Economic and epidemiological impact of youth suicide in countries with the highest human development index

Physical activity and suicidal behavior in medical students from the United States

BACKGROUND

There are little data on the relationship between physical activity and suicidal behavior in medical students. Therefore, this cross-sectional study aimed to investigate the association between physical activity and suicidal behavior and identify mediating factors involved in the association among medical students from the United States.

METHODS

Data from the Healthy Minds Study (2007-2023) were used. Physical activity and suicidal behavior (i.e., suicidal ideation, suicide plans, and suicide attempts) were self-reported. Control variables included age, gender, ethnicity/race, relationship status, citizenship, current financial stress, and academic year. Mediating factors were flourishing, generalized anxiety disorder symptoms, depressive symptoms, eating disorder symptoms, binge drinking, smoking, and drug use.

RESULTS

There were 6452 medical students included in the study (median [IQR] age 25.0 [3.0] years; 4032 [62.5 %] women). After adjusting for control variables, compared with <1 h of physical activity per week, the odds of any suicidal behavior were significantly lower for 3-4 h (OR = 0.57, 95 % CI = 0.41-0.79) and ≥5 h of physical activity per week (OR = 0.52, 95 % CI = 0.39-0.70). The physical activity-any suicidal behavior relationship was partially explained by decreased depressive symptoms (39.4 %), increased flourishing (27.6 %), and decreased generalized anxiety disorder symptoms (18.7 %).

LIMITATIONS

Data are of a cross-sectional nature.

CONCLUSIONS

There was an inverse association between physical activity and suicidal behavior in medical students from the United States, while several variables were identified as mediating factors (i.e., depressive symptoms, flourishing, and general anxiety disorder symptoms). Further research is needed to corroborate these findings in other settings, while longitudinal data are urgently warranted.

Suicidal Ideation, Suicide Attempts, and Suicide Deaths in Adolescents and Young Adults With Type 1 Diabetes: A Systematic Review and Meta-analysis

BACKGROUND

Evidence is lacking on the risk of suicide-related behaviors (suicidal ideation, suicide attempt, suicide death) in youth with type 1 diabetes (T1D).

PURPOSE

We aimed to 1) determine the prevalence of suicidal ideation, suicide attempts, and suicide deaths in adolescents and young adults (AYA) with T1D aged 10-24 years; 2) compare suicide-related behavior prevalence in youth with and without T1D; and 3) identify factors associated with suicide-related behaviors.

DATA SOURCES

A systematic search was conducted in MEDLINE, Embase, and PsycInfo up to 3 September 2023.

STUDY SELECTION

We included observational studies where investigators reported the prevalence of suicide-related behaviors among AYA aged 10-24 years with T1D.

DATA EXTRACTION

We collected data on study characteristics, data on prevalence of suicide-related behaviors, and data on associated factors.

DATA SYNTHESIS

We included 31 studies. In AYA with versus without T1D, pooled prevalence of suicidal ideation was 15.4% (95% CI 10.0-21.7; n = 18 studies) vs. 11.5% (0.4-33.3; n = 4), respectively, and suicide attempts 3.5% (1.3-6.7; n = 8) vs. 2.0% (0.0-6.4; n = 5). Prevalence of suicide deaths ranged from 0.04% to 4.4% among youth with T1D. Difficulties with T1D self-management were frequently reported to be associated with higher rates of suicide-related behaviors. However, findings on the association of glycemic levels and suicide-related behaviors were inconsistent.

LIMITATIONS

There was a considerable level of heterogeneity in meta-analysis of both suicidal ideation and suicide attempts.

CONCLUSIONS

Suicidal ideation and suicide attempts are prevalent in AYA with T1D. Current evidence does not suggest that these rates are higher among AYA with T1D than rates among those without.

Can sports participation be a protective factor against suicide-related outcomes in adolescents: a systematic review

Background

Suicide-related outcomes among adolescents have become a serious public health problem worldwide. Emerging evidence suggests that sports participation may interact with suicide-related outcomes. The objective of this systematic review is to systematically review and summarize the association between sports participation and suicide-related outcomes among adolescents.

