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El suicidio se ha convertido en un problema social y de salud pública a nivel mundial. En este sentido, la Terapia de Aceptación y Compromiso (ACT) podría ser eficaz en su abordaje, existiendo evidencia sobre la relación entre algunos de sus componentes y la conducta suicida. Así, el presente estudio tuvo por objetivo realizar una revisión sistemática sobre la eficacia de ACT en conducta suicida. Para ello se siguió el protocolo PRISMA, empleando las siguientes bases de datos: PsycInfo, PubMed, Scopus y PsicoDoc. Inicialmente se obtuvieron 108 publicaciones potencialmente relevantes, de las cuales, finalmente, 13 fueron incluidas en la revisión. La calidad de los estudios se analizó a través de un instrumento de evaluación de riesgo de sesgos. Como resultados, a nivel general se observaron disminuciones estadísticamente significativas en ideación suicida (IS) y factores de riesgo de suicidio. Además, algunos estudios señalaron relaciones estadísticamente significativas entre un aumento de flexibilidad psicológica y la disminución de IS. Si bien los datos apuntaron a una posible eficacia de ACT en la reducción de IS, es necesario llevar a cabo mayor número de estudios experimentales que contemplen la complejidad de la conducta suicida y exploren los procesos de cambio implicados.(AU)

Suicide has emerged as a pressing global issue affecting both so-ciety and public health.In this context, Acceptance and Commitment Therapy (ACT) could prove effective in its approach, supported by evi-dence of the relationship between certain components of ACT and suicidal behavior. Thus, the present study aims to conduct a systematic review on the efficacy of ACT in suicidal behavior. For this, the PRISMA protocol was followed, using thefollowing databases: PsycInfo, PubMed, Scopus and PsicoDoc. Initially, 108 potentially relevant publicationswereobtained,13ofwhichwerefinallyincludedinthereview.Weanalyzedstudy qualityus-ingariskofbiasassessmentinstrument.Asaresult,statisticallysignificantdecreases in suicidal ideation (SI) and suicide risk factors were observed. In addition, some studies indicated statistically significant relationships be-tween increased psychological flexibility and decreasedSI.WhilethedatasuggestedthepotentialeffectivenessofACTinreducingsuicidal ideation (SI), more experimental studies are needed to consider the complexity of suicidal behavior and explore the processes of changeinvolved.(AU)

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BACKGROUND: Differences in social and environmental factors contribute to disparities in fatal injury rates. This study assessed the relationship between social vulnerability and homicide and suicide rates across United States counties. METHODS: County-level age-adjusted homicide and suicide rates for 2016-2020 were linked with data from the Centers for Disease Control and Prevention's 2020 Social Vulnerability Index (SVI), a dataset identifying socially vulnerable communities. We conducted negative binomial regressions to examine the association between SVI and homicide and suicide rates, overall and by Census region/division. We mapped county-level data for SVI and homicide and suicide rates in bivariate choropleth maps. RESULTS: Overall SVI was associated with homicide rates across U.S. counties. While no association was found for overall SVI and suicide rates, Socioeconomic Status and Racial & Ethnic Minority Status domains were associated. The geographic distribution of SVI and homicide and suicide rates varied spatially; notably, counties in the South had the greatest levels of social vulnerability and greatest homicide rates. CONCLUSIONS: Our findings demonstrate county-level social vulnerability is associated with homicide rates but may be more nuanced for suicide rates. A modified SVI for injury should include additional social and structural determinants and exclude variables not applicable to injuries. PRACTICAL APPLICATIONS: This study combines the SVI with homicide and suicide data, enabling researchers to examine related social and environmental factors. Modifying the SVI to include relevant predictors could improve injury prevention strategies by prioritizing efforts in areas with high social vulnerability.

