Mood disorders (MD) are closely related to suicide attempt (SA). Developing an effective prediction model for SA in MD patients could play a crucial role in the early identification of high-risk groups.

1099 patients with MD were collected to Model construction. 387 MD patients were enrolled for external validate. The least absolute shrinkage and selection operator (LASSO) regression was used to screen features that may be related to SA as predictors. Ten machine learning algorithms were applied to the training set to construct the SA prediction model. The machine learning model with the best sensitivity and stability was selected according to AUC, F1 score, accuracy and other indicators. The locally explanatory technique of Shapley Additive Explanations (SHAP) was used to rank and interpret the importance of features collected in best model to analyze the potential impact of each feature on SA. Meanwhile, to further validate the stability of the model, the sensitivity analysis utilizing k-fold cross-validation and external validate in another center were performed.

This study incorporates 8 features. Prediction models was constructed based on 10 different machine learning methods. The results showed that the prediction model constructed by Random Forest (RF) method had good discriminant ability and stability (AUC of Testing = 0.741, AUC of Training = 0.786, AUC of validation = 0.788) and acceptable discriminant. Further, the prediction model showed that the most valuable features for predicting SA were Polarity and previous SA.

The RF method can better construct the risk prediction model of SA in MD patients.

Clinical decision support systems (CDSSs) have the potential to assist health professionals in making informed and cost-effective clinical decisions while reducing medical errors. However, compared to physical health, CDSSs have been less investigated within the mental health context. In particular, despite mental health professionals being the primary users of mental health CDSSs, few studies have explored their experiences and/or views on these systems. Furthermore, we are not aware of any reviews specifically focusing on this topic. To address this gap, we conducted a scoping review to map the state of the art in studies examining CDSSs from the perspectives of mental health professionals.

In this review, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline, we systematically searched the relevant literature in two databases, PubMed and PsycINFO.

We identified 23 articles describing 20 CDSSs Through the synthesis of qualitative findings, four key barriers and three facilitators to the adoption of CDSSs were identified. Although we did not synthesize quantitative findings due to the heterogeneity of the results and methodologies, we emphasize the issue of a lack of valid quantitative methods for evaluating CDSSs from the perspectives of mental health professionals.

To the best of our knowledge, this is the first review examining mental health professionals' experiences and views on CDSSs. We identified facilitators and barriers to adopting CDSSs and highlighted the need for standardizing research methods to evaluate CDSSs in the mental health space.

Understanding socioeconomic inequalities in health helps identify vulnerable groups and guide targeted interventions. Mental health disorders significantly affect well-being and productivity. This study assessed the prevalence and socioeconomic inequalities in depression, anxiety, and stress among employees of the Tehran University of Medical Sciences. This cross-sectional study analyzed data from the Tehran University of Medical Sciences Employees' Cohort (TEC) baseline phase, comprising 4,442 individuals. The Depression, Anxiety, and Stress Scale-42 (DASS-42) was utilized to measure mental health disorders. Education level and wealth index were considered as socioeconomic indicators. The Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were employed to estimate socioeconomic inequality. The age-adjusted prevalence of depression, anxiety, and stress was 8.7%, 8.6%, and 11.5%, respectively. The relative wealth-related inequality analysis revealed that, after adjusting for age, sex, marital status, and education level, the prevalence of depression, anxiety, and stress in the lowest wealth index was 2.54, 2.89, and 1.65 times higher than in the highest wealth index, respectively. Additionally, the relative education-related inequality analysis indicated that, adjusted for age, sex, marital status, and wealth index, individuals with primary education or no formal education had 2.58, 2.99, and 2.14 times higher prevalence of depression, anxiety, and stress compared to those with a doctoral degree, respectively. Significant disparities in the prevalence of mental health disorders were found across educational and wealth index levels. Targeted interventions and policies should aim to achieve and sustain long-term benefits for vulnerable and disadvantaged groups.

Suicidal ideation has not been extensively studied in spinocerebellar ataxias (SCAs). The authors examined whether individuals with SCAs have increased suicidal ideation and related factors.

The authors studied patients with genetically confirmed SCAs enrolled in the Clinical Research Consortium for the Study of Cerebellar Ataxia cohort, examining the percentages of patients with SCA subtypes 1, 2, 3, and 6 who reported suicidal ideation and comparing findings with nationally representative data from the National Survey on Drug Use and Health (NSDUH). Clinical characteristics that may contribute to suicidal ideation in SCAs, including age, disease duration, sex, ataxia severity, depression, and SCA subtype, were also studied.

Suicidal ideation was present among 12% of 769 patients with SCAs and 4.3% of individuals in the general population recorded in the NSDUH. Compared with individuals in the general population, SCA patients had higher odds of suicidal ideation (OR=2.72). Compared with patients with SCA without suicidal ideation, patients with SCA and suicidal ideation had a longer disease duration (mean±SD=13.1±8.2 years vs. 11.2±9.4 years), more severe ataxia (Scale for the Assessment and Rating of Ataxia mean score=15.9±8.6 vs. 12.9±7.6), and more severe depression. Having suicidal ideation at baseline significantly increased the odds of suicidality later in the disease course (OR=58.73, 95% CI=36.00-98.40).

Suicidal ideation was more prevalent among patients with SCAs than in the general population. The findings of this study underscore the importance of continuous suicidal risk screening among individuals with SCAs and the need for effective depression management.

To estimate the effect of gabapentinoid treatment on self-harm.

A population based self-controlled case series study.

UK Clinical Practice Research Datalink Aurum database linked to the Hospital Episode Statistics and Office for National Statistics databases.

10 002 adults (aged ≥18 years), with gabapentinoid prescriptions, who had an incident event of self-harm between 1 January 2000 and 31 December 2020. Individual censoring occurred on the date of epilepsy, substance misuse, or cancer diagnosis.

