by a choice process undermined by randomness. Case–control studies using gambling tasks, armed bandits, and delay discounting support this claim. Future experimental studies will need to uncover real‐time dynamics of choice processes in suicidal people. In summary, the decision process framework sheds light on neurocognitive mechanisms that facilitate the progression of the suicidal crisis.

This article is categorized under:

Economics > Individual Decision‐Making

Psychology > Emotion and Motivation

Psychology > Learning

Neuroscience > Behavior

Risk factors for completed suicide among people who use drugs: A scoping review protocol

Background: Research over the past several decades has shown an increased risk for completed suicide among people who use drugs (PWUD). However, no study to date has attempted to summarise the available literature on the variety of risk factors associated with this increased risk. This paper presents a protocol for a scoping review that aims to systematically map and synthesise the extent and nature of published, unpublished and grey literature related to risk factors for suicide among PWUD.

Methods: The following six-stage methodological framework for scoping reviews proposed by Arksey and O’Malley with enhancements by Levac and colleagues will be used: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting/mapping the data, (5) collating, summarising and reporting results and (6) expert consultation. The review will be conducted and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Key inclusion and exclusion criteria will be developed to guide literature screening and data charting. Three reviewers will conduct the initial screening of published, unpublished and grey literature. Identified risk factors will be collated, summarised and categorised iteratively by two independent reviewers. Stakeholder consultation will occur with experts from a national steering committee, a national advisory group, a national suicide prevention centre and a European drug monitoring centre.

Conclusion: Collating and thematically categorising the various risk factors for suicide among this high-risk group will hold important implications for future research, policy and practice. The research will be disseminated through publication in a peer-reviewed academic journal and a conference presentation, and by sharing the findings with key stakeholders working within research, policy-making and professional practice contexts.

The role of social isolation in opioid addiction

Humans are social animals: social isolation hurts people both psychologically and physically. Strong, positive social bonds help people to live longer and healthier lives compared with their more isolated peers. Opioid use disorder is associated with feelings of social isolation, an increased risk of suicide and, at the community level, lower social capital. I propose a psychobiological mechanistic explanation that contributes to the association between opioid use and social isolation. The endogenous opioid system plays a central role in the formation and maintenance of social bonds across the life span and has been investigated primarily through the framework of the brain opioid theory of social attachment. In primates, maternal-infant bonding and social play are both impaired by the administration of naltrexone (an opioid antagonist), and in humans, the chronic use of opioids appears to be particularly (relative to other drugs) corrosive to close relationships. Social isolation may play a role in the development and exacerbation of opioid use disorder. Taken together, work on the brain’s opioid system suggests a possible mechanistic basis for bidirectional causal links between social isolation and opioid use disorder. Evaluation of this hypothesis would benefit from longitudinal psychosocial and neuropsychopharmacological investigations.

Suicide during COVID-19 and other major international respiratory outbreaks: A systematic review

Coronavirus disease 2019 (COVID-19) was recently declared a pandemic by the WHO. This outbreak threatens not only physical health but also has significant repercussions on mental health. In recent world history, major infectious outbreaks were associated with severe mental health sequelae, including suicide. In this study, we systematically review the literature on suicidal outcomes during major international respiratory outbreaks, including COVID-19. We reviewed descriptive and analytic articles addressing suicide during major international respiratory outbreaks. We searched PubMed, Medline, Embase, Scopus, and PsycInfo databases and then utilized an independent method for study selection by a pair of reviewers. Two reviewers completed data abstraction and conducted a narrative summary of the findings. Our search generated 2,153 articles. Nine studies (three descriptive, five analytical, and one with mixed methodology) were eligible. The included studies were heterogeneous, divergent in methods, and with a low degree of evidence. Deducing an association between pandemics, suicide, and suicide-related outcomes remains thus poorly supported. Future research with better methodological characteristics, the use of longitudinal studies, and a focus on suicide as the primary outcome would allow for an in-depth understanding and formulation of the scope of this problem.

