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AIMS: Suicide prevention strategies have shifted in many countries, from a national approach to one that is regionally tailored and responsive to local community needs. Previous Australian studies support this approach. However, most studies have focused on suicide deaths which may not fully capture a complete understanding of prevention needs, and few have focused on the priority population of youth. This was the first nationwide study to examine regional variability of self-harm prevalence and related factors in Australian young people. METHODS: A random sample of Australian adolescents (12-17-year-olds) were recruited as part of the Young Minds Matter (YMM) survey. Participants completed self-report questions on self-harm (i.e., non-suicidal self-harm and suicide attempts) in the previous 12 months. Using mixed effects regressions, an area-level model was built with YMM and Census data to produce out-of-sample small area predictions for self-harm prevalence. Spatial unit of analysis was Statistical Area Level 1 (average population 400 people), and all prevalence estimates were updated to 2019. RESULTS: Across Australia, there was large variability in youth self-harm prevalence estimates. Northern Territory, Western Australia, and South Australia had the highest estimated state prevalence. Psychological distress and depression were factors which best predicted self-harm at an individual level. At an area-level, the strongest predictor was a high percentage of single unemployed parents, while being in an area where ≥30% of parents were born overseas was associated with reduced odds of self-harm. CONCLUSIONS: This study identified characteristics of regions with lower and higher youth self-harm risk. These findings should assist governments and communities with developing and implementing regionally appropriate youth suicide prevention interventions and initiatives.
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Factores Protectores , Conducta Autodestructiva , Prevención del Suicidio , Humanos , Adolescente , Conducta Autodestructiva/epidemiología , Conducta Autodestructiva/psicología , Prevalencia , Femenino , Masculino , Australia/epidemiología , Factores de Riesgo , Niño , Intento de Suicidio/estadística & datos numéricos , Intento de Suicidio/psicología , Análisis Espacial , Depresión/epidemiología , Depresión/psicologíaRESUMEN
BACKGROUND: People with lived experience have had limited opportunities to meaningfully contribute to the design of caring contacts interventions. The objective of this study was to co-design text messages with peer support specialist staff to determine optimal language and delivery, within a cultural context. METHODS: In this qualitative study, participants were professional peer support specialist staff with lived experience employed by specialist mental health services. They were asked to evaluate the initial series of text messages by taking part in a focus group using a semi-structured interview. This was audiotaped, transcribed and analysed using reflexive thematic analysis with specific coding of cultural themes. RESULTS: Three main themes were identified: upholding a person's autonomy; establishing connection as a bridge to safety; and, words as healing rongoa (remedy). The last theme contained a cultural subtheme: Maori language providing entry to the Maori world. CONCLUSION: People with lived experience breathe empowerment and hope into caring contacts interventions and should be considered vital partners in developing any suicide prevention initiative. Feeling genuinely cared for promotes connection and may enable an internal sense of safety. Tailoring of texts can be enhanced by culturally nuanced language.
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Intento de Suicidio , Envío de Mensajes de Texto , Humanos , Femenino , Masculino , Intento de Suicidio/psicología , Investigación Cualitativa , Adulto , Grupos Focales , Persona de Mediana EdadRESUMEN
Importance: Suicide is a leading cause of death among adolescents, who demonstrate high rates of sleep disturbance. Poor sleep appears to confer risk for suicide, but longitudinal investigation of suicidal behaviors remains rare, particularly in the transition from childhood to early adolescence. Objective: To evaluate sleep disturbances in preadolescent children (aged 9 and 10 years) in association with longitudinal risk for suicidal ideation and suicide attempts at the 2-year follow-up. Design, Setting, and Participants: This cohort study used data from the Adolescent Brain Cognitive Development Study between June 2016 and January 2021. This dataset included children aged 9 or 10 years at baseline and their parents or caregivers who were recruited at 21 sites across the US. Data were analyzed July 2023 to June 2024. Exposures: The Sleep Disturbance Scale for Children, a 26-item parent-reported inventory, was administered at baseline, generating a total score and 6 subscales. Central covariates included the Child Behavior Checklist Anxiety and Depression subscale and demographic variables. Main Outcomes and Measures: The computerized Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-COMP) assessed parent- and youth-reported suicidal behaviors and outcomes (none; passive, active nonspecific, and active specific suicidal ideation; and suicide attempt) at the 2-year follow-up. Sleep disturbance was further grouped by symptom severity (minimal, moderate, elevated, high, and severe). Results: Of the 10â¯136 youths who reported no baseline suicidal ideation or behavior, 8807 youths (mean [SD] age, 9.9 [0.6] years; 4507 males [51.2%]; 197 Asian individuals [2.2%], 1273 Black individuals [14.5%], and 5775 White individuals [65.6%]) completed the K-SADS-COMP assessment at the 2-year follow-up and were included in the analysis. At the follow-up, 8044 participants (91.3%) had no suicidal behavior, 317 (3.6%) had passive suicidal ideation, 258 (2.9%) had active nonspecific suicidal ideation, 130 (1.5%) had active specific suicidal ideation, and 58 (0.7%) had a first-time suicide attempt. Baseline sleep disturbance was associated with increased incidence risk for suicidal behavior at age 12 years (odds ratio, 2.68; 95% CI, 1.44-4.98; P = .002), adjusting for covariates. Individual subscales or items demonstrating associations with risk included disorders of excessive somnolence and frequency of nightmares. Conclusions and Relevance: Results of this longitudinal cohort study revealed that disturbed sleep at age 10 years was associated with risk for suicidal thoughts and behaviors in the next 2 years. The findings highlight the potential importance of sleep as a visible risk factor and intervention target in the prevention of youth suicide.
