Global, regional, and national burden of suicide mortality 1990 to 2016: systematic analysis for the Global Burden of Disease Study 2016

Impact of COVID-19 pandemic-related restrictive measures on overall mental and physical health and well-being, specific psychopathologies and emotional states in representative adult Greek population: Results from the largest multi-wave, online national survey in Greece (COH-FIT)

BACKGROUND

Greece faced particular COVID-19-pandemic-related challenges, due to specific socio-cultural-economic/public-health factors and drastic restrictive policies.

OBJECTIVES

To understand trajectories of overall mental and physical health, well-being, emotional states and individual psychopathology in response to pandemic-related restrictive measures within general adult Greek population across the first two pandemic waves.

METHODS

Using multiple time-point cross-sectional data from the "Collaborative Outcomes study on Health and Functioning during Infection Times" (COH-FIT), we examined changes in outcomes from retrospective pre-pandemic ratings (T0) to three distinct intra-pandemic time points (lockdown 1: T1, between lockdowns: T2, lockdown 2: T3). Primary outcomes included WHO-5 well-being scores and a composite overall psychopathology "P-score", followed by a wide range of secondary outcomes.

RESULTS

10,377 participant responses were evaluated, including 2737 representative-matched participants. Statistically significant differences in well-being and overall psychopathology before and after quarantine (T0 vs. T1-T3), as well as across the assessed time frames (T1, T2, and T3) emerged in both samples. Global mental and physical health, individual psychopathology scores (anxiety, depression, PTSD, OCD, panic, mania, mood swings, sleep and concentration problems), emotional states (anger, helplessness, fear of infection, boredom, frustration, loneliness and overall stress scores), BMI and pain scores also showed statistically significant time differences in both samples, with the exemption of self-injury and suicidal attempt scores, showing lower intra-pandemic scores.

CONCLUSIONS

This is the largest multi-wave report on well-being, mental and physical health across different pandemic restriction periods in Greece, suggesting a substantial negative effect of lockdowns on most outcomes at least during the acute pandemic waves.

Alterations in the Blood-Brain Barrier in Mood Disorders and Neurodegenerative Diseases

Depressive disorders and suicidal behaviors represent major causes of health loss. Modifications of brain microvasculature, and specifically alterations of the blood-brain barrier have been supposed to participate in the vulnerability to those disorders along with cognitive impairment, especially in the older adults. In this article, we addressed evidence linking blood-brain barrier impairments with mood disorders and suicide. Secondly, we investigated their relationship with depression in old age, and with neurodegenerative processes. Particular attention was drawn toward the potential interactions between the coagulation processes and the blood-brain barrier dysfunctions, as innovative treatment strategies may emerge from research in those fields. Overall, the studies reviewed highlight the implication of multiple dysfunctions of the blood-brain barrier in mood disorders and suicide. Impairments of the blood-brain barrier show relationships with altered expression of endothelial cell junction proteins. These modifications also implicate receptors of the extracellular matrix, the vascular endothelial growth factor, changes in perivascular astrocytes, and has links with local and systemic inflammatory processes. Dysfunctions of the blood-brain barrier underly chronic stress and participate in psychiatric diathesis in old age. In addition, we outline that coagulation processes are likely to interact with the blood-brain barrier and further contribute to neurodegenerative disorders. In conclusion, new pathophysiological models offer perspectives toward detecting new biomarkers in mood disorders and suicide. In parallel, these models open avenues for developing innovative therapeutic agents, although further considering their potential risks and eventual benefits is needed.

Depression leading to suicide in United States: A retrospective analysis of CDC WONDER from 1999 to 2022

BACKGROUND

Depressive disorder is a prevalent mental health condition in the United States, where suicide has been a leading cause of death among depressive patients. This study aimed to analyze suicide mortality trends in depressive disorder patients in the U.S. from 1999 to 2022.

METHODS

Data were extracted from the CDC WONDER database, identifying depression-related and suicide-related deaths using ICD-10-CM codes (F32, F33, F41.2, F92.0) and ICD-10-CM codes (U03, X60-X84, Y87.0) respectively. Age-adjusted mortality rates (AAMRs) per 1,000,000 and annual percent changes (APCs) were calculated and stratified by year, gender, age-group, race/ethnicity, region, and urbanization status.

RESULTS

A total of 57,103 deaths due to suicide and depressive disorder were analyzed. From 1999 to 2022, the AAMR significantly increased from 1999 to 2015 (APC: 2.05; 95 % CI: 1.65-2.74; p < 0.0001), followed by a stable trend from 2015 to 2022 (APC: 0.81; 95 % CI: 3.67 to 0.36; p = 0.14). Men consistently exhibited higher AAMRs (10) than women (3.9), with particularly highest rates observed in the 50-59 age group (11.2). Non-Hispanic (NH) White individuals had the highest AAMRs (9.9), followed by NH American Indian/Alaska Native populations (3.7), and NH Black individuals exhibiting the lowest rates (1.9). Rural areas showed significantly higher rates (12.5) compared to urban areas (5.4), with the Western U.S. region experiencing the steepest increases [Average Annual Percent Change (AAPC): 2.44; 95 % CI: 1.76 to 3.49].

CONCLUSION

This study reveals critical demographic and geographic disparities in suicide and depression-related mortality. Addressing the disproportionate burden on high-risk groups can guide future preventive strategies to mitigate the rising trends (Central Illustration).

Bibliometric analysis of suicide risk assessment in children and adolescents: Trends and future directions

Suicide risk among children and adolescents continues to rise, yet critical trends and research gaps in suicide risk assessment remain unexamined. This study aimed to analyze global research trends on suicide risk assessment in children and adolescents using Scopus-indexed literature from 1984 to 2024. VOSviewer was used to visualize keyword co-occurrence and thematic trends. Bibliometric data were extracted from abstracts, including publication volume, citation counts, and author productivity. The search strategy identified 1195 articles, with 259 meeting the inclusion criteria. Publications grew annually by 7.78 %, with contributions from 1243 unique authors and an average document age of 9.22 years. The United States was the leading contributor, followed by China, Spain, and the United Kingdom. The Journal of Affective Disorders is the one with the highest number of publications on network analysis in suicide risk assessment, followed by the Journal of Archives of Suicide Research and Psychiatry Research. Most documents were articles (236), with few reviews (15). Key research areas included suicidal ideation, psychometric evaluations, and stress markers. However, critical gaps persist, particularly in developing culturally sensitive assessment tools, integrating biological and psychosocial risk factors, and expanding research in low- and middle-income countries. Most assessment tools are developed in Western settings, limiting cross-cultural applicability. Given the role of sociocultural factors in suicidal behaviors, future research should prioritize culturally adapted assessment methods and validate self-report tools in diverse populations. Addressing these gaps is essential for improving global suicide prevention strategies.

Progress towards prevention of suicide in India by improving print media reporting of suicide news: a repeat content analysis study in Tamil Nadu

OBJECTIVES

Suicide rates in India are among the highest in the world, with the most recent suicide death rate estimates ranging between 18 and 21 deaths per 100 000 population (compared with the global average of 11/100 000). Responsible media reporting of suicide is one of the few evidence-based population-level suicide prevention interventions. Reports of recent suicides are a routine daily feature in major newspapers in India, and the reporting style carries many concerning features. In 2019, the Press Council of India adopted the WHO media guidelines, yet there has been no investigation as to whether this guidance is being followed. The aim of this paper was to systematically investigate whether the quality of print media reports of suicides has changed since the adoption of media guidelines for suicide reporting in India.

DESIGN

We used content analysis to assess the quality of suicide reporting against WHO guidelines in nine of the most highly read daily newspapers in the southern state of Tamil Nadu between June and December 2016 and June and December 2023. Our analyses of changes in reporting were based on a sample of 1681 print newspaper articles from 2016 and 512 print newspaper articles from 2023. Two-tailed t-tests and proportion tests on aggregate means and frequencies assessed whether the reporting characteristics had changed between 2016 and 2023.

RESULTS

There were small yet statistically discernible reductions in the proportion of articles containing various potentially harmful reporting characteristics, such as articles placed on the front page (4.9-1.8%, p=0.002) and articles mentioning the suicide method (92.7-86.5%, p<0.001). There were statistically discernible increases in the proportion of articles containing various potentially helpful reporting characteristics, such as recognition of the link between suicide and poor mental health (7.6-10.5%, p=0.035), mentions of suicide prevention support services/programmes (3.6-11.7%, p<0.001) and the provision of contact details for a suicide support service (2.5-8.8%, p<0.001). There was no statistically discernible improvement in several quality indicators, for example, providing a detailed account of the suicide method (43.1-38.9%, p=0.092), the naming of publicly accessible sites where suicides have occurred (8.2-10.0%, p=0.216), dispelling of suicide myths (2.0-1.8%, p=0.705) and drawing on expert opinions from mental health professionals (1.2-2.0%, p=0.238). In some instances, quality indicators had worsened, such as an increase in articles published in the first three pages of the newspaper (16.8-19.1%, p<0.001) and the use of monocausal explanations for the suicidal behaviour (53.4-70.7%, p<0.001). Analyses at the newspaper level showed that the small improvements that were observed were mainly driven by quite profound improvements in the quality of reporting by two English-language newspapers. For example, at The Hindu, there was a very large decrease in the proportion of articles mentioning the suicide method (85.7-14.3%, p<0.001) and increases in the proportion of articles dispelling suicide myths (2.5-21.4%, p=0.001) and providing contact details for a suicide support service (32.8-71.4%, p=0.005). Conversely, there were largely no observable improvements in reporting by any individual Tamil-language newspaper.