Crude incidence rates of self-harm in different risk periods: 90 days before gabapentinoid treatment, gabapentinoid treatment period, 14 days after treatment periods, and reference periods were calculated. Conditional Poisson regression derived the incidence rate ratio and 95% confidence intervals (CIs) to evaluate the risk of self-harm in different risk periods, compared with reference period for each individual.

1 503 597 individuals received gabapentinoid prescriptions and 10 002 individuals were included in the analysis. The incidence rate of self-harm per 100 person years was 16.79 (95% CI 16.65 to 16.92) in the 90 days before treatment period, 9.66 (9.62 to 9.70) in the treatment period, 29.60 (29.09 to 30.11) in the 14 days after treatment period, and 6.75 (6.74 to 6.77) in the reference period. The results yielded an increased risk of self-harm during the 90 day period before treatment, with an adjusted incidence rate ratio of 1.69 (95% CI 1.55 to 1.85). The spline based analysis showed that the risk of self-harm declined gradually around the time of treatment initiation and returned to reference level during the treatment period (adjusted incidence rate ratio 1.06 (0.98 to 1.13)). Adjusted incidence rate ratio for self-harm increased within 14 days after treatment cessation (3.02 (2.53 to 3.60)). The findings remained consistent throughout a series of subgroups and sensitivity analyses.

The association between gabapentinoids and risk of self-harm seems to be multifaceted: an elevated risk of self-harm is present before initiation of gabapentinoid treatment, which persists during the initial phase of the treatment period, and rises again shortly after treatment discontinuation. These findings do not support a direct effect of gabapentinoid treatment on self-harm but underscore the necessity for close patient monitoring of self-harm throughout the gabapentinoid treatment journey.

A systematic review and meta-analysis were conducted to identify peripheral biological correlates of suicidality in children and adolescents. The review was pre-registered through PROSPERO (CRD42023417128) and included four databases (PubMed, Cochrane Library, Embase, and PsycINFO). From 27,977 non-duplicated articles, 102 full-text studies were selected. Studies investigated suicide attempts (n = 52), suicidal ideation (n = 42), or individuals with suicidal ideation or attempts grouped together (n = 22). Seropositive toxoplasmosis, cortisol, neutrophil, and neutrophil to lymphocyte ratio (NLR) exhibited significant effect size after Bonferroni correction. Effect sizes for biological correlates of suicidality were pooled using Cohen's d (effect size = -0.04, 95% confidence interval [CI]: -1.36 to 1.27) and odds ratio (effect size = -0.31, 95% CI: -1.06 to 0.42). Meta-regression analysis revealed that type of suicidality, type of control, means collected, and sample size significantly impacted the pooled effect size. Analysis showed significant publication bias and heterogeneity, as well as notable moderators and potential biomarkers for future research.

Suicide is a critical public health issue disproportionately affecting Indigenous communities in Canada, especially children. Research on child suicide remains scarce, resulting in a limited understanding of its risk and protective factors. Identified risk dimensions include mental and behavioral health, relational issues, and significant adverse childhood experiences like abuse, and bullying. Studies on Indigenous youth and adults also emphasize the effects of colonization, public policy on child welfare, and systemic racism. The lack of research specifically addressing Indigenous child suicidality underscores the urgent need for tailored research. This article presents findings from a study engaging First Nations and Inuit educators, revealing factors linked to suicidal distress among Indigenous children. Through reflexive thematic analysis, three major themes emerged: the proximal emotional toll of distal risk factors, the impact of adverse childhood experiences, and the role of material deprivation in enhancing risk. Insights from educators are vital for developing targeted interventions to improve prevention efforts.

Suicide remains a major risk factor for individuals suffering from schizophrenia and its prodromal state (i.e., Ultra-High Risk for Psychosis). However, less is known about the prevalence of suicidal behaviour among the adolescent and youth UHR population, a demographic vulnerable to the psychosocial and environmental risk factors of suicide. This review aims to synthesise existing literature on the prevalence of suicidal ideation and behaviour in the adolescent and youth at Ultra-High Risk for Psychosis (UHR), and the associations between suicidal behaviour and its correlates.

The databases PsycINFO, PubMed, Embase, Cochrane Library, Web of Science, and Scopus were accessed up to July 2024. A meta-analysis of prevalence was subsequently performed for lifetime suicidal ideation, lifetime non-suicidal self-injury, lifetime suicidal attempt, and current suicidal ideation. A narrative review was also carried out for the correlates of suicidal behaviour amongst adolescents and youth in the UHR population.

Studies were included in this meta-analysis. Meta-analysis revealed a high prevalence of lifetime suicidal ideation (58%), lifetime non-suicidal self-injury (37%), lifetime suicidal attempt (25%), and current (2 week) suicidal ideation (56%). The narrative review revealed that a personal transition to psychosis and a positive family history of psychosis were associated with suicidal attempts, while depression was associated with both suicidal attempts and suicidal ideation.

The prevalence of suicidal ideation and behaviour among UHR adolescents and youth is high and comparable to that of the general UHR population. Existing measures that mitigate suicide risk in the general UHR population should be adopted for the youth context.

The long-chain omega-3 polyunsaturated fatty acids (PUFAs) docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) have beneficial effects in depression, and these effects may be mediated via changes in functional brain connectivity. However, little is known about these effects in those with subthreshold depression.

15 Participants aged 18-29 years with Patient Health Questionnaire-8 (PHQ-8) scores ≥ 4 and Generalised Anxiety Disorder Assessment-7 (GAD-7) scores ≥ 5, underwent resting-state functional magnetic resonance imaging. Whole-brain, seed-based connectivity analyses were performed using bilateral orbitofrontal cortex (OFC) and amygdala seeds. Omega-3 and -6 PUFA status was assessed from dried bloodspot analysis of %DHA, %EPA, Omega-3 Index (calculated as the sum of DHA plus EPA expressed as a percentage of the total measured fatty acids and a correction applied as dried blood spot samples were used instead of erythrocytes) and ratio of the omega-6 PUFA arachidonic acid (ARA) to EPA (ARA/EPA).

