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INTRODUCTION: Suicidal behavior necessitates prompt diagnosis due to its severe consequences. C-reactive protein (CRP) levels may offer insights into its pathophysiology and aid in risk assessment, potentially enhancing preventive interventions and treatment strategies. The aim of this study is to assess the CRP levels in depressed patients with and without suicidal behavior. METHODS: Our systematic review was registered in Prospero (#CRD42024518477). We searched five databases (PubMed, Scopus, PsycINFO, Web of Science, and CINAHL Complete) for records in English from inception to February 2024. We included observational studies that measured CRP in depressed patients with and without suicidal behavior. We used the Newcastle-Ottawa Scale (NOS) to assess the quality of the included studies. We employed a random-effects model, and the statistical analysis was conducted using Stata software version 17. RESULTS: Initial 632 articles narrowed to 15 for systematic review. Fifteen studies with 3652 participants included. Fourteen studies involving 3387 depressed patients, 1269 with suicidal behavior, analyzed CRP levels. Suicidal patients exhibited higher CRP levels (SMD: 0.80 [0.37, 1.23]). Analysis of seven studies with 465 participants, including 200 depressed patients with suicidal behavior and 265 healthy controls, showed higher CRP levels in depressed patients (SMD: 1.58 [0.97, 2.19]). CONCLUSION: In summary, our systematic review and meta-analysis of CRP levels in suicidal patients revealed that those with suicidal behavior exhibited higher CRP levels, suggesting possible implications for treatment approaches.

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INTRODUCTION: Understanding the mechanisms of suicidal behavior is a prerequisite for suicide prevention and intervention. The current study aims to propose and verify the utility of pre-suicidal attempt as an intermediate type in the transition from suicidal ideation to suicidal attempt within the ideation-to-action framework. METHODS: A sample of 1084 college students completed a measurement package consisting of suicide history, suicide risk factors, and demographic information. Stratified stepwise multiple regression models and mediated moderation models were used to examine the relationship among the variables. RESULTS: Pre-suicidal attempts rather than suicidal ideation are predictive of suicide attempts. Age, depression, thwarted belongingness, fearlessness about death, perceived burdensomeness and suicidal ideation were predictors of pre-suicidal attempts. Supporting the interpersonal theory of suicide, pre-suicidal attempts mediated the relationship between suicidal ideation and suicidal attempts and were positively moderated by pain tolerance and fearlessness about death. The pre-suicidal attempters scored higher on fearlessness about death and suicide risk than the ideators, while pre-suicidal attempters scored significantly lower on suicide risk than suicide attempters. CONCLUSION: As an independent intermediate type within the ideation-to-action framework, pre-suicidal attempts contribute to deepen the understanding of the intermediate transition from suicidal ideation to suicidal attempts.

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BACKGROUND: People who are forced to leave home often experience emotional suffering and may be disproportionately subjected to risk factors for suicide. Although it is a grave concern for the global public health community, it has not been understood in Ethiopia. AIMS: This study aims to assess the prevalence and factors associated with suicidal ideation and attempts among war-affected internally displaced people in northwest Ethiopia, 2022. METHOD: From 23 May to 22 June 2022, a cross-sectional study design was conducted, and a sample of 765 participants was selected through simple random sampling. A structured interview was employed to collect data. Suicidal ideation and attempts were assessed using the Composite International Diagnostic Interview. RESULTS: Out of 751 interviewed participants with a response rate of 98.2%, the magnitude of suicidal ideation and attempt was 22.4% (95% CI: 19.5%, 25.4%) and 6.7% (95% CI: 5.1%, 8.7%), respectively. People of female gender, having depression, family with a history of mental illness, and poor social support were significantly associated with both suicidal ideation and attempts. Furthermore, post-traumatic stress symptoms and the death of a family member were significantly associated with suicide ideation and attempt, respectively. CONCLUSION: At least one in five of the displaced people in this population had experienced suicide ideation, and one in fifteen had attempted suicide. Therefore, strengthening early detection and intervention for individuals is recommended, especially for females with depression, post-traumatic stress symptoms, family with a history of mental illness, poor social support and the death of family members.