CONCLUSIONS

We observed substantial improvements in the reporting quality of some English-language newspapers, with minimal improvements in the quality of reporting in Tamil-language newspapers. The media guidelines in India are supporting the early phases of a culture shift on media reporting of suicide, yet they are just the start of the conversation. Strategies are required to engage and support vernacular language newspapers in India on their reporting of suicide, with media sector leadership as a core component.

The real-world evidence to the effects of primary psychological healthcare system in diluting risks of suicide ideation in underrepresented children/adolescents: an observational, multi-center, population-based, and longitudinal study

BACKGROUND

Establishing a primary psychological healthcare system to prevent suicide was eagerly advocated. Such system was developed as a low-cost healthcare framework integrating family, school, and hospitals to provide early psychological screening and intervention. However, it remains unclear whether such a policy-driven and low-cost healthcare system could be practical, especially with equal benefits for underrepresented children/adolescents. We aimed to examine the real-world practical effects of the primary psychological healthcare system in preventing suicide ideation among children/adolescents, particularly underprivileged ones.

METHODS

The study was conducted using an observational, multi-center, population-based, and longitudinal design. A total of 19,140 children and adolescents were sampled from lower- and middle-income areas in Nanchong, western China, with the majority for being underprivileged and underrepresented. They were followed up for one year. The primary outcome was the incidence of reported severe suicide ideation after implementing the primary psychological healthcare system at the 0.5-year and 1-year follow-ups, compared to baseline. Subgroup analysis was conducted to examine the equal benefits of the system for underrepresented children/adolescents.

RESULTS

The risks of suicide ideation for children/adolescents included in the system were found to be significantly lower compared to those not included at 0.5-year (adjusted relative risk [aRR] 0.28, 95%CI 0.23-0.33; p < 0.001) and 1-year follow-ups (aRR 0.28, 95% CI 0.23-0.33; p < 0.001). The effects were also observed among underrepresented children/adolescents, including "left-behind" children/adolescents, "single-parent" children/adolescents and children/adolescents in especially difficult circumstances (CEDC, all pcorrected < 0.001). The effects in "left-behind" children/adolescents, CEDC, and "single-parent" children/adolescents were found to be non-inferior to the typically developing cohort at non-inferiority thresholds of 30%, 35%, and 45%, respectively (all pcorrected < 0.05).

CONCLUSIONS

The primary psychological healthcare system was effective in reducing suicide ideation risks among children/adolescents over a period of at least 1 year. However, certain underprivileged groups, such as orphans and unattended children, did not experience the same level of benefits, highlighting the need for targeted improvements.

Global burden and trends of self-harm from 1990 to 2021, with predictions to 2050

Background

Self-harm has become a major public health problem globally. Data on the burden of self-harm in this study were taken from the GBD 2021. This study aimed to quantify historical trends (1990-2021) in the global burden of self-harm across genders, age groups, and regions, and project future changes (2022-2050) through Bayesian forecasting models.

Methods

Based on the seven GBD super-regions, the burden of self-harm was analyzed by region, age, and gender from 1990 to 2021. Hierarchical statistical approach was used to predict trends in global and regional changes in the burden of self-harm, 2022-2050.

Result

In 2021, the global DALYs and death counts from self-harm were 33.5 million (95% UI: 31.3-35.8) and 746.4 thousand (95% UI: 691.8-799.8). The region with the highest number of DALYs and deaths is South Asia and the highest age-standardized rates of DALYs and mortality were in central Europe, eastern Europe, and central Asia. Globally, the burden of self-harm was higher for males than for females. DALYs rates were highest among adolescents and young adults (20-29 years), whereas mortality rates showed a predominantly age-progressive pattern with the highest burden observed in middle-aged and older populations, albeit with a modest decline in the oldest age groups. Forecasting models showed a sustained decline in the global burden of self-harm from 2022-2050.

Conclusion

The results highlight the need for policymakers to allocate resources to high-burden regions (e.g., South Asia and Eastern Europe), to implement gender- and age-specific prevention programs, and to strengthen cross-sectoral collaboration to address the underlying social determinants of self-harm. The findings call for strengthened mental health services and targeted interventions to effectively respond to and reduce the devastating impact of self-harm on individuals and the global community.

Morbidities associated with suicide mortality in the USA according to education using death certificates from 2010 to 2019

OBJECTIVES

To identify relationships between multiple causes of death information and a decedent's sex and education in suicide compared with accidental deaths.

METHODS

Based on the US Mortality Multiple Cause-of-Death Public Use Record from 2010 to 2019, we performed correspondence analysis to visualise the relationships between comorbidity and sex-education profiles of individuals who died by suicide, and logistic regression models to estimate the odds that a comorbidity group is associated with suicide deaths relative to accidental deaths.

RESULTS

Sex and education are important factors of comorbidity registration in suicide deaths, but sex explains most of it. Having a high school degree was differentiated from other educational level groups among males' suicide deaths. Poisoning due to drugs and medication, mood disorders, and other mental and behavioural disorders are more associated with females, while neoplasms and injuries are associated with male suicides. Schizophrenia, mood disorders, and anxiety, dissociative and non-psychotic disorders have higher odds of suicide compared with accidental death.

CONCLUSIONS

This study highlights the need for adapted prevention among sex-educational groups to prevent suicide due to their differences in registered comorbidity.

Global burden and trend of substance use disorders, self-harm, and interpersonal violence from 1990 to 2021, with projection to 2040

BACKGROUND

Alcohol use disorders (AUD), drug use disorders (DUD), interpersonal violence, and self-harm are a major public health concern globally, with high rates of disability, morbidity, and mortality associated with this. This study aims to estimate the disease burden, trends, projections, and disparities of AUD, DUD, interpersonal violence, and self-harm among all ages and sexes from 1990 to 2021.

METHODS

This study is a secondary analysis utilizing data from the Global Burden of Disease (GBD) 2021 in 204 countries and territories. The incidence, deaths, and disability-adjusted life years (DALYs), projection, and the inequality were estimated for AUD, DUD, interpersonal violence, and self-harm among all age and sex.

RESULTS

In 2021, there were 55.78 (46.56-64.31) million new cases of AUD, 13.61 (11.63-15.67) million new cases of DUD, 29.40 (26.17-32.65) million new cases of interpersonal violence, 5.49 (4.6-6.5) million new cases of self-harm globally. By 2040, AUD is forecasted to be 51.98 (29-74.97) million, DUD will be 13.81 (9.23-18.39) million, 36.01 (15.25-56.78) million for interpersonal violence, and 10.55 (3.16-17.94) million for self-harm. In terms of gender and age distribution, males had higher incidence, mortality, and DALYs for AUD, DUD, and interpersonal violence compared to females. Females had higher incidence of self-harm, while males had higher mortality. By age group, individuals aged 15-49 bore the highest burden of DUD, interpersonal violence, and self-harm, while those aged 50-74 had the highest burden of AUD. The burden of these conditions is closely related to the socio-demographic index (SDI). High- and middle-high SDI regions had a heavier burden of AUD, DUD, and self-harm, while low- and middle-low SDI regions had a heavier burden of interpersonal violence. Additionally, from 1990 to 2021, health inequalities for AUD and self-harm decreased, while those for DUD and interpersonal violence increased.

CONCLUSIONS

From 1990 to 2021, the disease burden of AUD, DUD, interpersonal violence, and self-harm exhibited specific patterns across different genders, age groups, and regions. Multilevel interventions should be initiated, with a focus on reducing inequalities through resource allocation and policy support.

Epidemiology and predictors of suicide and suicide attempt in Northwest Iran: a pilot study for local prevention strategies

The suicide rate in Bonab County, northwest Iran, has been reported to exceed 16 per 100,000. To develop and implement an effective suicide prevention program (SPP) at the local level in this County, a population-based epidemiological study was conducted to investigate factors associated with suicide and suicide attempts (SA). In this population and registry-based descriptive-analytical study, all deaths of suicide and SA from 2021 to 2023 were analyzed. Data were collected through a population-based registry for suicide and using community health workers in primary care. The study compared epidemiological characteristics and related risk factors between suicide and SA. Multiple logistic regression was used to adjust for potential confounders and calculated the adjusted odds ratios (AOR) for the likelihood of suicide compared to attempts. During 2021-2023, the suicide rates were 16.2, 11.44, and 12.08, while the SA rates were 212, 234, and 237 per 100,000 people. Overall, the suicide rate decreased, whereas the SA rate increased during this period. In the final analysis, males (AOR = 1.97: 1.2-3.6), individuals aged 35-60 (AOR = 1.56: 1.01-3.7), hanging (AOR = 7.4: 2.6-14.2), family conflicts (AOR = 2.65: 1.8-6.13), stressful life events (AOR = 1.25: 1.1-3.9), and unemployment (AOR = 1.8: 1.04-3.5) were associated with an increased likelihood of suicide. The suicide rate in this county surpasses the national average. Predictors of suicide and SA exhibit fundamental differences in this County. The study identified family conflicts, stressful life events, the hanging method, male gender, unemployment, and adult age as reliable predictors for suicide, while factors such as having psychiatric disorders, previous SA, and being female were linked to SA. These factors should be taken into account when developing SPP in Bonab County. Furthermore, the study highlights the need to consider various socioeconomic and cultural factors when developing SPP.

