Lifetime prevalence of suicide ideation, plan, and attempt in metropolitan China

Suicidal thoughts and behaviors in the Kingdom of Saudi Arabia

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

INTRODUCTION

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

The role of premeditation in suicide: Identifying factors associated with increased planning among suicide decedents

INTRODUCTION

Suicide premeditation is a critical factor to consider when assessing suicide risk. Understanding which individuals are more or less likely to plan their suicidal behavior can shed light on how suicidal thoughts turn into actions.

METHOD

The present study used psychological autopsy data to identify factors associated with level of premeditation among 131 adults who died by suicide.

RESULTS

Logistic regression analyses indicated that suicide decedents with higher premeditation scores had higher odds of being diagnosed with a depressive disorder and choosing a violent suicide method, specifically a firearm. Individuals with lower premeditation scores had higher odds of being diagnosed with a polysubstance use disorder.

CONCLUSION

Suicide decedents exhibiting greater premeditation before their deaths were different in several ways from suicide decedents exhibiting less premeditation. A better understanding of suicide premeditation can ultimately aid in the development of improved risk assessments and targeted safety interventions for those struggling with suicidal thoughts.

Connectomics-based resting-state functional network alterations predict suicidality in major depressive disorder

Suicidal behavior is a major concern for patients who suffer from major depressive disorder (MDD). However, dynamic alterations and dysfunction of resting-state networks (RSNs) in MDD patients with suicidality have remained unclear. Thus, we investigated whether subjects with different severity of suicidal ideation and suicidal behavior may have different disturbances in brain RSNs and whether these changes could be used as the diagnostic biomarkers to discriminate MDD with or without suicidal ideation and suicidal behavior. Then a multicenter, cross-sectional study of 528 MDD patients with or without suicidality and 998 healthy controls was performed. We defined the probability of dying by the suicide of the suicidality components as a 'suicidality gradient'. We constructed ten RSNs, including default mode (DMN), subcortical (SUB), ventral attention (VAN), and visual network (VIS). The network connections of RSNs were analyzed among MDD patients with different suicidality gradients and healthy controls using ANCOVA, chi-squared tests, and network-based statistical analysis. And support vector machine (SVM) model was designed to distinguish patients with mild-to-severe suicidal ideation, and suicidal behavior. We found the following abnormalities with increasing suicidality gradient in MDD patients: within-network connectivity values initially increased and then decreased, and one-versus-other network values decreased first and then increased. Besides, within- and between-network connectivity values of the various suicidality gradients are mainly negatively correlated with HAMD anxiety and positively correlated with weight. We found that VIS and DMN-VIS values were affected by age (p < 0.05), cingulo-opercular network, and SUB-VAN values were statistically influenced by sex (p < 0.05). Furthermore, the SVM model could distinguish MDD patients with different suicidality gradients (AUC range, 0.73-0.99). In conclusion, we have identified that disrupted brain connections were present in MDD patients with different suicidality gradient. These findings provided useful information about the pathophysiological mechanisms of MDD patients with suicidality.

Suicidal behaviors and associated factors among patients attending an emergency department: a facility-based cross-sectional study

BACKGROUND

Emergency departments (ED) are an important site for screening patients with suicidal behaviors. However, there is insufficient data in low-and middle-income countries regarding the magnitude of suicidal attempts among patients attending EDs. Therefore, the present study aimed to screen suicidal behavior and factors associated with suicide in patients attending an ED of Addis Ababa Burn, Emergency and Trauma Hospital, Ethiopia.

METHOD

A facility-based quantitative cross-sectional study was conducted between April and June 2018. A total of 398 participants were recruited using a consecutive sampling technique. The collected data collected includes structured questionnaires containing sociodemographic determinants, chronic medical illness conditions, substance use characteristics, social support level, common mental disorders (CMD) screening, suicidal behaviors assessment and suicidal attempts reason and method.

RESULTS

The prevalence of suicidal behavior and suicidal attempts were 8% and 6.3%, respectively. Suicide was attempted most frequently in the 18-24 age group. There was no overall difference in sex distribution for suicidal attempts. However, there were sex-based differences when the age group was taken into consideration. The commonest underlying reason for the attempt was social reasons (44%), while the most frequently reported attempt method was hanging (36%). No single factor was found to be significantly associated with the suicidal attempt.

CONCLUSION

Although suicidal behaviors are more common in patients attending the ED than in the general population, these facts have previously got little attention in patient attending EDs in low and middle income countries. The present findings support the need for a more detailed assessment of suicidal behaviours in patients attending ED and in patients with CMD.

Ketamine study: Protocol for naturalistic prospective multicenter study on subcutaneous ketamine infusion in depressed patients with active suicidal ideation

Background

Psychiatric disorders are associated with more than 90% of reported suicide attempts worldwide, but few treatments have demonstrated a direct effect in reducing suicide risk. Ketamine, originally an anesthetic, has been shown anti-suicide effects in clinical trials designed to treat depression. However, changes at the biochemical level were assessed only in protocols of ketamine with very limited sample sizes, particularly when the subcutaneous route was considered. In addition, the inflammatory changes associated with ketamine effects and their correlation with response to treatment, dose-effect, and suicide risk warrant further investigation. Therefore, we aimed to assess whether ketamine results in better control of suicidal ideation and/or behavior in patients with depressive episodes and whether ketamine affects psychopathology and inflammatory biomarkers.

Materials and methods

We report here the design of a naturalistic prospective multicenter study protocol of ketamine in depressive episodes carried out at Hospital de Clínicas de Porto Alegre (HCPA) and Hospital Moinhos de Vento (HMV). The study was planned to recruit adult patients with Major depressive disorder (MDD) or Bipolar disorder (BD) types 1 or 2, who are currently in a depressive episode and show symptoms of suicidal ideation and/or behavior according to the Columbia-Suicide Severity Rating Scale (C-SSRS) and have been prescribed ketamine by their assistant psychiatrist. Patients receive ketamine subcutaneously (SC) twice a week for 1 month, but the frequency can be changed or the dose decreased according to the assistant physician’s decision. After the last ketamine session, patients are followed-up via telephone once a month for up to 6 months. The data will be analyzed using repeated measures statistics to evaluate the reduction in suicide risk as a primary outcome, as per C-SSRS.

Discussion

We discuss the need for studies with longer follow-ups designed to measure a direct impact on suicide risk and that additional information about the safety and tolerability of ketamine in particular subset of patients such as those with depression and ideation suicide. In line, the mechanism behind the immunomodulatory effects of ketamine is still poorly understood.

Trial registration

https://clinicaltrials.gov/, identifier NCT05249309.

Prevalence of depression, anxiety, and suicidal ideation during the Shanghai 2022 Lockdown: A cross-sectional study

BACKGROUND

Common mental disorders and suicidal ideation are associated with exposures to COVID-19 pandemic stressors, including lockdown. Limited data is available on the effect of city-wide lockdowns on population mental health. In April 2022, Shanghai entered a city-wide lockdown that sealed 24 million residents in their homes or residential compounds. The rapid initiation of the lockdown disrupted food systems, spurred economic losses, and widespread fear. The associated mental health effects of a lockdown of this magnitude are largely unknown. The purpose of this study is to estimate the prevalence of depression, anxiety, and suicidal ideation during this unprecedented lockdown.