Design

A systematic review according to PRISMA Statement (International Platform of Registered Systematic Review and Meta-Analysis Protocols registration: INPLASY202330072) https://inplasy.com/inplasy-2023-3-0072/.

Methods

The literature search was conducted in three electronic databases: Web of Science, PubMed, and EBSCOhost.

Results

A total of 16 studies (12 cross-sectional studies, 4 prospective studies) met the inclusion criteria were evaluated. Strong consistent evidence was found for the negative association between suicidal ideation, suicide attempts, and sports participation among adolescents. There was insufficient evidence to support consistency in the association between sports participation and suicide plans, and no evidence regarding gender differences between sports participation and these suicide-related outcomes. Furthermore, there was heterogeneity in the measures of sports participation and suicide-related outcomes across the included studies.

Conclusion

Evidence suggests that more sports participations are associated with lower suicidal ideation and suicide attempts in adolescents. However, the directionality of the observed associations should be examined based on more high-quality longitudinal studies in the future.

Link between neurodevelopmental disorders and suicidal risk in children

INTRODUCTION

Suicide represents a significant public health issue among children and adolescents. However, in this population, while the literature seems to support a link between suicidal risk and neurodevelopmental disorders, there are still few studies on the subject. The psychopathological description of children who have realized a suicide attempt with a high potential for lethality, which can be defined as "serious", appears to resemble that of children who have died by suicide. This study aimed to characterize the dimensional aspects of the neurodevelopmental profile of a population of children and adolescents hospitalized at Necker-Enfants-Malades Hospital for a serious suicide attempt.

METHODS

This is an observational, prospective, and single-center study. Questionnaires for collecting general information and dimensional scales of neurodevelopment (Autism-Tics, ADHD, and Other Comorbidities Inventory, Social Responsiveness Scale, and Conners-3 for parents) were used. This study included 21 patients aged 9 to 15 years at the time of their hospitalization.

RESULTS

The results supported the presence of at least one neurodevelopmental disorder (autistic traits, attention-deficit/hyperactivity disorder, learning disorder, or motor disorder) in 70% (n=14) of the subjects, and at least one behavioral disorder (oppositional defiant disorder, conduct disorder) in 65% (n=13) of these subjects.

CONCLUSION

The observed frequency of traits indicative of neurodevelopmental disorders in our population was higher than that observed in the general population, without the presented symptoms being eligible for categorical diagnosis. Considering the dimensional aspects of neurodevelopmental symptoms would therefore enable better identification of children at suicidal risk and more tailored interventions to contribute to the prevention of suicide in children.

The cost of illness and burden of suicide and suicide attempts in France

BACKGROUND

With 11,558 deaths and 200,000 suicide attempts in 2019, France is among the European countries most affected. The aim of this study was to determine the costs and burden of suicides and suicide attempts in France (population 67 million).

METHODS

We estimated direct costs, comprising healthcare, as well as post-mortem costs including autopsy, body removal, funeral expenses, police intervention and support groups; indirect costs comprised lost productivity, daily allowances; the burden of disease calculations used a monetary value for death and disability based on incidence data. Data was obtained from the national statistics, health and social care database, registries, global burden of disease, supplemented by expert opinion. We combined top down and bottom up approaches.

RESULTS

The total costs and burden of suicides and suicide attempts was estimated at €18.5 billion and €5.4 billion, respectively. Direct costs were €566 million and €75 million; indirect costs were €3.8 billion and €3.5 billion; monetary value for death and disability was €14.6 billion and €1.3. The monetary value for death and disability represented 79.1% and 24.8% of total costs for suicide and suicide attempt respectively. Some costs were based upon expert opinion, caregivers' burden was not counted and pre COVID data only is reported.

CONCLUSIONS

In France, the total cost and burden of suicides and suicide attempts was several billion €, suggesting major potential savings from public health interventions.

Depression and Suicidality: The Roles of Social Support and Positive Mental Health

OBJECTIVE

Despite being preventable, suicide remains a leading cause of death globally, with depression being one of the more prominent risk factors. This study examines the roles of social support and positive mental health in the depression-suicidality pathway.

