Sleep disturbance and suicidal ideation among youth with depression

BACKGROUND

Sleep disturbance may exacerbate the risk of suicide among youth with depression, but whether this association is independent of psychopathology requires further study.

METHODS

This cross-sectional study included 576 youths (13-25 years old) recruited from January 2022 to May 2023. The patients were first divided into two groups by the presence of suicidal ideation according to the Columbia-Suicide Severity Scale (C-SSRS). Sleep quality was assessed by the Athens Insomnia Scale (AIS) and mental health with the Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA). Logistic regression was conducted to analyze the association between sleep disturbance and suicidal ideation, adjusted for depressive symptoms severity.

RESULTS

The suicidal ideation group exhibited more severe sleep disturbances, anxiety symptoms, and depressive symptoms than the non-suicidal ideation group. Pearson correlation showed that sleep disturbance (AIS) was significantly correlated with the severity of anxiety symptoms, depressive symptoms, and suicidal ideation. Logistic regression analysis revealed that the AIS factor "daytime dysfunction" (β = 0.145; OR = 1.156, 95 % CI: 1.02, 1.309; p = 0.023) was significantly associated with suicidal ideation after adjusting for demographic characteristics and depressive symptoms severity.

LIMITATIONS

Due to the cross-sectional nature of the data, no causal inference can be made regarding the observed associations between sleep disturbance and suicidal ideation.

CONCLUSION

Sleep disturbance, particularly in the realm of daytime dysfunction, is associated with increased suicidal ideation among depressed youth. Clinicians need to assess and manage sleep disturbance in the context of suicidal ideation for young depression patients.

Positive mental health accounts for the relationship between insomnia symptoms and suicide-related outcomes

Insomnia symptoms have been shown to be associated with suicide ideation/behavior. However, the underlying mechanism is unclear and studies on protective factors that might mitigate the association between sleep-related problems and suicide ideation/behavior are largely missing. On this background the aim of the current study was to investigate, whether positive mental health (PMH) accounts for the association between insomnia symptoms and suicidal ideation/behavior. A total of 913 participants (72.2% women; age: M(SD) = 25.91 (7.08)) completed measures on insomnia symptoms, PMH and suicide ideation/behavior via an online survey. The results reveal a significant association between insomnia symptoms and PMH. Both variables were significantly linked to lifetime suicide ideation/behavior and 12-month suicide ideation. Moreover, the association between insomnia symptoms and suicide-related outcomes was significantly mitigated by PMH. The current findings complement previous studies on the association between insomnia symptoms and suicide ideation/behavior. Furthermore, they demonstrate that PMH can mitigate the risk of suicide-related outcomes. Therapeutic intervention targeting insomnia symptoms and fostering PMH might be useful in the prevention of suicide ideation/behavior.

The moderating role of belongingness in the contribution of depression to suicide ideation following the October 7, 2023, terrorist attack in Israel: A nationwide prospective study

INTRODUCTION

With >1300 civilians murdered, the terrorist attack of October 7 is one of the deadliest terrorist attacks in modern history. Previous research documented a sharp increase in depression in the aftermath of the attacks and the military conflict that followed. In this national prospective cohort study, we examined to what extent perceived belongingness (PB) moderates the association between depression and suicide ideation (SI) in the wake of the October 7th terrorist attack.

METHODS

A representative sample of 710 Israeli adults (of them, 362 females, 51.1 %), Jews (557, 79.9 %), and Arabs (153, 20.1 %), aged 18-85 (M = 41.01, SD = 13.72) completed questionnaires assessing depression, current SI, and perceived belongingness at two timepoints: T1 (in August 2023) and T2 (in November 2023).

RESULTS

Perceived belongingness at T1 predicted SI at T2 beyond demographic and trauma-related characteristics. Importantly, we found a significant interaction in which a PB at T1 moderated the link between depression and current SI at T2. Specifically, the level of depression at T2 contributed to current SI-T2 more strongly for individuals with low PB levels than for individuals with high PB levels.

DISCUSSION

Our study highlights the impact of PB on SI following the October 7th terrorist attack. Clinicians treating individuals coping with depression should attend to their patients' sense of belongingness, as low PB comprises a significant risk factor for current SI. Moreover, community and national initiatives that could increase levels of PB among the citizens may help to diminish suicide risk in the aftermath of the attack.

Neurological, Metabolic, and Psychopathological Correlates of Lifetime Suicidal Behaviour in Major Depressive Disorder without Current Suicide Ideation

INTRODUCTION

Suicidal behaviour (SB) has a complex aetiology. Although suicidal ideation (SI) is considered the most important risk factor for future attempts, many people who engage in SB do not report it.

METHODS

We investigated neurological, metabolic, and psychopathological correlates of lifetime SB in two independent groups of patients with major depression (sample 1: n = 230; age: 18-65 years; sample 2: n = 258; age >60 years) who did not report SI during an index episode.

RESULTS

Among adults (sample 1), SB was reported by 141 subjects (58.7%) and severe SB by 33 (15%). After controlling for interactions, four risk factors for SB emerged: male gender (OR 2.55; 95% CI: 1.06-6.12), negative self-perception (OR 1.76; 95% CI: 1.08-2.87), subthreshold hypomania (OR 4.50; 95% CI: 1.57-12.85), and sexual abuse (OR 3.09; 95% CI: 1.28-7.48). The presence of at least two of these factors had the best accuracy in predicting SB: sensitivity = 57.6% (39.2-74.5); specificity = 75.1% (68.5-82.0); PPV = 27.9% (20.9-37.2); NPV = 91.4% (87.6-94.1). In older patients (sample 2), 23 subjects (9%) reported previous suicide attempts, which were characterized by earlier onset (25 years: OR 0.95: 0.92-0.98), impaired verbal performance (verbal fluency: OR 0.95: 0.89-0.99), higher HDL cholesterol levels (OR 1.04: 1.00-1.07) and more dyskinesias (OR 2.86: 1.22-6.70).

CONCLUSION

Our findings suggest that SB is common in major depressive disorder, even when SI is not reported. In these individuals it is feasible and recommended to investigate both psychiatric and organic risk factors. The predictive power of models excluding SI is comparable to that of models including SI.

Unlocking the link between temporomandibular disorders and suicide ideation in pre-orthodontic patients: A moderated mediation model of depression and anxiety

BACKGROUND

Temporomandibular disorders (TMD) are a series of musculoskeletal diseases with high prevalence. A few studies have reported the correlation between TMD and suicide ideation (SI). However, the underlying mechanism of the relationship lacks in-depth exploration.

METHODS

A cross-sectional study was conducted among 954 pre-orthodontic patients. TMD assessment was based on the quintessential five TMD symptoms (5Ts) questionnaire. Anxiety, depression and pain catastrophizing was evaluated by Seven-item Generalized Anxiety Disorder Scale (GAD-7), Nine-item Patient Health Questionnaire (PHQ-9), and Pain Catastrophizing Scale (PCS), respectively. Correlational and moderated mediated analysis was preformed to demonstrate the relationship between TMD and SI.

RESULTS

In pre-orthodontic patients, 31.87 % reported having TMD symptoms and 6.50 % declared SI during the past two weeks. The SI prevalence was 10.53 % in participants with TMD and 4.62 % in those without TMD. Intra-articular TMD, rather than pain-related TMD were especially related with SI. Individuals with TMD had higher risk to SI (rs = 0.112, adjusted OR = 2.213, p < 0.001). The effect of TMD on SI was fully mediated through depression (β = 0.445, 95 % CI = [0.326, 0.563]). Anxiety exerted a negative moderating effect on the depression-SI relation (β = -0.033, 95 % CI = [-0.047, -0.019]).

LIMITATIONS

This study was a single-centered and cross-sectional survey. The data collection relied on self-reporting methods.

CONCLUSIONS

A positive link between TMD and SI was disclosed. The effect of TMD on SI was fully mediated through depression with anxiety as a negative moderator.

Protective factors for suicidal ideation: a prospective study from adolescence to adulthood

Adolescent suicidality is associated with negative outcomes in adulthood. Suicide prevention has traditionally focused on identifying risk factors, yet suicide rates have remained stable. With suicidality often going undetected-especially suicidal ideation, further knowledge about protective factors is needed. The main objective of this study was to investigate potential protective factors for suicidal ideation from adolescence to adulthood. The study employed longitudinal population survey data, "Youth and Mental Health Study" consisting of self-reports at two-time points (mean age 14.9, SD = 0.6 and 27.2, SD = 0.6) (n = 2423 and n = 1198). Protective factors (at individual, social and environmental level) were selected based on a priori knowledge. Internal consistency of scales was analyzed using McDonald's omega. We used a linear mixed model with suicidal ideation as the dependent variable, time-points, a protective factor variable and their interaction as covariates, and individual participant as random effects. We adjusted for sex and also conducted separate analyses for males and females. The Benjamini-Hochberg procedure was used to adjust p-values for multiple hypotheses. Investigated protective factors were associated with temporal change in suicidal ideation (significant interactions). For both sexes, less emotion-orientated coping, higher self-perception scores, greater levels of physical activity and higher school wellbeing/connectedness were protective factors for suicidal ideations. Secure attachment and higher family function were protective factors for females only. The effects in adolescence were mostly maintained in adulthood. In this study, several protective factors for suicidal ideation persisted into adulthood, with distinct differences between males and females.