METHODS

In this cross-sectional study, data were obtained via purposive sampling across 16 districts in Shanghai. Online surveys were distributed between April 29 and June 1, 2022. All participants were physically present and residents of Shanghai during the lockdown. Logistic regression was used to estimate the associations between lockdown-related stressors and study outcomes, adjusting for covariates.

FINDINGS

A total of 3230 Shanghai residents who personally experienced the lockdown participated the survey, with 1657 (55.5 %) men, 1563 (44.3 %) women, and 10 (0.02 %) other, and a median age of 32 (IQR 26-39), who were predominately 3242 (96.9 %) Han Chinese. The overall prevalence of depression based on PHQ-9 was 26.1 % (95 % CI, 24.8 %-27.4 %), 20.1 % (18.3 %-22.0 %) for anxiety based on GAD-7, and 3.8 % (2.9 %-4.8 %) for suicidal ideation based on ASQ. The prevalence of all outcomes was higher among younger adults, single people, lower income earners, migrants, those in poor health, and with a previous psychiatric diagnosis or suicide attempt. The odds of depression and anxiety were associated with job loss, income loss, and lockdown-related fear. Higher odds of anxiety and suicidal ideation were associated with being in close contact with a COVID-19 case. Moderate food insecurity was reported by 1731 (51.8 %), and 498 (14.6 %) reported severe food insecurity. Moderate food insecurity was associated with a >3-fold increase in the odds of screening for depression and anxiety and reporting suicidal ideation (aOR from 3.15 to 3.84); severe food insecurity was associated with >5-fold increased odds for depression, anxiety, and suicidal ideation (aOR from 5.21 to 10.87), compared to being food secure.

INTERPRETATION

Lockdown stressors, including food insecurity, job and income loss, and lockdown-related fears, were associated with increased odds of mental health outcomes. COVID-19 elimination strategies including lockdowns should be balanced against the effects on population wellbeing. Strategies to avoid unneeded lockdown, and policies that can strengthen food systems and protect against economic shocks are needed.

FUNDING

Funding was provided by the NYU Shanghai Center for Global Health Equity.

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.

Common and differential risk factors behind suicidal behavior in patients with impulsivity-related disorders: The case of bulimic spectrum eating disorders and gambling disorder

BACKGROUND AND AIMS

Mental disorders with high levels of impulsivity such as bulimic spectrum eating disorders (BSED) and gambling disorder (GD) are associated with high risk of suicidal behavior. The aim of the present study was to identify the common and differential vulnerability factors behind suicide attempts in a sample of patients with BSED compared to patients with GD.

METHODS

A total of 6,077 adults who sought treatment and met criteria either for BSED (n = 2,391) or GD (n = 3,686) were assessed at a specialized hospital unit. Personality traits, psychopathological symptomatology, lifetime history of suicide attempts and socio-demographic variables were evaluated.

RESULTS

The prevalence of suicide attempts was higher for BSED patients (26.2%) compared to GD patients (7.1%) being anorexia nervosa (Binge/Purge type) and bulimia nervosa the most affected subtypes. In the predictive model, the transdiagnostic vulnerability factors with the highest contribution to the risk of suicidal behavior both in BSED and GD were unemployment, early age of onset of the disorder, worse psychopathological state, and self-transcendence personality trait. However, specific risk factors for suicidal acts were identified in each disorder: longer duration of the disorder, lower education levels and reward dependence were exclusively associated with BSED while female gender, older age, and higher harm avoidance were associated with GD.

DISCUSSION

Patients with GD and BSED share certain vulnerability factors although certain factors are exclusive to each disorder.

CONCLUSIONS

Interventions need to pay special attention to both common and specific vulnerability factors to mitigate the risk of suicidal acts in these disorders.

Identification of suicidality in patients with major depressive disorder via dynamic functional network connectivity signatures and machine learning

Major depressive disorder (MDD) is a severe brain disease associated with a significant risk of suicide. Identification of suicidality is sometimes life-saving for MDD patients. We aimed to explore the use of dynamic functional network connectivity (dFNC) for suicidality detection in MDD patients. A total of 173 MDD patients, including 48 without suicide risk (NS), 74 with suicide ideation (SI), and 51 having attempted suicide (SA), participated in the present study. Thirty-eight healthy controls were also recruited for comparison. A sliding window approach was used to derive the dFNC, and the K-means clustering method was used to cluster the windowed dFNC. A linear support vector machine was used for classification, and leave-one-out cross-validation was performed for validation. Other machine learning methods were also used for comparison. MDD patients had widespread hypoconnectivity in both the strongly connected states (states 2 and 5) and the weakly connected state (state 4), while the dysfunctional connectivity within the weakly connected state (state 4) was mainly driven by suicidal attempts. Furthermore, dFNC matrices, especially the weakly connected state, could be used to distinguish MDD from healthy controls (area under curve [AUC] = 82), and even to identify suicidality in MDD patients (AUC = 78 for NS vs. SI, AUC = 88 for NS vs. SA, and AUC = 74 for SA vs. SI), with vision-related and default-related inter-network connectivity serving as important features. Thus, the dFNC abnormalities observed in this study might further improve our understanding of the neural substrates of suicidality in MDD patients.

Depression and suicide attempts in Chinese adolescents with mood disorders: the mediating role of rumination

Mood disorders (MD) are often associated with a higher incidence of suicidal behavior, especially in adolescent patients. However, the mechanisms by which depression affects suicide attempts in adolescents with MD remain poorly elucidated. Therefore, the purpose of this study was to determine the incidence, risk factors, and clinical correlates of suicide attempts in Chinese adolescent patients with MD, as well as the inter-relationship between depressive symptoms, rumination, and suicide attempts, and the role of rumination in mediating depression and suicide attempts. A total of 331 MD adolescent patients aged 11 ~ 18 years were recruited from a psychiatric hospital. Suicide attempts were assessed with the MINI Suicide Scale. Depressed symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9). To assess rumination, we used the 21-item Chinese version of the Ruminative Responses Scale (RRS). Overall, the percentage of suicide attempts among MD adolescents was 51.96%, with a higher percentage of females (58.62%) than males (36.36%). Compared to non-suicide attempters, suicide attempters had higher scores on PHQ-9, RRS, depression-related, brooding, and reflective pondering. Gender and RRS were independently associated with suicide attempts. Rumination played a fully mediating role between depression and suicide attempts. In addition, the mediating effect of depression between rumination and suicide attempts was not significant. The incidence of suicide attempts was higher in MD adolescents than in general adolescents. Gender and rumination were associated with suicide attempts in MD adolescents. Moreover, rumination mediated the correlation between depressive symptoms and suicide attempts, suggesting that rumination may be an important intervention component for clinical staff to prevent suicidal behavior in adolescents with MD.

Carbon Monoxide Poisoning was Associated With Lifetime Suicidal Ideation: Evidence From A Population-Based Cross-Sectional Study in Hebei Province, China

Objectives: We want to test the association between carbon monoxide poisoning (CMP) experiencing and lifetime suicidal ideation/suicide plan among community residents.

Methods: This is a population-based cross-sectional study conducted among community residents in Hebei province, China. We analyzed a total of 21,376 valid questionnaires. CMP experience and lifetime suicidal ideation/suicide plan were assessed in this study. Logistic regression and false discovery rate correction were conducted to analyze the associations and correct the p values.