Genetic approach uncovering the pathways between childhood maltreatment and suicide attempt

Childhood maltreatment significantly heightens the risk of suicide attempt, but the causal mechanisms and underlying pathways are not fully understood. Using genetic instruments for both childhood maltreatment (n = 185,414) and suicide attempt (cases = 29,782; controls = 519,961), we performed two-sample Mendelian randomization analyses. Our results show that higher level of childhood maltreatment is causally associated with an increased risk of suicide attempt (OR = 3.40; 95% CI, 2.34-4.96, P = 1.3e-10). We then conducted a two-step Mendelian randomization mediation analysis, identifying 11 out of 58 potential mediators between childhood maltreatment and suicide attempt. These mediators included neurobiological, psychopathological and behavioral factors. The psychopathological factors had the most significant impact, accounting for 10.4-50.2% the mediation. This study confirms the causal relationship between childhood maltreatment and suicide attempt, highlighting specific mediators-especially within the psychopathological dimension-that can guide targeted interventions to alleviate the adverse effects of childhood maltreatment and prevent suicide attempt.

Suicide in adults within 30 days of discharge from hospital emergency department

Suicide remains a frequent cause of death in adults, often overlooked despite known risk factors like mental disorders, older age, and chronic illness. Emergency department visits offer critical opportunities to identify suicidal ideation and provide preventive care. This study reviewed deaths within 30 days of discharge from the emergency department of a major public hospital in Alicante, Spain, focusing on deaths by suicide. Over five years, 529,312 emergency visits were recorded, with 453,599 patients (85.7%) discharged home. Of the 356 patients (0.078%) who died within 30 days post-discharge, 7 (1.97%) died by suicide. Among these, four had a psychiatric history, and one had a history of substance abuse, both established risk factors. The overall suicide rate among adults discharged from the emergency department was 1.54 per 100,000. Compared with those who died from other causes within 30 days of discharge, patients who died by suicide were younger (median age 72 vs. 83 years; p = 0.037, adjusted OR: 0.59, 95% CI: 0.34-1.03; p = 0.06), had a lower Charlson Comorbidity Index (median 3 vs. 6; p = 0.003), and were more often male (6/7 vs. 50.1%; p = 0.1). The presence of psychiatric history was the most significant risk factor for suicide within 30 days of discharge from the emergency department among patients aged 15 and older. Men were more likely than women to die by suicide, with the majority between the ages of 65 and 79. Notably, only one individual had a prior suicide attempt.

Suicide risk in prostate cancer patients: Trends, predictors, and development of predictive nomograms using SEER data

PURPOSE

To assess suicide risk in prostate cancer (PCa) patients by analyzing trends, key predictors, and developing predictive tools. Using the Surveillance, Epidemiology, and End Results (SEER) database data, we aimed to identify high-risk populations and guide strategies to reduce suicide-related mortality.

METHODS

A retrospective analysis was conducted using SEER data from 2010 to 2020. Standardized mortality ratios (SMRs) were calculated to compare suicide risk in PCa patients with that of the general male population, with subgroup analyses stratified by age and race. Proportional mortality ratios (PMRs) were determined for the leading causes of death, including suicide, across clinical and demographic variables. Predictive nomograms for 3-year and 5-year suicide risk were developed using Cox regression models and validated through calibration curves and concordance indices.

RESULTS

PCa patients exhibited elevated suicide SMRs, particularly among younger (<55 years, SMR = 8.50) and White patients (SMR = 14.98). While overall suicide risk declined over the study period, specific subgroups remained disproportionately affected. PMR analysis indicated younger age, White race, and earlier disease stages were associated with higher suicide proportions. Time-to-event analysis revealed that 20.28 % of suicide cases occurred within the first year after diagnosis. Predictive modeling identified age, race, radiotherapy, and marital status as independent risk factors for suicide mortality.

CONCLUSIONS

Suicide poses a significant yet preventable risk for PCa patients, especially among younger (especially<55 years), White, and unmarried individuals (both separated, divorced, and widowed and never married). The developed predictive tools can aid in identifying high-risk patients and implementing targeted psychosocial interventions.

Global spatiotemporal analysis of suicide epidemiology and risk factor associations from 2000 to 2019 using Bayesian space time hierarchical modeling

Suicide is a significant global public health issue, with marked disparities in rates between countries. Much of the existing research has concentrated on high-income nations, creating a gap in the understanding of global suicide epidemiology. This study aims to address this gap through a comprehensive spatiotemporal analysis of global suicide trends from 2000 to 2019. Data were collected from the Global Health Observatory, encompassing 183 countries across five regions. Bayesian spatiotemporal modeling and cluster detection techniques were employed to assess variations in suicide rates and identify high-risk clusters, alongside examining associations with various risk factors. The findings indicate diverse global and regional age-standardized suicide trends, with overall rates decreasing from an average of 12.97 deaths per 100,000 population in 2000 to 9.93 deaths per 100,000 in 2019. Significant regional variations were noted, particularly in Europe, Asia, and Africa, where high-risk clusters were identified. Additionally, age and sex-specific trends revealed consistently higher rates among males, although these rates have been declining over time. Spatial maps illustrated hotspots of elevated suicide rates, which can inform targeted intervention strategies. Risk factor analysis further revealed associations with socioeconomic and health indicators. The results underscore the necessity for tailored prevention strategies and highlight the importance of international collaboration and surveillance systems in addressing the complexities of global suicide epidemiology. This study contributes valuable insights into suicide patterns and offers implications for mental health policies worldwide.

Revisiting Cultural Issues in Suicide Rates: The Case of Western Countries

Suicidal behaviors among different age groups show epidemiological differences between countries. Specifically, suicide rates for the younger populations appear to be lower in Latin-origin countries (such as Italy, Spain, and Portugal) in comparison to other Western countries (especially Anglo-Saxon countries such as Canada, New Zealand, and Australia). The opposite seems to be true for the older population, suggesting a cross-cultural pattern for suicidal behavior in different ages. The current study replicates a study published in 1999 and compares suicide data between 1990 and 1994 with more recent data from the years 2016 and 2020 to investigate the persistence of previously observed trends. Basically, the recent years' data confirm the patterns evidenced a quarter of a century ago, and substantially confirm the existence of suicide trends embedded with countries' cultural factors and traditions. This investigation underlines the importance of incorporating anthropology, sociology, ethnography, and geography while studying culture-related patterns in suicide.

Mental and Behavioral Disorders, Comorbidity, and Self-Harm: Results From Korea National Hospital Discharge In-Depth Injury Survey

OBJECTIVE

Suicide is a complex issue influenced by various factors, including mental illness, economic, and cultural elements. Mental and behavioral disorders are significant contributors to suicide risk, and individuals who attempt self-harm often present with comorbidities. This study aims to identify the significance of characteristics and comorbidities among hospitalized patients who engaged in self-harm and have been diagnosed with mental and behavioral disorders.

METHODS

We targeted patients aged 19 or older who attempted self-harm and were hospitalized from the 2022 Korea National Hospital Discharge In-depth Injury Survey covering the period from 2008 to 2021. After applying sampling weights, the estimated total sample size was 10,140. The analysis was conducted using a general linear model for complex samples, incorporating analysis of variance and regression analyses. Additionally, network analysis was used to explore relationships among comorbidities.

RESULTS

The incidence of self-harm varied seasonally, peaking in spring, with higher rates observed in winter. Hospitalization duration was significantly longer when surgical interventions were required or when comorbidities were present. The average length of hospitalization was 20.52 days, but patients with alcohol-related addictions had a significantly longer stay (71.57 days). For each additional comorbidity, the hospitalization duration increased by 1.889 days. About 46.78% of patients had one or more comorbidities, with strong associations between mental disorders (F00-F99) and cases of poisoning or external injuries (S00-T98).

CONCLUSION

This study underscores the importance of managing comorbidities in patients with mental illness to reduce the clinical and social costs of self-harm.

Social Determinants of Health and Suicide-Related Outcomes: A Review of Meta-Analyses

Importance

Preventing suicide is one of the top priorities in public health policy. Identifying key social determinants of health (SDOH) in suicide risk is critical for informing clinical practices, future research, and policy solutions to prevent suicide.

Objective

To examine the associations of SDOH with suicide-related outcomes.

Data Sources

Studies published before July 2023 were searched through PubMed, PsycINFO, Embase, and Web of Science. The date of the search was August 4, 2023.

Study Selection

We included the most up-to-date meta-analyses reporting associations between SDOH and suicide-related outcomes.

Data Extraction and Synthesis

Three independent reviewers extracted data and conducted quality assessment using the Joanna Briggs Institute Checklist for Systematic Reviews and Research Syntheses.

Main Outcomes and Measures

The main outcomes of interest were suicide mortality, suicide attempt, and suicidal ideation.

Results

A total of 46 meta-analyses met inclusion criteria. For suicide mortality, justice system-involved individuals in the community, exposure to others' and parental suicide, firearm accessibility, divorce, experience in foster care, release from incarceration, and midlife (age 35-65 years) unemployment were the SDOH with consistently strong effects. Individuals released from incarceration demonstrated a high prevalence of suicide mortality (114.5 per 100 000 persons). With regard to suicide attempt, experience of childhood abuse and maltreatment and sexual assault, gender and sexual minority status, and parental suicide mortality were the strongest risk factors. The prevalence of suicide attempt among homeless individuals (28.9%; 95% CI, 21.7%-37.2%) and incarcerated female youths (27%; 95% CI, 20%-34%) and adults (12.2%; 95% CI, 7.1%-17.2%) was high. For suicidal ideation, identification as bisexual and intimate partner violence in women were the strongest risk factors. The prevalence of lifetime suicidal ideation in homeless individuals was 41.6% (95% CI, 28.6%-56.0%). Protective factors associated with reduced risk of suicide mortality were religious affiliation and being married. School connectedness showed protective associations against suicide attempt and suicidal ideation.