PHQ-8 scores indicated subthreshold depression (mean = 10.0; SD = 4.2) and were negatively associated with DHA levels and Omega-3 Index. Significant negative associations were also identified between connectivity of the OFC with the angular gyrus and DHA and Omega-3 Index, while weaker connectivity of these regions was associated with lower PHQ-8 and GAD-7 scores. DHA and Omega-3 Index values were significantly associated with greater connectivity of the amygdala with the posterior cingulate cortex, which was also associated with lower PHQ-8 scores.

Higher omega-3 PUFA status in young adults with moderate, but mean subthreshold depression was associated with lower depression rating scores and altered functional connectivity of brain regions shown to play a role in the neurobiology of depression.

Intimate partner violence (IPV) can affect individuals across various professions, including health care workers (HCWs). Therefore, this qualitative study aimed to explore the coping strategies of HCWs experiencing IPV in Malaysia, providing insights to inform workplace support mechanisms. In-depth interviews were conducted among six HCWs in a tertiary hospital who were also the survivors of IPV. The findings revealed that the survivors employed diverse coping strategies, including seeking help, inclining toward spirituality, avoiding abusive situations, engaging in self-harm, and staying or leaving abusive relationships. Survivors primarily relied on coworkers for support and only sought formal support assistance when situations became critical. While some supportive workplace responses were reported, some hesitated to seek help due to misconceptions about IPV, concerns about privacy, and fear of workplace gossip. To address these barriers, workplaces should make efforts to raise IPV awareness among employees and implement dedicated support policies tailored to the IPV survivors' coping needs.

Suicidal ideation and behavior present profound challenges in mental health care, particularly among individuals contending with Depression and Obsessive-Compulsive Disorder (OCD). While existing research has elucidated the intricate pathways through which depression and OCD independently contribute to suicide risk, there remains a critical gap in understanding the interplay between these disorders in shaping suicidal tendencies.

This qualitative study aims to address this gap by exploring expert's perspective about the risk and protective factors associated with suicidal ideation among individuals diagnosed with depression and OCD.

Through semi-structured interviews with mental health experts, thematic analysis was employed to uncover the cognitive, emotional, and environmental stressors influencing suicidal thoughts and behaviors in this clinical population.

Findings reveal multifaceted cognitive vulnerabilities, adverse childhood experiences, and familial factors as prominent risk factors, while coping skills, social support, and religious beliefs emerged as key protective factors.

By illuminating the complex interplay of factors contributing to suicidal ideation in the context of comorbid depression and OCD, this study provides valuable insights for the development of targeted interventions aimed at mitigating suicide risk and improving outcomes for affected individuals.

Suicide is a major global public health issue, with mental health disorders closely linked to suicidal behaviors. Community pharmacists, as accessible health care providers, can play a key role in prevention but face challenges like limited training and societal stigma.

This study aimed to evaluate community pharmacists' awareness regarding suicide warning signs, identify perceived barriers to engaging in suicide prevention, and assess their attitudes and perceptions regarding their role in mental health support in Jordan.

A cross-sectional survey was conducted from August to September 2024 among practicing community pharmacists registered with the Jordanian Pharmacy Association. The study survey was distributed electronically through social media and professional networks, included questions on demographics, knowledge of suicide warning signs, training, experiences with suicidal patients, and perceptions of their role in mental health support. Data were analyzed using SPSS version 26 (IBM Corp.).

A total of 412 pharmacists participated in this study. Regarding familiarity with suicide warning signs, 150 (36.4%) reported being familiar; however, confidence in identifying suicide warning signs was low, with only 73 (17.7%) feeling very confident. Among the 208 (50.5%) pharmacists who encountered patients with suicidal thoughts, common warning signs included withdrawal from activities (181, 87.0%) and feelings of hopelessness (179, 86.1%). In response to these situations, 187 (89.9%) pharmacists provided empathetic support, 172 (82.7%) encouraged seeking professional help, and 167 (80.3%) assessed the seriousness of the situation. Barriers to effective intervention included cultural barriers (329, 79.9%), lack of training (327, 79.4%), and fear of offending patients (323, 78.4%).

Community pharmacists in Jordan recognize the importance of their role in suicide prevention but face barriers such as lack of training and cultural sensitivities. Enhancing training and providing clear guidelines can improve their effectiveness in supporting mental health and suicide prevention efforts.

The Russo-Ukrainian War (RUW) poses a significant mental health burden, warranting a scoping review of the evidence to shed light on the unmet needs.

MEDLINE/PubMed and EMBASE databases were inquired from inception until September 1st, 2023, to address the following a-priori-formulated questions: i) "Which psychiatric population has been assessed? How did the conflict affect the functioning of people with established mental health conditions (e.g., treatment adherence, hospitalization rates, and use of illicit substances)?" ii) "Did any psychiatric symptoms or disorders arise because of the RUW? If so, among which groups (e.g., civilians, combatants, refugees, caregivers) and in what geographical regions?", iii) "The impact of the Russo-Ukrainian war: what evidence focused on pre- and post-mental health status?", iv) "Did the conflict affect the rates of suicidal ideation or behaviors (e.g., attempt and death by suicide)? How did the war affect mental status, especially among vulnerable populations?", v) "What psychosocial or medical interventions have been adopted for internally displaced people or refugees complaining of mental health disturbances?", vi) "What rating tools or ad-hoc measures have been developed/adopted?", vii) "How did the existing evidence compare the RUW with other conflicts in different geographical regions or periods?".

Twenty-seven records addressed questions 1-3 and 5-6, with the female gender facing the highest burden. Reliable records about the Russian side of the conflict are needed.

Cohort studies across different phases of the RUW and populations are required to deliver effective clinical and public health interventions, especially to at-risk populations.

The health statuses of closely connected individuals are interdependent. Little is known about mortality risk associated with partner's cancer diagnosis and cause-specific mortality risk associated with partner's death.