Reasons for Suicide in Black Young Adults: A Latent Class Analysis

BACKGROUND

Suicides have increased among Black youth in the US, though it remains unclear if these trends persist into young adulthood. Further, even less is known about the reasons why individuals begin to consider suicide as a viable option. The current study aims to redress these gaps by identifying specific reasons for suicide among a sample of 264 Black young adults who reported experiencing suicidal thoughts within the past 2 weeks.

METHODS

Participants were recruited from an online panel. Reasons for suicide were measured using eight individual items/indicators. Latent class analysis was used to detect underlying patterns in Black young adults' reasons for considering suicide.

RESULTS

The most commonly reported reason for considering suicide among the entire sample was feeling hopeless about the future. Black women were more likely to report considering suicide because they could not live up to other's expectations and because they felt lonely and sad. Findings for the 3-class model were retained. The first class is described as the "Somewhat hopeless and other reasons" class (n = 85; 32%). The second class is "Accomplished but extremely lonely and sad" (n = 24; 9%). The third class is described as "Pronounced feelings of failure, hopelessness, being overwhelmed, and lack of accomplishment" and includes 59% of the sample (n = 155).

CONCLUSIONS

Culturally grounded clinical treatments and interventions are needed to meet the specific mental health needs of Black young adults. A particular focus on identifying factors that drive feelings of hopelessness and failure is warranted.

Relationship between biological rhythm dysregulation and suicidal ideation in patients with major depressive disorder

BACKGROUND

Although the disturbance of circadian rhythms represents a significant clinical feature of major depressive disorder (MDD), the relationship between biological rhythm disturbances and the severity of suicidal ideation in individuals with MDD remains unclear. We aimed to explore the characteristics of different biological rhythm dimensions in MDD and their association with the severity of depressive symptoms and suicidal ideation.

METHODS

A total of 50 MDD patients and 50 healthy controls were recruited and their general information was collected. The severity of depressive symptoms was assessed with the 17-item Hamilton Depression Rating Scale (HDRS17). The intensity of suicidal ideation was evaluated with the Beck Scale for Suicide Ideation (BSS). The Chinese version of the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) scale was utilized to assess the participants' biological rhythm dysregulation. Multiple logistic regression analysis was conducted to explore the relationship between biological rhythm and the risk of MDD. Multiple linear regression analysis was performed in the MDD group to investigate the relationship between different biological rhythm dimensions and suicide ideation.

RESULTS

Significant differences were observed between the MDD group and the control group in total BRIAN score (Z=-5.41, P < 0.001) as well as scores for each dimension. After adjusting for confounding factors, multiple logistic regression analysis revealed a significant association between total BRIAN score and the presence of MDD (OR = 1.20, 95% CI = 1.10-1.29, P < 0.001), as well as between scores in different BRIAN dimensions and the presence of MDD (activity: OR = 1.47, 95% CI = 1.24-1.74, P < 0.001; sleep: OR = 1.52, 95% CI = 1.28-1.79, P < 0.001; social: OR = 1.80, 95% CI = 1.32-2.46, P < 0.001; eating pattern: OR = 1.34, 95% CI = 1.12-1.60, P = 0.001). In patients with MDD, linear regression analysis demonstrated a positive relationship between BSS scores and BRIAN eating pattern scores (β = 0.34, P = 0.022), even after adjusting for demographic factors and the severity of depression.

CONCLUSIONS

Patients with MDD exhibited significantly higher levels of dysregulation in all four biological rhythm dimensions compared to healthy controls and the degree of dysregulation was associated with the severity of depression. More importantly, dysregulation of eating pattern may increase the intensity of suicidal ideation in MDD, thus elevating the risk of suicide.

Prevalence of suicide attempts across the African continent: A systematic review and meta-analysis

BACKGROUND

Over 700,000 people worldwide lose their lives through suicide every year. The prevalence of suicide has increased, especially in low- and middle-income countries such as many African countries. For every fatal suicidal attempt, there are approximately 20 other non-fatal suicide attempts within the population. The purpose of this study is to investigate the prevalence of attempts of suicides in the African continent through a systematic review and meta-analysis.

METHODS

To identify relevant sources, the PubMed, Scopus, Web of Science, Embase, ScienceDirect and Google Scholar repositories and databases were systematically searched without a lower time limit and until July 2023. The heterogeneity of the studies was checked with the I2 index, and accordingly random effects model was adopted to perform the analysis. Data analysis was conducted within the Comprehensive Meta-Analysis software (v.2).

RESULTS

In the review of 48 studies with a sample size of 244,701 people, the prevalence of suicide attempts in Africa was found to be 9.9% (95%CI: 8.5%-11.6%). With the increase in the year of study, the prevalence of suicide attempt in the African continent increases. Also, with the increase in the sample size, the prevalence of suicide attempts in Africa decreases. The suicide attempt prevalence among African men and woman slightly differed with 7.6% and 8.2%, respectively.

CONCLUSION

Suicide attempt is an important public health concern in Africa. The findings of this study are important not only for African health policy making, but also to contribute to the accuracy of global estimates with respect to suicide attempts.

Smartphone-based safety plan for suicidal crisis: The SmartCrisis 2.0 pilot study

Here we present the findings of the pilot phase of the SmartCrisis 2.0 Randomized Clinical Trial. This pilot study aimed to explore the feasibility and acceptability of a safety plan contained in a smartphone app. Our sample consisted patients with a history of recent suicidal behaviour who installed a smartphone-based safety plan. To explore the satisfaction with of the safety plan, two patient satisfaction surveys were conducted: one qualitative and one quantitative. To explore the objective use of the safety plan, we gained access to texts contained in the safety plans completed by the patients. Participation rate was 77%, while 48.9% patients completed both satisfaction surveys at the end of the pilot phase. N = 105 successfully installed the safety plan. In a scale from 1 to 10, users rated the usefulness of the security plan at 7.4, the usability at 8.9, the degree to which they would recommend it to others at 8.6 and the overall satisfaction with the project including evaluations at 9.6. The most widely completed tab was warning signs. Feeling sad or lonely was the warning sign most commonly reported by patients. The second most completed tab was internal coping strategies. Walking or practicing any other exercise was the strategy most commonly resorted to. Our smartphone-based safety plan appears to be a feasible intervention. Data obtained from this pilot study showed high participation rates and high acceptability by patients. This, together with the general satisfaction with the project, supports its implementation in the clinical practice.

Problematic internet use and suicide ideation among Chinese adolescents: The indirect effects of insomnia, nightmares, and social jetlag

BACKGROUND

Problematic Internet use (PIU) is related to suicide ideation (SI) in adolescents, but little is known about the potential mechanisms between them. This study aimed to examine the mediation roles of insomnia, nightmares, and social jetlag in the association of PIU with SI in adolescents.

METHODS

A total of 39,731 adolescents (mean age = 13.49 ± 0.76 years, 54.4 % males) from Shenzhen, China, participated in a cross-sectional survey. SI was assessed using the ninth item of the Patient Health Questionnaire-9. PIU was measured by the Revised Chinese Internet Addiction Scale. A self-administered questionnaire was used to assess insomnia symptoms, nightmare frequency, social jetlag, sleep duration, psychological distress, and social-demographical characteristics. Logistic regression and path analyses were performed to examine the associations between PIU, insomnia symptoms, nightmares, social jetlag, and SI.

RESULTS

The prevalence of PIU and SI were 14.9 % and 18.6 %, respectively. PIU, insomnia symptoms, frequent nightmares, and social jetlag were significantly associated with SI. Path analyses showed that the indirect effects of PIU on SI through insomnia symptoms, frequent nightmares, and social jetlag were significant. Conversely, social jetlag significantly mediated the pathway from SI to PIU. The mediation effect sizes of these sleep and circadian problems were slightly larger in females than in males.

LIMITATIONS

Cross-sectional design limited the capacity to infer causal relationships.

CONCLUSIONS

The associations between PIU and SI were mediated by sleep and circadian problems. These findings underscore the importance of assessing and intervening in sleep and circadian problems among adolescents with PIU or SI.

The Impact of Adverse Childhood Experiences on Mental Health and Suicidal Behaviors: A Study from Portuguese Language Countries

Background: Research on adverse childhood experiences (ACEs) demonstrates that they can be associated with physical and mental health problems throughout the lifecourse. However, few studies have examined this topic in the Community of Portuguese Language Countries (CPLC). Objective: This study aims to assess the impact of ACEs on mental health and suicidal behaviors in a sample of participants from the CPLC. Participants and Setting: The sample consists of 1006 participants aged between 18 and 80 years (mean = 41.76; SD = 14.19). Methods: This study used an online survey that included a sociodemographic questionnaire, the Brief Symptom Inventory-18 (BSI-18) to assess somatization, depression, and anxiety symptoms, and overall mental functioning, the Suicidal Behaviors Questionnaire-Revised (SBQ-R) to assess suicidal behaviors, and the Family Adverse Childhood Experiences Questionnaire to assess ACEs. Results: Emotional abuse was the most reported ACE (32.7%). Participants from Brazil had higher levels of somatization, depression, anxiety, and suicide ideation and attempt, while participants from Portugal had a higher probability of suicide in the future. ACEs were strong and significant predictors of psychological symptoms and the likelihood of suicide in the future, with emotional abuse and emotional neglect being the domains with the greatest contribution, respectively. Conclusions: ACEs are a prevalent and general phenomenon across several countries. It is urgent to alert policymakers and mental health professionals of the need to intervene with children and families to ensure their harmonious and adjusted development, thus promoting quality of life and well-being of populations.