Results: We found that CMP (OR = 2.56, p &lt; 0.001, corrected-p = 0.001) was associated with lifetime suicidal ideation, and the other risk factors were female (OR = 0.53, p &lt; 0.001, corrected-p = 0.001). The association between CMP and suicide plan was not supported after false discovery rate correction (OR = 2.15, p = 0.035, corrected-p = 0.385). For the CMP patients, experiencing ≥2 times CMP (OR = 2.76, p = 0.001, corrected-p = 0.011) was also in higher risk of lifetime suicidal ideation. The association between CMP times and lifetime suicidal plan was not supported after false discovery rate correction (OR = 4.95, p = 0.021, corrected-p = 0.231).

Conclusion: CMP patients are in higher risk of lifetime suicidal ideation. For CMP patients, some strategies are needed to control their suicidal ideation.

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

Background

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

Materials and Methods

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

Results

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

Conclusion

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

The mediating role of attachment and mentalising in the relationship between childhood maltreatment, self-harm and suicidality

BACKGROUND

Although the relationship between childhood maltreatment, self-harm and suicidality is well-established, less is known about the mediating mechanisms explaining it. Based on a developmental mentalisation-based theoretical framework, childhood adversity compromises mentalising ability and attachment security, which in turn increase vulnerability to later stressors in adulthood.

OBJECTIVE

This study aimed to investigate the role of attachment and mentalising as potential mechanisms in the relationship between childhood maltreatment, self-harm and suicidality.

PARTICIPANTS AND SETTING

We recruited 907 adults from clinical and community settings in Greater London.

METHODS

The study design was cross-sectional. Participants completed self-report questionnaires on retrospectively rated childhood trauma, and current attachment to the romantic partner, mentalising, self-harm, suicidal ideation and attempt. We used structural equation modelling to examine the data and conceptualized childhood maltreatment as a general factor in a confirmatory bifactor model.

RESULTS

The results showed that childhood maltreatment was both directly associated with self-harm and suicidality and indirectly via the pathways of attachment and mentalising.

CONCLUSIONS

These findings indicate that insecure attachment and impaired mentalising partially explain the association between childhood maltreatment, self-harm and suicidality. Clinically, they provide support for the potential of mentalisation-based therapy or other psychosocial interventions that aim to mitigate the risk of self-harm and suicidality among individuals who have experienced childhood maltreatment via increasing understanding of self and other mental states.

Predictors of suicide attempt in patients with obsessive-compulsive disorder: an exploratory study with machine learning analysis

BACKGROUND

Patients with obsessive-compulsive disorder (OCD) are at increased risk for suicide attempt (SA) compared to the general population. However, the significant risk factors for SA in this population remains unclear - whether these factors are associated with the disorder itself or related to extrinsic factors, such as comorbidities and sociodemographic variables. This study aimed to identify predictors of SA in OCD patients using a machine learning algorithm.

METHODS

A total of 959 outpatients with OCD were included. An elastic net model was performed to recognize the predictors of SA among OCD patients, using clinical and sociodemographic variables.

RESULTS

The prevalence of SA in our sample was 10.8%. Relevant predictors of SA founded by the elastic net algorithm were the following: previous suicide planning, previous suicide thoughts, lifetime depressive episode, and intermittent explosive disorder. Our elastic net model had a good performance and found an area under the curve of 0.95.

CONCLUSIONS

This is the first study to evaluate risk factors for SA among OCD patients using machine learning algorithms. Our results demonstrate an accurate risk algorithm can be created using clinical and sociodemographic variables. All aspects of suicidal phenomena need to be carefully investigated by clinicians in every evaluation of OCD patients. Particular attention should be given to comorbidity with depressive symptoms.

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

Purpose

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

Methods

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

Results

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

Conclusion

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

The Mediating Effect of Depression on the Relation Between Interpersonal Needs and Suicidal Ideation Among Chinese Transgender Women

BACKGROUND

Transgender women are at high risk of depression and suicidal ideation. The interpersonal theory of suicide proposes that suicidal ideation could be a consequence of high interpersonal needs (thwarted belongingness and perceived burdensomeness). The current study tests this theory and investigates whether depression could mediate the relationship between interpersonal needs and suicidal ideation among transgender women in Shenyang, China.

METHODS

A total of 198 transgender women were recruited by snowball sampling. A cross-sectional study was conducted through a structured questionnaire. Suicidal ideation, depression, and interpersonal needs were assessed. Path analysis was used to carry out the research goals and the mediating effect of depression was tested.

RESULTS

There were nearly 37% of the participants reported lifetime suicidal ideation. Suicidal ideation was positively correlated with thwarted belongingness (t = -5.53, p < 0.01) and perceived burdensomeness (t = -5.02, p < 0.01). The direct effect from thwarted belongingness to suicidal ideation via depression was statistically significant (Std. β = 0.232, p < 0.01). Depression could also mediate the indirect path from perceived burdensomeness to suicidal ideation through depression (Std. β = 0.222, p < 0.01) although the direct path between them was not significant (Std. β = 0.046, p = 0.693).

CONCLUSIONS

Depression fully mediated the relationship between perceived burdensomeness and suicidal ideation, and partially mediate the relationship between thwarted belongingness and suicidal ideation. To reduce the risk of suicidal ideation among transgender women, interventions targeting thwarted belongingness, perceived burdensomeness, and depression are needed.

Differentiating the associations between sleep quality and suicide behaviors: A population-based study in China

BACKGROUND

Although the association between sleep problems and suicidal behaviors were found in many studies, their associations are not built until now. One of the reasons may be the identified differences among different suicide behaviors, which also implied that sleep quality may play different roles on these suicidal behaviors. However, absent study explores the possible distinguishing associations between sleep quality and different suicidal behaviors.

METHODS

This is a population-based study conducted in Hebei province, China. Totally, 21,376 valid questionnaires were analyzed in this study. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality. Suicidal behaviors, living alone, and social-demographic variables were assessed for all the participants.

RESULTS

The prevalence of suicidal ideation, plan, and attempt were 1.4%, 0.3%, and 0.2%, respectively. The PSQI scores were separately associated with suicidal ideation (OR=1.25, p<0.001), plan (OR=1.19, p<0.001), and attempt (OR=1.18, p<0.001). The similar results were also supported when we compared conditional suicidal behaviors with general population without any suicidal behaviors. However, when we compared suicide attempters with suicidal ideators (with or without suicide plan), the associations between PSQI scores and suicide attempt were not supported (OR=1.93, P>0.05 or OR=1.02, p>0.05).

LIMITATIONS

The cross-sectional design made us cannot get any causal relationships. The self-reported sleep quality may also produce some influence on the results.

CONCLUSION

The results imply us that improving sleep quality may be not effective to control further suicidal behaviors, when people have considered or planned to suicide. The findings also can be translated into the clinical and preventive practice for suicide control.

The Influence of Family-Related Factors on Suicide in Major Depression Patients

OBJECTIVE

To explore the influence of family-related factors on suicide-related behaviors of patients with major depression disorder, and to provide scientific evidence for effective preventive measures.

METHODS

A total of 852 outpatients at Renmin Hospital of Wuhan University were enrolled in this cross-sectional study from April 2019 to January 2021. The general demographic information and family-related information of the patients were collected via a general information questionnaire, the Family Assessment Device, the Egna Minnen av Barndoms Uppfostran, and the Childhood Trauma Questionnaire.