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Trastornos del Sueño-Vigilia , Ideación Suicida , Intento de Suicidio , Humanos , Niño , Masculino , Femenino , Trastornos del Sueño-Vigilia/epidemiología , Trastornos del Sueño-Vigilia/psicología , Intento de Suicidio/estadística & datos numéricos , Intento de Suicidio/psicología , Factores de Riesgo , Estudios Longitudinales , Estados Unidos/epidemiología , Estudios de CohortesRESUMEN
Introduction: Warning signs serve as proximal indicators of suicide risk, making early recognition imperative for effective prevention strategies. This study aimed to explore self-identified suicide warning signs among Chinese patients with mood disorders based on safety planning framework. Methods: Researchers collaborated with patients to develop a safety plan and compiled warning signs based on it. Word frequency and network analysis were conducted to identify key warning signs. Directed content analysis categorized these signs into cognitive, emotional, behavioral, or physiological themes according to the suicide mode theory. Additionally, we examined potential variations in reported warning signs among participants with different demographic characteristics, including age, gender, and history of suicide attempts. Results: "Low mood" and "crying" emerged as prominent warning signs, with "social withdrawal" closely following. Patients commonly reported emotional themes during suicidal crises, often experiencing two to three themes simultaneously, primarily focusing on emotional, behavioral, and physiological themes. Males exhibited a higher proportion of concurrently reporting three sign themes compared to females (P < 0.05), while no difference was observed in warning signs among patients with other demographic traits. Discussion: This study offers a nuanced understanding of warning signs among mood disorder patients in China. The findings underscore the necessity for comprehensive suicide risk management strategies, emphasizing interventions targeting emotional regulation and social support. These insights provide valuable information for enhancing suicide prevention and intervention efforts.
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Trastornos del Humor , Investigación Cualitativa , Humanos , Masculino , Femenino , Trastornos del Humor/psicología , Adulto , China , Persona de Mediana Edad , Prevención del Suicidio , Intento de Suicidio/estadística & datos numéricos , Intento de Suicidio/psicología , Ideación Suicida , Suicidio/psicología , Suicidio/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND: The proliferation of electronic cigarettes (e-cigarettes) has presented new challenges in public health, particularly among adolescents and young adults. While marketed as safer than tobacco and as cessation aids, e-cigarettes have raised concerns about their long-term health and psychosocial impacts, including potential links to increased suicidal behaviors. This study aims to evaluate the relationship between e-cigarette use and suicidal behaviors by conducting a systematic review of the current literature. METHODS: We searched PubMed, Web of Science, and EMBASE for studies up to March 10, 2024, examining the relationship between e-cigarette use and suicidal behaviors. Eligible studies included cross-sectional, longitudinal, retrospective, prospective, and case-control designs. Meta-analysis was performed to calculate pooled odds ratios (ORs). Newcastle Ottawa scale was used to assess the quality of studies. R software (V 4.3) was used to perform the meta-analysis. RESULTS: Our analysis included fourteen studies, predominantly from the US and Korea, with participants ranging from 1,151 to 255,887. The meta-analysis identified a significant association between e-cigarette use and an increased risk of suicidal ideation (OR = 1.489, 95% CI: 1.357 to 1.621), suicide attempts (OR = 2.497, 95% CI: 1.999 to 3.996), and suicidal planning (OR = 2.310, 95% CI: 1.810 to 2.810). Heterogeneity was noted among the studies. CONCLUSION: E-cigarette use is significantly associated with the risk of suicidal behaviors, particularly among adolescents. The findings underscore the necessity for caution in endorsing e-cigarettes as a safer smoking alternative and call for more extensive research to understand the underlying mechanisms. Public health strategies should be developed to address and mitigate the risks of suicidal behaviors among e-cigarette users.