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Suicidality remains a clear and present danger in society in general, and for mental health patients in particular. Lack of widespread use of objective and/or quantitative information has hampered treatment and prevention efforts. Suicidality is a spectrum of severity from vague thoughts that life is not worth living, to ideation, plans, attempts, and completion. Blood biomarkers that track suicidality risk provide a window into the biology of suicidality, as well as could help with assessment and treatment. Previous studies by us were positive. Here we describe new studies we conducted transdiagnostically in psychiatric patients, starting with the whole genome, to expand the identification, prioritization, validation and testing of blood gene expression biomarkers for suicidality, using a multiple independent cohorts design. We found new as well as previously known biomarkers that were predictive of high suicidality states, and of future psychiatric hospitalizations related to them, using cross-sectional and longitudinal approaches. The overall top increased in expression biomarker was SLC6A4, the serotonin transporter. The top decreased biomarker was TINF2, a gene whose mutations result in very short telomeres. The top biological pathways were related to apoptosis. The top upstream regulator was prednisolone. Taken together, our data supports the possibility that biologically, suicidality is an extreme stress-driven form of active aging/death. Consistent with that, the top subtypes of suicidality identified by us just based on clinical measures had high stress and high anxiety. Top therapeutic matches overall were lithium, clozapine and ketamine, with lithium stronger in females and clozapine stronger in males. Drug repurposing bioinformatic analyses identified the potential of renin-angiotensin system modulators and of cyclooxygenase inhibitors. Additionally, we show how patient reports for doctors would look based on blood biomarkers testing, personalized by gender. We also integrated with the blood biomarker testing social determinants and psychological measures (CFI-S, suicidal ideation), showing synergy. Lastly, we compared that to machine learning approaches, to optimize predictive ability and identify key features. We propose that our findings and comprehensive approach can have transformative clinical utility.

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INTRODUCTION: Maternal suicide is a significant contributor to maternal mortality with devastating consequences for women, families and society. Maternal mortality reporting systems differ across countries and there is no up-to-date overview of maternal suicide deaths globally. This systematic review aims to synthesise the evidence on maternal suicide. The primary objective is to determine the contribution of suicide towards maternal mortality globally and explore differences between geographical regions. The secondary objectives are to summarise the availability and quality of data globally and to describe how suicide deaths are classified across different countries. METHODS AND ANALYSIS: This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. Medline, Embase, PsycINFO, Global Health and CINAHL databases and the grey literature were searched with no date or language restrictions. Observational studies, national surveys and reports that present data on maternal deaths due to suicide occurring during pregnancy, intrapartum and in the postpartum period will be included. Screening, data extraction and quality assessment will be conducted independently by two reviewers. Results will be summarised narratively. If sufficient outcome data are available, random-effects meta-analyses will be conducted to determine global pooled estimates of suicide-related maternal mortality rates and the proportion of maternal deaths attributable to suicide. ETHICS AND DISSEMINATION: Ethical approval is not required for this systematic review. Results will be written up for publication in a peer-reviewed journal and findings will be shared at national and international conferences. PROSPERO REGISTRATION NUMBER: CRD42023429072.

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BACKGROUND: It is well known that individuals recently discharged from psychiatric inpatient care face a high risk of suicide. Severe physical health conditions have also been linked to suicide risk. The risk of suicide following discharge from somatic hospitals is not known for individuals admitted due to acute physical health conditions. METHODS: A Cohort study using data from the entire Norwegian population aged 12 years and older from 2008 to 2022 linked with information on health service use and cause of death. We used Cox regression with age as time axis to estimate sex-adjusted hazard ratios of suicide following discharge for ages 12 to 64 years and 65 years and older. We also performed analyses after excluding hospitalizations with indications of concurrent mental disorders, self-harm, or suicide attempts. To assess individual risk, we performed an adapted case-crossover analysis among discharged patients who died from suicide. RESULTS: A total of 4 632,980 individuals aged 12 to 64 years and 1,469,265 individuals aged 65 years and older were included. Compared to unexposed individuals at similar ages, we found an increased risk of suicide in the first 4 weeks after discharge, with a hazard ratio (HR) of 7.0 (95% confidence interval (CI) 5.9 to 8.3) among those aged 12 to 64 years and 6.8 (95% CI 5.4 to 8.6) among those 65 years and older. In the younger age group, the risk was attenuated, with a HR of 2.4 (95% CI 1.7 to 3.2) after excluding hospitalizations with indications of concurrent mental disorders, self-harm, or suicide attempts. The corresponding HR was 4.8 (95% CI 3.5 to 6.4) among those 65 years and older, declining to 1.9, (1.2 to 3.1) in weeks 5 to 8 and 1.2 (0.7 to 2.2) in weeks 21 to 24. The case-crossover analysis confirmed that individuals 65 years and older were particularly vulnerable. CONCLUSIONS: The heightened risk of suicide following discharge from acute somatic hospitalization, even in the absence of concurrent mental disorders, self-harm, or prior suicide attempts, underscores the critical need for comprehensive mental health and existential support for patients post-discharge.