RESULTS

Participants without suicide-related behaviors accounted for 10.45% of the total sample, those with suicidal ideation accounted for 47.54%, those with suicidal plans accounted for 24.77% and with suicidal attempts for 17.25%. Patients with major depression disorder who have lower education level, who were separated from their parents, who have severely impaired family function, who experienced childhood abuse, and whose parents adopted apathetic and severe child-rearing styles had a higher risk of suicide-related behaviors. In the multivariate regression model, degree of major depression disorder, education and child-rearing style were independent risk factors for suicide-related behaviors.

CONCLUSION

Patients with major depression disorder who have been separated from their parents, have severely impaired family function, were abused in childhood or have been exposed to improper childrearing styles have a greater risk of suicide. Family-related factors play a predictive role in suicide in patients with major depression disorder. More attention should be paid to family-related factors to reduce the occurrence of suicidal ideation and attempt.

Prevalence and correlates of suicidal behaviors in the Taiwan Psychiatric Morbidity Survey

BACKGROUND/PURPOSE

Suicide is a huge global health burden. High suicide rates with a low prevalence of major depressive disorder were reported in East Asia. This study aimed to investigate the prevalence of suicidal behaviors in relation to the demographic characteristics and major depressive disorder in Taiwan.

METHODS

This study was based on the Taiwan Psychiatric Morbidity Survey, conducted between 2003 and 2005, a survey of common psychiatric disorders in a nationally representative sample of non-institutionalized civilians aged 18 or above. Demographic data, major depressive disorder, and suicidal behaviors were ascertained by a face-to-face interview using the paper version of the World Mental Health Survey Composite International Diagnostic Interview.

RESULTS

According to the total sample of 10,135 participants, the lifetime prevalence of suicidal ideation, plans and attempts was 7.52% (S.E = 0.46%), 1.31% (S.E. = 0.16%) and 1.29% (S.E. = 0.16%), respectively. Among suicide ideators, the conditional probability of making a suicide plan was 17.39% (S.E. = 1.92%), and a suicide attempt 17.16% (S.E. = 2.15%). Age ≤ 40, female sex, and major depressive disorder were related to a higher risk of suicidal behaviors in the general population; the former two were associated with further developing suicide attempts and the latter one developing plans among ideators.

CONCLUSION

Despite low prevalence, major depressive disorder remained a significant risk factor for suicidal behaviors in Taiwan.

Obsessive Thought, Compulsive Behavior, and Their Associations With Suicide Ideation and Attempts and Major Depressive Disorder: A Nationwide Community Sample of Korean Adults

ABSTRACT

In this study, we defined obsessive thoughts (OT) as bothersome, unpleasant thoughts about oneself that keep entering the mind against one's will, and compulsive behavior (CB) as behavior that a person repeats against his or her wishes. The study included 12,532 adults selected randomly through a one-person-per-household method. Each subject selected underwent a face-to-face interview using the Korean version of the Composite International Diagnostic Interview with a questionnaire that examines lifetime suicide attempts (LSAs). Among the participants, 341 (2.74%) had OT and 639 (5.14%) had CB. The highest LSA rate was in subjects with both OT and CB, followed by those with either OT or CB; subjects with neither OT nor CB had the lowest LSA rate. In a multivariate logistic regression analysis of OT and CB, OT, ordering, and rituals of repeating words were significantly associated with LSAs. In subjects with OT and CB, those with MDD had a significantly higher risk of LSAs compared with those without, and MDD with both OT and CB showed odds of approximately 27-fold (adjusted odds ratio, 27.24; 13.29-55.82; p < 0.0001) compared with those without MDD, OT, or CB. OT and CB were associated with increased risk of LSAs, and comorbid MDD further increased LSAs.

Prevalence of suicidal ideation, suicide attempt, and suicide plan among HIV/AIDS: A systematic review and meta-analysis

BACKGROUND

Suicidality is common in people living with HIV/AIDS. However, the prevalence estimates of the suicidality vary between studies. Here, we performed a systematic review and estimated the prevalence of suicidal behavior in this population.

METHODS

Systematic search of PubMed, Embase, Web of Science, CINAHL, Scopus and PsycINFO for relevant studies published before August 29, 2020. A random-effects model was used to pool the estimates of the prevalence of suicidal ideation, attempts and plans, which were also stratified by continent or region and screening instrument from the studies included in this meta-analysis.

RESULTS

Suicide prevalence data were extracted from 36 studies(n=32,818) from 15 countries. The overall pooled crude prevalence estimates of suicidal ideation, plans, and attempts were 20.9% [95% confidence interval (CI) 16.5-21.6%],8.1% (95% CI 5.4-11.3%), and 7.5% (95% CI 5.7-9.5%), respectively. For lifetime suicidal ideation and attempts prevalence, this was 22.4% (95% CI 15.9-29.8%), and 12.0% (95% CI 6.9- 18.1%), respectively. Summary prevalence estimates ranged across assessment modalities from 6.5% to 33.7%. Pooled estimates were generally higher for females, as compared with males (risk ratios in the range 1.48-1.85). The leave-one-out analysis showed that no single study significantly affected the final pooled results.

The analysis of acne increasing suicide risk

Acne is associated with depression and anxiety; however, the relationship between acne and suicide is still unclear. This study is aimed to evaluate the association between acne and suicide by conducting a meta-analysis. Studies were identified by electronic searches of the PubMed and EMBASE databases from their inception through Jan 10, 2020. Two authors separately assessed the quality and extracted data from the selected studies. When the heterogeneity was significant, we used a random-effects model to calculate overall pooled risk estimates.Five studies involving a total of 2,276,798 participants were finally included in the meta-analysis; 52,075 participants had acne. Suicide was positively associated with acne in the overall analysis (odds ratio (OR) 1.50, 95% confidence interval (95% CI): 1.09-2.06, P = .004, I2 = 74.1%). Subgroup analyses were performed for suicidal behavior groups (P = .002, I2 = 80.4%), suicidal ideation or thoughts groups (P = .849, I2 = 0.0%), International Classification of Diseases version 9 (ICD-9) groups (P = .137, I2 = 49.6%), non-ICD-9 groups (P = .950, I2 = 0.0%), American groups (P = .311, I2 = 2.4%), and non-American groups (P = .943, I2 = 0.0%). Sensitivity analyses indicated flawed results. No publication bias was detected.Acne may significantly increase suicide risk. Clinicians should actively treat acne and consider suicide screening. Further international studies with high-quality analyses are needed as more data are published.Ethical approval and patient consent are not required because this study is a literature-based study.

Prevalence of suicidal ideation and attempted suicide in the general population of Ethiopia: a systematic review and meta-analysis

Background

In Ethiopia, in spite of the high burden of suicide related-adverse effect, substantial variability in the reported prevalence of individual studies about suicidal ideation and attempted suicide; there is no national level epidemiological evidence. Thus, the present study aimed to determine the pooled prevalence of suicide ideation and suicidal attempt in the general population.

Methods

We followed the PRISMA Guidelines to report the results of the finding. Databases including: PubMed/Medline, SCOPUS, CINAHL (EBSCOhost), African Journal Online (AJOL) and African Indexed Medicus (AIM) were searched. Heterogeneity was assessed by Cochrane chi-square (χ²) and quantified by I² statistics test. Sensitivity test and subgroup analysis performed. Publication bias was tested by funnel plots and Egger’s test. Effect size was calculated by random effects model.