The global burden of suicidal behavior among people experiencing food insecurity: A systematic review and meta-analysis

BACKGROUND

Food insecurity has become a growing burden within a global context where climate change, catastrophes, wars, and insurgencies are increasingly prevalent. Several studies have reported an association between suicidal behaviors (i.e., suicide ideation, plans, and attempts) and food insecurity. This meta-analytic review synthesized the available literature to determine the pooled prevalence of suicidal behaviors among individuals experiencing food insecurity, and examined the strength of their association.

METHODS

Databases (Ovid, PubMed, Web of Science, and CINAHL) were searched from inception to July 2022 using appropriate search terms. Eligible studies reporting the number/prevalence of suicidal behaviors among individuals experiencing food insecurity or the association between food insecurity and suicidal behaviors were included. The pooled prevalence of suicidal behaviors was determined using the random-effects model. The review was registered with PROSPERO (CRD42022352858).

RESULTS

A total of 47 studies comprising 75,346 individuals having experienced food insecurity were included. The pooled prevalence was 22.3 % for suicide ideation (95 % CI: 14.7-29.9; I2 = 99.6 %, p < 0.001, k = 18), 18.1 % for suicide plans (95 % CI: 7.0-29.1; I2 = 99.6 %, p < 0.001, k = 4), 17.2 % for suicide attempts (95 % CI: 9.6-24.8; I2 = 99.9 %, p < 0.001, k = 12), and 4.6 % for unspecified suicidal behavior (95 % CI: 2.8-6.4; I2 = 85.5 %, p < 0.001, k = 5). There was a positive relationship between experiencing food insecurity and (i) suicide ideation (aOR = 1.049 [95 % CI: 1.046-1.052; I2 = 99.6 %, p < 0.001, k = 31]), (ii) suicide plans (aOR = 1.480 [95 % CI: 1.465-1.496; I2 = 99.1 %, p < 0.001, k = 5]), and (iii) unspecified suicide behaviors (aOR = 1.133 [95 % CI: 1.052-1.219; I2 = 53.0 %, p = 0.047, k = 6]). However, a negative relationship was observed between experiencing food insecurity and suicide attempts (aOR = 0.622 [95 % CI: 0.617-0.627; I2 = 98.8 %, p < 0.001, k = 15]). The continent and the countries income status where the study was conducted were the common causes of heterogeneity of the differences in the odds of the relationships between experiencing food insecurity and suicidal behaviors - with North America and high-income countries (HICs) having higher odds. For suicide attempts, all non HICs had a negative relationship with food insecurity.

LIMITATIONS

There was significant heterogeneity among the included studies.

CONCLUSION

There is a high prevalence of suicidal behaviors among individuals experiencing food insecurity. Initiatives to reduce food insecurity would likely be beneficial for mental wellbeing and to mitigate the risk of suicidal behaviors among population experiencing food insecurity. The paradoxical finding of suicide attempts having a negative relationship with food insecurity warrants further research.

Induced optimism to lessen hopelessness-related cognitions among young adults at risk for suicidal thoughts and behavior

Background

Hopelessness is one of the best-studied cognitive predictors of depression and suicide. Previous research suggests that hopelessness may develop through repetitive thinking about the occurrence of positive and negative future outcomes. The present study sought to investigate whether mental rehearsal in making optimistic future-event predictions, or induced optimism, would lead to reductions in hopelessness, particularly among individuals with a history of suicide ideation or suicide attempts.

Methods

Participants with (n = 58) and without (n = 76) a history of suicide ideation or attempts were randomly assigned to either practice making optimistic future-event predictions or to a control condition in which they practiced making a lexical decision (using the same stimuli) over three study sessions, each separated by one week.

Results

Findings offered modest support for the hypothesis that induced optimism would decrease hopelessness but not improve mood; this was regardless of history of suicide ideation or attempts.

Limitations

The sample was predominantly female, and assessment of suicide ideation and attempt history was not confirmed by clinical interview, which may limit generalizability.

Conclusion

Practice in making optimistic future-event predictions over time may be one way to reduce the hopelessness-related cognitions that confer vulnerability to suicide ideation and behavior.

Reliability and validity of proxy reports of impulsivity and aggression: An evidence-based assessment approach to psychological autopsy methods

INTRODUCTION

Psychological autopsy methods often include measures of impulsivity and aggression. The aim is to assess their reliability and validity in a Spanish sample.

METHODS

Cross-sectional web-based survey was fulfilled by 184 proband and proxy pairs. Data was collected on sociodemographic characteristics, impulsivity through Barratt Impulsiveness Scale (BIS-11), aggression through Buss-Perry Aggression Questionnaire (BPAQ), and history of suicide ideation. Proxies filled out BIS-11, BPAQ and suicide ideation with the responses they would expect from the probands. Reliability was assessed using intraclass correlation coefficients (ICC) between proband and proxies. Logistic regression analysis was performed to assess the predictive validity of proxy reports in predicting probands' suicide ideation.

RESULTS

Bivariate analysis showed differences in BPAQ (Median 68 vs. 62; p=0.001), but not in BIS-11 (p>.050). BIS-11 showed good concordance (ICC=0.754; CI 95% 0.671-0.816) and BPAQ acceptable (ICC=0.592; CI 95% 0.442-0.699). In the probands regression model BPAQ predicted suicide ideation (OR 1.038; CI 95% 1.016-1.061) but not BIS-11 (OR 0.991; CI 95% 0.958-1.025). In the proxy-report model BPAQ also predicted probands' suicide ideation (OR 1.036; CI 95% 1.014-1.058) but not BIS-11 (OR 0.973; CI 95% 0.942-1.004).

CONCLUSION

Used as proxy-reported assessment tools, BIS-11 showed better reliability than the BPAQ. However, both showed validity in Spanish population and could be included in psychological autopsy protocols.

The effect of cyberbullying victimization and traditional bullying victimization on suicidal ideation among Chinese female college students: The role of rumination and insomnia

BACKGROUND

The issue of college student suicide has emerged as a significant global public health concern. To date, there has been a lack of extensive research on the effects of distinct forms of bullying victimization (traditional bullying victimization and cyberbullying victimization) on suicidal ideation, as well as the differences between them. The present study aimed to investigate the relationship between two forms of bullying victimization and suicidal ideation among female college students, while also considering the potential mediating effects of rumination and insomnia.

METHODS

A total of 2106 female college students from Southern China participated in this study. The participants had a mean age of 19.83 years (SD = 1.04 years). Participants completed the MINI-C questionnaire, School Bullying Behavior Questionnaire, Cyberbullying Inventory (CBI), Ruminative Responses Scale (RRS), and Insomnia Severity Index (ISI). The mediation models were conducted using Model 4 and Model 6 of the Process macro program in SPSS.

RESULTS

The results showed that (1) the mediating effect of rumination in the relationship between different forms of bullying victimization and suicidal ideation was significant; (2) The mediating effect of insomnia in the relationship between traditional bullying victimization and suicidal ideation was not significant; the mediating effect between cyberbullying victimization and suicidal ideation was significant. (3) The chain mediating effect of rumination and insomnia in the relationship between different forms of bullying victimization and suicidal ideation were both significant.

CONCLUSION

This study endeavor represents the first attempt to investigate the relationship between two forms of bullying victimization and suicidal ideation.

Major depressive disorder with suicidal ideation or behavior in Chinese population: A scoping review of current evidence on disease assessment, burden, treatment and risk factors

BACKGROUND

Identifying and managing major depressive disorder (MDD) patients with suicidal ideation or behavior (MDSI) is critical for reducing the disease burden. This scoping review aims to map the existing evidence related to MDSI in the Chinese population.

METHOD

A scoping review was conducted to summarize the published evidence regarding epidemiology or disease burden, evaluation, diagnosis, management, and prognosis of MDSI. The search strategy imposed restriction on English or Chinese publications between 1 January 2011 and 28 February 2022.

RESULTS

Of the 14,005 identified records, 133 met the eligibility criteria and were included for analysis. The included studies were characterized as high heterogeneity in evaluation of suicidal ideation or behavior. Compared with MDD patients without suicidal ideation or behavior, MDSI patients were more likely to suffer from psychological and somatic symptoms, social function impairment, and lower quality of life. Younger age, female gender, longer disease course, and comorbid psychological or physical symptoms were consistently found to be risk factors of suicidal ideation or behavior. Relevant research gaps remain regarding comprehensive evaluation of standard clinical diagnosis, disease burden, social-cultural risk factors, and effectiveness of interventions targeting MDSI. Studies with large sample size, representative population are warranted to provide high-quality evidence.

CONCLUSIONS

MDD patients with suicidal ideation or behavior should be prioritized in treatment and resource allocation. Heterogeneity exists in the definition and evaluation of MDSI in different studies. To better inform clinical practice, it is imperative to establish a unified standard for evaluation and diagnosis of suicidal ideation or behavior among MDD population.