METHODS

We utilized data from the Singapore Mental Health Study 2016. Social support and positive mental health were examined as mediators in the relationship between 12-month depression and 12-month suicidality using survey-weighted generalized structural equation modeling.

RESULTS

Overall positive mental health was found to partially mediate the relationship between depression and suicide. Of the discrete positive mental health domains, the depression-suicidality relationship was partially mediated by general coping and fully mediated by personal growth and autonomy.

CONCLUSION

While findings regarding social support were inconclusive, positive mental health may play a significant role in alleviating the effects of depression on suicidality. This highlights the multifaceted nature of suicidality and reveals positive mental health as a new area in assessing and treating at-risk people, to improve clinical outcomes.HIGHLIGHTSThe effect of depression on suicidality was partially mediated by overall positive mental health.General coping partially mediated the relationship between depression and suicidality.Personal growth and autonomy fully mediated the relationship between depression and suicidality.

The prevalence of suicidal behaviour and its associated risk factors among school-going adolescents resident in the United Arab Emirates

Suicidal behaviour which includes suicidal ideation, having a plan to commit suicide and suicide attempts remains a global public health issue as it substantially impacts adolescent health and wellbeing. Suicidal behaviour, however, remains understudied in Middle Eastern contexts. This study analysed data from the 2016 Global School-based Student Health Survey collected in the United Arab Emirates (UAE). A sample of 5826 adolescents aged between 11 and 18 years were sampled. Potential risk factors associated with an elevated risk for engagement in suicidal behaviour were examined. These factors were stratified into categories for analysis (demographics, psychosocial, risky health, and socio-environmental). The age-adjusted prevalence of suicidal behaviour amongst the school-going adolescent population in the UAE was 54%. Analyses indicated that elevated risk was significantly associated with anxiety difficulties, the experience of loneliness, and amongst those who smoked tobacco. None of the socio-environmental factors emerged as significant. A dose-dependent relationship was evident in that the degree of risk that was evident appeared to compound as the number of adverse risk factors increased. The data suggest that suicidal behaviour may be highly prevalent in this location. Findings highlight the immense need to develop preventative interventions, some of which may be school-delivered and targeted at parents. Our findings provide initial indications as to which risk factors could be targeted for remediation in developing these interventions.

Suicides among adults in Paraguay: An 18-year national exploratory study (2004-2022)

BACKGROUND

The number of suicides has been increasing worldwide, year after year, becoming the fourth leading cause of death among young people between 15 and 29 years of age.

AIM

In this study, we explored the frequency and characteristics of suicides among the adult general population in Paraguay between 2004 and 2022, considering that suicide attempts and suicidal risk/ideation are frequent and relevant issues in the consultation activity, even if epidemiological evidence on the national rates of suicide is scarce.

METHODS

In this observational, descriptive, and exploratory study, official records of all deaths by suicide were reviewed and information analyzed. In addition, an attempt was made to predict the number of suicides in the next 5 years according to a mathematical modeling.

RESULTS

In the 18-year period, 5,527 suicides of adults were recorded. Patients' mean age was 36.8 ± 17 years old. A 76.77% of them were males, 77.44% were from an urban area and 25.98% from the Greater Asunción and Central Department of Paraguay. The most frequently used method of suicide was intentional self-inflicted injury by hanging, strangulation, or suffocation (all 67.6%). The expected number of national suicides in the following years from 2023 to 2027 will range between 462 and 530. Limitations include the lack of information regarding diagnoses and personal history in the suicide reports as well as the possibility of underreporting of national suicide cases.

CONCLUSION

Our results represent the first large national epidemiological report of suicides in Paraguay and may be of interest for mental health professionals and health authorities in order to reduce the suicide mortality rate within the country.

Dietary Carotene Intake and Suicidal Ideation in Korean Females: Analysis of Data From the Korea National Health and Nutrition Examination Survey (2012, 2013, and 2015)

OBJECTIVE

The suicide rate in Korea was the highest among countries in the Organisation for Economic Co-operation and Development in 2019. In a previous study, higher intake of vegetables and fruits was associated with a lower risk of suicidal ideation, and carotene-rich fruits and vegetables lowered the risk of depression. This study aimed to examine the direct relationship between carotene intake and suicidal ideation, adjusting for the effect on depression.