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BACKGROUND: A relatively small number of studies have researched the relationship between sleep duration and suicidal ideation, attempts, and behavior. This research aims to investigate the link between sleep duration and suicide in Chinese adolescents, and to examine the role of depression as a mediating factor. METHOD: Data were collected from 3315 students using a multi-stage random cluster sampling method and self-administered questionnaires. The study applied logistic regression to investigate the relationship between sleep duration and various forms of suicidal behavior, and mediation analysis to understand how depression might influence this relationship. RESULTS: The average sleep duration among the adolescents was 7.25 h (±0.20), with 59.67 % reporting insufficient sleep. The logistic regression analysis showed that longer sleep duration is linked with lower risks of suicidal ideation (OR: 0.753, 95%CI: 0.696 to 0.814), suicidal attempts (OR: 0.830, 95%CI: 0.748 to 0.922), and suicidal behavior (OR: 0.841, 95%CI: 0.713 to 0.992). Analysis using restricted cubic spline plots indicated the connection between sleep duration and these suicidal factors was not linear. The study found that depression plays a partial mediating role between sleep duration and suicidal ideation, with an effect of 52.29 %. LIMITATIONS: The cross-sectional study design could not prove causation. CONCLUSIONS: There is a clear non-linear association between sleep duration and suicidal tendencies in adolescents, with depression acting as a mediator. This suggests that future research could focus on sleep and mood management as ways to address suicide risk in this age group.

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INTRODUCTION: In the United States, it is reported that 1.4% of the general population commits suicide. It has been postulated that antiseizure medications (ASMs) can lead to the development of suicidal ideation and suicidal behavior; however, this risk is still very low and has yet to be precisely established. AREAS COVERED: This narrative review evaluates the risk of suicide-related events (SREs) in subjects taking ASMs for various neurological disorders. Screening tools for suicidal ideation and suicidal behavior are also discussed. References for this article were found using PubMed/MEDLINE. EXPERT OPINION: Although some ASMs can be associated with SREs, this is not yet clearly established. The mechanisms involved in suicide risk in subjects taking ASMs are multifactorial. The bidirectional relationship between depression and epilepsy, as well as other associations, should be kept in mind when interpreting any impact of ASMs in PWE. Screening for SREs, close monitoring of subjects taking ASMs are the most appropriate strategies to minimize suicide risk. More efforts should be made to achieve accurate risk stratification through prognostic models that could be applied to subjects taking ASMs. Studies exploring the association between ASMs and suicide should consider ASMs individually and control for prior SREs.

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OBJECTIVES: Adolescent suicide is a significant global public health concern. Although numerous studies have investigated factors that influence the risk of suicide among adolescents around the world, limited data are available in the Malaysian context, especially among the diverse ethnic communities of Sarawak. This study aimed to determine the factors associated with the risk of suicide among adolescents in Sarawak, Malaysia. METHODS: A community-based cross-sectional study was conducted among 1,344 adolescents in Sarawak using face-to-face interviews. Hierarchical binary logistic regression analysis was performed to identify factors that determine the risk of suicide among adolescents. RESULTS: Two predictive models were constructed. Both models revealed that being female (OR=1.578, 95 % CI: 1.191, 2.092, p=0.001), having Malay ethnicity (OR=1.733, 95 % CI: 1.236, 2.429, p=0.001) and having a disease significantly increased the risk of suicide (OR=1.895, 95 % CI: 1.221, 2.942, p=0.004). In particular, Model 2, which showed a better fit, found that occasional religious practice (OR=1.610, 95 % CI: 1.126, 2.303, p=0.009), poor parental relationships (OR=1.739, 95 % CI: 1.035, 2.922, p=0.037) and higher addiction (OR=1.015, 95 % CI: 1.008, 1.022, p=0.001), depression (OR=1.919, 95 % CI: 1.241, 2.968, p=0.003), and stress (OR=2.707, 95 % CI: 1.689, 4.340, p=0.001) scores were significantly associated with an increased risk of suicide. CONCLUSIONS: This study sheds light on multiple factors that contribute to the risk of suicide among adolescents in Sarawak. These findings underscore the importance of holistic prevention strategies, including psychological and social dimensions, to mitigate the risk of suicide in this population. Further research is warranted to understand the complex interplay of these factors and guide the development of targeted interventions.