Suicidal Thoughts and Behaviors Among LGBTQ Youth: Meta-Analyses and a Systematic Review

Suicide continues to be the second-leading cause of death for all youths aged 15-24. Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are at a significantly higher risk for suicidal thoughts or behaviors (STB). Establishing and understanding correlates of STB among LGBTQ youth is one important step toward enhancing prevention, intervention, and research efforts. To synthesize current knowledge on suicide among LGBTQ youth, the present meta-analyses offer results from 44 studies over the past 20 years. Two-hundred and thirty-four correlation coefficient effect sizes were calculated and categorized. To be included, the study had to quantitatively examine correlates of STB among LGBTQ youth. A number of social-science databases were used to examine the existing published research. Results illustrated the variability among correlates of STB as well as substantial limitations in the extant literature. There was a heterogeneity of effect sizes, a lack of novel correlates, a focus on risk, a dearth of theoretically driven designs, moderate publication bias, a paucity of developmentally driven analyses, and a dearth of research with transgender youth.

Risk factors for completed suicide among people who use drugs: A scoping review protocol

Background: Research over the past several decades has shown an increased risk for completed suicide among people who use drugs (PWUD). However, no study to date has attempted to summarise the available literature on the variety of risk factors associated with this increased risk. This paper presents a protocol for a scoping review that aims to systematically map and synthesise the extent and nature of published, unpublished and grey literature related to risk factors for suicide among PWUD. Methods: The following six-stage methodological framework for scoping reviews proposed by Arksey and O’Malley with enhancements by Levac and colleagues will be used: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting/mapping the data, (5) collating, summarising and reporting results and (6) expert consultation. The review will be conducted and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Key inclusion and exclusion criteria will be developed to guide literature screening and data charting. Three reviewers will conduct the initial screening of published, unpublished and grey literature. Identified risk factors will be collated, summarised and categorised iteratively by two independent reviewers. Stakeholder consultation will occur with experts from a national steering committee, a national advisory group, a national suicide prevention centre and a European drug monitoring centre. Conclusion: Collating and thematically categorising the various risk factors for suicide among this high-risk group will hold important implications for future research, policy and practice. The research will be disseminated through publication in a peer-reviewed academic journal and a conference presentation, and by sharing the findings with key stakeholders working within research, policy-making and professional practice contexts.

Transcultural Differences in Risk Factors and in Triggering Reasons of Suicidal and Self-Harming Behaviour in Young People with and without a Migration Background

Minors with and without migration background can have different risk factors and triggering reasons for self-harming and suicidal behaviour. We retrospectively analysed the data of 192 children and adolescents to investigate the transcultural differences in self-harming, as well as suicidal behaviour in Austrian, Turkish, and Bosnian/Croatian/Serbian (BCS)-speaking patients, who were treated in an emergency out-patient clinic in Vienna. Our results showed transcultural differences in both behaviours. In all groups, females had higher rates of suicide attempts and self-harming behaviour than males. While Turkish-speaking patients received treatment more often, after attempted suicide, Austrians and BCS-speaking patients needed treatment more often for acute stress disorder. Suicide attempts and self-harming behaviours were triggered most frequently by intrafamilial problems, but more frequently in migrant patients. Turkish-speaking patients were at a more than 2 times (OR = 2.21, 95%CI: 1.408–3.477) higher risk for suicide attempts, and were triggered almost 3 times (OR = 2.94, 95%CI: 1.632–5.304) more often by interfamilial conflicts. The suicide attempts of BCS-speaking minors were more often caused by relationship and separation crises (OR = 2.56, 95%CI: 1.148–5.705). These transcultural differences in suicidal and self-harming behaviour of minors, demand an increase of transcultural competence to provide optimal treatment of migrant children.

Sex, Gender, and Suicidal Behavior

This chapter reviews gender differences in suicide, commonly known as the gender paradox in suicide. While men are more likely to complete suicide, suicide attempts are more frequent in women. Although there are exceptions, this paradox occurs in most countries over the world, and it is partially explained by the preference of men for more lethal methods. Nevertheless, there are differences in the known risk factors for suicide between men and women, and this chapter summarizes the more relevant findings for the gender paradox. Apart from previous attempts, which still is the strongest predictor of death by suicide, with a higher rate in males than in females, we will emphasize in the role of male depression. It is commonly recognized that over 90% of people who die by suicide had a psychiatric diagnosis, mostly depression, and male depression seems to be a distinct clinical phenotype challenging to recognize, which might contribute to the gender paradox. Finally, in light of all the information reviewed, some recommendations on prevention of suicide from a gender perspective in the clinical setting will be made.