METHODS

This study used data from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted in 2012, 2013, and 2015. Carotene intake was assessed through a food intake frequency survey with a 24-hour recall. Suicidal ideation and depression were assessed using the mental health section of the KNHANES. We applied logistic regression to assess the relationship between carotene intake and suicidal ideation, adjusting for potential confounders.

RESULTS

A total of 5,480 females aged 19-64 years were included in this study. Carotene intake was significantly lower in the suicidal ideation group (3,034.5±1,756.4 μg/day) than in the nonsuicidal ideation group (3,225.4±1,795.1 μg/day) (p=0.015). We found a significant inverse association between carotene intake and the risk of suicidal ideation after adjusting for potential confounders (odds ratio=0.934, 95% confidence interval=0.873-0.999).

CONCLUSION

These results suggest that carotene intake may be inversely associated with the risk of suicidal ideation. Our findings may inform the development of new nutritional interventions to prevent increases in the risk of suicide worldwide.

Scale-up costs and societal benefits of psychological interventions for alcohol use and depressive disorders in India

There is growing evidence for cost-effective psychological interventions by lay health workers for managing mental health problems. In India, Counseling for Alcohol Problems (CAP) and Healthy Activity Program (HAP) have been shown to have sustained cost-effectiveness for improving harmful alcohol use among males and depression remission among both sexes, respectively. We conducted a retrospective analysis of annual costs and economic benefits of CAP and HAP national scale-up with 2019 as the baseline. The CAP and HAP per capita integration costs were obtained from original studies, prevalence and disability-adjusted life-years for alcohol use disorders (AUD) and depressive disorders for 20-64 years old males and females from Global Burden of Disease study, and treatment gaps from National Mental Health Survey. We calculated three outcomes: 1) Programmatic scale-up costs for covering total or unmet needs. 2) Societal benefits from averted disease burden using human capital and value of life-year approaches. 3) Combinations of net benefits as differences between societal benefits and scale-up costs. Values were transformed to 2019 international dollars. CAP scale-up costs ranged from Int$ 2.03 (95%UI: 1.67, 2.44) billion to Int$ 6.34 (5.21, 7.61) billion while HAP ones ranged from Int$ 6.85 (5.61, 8.12) billion to Int$ 23.21 (19.03, 27.52) billion. Societal benefits due to averted AUD burden ranged from Int$ 11.51 (8.75, 14.90) billion to Int$ 38.73 (29.43, 50.11) billion and those due to averted depression burden ranged from Int$ 30.89 (20.77, 43.32) billion to Int$ 105.27 (70.78, 147.61) billion. All scenarios showed net positive benefits for CAP (Int$ 6.05-36.38 billion) and HAP (Int$ 11.12-93.50 billion) scale-up. The novel national-level scale-up estimates have actionable implications for mental health financing in India.

Systematic Review and Meta-analysis: International Prevalence of Suicidal Ideation and Attempt in Youth

OBJECTIVE

Globally, rates of youth suicide vary considerably. Suicidal thoughts and behaviors (STB) are consistently associated with risk of death by suicide. However, international trends in STB have not yet been compared. To address this gap, an international meta-analysis of epidemiological and school-based studies that report on STB in youth was conducted.

METHOD

Systematic searches were conducted in PubMed and PsycINFO through April 2022. Eligible studies included prevalence of active suicidal ideation (SI) or suicide attempts (SA) in community youth younger than age 22. All studies were coded by 2 authors. Mixed models accounting for shared methods and including hypothesized moderators were conducted using the metafor package in R.

RESULTS

There were 371 effect sizes for SI, 94 for SI with a plan, and 316 for SA, representing 149 regions. Year of data collection ranged from 1981 to 2021. Participants were 6 to 21 years old. The prevalence of SI ranged across regions from 14.3% to 22.6%; the prevalence of SA ranged from 4.6% to 15.8%. Year was not associated with increasing STB prevalence except for studies from the United States, which showed increasing rates of SI and SA since 2007.