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We aimed to evaluate the association of unmet health-related need with suicidal behaviors among Korean adults. We included 26,219 adults (13,937 men and 17,788 women) aged ≥ 19 years from the Korea National Health and Nutrition Examination Survey (2015-2020). Suicidal behavior included suicidal plan and attempt. We analyzed the odds ratios and 95% confidence intervals of suicidal behaviors according to unmet health-related need via multivariable logistic regression analysis and performed stratified analyses according to sex, age, income, education, and type of insurance. Of the participants, 9.6% had unmet health-related need. Suicidal plans and attempts had 1.3% and 0.5% of the participants, respectively. The prevalence of suicidal plans and attempts was 0.9% and 0.4% among participants without unmet health-related need and 3.1% and 1.0% among those with such need, respectively. The odd ratios of suicidal plans and attempts increased significantly among participants with unmet health-related need compared to those without. In subgroup analysis, most subgroups showed similar results, except for suicidal plan and attempt in the 45-64 age group, high education, and medical care and suicidal attempt in 19-44 age group, low-income, and unmarried. Unmet health-related need was independently associated with suicidal plan and attempt. A policy alternative is needed for these associations.

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AIMS: Limited understanding exists regarding the neurobiological mechanisms underlying non-suicidal self-injury (NSSI) and suicide attempts (SA) in depressed adolescents. The maturation of brain network is crucial during adolescence, yet the abnormal alternations in depressed adolescents with NSSI or NSSI+SA remain poorly understood. METHODS: Resting-state functional magnetic resonance imaging data were collected from 114 depressed adolescents, classified into three groups: clinical control (non-self-harm), NSSI only, and NSSI+SA based on self-harm history. The alternations of resting-state functional connectivity (RSFC) were identified through support vector machine-based classification. RESULTS: Convergent alterations in NSSI and NSSI+SA predominantly centered on the inter-network RSFC between the Limbic network and the three core neurocognitive networks (SalVAttn, Control, and Default networks). Divergent alterations in the NSSI+SA group primarily focused on the Visual, Limbic, and Subcortical networks. Additionally, the severity of depressive symptoms only showed a significant correlation with altered RSFCs between Limbic and DorsAttn or Visual networks, strengthening the fact that increased depression severity alone does not fully explain observed FC alternations in the NSSI+SA group. CONCLUSION: Convergent alterations suggest a shared neurobiological mechanism along the self-destructiveness continuum. Divergent alterations may indicate biomarkers differentiating risk for SA, informing neurobiologically guided interventions.

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Background: Suicidal behaviour is an established psychiatric complication of congestive cardiac failure (CCF), contributing significantly to morbidity and death by suicide. The magnitude and risk factors for suicidal behaviour among patients with CCF are yet to be unpacked, especially in developing nations such as Nigeria. Aim: To determine the prevalence of suicidal behaviour and the risk factors associated with suicidal behaviour, among patients with CCF in Nigeria. Setting: Cardiology outpatient clinic of Lagos State University Teaching Hospital, Lagos, Nigeria. Methods: A cross-sectional study was conducted among 98 randomly selected patients with a diagnosis of CCF. Participants were assessed with a socio-demographic and clinical factors questionnaire and Beck Scale of Suicidal Ideation. Chi-square test, t-test and logistic regression were used to analyse data. Results: The prevalence of suicidal ideation and suicidal attempt among patients with CCF was 52% and 1%, respectively. No socio-demographic factor was significantly associated with suicidal ideation. Clinical factors associated with suicidal ideation were age at diagnosis (p = 0.042), aetiology of CCF (p = 0.001) and severity of CCF (p = 0.032). Only the severity of CCF (odds ratio [OR] = 20.557, p = 0.014) predicted suicidal ideation among patients with CCF. Conclusion: Suicidal behaviour constitutes a huge burden among the outpatient CCF population. The identification of clinical risk factors for suicidal ideation (age at diagnosis, aetiology and severity of CCF) further illuminates a pathway to mortality among patients with CCF. Contribution: The findings lend a voice to the need for screening for suicidal behaviour, suicide prevention programmes, surveillance systems and government policies that support mental health for patients with CCF.