Risk factors for completed suicide among people who use drugs: A scoping review protocol

Background: Research over the past several decades has shown an increased risk for completed suicide among people who use drugs (PWUD). However, no study to date has attempted to summarise the available literature on the variety of risk factors associated with this increased risk. This paper presents a protocol for a scoping review that aims to systematically map and synthesise the extent and nature of published, unpublished and grey literature related to risk factors for suicide PWUD. Methods: The following six-stage methodological framework for scoping reviews proposed by Arksey and O’Malley with enhancements by Levac and colleagues will be used: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting/mapping the data, (5) collating, summarising and reporting results and (6) expert consultation. The review will be conducted and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Key inclusion and exclusion criteria will be developed to guide literature screening and data charting. Three reviewers will conduct the initial screening of published, unpublished and grey literature. Identified risk factors will be collated, summarised and categorised iteratively by two independent reviewers. Stakeholder consultation will occur with experts from a national steering committee, a national advisory group, a national suicide prevention centre and a European drug monitoring centre. Conclusion: Collating and thematically categorising the various risk factors for suicide among this high-risk group will hold important implications for future research, policy and practice. The research will be disseminated through publication in a peer-reviewed academic journal and a conference presentation, and by sharing the findings with key stakeholders working within research, policy-making and professional practice contexts.

Lifetime History of Suicide Attempts among Not Guilty by Reason of Insanity State Hospital Inpatients: The Roles of past Harmful Substance Use and Current Social Support

This study tested current perceived social support (CPSS) as a moderator of the relation between previous substance use (PSU) and lifetime suicide attempt (SA) history among 200 NGRI inpatients. Results indicated no significant CPSS main effect. PSU was associated with greater odds of multiple prior lifetime SA. Moderation indicated those low in PSU but high in CPSS were least likely to report multiple prior lifetime SA. Conversely, NGRI inpatients with high CPSS and high PSU were most likely to report multiple lifetime SA. Our study suggests CPSS and PSU assessments may inform suicide risk assessments and interventions among NGRI inpatients.

Impulsivity and Impulsivity-Related Endophenotypes in Suicidal Patients with Substance Use Disorders: an Exploratory Study

Suicidal behavior (SB) is a major problem in patients with substance use disorders (SUDs). However, little is known about specific SB risk factors in this population, and pathogenetic hypotheses are difficult to disentangle. This study investigated some SB and SUD-related endophenotypes, such as impulsivity, aggression, trait anger, and risk-taking behaviors (RTBs), in forty-eight patients with SUDs in relation to lifetime history of suicide attempts (SAs). Disorders related to alcohol, cannabis, cocaine, opiates, and hallucinogenic drugs were included. Lifetime SAs was significantly associated with both higher impulsivity and higher aggression, but not with trait anger. A higher number of RTBs were associated with lifetime SAs and higher impulsivity, but not with aggression and trait anger. Assessing these endophenotypes could refine clinical SB risk evaluation in SUDs patients by detecting higher-risk subgroups. An important limitation of this study is exiguity of its sample size. Its primary contribution is inclusion of all SUD types.

Alcohol use and risk of suicide: a systematic review and Meta-analysis

Objectives: Alcohol use has several consequences and is one of the variables that increase risk of suicide. This meta-analysis was performed using cohort studies to clarify the association of alcohol use and suicide.Method: Scientific sources were reviewed regarding the keywords. After screening, thirty cohort studies were identified for the meta-analysis. The analysis was performed based on the random effects and subsequent analysis of the subgroups, based on various variables.Result: Analysis of the results showed that there is a relationship between alcohol use and suicide. Risk Ratio (RR) between alcohol use and suicide was 1.65. In men, pooled RR was 1.56 with 95% CI = 1.20-2.03, and in women, the pooled RR was equal to 1.40 with 95% CI = 1.11-1.77.Conclusion: Overall, the findings indicate that alcohol use is a risk factor for suicide. Therefore, it seems that prevention and control of alcohol use can be effective in promoting mental health.