CONCLUSION

This is the most comprehensive meta-analysis of STB in youth, providing valuable data about how risk factors most commonly associated with suicide vary internationally and over time. International rates of STB among youth are not improving and may be getting worse in the United States, despite efforts to reduce suicide risk. Most studies did not report rates of SI or SA separately for LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and others) youth and youth of color. A better understanding of proximal risk at the individual level will be important to informing future prevention efforts, especially for high-risk groups.

Emotion self-stigma as a unique predictor of help-seeking intentions: A comparative analysis of early adolescents and young adults

OBJECTIVES

There has been limited consideration of the role emotion self-stigma (i.e. beliefs that experiencing and expressing so called 'negative' emotions are unacceptable) may play in help-seeking for emotional distress. This study is the first to investigate whether emotion self-stigma uniquely predicts help-seeking intentions across two key emotion vulnerability periods in development: (a) early adolescence and (b) young adulthood.

METHODS AND DESIGN

Cross-sectional data were collected from secondary school (n = 510; M age = 13.96 years) and university students (n = 473; M age = 19.19 years) residing in Australia. Both samples completed measures online examining demographic characteristics, emotional competence, mental health and help-seeking stigma, emotion self-stigma, and help-seeking intentions. The Data were analysed using hierarchical multiple regression.

RESULTS

Emotion self-stigma was a significant unique predictor of help-seeking intentions in young adults but not adolescents. The strength of the relationship between increased emotion self-stigma and lowered help-seeking intentions was similar for both males and females, regardless of developmental period.

CONCLUSIONS

Addressing emotion self-stigma alongside mental illness and help-seeking stigma may be useful to improve help-seeking outcomes, particularly as young people transition into early adulthood.

What Will Be the Impact of the COVID-19 Pandemic on the Human Capital and Economic Growth? Evidence from Eurozone

This study provides new empirical evidence concerning the relationship between human capital and economic growth for 17 European countries over the periods 2015–2019 and 2019–2022. The results show that both education and health have a positive and significant impact on economic growth, and thus support higher growth. Also, our empirical results before COVID-19 show that there is bidirectional causality between economic growth and health, as well as education and economic growth, and there is unidirectional causal relationship running from education to health. After COVID-19, there is no significant causality between economic growth education and health. The results of this study may be of great importance for policy and decision makers in developing policies to foster human capital for European countries.

Nursing Students Facilitating the Transition from Suicidal Ideation to Action in the Rural: A Qualitative Study

OBJECTIVE

This study aims to increase understanding of the process of nursing students at risk of completing suicide attempts that facilitates the transition from suicidal ideation to action. And The Central Bureau of Statistics, there were 812 suicide cases throughout Indonesia.

METHODS

The qualitative research involved 15 nursing students who were selected purposively. data collection in rural East Java Data were collected through semi-structured interviews and analyzed using the Colaizzi phenomenological method.

RESULTS

We identified six main themes; 1 (the dimension of individual history). 2 (socio-cultural dimension) describes the problems experienced by nursing students on campus and off campus. 3 (interpersonal dimension). 4 (intrapersonal dimension); Factors of family conflict, peer conflict, and psychiatric and/or medical disorders. 5 (emotional dimension). 6. (be a good listener).

CONCLUSION

The intrapersonal element is the most influential catalyst in the progression from suicidal ideation to action. As prospective targets for preventive interventions and practices with nursing students at risk of suicide, our findings suggest the need for specific measures addressing freshman recruitment during selection for faculty, emotional dysregulation, and feelings of invalidity and entrapment. Nursing students need intrapersonal training. Being a good listener for all students, lecturers and staff is important to create a support system for suicide prevention in the nursing environment.

Suicide attempts among students of higher education, Nelson Mandela Bay Municipality, South Africa

BACKGROUND

Worldwide, death by suicide is a leading cause of death among young people, and students of higher educational institutions constitute a vulnerable group. This study aimed to determine the lifetime prevalence and associated factors of suicide attempt among students of a higher education institution in Nelson Mandela Municipality.