A network analysis of depressive symptoms, psychosocial factors, and suicidal ideation in 8686 adolescents aged 12-20 years

Suicide has aroused global concern, and a better understanding of the complex interactions between suicide ideation and various psychopathological features is critical. We aimed to explore the complex interplays among adolescents. This study adopted a multistage stratified cluster sampling method and recruited adolescents aged 12 to 20 year-old from 8 middle and high schools between December 2020 and September 2021 in Guangzhou, China. We assessed loneliness, social support, bullying victimization, depressive symptoms, and suicidal ideation. We used network analysis to examine the network structure of the correlates of suicidal ideation and identify central symptoms and bridge symptoms. We used case-drop bootstrapping and correlation stability coefficients to examine the stability of the network. Among 8686 adolescents, 347 (4 %) adolescents reported suicidal ideation in the past two weeks. Network analyses identified 'hopeless', 'psychomotor', and 'failure' were the three strongest edges linked to suicidal ideation. The most central nodes were identified as 'hopeless' being the most central node, followed by loneliness and verbal bullying victimization, while sexual bullying victimization, sex, and relational bullying were the strongest bridging symptoms. The findings shed light on the complexity of associations of suicidal ideation and could provide insight into school-based suicide risk assessment and prevention for adolescents.

Content and Process of Adolescent Suicide Ideation: Implications for Risk Assessment

This study examined differences in the content and process of suicide ideation between adolescents presenting with recent suicide ideation or a suicide attempt in clinical settings. Across two combined study samples, adolescents (N = 229; 79% female; 73% Hispanic/Latine), ages 12-19, presenting with a recent suicide attempt, recent suicide ideation with a past suicide attempt history, or recent suicide ideation with no past suicide attempt history were interviewed in detail about the process and content of their suicide ideation. The group with suicide ideation and a past suicide attempt more often reported that their recent ideation lasted greater than 4 h compared to those with suicide ideation but no past suicide attempt history. The suicide attempt group more often considered ingestion as their first method of attempt, compared to the other two suicide ideation groups, and less often considered "other" methods (e.g., jumping from a height or onto train/traffic, hanging). Wish to die was lower in the ideation-only group, compared to both other groups. Separate analyses from Study 2 suggested that the majority of adolescents' suicide ideation contained imagery; however, a higher proportion of adolescents with suicide ideation and a past suicide attempt reported imagery in their ideation than those with ideation but no past attempt. Understanding what adolescents think about when they consider suicide and how they think about it may be informative about risk of a suicide attempt.

The effects of short video app-guided loving-kindness meditation on college students' mindfulness, self-compassion, positive psychological capital, and suicide ideation

OBJECTIVE

The study investigated the effects of a short video app guided loving-kindness meditation (LKM) on college students' mindfulness, self-compassion, positive psychological capital, and suicide ideation. The purpose of the study is to investigate the intervention effect of LKM training on suicidal ideation among college students with the help of the short video application and to provide an empirical basis for the exploration of early suicide intervention strategies for college students.

METHODS

We recruited 80 college students from a university in China. The final 74 eligible participants were divided into two groups: app use group (n = 37) and the control group (n = 37). The app group accepted an 8-week app use interference, while the control group underwent no interference. We measured four major variable factors (mindfulness, self-compassion, positive psychological capital, and suicide ideation) before and after the app use intervention.

RESULTS

In the app group, self-compassion and positive psychological capital were significantly higher, and suicide ideation was significantly lower than the control group. In the control group, there were no noticeable differences in any of the four variables between the pre-test and post-test.

CONCLUSIONS

Our findings demonstrate that the short video app guided LKM may help to improve self-compassion, and positive psychological capital, and reduce suicide ideation. The finding of the short video app-guided LKM's effect extends our understanding of the integrative effects of positive psychology and digital media on the reduction of suicide ideation.

Impulsivity traits and suicide related outcomes: A systematic review and meta-analysis using the UPPS model

BACKGROUND

The affective, cognitive, and behavioral aspects of impulsivity involved in suicide-related outcomes can be investigated through the UPPS model, which conceptualizes these facets in multidimensional terms related to negative and positive urgency, lack of premeditation and perseverance, and sensation seeking. This systematic review and meta-analysis provided a comprehensive understanding of the role of all facets of impulsivity in the development of suicidal ideation and behaviors.

METHODS

We conducted a systematic search on six databases (PsycINFO, PsycARTICLES, PubMed, MEDLINE, Scopus, and Web of Science) until May 5,2023. Overall, 49 studies met the criteria for systematic review, of which 37 were included in a meta-analysis of data from 17.898 individuals. Additional moderation analyses included age, gender, sample status, country of study conduct, assessment instruments, type of suicide-related outcome, study quality, and research design.

RESULTS

We found significant relationships between aspects of impulsivity and suicide-related outcomes. Specially, affective facets related to impulsivity showed a stronger association with suicidal ideations and attempts than cognitive and behavioral dimensions, recommending the main involvement of emotional aspects-positive and negative-in suicide-related dimensions.

LIMITATIONS

The limited number of studies may have negatively impacted the power of moderation analyses. In addition, for most dimensions of impulsivity, the limited number of longitudinal studies did not allow to test the moderating role of research design.

CONCLUSIONS

This study supports the role of impulsivity in suicidal ideation and behavior, identifying the affective component of impulsivity as the most involved, providing a significant contribution from a clinical and diagnostic point of view.

Study protocol for ELders AT Ease (ELATE): a cluster randomised controlled trial of cognitive behaviour therapy to reduce depressive symptoms in aged care residents

BACKGROUND

This protocol describes a study of the effectiveness of cognitive behaviour therapy (CBT) for reducing depressive symptoms in older adults living in residential aged care (RAC) facilities in Australia. Depressive symptoms are highly prevalent in this population, yet the benefits of CBT for reducing such symptoms in RAC facilities have not been widely investigated. Elders at Ease (ELATE) is a 16-session CBT intervention designed for implementation in RAC facilities. The intervention includes cognitive, behavioural and reminiscence strategies and is delivered by mental health trainees (MHTs) in collaboration with RAC facility staff and residents' family.

METHODS AND ANALYSIS

ELATE will be evaluated using a cluster randomised trial comparing outcomes for residents who participate in the intervention with those living in usual care control facilities. The participants are RAC residents aged 65 years or above, with depressive symptoms (Patient Health Questionnaire-2 ≥ 3) and normal cognition or mild cognitive impairment (Standardised Mini Mental Status Examination ≥ 21). They are assessed at four time points: baseline prior to randomisation (T1), mid-treatment (T2; 2.5 months post randomisation), post-treatment (T3; 5 months post-randomisation) and 3-month follow-up (T4; 8 months post randomisation). The primary outcome is change in depressive symptoms between T1 and T3. Secondary outcomes are depressive symptoms at T4, anxiety, suicide ideation, sleep problems, quality of life, staff and family knowledge of late-life depression, stress levels and efficacy in caring for residents, and MHT levels of geropsychology competencies. Residents receiving the intervention are hypothesised to report a greater decrease in depressive symptoms between T1 and T3 compared to residents receiving usual care. The primary analysis is a regression, clustered over site to account for correlated readings, and independent variables are condition and depressive symptoms at T1. A cost-utility analysis is also undertaken.

DISCUSSION

ELATE is a comprehensive CBT intervention for reducing depressive symptoms in RAC residents. It is designed to be implemented in collaboration with facility staff and residents' families, individually tailored to residents with normal cognition to mild cognitive impairment and delivered by trainee therapists. ELATE offers a model that may be widely applicable across the RAC sector.

TRIAL REGISTRATION

Trial registered with the Australian and New Zealand Clinical Trial Registry (ANZCTR) Number ACTRN12619001037190, prospectively registered on 22 July 2019.

Suicide ideation and the related factors among Iranian transgender people: a cross-sectional study

OBJECTIVE

Suicide is a significant public health concern worldwide, and efforts to prevent it are crucial. This study aims to assess suicide ideation among transgender individuals in Iran. A cross-sectional design was used, with 235 transgender participants recruited through snowball sampling across Iran. The data collection included a questionnaire containing demographic inquiries, while the Beck Scale for Suicide Ideation was employed to gather data. Descriptive and analytical statistics were performed using SPSS software.

RESULTS

The findings indicate that the prevalence of suicidal ideation among the transgender individuals in the study was 83%, with a mean score of 12.8 ± 8.8 on the suicide ideation scale. Individuals with lower levels of education, younger age, unemployment, and being divorced or single demonstrated significantly higher scores compared to others (p < 0.05). This study highlights the high prevalence of suicidal ideation among Iranian transgender individuals, particularly among those with lower age and education levels, as well as those who have not undergone gender reassignment surgery.

Comparative analysis of the effect of interactive audio-visual based art therapy and music therapy in reducing suicidal ideation among school children who survived abduction

This study looked at how exposure to interactive TV-based music and art therapy could assist in reducing suicidal thoughts of secondary school female children who survived abduction in Nigeria. A quasi-experiment was carried out in three randomly selected secondary schools in Northern Nigeria. The study sample comprised 470 students divided into three groups to form control group 235, art therapy group 118 and music therapy group 117. Results suggest that participants exposed to interactive TV-based art therapy and music therapy reported a lower score for suicidal ideation compared to the control group that was not exposed to any form of therapy aside from routine clinic checkups. Specifically, those exposed to interactive TV-based art therapy reported a lesser suicidal ideation score than the music and the control group. We recommend the introduction of interactive TV-based music therapy and art therapy in reducing suicidal ideation among children that survived kidnapping in Nigeria.