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OBJECTIVE: To evaluate the clinico-pathological determinants of suicidal thoughts and behavior in patients with post-stroke depression (PSD) in a teaching hospital in south-west Nigeria. METHOD: A cross-sectional study was carried out in Lagos State University Teaching Hospital and it involved 89 consecutively selected outpatients with post-stroke depression (diagnosed using the depression module of Mini International Neuropsychiatric Inventory). Socio-demographic and clinical factors questionnaire, Mini-Mental State Examination, National Institute of Health Stroke Scale, and Beck Scale of Suicidal Ideation (BSSI) were administered to the participants. BSSI total score was used as a measure of suicidal thoughts. Ethical approval was obtained from the ethics and research committee of Lagos State University Teaching Hospital. RESULT: Time since stroke (the time since onset of the most recent stroke) had a significant negative correlation with suicidal thoughts (r = -0.263, p = 0.013). In the same vein, the probability of attempting suicide significantly reduces with time since stroke, Odds Ratio = 0.925, p = 0.047. CONCLUSION: Suicidal thoughts and behavior occur early in patients with post-stroke depression. The identification of shorter time since stroke as a correlate of suicidal thoughts and behavior among this patient population underscores the need for performing early assessment and prompt intervention for the at-risk individuals.

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Introduction: Treatment-resistant depression (TRD) is commonly defined as the failure of at least two trials with antidepressant drugs, given at the right dose and for an appropriate duration. TRD is associated with increased mortality, compared to patients with a simple major depressive episode. This increased rate was mainly attributed to death from external causes, including suicide and accidents. The aim of our study is to identify socio-demographic and psychopathological variables associated with suicidal attempts in a sample of outpatients with TRD. Material and methods: We performed a monocentric observational study with a retrospective design including a sample of 63 subjects with TRD referred to an Italian outpatient mental health centre. We collected socio-demographic and psychopathological data from interviews and clinical records. Results: 77.8% of the sample (N=49) were females, the mean age was 49.2 (15.9). 33.3% (N=21) of patients had attempted suicide. 54% (N=34) of patients had a psychiatric comorbidity. Among the collected variables, substance use (p=0.031), psychiatric comorbidities (p=0.049) and high scores of HAM-D (p=0.011) were associated with the occurrence of suicide attempts. In the regression model, substance use (OR 6.779), psychiatric comorbidities (OR 3.788) and HAM-D scores (OR 1.057) were predictive of suicide attempts. When controlling for gender, only substance use (OR 6.114) and HAM-D scores (OR 1.057) maintained association with suicide attempts. Conclusion: The integrated treatment of comorbidities and substance abuse, which involves different mental health services, is fundamental in achieving the recovery of these patients. Our study supports the importance of performing a careful clinical evaluation of patients with TRD in order to identify factors associated with increased risk of suicide attempts.

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Objective: The study investigated the prevalence of suicidal behavior and its association with depression, hopelessness, perceived burdensomeness, and thwarted belongingness in a sample of undergraduates in Nigeria. Introduction: Suicide is a leading cause of death among young adults globally. However, information about suicidal ideation, attempts, and relationships with psychiatric factors, perceived burdensomeness, and thwarted belongingness is sparse in Nigeria. The study investigated the prevalence of suicidal ideation and attempts and associated factors in a sample of undergraduates in Nigeria. Methods: We collected data from a cross-sectional survey of 625 undergraduate students primarily recruited from universities, colleges of education, and polytechnics in Adamawa Central Senatorial Zone, Adamawa State, northeast Nigeria. The Suicidal Behaviors Questionnaire-Revised, the 15-item Interpersonal Needs Questionnaire, the 9-item Patient Health Questionnaire, and the 20-item version of the Beck Hopelessness Scale were administered to the participants. We used descriptive statistics and binary and multivariate logistic regressions for data analysis. Results: A total of 616 students with a mean age of 21.41 ± 4.72 years completed the study. The prevalence of suicidal behavior was 34.9% (215/616). Having a female sex (adjusted odds ratio [AOR] = 8.37, 95% confidence interval (CI): 2.06, 34.03), depression (AOR = 45.15, 95% CI: 0.95, 5.11), hopelessness (AOR = 20.10, 95% CI: 5.56, 72.41), and perceived burdensomeness (AOR = 89.15, 95% CI: 29.63, 268.30) were associated with suicidal ideation. In addition, being a female (AOR = 1.69, 95% CI = 1.02, 2.83), being a 200-level student (AOR = 3.41, 95% CI = 1.46, 7.96), and being a 300-level student (AOR = 0.28, 95% CI = 0.11, 0.74) were associated with suicidal attempt. Conclusion: The study's findings show that suicidal behaviors (ideations and attempts) are prevalent among undergraduate students in northeast Nigeria. The findings underline the need for the development of mental health services and early identification and intervention for at-risk young people in Nigeria.