METHODS

A cross sectional study was conducted among students of East Cape Midland College in Nelson Mandela Municipality. The participants were selected by stratified random sampling and a standardised self-administered questionnaire was used to collect data.

RESULTS

The prevalence of lifetime suicide attempts was 16.0% among the participants. Multivariate logistic regression analysis revealed higher odds of suicide attempts among participants who: experienced bullying (OR: 1.66, CI: 1.05-2.61; p  0.001), had underlying medical conditions (OR: 3.27, CI: 2.08-5.14; p  0.001), had abnormal body weight perceptions (OR: 1.64, CI: 1.03-2.62; p  0.05), had experienced sexual abuse (OR: 5.72, CI: 2.86-11.45; p  0.001), or had someone very close who had experienced sexual abuse (OR: 1.77, CI: 1.02-3.05; p  0.05).

CONCLUSION

This study identified history of sexual abuse, bullying, perceptions of abnormal body weight and underlying medical conditions as associated risk factors of suicide attempts among the participants. The high prevalence of suicide attempts among the participants (16%) demonstrates the urgent need for campus-based interventions and prevention strategies aimed at addressing the identified associated factors.

Alcohol use and death by suicide: A meta-analysis of 33 studies

INTRODUCTION

Decades of research show an association between alcohol use and death by suicide. However, findings on the temporal link between alcohol use and death by suicide are unclear. In the most comprehensive meta-analysis on the topic to date, we analyzed data from longitudinal studies to determine if alcohol use is a risk for death by suicide. We also explored moderators to uncover conditions where the alcohol use-suicide link is strengthened/weakened.

METHODS

Our literature search of six databases yielded 33 eligible studies involving 10,253,101 participants (community, psychiatric, and military samples).

RESULTS

Alcohol use was associated with a 94% increase in the risk of death by suicide. Specifically, random-effects meta-analysis revealed alcohol use displayed small-to-large significant risk and odds ratios with suicide for quantity of alcohol use and alcohol use diagnosis/alcohol-related problems. Meta-regression generally indicated larger effect sizes for studies with a higher percentage of women, younger age, unadjusted estimates, longer follow-up periods, military samples, and higher frequencies and quantities of alcohol use (relative to drinker/non-drinker status).

CONCLUSION

Our study highlights alcohol use as a substantive risk factor for death by suicide and underscores the importance of monitoring alcohol use among suicidal individuals and screening for suicidality among heavier alcohol users.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Lithium in Drinking Water as a Public Policy for Suicide Prevention: Relevance and Considerations

Although suicide is considered a major preventable cause of mortality worldwide, we do not have effective strategies to prevent it. Lithium has been consistently associated with lowering risk of suicide. This effect could occur at very low concentrations, such as trace doses of lithium in tap water. Several ecological studies and recent meta-analysis have suggested an inverse association between lithium in water and suicide in the general population, with a lack of knowledge of clinically significant side effects. This paper is aimed as a proposal to discuss the addition of lithium to drinking water to decrease the suicide rate. For this, we review the evidence available, use previous experiences, such as water fluoridation to prevent dental caries, and discuss the complexity involved in such a public policy. Considering the limited data available and the controversies contained in this proposal, we suggest that a consensus on lithium concentration in water is needed, where the suicide rates start to reduce, as happened with water fluoridation. This measure will require to develop community-controlled trials with strict monitoring of any side effects, where democratic procedures would constitute one of the most appropriate ways to validate its implementation according to the reality of each community.

Preventing Adolescent and Young Adult Suicide: Do States With Greater Mental Health Treatment Capacity Have Lower Suicide Rates?

PURPOSE

Youth suicide is increasing at a significant rate and is the second leading cause of death for adolescents. There is an urgent public health need to address the youth suicide. The objective of this study is to determine whether adolescents and young adults residing in states with greater mental health treatment capacity exhibited lower suicide rates than states with less treatment capacity.