Harsh parenting and suicide ideation among Chinese adolescents: the roles of self-esteem and school social support

BACKGROUND

While negative parenting style has considered as a risk factor for suicide ideation, little attention has been given to the mechanisms between harsh parenting and suicide ideation in the context of Chinese culture. This study explored the the potential mediating roles of self-esteem and the potential moderating roles of school social support in the relationship between harsh parenting and suicide ideation among Chinese adolescents.

METHODS

We conducted a cross-sectional study among 4189 Chinese adolescents who completed measures of harsh parenting, school social support, self-esteem, and suicide ideation. The moderated mediation model was used to test the roles of self-esteem and school social support on the association between harsh parenting and adolescent suicide ideation.

RESULTS

(1) There were significant positive correlations between harsh parenting and adolescents suicide ideation. (2) Self-esteem mediates the relationship between harsh parenting and suicide ideation in adolescents. (3) School social support moderates the indirect effect of harsh parenting on suicidal ideation.

CONCLUSIONS

Beyond the direct impact of harsh parenting, harsh parenting also indirectly contributes to adolescent suicide ideation via the mediator of adolescents' self-esteem. School social support moderates the relationship between harsh parenting and self-esteem as well as the relationship between self-esteem and suicide ideation. The findings suggest potential pathways for suicide prevention and intervention strategies and highlighted that buffering effect of school social support is limited as risk increasing.

Attachment, suicidal behavior, and self-harm in childhood and adolescence: a study of a cohort of Brazilian schoolchildren

BACKGROUND

Attachment influences the development and the formation of the self and subjectivity and, just as early adverse events, may be related to the occurrence of mental disorders, suicidal behavior, and self-harm throughout life. This study aimed to analyze the effect of mental representation of attachment in children on suicidal behavior and self-harm throughout childhood and adolescence, considering the mediating role of internalizing problems.

METHODS

Based on a cohort of 500 students (mean age 8 years, SD 1.2) sampled from public schools in a Brazilian southeastern metropolis, 316 children were followed for eight years in three waves (2006, 2008, 2012). The following data from the research baseline (2005) were used: family drawing, maternal and family variables, and sociodemographic data. The mental representation of attachment (independent variable) was measured by the Family Drawing Global Scale, discriminating between secure attachment and non-secure attachment. Suicidal behavior/self-harm (dependent variable) and internalizing problems were evaluated in three research waves through CBCL and YSR (ASEBA). Descriptive analysis, calculation of frequencies and p-values of the variables of interest, as well as modeling of structural equations, were performed.

RESULTS

The prevalence throughout the study was: 17.1% [CI 13.3-20.8] for suicidal ideation and 8.9% [CI 5.6 - 12.2] for self-harm; there was a recurrence at one time in 16.5% [IC 12.6 - 20.3] and in two or more moments in 4.1% [CI 2.0 - 6.3] of the sample. Female gender (p = 0.035), internalizing disorders (p < 0.01), and non-secure attachment (p = 0.035) were associated with the occurrence of suicidal behavior/self-harm. The modeling indicated that 92,2% of the total effect of attachment (p = 0.069) on suicidal behavior/self-harm was due to direct effect, the other 7,8% of the effect being mediated by internalizing problems, adjusted for the confounding variables sex, skin color/race, and social stratum. The total effect showed a positive value, which indicates an increase in suicidal behavior/self-harm when the non-secure attachment is present. The approximate OR of non-secure attachment on the total effect (direct + indirect) was 1.15, indicating that, when adjusting for confounding variables, there was a 15% increase in suicidal behavior/self-injury from non-secure attachment.

CONCLUSIONS

The study supports the hypothesis that there is a relationship between disruptive attachment patterns (non-secure attachment) developed during infancy and suicidal and self-harm behavior during childhood and adolescence. These findings validate the concern about the first thousand days of childhood as a critical period for child growth and development, but also for the mental health of children and adolescents.

Characteristics of single vs. multiple suicide attempters among adolescents: a systematic review and meta-analysis

There might be differential characteristics between those who have attempted suicide once in their lifetime (single attempters) and those who have attempted suicide two or more times (multiple attempters). We aimed to identify the factors that differentiate single and multiple attempters in child and adolescents. This study was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, and the review protocol was registered in PROSPERO. We conducted a systematic literature search in three databases to identify original studies exploring the characteristics of single attempters vs. multiple attempters among adolescents. We considered a wide range for the definition of adolescent, following most recent recommendations: 10-24 years. We carried out a meta-analysis. Fourteen studies were included in the systematic review and 13 in the meta-analysis with a total sample of with a total of 4286 participants. The factors statistically significantly associated with being a multiple attempter in the meta-analysis were: anxiety disorders, depression severity, alcohol abuse, substance abuse, aggressiveness, and hopelessness. Multiple attempters have a more severe clinical profile, with greater severity of symptoms. Knowledge of the risk factors associated with being a multiple attempter could help us to predict which patients are more likely to reattempt suicide and need further monitoring and a tailored treatment. Prevention programs tailored for the adolescent population, along with identification of early risk factors, could help to prevent suicidal behavior among this vulnerable population.

Dramatic increase of suicidality in children and adolescents after COVID-19 pandemic start: A two-year longitudinal study

The COVID-19 pandemic has impacted the mental health of the youngest, worsening their emotional well-being. The demand for care in psychiatric emergencies may indirectly reflect the mental health state of children and adolescents and the emotional consequences of the pandemic. Moreover, suicidality can be considered a marker of severity in this population group. Therefore, we have aimed to longitudinally describe the number of children and adolescents attended in the psychiatry emergency department due to suicidal ideation or attempts and, to explore differences in suicidality according to gender and age. A retrospective study was carried out in the University Hospital of San Juan, Alicante, Spain, from January 01, 2018 to December 31, 2021. A total of 138 participants under 18 years requesting psychiatric care due to suicidal ideation or attempts were included. The sample was composed by 35% of males and the mean age was 14.8 years old (SD = 2.2). The number of cases per year range from 10 in 2018 to 88 in 2021. Attendances were significantly higher between 2021 and the three previous years. Besides, the number of attentions registered in the last 9 months of 2021 equals those that occurred in the entire previous period. Most of the cases were girls and middle adolescents. Suicide ideation or attempts have skyrocketed in children and adolescents. This alarming increase presents a one-year lag peak from the COVID-19 outbreak and continues until the end of 2021. Girls and those over 12 years have been identified as risk groups to present suicidal ideation or attempts.

The amygdala connectivity with depression and suicide ideation with suicide behavior: A meta-analysis of structural MRI, resting-state fMRI and task fMRI

In recent decades, the primary intention of neuroscientists and psychiatrics is to evaluate the connectivity between brain regions and psychiatric disorders. The amygdala has central immersion in memory alliance, stress response, emotional perception, and automatic responses to emotional stimuli. This paper uses a meta-analysis approach to establish the relationship between structural resting state and functional amygdala connectivity with depression and suicide ideation with suicide behavior. In addition, this study explores the moderating effect of patients' demographic characteristics (gender and age) based on 30 studies. The results show that structural amygdala connectivity is positively related to the instability of depression, while for resting and task functional connectivity amygdala shows a significant negative connection with depression. Furthermore, the amygdala showed a partial activation for non-suicide self-injuries and suicide ideation. From structural and functional magnetic imaging, the current findings also support the moderating effect of the age of the participants on the amygdala connectivity with psychiatric conditions. Generally, amygdala connectivity with psychiatric disorders was not significantly moderate with the role of gender, however, this study enhances the existing hypothetical review articles and confirms the connectivity of the psychological condition with the amygdala region. It concludes that the amygdala plays a vital role in regulating and responding to emotions.

Future-oriented repetitive thought, depressive symptoms, and suicide ideation severity: Role of future-event fluency and depressive predictive certainty

BACKGROUND

Knowing how future-oriented repetitive thought - i.e., repeated consideration of whether positive or negative outcomes will happen in one's future - leads to hopelessness-related cognitions may elucidate the role of anticipating the future in depressive symptoms and suicide ideation. This study examined future-event fluency and depressive predictive certainty - i.e., the tendency to make pessimistic future-event predictions with certainty - as mechanisms explaining the relation between future-oriented repetitive thought, depressive symptoms, and suicide ideation.

METHODS

Young adults (N = 354), oversampled for suicide ideation or attempt history, completed baseline measures of pessimistic future-oriented repetitive thought (i.e., the degree to which people consider whether negative outcomes will happen or positive outcomes will not happen in their futures), future-event fluency, depressive predictive certainty, depressive symptoms, and suicide ideation severity and were followed up 6 months later (N = 324).

RESULTS

Pessimistic future-oriented repetitive thought predicted depressive predictive certainty at 6-months, partially mediated by lower positive but not increased negative future-event fluency. There was an indirect relationship between pessimistic future-oriented repetitive thought and 6-month suicide ideation severity via 6-month depressive predictive certainty through 6-month depressive symptoms, and also via 6-month depressive symptoms (but not depressive predictive certainty) alone.