Suicidality in Fibromyalgia: A Systematic Review of the Literature

Fibromyalgia (FM), a poorly understood rheumatic condition, is characterized by chronic pain and psychiatric comorbidities, most notably depression and anxiety. Additional symptoms include sleep difficulties, fatigue, and various cognitive impairments. Furthermore, FM is surrounded by social stigma, due to the unclear nature and etiology of this condition. While there is widespread evidence for the emotional and psychological suffering of those with FM, the scope of suicidality, as well as the underlying factors that are associated with suicidal ideation and behavior among this population, are not well understood. The present review, which is the first of its kind, aims to summarize existing data on the prevalence of suicide-related outcomes among FM patients, highlight factors associated with suicidal ideation and behavior in FM, and identify gaps in the literature to better inform research and clinical care. Studies were extracted from the literature that measured suicidal ideation, attempted suicide, and/or completed suicide among FM patients. Results indicated that both suicidal ideation and suicidal behavior were prevalent among individuals suffering from FM. Psychiatric comorbidity, sleep difficulties, and inpatient hospitalization were associated with both suicidal ideation and suicidal behavior. Functional impairment was associated with suicidal ideation in FM. Factors associated with higher levels of suicidal behavior in FM included female gender, unemployment and lower income, medical comorbidity, and drug dependence. While an understanding of currently recognized risk factors is important for improving FM research and clinical care, some clear methodological and conceptual limitations of the reviewed studies were identified. Future work should focus on longitudinal studies, as well as on gaining a better biological and psychological understanding of the underpinnings of FM and suicidality.

How Behavioral Economics and Nudges Could Help Diminish Irrationality in Suicide-Related Decisions

People regularly make decisions that are not aligned with their own self-interests. These irrational decisions often stem from humans having bounded rationality (e.g., limited computational power), which produces reliable cognitive biases that occur outside of people's awareness and influences the decisions people make. There are many important decisions leading up to a suicide attempt, and it is likely that these same biases exist within suicide-related decisions. This article presents an argument for the likely existence of cognitive biases within suicide-related decision making and how they may influence people to make irrational decisions. In addition, this article provides new evidence for using a behavioral economic intervention-nudges-as a potential way to combat rising suicide rates. We explore how nudges can help increase means safety, disseminate suicide prevention skills/materials, diminish well-known biases (e.g., confirmation bias), and uncover biases that may be occurring when making suicide-related decisions.

Patterns and predictors of self-harm in patients with substance-use disorder

BACKGROUND

Suicide is a growing health concern and causes significant health burden. Patients with substance use disorders represent an especially vulnerable population in terms of self-harm. Data on risk factors for self-harm in substance-using population in the Indian context are limited. We aimed to determine the patterns and sociodemographic/clinical predictors of self-harm in patients with substance use disorders.

MATERIALS AND METHODS

We assessed 300 male patients on Deliberate Self-Harm Inventory to assess the patterns of self-harm. We performed mediation analysis to determine whether clinical variables acted via sociodemographic variables in their effect on self-harm.

RESULTS

The occurrence rate of self-harm was 32.7%. It was significantly associated with a younger age, being unmarried/separated, unemployed, history of injecting drug use, high-risk sexual behavior, and cannabis use disorders.

CONCLUSION

Self-harm is an important consideration among patients with substance use disorders, and needs to be addressed by the clinicians involved in the care of such patients.

Association between illegal use of substances and suicidal behavior in school students: An integrative review of empirical data

PURPOSE

Investigation of the association between type of suicidal behavior and type and frequency of illegal use of substances (IUS) among school students (aged between 12 and 18 years), with a focus on gender differences.

DESIGN AND METHODS

A systematic review in PubMed, CINAHL, PsychINFO, and Scopus was performed. Identified articles were published between 2007 and 2018.

RESULTS

Twenty empirical studies confirmed the association between IUS and suicidality, strongly differentiated between males and females, highlighting the importance of gender-specific mediating factors.

CONCLUSIONS

Mental health nurses need to document gender factors, frequency, and motivation of IUS when screening adolescents experiencing suicidal behavior and IUS.