Relative risks for all-cause and cause-specific mortality following a partner's cancer diagnosis or death compared to the period when the partner is cancer-free and alive were investigated in the population-based prospective cohort study that enrolled 140,420 people at the age between 40-69 years in 1990-1994.

55,050 participants (27,665 men and 27,385 women) who were identified as married couples were followed-up for 1,073,746.1 (518,368.5 in men and 555,377.6 in women) person-years, during which 9,816 deaths were observed (7,217 in men and 2,599 in women). After a partner's cancer diagnosis, the mortality rate ratio (MRR) of all-cause mortality was not increased among both men and women, while an increase of externally-caused MRR was observed. The suicide MRR significantly increased among men (MRR 2.90; 95% confidence interval, 1.70-4.93), and it persisted for more than 5 years. After a partner's death, the MRRs of all-cause, cardiovascular disease (CVD), respiratory disease (RD), and externally-caused mortality significantly increased only among men. Stratified analysis by smoking status among men showed significantly increased MRRs of CVD and RD mortality among former/current smokers, but not among never-smokers.

Partner's cancer diagnosis did not increase all-cause mortality risk, but increased externally-caused mortality risk, especially suicide among men. The impact of partner's death on mortality risk differed by the mortality causes and sex, and smoking affected some of cause-specific mortality risk.

Mental illness is an important risk factor for suicidal ideation. However, little has been known about the burden and associated factors of suicidal ideation among persons with psychiatric disorders in Iraq. We aim to investigate the rate and the associated demographic and clinical factors of suicidal ideation among persons with mental illness in Iraq.

Data were collected from 388 persons with mental disorders from psychiatric outpatient clinics in Baghdad in 2023 for this cross-sectional study. The instrument contained socio-demographic and clinical variables, and the Columbia-Suicide Severity Rating Scale (C-SSRS). A descriptive analysis was conducted using the Chi-square test to determine the relationships in which a significance level of 0.05 was considered.

Among the 388 respondents, 67% were males, and about half of the patients were younger than 40 years old. Affective (49.8%) and psychotic disorders (17.5%) were the most common mental disorders. The prevalence of suicidal ideation was 37.1% in the last year. The majority of suicidal ideation fell into a low severity range on the C-SSRS, particularly for patients who had no prior history of suicidal behavior. Suicidal ideation was significantly associated with female gender, crowded accommodations experiencing recent psychological trauma, presence of a family history of mental disorder, and family history of suicidal behavior.

Suicidal ideation was present in more than one-third of persons with psychiatric disorders. Policy-level implications could be warranted during regular appointments of psychiatric patients to identify risky individuals in outpatient settings.

The study aimed to explore the relationship between intrinsic spirituality, emotion dysregulation, resilience, and PTSD in Turkish university students who were earthquake survivors. In addition, the validity and reliability of the Brief Emotion Dysregulation Scale (BEDS) were evaluated among Turkish university students who were earthquake survivors.

A sample of 651 Turkish university students who were earthquake survivors participated in an online survey distributed via WhatsApp, completing the Intrinsic Spirituality Scale (ISS), the Brief Emotion Dysregulation Scale (BEDS), the Brief Resilience Scale (BRS), and the Post-Traumatic Stress Disorder Checklist for DSM-5. Structural equation modeling and mediation analysis were employed to explore the predictive relationships between these psychological variables and PTSD symptoms.

The findings confirmed that the BEDS is a valid and reliable scale for assessing emotion dysregulation levels in Turkish university students who were earthquake survivors. Intrinsic spirituality had a negative correlation between emotion dysregulation and PTSD, indicating that higher levels of PTSD are associated with lower intrinsic spirituality. A positive correlation was found between intrinsic spirituality and resilience, suggesting that increased intrinsic spirituality is linked to higher levels of resilience. Furthermore, emotion dysregulation and resilience were found to mediate the relationship between intrinsic spirituality and PTSD. Moreover, emotion dysregulation has a mediating effect in the relationship between resilience and PTSD.

The study highlights the determinant effects of intrinsic spirituality on emotional dysregulation, resilience and PTSD in Turkish university students who survived the earthquake. Interventions and support programs designed to reduce PTSD symptoms should benefit from the results of this research, and future research should include longitudinal studies to assess the long-term effects of intrinsic spirituality on PTSD. It is also crucial to examine the effects on various demographic groups, including differences in age, education level, and socio-economic status.

Off-label prescribing of ketamine to treat psychiatric disorders has been increasing, as has recreational use and availability of illicit ketamine. It is important to examine trends in ketamine-related poisonings to inform public health efforts.

We examined data from poisonings (exposures) involving ketamine reported to Poison Centers in the US between 2019 and 2023 (n = 1519). Annual trends were examined for number of exposures and characteristics of exposures, and we delineated correlates of major (life-threatening) adverse effects and death compared to less severe outcomes.

The number of reported ketamine exposures increased from 205 in 2019 to 414 in 2023. Most cases involved ketamine ingestion (57.2 %), and a plurality involved misuse or "abuse" (36.2 %) and moderate effects (44.8 %). The percentage of cases involving suspected suicide attempts doubled from 12.7 % in 2019 to 25.9 % (a 103.9 % increase; P < 0.001); ingestion use increased from 46.0 % to 65.2 % (a 41.7 % increase; P < 0.001), and cases involving ketamine in liquid form decreased from 65.1 % to 41.2 % (a 36.7 % decrease; P < 0.001). Cases with major effects or death decreased from 23.4 % in 2019 to 15.6 % in 2023 (a 33.2 % decrease; P = 0.039). A major event or death was experienced by 18.6 % of cases, but prevalence was lower for those who inhaled ketamine (aPR=0.49, 95 % CI:0.29-0.85) compared to those who did not inhale.

Poisonings involving ketamine are at their highest in reporting history. Both medical and recreational ketamine use and related adverse events need to be monitored, especially as off-label prescribing of take-home oral formulations appears to be increasing.

Prison correctional personnel often experience increased workplace violence (WPV) and higher risk of suicide, but the link between the two is not yet clear. This study aims to explore the specific mediating variables and mediating paths between WPV and suicide.