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Mais de 700.000 pessoas perdem suas vidas para o suicídio a cada ano. A Organização Mundial da Saúde (OMS) defende que os países ajam na prevenção do suicídio, idealmente por meio de uma estratégia nacional de prevenção do suicídio. Os governos e as comunidades podem excercer seus papéis na contribuição para a prevenção do suicídio implementando o guia VIVER A VIDA - uma abordagem da OMS para a prevenção do suicídio, a fim de que os países possam desenvolver uma estratégia nacional de prevenção. O guia destina-se a todos os países, que possuem ou não, uma estratégia nacional de prevenção do suicídio; pontos focais nacionais ou locais para prevenção do suicídio e partes interessadas da comunidade com interesse ou que já estejam envolvidas na implementação de atividades de prevenção do suicídio. Este guia serve como um catalisador para que os governos tomem medidas baseadas em evidências. Permite aos países proteger as vidas de pessoas que se encontram em situação de sofrimento intolerável e em risco de suicídio, apresentando uma abordagem multissetorial de prevenção, uma vez que todos nós temos a responsabilidade de trabalhar juntos para prevenir o suicídio.

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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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Objective: Covitality is a meta-construct of positive intra/interpersonal self-schemas that organize and process life experiences. Its synergy favors psychosocial adjustment and prevents mental health problems during adolescence. At these ages, suicide is one of the leading causes of death worldwide. The purpose of this study was to determine which psychosocial strengths of the covitality model could combat adolescent suicide spectrum. Method: Participants were 5,528 Spanish adolescents aged 12-18 years, 50.74% females. The assessment protocol was completed in schools, under the supervision of the research staff. Statistical analyses were conducted using hurdle models, i.e., modeling zero-inflated count data. This process provided two sets of outcomes: the association - in probabilistic terms - between psychosocial strengths and the absence of suicide indicators (i.e., non-occurrence) and the association of these assets - via regression coefficients - with increased experimentation (i.e., duration/quantity). Results: All psychosocial strengths of the covitality model were related to the non-ocurrence of suicidal thoughts and behaviors, but not all to a shorter duration/quantity of their phenotypic manifestations. Covitality obtained greater association values on suicidal tendencies than its components analyzed independently. Belief in self and engaged living were the second-order factors with the higher estimating capacity. Specifically, emotional self-awareness, enthusiasm, gratitude, family support, and behavioral self-control were key first-order assets. Conclusions: These findings suggest that training adolescents in covitality assets could be an effective strategy for universal prevention against premature suicide. Moreover, this study provide evidence on which psychosocial strengths could counteract each phenotypic manifestation of suicide in order to customize selective and indicated preventive actions.

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This cohort study describes suicide incidence among patients with cancer compared with the general population and by surgical status and cancer treatment.

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BACKGROUND: The medical profession faces a critical challenge with the mental health of its practitioners, leading to an alarming increase in suicide rates among healthcare workers (HCW). Factors such as the culture of perfectionism, excessive workloads, and stigma against seeking help exacerbate this issue. This umbrella review synthesizes the existing literature on HCW suicide, exploring the prevalence, causes, and potential preventive strategies. METHODS: This study conducted a search of the literature from PubMed/Medline, Scopus, Web of Science, Cochrane Library, PsycINFO, and Google Scholar until April 2, 2024. The non-exhaustive search terms used were "doctor suicide," "physician suicide," "medical professional suicide," "suicide in healthcare," "healthcare worker suicide prevention," and "causes of healthcare worker suicide." Hand-searches were also conducted. Of the 487 studies initially identified, a total of 10 systematic reviews/meta-analyses were included. RESULTS: This umbrella review collates findings from 400 primary clinical studies conducted between the years 2004 and 2023. With a focus on mental health factors contributing to suicide in HCW, there are regional and specialty-specific variations in stress prevalence in the populace. Further, anesthesiologists and psychiatrics depicted higher rates of burnout compared to other HCW; causative factors such as seeking perfection and challenging work-life balance were key when assessing suicidal behaviors in these groups. Job demand level was found to correlate directly with suicidal thoughts, specifically among psychiatric ward HCW, where access to drugs and sharp instruments is readily available. In specific contexts, female HCWs showed a standardized mortality ratio (SMR), indicating that the rate of suicide was higher among them as compared to the general female population. Interventions such as cognitive behavioral therapy (CBT) and mindfulness were effective in decreasing depression, psychological distress, and anxiety in several included studies. This umbrella review also identified major obstacles to seeking help, including stigma and the fear of professional consequences. CONCLUSION: To reduce suicide rates among HCWs, it is the need of the hour to implement evidence-based interventions and create supportive work environments that encourage mutual care for each other's emotional health. Further research is necessary to determine the effectiveness of various measures in preventing suicide among HCW.