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Ideación Suicida , Intento de Suicidio , Vapeo , Humanos , Vapeo/psicología , Intento de Suicidio/estadística & datos numéricos , Intento de Suicidio/psicología , Sistemas Electrónicos de Liberación de Nicotina/estadística & datos numéricos , Adolescente , Adulto JovenRESUMEN
The cognitive model of suicide proposes that biased cognitive processes contribute to suicidal thoughts and behaviors, and initial evidence suggests that attentional bias to suicide-congruent cues may predict suicidal behavior beyond established clinical risk factors. To date, much less work has explored the potential role of interpretation biases in the development and prediction of suicide risk. The present study assessed the psychometric properties, including reliability, concurrent validity, and predictive validity, of a novel adaptation of the Word Sentence Association Paradigm (WSAP) to assess suicide-suicide interpretation biases. In a sample of 239 psychiatric inpatients, including patients with no recent suicidal ideation or lifetime attempts (n = 35), those with recent suicide attempts (n = 29), and those with recent suicidal ideation (n = 174), participants completed the modified WSAP as well as self-reported suicidal ideation and attempts for the subsequent 6 months. Although the WSAP demonstrated good reliability, evidence of concurrent and prospective validity (in terms of self-reported suicidal ideation and attempts) was limited. Specifically, the clinical groups did not differ from one another on any measure of interpretation bias, nor did suicide-specific interpretation endorsements predict concurrent or future suicidal ideation when controlling for dysphoric interpretation bias. However, suicide-specific interpretation biases were uniquely associated with a history of a lifetime suicide attempt. Future work should further clarify the extent and specificity of the relationship between suicide-specific interpretation biases and clinical outcomes.
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Psicometría , Ideación Suicida , Intento de Suicidio , Humanos , Femenino , Masculino , Adulto , Intento de Suicidio/psicología , Reproducibilidad de los Resultados , Persona de Mediana Edad , Adulto Joven , Sesgo Atencional , Suicidio/psicología , Pruebas de Asociación de PalabrasRESUMEN
INTRODUCTION: Researchers predict long-term increases in suicide deaths following the COVID-19 pandemic. Little is known about risk factors for suicidal ideation (SI) and suicidal attempts (SA) or treatment barriers and promoters during the pandemic. We examine these factors in a young adult sample. METHODS: Analyses used a 2022 cross-sectional survey dataset (N = 1,956). Logistic regression identified factors associated with pandemic suicidality (i.e., SI, SA). Non-treatment seekers reported barriers to seeking treatment. Logistic regression identified promotive factors associated with treatment-seeking. RESULTS: 28.6 % of our sample developed suicidality during the pandemic, of whom 49.6 % did not seek treatment. Asian race and sexual minority status were strongly associated with increased odds of pandemic suicidality. Among SI non-treatment-seekers, barriers were primarily attitudinal (e.g., "symptoms are not serious enough for treatment"); among non-treatment-seekers with SA, barriers were mostly structural (e.g., insufficient funds). Previous depression treatment was strongly associated with increased odds of treatment-seeking. CONCLUSION: Asian American individuals were at increased risk for pandemic suicidality, which may reflect interpersonal risks related to COVID-19-related anti-Asian racism. Our findings point to a "foot-in-the-door" effect: past treatment-seeking was positively associated with future treatment-seeking. To promote this effect and decrease barriers, we suggest integrated mental health screening and referrals in primary care.