This is a cross-sectional study of 472 Chinese correctional personnel conducted through an online survey. We used the Workplace Violence Scale (WVS), the Athens Insomnia Scale (AIS), the Chinese version of the Depression Anxiety Stress Scale (DASS), and the revised Beck Suicidal Ideation scale (BSI) to quantify the WPV experienced by subjects and their mental health status. Data analysis, including mediation and network analysis, was performed using SPSS and R software.

Presence of insomnia and/or depression mediated the relationship between WPV and suicide risk, which accounted for 36.62% of the total effect. Insomnia alone accounted for 9.87%, depression alone accounted for 12.73%, whereas both put together accounted for 14.03%. Male personnel experienced more WPV than their female counterparts, and WPV in men had a stronger association with suicide risk. Network analysis indicated that daytime dysfunction and downheartedness were important nodes in mediating pathways.

Experiencing WPV may lead to an increased risk of suicide among correctional personnel, particularly men, with insomnia and depression mediating the experienced risk. Correctional institutions should take measures to reduce the occurrence of WPV experienced by correctional personnel mitigate the impact of this occupational hazard, and prioritise the mental health of correctional personnel, particularly those already experiencing worrying symptoms.

Suicide is a significant public health problem, with increased rates in low- and middle-income countries such as Mexico; therefore, suicide prevention is important. Suicide is a complex and multifactorial phenomenon in which biological and social factors are involved. Several studies on the biological mechanisms of suicide have analyzed the proteome of the dorsolateral prefrontal cortex (DLPFC) in people who have died by suicide. The aim of this work was to analyze the protein expression profile in the DLPFC of individuals who died by suicide in comparison to age-matched controls in order to gain information on the molecular basis in the brain of these individuals and the selection of potential biomarkers for the identification of individuals at risk of suicide. In addition, this information was analyzed using machine learning (ML) algorithms to propose a model for predicting suicide.

Brain tissue (Brodmann area 9) was sampled from male cases (n=9) and age-matched controls (n=7). We analyzed the proteomic differences between the groups using two-dimensional polyacrylamide gel electrophoresis and mass spectrometry. Bioinformatics tools were used to clarify the biological relevance of the differentially expressed proteins. In addition, this information was analyzed using machine learning (ML) algorithms to propose a model for predicting suicide.

Twelve differentially expressed proteins were also identified (t 14 ≤ 0.5). Using Western blotting, we validated the decrease in expression of peroxiredoxin 2 and alpha-internexin in the suicide cases. ML models were trained using densitometry data from the 2D gel images of each selected protein and the models could differentiate between both groups (control and suicide cases).

Our exploratory pathway analysis highlighted oxidative stress responses and neurodevelopmental pathways as key processes perturbed in the DLPFC of suicides. Regarding ML models, KNeighborsClassifier was the best predicting conditions. Here we show that these proteins of the DLPFC may help to identify brain processes associated with suicide and they could be validated as potential biomarkers of this outcome.

Suicide is defined as the act of a person attempting to take their own life by causing death. Suicide is a complex phenomenon that is influenced by a multitude of factors, including psychosocial, cultural, and religious aspects, as well as genetic, biochemical, and environmental factors. From a biochemical perspective, it is crucial to consider the communication between the endocrine, immune, and nervous systems when studying the etiology of suicide. Several pathologies involve the bidirectional communication between the peripheral activity and the central nervous system by the action of molecules such as cytokines, hormones, and neurotransmitters. These humoral signals, when present in optimal quantities, are responsible for maintaining physiological homeostasis, including mood states. Stress elevates the cortisol and proinflammatory cytokines levels and alter neurotransmitters balance, thereby increasing the risk of developing a psychiatric disorder and subsequently the risk of suicidal behavior. This review provides an integrative perspective about the neurochemical, immunological, and endocrinological disturbances associated with suicidal behavior, with a particular focus on those alterations that may serve as potential risk markers and/or indicators of the state preceding such a tragic act.

Inpatient psychiatry is a critical service in a community-based care system for persons with serious mental illness (SMI). Currently, there are few generally accepted or widely used outcomes to assess the effectiveness of inpatient treatment.

Following a Donabedian Model of Health Care Quality, we utilized eight scales from the RAI Mental Health assessment to derive a clinician-scored outcome measure consisting of 4 domains (Psychosis, Depression, Impairment, and Aggression). We combined subscales measuring these domains into a Composite Measure. We used this measure to assess the entire population (N=719) of our large specialized mental health hospital at the beginning (T1) and end (T2) of three months in the hospital (or admission to discharge in shorter stays). We evaluated the content validity of the measure by comparing items and scales with a list of putative contributors to hospital admission (symptoms and complications). To evaluate concurrent validity, we compared mean scores among hospital units with varying lengths of stay and clinical complexity (acute versus chronic versus complex chronic). We used ROC analysis to evaluate the CIIMHS's ability to predict discharge from the hospital. To evaluate construct validity, we examined the measure's responsiveness to changes among patients after treatment in the hospital.

We found strong evidence for all four kinds of validity.

The composite measure represents a valid measure of inpatient mental health status and will serve as a valuable measure of the quality of care for inpatient psychiatry.

Youth suicide is a concern worldwide, and suicidality-the presence of suicidal ideation or intent-is a critical risk for youth mental health services. This study aimed to determine the prevalence of suicidality in primary care, youth mental health services, along with its correlates and the course of treatment offered to clients.

Routinely collected data from Australia's headspace National Youth Mental Health Foundation, which has over 160 centres across Australia providing mental health care to young people aged 12-25 years, were analysed for new clients who started and completed their first episode of care between 1 July 2022 and 30 June 2023. This included 30 437 young people/episodes of care and 74 393 occasions of service.

Results showed that suicidality was evident in almost one-quarter of young people, although it was rarely reported as a primary presenting issue. When present, it was usually identified at first visit. Those most at risk were young people in unstable accommodation, who identified as LGBTIQA+ or who were indigenous.

