Suicidal ideation among Canadian adults during the COVID-19 pandemic: the role of psychosocial factors and substance use behaviours

Substance use and risk of suicide among adults who sought mental health and addiction specialty services through a centralised intake process in Nova Scotia: a cross-sectional study

OBJECTIVES

The objectives of this study are as follows: (1) to estimate the prevalence of suicide risk among individuals seeking mental health and addiction (MHA) services in Nova Scotia; (2) to examine the relationship between substance use and suicide risk among this population.

SETTING

MHA intake programme, a province-wide centralised intake process established in 2019 by the Department of Health and Wellness of Nova Scotia.

PARTICIPANTS

We included 22 500 MHA intake clients aged 19-64 years old who contacted MHA intake from 2020 to 2021.

PRIMARY OUTCOME MEASURES

During the intake assessment, clients were assessed for suicide risk (past suicide attempt, suicidal ideation during the interview or 2 weeks before the interview).

RESULTS

The lifetime prevalence of suicide attempt was 25.25% in the MHA clients. The prevalence of mild and moderate/high suicide risk was 34.14% and 4.08%, respectively. Clients who used hallucinogens had the highest prevalence of mild and moderate/high suicide risk (61.3% and 12.9%, respectively), followed by amphetamine/methamphetamine (47.6% and 13.3%, respectively) and sedative/hypnotics (47.2% and 8.9%, respectively) users. Stimulant (aOR=1.84, 95% CI 1.23 to 2.75) and hallucinogen (aOR=3.54, 95% CI 1.96 to 6.43) use were associated with increased odds of moderate/high suicide risk compared with denying current use. Additionally, alcohol (aOR=1.17, 95% CI 1.06 to 1.30) and tobacco (aOR=1.20, 95% CI 1.10 to 1.30) use were associated with increased odds of mild suicide risk.

CONCLUSION

Suicide behaviours were prevalent among clients seeking MHA services. Substance use is an important factor associated with suicide risk in this population. This result underscored the importance of considering substance use patterns when assessing suicide risk and highlighted the need for targeted interventions and preventive measures for individuals engaging in substance use. Future interventional studies are needed to identify and evaluate effective strategies for reducing substance use and suicide risk among clients of MHA central intake.

COVID-19 impacted the suicidal ideation among health care workers and medical students: An interrupted time-series analysis of data from 30 countries

AIM

To investigate the impact of public health emergencies on the prevalence of suicidal ideation among healthcare workers (HCWs) and medical students.

METHODS

The prevalence of suicidal ideation among HCWs and medical students was searched for analysis. The platforms included PubMed, medRVix, bioRvix, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science. Interrupted time-series analysis was employed to determine whether the COVID-19 pandemic influenced the prevalence and trends of suicidal ideation. To account for autocorrelation and heteroskedasticity, Newey-West standard errors were utilized with a lag of order one.

RESULTS

Seventy studies with 145,641 HCWs and medical students from 30 countries were included in the final analysis, with 30 studies before COVID-19 and 40 studies during the pandemic. Before the pandemic outbreak (April 2020), the monthly increasing rate was 0.063 % (95 % CI: -0.009 %, 0.135 %, z = 1.73, P = 0.084). The tendency of suicidal ideation prevalence increased by 1.116 % (95%CI: 0.888 %, 1.344 %, z = 9.60, P < 0.001). In other words, the calculated monthly growth rate of suicidal ideation after the pandemic outbreak is 1.179 % (95%CI: 0.968 %, 1.391 %, z = 10.93, P < 0.001) per month. The overall growing trend of prevalence of suicidal ideation during the pandemic is 1.896 % per month in America; 1.590 % in Europe; 0.443 % (95%CI: 0.213 %, 0.673 %, z = 3.77, P < 0.001) in Asia; 1.055 % in HCWs; and 0.645 % in medical students.

CONCLUSION

This study highlights that the COVID-19 pandemic can significantly impact the prevalence of suicidal ideation among HCWs and medical students, and the prevalence showed an upward trend.

Evidence of higher suicidal ideation among young adults in Canada during the COVID-19 pandemic

In this national study, we analyzed population-level data from a representative longitudinal survey to understand the impact of the COVID-19 pandemic on suicidal ideation rates. Between April and May 2021, responses from 1793 adults aged 20 and older were collected regarding suicidal ideation. Our analysis revealed a significant increase in suicidal ideation during the pandemic's first year, with an age-adjusted incidence rate of 7.6%-nearly three times the pre-pandemic rate of 2.7%. Young adults, particularly those between 20 and 29 years of age, had a higher incidence of suicidal ideation (10.9%) in contrast to those aged 30 and older (6.6%). Furthermore, 21.4% of young adults aged 20 to 29 reported having experienced suicidal ideation at some point in their lives, compared to 13.1% among adults aged 30 and older, indicating a heightened susceptibility to suicidal ideation in this age group. Using multinomial logistic regression, the study identified factors like younger age and job loss due to COVID-19 as contributors to suicidal ideation with other sociodemographic variables, presenting new insights in the scientific literature. Job loss contribution was independent of the age effect. The study highlights a significant increase in suicidal ideation during the pandemic, particularly among young adults, emphasizing the need for targeted mental health interventions and prioritizing their well-being for future public health strategies.

Editorial: Marijuana Legalization and Suicide in Adolescents and Transitional-Age Youth: Important Future Directions for This Line of Research

Marijuana legalization (ML) processes for medical and recreational use in the United States have been prompted by the potential for positive downstream legal effects of decriminalization, including fewer cannabis-related arrests and prosecutions, which have historically disproportionately impacted minoritized communities. However, ML evolved through primarily political processes, with minimal scientific guidance to inform policies. Commercialization has increased youth cannabis access, diversion of parental cannabis, and proliferation of high-potency products, which, along with early use, are associated with poor mental health outcomes.1 Taken together, these findings raise concerns about the impact of medical (MML) and recreational marijuana legalization (RML) on youth mental health.