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Background: Previous studies have reported alterations in brain structure in major depressive disorder (MDD) patients with suicide attempts. However, age-related changes in suicidal MDD patients remain unclear. Methods: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Embase, PubMed, and Web of Science were searched to identify relevant studies from inception to January 2023. All voxel-based and surface-based morphometry studies comparing suicidal MDD patients to MDD or healthy controls were included. Studies were then grouped by age range (old, middle-age, adolescent) and the commonalities and age-related structural brain alterations were summarized. The included studies were evaluated using the Newcastle-Ottawa Scale (NOS). Results: A total of 17 studies met the inclusion criteria, including 3 of late-life depression (LLD) patients, 11 of middle-aged depression (MAD) patients, and 3 of adolescent depression (AOD) patients. The majority of studies had moderate to high NOS scores, indicating good quality. Patients in all three age groups exhibited extensive alterations in the lateral, medial, and orbital regions of the frontal lobes. Furthermore, suicidal MAD patients showed a specific decrease in the gray matter volume of the dorsolateral prefrontal cortex compared to suicidal LLD patients. Cortical thickness and left angular gyrus volume were decreased in suicidal MAD and suicidal LLD patients, but increased in suicidal AOD patients. Conclusion: This systematic review summarizes structural brain changes in suicidal MDD patients at three age groups: elderly, middle-aged, and adolescent. These findings help elucidate the common circuitry of MDD related to suicide over the lifespan and highlight unique circuitry associated with different ages. These findings may help predict the risk of suicide in MDD patients at different ages.

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BACKGROUND: Insomnia is common in patients with schizophrenia, which contributes to worsening psychiatric symptoms and suicidality. We aimed to assess the inter-relationships of insomnia and psychopathology with suicidal ideation (SI) among 1407 Chinese patients with chronic schizophrenia via the network approach. METHOD: We used Positive and Negative Syndrome Scale, Insomnia Severity Index, and Beck Scale for Suicidal Ideation to assess psychiatric symptoms, insomnia, and SI, respectively. Lifetime suicidal attempts (SA) were collected. RESULTS: (1) The incidence of insomnia, lifetime SI, lifetime SA, and current SI was 13.5% (n = 190), 22.8% (n = 321), 13.5% (n = 190), and 9.7% (n = 136), respectively. (2) Patients with insomnia had worse clinical symptoms and higher suicidal risk. (3) Daytime dysfunction, sleep-related distress, conceptual disorganization, delusions, anxiety, and poor rapport were the core symptoms, while late sleep onset and sleep dissatisfaction emerged as bridge symptoms connecting insomnia and psychopathology. (4) Depressive mood, hallucinations, poor impulse control, guilty feelings, insomnia-related impaired quality of life, and sleep dissatisfaction were directly associated with SI. CONCLUSION: Our findings called for formal assessment of insomnia in patients with schizophrenia, which should cover both nocturnal and daytime insomnia symptoms. Targeted interventions for key symptoms may help reduce insomnia, psychiatric symptoms, and SI in patients with schizophrenia.