LIMITATIONS

Lack of an experimental design limits inferences about causality, and a predominantly female sample may limit generalizability by sex.

CONCLUSION

Clinical interventions should address pessimistic future-oriented repetitive thought - and its impact on how easily people can think about positive future outcomes - as one potential way to reduce depressive symptoms and, indirectly, suicide ideation.

Suicidal ideation of people living with HIV and its relations to depression, anxiety and social support

BACKGROUND

The HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome) remains a global threat to health. Suicidal ideation has been a serious public health problem among people living with HIV (PLWH). However, the suicide prevention mechanism among PLWH still unclear. This study aims to analyze the suicidal ideation and its related factors in PLWH, and further explore the relationships between suicidal ideation and depression, anxiety and perceived social support.

METHODS

This is a cross-sectional study. A total of 1146 PLWH were investigated by the general information questionnaire, the perceived social support scale (PSSS), the Beck scale for suicide ideation of Chinese version (BSI-CV), the generalized anxiety disorder scale-2 (GAD-2) and the patient health questionnaire-2 (PHQ-2) though the WeChat in China in 2018. By using statistical description and the binary unconditional logistic regression, we assessed the incidence of suicidal ideation and its related factors in PLWH. Besides, the intermediary effect of social support between anxiety, depression and suicidal ideation were explored by the stepwise test and Bootstrap method.

RESULTS

The incidence of suicide ideation was 54.0% (619/1146) among the PLWH in the last week or during the most serious depression. Binary logistic regression analysis results showed that the PLWH who with short time for HIV positive diagnosis (aOR (adjusted odd ratio) = 1.754, 95% CI (confidence interval):1.338-2.299), low monthly income (aOR = 1.515, 95%CI:1.098-2.092), other chronic diseases except HIV (aOR = 1.555, 95%CI:1.134-2.132), irregular lovers (aOR = 1.369, 95%CI:1.021-1.837), anxiety (aOR = 2.711, 95%CI:1.767-4.161), depression (aOR = 1.614, 95%CI:1.078-2.417), low PSSS (aOR = 2.139, 95%CI:1.345-3.399) had high risk of suicide ideation.The social support played a mediating role between the anxiety (the mediating effect accounted for 30.43% of the total effect), depression (the mediating effect accounted for 23.76% of the total effect) and the suicide ideation among PLWH.

CONCLUSION

The incidence of suicide ideation of PLWH was high. Anxiety, depression, and social support are the key factors of suicide ideation of PLWH. Social support plays a partial mediating role between anxiety, depression and suicidal ideation, which provides a new approach for prevention of suicidal ideation in PLWH and should be known widely for people to prevent suicide.

Prevalence and correlates of suicide planning and attempt among individuals with suicidal ideation: Results from a nationwide cross-sectional survey

BACKGROUND

Suicidality spans from having suicidal ideation to planning and making an attempt. However, not all individuals with suicidal thoughts will proceed to plan or attempt suicide. Our study investigated (i) the prevalence of suicide planning and attempt among those with suicidal ideation and (ii) their associations with sociodemographic characteristics, mental disorders, adverse childhood events and prior suicidal behaviour.

METHOD

This cross-sectional analysis utilised data from Singapore Mental Health Study 2016. Only respondents with suicidal ideation were included. A total of 411 and 365 individuals were examined to establish the prevalence of suicide planning and attempt respectively. Multivariable logistic regressions were performed to determine associations.

RESULTS

The prevalence of suicide planning and attempt were 17.7 % and 10.6 % respectively, with >80.0 % occurring within a year of suicidal ideation. Suicide planning was more likely among those who had mood disorders. Suicide attempt was more likely for those were currently married, had lower educational qualifications, history of anxiety disorders, history of emotional neglect and parental separation.

LIMITATIONS

Recall bias may be present because the age of onset for various mental disorders and suicidal behaviours were self-reported. As suicide was criminalised when the study was conducted, the prevalence of suicidal behaviours may have been underestimated.

CONCLUSION

Individuals at risk of suicide planning and attempt should be identified early since most of them progressed within a year. Findings suggest the importance of including prior suicide behaviour and history of dysfunctional family and emotional abuse in suicide risk assessment and intervention.

Street scars: Suicide ideation and suicide attempt among street-involved adolescents and youth in southern Brazil

OBJECTIVE

To measure the prevalence of suicidal ideation and attempts as well as suicide attempts' associated factors among street-involved youth in southern Brazil.

PARTICIPANTS AND SETTING

Cross-sectional study was conducted with street-involved adolescents and children from Porto Alegre and Rio Grande, Brazil.

METHODS

A respondent-driven sampling strategy was used to access this hard-to-reach population quickly and efficiently. Descriptive, bivariate, and multivariate analyses were conducted, with the latter being binary logistic regression.

RESULTS

The prevalence of suicide attempts was 16.3%, while the frequency of suicidal ideation was 30.9%. Most participants were male, aged between 16 and 18 years, with no ties to school and family. Almost half of the sample had been in a street situation for five years or more, and two-thirds reported spending more than seven hours a day on the streets. Variables independently associated with suicide attempts were aged 19-21 years old, with reduced ties with school and family, having had an experience of sexual abuse, and lifetime use of crack.

CONCLUSIONS

Public policies targeting the strengthening ties of street-involved children, adolescents, and youth with school and family might reduce their vulnerability to threats, such as sexual abuse and use of crack, and hence focus on decreasing suicide attempts.

Long-term trajectories of suicide ideation and its socioeconomic predictors: A longitudinal 8-year follow-up study

OBJECTIVE

Suicide ideation is the first stage of suicide behavior, and the long-term course of suicide ideation is highly variable. The aim of this study is to identify trajectories of suicide ideation over an 8-year period and explore the association of socioeconomic status (SES) with suicide ideation trajectories.

METHODS

We included 10,017 participants from Waves 7-15 of the Korea Welfare Panel Study; these have data on suicidal ideation (2012-2020). Trajectories analysis was conducted to identify distinct trajectories of suicidal ideation. Multinomial logistic regression was used to examine associations of SES with suicidal ideation trajectories. The interaction effects between current SES and prospective economic condition on trajectories were examined using a synergy index (SI).

RESULTS

We identified three suicide ideation trajectory groups: low-stable, moderate-decreasing, and high-persistent. Individuals in both moderate-decreasing and high-persistent trajectories had poorer current SES and prospective economic conditions than low-stable trajectories. Interestingly, those reporting poorer prospective economic conditions had a greater risk of being in a high-persistent trajectory than being in a moderate-decreasing trajectory. Further, individuals with poorer current SES and prospective economic conditions were more likely to be in the high-persistent trajectory.

CONCLUSIONS

Our findings demonstrated three distinct trajectories of suicide ideation which provide useful information for specific preventive interventions that could be developed. Moreover, poor prospective economic condition is a significant predictor of the high-persistent suicide ideation trajectory. Supporting economic difficulties and helping make goals and plans to strengthen positive thinking would help attenuate suicidal ideation and prevent suicidal behavior.

Specific anxiety and depression symptoms are risk factors for the onset of suicidal ideation and suicide attempts in youth

BACKGROUND

Suicidality research has typically focused on affective disorders to identify at-risk youth. Investigating the predictive role of individual symptoms, particularly anxiety symptoms, may allow for preventative targeting of additional risk factors for suicidal ideation and attempts.

METHODS

This analysis used the Sources of Strength Australia project dataset, a cluster randomised controlled trial which assessed the impact of a schools-based intervention for youth help-seeking over 18 months (Calear et al., 2022). Symptoms of anxiety, depression and distress at baseline were used to predict the onset of suicidal ideation, planning for suicide and suicide attempts at 18 months.

RESULTS

Worry, lack of sleep and anxiety interfering with everyday activities at baseline predicted new onset of suicidal ideation 18 months later. Worry about the future and past, reduced appetite and a belief that life wasn't worth living were risk factors for later suicide plans and attempts. Total scale scores on the scales were typically poor predictors of onset of suicidal behaviours.

LIMITATIONS

Analyses were impacted by dropouts over the 18 month study period and restricted further investigation into potential behaviour transition trajectories.

CONCLUSIONS

These findings identify individual symptom profiles associated with later onset of suicidal behaviour. Broadening the focus beyond depression and hopelessness to incorporate anxiety, worry and reduced sleep as risk factors for suicidality is important for public health and clinical settings.

Association of Obesity, Suicide Behaviors, and Psychosocial Wellness Among Adolescents in the United States

BACKGROUND

Adolescents with obesity are more likely to exhibit suicide behaviors, but this association may be confounded by psychosocial stigma related to obesity. We examined whether the obesity is independently associated with suicide behaviors among United States adolescents, after adjusting for the psychosocial factors.

METHODS

We analyzed data from 2019 Youth Risk Behavior Survey data (N = 13,871 United States adolescents) on recent (past year) suicide behavior (attempt, ideation, and plan); demographics (age, sex, and race/ethnicity); and psychosocial factors (feeling sad/hopeless, alcohol and illegal drug use, being bullied, and sexually abused). Participants were classified as having obesity (Y/N) per standardized percentiles. Logistic regression was employed to examine the association between obesity and suicide attempt, ideation, and plan, while adjusting for psychosocial covariates.