The findings show that suicidality should be anticipated in young people presenting to primary care mental health settings, and youth services need to be able to competently deal with suicide risk rather than using this as exclusion criteria.

Suicide, as one of the most important psychological consequences of the COVID-19 pandemic, can be a threat to public health. Understanding the changes in suicide rates before and after the pandemic provides insights into the psychological effects of such crises on communities. This study aimed to compare the trends in suicide and suicide attempt rates in Southeast Iran before and after the COVID-19 pandemic, covering the period from 2016 to 2023.

This descriptive-analytical study was conducted through a census method on 5676 individuals who attempted suicide from 2016 to 2023. Medical records of those who attempted suicide were collected from the integrated system of the Ministry of Health (SIB) during the specified years. The data was collected using a checklist and analyzed with descriptive and inferential statistical tests at the significance level of P < 0.05.

The findings indicate a significant increase in suicide rates after the COVID-19 pandemic, with 61.8% of the total 5,676 cases occurring post-pandemic compared to 38.2% before. The most affected demographic was young adults aged 19 to 34, whose suicide rates increased by a factor of 9.8, while women experienced a notable rise of 28.2 times in suicide rates after the pandemic. Additionally, uneducated individuals had the highest suicide rates, with a dramatic increase of 35.8 times among illiterate individuals after COVID-19, highlighting the urgent need for targeted mental health interventions and support systems.

A significant increase in suicide rates after the COVID-19 pandemic, particularly among young adults and women, highlights the urgent need for targeted mental health interventions, especially for vulnerable groups such as housewives and single individuals. Additionally, the correlation between education levels and suicide rates underscores the importance of addressing educational disparities as part of comprehensive mental health strategies.

Google Trends has emerged as a vital resource for understanding public information-seeking behavior. This study investigates the interconnected search trends of stress, headaches, migraines, and suicide, highlighting their relevance to public health and mental well-being. By employing infodemiology, the study explores temporal and geographical patterns in search behavior and examines the impact of global events like the COVID-19 pandemic.

Data mining was conducted using Google Trends for the search terms "stress," "headache," "migraine," and "suicide." Relative Search Volume (RSV) data from October 2013 to October 2023 was collected and adjusted for time and location. Statistical analyses, including Pearson correlation tests, linear regression, and seasonal Mann-Kendall tests, were applied to identify correlations, trends, and seasonal variations. Geographical differences were also analyzed to understand regional disparities.

Significant correlations were observed among the search terms, with "migraine" and "suicide" showing the strongest association. Seasonal variations revealed a peak in search volumes during winter months. Geographical analysis highlighted consistently high RSV in the Philippines for all terms. During the COVID-19 pandemic, searches for stress, headaches, and migraines showed notable increases, reflecting heightened public interest in mental health-related topics during this period.

The study underscores the interconnected nature of stress, headaches, migraines, and suicide in public search behavior. Seasonal patterns and regional variations emphasize the need for targeted interventions. The observed surge in search volume during the COVID-19 pandemic highlights the profound impact of global crises on mental health and the importance of timely public health responses.

Google Trends provides valuable insights into the public's interest in health-related topics, demonstrating the intricate relationship between stress, headaches, migraines, and suicide. The findings highlight the need for increased mental health awareness and interventions, particularly during times of heightened stress. Further research is essential to develop strategies that mitigate the impact of these stressors on public health.

This study aims to review and analyze factors associated with suicidal ideation to provide a rationale for subsequent effective interventions.

Data from this study were obtained from the Assessing Nocturnal Sleep/Wake Effects on Risk of Suicide (ANSWERS). The University of Arizona evaluated 404 young adults aged 18-25 years using different scales. Then, general demographic data was recorded. An elastic network (EN) was used to optimize feature selection, combined with logistic regression, to determine the influencing factors associated with SI in young adults.

The EN regression retained 11 potential influencing factors with nonzero coefficients. In the multivariate logistic regression analysis, INQ-15 perceived burdensomeness (PB) scores (OR: 1.10, 95% CI: 1.04-1.17), CESD depression mood scores (OR: 1.16, 95% CI: 1.07-1.26), and age (OR: 0.72, 95% CI: 0.55-0.94) were significant factors for SI.

This is the first study to use an Elastic Network logistic regression model to assess the factors affecting suicidal ideation in young adults. Perceived Burdensome, depression, and age play an important risk role and are the best predictor combination of suicidal ideation in young adults, with depression being the most significant risk factor. Increased focus on Perceived Burdensome and negative emotions, along with simultaneous interventions for other potentially influential factors, can be more effective in preventing suicidal behavior in young adults.

Despite lower depression rates in men than in women, men's suicide rates are significantly higher, suggesting potential gaps in depression screening. Rutz et al. developed the Gotland Male Depression Scale (GMDS), which includes symptoms commonly associated with male depression. This study was conducted to validate the Korean version of the GMDS (K-GMDS).

The K-GMDS, Patient Health Questionnaire-9 (PHQ-9), and outpatient records of 233 new patients at the outpatient psychiatry department of Catholic University Hospital in Daegu from February and May 2022 were retrospectively reviewed. Internal consistency was measured using Cronbach's α, and external validity was tested by analyzing the scale's correlation with the PHQ-9. The screening capacity of the K-GMDS was tested based on the receiver operating characteristic (ROC) curve, sensitivity, specificity, and overall accuracy.

Of 233 patients, 42.6% (n=98) were classified to the depression group. Cronbach's α was 0.92, and external validity was established with a Pearson's correlation coefficient of 0.83 between the total score of the K-GMDS and the PHQ-9. While there were no significant differences in the area under the ROC curve between the K-GMDS and the PHQ-9, the K-GMDS had better sensitivity, specificity, and overall accuracy in screening depressive symptoms among men compared to the PHQ-9.

The K-GMDS exhibits satisfactory reliability and validity in psychiatric outpatient settings and outperforms the PHQ-9 in screening for depression among men. This study will be useful in developing male depression scales that are currently unavailable in South Korea.