Conclusions and Relevance

Tailoring interventions and future research for identified priority subpopulations, such as justice system-involved individuals in the community, and implementing policy measures addressing the SDOH that showed strong associations with suicide mortality, attempts, and ideation, such as gun licensing requirements, are critical to counteracting social and environmental forces that increase suicide risk.

Suicidal Ideation in Medicinal Cannabis Patients: A 12-Month Prospective Study

OBJECTIVE

To document the prevalence and correlates of suicidal ideation (SI) among individuals seeking cannabis-based medicinal products (CBMPs); to test whether SI declines or intensifies after three months of CBMP treatment and to document 12-month trajectories of depression in those reporting SI and other patients.

METHOD

Observational data were available for 3781 patients at entry to treatment, 2112 at three months and 777 for 12 months. Self-reported depressed mood and SI were assessed using items from the PHQ-9. Additional data included sociodemographic characteristics and self-reported well-being.

RESULTS

25% of the sample reported SI at treatment entry and those with SI had higher levels of depressed mood (mean = 17.4 vs. 11.3; F(1,3533) = 716.5, p < .001) and disturbed sleep (mean = 13.8 vs. 12.2, F(1,3533) = 125.9, p < .001), poorer general health (mean = 43.6 vs. 52.2, F(1,3533) = 118.3, p < .001) and lower quality of life (mean = 0.44 vs. 0.56 (F(1,3533) = 118.3, p < .001). The prevalence of SI reduced from 23.6% to 17.6% (z = 6.5, p < .001) at 3 months. Twelve-month follow-up indicated a substantial reduction in depressed mood with this reduction being more pronounced in those reporting SI (mean (baseline) = 17.7 vs. mean (12 months) = 10.3) than in other patients (mean (baseline) = 11.1 vs. mean (12 months) = 7.0).

CONCLUSIONS

SI is common among individuals seeking CBMPs to treat a range of chronic conditions and is associated with higher levels of depressed mood and poorer quality of life. Treatment with CBMPs reduced the prevalence and intensity of suicidal ideation.

MATES in Manufacturing: A Cluster RCT Evaluation of a Workplace Suicide Prevention Program

BACKGROUND

The MATES in Construction suicide prevention program was adapted to the manufacturing sector and evaluated in a pilot of the program.

METHODS

Ten manufacturing worksites were randomly assigned to intervention (5 sites) and wait-list control (5 sites) conditions in a two-arm cluster randomized design. 1245 workers responded at baseline (87% response rate) and 648 at final (35% response rate). Literacy of Suicide Scale (LOSS) was assessed as a process outcome, and help-seeking intentions as the primary outcome (General Help-Seeking Questionnaire [GHSQ] score). Secondary outcomes included help sought, suicidal thoughts and likelihood of suicide attempt scores, and Kessler-6 scores. Linear mixed models for repeated measures were used in intention-to-treat (ITT) and completer analyses.

RESULTS

All sites finished the trial, with intervention periods ranging from 8 to 11 months; however, none of the five intervention sites fully implemented the intervention as planned. ITT analyses showed an improvement in LOSS scores within the intervention group (0.49, 95% CI 0.13-0.49), but the mean difference in change between intervention and control included the null (0.34, 95% CI -0.10 to 0.80). The primary outcome of GHSQ scores also improved within the intervention group, but the difference in change included the null (mean difference 1.52, 95% CI -0.69 to 3.74). No secondary outcomes improved relative to control in ITT or completers analyses. Exploratory analysis of disaggregated GHSQ help sources showed greater improvement in mean difference in change for the main MATES message of seeking help from MATES Connectors.

CONCLUSION

The intervention, as implemented, was not effective at achieving the primary or secondary outcomes.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trial Registry: ACTRN 12622000122752.

Effect of the LifeSpan suicide prevention model on self-harm and suicide in four communities in New South Wales, Australia: a stepped-wedge, cluster randomised controlled trial

BACKGROUND

There have been few rigorous evaluations of population, multi-strategy, suicide prevention programmes, despite increasing global recognition that such approaches are needed to reduce suicide.

OBJECTIVE

To examine the effects of a multi-strategy suicide prevention model on age-standardised rates of hospital presenting self-harm and suicide after 24 months of implementation.

METHODS

A stepped-wedge cluster randomised trial was conducted in four sites across New South Wales (NSW), Australia, from 2016 to 2020. Sites were randomised to a starting order and implemented the same set of interventions over a 24-month period. Changes in rates of hospital presenting self-harm and suicide deaths were measured using linked administrative health data sets of persons aged 10 or older.

RESULTS

Negative binomial regression models adjusted for linear trends and seasonality showed that LifeSpan was associated with a 13∙8% (incident response rate 0.86; 95% CI 0.79 to 0.94) reduction in hospital-presenting self-harm rates over the intervention period, compared with preintervention. These effects were not observed in the rest of NSW. There were statistically non-significant changes in suicide death rates during the intervention across all sites.

CONCLUSIONS

Locally implementing a multi-strategy suicide prevention model can reduce rates of hospital presentations for self-harm, but longer implementation and evaluation periods may be required to realise the full impacts of interventions for suicide, as a more intractable outcome.

CLINICAL IMPLICATIONS

Our findings can inform policy at all levels of government to invest in actions that may build cross-sectoral capacity in local communities to detect and respond to suicide risk.

Trends in mortality, disability-adjusted life years, and years of healthy life lost due to self-harming in Brazilian states from 1990 to 2019

OBJECTIVES

To compare rates, disability-adjusted life years (DALYs), and years of healthy life lost due to disability (YLDs) associated with deaths due to self-harm in Brazil.

METHODS

This epidemiological study utilized secondary data obtained from the Global Burden of Disease Study. Analytical examinations were conducted to provide detailed descriptions of national and subnational rates.

RESULTS

We identified mortality rates, DALYs, and YLDs resulting from deaths due to self-harm - national data from 26 states and the Federal District - between 1990 and 2019. The national rates in 1990 and 2019 were the same for mortality = 6.2 deaths per 100.000 inhabitants, reduced for DALYs = 312-289 DALYs, and the same for YLDs = 1.6 YLDs. Four united federations had higher mortality rates, DALYs, and YLDs caused by self-harm compared to national rates throughout the analyzed period (between 1990 and 2019) - Goiás (mortality = 11-67%, DALYs = 13-73%, and YLDs = 4-45%), Mato Grosso do Sul (mortality = 23-42%, DALYs = 28-46%, and YLDs = 13-64%), Minas Gerais (mortality = 5-25%, DALYs = 7-25%, and YLDs = 19-35%), and Rio Grande do Sul (mortality = 73-98%, DALYs = 55-84 %, and YLDs = 52-70%).

CONCLUSION

Although national mortality rates and YLD caused by self-harm have been maintained, there has been a decrease in the incidence of DALYs. However, certain states in Brazil have rates higher than the national average, indicating the need for multiple strategies to be implemented to reduce mortality rates, DALYs, and YLDs resulting from self-harm in these specific states.

Cross-sectional and longitudinal analysis of high-sensitivity C-reactive protein as a biomarker for suicidal behavior in depressive patients undergoing pharmacotherapy

This study investigated the role of serum high-sensitivity C-reactive protein (hsCRP) as a biomarker for suicidal behavior (SB) in both cross-sectional and longitudinal contexts, driven by emerging evidence that systemic inflammation, marked by elevated hsCRP levels, may be linked to increased suicidality in individuals with depressive disorders. Serum hsCRP levels were measured at baseline in 1,094 patients with depressive disorders. Of these, 884 were followed during a 12-month period of stepwise pharmacotherapy. SB assessments included previous suicide attempts and baseline suicidal severity at baseline, and increased suicidal severity and fatal/non-fatal suicide attempts at follow-up. We analyzed the associations between hsCRP levels (and elevated levels ≥1.0 mg/L) with these SB categories using logistic regression, adjusting for relevant covariates. Higher or elevated serum hsCRP levels were significantly associated with SB at baseline in cross-sectional analyses. However, these associations did not persist in the 12-month longitudinal analyses after adjustments. While hsCRP serves as a concurrent biomarker for SB, it does not act as a predictive marker for future suicidal behaviors. Future research should include repeated measures of hsCRP in a controlled setting to confirm these findings.

Predictors of Suicide Attempts and Reattempts in a Sample of Chilean Adolescents

BACKGROUND

Suicide is a public health problem worldwide, especially among adolescents. Chile is one of the Latin American countries with the highest suicide rates; however, few studies have investigated the risk factors for suicide attempts in this specific population. We aimed to describe the suicidal behaviour of Chilean adolescents and to explore the factors associated with suicide attempts and reattempts in this population.

METHODS

Adolescents (10-19 years) with a diagnosis of psychiatric disorders were recruited in the Maule region, Chile, between 2018 and 2021. Sociodemographic and clinical variables were collected. Logistic regression was performed to explore the association between these variables and suicide attempts.

RESULTS

Factors associated with increased odds of suicide attempts included age, sexual orientation, Adverse Childhood Events (ACEs) and past and current symptomatology. Factors that decreased the odds of suicide attempts were previous psychotherapy or pharmacological treatment, responsiveness and warmth from mother and father. Active symptoms at the time of assessment increased the odds of reattempting suicide.

CONCLUSIONS

In our sample, clinical and trauma-related factors emerged as the most important factors in predicting suicide attempts. Although age, sexual orientation and family dysfunction also played a notable role, positive relationships with parents seemed to be protective. In addition, current symptoms of stress, anxiety and depression significantly increased the likelihood of reattempts. These findings provide valuable knowledge about suicidality in Chile, although further research is needed to expand the evidence in our media.