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COVID-19 , Aceptación de la Atención de Salud , Ideación Suicida , Intento de Suicidio , Humanos , COVID-19/psicología , COVID-19/epidemiología , Masculino , Femenino , Adulto Joven , Aceptación de la Atención de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Factores de Riesgo , Intento de Suicidio/estadística & datos numéricos , Intento de Suicidio/psicología , Estudios Transversales , Adulto , Adolescente , Asiático/psicología , Asiático/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Minorías Sexuales y de Género/psicología , Minorías Sexuales y de Género/estadística & datos numéricosRESUMEN
Dementia is a global health concern with increasing numbers of people living long enough to develop dementia. People with dementia (PwD) may be particularly vulnerable to suicidality. However, suicide in PwD has not been thoroughly explored. The objective of this review was to determine the prevalence and risk factors of suicide in PwD. Five databases were searched from inception to July 2023. Peer-reviewed publications reporting prevalence, risk factors or quantitative summary data for suicide outcomes in PwD were included. Random effects models were used to calculate the pooled prevalence and effect sizes. 54 studies met inclusion criteria. In PwD, the point prevalence of suicidal ideation was 10â¯% (95â¯%CI=6â¯%;16â¯%), 2-year period prevalence of suicide attempts was 0.8â¯% (95â¯%CI=0.3â¯%;2â¯%), 10-year period prevalence of suicide attempts was 8.7â¯% (95â¯%CI=6.0â¯%%;12.7â¯%) and the incidence of death by suicide 0.1â¯% (95â¯%CI=0.1â¯%;0.2â¯%). Compared to not having dementia, a diagnosis of dementia increased risk of suicidal ideation (OR=1.62[95â¯%CI=1.17;2.24]) but not risk of suicide attempt (OR=1.77 [95â¯%CI=0.85;3.69]) or death by suicide (OR=1.30 [95â¯%CI=0.81;2.10]). People with moderate dementia had significantly increased risk of suicidal ideation than those with mild dementia (OR=1.59[95â¯%CI=1.11;2.28]), younger PwD were at increased risk of dying by suicide (OR=2.82[95â¯%CI=2.16;3.68]) and men with dementia were more likely to attempt (OR=1.28[95â¯%CI=1.25;1.31]) and die by suicide (OR=2.88[95â¯%CI=1.54;5.39]) than women with dementia. This review emphasises the need for mental health support and suicide prevention in dementia care, emphasising tailored approaches based on age, symptoms, and being male.
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Demencia , Ideación Suicida , Suicidio , Humanos , Demencia/epidemiología , Demencia/psicología , Factores de Riesgo , Prevalencia , Suicidio/psicología , Suicidio/estadística & datos numéricos , Intento de Suicidio/estadística & datos numéricos , Intento de Suicidio/psicología , MasculinoRESUMEN
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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Ideación Suicida , Intento de Suicidio , Humanos , Femenino , Masculino , Intento de Suicidio/psicología , Adulto Joven , Adulto , Adolescente , Estudiantes/psicología , Factores de Riesgo , UniversidadesRESUMEN
BACKGROUND: Suicidal ideation (SI) and suicide attempts (SA) are risk factors for suicide which peak during adolescence; however, evidence focused on differences in SI and SA risk among racial/ethnic minority youth is limited despite increasing suicide rates among several racial/ethnic minority groups. METHODS: We analyzed a representative sample of adolescents aged 12-17 with prior depressive symptoms (n = 32,617) from the cross-sectional National Surveys on Drug Use and Health (2008-2019). Survey-weighted adjusted logistic regressions estimated the association of race/ethnicity with self-reported lifetime SI and SA, controlling for sociodemographics, lifetime substance use, lifetime major depressive episode, and self-rated health. RESULTS: Compared to white adolescents, Black and Hispanic adolescents had a 2.5 % (p = 0.04) and 4.2 % (p < 0.001) lower likelihood of reporting SI. However, among participants reporting SI, Black and Hispanic adolescents had a 3.2 % (p = 0.03) and 3.1 % (p = 0.03) higher likelihood of reporting SA than white adolescents. Multiracial adolescents were 5.9 % (p = 0.03) more likely to report SA than white adolescents. LIMITATIONS: Although racial/ethnic minority groups are less likely to self-report mental health symptoms, we could only assess SI/SA among adolescents self-reporting prior depressive symptoms, and we could only assess SA among adolescents self-reporting SI due to survey methods. CONCLUSIONS: Variation in the racial/ethnic distribution of suicidality supports theories conceptualizing separate pathways for SI and SA. This underscores the need for greater attention to racial/ethnic differences in suicide-related research, surveillance, and prevention efforts, including ensuring that mental health risk assessments directly evaluate SA in addition to SI in order to better identify high-risk racial/ethnic minority youth.