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Importance: Domestic violence (DV; including intimate partner and family violence) is associated with heightened lethality risks, yet limited research has comprehensively assessed the connection between DV and fatal violence considering both homicides and suicides. Understanding the fatal consequences of DV can point to missed opportunities to support individuals and their families. Objective: To assess the proportion of violent deaths that were connected to DV and describe contacts with the legal system or social services prior to each DV-related fatality. Design, Setting, and Participants: This cross-sectional study used quantitative and qualitative data from the National Violent Death Reporting System (NVDRS) for all individuals who died by homicide or suicide in Washington from January 1, 2015, to December 31, 2020. Analyses were conducted from August 1, 2022, to September 30, 2023. Main Outcomes and Measures: A multipronged approach was used to assess DV history using existing NVDRS variables, leveraging data from prior review of NVDRS death narratives, applying a validated natural language processing tool, and linking related deaths. Domestic violence was recorded as yes or no, but the decedent's role in the abusive relationship (ie, experiencing or enacting DV) could not be differentiated. To describe system involvement prior to each death, keyword searching and hand review of NVDRS death narratives were used. Results: A total of 7352 intentional violent deaths (1192 homicides [16.2%]; 6160 suicides [83.8%]) with known circumstances were recorded in Washington during the study period. Of these, 948 deaths (12.9%) were connected to DV (624 [65.8%] among males; mean [SD] age at death, 45.3 [19.2] years), including 588 suicides (62.0%) and 360 homicides (38.0%). For 420 DV-related deaths (44.3%), there was evidence to suggest that the person who died or their intimate partner(s), family, or cohabitants had prior contacts with the legal system or social services. Specifically, 318 records (33.5%) mentioned prior contacts with law enforcement or the criminal legal system (eg, prior 9-1-1 calls, criminal convictions), and 225 (23.7%) described engagement with social services or the civil legal system (eg, civil protection order, divorce, or child custody problems). Conclusions and Relevance: In this cross-sectional study, 12.9% of violent deaths in Washington were connected to DV. The findings suggest that more resources are needed to support law enforcement, court professionals, and social services specialists to proactively identify and refer families to wraparound supports before the situation can escalate to a fatality.

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LGBTQIA+ youth are disproportionately affected by mental health issues including suicidal ideation and suicide attempts. Minoritized youth have numerous social and structural factors influencing their health, including a lack of access to care and resources. However, these youth and their caregivers also have many unique and individual cultural strengths. Awareness of special considerations and work toward dismantling structural drivers is essential in improving the health of these youth. Additionally, it is important to support minoritized youth and their caregivers through tailored evidence-based treatments in addressing social and structural drivers to influence individual, community, educational, institutional, and policy levels and prevent suicide in achieving mental health equity.