Results

A total of 12 studies for suicidal ideation and 10 studies for attempted suicide were included in the study. The prevalence of suicidal ideation and attempted suicide were ranged from 1 to 55% and 0.6% to 14% respectively. The 12-month pooled prevalence of suicidal ideation and suicidal attempt were 9% (5–16%), I² = 99.64%, p < 0.001 and 4% (1–8%), I² = 98.11%, p < 0.001] respectively. The lifetime pooled prevalence of attempted suicide was found to be 4% (3–6%). We found evidence of significant heterogeneity for suicidal ideation [I² = 99.64%, p < 0.001] and attempted suicide [I² = 98.11%, p < 0.001]. The subgroup analysis could not identified source of heterogeneity. The sensitivity analysis showed that none of the point estimates was outside of the overall 95%CI for suicidal ideation and attempted suicide. No evidence of publication bias from the visual inspection of the funnel plot for suicidal ideation and [Egger’s test (P = 0.174)] and attempted suicide [Egger’s test (P = 0.318)].

Conclusion

High prevalence of suicidal ideation and attempted suicide were observed in the general population of Ethiopia. These suggest the need of strengthening the awareness of suicidal behaviours and evaluate the effectiveness of the national health strategy in addressing the issues of suicidal behaviours.

Physical multimorbidity and lifetime suicidal ideation and plans among rural older adults: the mediating role of psychological distress

BACKGROUND

Previous studies have revealed that single physical chronic condition was associated with suicidal ideation/plans, but few studies have examined the relationship between multimorbidity and suicidal ideation/plans, and no studies have explored the underlying potential mechanism on this relationship in China. This study aimed to explore association between physical multimorbidity and suicidal ideation as well as plans, and further examine the mediating role of psychological distress (PD) on this relationship.

METHODS

This study was based on the data from a survey about the health service of rural elderly household in Shandong, China. A total of 3242 adults aged 60 years and older were included in this study. PD was measured by Kessler Psychological Distress Scale (K10). Ordinal and binary logistic regression analyses were employed to explore the association between physical multimorbidity, PD and suicide ideation/plans. Bootstrapping analysis was further used to examine the mediation effect of PD on the association of multimorbidity and suicidal ideations/plans.

RESULTS

The prevalence of multimorbidity, lifetime suicidal ideation, and suicidal plan in rural older adults was 35.2, 10.6 and 2.2%, respectively. Older adults living in rural areas with two or more chronic physical conditions experienced significantly higher risk of suicidal ideation and suicidal plans. The association between multimorbidity and suicidal ideations/plans was partially mediated by PD, of which, the mediating effect of PD accounted for 31.7 and 25.5% of the total effect, respectively.

CONCLUSION

This study demonstrated the associations between physical multimorbidity and suicidal ideation/plans, and the mediating role of PD on this relationship among Chinese rural elderly. Healthcare providers in rural community should provide regular surveillance for the mental health status among the rural elderly with multimorbidity, and carry out various effective intervention measures to improve the mental health status, so as to reduce the risk of suicide.

Differences in physical, mental, and social functions between males and females in multiple sclerosis: A multicenter cross-sectional study in China

Background Sex-specific differences in multiple sclerosis (MS) have been recognized, but few were known about how sex influences the characteristics of MS in Asian and the social burden of MS. This study aimed to investigate the symptoms, mental health, and social functions of Chinese MS patients and find differences between sexes. Methods MS patients were enrolled from January 2004 to September 2018. A questionnaire was distributed by 47 medical centers. Patients' physical symptoms, negative emotions, interpersonal communication, social intercourse, employment condition, and suicidal thoughts and behavior were collected. Patients were asked to fill in the questionnaire independently and undergo Expanded Disability Status Scale (EDSS) measurement. Unpaired t-tests between sexes were conducted for normally distributed continuous variables. Mann-Whitney u-tests were conducted for non-normally distributed data. Chi-square tests, Fisher exact tests and rank sum tests were performed for categorical variables. Results 931 patients were enrolled and 631 were female. Frequency of fatigue and pain were higher in female MS patients (P<0.05), while male patients complained more weakness, diplopia, sexual dysfunction, and micturition and defecation dysfunction (P<0.05). Females were more likely to experience sadness and helplessness than males (P<0.05) while males were more likely to experience nonacceptance than females (P<0.05). MS had a worse influence on male patients in relationships with family and friends (P<0.05). The employment rate of MS patients was 39.31%. The frequency of suicidal attempt was 2.36%, which was higher than general population. Conclusions The study provided evidence that characteristics of MS were different between males and females, and influence in mental and social function was a common problem among MS patients. More attention should be paid to the mental health and social function of MS patients.

Prevalence of suicidal ideation and suicide attempt in patients with migraine: A systematic review and meta-analysis

BACKGROUND

Suicidality is common in patients with migraine. Here, we performed a systematic review and estimated the prevalence of suicidal ideation (SI) and suicide attempt (SA) in patients with migraine.

METHODS

We searched Pubmed, Embase, Web of Science, Cochrane database library, CINAHL, and PsycINFO for relevant publications. A random-effects model was used to pool the estimates of the prevalence of SI and SA, which were also stratified by the geographical location of the research institutions from the studies included in this meta-analysis.

RESULTS

Fifteen studies involving 2,247,648 participants with migraine were selected. Pooled prevalence estimates of SI and SA were 15.5% [95% confidence interval (CI) 10.4-21.3%] and 3.9% (95% CI 0.9-8.8%), respectively, and the prevalence of SI was higher in Asian countries (21.5%, 95%CI 16.8-26.6%) compared with non-Asian countries (11.0%, 95%CI 6.1-17.2%). Measures of heterogeneity between studies were high for all outcomes (I² = 89-100%), indicating that the substantial between-study heterogeneity in estimated proportions was not attributed to sampling error. The leave-one-out analysis showed that no single study significantly affected the final pooled results.

CONCLUSIONS

This meta-analysis indicated a high prevalence of SI and SA in migraine patients. Thus, it is necessary to design targeted preventive measures for the management of migraine-related suicide.

The relationship between activities of daily living and suicidal ideation among Chinese rural older adults: a multiple mediation model through sleep quality and psychological distress

Few studies clarified the mechanisms underlying the relationship between activities of daily living and suicidal ideation among older adults. This study aimed to explore the multiple mediating roles of sleep quality and psychological distress between this relationship. A total of 3,243 rural older adults were included. Multiple mediation analysis was performed using Mplus 8.3. Activities of daily living was found to directly affect suicidal ideation (β=0.092, 95% CI=0.043−0.140) and through three significantly mediation pathways: (1) the path through sleep quality (β=0.019, 95% CI=0.007−0.031), which accounted for 9.79 % of the total effect; (2) the path through psychological distress (β=0.049, 95% CI=0.036−0.063), which accounted for 25.26 % of the total effect; (3) the path through sleep quality and psychological distress (β=0.034, 95% CI=0.026−0.042), which accounted for 17.53 % of the total effect. The total mediating effect was 52.58%. Attention should be paid to sleep quality and mental health among the Chinese rural older adults with activities of daily living limitation. For early detection and prevention of suicidal ideation, it is necessary to take sleep-based and positive psychological interventions for older adults with activities of daily living limitation.