METHODS

We conducted a state-level analysis of mental health treatment capacity and suicide outcomes for adolescents and young adults aged 10-24 spanning 2002-2017 using data from Centers for Disease Control and Prevention, U.S. Bureau of Labor Statistics, Federal Bureau of Investigation, and other sources. Multivariable linear fixed-effects regression models tested the relationships among mental health treatment capacity and the total suicide, firearm suicide, and nonfirearm suicide rates per 100,000 persons aged 10-24.

RESULTS

We found a statistically significant inverse relationship between nonfirearm suicide and mental health treatment capacity (p = .015). On average, a 10% increase in a state's mental health workforce capacity was associated with a 1.35% relative reduction in the nonfirearm suicide rate for persons aged 10-24. There was no significant relationship between mental health treatment capacity and firearm suicide.

CONCLUSIONS

Greater mental health treatment appears to have a protective effect of modest magnitude against nonfirearm suicide among adolescents and young adults. Our findings underscore the importance of state-level efforts to improve mental health interventions and promote mental health awareness. However, firearm regulations may provide greater protective effects against this most lethal method of firearm suicide.

Relationships between neighborhood collective efficacy and adolescent suicidal ideation

INTRODUCTION

Until now, South Korean adolescent suicidal ideation literature has focused mainly on individual-level characteristics. Little is known about the contextual effects of social integration and social regulation on an individual's suicide behavior in South Korea as identified through the use of Durkheim's sociological insights. This study drew on Durkheim's suicide and collective efficacy theories and analyzed the effects of the structural characteristics and collective efficacy of neighborhoods on adolescents' suicidal ideation.

METHODS

The data analyzed was from three sources: the 2013 Korean National Survey of the Present Status of Children (n = 1,915; 50.41% girls; mean age = 13.04 years), government census data from the Korea Statistical Information System, and administrative data from the Korea Ministry of Health and Welfare. The Hierarchical Generalized Linear Model was used to investigate the effects of neighborhood structural characteristics and collective efficacy on adolescent suicidal ideation.

RESULTS

There were no significant associations between neighborhood characteristics such as concentrated poverty, divorce rate, and residential instability; however, adoles cents' perceptions of collective efficacy in neighborhoods was associated with lower suicidal ideation after accounting for individual adolescent differences.

CONCLUSION

The findings provide significant implications for the prevention of suicide in adolescents and suggest that enhancing the collective efficacy of neighborhoods through community-based intervention may be an important target of future suicide prevention strategies in South Korea.

Association Between Suicide and Drinking Habits in Adolescents

Objectives

Adolescent suicide is a serious social problem. Adolescent alcohol use is one of the most important risk factors for adolescent suicide. This study aimed to identify the relationship between drinking habits and suicide among Korean adolescents.

Methods

Data from the 14th and 15th Korean Youth Risk Behavior Web-based Survey, conducted in 2018 and 2019, were used for analysis. Multiple logistic regression analysis was used to identify the relationship between drinking habits—including the age of drinking initiation, frequency of drinking, average drinking amount, frequency of drunkenness—and suicidal ideation, plans, and attempts.

Results

Even after adjusting for age, sex, school grade, academic achievement, socioeconomic status, depression, stress, and drinking habits, the frequencies of drinking and drunkenness increased the risk of suicide attempts. Suicide attempts were associated with the frequency of drinking in girls and middle school students, and with the frequency of drunkenness in boys and high school students.

Conclusion

This study identified associations between drinking habits (the age of drinking initiation, frequency of drinking, average amount of drinking, frequency of drunkenness) and suicidal behavior in adolescents. Our findings suggest that to prevent adolescent suicide, it might be necessary to investigate drinking habits, including the frequencies of drinking and drunkenness. Moreover, considering the differences in sex and school grade, it is important to include the individual group characteristics when evaluating drinking habits.

Production losses attributable to suicide deaths in European Union

BACKGROUND

Suicide is an important public health problem with multidimensional consequences for societies. One of the under-researched areas of suicide consequences are cross-country analyses of production losses associated with these deaths. The aim of this study was to estimate the production losses (indirect cost) of suicide deaths in 28 European Union states (EU-28) in 2015.