The Role of Substance Use Disorders on Suicidal Ideation, Planning, and Attempts: A Nationally Representative Study of Adolescents and Adults in the United States, 2020

Few nationally representative studies examine suicidality and substance use during 2020; as such, we explored the role of substance use disorders (SUDs) on suicidality among adults and adolescents in 2020. Data were derived from N = 26,084 adult participants, representing 240 million U.S. adults weighted, and N = 5,723 adolescent participants, representing 25 million U.S. adolescents (12-17 years.). Separate logistic regressions for adults and adolescents were used to assess the association of DSM-5 SUDs, related factors, and suicidal thoughts and behaviors (ideation, planning, and attempts). In 2020, adults with SUDs were nearly 4 times more likely to seriously consider suicide (aOR = 3.94, 95% CI: 3.19, 4.86), 3 times more likely to make a suicide plan (aOR = 3.09, 95% CI: 2.25, 4.25), and nearly 4 times more likely to attempt suicide (aOR = 3.77, 95% CI: 2.29, 6.19) than adults without SUDs. Adolescents with SUDs were 4 times more likely to consider suicide (aOR = 3.69, 95% CI: 2.47, 5.51), 5 times as likely to make a suicide plan (aOR = 5.14, 95% CI: 3.25, 8.13) and to attempt suicide (aOR = 5.27, 95% CI: 2.91, 9.53) than adolescents without SUDs. Adult females and individuals experiencing poverty were twice as likely to attempt suicide than adult males and individuals not living in poverty. Adolescent females were 3-5 times more likely to seriously consider, plan, and attempt suicide than adolescent males. Interventions to curb suicidality among individuals with SUDs are crucial.

Prevalence and Risk Factors for Suicidal Ideation Following the COVID-19 Pandemic in Kerman Province: A Cross-Sectional Study

BACKGROUND

Suicidal ideation (SI) serves as an important predictor of suicide. The prevalence of SI has increased following the COVID-19 pandemic. This study aims to investigate the prevalence and risk factors associated with SI after the pandemic in the Kerman province.

METHODS

This cross-sectional study was conducted in 23 counties of the Kerman province between 2021 and 2022. The Beck Scale for Suicidal Ideation (BSSI) was utilized to estimate SI, while multiple logistic regression analysis was employed to examine the impact of various variables on SI.

RESULTS

A total of 1421 individuals (47.7% men, 50.0% women and 2.3% unknown) with an average age of 35.17±9.47 years participated in this study. The estimated prevalence rate of SI was 9.2%, with variations ranging from 0% to 42% across different counties. Individuals with SI exhibited a significantly younger mean age and fewer family members. Furthermore, SI was significantly more prevalent among single participants, unemployed individuals, students, those with a history of mental illness, prior psychiatric medication use, and previous SI. Employed individuals had 87% lower odds of experiencing SI compared to the unemployed. Individuals with a history of prior SI had 239 times higher odds of SI than those without such a history. Additionally, each year increase in age corresponded to an 8.8% decrease in the odds of SI.

CONCLUSION

The high prevalence of SI is concerning, and it is essential to remain vigilant regarding its health and social consequences as the pandemic continues. Therefore, it is imperative to provide enhanced mental health services, particularly targeting at-risk groups.

Systematic Review and Meta-Analysis: Malnutrition and In-Hospital Death in Adults Hospitalized with COVID-19

BACKGROUND

Malnutrition and increased malnutrition risk are frequently identified in hospitalized adults. The increase in hospitalization rates during the COVID-19 pandemic was accompanied by the documentation of adverse hospitalization outcomes in the presence of certain co-morbidities, including obesity and type 2 diabetes. It was not clear whether the presence of malnutrition increased in-hospital death in patients hospitalized with COVID-19.

OBJECTIVES

To estimate the effect of malnutrition on in-hospital mortality in adults hospitalized with COVID-19; and secondarily, to estimate the prevalence of malnutrition in adults hospitalized with malnutrition during the COVID-19 pandemic.

METHODS

EMBASE, MEDLINE, PubMed, Google Scholar, and Cochrane Collaboration databases were queried using the search terms malnutrition and COVID-19 and hospitalized adults and mortality. Studies were reviewed using the 14-question Quality Assessment Tool for Studies with Diverse Designs (QATSDD) (questions appropriate for quantitative studies). Author names; date of publication; country; sample size; malnutrition prevalence; malnutrition screening/diagnostic method; number of deaths in malnourished patients; and number of deaths in adequately nourished patients were extracted. Data were analyzed using MedCalc software v20.210 (Ostend, Belgium). The Q and I² tests were calculated; a forest plot was generated, and the pooled odds ratio (OR) with 95% confidence intervals (95%CI) were calculated using the random effects model.

RESULTS

Of the 90 studies identified, 12 were finally included in the meta-analysis. In the random effects model, malnutrition or increased malnutrition risk increased odds of in-hospital death by more than three-fold: OR 3.43 (95% CI 2.549-4.60), p < 0.001. The pooled prevalence estimate for malnutrition or increased malnutrition risk was 52.61% (95% CI 29.50-75.14%).

DISCUSSION AND CONCLUSIONS

It is clear that malnutrition is an ominous prognostic sign in patients hospitalized with COVID. This meta-analysis, which included studies from nine countries on four continents with data from 354,332 patients, is generalizable.