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Ideación Suicida , Intento de Suicidio , Adolescente , Niño , Femenino , Humanos , Masculino , Negro o Afroamericano/estadística & datos numéricos , Negro o Afroamericano/psicología , Estudios Transversales , Etnicidad/estadística & datos numéricos , Etnicidad/psicología , Hispánicos o Latinos/estadística & datos numéricos , Hispánicos o Latinos/psicología , Factores de Riesgo , Intento de Suicidio/estadística & datos numéricos , Intento de Suicidio/etnología , Intento de Suicidio/psicología , Estados Unidos/epidemiología , Blanco/psicología , Blanco/estadística & datos numéricosRESUMEN
Little is known about the individual course of suicidal ideations and attempts (i.e., suicidality) after treatment initiation. We examined the trajectories of suicidality and associated risk factors over a 2-year early intervention program for first-episode psychosis in 450 patients (age range 18-35 years at admission) consecutively admitted from 2003 to 2017. Suicidality was assessed via systematic file review, while sociodemographic and clinical variables were assessed at admission. Latent class growth modelling identified three trajectories: low (69.6 %), initially high (22.9 %), and persistently high (7.6 %) suicidality. Patients who were younger, lived alone and were diagnosed with affective psychosis were significantly more likely to follow the initially high trajectory. Patients who attempted suicide up to 3 months before admission, lived alone and presented lower levels of the PANSS excited factor were significantly more likely to follow the persistently high trajectory. Attempting suicide up to 3 months before admission distinguished persistently high and initially high suicidality trajectories. Suicide risk during early intervention program for first-episode psychosis is heterogenous, with acute and enduring suicidal risk, suggesting the need to adapt suicide prevention strategies to these different risk profiles.
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Trastornos Psicóticos , Ideación Suicida , Intento de Suicidio , Humanos , Trastornos Psicóticos/terapia , Trastornos Psicóticos/psicología , Masculino , Femenino , Adulto , Adulto Joven , Adolescente , Estudios Longitudinales , Intento de Suicidio/estadística & datos numéricos , Intento de Suicidio/psicología , Intervención Médica Temprana , Factores de RiesgoRESUMEN
BACKGROUND: The pandemic caused by the SARS-CoV-2 virus led to a series of containment and mitigation measures through lockdowns, social distancing, and the closure of educational establishments, which have had a profound impact on the mental health of the adolescent population. OBJECTIVE: The main objective of the present study has been to identify the sociodemographic and mental health variables related to suicidal ideation, planning, and attempts in young people participating in outpatient intervention projects within the Chilean protection network since the onset of the pandemic and the strictest lockdowns. METHOD: The study's sample consists of 125 young people aged 14 to 18 years (M = 15.65; SD = 1.22), participating in outpatient intervention projects within the National Service for Minors (SENAME)/Better Childhood protection network. Through a self-report survey, the young participants provided responses on sociodemographic variables and suicidal behaviour (ideation, planning, and attempts). RESULTS: 29.9% of the participants reported suicidal ideation during the onset of the pandemic and the established lockdowns; 29.2% reported having devised a plan to do so, and 18.2% indicated having attempted suicide during the evaluated period. A higher occurrence of suicidal behaviour was observed in females, sexual minorities, respondents over 15 years old, and respondents presenting depressive symptoms. CONCLUSIONS: The Covid-19 pandemic has had a significant impact on suicidal behaviour among the adolescent population served by the protection network in Chile. The prior violation of their rights may have contributed to the issue, particularly affecting young females in late adolescence with indicators of depression, who require specialized intervention due to the high risk detected.
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COVID-19 , Ideación Suicida , Intento de Suicidio , Humanos , COVID-19/epidemiología , COVID-19/psicología , COVID-19/prevención & control , Adolescente , Chile/epidemiología , Femenino , Masculino , Intento de Suicidio/estadística & datos numéricos , Intento de Suicidio/psicología , Salud Mental , PandemiasRESUMEN
BACKGROUND: Suicide is a leading cause of death globally and a serious public health concern. Childhood trauma has been found to be associated with adult suicide vulnerability. Recent research has turned attention to investigating the role of attachment in the context of the childhood trauma-adult suicide relationship. The current study investigated for the first time whether attachment influences and moderates the childhood trauma-suicidality relationship, using a daily diary design, in the general population. METHODS: 481 participants completed questionnaires assessing experiences of childhood trauma, attachment patterns, and history of suicidality. 243 participants continued to a daily diary phase where measures of daily stress, defeat and entrapment were completed for 7 consecutive days. RESULTS: Higher levels of childhood trauma were associated with a history of suicide ideation and attempt and also higher levels of daily defeat, entrapment and stress during the 7 day study. Similarly, higher levels of attachment anxiety and avoidance were associated with a history of suicide ideation and attempt together with higher levels of daily defeat, entrapment and stress. However, the effects of childhood trauma on suicide history and on daily suicide vulnerability factors were not moderated by attachment anxiety or avoidance. LIMITATIONS: The measure of childhood trauma was a retrospective self-report tool that may be influenced by memory biases. CONCLUSIONS: Childhood trauma and insecure attachment are implicated in adult suicide risk. Interventions aimed at mitigating the negative effects of childhood trauma and insecure attachment should also incorporate components that target modifiable risk factors such as defeat, entrapment and stress.