Self-harm and suicidal ideation are increasing public health concerns globally and are paramount in Africa. Therefore, a review of suicidal ideation and self-harm interventions would be beneficial in identifying culturally appropriate interventions for the African context.

The Population, phenomenon of Interest and Context (PICo) model was adopted to formulate the review strategy. Thus, the Population (Africans), phenomenon of Interest (intervention) and Context (self-harm and suicidal ideation). We used this PICo strategy which is a modified version of PICO for qualitative studies. Framework with Boolean operators (AND/OR/NOT) was further used to ensure rigor through search terms such as ("Suicide" OR "suicidal ideation") AND ("Intervention" OR "Treatment" OR "Therapy" OR "Psychological" OR "Psychosocial" OR "Culturally adapted") AND "Africa" OR "African countries." Six databases were searched (Embase, PsycINFO, ProQuest Central, Cochrane Controlled Trials Register, Medline, and Web of Science) for published articles between 2000 and March 2023. N = 12 studies met the inclusion criteria, and the relevant data extracted were synthesized and thematically analyzed. The review protocol was pre-registered on the PROSPERO Registry (no. CRD42021283795).

N = 12 studies met the inclusion criteria, and the following themes emerged from the synthesized literature and analyses of current African approaches to curbing self-harm and suicidal ideation: (a) Western medical and compassion-focused intervention (b) the helpful role of traditional healing and healers (c) psychoeducation and self-help techniques (d) use of technology and a nation-wide approach.

Self-harm and suicidal ideation are global health concerns. To address this health concern in Africa, the authors recommend culturally adapted psychological interventions to be tested via randomized control trials.

This study examines the causal effects of sunlight exposure on suicide rates. Leveraging county-month-year data on solar insolation and suicide rates in the U.S. from 1979 to 2004, we provide first robust evidence that insufficient sunlight increases suicide rates. We also find that insufficient sunlight increases Google searches containing depressive language, suggesting a potential adverse impact on mental well-being. Importantly, our findings favor a biological pathway over alternative mechanisms. The estimated effect of sunlight on suicide, often exceeding other interventions in magnitude, sheds new light on sunlight as a significant risk factor in suicide incidence.

Individuals with intellectual disability or autism exhibit suicidal behaviours at an equal or greater rate than the general population, yet little is known about associated risk factors. This study explores suicidality in these populations, focusing on their understanding of suicide and death and perceptions of their direct support staff regarding their suicidality.

Semi-structured interviews from 23 suicidal and non-suicidal participants and their support staff were analysed qualitatively to extract common themes and compare between groups.

A breadth of suicidal behaviours was documented. Generally, suicidal participants demonstrated a more elaborate understanding of suicide and death than non-suicidal participants. While staff often acknowledged never having discussed the topic with their client, most assumed they understood death accurately.

Results suggest interactions between conceptions of death and suicidal behaviour and a need for discussion around death and suicide in clinical settings. Implications for future research and clinical practice are discussed.

Suicidal ideation and behaviors are a leading cause of disability worldwide. Approximately 90 % of suicide completers have a diagnosable mood disorder. Extant literature reports rumination mediates functional impairment across mood disorders. Herein, we report the association between rumination and suicidality amongst persons with psychiatric disorders and healthy controls.

Our systematic review and meta-analysis included relevant articles retrieved from Web of Science, OVID and PubMed from inception to March 20, 2024. Random effects model was used to calculate the correlation between rumination, suicidal ideation and attempt.

A total of 27 eligible studies were included in our systematic review and meta-analysis. Rumination (r = 0.25 [95 % CI: -0.03, 0.49]), reflection (r = 0.15 [-0.71, 0.83]) and brooding (r = 0.13 [-0.58, 0.73]) were nonsignificantly correlated with suicidal ideation in mood disorders. Suicide attempt history was significantly associated with greater odds of rumination in persons with depressive disorders (OR = 1.13 [0.42, 3.02]). In healthy controls, rumination (r = 0.30 [0.21, 0.38]), reflection (r = 0.23 [0.13, 0.32]) and brooding (r = 0.24 [0.12, 0.36]) were significantly correlated with suicidal ideation. Rumination also predicted lifetime history of suicide attempts in healthy controls (OR = 1.70 [1.16, 2.49]).

There were inadequate sample sizes of persons with different mood and psychiatric disorders which may have underpowered our ability to detect clinically meaningful associations.

Our study reports a transdiagnostic association between measures of rumination and suicidality. Future research vistas should parse the neurobiological substrates subserving rumination and identify targeted therapies and their association with general cognition and treatment response.

Suicide is a significant but understudied public health concern in developing nations like Pakistan, where risks factors have not been investigated by mixed methods studies. Hence, we aimed to explore the risk factors for suicide based on a mixed methodology.

This study followed a mixed methods convergent component design. A retrospective case-control psychological autopsy with a semistructured interview protocol was performed. Additionally, health professionals' opinions on the psychiatric risk factors for suicide were assessed through qualitative interviews. Data were collected between 2021 and 2022 and analyzed by SPSS (V-25) and thematic analysis (NVIVO-12 Plus).

Based on the mixed methods meta-inferences, suicidal ideation; depression; hopelessness; social isolation; previous history of self-harm and traumatic experiences; lack of motivation; purposelessness; feeling like a burden; substance abuse; impulsivity; anger; anxiety; psychiatric disorders such as personality disorders, bipolar disorder, schizophrenia, gaming addiction, and eating disorders; and family history of psychiatric illness were identified as risk factors for suicide.

More must be learned about the mental health components contributing to suicide and the culturally appropriate prevention methods used in Pakistan. This study reveals novel targets for suicide prevention and may aid policymaking by providing a better understanding of predictors and specific psychiatric characteristics of suicide in Pakistan.

Korea has one of the highest suicide rates in the world. Many factors associated with suicidal thoughts or behaviors are known. This study examines the association between 1) smoking status or intensity (pack-years) and 2) risk of suicide mortality in South Korea.