Psychological Strain and Suicidal Ideation in Athletes: The Multiple Mediating Effects of Hopelessness and Depression

The present study aims to examine the relationship between psychological strain, suicidal ideation, hopelessness, and depression among Chinese athletes. Participants were 774 Chinese athletes (454 men and 320 women), with a range of ages from 12 to 35 (M = 18.47, SD = 3.39). The structural equation modeling method was used to examine the multiple mediating effects of hopelessness and depression between psychological strain and suicidal ideation. As expected, a positive correlation between psychological strain, suicidal ideation, hopelessness, and depression was found. Additionally, results seem to indicate that psychological strain directly and positively influenced suicidal ideation, and that hopelessness and depression played a serial mediating role in the relationship between psychological strain and suicidal ideation. To conclude, the psychological strain theory is applicable for explaining suicidal ideation in athletes. In athletes, psychological strain is sequentially associated first with a sense of hopelessness and then depression, which is in turn related to suicidal ideation. The present study makes a significant contribution to the literature because we provide a new theoretical basis and new methods for preventing mental disorder and suicidality in athletes.

Childhood Abuse and Suicidal Behaviors Among Chinese Migrant Workers: The Mediating Role of Alexithymia and Social Support

This study aims to investigate the lifetime prevalence of suicidal behaviors in a sample of Chinese migrant workers. It also examined the mediating role of alexithymia and social support in the link between childhood abuse and suicidal behaviors. A total of 1,563 migrant workers were surveyed by using cluster sampling. Results showed that the estimated lifetime prevalence of suicide ideation, plan, and attempt among Chinese migrant workers was 12.8%, 8.1%, and 4.6%, respectively. Structural equation modeling analyses revealed a significant positive association between childhood abuse and suicidal behaviors; this association was partially mediated by social support. A significant path from childhood abuse through alexithymia and social support to suicidal behaviors was also established. Findings of this study emphasize the importance of social support and alexithymia in understanding the possible mechanisms underlying the relationship between childhood abuse and suicidal behaviors and suggest possible avenues for suicide interventions.

Suicide attempts in Chinese Han patients with schizophrenia: cognitive, demographic, and clinical variables

OBJECTIVE

The purpose of this study was to investigate the lifetime suicide attempt rate, clinical characteristics and cognitive function of Chinese patients with chronic schizophrenia who had attempted suicide.

METHODS

We collected data from 908 schizophrenia inpatients about suicide attempts through interviews with the patients and their families, as well as through medical records. All patients were assessed with the Positive and Negative Syndrome Scale, the Rating Scale for Extrapyramidal Side Effects, the Abnormal Involuntary Movement Scale, and the Repeated Battery for the Assessment of Neuropsychological Status.

RESULTS

Of this sample, 97 (10.68%) had attempted suicide. Patients who had attempted suicide were younger, had longer illness duration, and more severe general psychopathology and depressive symptoms than those who had not. Logistic regression analysis confirmed that suicide attempts were correlated with age, smoking, and depression. No cognitive performance differences were observed between patients who had and had not attempted suicide.

CONCLUSIONS

In China, patients with chronic schizophrenia may have a higher prevalence of lifetime suicide attempts than the general population. Some demographic and clinical variables were related to suicide attempts in patients with chronic schizophrenia.

Why Are Suicide Rates Increasing in the United States? Towards a Multilevel Reimagination of Suicide Prevention

Suicide, a major public health concern, takes around 800,000 lives globally every year and is the second leading cause of death among adolescents and young adults. Despite substantial prevention efforts, between 1999 and 2017, suicide and nonfatal self-injury rates have experienced unprecedented increases across the United States - as well as in many other countries in the world. This chapter reviews the existing evidence on the causes behind increased suicide rates and critically evaluates the impact of a range of innovative approaches to suicide prevention. First, we briefly describe current trends in suicide and suicidal behaviors and relate them to recent time trends in relevant suicide risk markers. Then, we review the existing evidence in suicide prevention at the individual and the population levels, including new approaches that are currently under development. Finally, we advocate for a new generation of suicide research that examines causal factors beyond the proximal and clinical and fosters a socially conscious reimagining of suicidal prevention. To this end, we emphasize the need for the conceptualization of suicide and suicidal behaviors as complex phenomena with causes at several levels of organization. Future interdisciplinary research and interventions should be developed within a multilevel causal framework that can better capture the social, economic, and political settings where suicide, as a process, unfolds across the life course.

Identifying Suicidal Ideation Among Chinese Patients with Major Depressive Disorder: Evidence from a Real-World Hospital-Based Study in China

BACKGROUND

A growing body of research suggests that major depressive disorder (MDD) is one of the most common psychiatric conditions associated with suicide ideation (SI). However, how a combination of easily accessible variables built a utility clinically model to estimate the probability of an individual patient with SI via machine learning is limited.

METHODS

We used the electronic medical record database from a hospital located in western China. A total of 1916 Chinese patients with MDD were included. Easily accessible data (demographic, clinical, and biological variables) were collected at admission (on the first day of admission) and were used to distinguish SI with MDD from non-SI using a machine learning algorithm (neural network).

RESULTS

The neural network algorithm distinguished 1356 out of 1916 patients translating into 70.08% accuracy (70.68% sensitivity and 67.09% specificity) and an area under the curve (AUC) of 0.76. The most relevant predictor variables in identifying SI from non-SI included free thyroxine (FT4), the total scores of Hamilton Depression Scale (HAMD), vocational status, and free triiodothyronine (FT3).

CONCLUSION

Risk for SI among patients with MDD can be identified at an individual subject level by integrating demographic, clinical, and biological variables as possible as early during hospitalization (at admission).

Negative self-evaluation and the genesis of internal threat: beyond a continuum of suicidal thought and behaviour

BACKGROUND

Death by suicide is often preceded by attempted suicide, suicidal ideation and non-suicidal self-injury. These extreme thoughts and behaviours have been considered in terms of a continuum of suicidality. Little known research, however, has considered a suicide continuum that extends beyond these extreme thoughts and behaviours and incorporates a much wider array of phenomena that may vary in severity and may constitute a broader negative self-evaluation (NSE) continuum.

METHOD

Harvesting key indicators of NSE from a British epidemiological survey (N = 8580), the current study used exploratory factor analysis, confirmatory factor analysis and factor mixture modelling to (i) identify the dimensional structure of NSE in the general population and (ii) profile the distribution of the resultant NSE dimensions. Multinomial logistic regression was then used to differentiate between classes using an array of risk variables, psychopathology outcome variables and a suicide attempt indicator.

RESULTS

A 4-factor model that reflected graded levels of NSE was identified; (F1) Low self-worth & subordination (F2) depression, (F3) suicidal thoughts, (F4) self-harm (SH). Seven classes suggested a clear pattern of NSE severity. Classes characterised by higher levels across the dimensions exhibited greater risk and poorer outcomes. The greatest risk for suicide attempt was associated with a class characterised by engagement in SH behaviour.

CONCLUSIONS

Low self-worth, subordination and depression, while representative of distinct groups in the population are also highly prevalent in those who entertain suicidal thoughts and engage in SH behaviour. The findings promote further investigation into the genesis and evolution of suicidality and internal threat.