Suicide Among Older People in Spain: The Role of Sex and Urbanicity

OBJECTIVES

Suicide rates are driven by availability of lethal means, increase with age, and are often higher in rural versus urban areas. This study examines temporal and geographic variations in suicides among elderly with a focus on rural-urban differences in method-specific suicide rates among people aged 65 and older in Spain, a rapidly aging country.

METHODS

Population-based study including all suicides among people over 65 in Spain between 2010 and 2022. We examined overall and method-specific suicide rates and their temporal and geographical variation, stratifying results by sex and urbanicity level. Time trends were estimated via joinpoint regression. Maps were created to analyze the geographical distribution of suicide rates.

RESULTS

While 2010-2022 suicide rates in people aged 65 and older remained largely stable overall, they increased by an annual 2.6% for women living in urban areas. The most common suicide methods were hanging for men living in rural and urban areas (68.5% and 47.3%, respectively) and for women living in rural areas (42.1%); for women living in urban areas jumping was the modal suicide method (46.9%). Method-specific trend analyses revealed recent increases in male suicide by poisoning and hanging in rural areas, decreases in male suicide by hanging and increases in male suicide by jumping in urban areas, and increases in female suicide by poisoning and jumping in urban areas. We identified and mapped remarkable geographic variation in overall and sex-specific suicide rates across Spain's regions.

CONCLUSIONS

These results, highlighting recent increases in female suicides in urban areas and in specific method-specific male suicides both in rural and urban areas, and demonstrating geographical variation across regions, should help guide targeted suicide prevention efforts.

Elevated suicide risk in individuals with epilepsy: a systematic review and meta-analysis

OBJECTIVE

Suicide is among the top 10 leading causes of death. Epilepsy is associated with increased diagnoses of psychiatric conditions. Approximately 5% of deaths in people with epilepsy (PwE) are caused by suicide. We aim to compare the suicide incidence in PwE vs. people without epilepsy.

METHODS

A systematic review was performed looking at suicide incidence among PwE compared to persons without epilepsy. The reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were followed in this study. The search included records until February 2024 in Ovid® MEDLINE, Embase®, and PsycINFO. Abstracts were screened in duplicate and extracted using standard proforma. Data were recorded on the incidence of suicide ideation, attempt, or completed suicide in PwE compared to persons without epilepsy. Meta-analyses were performed along with descriptive analyses.

RESULTS

Out of a total of 7,371 records identified from the systematic search, 13 met the eligibility criteria. Meta-analysis showed a significantly higher incidence proportion of suicide ideation in PwE than those without epilepsy (risk ratio [RR]: 2.06, 95% CI 1.47-2.89). For suicide attempts, incidence proportion (RR: 3.62, 95% CI 2.88-4.55), incidence rate (incidence rate ratio [IRR]: 4.94, 95% CI 4.44-5.50) and hazard (adjusted hazard ratio [HR]: 2.32, 95% CI 2.17-2.48) were all significantly higher in PwE vs. people without epilepsy. Lastly, incidence proportion (RR: 2.39, 95% CI 1.28-4.47), incidence rate (IRR: 2.26, 95% CI 2.13-2.40), and hazard (adjusted HR: 2.50, 95% CI 1.99-3.16) of completed suicide were all significantly higher in PwE than those without epilepsy.

SIGNIFICANCE

The incidence of suicide ideation, suicide attempt, and completed suicide were significantly higher in PwE compared to people without epilepsy. Comprehensive support systems to educate, diagnose, and manage epilepsy and concurrent psychiatric conditions in PwE are highly suggested.

Lifetime and Jail-Specific Suicidal Ideation: Prevalence and Correlates in a Sample of People in Jail in the United States

Despite high suicide mortality in U.S. jails, there is limited research into precursors for suicide in this population, such as suicidal ideation. The current study examined the prevalence and correlates of lifetime and jail-specific suicidal ideation among a sample of 196 individuals (137 men) in custody in a U.S. jail. Nearly half the sample had reported lifetime suicidal ideation (45%), whereas 30% had reported jail-specific suicidal ideation. Adjusted correlates of lifetime suicidal ideation included a history of mental illness (OR = 2.79) and drug use (OR = 2.70). Adjusted correlates of jail-specific suicidal ideation included a history of mental illness (OR = 2.74), drug use (OR = 3.16), and a dehumanizing custodial environment (OR = 3.74). Some theoretically and empirically relevant factors were not significantly associated with suicidal ideation. Both expected and unexpected findings are discussed within the context of suicide theory and research, and practical implications are explored.

Association between stimulant and non-stimulant ADHD medications and completed suicide in adolescents and adults: A population-based nested case-control study

INTRODUCTION

ADHD has been linked to an increased risk of completed suicide. The aim of this study was to assess the relationship between ADHD medication use and completed suicide.

METHODS

This nested case-control study included individuals aged 12-49 in Quebec, Canada, diagnosed with ADHD and/or dispensed ADHD medication. Suicide cases (n = 472) between 2000 and 2021 were matched with 5 controls each (n = 2360) on date of birth, sex, and continuous public drug insurance coverage for at least 365 days before suicide death (index date). Multivariable conditional logistic regression was used to estimate the association between ADHD medication use and completed suicide. The association between specific ADHD medication types and completed suicide was also assessed.

RESULTS

After controlling for potential confounders, no significant association was found between ADHD medication use and completed suicide in the overall sample, in individuals aged 12-24 and 25 to 49 years, and those with a prior ADHD physician diagnosis. No significant differences were found when comparing the use of non-stimulants only (aOR 1.27; 95 % CI: 0.62, 2.63), stimulants and non-stimulants (aOR 1.01; 95 % CI: 0.33, 3.08), and ADHD consultation without medication (aOR 0.94; 95 % CI: 0.69, 1.28) against stimulant-only use.

CONCLUSION

Both stimulants and non-stimulants were not associated with the risk of completed suicide. These findings can inform clinical decision-making.

Suicide prevention strategies in South Korea: What we have learned and the way forward

Suicide is a serious global public health concern. South Korea has consistently reported one of the highest suicide rates among Organization for Economic Cooperation and Development countries over the past few decades. In response to the increasing suicide rate, South Korea enacted the Suicide Prevention Act in 2011, and allocated significant budget funding for implementation of various policies according to its national strategy for suicide prevention. Suicide prevention policies, such as restricting access to highly hazardous pesticides, implementing emergency room-based follow-up management programs, and adhering to safety guidelines for the media while reporting on suicide, were effective. Thereafter, the overall suicide rate and the suicide rate in older people steadily declined. However, the suicide rate among younger age groups has increased since 2017, and South Korea continues to report higher suicide rates than those of most other countries. Further research is needed to develop and implement suicide prevention strategies that address the recently changing trends.

The relationships of plasma profenofos and ethanol concentrations to clinical outcome in acute profenofos self-poisoning

INTRODUCTION

Many patients acutely self-poisoned with organophosphorus insecticides have co-ingested ethanol. Currently, profenofos 50% emulsifiable concentrate (EC50) is commonly ingested for self-harm in Sri Lanka. Clinical experience suggests that ethanol co-ingestion makes management more difficult. Therefore, we aimed to determine the relationships between plasma ethanol concentration, plasma profenofos concentration and its toxicokinetics, and clinical outcome in acute profenofos self-poisoning.

METHODS

Demographic and clinical data, including a history of ethanol ingestion and blood samples, were prospectively collected from all cases of acute poisoning with profenofos EC50 presenting to Teaching Hospital Peradeniya, Sri Lanka, over four years. Plasma samples were analyzed by gas chromatography-mass spectrometry to quantify the ethanol (n = 99) and profenofos (n = 30 [15 with ethanol, 15 without ethanol]) concentrations. The PKSolver program was used to calculate the toxicokinetic parameters.

RESULTS

Of 99 patients (male 78/99) with acute profenofos self-poisoning, 50 reported a history of ethanol co-ingestion. Plasma from 44 of 99 profenofos-poisoned patients had detectable ethanol concentrations. No statistical difference was observed between the mortality in the ethanol group and the no ethanol group (5/44 [11.4%] versus 3/55 [5.5%]; P = 0.461). Similarly, the median half-lives of plasma profenofos absorption in the ethanol and no ethanol groups (0.1 h and 0.1 h, respectively; time 0-24 h) were not statistically different (P = 0.6594). However, the median half-life of plasma profenofos elimination was significantly longer in the ethanol group than the no ethanol group (23.1 h and 9.9 h, respectively; time 0-24 h; P = 0.0002). According to the regression analysis, the half-life of plasma profenofos elimination was longer by 29.4 h in the ethanol group (P = 0.013).

DISCUSSION

No significant differences in outcomes, including death and endotracheal intubation rates, were found between those who did and did not co-ingest ethanol. No differences were found in toxicokinetic variables between the ethanol and no ethanol groups, but the ethanol group had a longer elimination half-life.

CONCLUSION

The co-ingestion of ethanol leads to a slowing of the elimination kinetics of profenofos. However, the study did not reveal a significant impact of ethanol co-ingestion on clinical outcomes.

Suicides in Czech Republic, Slovakia, Hungary, and Poland in 1990-2019: Epidemiological Patterns and Trends in European and Global Context

BACKGROUND

Suicides are a major public health problem with serious consequences for societies.

AIM

To compare epidemiological patterns and trends of suicides in the Czech Republic, Slovakia, Hungary, and Poland in 1990-2019, and analyze them in the European and global context.