RESULTS

The prevalence of suicide attempt, ideation, and plan was 8.90%, 18.75%, and 15.71%, respectively. Obesity prevalence was 15.5%. The odds of suicide attempt, ideation, and plan were 1.65 (1.30-2.11), 1.31 (0.89-1.61), and 1.27 (1.02-1.57), respectively, among those with obesity versus without obesity.

DISCUSSION

Obesity is significantly associated with a suicide attempt, ideation, and plan among United States adolescents, even after adjusting for confounding psychosocial factors. Further research on the temporality and causality of this association is needed.

Risk for incident suicidality among psoriasis patients: a systematic review and meta-analysis

Previous meta-analyses have produced conflicting conclusions about suicidality risk among psoriasis patients. We aimed to update the evidence on the risk for the whole continuum of incident suicidality in psoriasis patients. We performed an update systematic review and meta-analysis and searched CENTRAL, PubMed, and Embase from January 1, 2017 to August 14, 2021 for relevant new cohort studies and incorporated new studies into our previous systematic review. Random-effects model meta-analysis was used to obtain pooled hazard ratio (HR) with 95% confidence interval (CI). Subgroup analysis was conducted according to age and disease severity. A total of 12 studies were included in this meta-analysis. We detected no significant differences in the risk for incident completed suicide (HR 1.33, 95% CI 0.91-1.95), suicide attempt (HR 1.22, 95% CI 0.96-1.56), suicidal behavior (HR 1.08, 95% CI 0.98-1.19), and suicide ideation (HR 1.74, 95% CI 0.99-3.06) between psoriasis patients and non-psoriatic controls. In the subgroup analysis based on age, an increased risk for incident suicide ideation was observed in pediatric subgroup (HR 1.50, 95% CI 1.12-2.03). The updated evidence suggests no increased risk for whole continuum of incident suicidality spectrum in psoriasis patients but an increased risk for incident suicide ideation among pediatric psoriasis patients. Involving mental health professionals may be crucial in psoriasis management especially in young patients.

The relationship between suicide bereavement and suicide ideation: Analysis of the mediating effect of complicated grief

People who have experienced suicide bereavement within social relationships are known to have high risk for suicide, which means that their suicide ideation is high. However, little is known about how suicide bereavement leads to suicide ideation. Therefore, this study aims to understand the pathway of suicide bereavement on suicide ideation by analyzing the mediating effect of complicated grief, which does not abate over time and is known to be highly related to suicide ideation. Data of 1224 people aged 19 or older with bereavement (636 bereaved by suicide and 585 by other causes) were obtained from the Longitudinal study on Suicide Survivors' Mental Health (LoSS) WAVE I [2015-2018], the first nationally-representative longitudinal study in South Korea. Suicide ideation, the dependent variable, was measured by the Scale for Suicide Ideation (SSI), and complicated grief, severe grief that does not abate over time, was measured by the Korean version of the Inventory of Complicated Grief (K-ICG). The results show that suicide bereavement was found to have a significant effect on suicide ideation, and that complicated grief plays a mediating role in the path of suicide bereavement to suicide ideation (Effect = 0.667, [0.387, 0.981]). Based on these findings, clinical and policy suggestions were discussed to understand and prevent suicide ideation of people with suicide bereavement.

Suicide, self-harm, and suicide ideation in nurses and midwives: A systematic review of prevalence, contributory factors, and interventions

BACKGROUND

Nurses have been identified as an occupational group at increased risk of suicide. This systematic review examines the prevalence of, and factors influencing, suicide and related behaviours among nurses and midwives (PROSPERO pre-registration CRD42021270297).

METHODS

MEDLINE, PsycINFO, and CINAHL were searched. Articles published from 1996 onwards exploring suicidal thoughts and behaviours among nurses and midwives were included. Quality of included studies was assessed. Articles were subjected to narrative synthesis informed by suicide data examined, study design, and quality. PRISMA guidelines were followed.

RESULTS

A total of 100 studies were eligible for inclusion in the review. Articles examining suicide exclusively among midwives were absent from the literature. Several studies confirmed that nursing professionals, especially female, are at increased risk of suicide, particularly by self-poisoning. Factors contributing to risk include psychiatric disorders, alcohol and substance misuse, physical health problems, and occupational and interpersonal difficulties. In studies of non-fatal suicidal behaviours, including during the COVID-19 pandemic, psychiatric, psychological, physical and occupational factors were contributory. There has been little investigation of interventions for prevention of suicide in nurses.

LIMITATIONS

Only articles published in English language were reviewed.

CONCLUSIONS

The findings highlight the risk of suicide in nurses. They also show a combination of factors contribute to suicide and non-fatal suicidal behaviour in nurses, with psychiatric, psychological, physical health, occupational and substance misuse (especially alcohol) problems being particularly important. The limited evidence regarding prevention measures indicates a major need to develop primary and secondary interventions for this at-risk occupational group, for example, education regarding enhancing wellbeing and safe alcohol use, alongside accessible psychological support.

Suicide ideation and anhedonia among clinically stable adolescents with the recurrent depressive disorder during the COVID-19 pandemic: A network perspective

BACKGROUND

Anhedonia is a suicide risk factor among adolescent patients with recurrent depressive disorder (depression hereafter). This study examined associations between suicidal ideation (SI) and residual depressive symptoms (RSD), including anhedonia, among clinically stable adolescents with depression.

METHOD

A network analysis was performed to examine the association between RDS and SI among adolescents with depression. Node-specific predictive betweenness was computed to examine short paths between anhedonia and SI. Additionally, a Network Comparison Test (NCT) was conducted to examine gender differences in derived network model characteristics.

RESULTS

The network analysis identified close associations of PHQ9 ("Suicide ideation") with PHQ1 ("Anhedonia") as well as some other RDS including PHQ6 ("Guilt"), PHQ2 ("Sad mood") and PHQ8 ("Motor disturbances"). Additionally, PHQ2 ("Sad mood") and PHQ4 ("Fatigue") were the main bridge nodes linking anhedonia and SI. Comparisons of network models did not find significant differences in network global strength or edge weights.

LIMITATION

Causal relations between anhedonia and SI could not be determined due to the cross-sectional study design.

CONCLUSIONS

SI was directly related to Anhedonia in addition to Guilt, Sad mood and Motor disturbances. Sad mood and Fatigue were the main bridge nodes linking Anhedonia and SI. To reduce the risk of SI among clinically stable adolescents with depression during the COVID-19 pandemic, specific RDS including Anhedonia, Guilt, Sad mood, Motor disturbances and Fatigue should be targeted in interventions.

Therapeutic alliance and change in suicide ideation among psychiatric inpatients at risk for suicide

BACKGROUND

Therapeutic alliance is thought to be essential in the treatment of suicidality. Surprisingly, studies about the association between therapeutic alliance and change in suicide ideation over the course of treatment are sparse and reported inconsistent results. Furthermore, theoretically important moderators were rarely explored empirically.

METHODS

We investigated the association between therapeutic alliance and change in suicide ideation (difference between intake and discharge), unadjusted and adjusted for potential confounding variables (diagnoses, sociodemographics etc.) in a sample of 351 inpatients treated in a psychiatric department specialized in crisis intervention and suicide prevention. We also explored if the association was moderated by suicide ideation at intake, history of suicide attempts, and borderline personality disorder (BPD). We ran sensitivity analyses for different diagnostic subgroups, history of suicide attempts, and a quantitative measure of BPD symptoms.

RESULTS

We found a moderate association between therapeutic alliance and change in suicide ideation (r = 0.30, p < 0.01). This association remained robust after accounting for potentially confounding variables. Suicide ideation at intake, history of suicide attempts, and BPD were not statistically significant moderators. Sensitivity analyses led to similar results.

LIMITATIONS

Therapeutic alliance was assessed only at the end of treatment and causality cannot be inferred from our study method.

CONCLUSIONS

Therapeutic alliance was a robust correlate of improvement in suicide ideation among psychiatric inpatients at risk for suicide, independent from diagnostic groups and other patient characteristics. Our results support the crucial role of therapeutic alliance in the treatment of patients at risk for suicide.

Hope and suicidal ideation and behaviour

Understanding the factors that protect against suicidal ideation and behaviour may strengthen our ability to identify and support those at risk of death by suicide, above and beyond that which is possible by focusing solely on risk factors. A factor that may confer protection against the development of suicidal ideation and behaviour is hope, a future orientated construct that features within recent theories of suicide. Here, we provide an overview of the literature examining the role of hope in moderating and mediating the relationship between suicide risk factors and suicide ideation and behaviour. Evidence suggests that hope may be important in buffering against suicide ideation and behaviour across different population. Limitations and recommendation for future research are also discussed.

Exploring Place-Based Differences in Suicide and Suicide-Related Outcomes Among North Carolina Adolescents and Young Adults

PURPOSE

Suicide is an ongoing public health crisis among youth and adolescents, and few studies have investigated the spatial patterning in the United States among this subpopulation. Potential precursors to suicide in this vulnerable group are also on the rise, including nonfatal self-injury.

METHODS

This study uses emergency department data, death certificates, and violent death reporting system data for North Carolina from 2009 to 2018 to investigate spatial clusters of self-injury and suicide.