Neuroimaging Correlates of Suicidality in Decision-Making Circuits in Posttraumatic Stress Disorder

In depression, brain and behavioral correlates of decision-making differ between individuals with and without suicidal thoughts and behaviors. Though promising, it remains unknown if these potential biomarkers of suicidality will generalize to other high-risk clinical populations. To preliminarily assess whether brain structure or function tracked suicidality in individuals with posttraumatic stress disorder (PTSD), we measured resting-state functional connectivity and cortical thickness in two functional networks involved in decision-making, a ventral fronto-striatal reward network and a lateral frontal cognitive control network. Neuroimaging data and self-reported suicidality ratings, and suicide-related hospitalization data were obtained from 50 outpatients with PTSD and also from 15 healthy controls, and all were subjected to seed-based resting-state functional connectivity and cortical thickness analyses using a priori seeds from reward and cognitive control networks. First, general linear models (GLM) were used to evaluate whether ROI-to-ROI functional connectivity was predictive of self-reported suicidality after false discovery rate (FDR)-correction for multiple comparisons and covariance of age and depression symptoms. Next, regional cortical thickness statistics were included as predictors of ROI-to-ROI functional connectivity in follow-up GLMs evaluating structure-function relationships. Functional connectivity between reward regions was positively correlated with suicidality (p-FDR ≤ 0.05). Functional connectivity of the lateral pars orbitalis to anterior cingulate/paracingulate control regions also tracked suicidality (p-FDR ≤ 0.05). Furthermore, cortical thickness in anterior cingulate/paracingulate was associated with functional correlates of suicidality in the control network (p-FDR < 0.05). These results provide a preliminary demonstration that biomarkers of suicidality in decision-making networks observed in depression may generalize to PTSD and highlight the promise of these circuits as transdiagnostic biomarkers of suicidality.

Attempted suicide and oxytocin-related gene polymorphisms

BACKGROUND

Oxytocin may moderate prosocial behaviors, but has also been implicated in negative mental health outcomes. A single-nucleotide polymorphism (SNP) of the oxytocin receptor gene (OXTR), rs53576, and a SNP of the CD38 gene, which regulates oxytocin secretion, rs3796863, have been associated with depression and suicidal ideation.

METHODS

We conducted an exploratory study investigating the relationship of these two SNPs to history of suicide attempt. Secondary analyses explored relationships of genotype with sex, diagnosis, history of abuse, depression, suicidal ideation, and attachment and personality traits. Subjects were depressed adults with DSM-IV major depressive disorder (MDD; n = 161) or bipolar disorder (BD; n = 75).

RESULTS

The A allele of rs53576 was associated with suicide attempt history. A differential effect of rs3796863 genotype on suicide attempt risk was found by diagnosis. In the BD sample, CC and AC genotypes were associated with higher odds of suicide attempt compared to AA, while in the MDD sample, AC subjects were more likely than CC subjects to have made an attempt.

LIMITATIONS

Our assessment of social sensitivity was limited to measures of attachment style and abuse history and did not differentiate between types of abuse. Plasma oxytocin was not measured.

CONCLUSIONS

These findings add to evidence for the involvement of oxytocin in suicide attempts and identify a potential biomarker for differentiating depressed attempters from non-attempters.

Epidemiology of Suicide and the Psychiatric Perspective

Suicide is a worldwide phenomenon. This review is based on a literature search of the World Health Organization (WHO) databases and PubMed. According to the WHO, in 2015, about 800,000 suicides were documented worldwide, and globally 78% of all completed suicides occur in low- and middle-income countries. Overall, suicides account for 1.4% of premature deaths worldwide. Differences arise between regions and countries with respect to the age, gender, and socioeconomic status of the individual and the respective country, method of suicide, and access to health care. During the second and third decades of life, suicide is the second leading cause of death. Completed suicides are three times more common in males than females; for suicide attempts, an inverse ratio can be found. Suicide attempts are up to 30 times more common compared to suicides; they are however important predictors of repeated attempts as well as completed suicides. Overall, suicide rates vary among the sexes and across lifetimes, whereas methods differ according to countries. The most commonly used methods are hanging, self-poisoning with pesticides, and use of firearms. The majority of suicides worldwide are related to psychiatric diseases. Among those, depression, substance use, and psychosis constitute the most relevant risk factors, but also anxiety, personality-, eating- and trauma-related disorders as well as organic mental disorders significantly add to unnatural causes of death compared to the general population. Overall, the matter at hand is relatively complex and a significant amount of underreporting is likely to be present. Nevertheless, suicides can, at least partially, be prevented by restricting access to means of suicide, by training primary care physicians and health workers to identify people at risk as well as to assess and manage respective crises, provide adequate follow-up care and address the way this is reported by the media. Suicidality represents a major societal and health care problem; it thus should be given a high priority in many realms.