METHODS

A trend analysis was conducted in Czech Republic, Slovakia, Hungary, Poland, in Western Europe and on global level for 1990-2019. All data were obtained from the Global Burden of Diseases study 2019. Numbers and age-standardized rates of deaths and Years of Life Lost (YLL) due to suicides were analyzed, stratified by sex and age (0-14 years old, 15-49 years old, 50-69 years old, 70+ years).

RESULTS

In 2019, 759,028 suicides occurred globally, 17,408 (2.3%) in Central Europe. The proportion of males was substantially larger, compared to the global and Western European levels (e.g., 82 vs. 69 and 75%, respectively). The highest rates of suicide were in Hungary (19.7 per 100,000), lowest in Slovakia (12.8); the rate in Central Europe was higher than the global rate (15.2 vs. 9.8), and the rate in Western Europe (11.4). A steady decline of rates was observed in all countries, particularly in Hungary. In Czech Republic we found an increasing relative importance of suicides among people 70 years and older.

CONCLUSIONS

Death rates due to suicides have been declining in the analyzed countries, but some characteristics and trends when compared to global and regional estimates, such as substantially higher proportion of male suicides or high death rates among the elderly warrant specifically tailored preventative action coordinated by governments with community involvement.

Rural-urban and age differences in association between depression and suicidal attempt: a large retrospective clinical sample study in China

OBJECTIVES

To assess the association between depression and suicide attempt (SA) by age and region.

DESIGN

Cross-sectional study.

SETTING

First Affiliated Hospital of Wannan Medical College from January 2021 to January 2022.

PARTICIPANTS

Hospitalised patients.

PRIMARY OUTCOME MEASURES

SA was the primary outcome and data on SA was obtained from the electronic medical records of hospitalised patients.

METHODS AND ANALYSIS

In this study, data on inpatients of the First Affiliated Hospital of Wannan Medical College from January 2021 to January 2022 were extracted from the medical record system using the convenience sampling method. According to the exclusion criteria, 7593 eligible research subjects were obtained. Logistic regression analysis was used to assess the association between depression and SA, combining age and region. Subgroup analyses were carried out to assess the relationship between age, region and SA in depressed patients, after excluding non-depressed patients, and to inspect the interaction of age and region. Finally, further comparisons of the disparities in suicide patterns among different age groups and regional groups were made.

RESULTS

Among 7593 patients (3630 males), 655 (8.6%) patients with SA were observed. We found that depression was significantly associated with SA by age and region (all p<0.05). Specifically, depressed juveniles and adults had a higher risk of SA compared with non-depressed adults, and ORs (95% CIs) were 2.62 (1.59 to 4.30) and 1.67 (1.30 to 2.13), respectively. Furthermore, rural individuals with depression, urban individuals without depression and urban individuals with depression had a higher risk of SA compared with rural participants without depression, and ORs (95% CIs) were 1.60 (1.22 to 2.12), 1.29 (1.04 to 1.61) and 2.53 (1.83 to 3.49), respectively. In subgroup analyses, we further found that depression was strongly associated with SA in juveniles (OR 2.84, 95% CI 1.19 to 6.76, p=0.018) and urban patients (OR 1.67, 95% CI 1.15 to 2.40, p=0.006). Notably, the predominant methods of suicide among individuals with depression were the utilisation of sleeping pills or antidepressants.

CONCLUSION

Our study found individuals with depression are at higher risk of SA, especially juveniles and urban individuals. Effective integration of mental health and urban-rural services could mitigate the risk of suicide and contribute to better outcomes.

Suicide literacy, suicide stigma, and help-seeking attitudes among men in a university setting in Ireland

This study sought to explore the relationship between sociodemographic-, mental health-, knowledge-, attitudinal-, and conformity to masculine norms variables with suicide literacy, suicide stigma, and help-seeking attitudes among men in a university setting (n = 471) in Ireland. Multiple linear regression with backward elimination was used to determine the independent variables associated with suicide literacy, suicide stigma, and help-seeking attitudes. Lower suicide literacy was associated with an ethnic minority background, living in a rural community, postgraduate students compared to undergraduate students, no depression symptoms in the past year, decreasing loneliness, greater suicide stigma, more negative help-seeking attitudes, lower resilience, greater conformity to the masculine norm power over women and lower conformity to the masculine norm emotional control. Greater suicide stigma was associated with a non-ethnic minority background, all departments of study compared to health and sports science, lower suicide literacy, more negative help-seeking attitudes, and greater conformity to the masculine norms of power over women, dominance, and heterosexual self-presentation. More negative help-seeking attitudes were associated with no generalized anxiety disorder symptoms in the past year, depression symptoms in the past year, greater suicide risk, lower suicide literacy, greater suicide stigma, greater resilience, and greater conformity to the masculine norms emotional control, self-reliance, violence, and heterosexual self-presentation. Findings highlight a need for gender-responsive psychoeducational programmes to target suicide literacy, suicide stigma, and/or help-seeking attitudes among men in university settings. They also highlight that such initiatives need to be co-produced alongside ethnic minority and rural-dwelling men to ensure they are culturally sensitive and acceptable.

Natural Language Processing and Social Determinants of Health in Mental Health Research: AI-Assisted Scoping Review

Background

The use of natural language processing (NLP) in mental health research is increasing, with a wide range of applications and datasets being investigated.

Objective

This review aims to summarize the use of NLP in mental health research, with a special focus on the types of text datasets and the use of social determinants of health (SDOH) in NLP projects related to mental health.

Methods

The search was conducted in September 2024 using a broad search strategy in PubMed, Scopus, and CINAHL Complete. All citations were uploaded to Covidence (Veritas Health Innovation) software. The screening and extraction process took place in Covidence with the help of a custom large language model (LLM) module developed by our team. This LLM module was calibrated and tuned to automate many aspects of the review process.

Results

The screening process, assisted by the custom LLM, led to the inclusion of 1768 studies in the final review. Most of the reviewed studies (n=665, 42.8%) used clinical data as their primary text dataset, followed by social media datasets (n=523, 33.7%). The United States contributed the highest number of studies (n=568, 36.6%), with depression (n=438, 28.2%) and suicide (n=240, 15.5%) being the most frequently investigated mental health issues. Traditional demographic variables, such as age (n=877, 56.5%) and gender (n=760, 49%), were commonly extracted, while SDOH factors were less frequently reported, with urban or rural status being the most used (n=19, 1.2%). Over half of the citations (n=826, 53.2%) did not provide clear information on dataset accessibility, although a sizable number of studies (n=304, 19.6%) made their datasets publicly available.

Conclusions

This scoping review underscores the significant role of clinical notes and social media in NLP-based mental health research. Despite the clear relevance of SDOH to mental health, their underutilization presents a gap in current research. This review can be a starting point for researchers looking for an overview of mental health projects using text data. Shared datasets could be used to place more emphasis on SDOH in future studies.

Can role model women in politics help married women reduce suicides? Evidence from a quasi-experimental study in Brazil

Background

The medical literature has demonstrated that macro-variables and social factors can influence suicide rates. Additionally, social science literature has shown that women in prominent political positions (such as mayors) can influence the behavior of other women. The purpose of our work is to demonstrate that women in such positions reduce suicide rates within a group affected by gender inequality: married women.

Methodology

We use regression discontinuity methodology and quasi-experimental electoral designs (elections with a margin of victory very close to zero) to ensure causal inference between the election of women and suicide rates among married women.

Principal findings

Municipalities that elected women as mayors have 1.33 fewer suicides among married women per 100,000 inhabitants compared to those that elected men as mayors.

Conclusion

These results offer new insights into how empowered women can challenge social norms and improve public health outcomes.

Inverse association between obesity and suicidal death risk

BACKGROUND

Suicide is a significant yet preventable public health issue. Body mass index (BMI) is a readily measurable indicator associated with various health outcomes. However, the relationship between BMI and suicidal death risk is complex and warrants further investigation, particularly within contemporary, non-Western contexts with consideration of potential confounders. The purpose of this study was to investigate the relationship between BMI and the risk of suicidal death.

METHODS

This study was nationwide, retrospective, observational study based on Korean National Health Insurance Service database. We analyzed 4,045,081 participants who were aged > 19 years and underwent national health surveillance in 2009. The participants were categorized according to their BMI (underweight: < 18.5 kg/m², normal weight: 18.5-23 kg/m², overweight: 23-25 kg/m², class I obesity: 25-30 kg/m², and class II obesity: > 30 kg/m²). The primary outcome was the death events caused by suicide which was defined by International Classification of Disorders (ICD-10) codes (X60-X84) and death records documented by the Korea National Statistical Office. Multivariate Cox proportional hazard regression analysis was performed to estimate the risk of suicidal death with respect to BMI categories after adjusting for potential confounders (age, sex, income, diabetes, hypertension, dyslipidemia, smoking, drinking, exercise, self-abuse, waist circumference, schizophrenia, bipolar disorder, eating disorder, cancer, anxiety, and substance use disorder).

RESULTS

Underweight individuals had an increased risk (hazard ratio [HR] 1.44, 95% confidence interval [CI] 1.31-1.57) while overweight (HR 0.79, 95% CI 0.76-0.83), class I (HR 0.76, 95% CI 0.71-0.80) and class II obesity (HR 0.71, 95% CI 0.63-0.81) were associated with decreased risks of suicidal deaths compared to those of the normal weight individuals (BMI 18.5-23). This trend was consistent regardless of the presence of major depressive disorder (MDD) or the type of living arrangements of the participants.

CONCLUSIONS

Suicidal death risk was inversely correlated with BMI categories, independent of MDD or living arrangements. Our data suggests the importance of physiological factors associated with body mass in understanding suicidal death risk. Furthermore, these data provide valuable insights to where the public health resources should be invested to reduce suicidal death rates.