RESULTS

Findings show that the demographic characteristics of individuals committing fatal and nonfatal self-injury are quite different. Self-injury and completed suicides exhibited different geographical patterns. Area-level measures like micropolitan status and measures of racial and income segregation predicted the presence of high-risk suicide clusters. Suicides among Native Americans and veteran status/military personnel also were associated with higher risk suicide clusters.

DISCUSSION

Future interventions should target these specific high-risk locations for immediate reductions in adolescent and youth suicides.

Self-reported anxiety and depression problems and suicide ideation among black and latinx adults and the moderating role of social support

Suicide is a critical public health problem. Over the past decade, suicide rates have increased among Black and Latinx adults in the U.S. Though depression is the most prevalent psychiatric contributor to suicide risk, Black and Latinx Americans uniquely experience distress and stress (e.g., structural adversity) that can independently operate to worsen suicide risk. This makes it important to investigate non-clinical, subjective assessment of mental health as a predictor of suicide ideation. We also investigate whether social support can buffer the deleterious impact of poor mental health on suicide ideation.We analyzed data from 1,503 Black and Latinx participants of the Washington Heights Community Survey, a 2015 survey of residents of a NYC neighborhood. Multivariable logistic regression was conducted to examine the effect of subjectively experienced problems with anxiety and depression on suicide ideation independent of depression diagnosis, and the role of social support as a moderator.Estimated prevalence of past two-week suicide ideation was 5.8%. Regression estimates showed significantly increased odds of suicide ideation among participants reporting moderate (OR = 8.54,95% CI = 2.44-29.93) and severe (OR = 16.84,95% CI = 2.88-98.46) versus no problems with anxiety and depression, after adjustment for depression diagnosis. Informational support, i.e., having someone to provide good advice in a crisis, reduced the negative impact of moderate levels of anxiety and depression problems on suicide ideation.Findings suggest that among Black and Latinx Americans, subjective feelings of anxiety and depression account for a significant portion of the suicide ideation risk related to poor mental health. Further, social support, particularly informational support, may provide protection against suicide ideation.

Wishing to die or self-harm after stroke: A planned secondary analysis of the AFFINITY Randomised Controlled Trial

We investigated the cumulative prevalence of self-harm ideation among stroke survivors of the AFFINITY trial. We assessed these thoughts with the last item of the PHQ-9, and functional impairment with the modified Rankin Scale (mRS). Of 1221 participants (age 63.9 ± 12.3 years, 775 men), 11 reported wishing to die or self-harm at baseline. By week 52, 36 of 1159 surviving participants had reported wishing to die or self-harm. Treatment with fluoxetine for 26 weeks did not change the prevalence of these thoughts compared with placebo. Clinically significant symptoms of depression were present in 95 % of participants with recurrent self-harm thoughts. The study was registered with the Australian and New Zealand Clinical Trials Registry, ACTRN12611000774921.

Impulsivity and aggression in suicide ideators and suicide attempters of high and low lethality

BACKGROUND

Impulsivity and aggression have been associated with all forms of suicidal behaviour and linked to theories of suicide capability. There is a need to clarify the role of impulsivity and aggression in the progression from suicidal thoughts to suicide attempts and suicide.

METHOD

In this naturalistic cross-sectional study, suicide ideators (35), low lethal suicide attempters (37), and high lethal suicide attempters (26) were compared with the Columbia-suicide severity rating scale (C-SSRS), Barratt impulsiveness scale (BIS-11), and the Buss & Perry aggression questionnaire (AQ).

RESULTS

Physical aggression score (p = 0.032) contributed to the difference between predicted low lethal suicide attempt and predicted high lethal suicide attempt. This model predicting physical aggression showed a fairly weak positive relationship (OR = 1.1) to high lethal attempt and explained 13% of the variance so there is a need for further replications to verify these results. Impulsive behaviour scores in females were significantly higher in the low lethal suicide attempt group compared to suicide ideators (F(2.51) = 3.47, p = 0.039, η²= 0.12). Hostility aggression in females was significantly higher in the high lethal suicide attempters compared to suicide ideators (F(2.52) = 3.53, p = 0.037, η² = 0.12). Physical aggression scores in females were significantly higher in the high lethal attempters compared to suicide ideators (F(2.52) = 6.79, p = 0.002, η²= 0.21). When these analyses were conducted without the participants who died in suicide, men in the high lethal attempt group scored significantly higher than men in the low lethal attempt group (F(2.37) = 3.8, p = 0.031, η² = 0.17), but men did not differ in aggression and impulsivity scores in other comparisons.

CONCLUSION

Suicide prevention should address physical aggression, as high levels can be associated with high lethal attempts. Assessment of suicidal patients should address impulsive behaviour with the insight that it can be more prominent in female low lethal suicide attempters. It could be that assessment and treatment of suicidal patients should be tailored differently for men and women. Aggression as a feature of suicide capability could be the link that makes suicide possible.

Lifelong versus not lifelong death wishes in older adults without severe illness: a cross-sectional survey

BACKGROUND

Some older adults with a persistent death wish without being severely ill report having had a death wish their whole lives (lifelong persistent death wish; L-PDW). Differentiating them from older adults without severe illness who developed a death wish later in life (persistent death wish, not lifelong; NL-PDW) can be relevant for the provision of adequate help and support. This study aims to gain insight into the characteristics, experiences, and needs of older adults with a L-PDW versus older adults with a NL-PDW and into the nature of their death wishes.

METHODS

In the Netherlands, in April 2019, a cross-sectional survey study was conducted among a large representative sample of 32,477 citizens aged 55 years and older. Respondents with a L-PDW (N = 50) were compared with respondents with a NL-PDW (N = 217) using descriptive statistics, Kruskal-Wallis tests, and Fisher's exact tests.

RESULTS

Respondents with a L-PDW were relatively younger and less often had (step)children. They less often looked back on a good and satisfying life with many good memories and more often reported trauma. Older adults with a NL-PDW more often reported loss and bereavement. Overall, the groups showed a lot of similarities. Both groups reported a death wish diverse in nature, numerous health problems, and a variety of needs for help and support.

CONCLUSIONS

Some of the differences we found between the groups might be particularly relevant for the provision of adequate help and support to older adults with a L-PDW (i.e., their past and trauma) and to older adults with a NL-PDW (i.e., their loss and bereavement). The heterogeneity of both groups and the diverse nature of their death wish indicate that careful assessment of the death wish, its background, and underlying needs is required to provide personalized help and support to older adults with a death wish.

Association of Workplace Bullying with Suicide Ideation and Attempt Among Chinese Nurses During the COVID-19 Pandemic

Nurses experience a high incidence of workplace bullying and are at a higher risk of suicide than the general population. However, there is no empirical evidence on how exposure to workplace bullying is associated with suicide ideation and attempts among nurses. Nurses were recruited from tertiary hospitals in Shandong Province, China, using stratified cluster sampling. Suicide ideation and attempts were assessed using two items, and the Workplace Psychologically Violent Behaviors Instrument was used to measure subtypes of workplace bullying. The prevalence of workplace bullying, suicide ideation, and suicide attempts was 30.6%, 16.8%, and 10.8%, respectively. After adjusting for covariates, victims of workplace bullying were at a high risk of suicide ideation and attempts. Among workplace bullying subtypes, individuals’ isolation from work and direct negative behaviors were predictors of both suicide ideation and attempts; attack on personality only predicted suicide attempts. The more bullying subtypes experienced by nurses, the greater their likelihood of suicide ideation and attempts. These findings suggested that workplace bullying was associated with an increased risk of suicide ideation and attempts in nurses, with both independent and cumulative risks. Interventions should focus on prevention and managing the effects of workplace bullying among nurses.

Increased alcohol use, heavy episodic drinking, and suicide ideation during the COVID-19 pandemic in Canada

OBJECTIVE

Alcohol use is a known risk factor for suicidality, yet this relationship has not been explored during the pandemic in Canada. As a growing body of evidence demonstrates the negative impact of COVID-19 on alcohol consumption and associated harms in Canada, there is a need to examine this more closely.

METHODS

Using the Survey on COVID-19 and Mental Health 2020, we compared the prevalence of suicide ideation among: (1) individuals who reported an increase in alcohol consumption vs those who reported a decrease/no change, and (2) individuals who reported past month heavy episodic drinking vs those who did not. We compared overall unadjusted odds ratios and across a number of sociodemographic and mental health variables. All estimates were weighted to ensure they were nationally representative.

RESULTS

The prevalence and likelihood of suicide ideation were significantly higher among people who reported increased alcohol consumption during the pandemic (4.9% vs 2.0%; OR = 2.6, 95% CI: 1.8, 3.7) and people who reported past month heavy episodic drinking (3.4% vs 2.1%; OR = 1.7, 95% CI: 1.2, 2.3). Males and middle-aged and older-aged individuals had the highest odds ratios for increased alcohol consumption and past month heavy episodic drinking with suicide ideation.

CONCLUSION

In the Canadian general population during the COVID-19 pandemic, there were significant associations between suicide ideation and increased alcohol use as well as past month heavy episodic drinking across specific sociodemographic subgroups. Future research could explore these associations while adjusting for social determinants of health such as income security, employment, education, social support, stress, and mental health.