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Apego a Objetos , Ideación Suicida , Intento de Suicidio , Humanos , Femenino , Masculino , Adulto , Persona de Mediana Edad , Intento de Suicidio/psicología , Intento de Suicidio/estadística & datos numéricos , Factores de Riesgo , Encuestas y Cuestionarios , Adulto Joven , Suicidio/psicología , Suicidio/estadística & datos numéricos , Estrés Psicológico/psicología , Ansiedad/psicología , Experiencias Adversas de la Infancia/estadística & datos numéricos , Experiencias Adversas de la Infancia/psicología , Adultos Sobrevivientes de Eventos Adversos Infantiles/psicología , Adultos Sobrevivientes de Eventos Adversos Infantiles/estadística & datos numéricos , Anciano , Adolescente , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Adultos Sobrevivientes del Maltrato a los Niños/estadística & datos numéricosRESUMEN
INTRODUCTION: Treatable mental disorders, such as psychotic, major depressive disorder (MDD), and bipolar disorder (BD), contribute to a substantial portion of suicide risk, often accompanied by neurocognitive deficits. We report the association between cognitive function and suicidal ideation/suicide attempts (SI/SA) in individuals with schizoaffective disorder, BD, and MDD. METHODS: A systematic search was conducted on PubMed, Ovid and Scopus databases for primary studies published from inception to April 2024. Eligible articles that reported on the effect size of association between cognition and SI/SA were pooled using a random effects model. RESULTS: A total of 41 studies were included for analysis. There was a negative association between executive functioning and SI/SA in schizoaffective disorder (SA: Corr = -0·78, 95 % CI [-1·00, 0·98]; SI: Corr = -0·06, 95 % CI [-0·85, 0·82]) and MDD (SA: Corr = -0·227, 95 % CI [-0·419, -0·017]; SI: Corr = -0·14, 95 % CI [-0·33, 0·06]). Results were mixed for BD, with a significant positive association between SA and global executive functioning (Corr = 0·08, 95 % CI [0·01, 0·15]) and negative association with emotion inhibition. Mixed results were observed for processing speed, attention, and learning and memory, transdiagnostically. LIMITATIONS: There is heterogeneity across sample compositions and cognitive measures. We did not have detailed information on individuals with respect to demographics and comorbidities. CONCLUSIONS: We observed a transdiagnostic association between measures of cognitive functions and aspects of suicidality. The interplay of cognitive disturbances, particularly in reward-based functioning, may underlie suicidality in individuals with mental disorders. Disturbances in impulse control, planning, and working memory may contribute to self-injurious behavior and suicide.
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Trastorno Bipolar , Trastorno Depresivo Mayor , Esquizofrenia , Ideación Suicida , Intento de Suicidio , Humanos , Intento de Suicidio/estadística & datos numéricos , Intento de Suicidio/psicología , Trastorno Bipolar/psicología , Trastorno Depresivo Mayor/psicología , Trastorno Depresivo Mayor/epidemiología , Trastornos Psicóticos/psicología , Función Ejecutiva , Cognición , Disfunción Cognitiva/psicologíaRESUMEN
High-quality clinical care and research on suicidal thoughts and behaviors (STBs) depends on availability and implementation of reliable and valid measures of STBs. In contrast to studies examining STB risk factors, screening instruments, or treatment, little research has rigorously examined the content, characteristics, and psychometric properties of STB measures themselves. This systematic review (1) identified STB measures that conform to empirically supported definitions of STBs, and (2) identified peer-reviewed papers reporting on the psychometric properties of these measures in adults. Data on psychometric properties and other measure characteristics were extracted. A total of 21 eligible measures were identified in the first stage. In the second stage, 70 articles (with 79 independent samples) were included with psychometric data in adult samples for 19 measures. Although there was support for strong internal consistency and content validity across many measures, face validity and clinical utility concerns were prevalent. Few measures comprehensively assessed suicidal behaviors, and interview-based assessments tended to show the strongest psychometric properties and clinical utility. Findings are discussed in the context of recommendations for improving existing measures, including future research to increase utility and translatability across clinical settings, delivery methods, and diverse populations.