Prevalence and correlates of suicide attempt among Chinese individuals receiving methadone maintenance treatment for heroin dependence

To date, there have been very limited studies regarding the clinical epidemiology of attempted suicide in Chinese individuals with heroin-dependence. The objective of this study was to examine the prevalence and correlates of suicide attempt in Chinese individuals receiving methadone maintenance treatment for heroin dependence. Demographic, clinical, and psychosocial data of 603 methadone-maintained patients with heroin dependence were collected with a standardized self-administered questionnaire. The presence of suicide attempt and antisocial personality disorder was assessed by using a single question and the Mini-International Neuropsychiatric Interview 5.0. The one-month and lifetime prevalence rates of suicide attempt were 9.5% and 34.2%, respectively. In multivariable logistic regression, lifetime suicide attempt was significantly associated with female gender (OR = 2.81), being 20–39 years old (OR = 2.73), an education level of primary school or lower (OR = 2.07), poor economic status (OR = 3.06), injecting heroin before methadone maintenance treatment (OR = 2.92), depressive symptoms (OR = 3.46), anxiety symptoms (OR = 1.88), and antisocial personality disorder (OR = 2.85). Suicide attempt is very prevalent among Chinese individuals receiving methadone maintenance treatment for heroin dependence. Services for patients with heroin dependence in methadone maintenance treatment clinics in China should include psychosocial supports, periodic screening for suicide attempt and other suicidal behaviors and, when needed, psychiatric treatment and crisis intervention.

Suicide ideation and suicide plan in Chinese left-behind children: Prevalence and associated factors

OBJECTIVE

Suicide ideation (SI) and suicide plan (SP) can be seen as immediate precursors of suicide. The major aim of this study is to estimate the severity of SI and SP among LBC, and explore their associated factors.

METHOD

A population-based random sampling survey of 2898 LBC was performed. Self-developed structured questionnaire was used to collect relevant information. The prevalence of one-week and lifetime SI and SP was estimated, univariate and multivariate logistic regression model were used to analyze the associated factors of SI in LBC, as well as the associated factors of SP in LBC who reported SI.

RESULTS

For surveyed LBC, the one-week prevalence rates of SI and SP were 6.76% (95%CI: 5.30-8.00%) and 2.31% (95%CI: 1.80-2.93%), the lifetime prevalence rates of SI and SP were 20.8% (95%CI: 17.2-25.0%) and 7.69% (95%CI: 4.84-11.0%). Girls reported higher prevalence of SI, while SP severity showed insignificant gender difference. Sex, grade, SH behaviors, depression and psychological resilience were consistently associated with both one-week and lifetime SI. Age and depression were prominent influencing factors of SP in one-week suicide ideators, grade, self-harm history, depression, mother's education level were associated factors of SP in lifetime suicide ideators.

CONCLUSIONS

The prevalence of SI and SA in Chinese LBC is high. Girls, junior high school students, self-harmed, depressed, less psychologically resilient individuals were observed increased prevalence of SI, depression may play a significant role in facilitating the transition from SI to SP.

Paranoid Ideation Without Psychosis Is Associated With Depression, Anxiety, and Suicide Attempts in General Population

This study aimed to characterize the association between paranoid ideation without psychosis (PIP) and suicide attempts in a general population. A total of 12,532 adults were randomly selected as the study sample through one-person-per-household method. Subjects completed a face-to-face interview. Among 12,532 subjects, 471 (3.76%) met criteria for the PIP group. The PIP group was younger with more divorced/widowed/separated and lower income than the non-PIP group. The PIP group showed more than fivefold higher lifetime suicide attempt (LSA) rates and ninefold multiple attempt rates than the non-PIP group. Among PIP symptoms, "spouse was being unfaithful" showed the strongest association with LSA (adjusted odds ratio [AOR], 4.49; 95% confidence interval, 2.95-6.85). Major depressive disorder (MDD) in combination with PIP was associated with a higher risk of LSA (AOR, 15.39; 95% confidence interval, 9.63-24.59) compared with subjects without MDD or PIP. In conclusion, PIP, especially "doubting spouse," was significantly associated with LSA. PIP in combination with comorbid MDD showed higher risk of LSA than subjects without PIP or MDD.

A Test of the Three-Step Theory of Suicide among Chinese People: A Study Based on the Ideation-to-Action Framework

The aim of this study was to test the Three-Step Theory (3ST) of suicide in a sample of college students in China (N = 1,097). All participants completed a battery of questionnaires indexing psychological pain, hopelessness, connectedness, suicide capacity, suicide ideation, and suicide attempt. The prevalence of suicide ideation and suicide attempt among the sample were 21.42% and 3.83%, respectively. The hierarchical regression analysis showed that psychological pain and hopelessness interacted to predict suicide ideation, and that connectedness was the most protective against ideation in those high on both pain and hopelessness. Suicide capacity differentiated attempters from ideators above and beyond current suicide ideation. These findings provide preliminary evidence for the validity of 3ST of suicide within Chinese contexts. Implications for suicide prevention and intervention and future research directions are also discussed.

Social Status and Suicidal Activity Among Psychiatric Patients: Moderating Effects of Gender, Race and Psychiatric Diagnosis

The relationship between suicide and social class has proved to be complex. Durkheim predicted suicide rates would increase with social status, while others thought the opposite. Results have been mixed. In some studies, suicidality has increased with increasing social status, and in other studies, the two variables have had an inverse relationship. These studies have been primarily conducted on general non-psychiatric populations The present study, in contrast, examines this relationship on a 20-year prospective longitudinal sample of 400 psychiatric patients (differentiated by psychiatric diagnosis) after index hospitalization. Of these, 160 patients show some sign of suicide risk (87 cases of suicidal ideation, 41 of suicide attempts, and 32 suicide completions). A complicated pattern emerges across psychiatric diagnosis, gender, and race. The great majority of patients show no statistically significant relationship between social status and suicide risk. At the maximally different extremes, however, a dramatic difference does emerge. White women diagnosed with nonpsychotic depression show a positive relationship between social status and suicide risk (p < .01) while black men diagnosed with schizophrenia show a negative relationship between these 2 variables (p < .02). The relationship between social status and suicidality among psychiatric patients varies across race, gender, and psychiatric diagnosis. More research needs to be done on this complex and important topic, especially with regard to samples of psychiatric patients. The role of anomie should be studied.

Nonfatal Suicidal Behaviors of Chinese Rural-to-Urban Migrant Workers: Attitude Toward Suicide Matters

OBJECTIVE

To examine the attitude toward suicide (ATS) and its influence on nonfatal suicidal behaviors of Chinese rural-to-urban migrant workers (MWs).

METHOD

Altogether, 3031 MWs completed the positive ATS Scale and structured questions regarding lifetime suicide ideation, plan, and attempt. Mental health help-seeking behaviors of MWs were also investigated.

RESULTS

Overall, MWs held a more negative ATS than the Chinese general population. The lifetime prevalence of suicide ideation, plan, and attempt was 5.5%, 1.3%, and 1.1%, respectively. After controlling for lifetime depressive disorders and other covariates, a negative ATS was still significantly associated with lower risk of lifetime suicide ideation (OR = 0.32), plan (OR = 0.22), and attempt (OR = 0.26). MWs with a negative ATS were more likely to talk to others and seek help by online/telephone consultation for their mental health and suicidal problems (p < .05). A more positive ATS was significantly associated with male gender, low education level, ethnic minority of Miao, low monthly income, and originating from western China.

CONCLUSIONS

The majority of MWs hold a negative ATS, which significantly contributes to their relatively low risk of nonfatal suicidal behaviors. The more help-seeking from others and online/telephone consultation in MWs with a negative ATS may lower their risk of nonfatal suicidal behaviors.