Impact of behavioral inhibitory control and startle reactivity to uncertain threat on youth suicide risk

Poor inhibitory control and exaggerated threat reactivity are two well-established risk factors for suicide. Theory suggests that these two factors may interact to influence suicide risk, although few studies have directly tested these relationships. In the present study, we examined the unique and interactive effects of inhibitory control (IC) and threat reactivity on self-reported suicide risk in a sample of 132 youth, ages 16-19. The stop signal task was used as a behavioral index of IC. Threat reactivity was captured using a modified version of the No-Predictable-Unpredictable threat paradigm that includes threat of predictable (P-) and unpredictable (U-) mild electrical shock. Startle eyeblink potentiation was measured throughout the task as an index of aversive responding. All participants completed a battery of well-validated self-report measures including current suicide risk. Hierarchical linear regression analyses controlling for age and sex revealed no main effects of IC or threat reactivity. However, there was a significant IC by reactivity to uncertain threat (U-threat) interaction. At lower levels of IC, greater startle reactivity to U-threat was associated with greater suicide risk. At higher levels of IC, there was no association between reactivity to U-threat and suicide risk. These results suggest that individual differences in IC and reactivity to U-threat interact to influence suicide cognitions, shedding light on potential subgroups of individuals who might be at elevated risk.

Practitioner Review: Treatments for young people who self-harm - challenges and recommendations for research and clinical practice

BACKGROUND

Self-harm is very common in young people and is associated with suicide. Rates of both self-harm and suicide have increased in young people, particularly in females. There is a clear need to identify new approaches to prevent repeat self-harm.

METHOD

We significantly update and build on previous reviews with the aim of identifying issues in research relevant to clinical practice. We identify challenges in developing, implementing and evaluating treatments for self-harm in children and adolescents, suggest a way forward for research, and provide clear and practical guidance for clinicians on how to apply current research evidence in the real world.

RESULTS

Currently, there is limited evidence for effective interventions, other than some support for dialectical behaviour therapy for adolescents (DBT-A). To improve research and, by extension, clinical practice, future studies need to address psychosocial factors associated with youth self-harm and suicide, investigate the critical mechanism(s) of action, ensure trials are sufficiently powered and representative, and involve young people more actively in the design, implementation and evaluation of these approaches. Consideration should also be given to alternative research designs, such as pragmatic or adaptive clinical trials, as well as registry-based randomised controlled trials which leverage administrative data collected in routine clinical practice, to help meet these goals.

CONCLUSIONS

Recommendations for practice include undertaking comprehensive assessment and formulation, and offering DBT-A where indicated. There should be further development and evaluation (with input from young people) of Cognitive Behavioural-based Therapy adapted for young people. Greater attention to the role of the therapeutic relationship and family involvement (where possible) is also an important considerations, irrespective of the specific therapeutic modality. Finally, more consideration should be given to improving staff training to ensure all clinical staff feel equipped to treat young people who self-harm in a person-centred and compassionate manner.

Suicidal Communication Prior to Suicide in Children and Young Adults-A Medical Records Review in Health Care Services in Sweden

Suicide among children and young adults is a leading cause of mortality, highlighting the importance of the development of life-saving interventions. This study is part of the nationwide study Retrospective investigation of health care utilization of individuals who died by suicide in Sweden in 2015, Lund University, Sweden. The aim was to gain a better understanding of verbal suicidal communication and suicidal behaviour in children and young adults who die by suicide, to analyse gender and age differences, and to discuss the findings in relation to the prevailing psychological theories of suicidality. The study sample consisted of medical records from final health care consultations of 114 individuals up to 25 years, who died by suicide in Sweden a single year. Suicidal plans were documented in 13 percent of children and young adults. Females were more likely to have a notation of suicidal communication than males. Twenty-seven percent had made previous suicide attempts. Approximately 90 percent of the study cohort had contact with health care settings within 24 months prior to suicide. Questioning about suicidal plans appears to be an insufficient tool to assess suicidality in children and young adults. Clinical implications regarding alternative assessment methods and preventive measures are discussed.

Validation of the Colombian-Spanish Suicidality Scale for Screening Suicide Risk in Clinical and Community Settings

Background/Objective: This study aimed to validate the eight-item Suicidality Scale (SS) in Spanish in a Colombian sample to aid in suicide risk assessment, given the pressing need for accurate, accessible tools in resource-strained settings. Methods: A sample of 313 participants, drawn from both clinical and community settings, was used to evaluate the psychometric properties of the SS through tests of internal consistency, item response theory (IRT), and comparisons with clinical risk evaluations. Results: The SS demonstrated strong psychometric properties, with high internal consistency (ω = 0.96) and a significant correlation with clinical risk assessments (r = 0.84). Model fit indices confirmed a unidimensional eight-item structure with low error rates, while item response analysis revealed strong item discrimination. No differential item functioning was observed by gender or psychiatric diagnosis, supporting its consistency across demographics. Items on past suicide attempts and desire to live were excluded as they did not improve scale performance. Variability within risk levels suggests that individual differences may require clinical judgment. Conclusions: The findings validate the Colombian-Spanish SS as a valuable tool for suicide risk assessment, usable in both self-report and clinician-administered formats. Its brief, culturally adapted structure supports its utility in resource-limited environments, providing an accessible option for rapid screening. While the SS effectively categorizes general risk, further longitudinal studies are recommended to enhance its applicability in guiding clinical decisions and long-term risk management.

Psychological therapy for the prevention of suicide in prison: study protocol for a randomised controlled trial

BACKGROUND

Suicide is the leading cause of preventable death in prisons. Deaths from suicide in prison are significantly, and persistently, elevated compared to those living in the community. Psychological therapies have been shown to be a potentially effective means of alleviating suicidal thoughts, plans and behaviours, but patients located in prison often have no access to evidence-based psychological interventions targeting suicide. The objectives of this programme of research are to investigate the clinical and cost effectiveness of a new psychological therapy programme delivered to male prisoners at risk of suicide.

METHODS

The PROSPECT trial is a two-armed single blind, pragmatic, randomised controlled trial and will recruit a target sample size of 360 male prisoners, identified as at-risk of suicide, across 4 prisons in the North of England. Participants will be randomised to receive a psychological talking therapy (Cognitive Behavioural Suicide Prevention, CBSP) plus treatment as usual, or treatment as usual alone. Co-primary outcomes (Suicide Ideation and Suicide Behaviours), as well as related secondary outcomes, will be assessed at baseline and at 6-months follow-up. An intention to treat analysis will be conducted with primary stratification based on prison site and lifetime history of suicide attempt (yes/no). A nested qualitative process evaluation will investigate the nature and context in which the intervention is delivered, with specific focus upon the facilitators and barriers to the implementation of the therapy within prisons.

DISCUSSION

The key outputs from this trial will be to determine whether a psychological therapy for suicidal prisoners is clinically and cost effective; and to generate a project implementation platform that identifies how best to implement the new intervention across the broader prison estate.

TRIAL REGISTRATION

ISRCTN (reference ISRCTN14056534 https://www.isrctn.com/ISRCTN14056534 ; 24th September 2021). Registration confirmed prior to participant recruitment commencing. Modifications to protocol are listed on the study website at ISRCTN.

Suicide methods among Brazilian women from 1980 to 2019: Influence of age, period, and cohort

OBJECTIVE

To analyze the effect of age, period, and cohort on suicides among women by hanging, strangulation, suffocation, firearms, and autointoxication in different Brazilian regions from 1980 to 2019.

METHODS

Ecological time-trend study employing estimable functions to estimate APC models, facilitated through the Epi library of the R statistical program, version 4.2.1. Specific rates by age group per 100,00 women and relative risks by period and cohort were estimated using this method.

RESULTS

Between 1980 and 2019, 49,997 suicides among women were reported using the methods under study. Higher suicide rates per 100,000 women were observed in the South using strangulation and suffocation (2.42), while lower firearm suicide rates were observed in the Northeast (0.13). After adjusting the APC model, there was an increase in age-specific rates with advancing age across all regions for suicides by hanging, strangulation, and suffocation. In contrast, suicides by firearms and autointoxication showed a decrease in rates with advancing age. The period effect indicated an increased risk of suicides by hanging, strangulation (RR >1 and p<0.05) in the five-year intervals of the 2000s in the North, Southeast, and South regions. During the same period, there was an increased risk of suicides by autointoxication in the Southeast, South, and Northeast (RR>1, p<0.05). Suicides by firearms exhibited a statistically significant reduction in the risk of death from 2005 to 2019 in the Southeast and South regions, and from 2005 to 2014 in the Northeast and Midwest. The observed increase in the North region was not statistically significant (RR>1, p>0.05). The cohort effect demonstrated an increased risk of suicides by hanging, strangulation in younger cohorts (RR>1, p<0.05), whereas other methods showed an elevated risk in older cohorts relative to the 1950-1954 generation.

CONCLUSION

The results presented here may suggest changes in suicide method preferences between 1980 and 2019.

Unveiling Student Suicides in the Post-Pandemic Period: A Retrospective Analysis of Online News Portals in Bangladesh

Background and Aims

The post-COVID-19 pandemic period has heightened concerns about student mental health and suicide risk in Bangladesh. While studies have explored these issues during the pandemic, post-pandemic student suicides remain under-researched. This study investigates the characteristics, methods, and triggering events associated with suicidal behaviors among students in Bangladesh during the post-pandemic period (2022-2023).

Methods

Data were collected from 150 online newspaper portals in Bangladesh, covering student suicides from 2022 to 2023. Variables such as causes, methods, timing, location, sex, age, and education level were analyzed using Microsoft Excel, SPSS, and ArcGIS.