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Background: The COVID-19 pandemic has had a significant impact on pediatric patients, increasing their vulnerability to psychological fragility. The aim of this study was to investigate the epidemiology and clinical spectrum of pediatric psychological fragility and suicide attempts in the emergency department (ED) before and after the onset of the COVID-19 outbreak. Methods: A total of 340 pediatric patients admitted to the ED for psychological fragility between 2019 and 2022 were retrospectively collated and categorized according to three periods: pre pandemic, pandemic, and post pandemic. Epidemiological and clinical information were analyzed and compared among the three groups. Moreover, patients with suicidal ideation or suicidal attempts and types of substance use disorders in children with suicidal attempts sent to the ED were analyzed. Results: The proportion of psychological fragility increased during the pandemic period (0.4%) and the post-pandemic period (0.8%) compared to that in the pre-pandemic period (0.28%). Suicide ideation was the highest before the pandemic period (0.04%), while suicidal attempts were the highest in the post pandemic period (0.42%). Significantly elevated trends in suicide attempts involving overdose and injury were observed among the three groups (p < 0.05). Intensive care unit (ICU) admission rates increased significantly after the COVID-19 outbreak (p < 0.05), and major depressive disorder was the most common psychological fragility in the ED in all three groups. Conclusion: An increase in the proportion of pediatric psychological fragility in the ED was noted in the post pandemic period than before or during the pandemic. With higher rates of ICU admissions and an increase in suicide attempts among children and adolescents during the pandemic compared to before or after the pandemic, it is of utmost importance to provide mental health support to this vulnerable population in order to prevent suicide attempts in the event of a new global outbreak of infectious diseases.

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The administration of intravenous lipid emulsion (ILE) is a proven antidote used to reverse local anesthetic-related systemic toxicity. Although the capacity of ILE to generate blood tissue partitioning of lipophilic drugs has been previously demonstrated, a clear recommendation for its use as an antidote for other lipophilic drugs is still under debate. Venlafaxine (an antidepressant acting as a serotonin-norepinephrine reuptake inhibitor (SNRI)) and quetiapine (a second-generation atypical antipsychotic) are widely used in the treatment of psychotic disorders. Both are lipophilic drugs known to induce cardiotoxicity and central nervous depression. We report the case of a 33-year-old man with a medical history of schizoaffective disorder who was admitted to the emergency department (ED) after having been found unconscious due to a voluntary ingestion of 12 g of quetiapine and 4.5 g of venlafaxine. Initial assessment revealed a cardiorespiratory stable patient but unresponsive with a GCS of 4 (M2 E1 V1). In the ED, he was intubated, and gastric lavage was performed. Immediately after the admission to the intensive care unit (ICU), his condition quickly deteriorated, developing cardiovascular collapse refractory to crystalloids and vasopressor infusion. Junctional bradycardia occurred, followed by spontaneous conversion to sinus rhythm. Subsequently, frequent ventricular extrasystoles, as well as patterns of bigeminy, trigeminy, and even episodes of non-sustained ventricular tachycardia, occurred. Additionally, generalized tonic-clonic seizures were observed. Alongside supportive therapy, antiarrhythmic and anticonvulsant therapy, intravenous lipid emulsion bolus, and continuous infusion were administered. His condition progressively improved over the following hours, and 24 h later, he was tapered off the vasopressor. On day 2, the patient repeated the cardiovascular collapse and a second dose of ILE was administered. Over the next few days, the patient's clinical condition improved, and he was successfully weaned off ventilator and vasopressor support. ILE has the potential to become a form of rescue therapy in cases of severe lipophilic drug poisoning and should be considered a viable treatment for severe cardiovascular instability that is refractory to supportive therapy.

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Aim: This study aims to establish a nomogram model to predict the relevance of SA in Chinese female patients with mood disorder (MD). Method: The study included 396 female participants who were diagnosed with MD Diagnostic Group (F30-F39) according to the 10th Edition of Disease and Related Health Problems (ICD-10). Assessing the differences of demographic information and clinical characteristics between the two groups. LASSO Logistic Regression Analyses was used to identify the risk factors of SA. A nomogram was further used to construct a prediction model. Bootstrap re-sampling was used to internally validate the final model. The Receiver Operating Characteristic (ROC) curve and C-index was also used to evaluate the accuracy of the prediction model. Result: LASSO regression analysis showed that five factors led to the occurrence of suicidality, including BMI (ß = -0.02, SE = 0.02), social dysfunction (ß = 1.72, SE = 0.24), time interval between first onset and first dose (ß = 0.03, SE = 0.01), polarity at onset (ß = -1.13, SE = 0.25), and times of hospitalization (ß = -0.11, SE = 0.06). We assessed the ability of the nomogram model to recognize suicidality, with good results (AUC = 0.76, 95% CI: 0.71-0.80). Indicating that the nomogram had a good consistency (C-index: 0.756, 95% CI: 0.750-0.758). The C-index of bootstrap resampling with 100 replicates for internal validation was 0.740, which further demonstrated the excellent calibration of predicted and observed risks. Conclusion: Five factors, namely BMI, social dysfunction, time interval between first onset and first dose, polarity at onset, and times of hospitalization, were found to be significantly associated with the development of suicidality in patients with MD. By incorporating these factors into a nomogram model, we can accurately predict the risk of suicide in MD patients. It is crucial to closely monitor clinical factors from the beginning and throughout the course of MD in order to prevent suicide attempts.