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OBJECTIVE: To assess the trend in mortality rates and years of potential life lost (YPLL) due to suicide among adolescents in Northeast Brazil. METHODS: This is an ecological time series study, with secondary data from 2011 to 2020 from the Mortality Information System for adolescents aged 10 to 19 years in the Northeast region of Brazil. Groups of causes from the 10th Revision of the International Classification of Diseases were included: X60-X84 (intentionally self-inflicted injuries), Y10-Y19 (poisoning of undetermined intent), and Y87 (sequelae of intentional self-harm). Mortality coefficients and frequency distribution by sociodemographic variables, place of occurrence, and method of suicide were estimates. YPLL were estimated by gender and age. Joinpoint regression analysis was used, and the annual percentage change (APC) was determined with 95% confidence intervals. RESULTS: A total of 2,410 deaths were recorded, with a predominance of adolescents aged between 15 and 19, males, of mixed-race, low schooling, and home was the main place of occurrence. The trend in the death rate was increasing in the Northeast (APC: 3.6%; p = 0.001), in girls aged 10 to 14 (APC: 8.7%; p = 0.003), in boys aged 15 to 19 (APC: 4.6%; p = 0.002) and in Bahia (APC: 8.1%; p = 0.012). Hanging/strangulation was the main method adopted by both sexes. The YPLL due to suicide were 11,110 in 2011 and 14,960 in 2020. CONCLUSION: The precociousness of suicide committed by girls and the increase in mortality among older adolescents are noteworthy, and specific preventive measures need to be adopted for these groups in order to reduce this preventable cause of death.

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As rates of adolescent hospitalization for suicide-related crises increase, so does the urgency for improving adolescent school reintegration. Communication and collaboration are considered key mechanisms for continuity of care during times of transition; however, to date, few studies have identified critical information to share or have explored strategies for navigating challenges to information sharing during and following school reintegration. The present study explored previously hospitalized adolescent (n = 19), parent (n = 19), school professional (n = 19), and hospital professional (n = 19) views of information sharing and their perceptions of facilitators and barriers to this communication. Applied thematic analysis revealed three key themes related to the best information to share across entities, including the (a) need to consider environmental relevance to information (i.e., informing school supports and hospital treatment), (b) importance of considering information unique to each patient's circumstance (i.e., sharing information on a "case-by-case basis"), and (c) duality between families preferring to share minimal information but school professionals desiring the maximum (i.e., less is more vs. more is better). Regarding facilitators and barriers to information sharing, six key themes emerged, including (a) understanding risks and benefits of information sharing; (b) trust in hospitals and schools; (c) mental health stigma; (d) communication processes; (e) navigating individual, family, school, and community contexts; and (f) "push and pull" between privacy and need. Findings inform key considerations for collaborating with families in determining if and what information to share during school reintegration.

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BACKGROUND: Suicide mortality remains a global health concern, and community characteristics affect regional variations in suicide. This study investigated spatially clustered patterns of suicide mortality rates in South Korea and evaluated the impact of community factors on suicide. METHODS: Suicide mortality rates were estimated by sex, age group, and district, using the 2021 Cause of Death Statistics in South Korea from the MicroData Integrated Service. Community-determinant data for 2021 or the nearest year were collected from the Korean Statistical Information Service. The spatial autocorrelation of suicide by sex and age was examined based on Global Moran's I index. Geographically weighted regression (GWR) was used to discern the influence of community determinants on suicide. RESULTS: Suicide mortality rates were significantly higher among men (40.64 per 100,000) and adults over the age of 65 years (43.18 per 100,000). The male suicide mortality rates exhibited strong spatial dependence, as indicated by a high global Moran's I with p < 0.001, highlighting the importance of conducting spatial analysis. In the GWR model calibration, a subset of the community's age structure, single-person household composition, access to mental healthcare centers, and unmet medical needs were selected to explain male suicide mortality. These determinants disproportionately increased the risk of male suicide, varying by region. The GWR coefficients of each variable vary widely across 249 districts: aging index (Q1:0.06-Q3:0.46), single-person households (Q1:0.22-Q3:0.35), psychiatric clinics (Q1:-0.20-Q3:-0.01), and unmet medical needs (Q1:0.09-Q3:0.14). CONCLUSIONS: Community cultural and structural factors exacerbate regional disparities in suicide among men. The influencing factors exhibit differential effects and significance depending on the community, highlighting the need for efficient resource allocation for suicide. A regionally tailored approach is crucial for the effective control of the community's mental health management system.

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Neste episódio do Coisa de Homem falamos de um tema muito importante: o Setembro Amarelo. A campanha visa alertar para os cuidados relacionados à prevenção do suicídio. Saiba com o #SUS pode ajudar quem precisa de apoio para cuidar da saúde mental.

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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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