METHODS

The study used societal perspective and human capital approach to investigate production losses due to suicide mortality at working age. Eurostat's data on the number of deaths was used to identify suicide mortality burden in terms of years of potential productive life lost. Labour and economic indicators were applied to proxy the discounted value of potential economic output lost. A one-way deterministic sensitivity analysis was conducted to test the robustness of the estimates.

RESULTS

The production losses attributable to suicide deaths in EU-28 in 2015 were €9.07 billion. The per suicide indirect cost of these deaths was €231,088 for the whole EU-28 population; Luxembourg experienced the highest per suicide burden of €649,148. The per capita production losses of suicides in EU-28 was €17.80 and Ireland experienced the highest per capita burden of €48.57. The losses constituted an economic burden of 0.061% of EU-28's GDP and this share ranged from 0.018% in Cyprus to 0.161% in Latvia. Most of the losses (71-91%) were due to men's deaths. The results of the sensitivity analysis exhibit a large variation of losses; the highest (lowest) cost was identified with no adjustment for lower employment rates among those dying by suicide (adjustment for minimum productivity) and was 92.3% higher (59.7% lower) on average than in the base scenario.

CONCLUSION

Public health actions aimed at prevention of suicides might reduce their health burden but also contribute to the economic welfare of European societies.

Investigating prolonged social withdrawal behaviour as a risk factor for self-harm and suicidal behaviours

BACKGROUND

Self-harm and suicidal behaviour are recognised as public health concerns. Prolonged social withdrawal behaviour, or hikikomori, is reported as a risk factor for suicidal behaviour.

AIMS

To examine the occurrence and additional risk of prolonged social withdrawal behaviour on self-harm and suicidal behaviour among Chinese university students.

METHOD

A cross-sectional online survey was conducted with three universities in southern China. A two-stage random sampling was adopted for recruitment, with students in different years of study, in different departments of each participating university. Hierarchical logistic regression analyses were conducted to investigate the sociodemographic and psychological correlates of self-harm and suicidal behaviours among male and female participants with hikikomori status.

RESULTS

Of the students who completed the online survey, 1735 (72.23%) were included in the analysis; 11.5% (n = 200) reported self-harm behaviour and 11.8% (n = 204) reported suicidal behaviours in the past 12 months. Men showed a higher prevalence rate of self-harm than women (14.7% v. 10.8%, P = 0.048), but a similar rate of suicidal behaviours (11.9% v. 11.3%, P = 0.78). The overall prevalence rate of social withdrawal behaviour was 3.2% (7.0% for men and 2.3% for women, P < 0.001). Prolonged social withdrawal behaviour status was significantly associated with self-harm (odds ratio 2.00, 95% CI 1.22-3.29) and suicidal behaviour (odds ratio 2.35, 95% CI 1.45-3.81). However, the associations became statistically insignificant after adjustment for psychological factors in the final models in the logistic regression analyses.

CONCLUSIONS

Prolonged social withdrawal behaviour appears to be associated with self-harm and suicidal behaviour, but psychological factors have stronger links with suicidality.

Contributions of Subjective Well-Being and Good Living to the Contemporary Development of the Notion of Sustainable Human Development

The article analyzes the contributions of the notions of Good Living attributable to epistemologies, traditions, and subjective well-being at work, given the current changes in the working context, to enrich the concept of human development. The article is developed with an analytical-descriptive and synthetic approach, reconstructing the concept of Good Living through a theoretical-economic, ontological, and epistemological comparison and its dimensional axes. Methodologically, a systematic review of human development literature is used in Latin America through the Web of Science (WOS), comparing the UNDP Technical Notes (HDI) with the various approaches to Good Living published between 2010 and 2020. These documents were subjected to semantic contrast, with reference to the various dimensions and positions of human development as a generator of subjective well-being for the configuration of public labor policies. The main findings refer to the disagreement points evidenced in the two-axes dimensions of the Good Living measurement systems (mobility and safety, and cultural satisfaction within territories), an important factor being the sumak kawsay, the concept of Good Living. Sumak is fullness, the sublime, excellent, magnificent, beautiful, superior. Kawsay is life, being. However, it is dynamic, changing, and is not a passive question, and is thus not considered by the different evolutionary changes of the HDI.