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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.

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Suicidal ideation and attempts are much more common in people with severe mental disorders than in the general population. As a result, the goal of this study was to look at suicidal ideation and attempts in people with severe mental disorders in Addis Ababa, Ethiopia, in 2022. Using a simple random sample technique, a facility-based cross-sectional study involving 423 patients with severe mental disorders was conducted. The factors associated with suicidal thoughts and attempts were identified using a bivariate and multivariate logistic regression analysis model. Significant factors were determined using a p-value of less than 0.05. The prevalence of suicidal ideation and attempt was 26.4% (95% CI: 22.3-30.99%) and 18.6% (95% CI: 15.2-22.7%), respectively. Moreover, suicidal thoughts were linked with being single (AOR = 2.1.1, 95% CI: 1.01, 4.72), having poor social support (AOR = 3.1, 95% CI: 1.05, 9.422), and having comorbid depression (AOR = 2.72, 95% CI: 1.62, 4.54). Suicidal attempt was also associated with secondary education (AOR = 4.06, 95% CI: 1.50, 10.98), illness duration (AOR = 2.48, 95% CI: 1.15, 5.35), hopelessness (AOR = 3.415, 95% CI: 2.114, 15.516), and the absence of positive symptoms (AOR = 0.37, 95% CI: 0.209, 0.683). A significant proportion of patients with severe mental disorders have contemplated or actually attempted suicide. Poor psychosocial support, a higher level of education, and comorbid depression were all linked to these issues. Therefore, controllable risk factors such as education, hopelessness, and psychosocial support should be prioritized and given particular emphasis.

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Background: Medical students face great stress and put their mental health at risk to become an individual contributing to society, and impulsively attempt suicide. Little is known in the Indian context, so additional knowledge on the magnitude and covariates is required. Aims: This study aims to evaluate the magnitude and covariates of suicidal ideation, plan, and attempts among medical students. Methods: This was a cross-sectional study conducted in two medical colleges located in rural Northern India and enrolled 940 medical students for a period of two months from February to March 2022. A convenience sampling method was executed to collect the data. The research protocol incorporates a self-administered questionnaire regarding sociodemographic and personal domains, as well as standardized tools to assess psychopathological domains such as depression, anxiety, stress, and stressors. The Suicidal Behavior Questionnaire-Revised (SBQ-R) scale was used to measure the outcomes. Stepwise backward logistic regression (LR) analysis was used to determine the covariates associated with suicidal ideation, plan, and attempts. Results: A sample of 787 participants (87.1% response rate) were finally enrolled in the survey, with a mean age of 21.08 (±2.78) years. Around 293 (37.2%) of respondents had suicidal ideation, 86 (10.9%) claimed planning suicide, and 26 (3.3%) mentioned attempting suicide in their lifetime as well as 7.4% of participants assessed the risk of suicidal behavior in the future. The identified covariates poor sleep, family history of psychiatric illness, never seeking psychiatric aid, regret for choosing the field of medicine, bullying, depressive symptoms, high stress, emotion-focused coping, and avoidant coping, were significantly associated with a higher likelihood of lifetime suicidal ideation, plan, and attempt. Conclusion: A high frequency of suicidal thoughts and attempts, indicates the need of addressing these concerns promptly. The incorporation of mindfulness techniques, resilience, faculty mentorship programs, and proactive student counseling may help foster the mental health of the students.