Fatal and Non-fatal Self-Injury in the USA: Critical Review of Current Trends and Innovations in Prevention

PURPOSE OF REVIEW

To examine current trends in suicide and self-injury in the USA, as well as potential contributors to their change over time, and to reflect on innovations in prevention and intervention that can guide policies and programs to reduce the burden of suicide and self-injury in the USA.

RECENT FINDINGS

Suicide and non-fatal self-injury are on the rise in the USA. Reasons for such trends over time remain speculative, although they seem linked to coincident increases in mood disorders and drug use and overdose. Promising innovative prevention and intervention programs that engage new technologies, such as machine learning-derived prediction tools and computerized ecologic momentary assessments, are currently in development and require additional evidence. Recent increases in fatal and non-fatal self-harm in the USA raise questions about the causes, interventions, and preventive measures that should be taken. Most innovative prevention efforts target individuals seeking to improve risk prediction and access to evidence-based care. However, as Durkheim pointed out over 100 years ago, suicide rates vary enormously between societal groups, suggesting that certain causal factors of suicide act and, hence, should be targeted at an ecological level. In the next generation of suicide research, it is critical to examine factors beyond the proximal and clinical to allow for a reimagining of prevention that is life course and socially focused.

Suicidal ideation among the hypertensive individuals in Shandong, China: a path analysis

BACKGROUND

Although massive studies have explored the risk factors of suicidal ideation (SI), the prevalence of SI and its associated factors in the hypertensive individuals are largely unknown. This study aims to investigate the factors associated with SI in the hypertensive individuals.

METHODS

Three thousand nine hundred eleven hypertensive individuals in Shandong, China were included in the analysis. SI was assessed by using a question from the NCS (National Comorbidity Survey). We used binary logistic regression analysis to explore the factors associated with SI, and path analysis to test the direct and indirect relationships between associated factors and SI among hypertensive patients.

RESULTS

The prevalence of SI in the hypertensive individual was19.6%. Psychological distress had the greatest direct (β = 0.640, p-value <0.01) and total effect (β = 0.640, p-value <0.01) on SI. Other factors including comorbidity (β = 0.090, p-value <0.01), gender (β = 0.088, p-value <0.01), marital status (β = - 0.037, p-value <0.01), economic status (β = - 0.106, p-value <0.01), residence (β = - 0.050, p-value <0.01), alcohol use (β = 0.011, p-value <0.01), exercise (β = - 0.114, p-value <0.01), hospitalization (β = 0.041, p-value <0.01) only had indirect effects on SI. Psychological distress was a mediator between SI and those variables.

CONCLUSION

A significant mediation effect of psychological distress on the associations between SI and some associated factors (i.e., economic status, comorbidity) was demonstrated.

Association between interpersonal trust and suicidal ideation in older adults: a cross-sectional analysis of 7070 subjects in Shandong, China

BACKGROUNDS

Suicidal ideation is an important public health issue due to devastating mortality. In the meantime, interpersonal trust was found to be negatively associated with mental disorder and physical health. Although there is increasing evidence that interpersonal trust is a significant predictor of suicidal ideation, evidence of this association is still lacking in the developing world. The aim of this study was to test the association between interpersonal trust and suicidal ideation among older adults in China.

METHODS

Using a multi-stage stratified sampling strategy, 7070 older adults aged 60 and above from Shandong Province, China were recruited in this study. Socio-demographic characteristics, health status, family relationship, psychological distress, interpersonal trust and suicidal ideation in the last 12 months were obtained through face to face interviews. The association between interpersonal trust and suicidal ideation was assessed using multiple logistic regression models adjusting for socio-demographic characteristics, health status, family relationship and psychological distress.

RESULTS

7.1% of participants reported suicidal ideation in the past 12 months, which was related to gender, resident area, marital status, educational level, self-rated economic, chronic disease, self-rated health status and family relationship within 1 month, psychological distress and interpersonal trust. After adjusting for sociodemographic factors, health status, family relationship and psychological distress, interpersonal mistrust was associated with two times odds of suicidal ideation when compared to interpersonal trust CONCLUSIONS: The interpersonal trust was associated with suicidal ideation among elderly in Shandong, China. Intervention approaches regarding inducing and promoting interpersonal trust should be developed to prevent suicide.

Suicide-related behaviours in schizophrenia in China: a comprehensive meta-analysis

AIMS

Suicide-related behaviours are common in schizophrenia and are significantly associated with premature death. The objective of this meta-analysis study was to estimate the pooled prevalence of suicide-related behaviours in schizophrenia patients in China.

METHODS

The relevant literature was searched systematically via the relevant electronic databases (PubMed, Embase, PsycINFO, Chinese National Knowledge Infrastructure, Wanfang Databases and Chinese Biological Medical Literature Database) from their inception until 14 September 2016. Only original studies that reported the prevalence of suicide-related behaviours including suicidal ideation (SI), suicide plan, suicide attempt (SA) and completed suicide were selected.

RESULTS

Nineteen articles met the inclusion criteria and were analysed. The pooled lifetime prevalence of SI and SA were 25.8% (95% CI 14.7-41.1%) and 14.6% (95% CI 9.1-22.8%), respectively. The 1-month prevalence of SI was 22.0% (95% CI 18.2-26.4%). Subgroup analyses of lifetime SI and SA showed that gender, sample size, survey year, study location and source of patients have no significant mediating effects on the results.

CONCLUSIONS

Suicide-related behaviours are common in Chinese schizophrenia patients. Due to the high mortality risk, regular screening and effective suicide prevention programmes are warranted.

Comparison of suicide attempts in individuals with major depressive disorder with and without history of subthreshold hypomania: A nationwide community sample of Korean adults✰,✰✰

BACKGROUND

Subthreshold hypomania is defined as a distinct period of elevated, expansive or irritable mood lasting for at least four days, but insufficient to fulfill the criteria of hypomania. This study aimed to investigate the association between suicidality and subthreshold hypomania in subjects with and without major depressive disorder (MDD).

METHODS

Face-to-face interviews were completed for 12,526 adults, randomly selected through a one-person-per-household method, using the Korean version of the Composite International Diagnostic Interview (K-CIDI) and a questionnaire relative to lifetime suicide attempts (LSA).

RESULTS

Of the 12,526 participants, 11,701 did not have MDD, and 825 were diagnosed with MDD. The MDD with subthreshold hypomania group (n = 72) revealed significantly higher rates of LSA and post-traumatic stress disorder (PTSD) than those without (n = 753). Compared to the no MDD without subthreshold hypomania group (n = 11,571), the no MDD with subthreshold hypomania group (n = 130) showed a significantly higher prevalence of suicidality and comorbid conditions. In multivariate logistic regression analyses of depressive symptoms, subthreshold hypomania was significantly associated with morning worsening of mood. The MDD with subthreshold hypomania group was significantly associated with LSA (AOR=16.82, 95% CI 9.81-28.83, p< 0.001), compared to the no MDD group without subthreshold hypomania. Compared to the MDD without subthreshold hypomania group, the MDD with subthreshold hypomania group revealed a significant association with LSA (AOR=2.08, 95% CI 1.20-3.62, p< 0.001).

CONCLUSIONS

A history of subthreshold hypomania doubled the risk of LSA in patients with MDD compared to those without subthreshold hypomania.