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Psicometría , Ideación Suicida , Humanos , Psicometría/normas , Adulto , Intento de Suicidio/psicología , Reproducibilidad de los ResultadosRESUMEN
INTRODUCTION: More than half of those who die by suicide do not communicate about suicide prior to their death. This project describes the emotional state and decision-making among "unplanned" attempt survivors to inform a conceptual model and suicide prevention interventions. METHODS: This qualitative study purposefully sampled patients who reported having no suicidal thoughts on a standardized mental health questionnaire within 60 days (about 2 months) prior to a nonfatal suicide attempt documented in the health record. Participants verbally consented to telephone interview participation. Semistructured audio-recorded interviews elicited suicide attempt survivor descriptions of their emotional state and experiences in the days, hours, and minutes leading up to their suicide attempt. Interviews were transcribed and analyzed using grounded theory. The biopsychosocial theory of emotion regulation informed conceptual model development. RESULTS: Participants (N = 26) described 2 distinct "phases" prior to the attempt. First, a phase of increasing life stressors, transitory and nonspecific suicidal thoughts, and a reluctance to disclose experiences. Second, an overwhelming emotional state led to a sudden suicide attempt and nondisclosure due to the rapidity and intensity of the experience. These results informed the conceptual model and intervention development to manage unplanned and overwhelming urges to attempt suicide. DISCUSSION: Qualitative analysis informed the development of an intervention for the high-intensity "hot" period preceding an attempt, including specific steps to manage a highly intense emotional state in combination with overwhelming urges to kill oneself. CONCLUSION: Future research is needed to evaluate whether and how this intervention helps support people with a chance of "unplanned" suicide attempts.
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Investigación Cualitativa , Intento de Suicidio , Humanos , Intento de Suicidio/psicología , Femenino , Masculino , Adulto , Persona de Mediana Edad , Ideación Suicida , Toma de Decisiones , Adulto Joven , Entrevistas como Asunto , Sobrevivientes/psicología , Anciano , Modelos Psicológicos , Teoría Fundamentada , Encuestas y CuestionariosRESUMEN
BACKGROUND: The widespread problem of suicide and its severe burden in bipolar disorder (BD) necessitate the development of objective risk markers, aiming to enhance individual suicide risk prediction in BD. METHODS: This study recruited 123 BD patients (61 patients with prior suicide attempted history (PSAs), 62 without (NSAs)) and 68 healthy controls (HEs). The Latent Dirichlet Allocation (LDA) model was used to decompose the resting state functional connectivity (RSFC) into multiple hyper/hypo-RSFC patterns. Thereafter, according to the quantitative results of individual heterogeneity over latent factor dimensions, the correlations were analyzed to test prediction ability. RESULTS: Model constructed without introducing suicide-related labels yielded three latent factors with dissociable hyper/hypo-RSFC patterns. In the subsequent analysis, significant differences in the factor distributions of PSAs and NSAs showed biases on the default-mode network (DMN) hyper-RSFC factor (factor 3) and the salience network (SN) and central executive network (CEN) hyper-RSFC factor (factor 1), indicating predictive value. Correlation analysis of the individuals' expressions with their Nurses' Global Assessment of Suicide Risk (NGASR) revealed factor 3 positively correlated (r = 0.4180, p < 0.0001) and factor 1 negatively correlated (r = - 0.2492, p = 0.0055) with suicide risk. Therefore, it could be speculated that patterns more associated with suicide reflected hyper-connectivity in DMN and hypo-connectivity in SN, CEN. CONCLUSIONS: This study provided individual suicide-associated risk factors that could reflect the abnormal RSFC patterns, and explored the suicide related brain mechanisms, which is expected to provide supports for clinical decision-making and timely screening and intervention for individuals at high risks of suicide.