Results

A total of 984 student suicide cases were identified. Females accounted for 61% of the cases, while males represented 39%, indicating a higher vulnerability among female students. The majority of cases (72.5%) involved students aged 13-19 years, followed by those aged 20-25 years (18.4%). Secondary school students represented 44.9% of the cases, with 7.2% from madrasahs. Hanging was the most common method (79.7%). Major causes included emotional distress (28%), romantic relationship issues (19.5%), academic pressure (8.4%), family problems (8.1%), mental instability (7%), and sexual harassment (3.3%). The Dhaka division reported the highest rate (27.8%) of student suicides. Suicide rates were lowest in August 2022 (4.3%) but spiked in 2023 (12.6%).

Conclusion

This study highlights the significant rise in student suicides in Bangladesh after the pandemic, primarily driven by emotional distress, with females and the 13-19-year age group being most vulnerable. These findings emphasize the urgent need for gender-specific mental health interventions to address this growing issue.

The State of Open Science Practices in Psychometric Studies of Suicide: A Systematic Review

The adoption of open science practices (OSPs) is crucial for promoting transparency and robustness in research. We conducted a systematic review to assess the frequency and trends of OSPs in psychometric studies focusing on measures of suicidal thoughts and behavior. We analyzed publications from two international databases, examining the use of OSPs such as open access publication, preregistration, provision of open materials, and data sharing. Our findings indicate a lack of adherence to OSPs in psychometric studies of suicide. The majority of manuscripts were published under restricted access, and preregistrations were not utilized. The provision of open materials and data was rare, with limited access to instruments and analysis scripts. Open access versions (preprints/postprints) were scarce. The low adoption of OSPs in psychometric studies of suicide calls for urgent action. Embracing a culture of open science will enhance transparency, reproducibility, and the impact of research in suicide prevention efforts.

Prevalence of suicidal ideation and associated factors among pregnant women attending ANC follow-up clinic in Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2022

Suicide is a worldwide concern and ranks as the third leading cause of death among individuals of reproductive age. According to many findings, Ethiopia remains to suffer with a considerable number of suicide deaths and attempts, so more research on the prevalence of suicidal ideation is necessary. Since there is limited research available about suicide ideation/attempts specifically from the study area, evidence-based and solution-oriented research is necessary. This study sought to determine the prevalence of suicidal ideation and its contributing factors among pregnant women visited ante-natal care (ANC) at the University of Gondar Specialized Compressive Hospital. Institutional based cross-sectional study was conducted among 174 pregnant women who visit ante-natal care (ANC) at the University of Gondar Specialized Compressive Hospital, from June 01 to August 30, 2022. Participants were selected by using a systematic random sampling method. The World Mental Health (WMH) survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) was used to measure suicidal ideation and attempt. The data was entered into SPSS version 25 for analysis, and descriptive and inferential statistics were done. Bivariable and multivariable binary logistic regression analyses were done to identify factors associated with suicidal ideation and attempt among pregnant women. Variables with a P value less than 0.05 were considered statistically significant with 95% CI. In the current study 174 pregnant women were screened, and 168 volunteered to participate with a response rate of 96.5%. The finding showed that the prevalence of suicidal ideation and a suicidal attempt was 5.4% (95% CI: 1.8-8.9) and 4.8% (95% CI: 1.8-8.9) respectively. Unplanned pregnancy [AOR: 1.9(1.22-0.88)], history of abortion [AOR: 2.5(1.5-12.6)], history of stillbirth [AOR: 2.32(1.7-13.2)], HIV status of seropositive [AOR: 1.5(01.2-16.0)] and history of lifetime substance use [AOR: 1.6(1.3-12.0)] were significant positive predictors of prevalence of suicidal ideation. The study finding shows that the prevalence of suicidal ideation and attempt among pregnant women was low. Unplanned pregnancy, history of abortion, history of stillbirth, HIV status of seropositive, and history of lifetime substance use were variables significantly associated with suicidal ideation among pregnant women.

Suicide attempts in Martinique and Reunion Island and appointments no-show

OBJECTIVES

Studies on suicidal behaviors in the French overseas territories remain rare. Although mental health resources are limited, some patients identified as being at risk of suicide do not attend the specialist consultations scheduled after identification or screening. Thus, the objective of our study was, firstly to provide a descriptive profile of patients followed up for a suicide attempt in Martinique and Reunion Island, and secondly to explore the risk factors associated with appointments no-show during follow-up.

METHODS

We conducted an ancillary retrospective cross-sectional study using data from the APSOM study. Data were collected on 255 patients aged at least 16, admitted to hospital emergency departments after a suicide attempt and followed up in ambulatory care, including 137 in Martinique and 118 in Reunion Island. The characteristics of the sample were described by means [min, max] and proportions [95% confidence intervals]. Differences according to the presence of appointments no-show or not were analyzed using comparison tests of means and percentages (Chi2, Fisher and Wilcoxon). Factors associated with appointments no-show were analyzed using a bootstrapped multivariate logistic regression model.

RESULTS

The mean age of patients was 35 years [16-84 years]. Women were predominant with a sex ratio of 2.4:1 (71% women). Unemployment affected 37% [28%, 46%] of patients in Martinique and 49% [40%, 59%] in Reunion Island. Psychoactive substances consumption at the time of the suicidal act was observed in 36% [27%, 45%] of patients in Martinique and 34% [26%, 44%] in Reunion Island. The average number of suicide attempts was two per patient [1-20]. Finally, we found no significant association with appointments no-show except for center. Patients from Reunion Island were associated with better compliance than patients from Martinique (OR: 0.20 [0.05-0.65], P<0.012).

CONCLUSION

Our study provides a description of suicide attempts admitted to hospital and followed up in ambulatory care in two French overseas territories and suggests interesting approaches for adapting prevention strategies to the socioeconomic context and cultural realities of these territories, particularly outreach interventions for the most vulnerable patients.

Suicidal ideation and thoughts of self-harm during the COVID-19 pandemic among Swedish employees: a cohort study on the role of job instability and job insecurity

BACKGROUND

Suicidal ideation may be a warning sign for suicide and previous work has indicated a higher prevalence of suicidal ideation during the COVID-19 pandemic. Job loss and job insecurity are potential risk factors for suicidal ideation, but their importance during the pandemic, and the role of organizational changes for suicidal ideation, is unclear. This study examined the association between various experiences associated with job loss and job insecurity during the pandemic and thoughts of suicide/self-harm in Sweden.

METHODS

The study sample was drawn from the Swedish Longitudinal Occupational Survey of Health (SLOSH). Auxiliary data collections in February 2021 and 2022 assessed exposure to job loss/unemployment, furlough, workplace downsizing, or increased job insecurity versus stable employment and thoughts of suicide or self-harm (PHQ-9) during the pandemic. The analyses were based on 1558 individuals (2 349 observations) participating in either or both waves and who had been working before the pandemic. Logistic regression models with cluster-robust standard errors were fitted, including sociodemographic factors and prior mental health problems to control for potential confounding. Measures of personality based on a brief version of the Big-Five personality inventory were also added.

RESULTS

The results indicated an association between all experiences, except furlough, and thoughts of suicide/self-harm, when adjusting for sex, age, civil status, socioeconomic status and prior mental health (job loss odds ratio (OR) = 3.70, 95% confidence interval (CI) 1.79-7.63, downsizing OR = 2.41, CI 1.24-4.70, job insecurity OR = 2.77, CI 1.15-6.67). The associations for job loss and insecurity were attenuated by adjustment for personality, although it remained statistically significant for downsizing.

CONCLUSIONS

The results suggested a higher risk of suicidal ideation connected with loss of employment and survival of a downsizing, but not a forced reduction in working times/pay during the COVID-19 pandemic. The association for subjective job insecurity was less robust and may be partly explained by personality.

Resting-State Electroencephalogram Complexity Is Associated With Oral Ketamine Treatment Response: A Bayesian Analysis of Lempel-Ziv Complexity and Multiscale Entropy

INTRODUCTION

Subanesthetic doses of ketamine are a promising novel treatment for suicidality; however, the evidence for predictive biomarkers is sparse. Recently, measures of complexity, including Lempel-Ziv complexity (LZC) and multiscale entropy (MSE), have been implicated in ketamine's therapeutic action. We evaluated electroencephalogram (EEG)-derived LZC and MSE differences between responders and nonresponders to oral ketamine treatment.

METHODS

A total of 31 participants received six single, weekly (titrated) doses of oral racemic ketamine (0.5-3 mg/kg) and underwent EEG scans at baseline (Week 0), post-treatment (Week 6), and follow-up (Week 10). Resting-state (eyes closed and open) recordings were processed in EEGLAB, and complexity metrics were extracted using the Neurokit2 package. Participants were designated responders or nonresponders by clinical response (Beck Suicide Scale [BSS] score reduction of ≥ 50% from baseline to the respective timepoint or score ≤ 6) and then compared in terms of complexity across resting-state conditions and time.

RESULTS

Employing a Bayesian mixed effects model, we found strong evidence that LZC was higher in the eyes-open compared to eyes-closed condition, as were MSE scales 1-3. At a global level, responders displayed elevated eyes-open baseline complexity compared to nonresponders, with these values decreasing from baseline to post-treatment (Week 6) in responders only. Exploratory analyses revealed that the elevated baseline eyes-open LZC in responders was spatially localized to the left frontal lobe (F1, AF3, FC1, and F3).

CONCLUSION

EEG-complexity metrics may be sensitive biomarkers for evaluating and predicting oral ketamine treatment response, with the left prefrontal cortex bein a possible treatment response region.