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Trastorno Bipolar , Encéfalo , Imagen por Resonancia Magnética , Humanos , Trastorno Bipolar/psicología , Trastorno Bipolar/fisiopatología , Trastorno Bipolar/diagnóstico por imagen , Femenino , Masculino , Adulto , Factores de Riesgo , Encéfalo/diagnóstico por imagen , Encéfalo/fisiopatología , Suicidio/psicología , Persona de Mediana Edad , Intento de Suicidio/psicología , Descanso/fisiología , Adulto JovenRESUMEN
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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Proteína C-Reactiva , Ideación Suicida , Intento de Suicidio , Humanos , Proteína C-Reactiva/análisis , Proteína C-Reactiva/metabolismo , Intento de Suicidio/psicología , Depresión/sangre , Depresión/psicología , Biomarcadores/sangreRESUMEN
PURPOSE: This study aimed to analyze the latent class of suicide-related behaviors among Korean adolescents and identify related factors. METHODS: This study used 2021 Korean Youth Risk Behavior Web-Based Survey data and analyzed 7300 participants using latent class analysis. RESULTS: Suicide-related behaviors were categorized into four classes: suicide ideation only (Class 1), suicide plan without ideation or attempt (Class 2), suicide attempt with ideation and plan (Class 3), and suicide attempt without ideation or plan (Class 4). Sexual intercourse experience, habitual drug use experience, and hospital treatment experience due to violence, which were set as risky behavior-related variables, were found to be factors influencing Class 3. However, these variables were not statistically significant factors affecting those belonging to Class 2 and Class 4. CONCLUSION: The findings emphasize the necessity of understanding the variances in suicide-related behaviors among adolescents to tailor interventions effectively. Adolescents who plan and attempt suicide despite having low levels of suicidal ideation exhibited high levels of stress and a tendency for sadness and despair compared to the suicide attempt with the ideation and plan group. These insights underscore the importance of addressing psycho-emotional factors and developing intervention strategies that cater specifically to the nuanced needs of each group to prevent potential suicide attempts.
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Conducta del Adolescente , Análisis de Clases Latentes , Ideación Suicida , Intento de Suicidio , Humanos , Adolescente , Femenino , Masculino , República de Corea , Intento de Suicidio/estadística & datos numéricos , Intento de Suicidio/psicología , Conducta del Adolescente/psicología , Factores de Riesgo , Encuestas y Cuestionarios , Asunción de RiesgosRESUMEN
INTRODUCTION: Suicidal ideation and attempts are considered to be graduated risks for suicide, yet they remain under studied. Suicide is among the leading causes of death in the U.S. for all individuals between the ages of 10 and 64 years. Suicide is a critical problem in the U.S. Military. The U.S. Army suicide rates surpassed civilian rates in 2008 and continue to climb steadily; with U.S. Army soldiers at more than twice the risk than U.S. civilians, and enlisted personnel at more than twice the risk of officers. Suicidal ideation and attempts are routinely reported within U.S. Army brigades using suicide-related serious incident reports (SR-SIRs). These reports could form a useful source of information for prevention planning, but to date there have been no efforts to summary these reports. This paper analyzes SR-SIRs among enlisted personnel for a 4-year period for 1 Army brigade, to test the usefulness of this information and to explore whether risk factors for attempts compared to ideation can be identified. MATERIALS AND METHODS: This report analyzes 130 de-identified reports of suicidal ideation (n = 102) and suicide attempts (n = 28) reported as SR-SIRs from August 2018 to June 2022 among enlisted personnel in an airborne infantry brigade combat team (BCT) outside the continental U.S. Analysis of de-identified data was not considered research by brigade and university human subject/IRB authorities. Fourteen soldier characteristics and context factors were examined to determine if they differentiate the two types of incidents, suicidal ideations and suicide attempts. RESULTS: Unit location and alcohol use at the time of the incident were strongly associated with suicide attempts compared to ideation. Attempts occurred disproportionately during off duty hours, and attempters were more likely to have had prior contact with behavioral health services than ideators; however, these differences did not attain conventional statistical significance. CONCLUSIONS: The study can help inform unit-specific suicide prevention and intervention strategies. Off duty hours and alcohol use are risk factors for attempts, particularly among soldiers who have sought behavioral health care. Plans to engage and support soldiers who have sought behavioral health care during off duty hours, and information regarding the risks of alcohol use, could meaningfully reduce their risk. This is the first known attempt to examine active duty U.S. Army brigade combat team SR-SIRs, and they are a potentially valuable source of health and mental health-related information.