We analyzed data from 3,966,305 individuals aged ≥20 who underwent health examinations conducted by the South Korean National Health Insurance Service in 2009 and were followed until December 2021. Participants were categorized based on their baseline smoking status and intensity. We performed a Multivariate Cox proportional hazards regression analysis with subgroup analysis by age, sex, body mass index, alcohol consumption, regular exercise, and depression.

During an 11.1-year follow-up period, 12,326 individuals died by suicide. Compared with never-smokers, increased hazard ratios of suicide mortality were observed in current smokers (1.64, 95 % CI = 1.56-1.72), but not in ex-smokers. The suicide mortality risk of current smokers increased for all types of smoking intensity without a dose-response relationship. The association between smoking and suicide mortality risk was stronger among women, non-drinkers, adults aged <40 years, non-obese patients, and individuals without depression.

Given that the study used retrospective data, the causal relationship remains unclear.

Current smoking is associated with a significant increased risk of suicide mortality. Smoking cessation is crucial to prevent suicide, especially among young adults, non-obese individuals, non-drinkers, women, and those without depression. Government policies in South Korea should focus on raising awareness about smoking hazards and providing cessation education to reduce the suicide mortality.

The present study examined the psychometric properties of the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS). A total of 742 Italian participants (84.6% female), with a mean age of 33.08 years (SD = 12.44) took part in a cross-sectional survey study. Confirmatory factor analysis and Rasch analysis were used to examine the psychometric properties. The CFA showed that the SWEMWBS had a unidimensional structure with robust psychometric properties and showed good internal consistencies (Cronbach's alpha 0.88; McDonald's omega 0.91). Overall, most items showed no substantial differential item functioning in the Rasch analysis, except for Item 7, indicating that female participants reported more difficulty with this item than the male participants. The SWEMWBS was positively associated with life satisfaction and negativity associated with general psychological distress (i.e., anxiety, stress, and depression). In sum, the SWEMWBS showed robust psychometric properties capable of assessing positive aspects of mental health and well-being among Italian-speaking adults.

Toxoplasma gondii is an Apicomplexan parasite that is estimated to infect at least one-third of the global human population. T. gondii infection may be transmitted horizontally or vertically. The main risk factors for transmission to humans are related to diet, especially the consumption of undercooked meat, along with soil contact. In immunocompetent persons, the acute infection may go undetected as it typically produces minor, non-specific symptoms that are self-limited. After infection is established, recurrent retinochoroiditis is the most common clinical disease. In contrast, severe systemic or cerebral toxoplasmosis may be life-threatening for immunocompromised individuals. Furthermore, congenital toxoplasmosis acquired in utero may have devastating consequences if not recognized and promptly treated. A growing body of research has identified associations between latent T. gondii infection, and personality traits and risk-taking behaviors. Other studies have documented associations between latent infection and psychiatric conditions that include schizophrenia and bipolar affective disorder. With no current treatment regimens being curative of T. gondii infection, effective prevention measures at both the public health and individual levels are vitally important.

This study explores the impact of sex on delays experienced by Australian military veterans in accessing advocacy support services within the veterans' non-profit sector. A detailed analysis of intake records from 150 injured veterans who entered the Returned and Services League of Australia's advocacy program in 2021 reveals significant disparities between male and female veterans in seeking assistance. On average, male veterans delay accessing support by 20.4 years post-service, compared to 9.1 years for female veterans. These prolonged delays hinder veterans' ability to secure financial and medical support from the Department of Veterans' Affairs, limiting timely access to essential healthcare services. As a result, delays can exacerbate physical and psychological symptoms, impede recovery, and increase the risk of suicide. The findings provide valuable insights for international healthcare professionals on the influence of military culture and traditional masculine norms in shaping veterans' help-seeking behaviors. By understanding these dynamics, healthcare practitioners can develop targeted, sex-sensitive interventions that address specific barriers faced by male and female veterans. Ensuring timely access to advocacy support is crucial for improving health outcomes and reducing suicide risk in this vulnerable population.

Community connectedness, outness, and internalized phobia are potential protective and risk factors for mental health in lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals. However, these interrelated factors have generally been examined in isolation and for the LGBTQ community in aggregate. As such, there may be undetected effects of factors on mental health for each LGBTQ group.

We examined the associations between mental health (i.e., depression and anxiety) and risk/protective factors (i.e., internalized phobia, community connectedness, outness) in each LGBTQ subgroup separately.

A large national U.S. sample ( N = 1,030) of individuals who identified as LGBTQ completed an anonymous Internet survey during fall 2019. Participants answered questionnaires about community connectedness, outness, internalized homophobia or transphobia, anxiety, and depression.

On average, most subgroups reported symptoms of depression and anxiety above clinical cutoffs. Less outness and greater internalized phobia were associated with more severe depression and anxiety, but this pattern was not consistent across LGBTQ subgroups. Greater community connectedness was generally associated with more severe anxiety and depression.

LGBTQ subgroups vary in how risk and protective factors relate to mental health outcomes. Our findings highlight the importance of examining LGBTQ subgroups separately and examining risk/protective factors simultaneously to identify the unique contribution of each factor. More research is needed to understand potential LGBTQ mental health risks and protective factors, and future researchers should examine the unique roles of risk and protective factors in separate LGBTQ subgroups.

The relationship between CDAI and suicidal ideation is unclear. This study investigates the relationship between CDAI and suicidal ideation and examines the association between CDAI and all-cause mortality (ACM) or cardiovascular disease mortality (CVM) among participants with and without suicidal ideation.

Data from seven NHANES cycles (2005-2018) were analyzed using cross-sectional and prospective cohort studies. Weighted multivariable logistic regression models, restricted cubic spline (RCS) plots, and subgroup analyses explored the association between CDAI and suicidal ideation. Kaplan-Meier (KM) curves, weighted multivariable Cox proportional hazards models, and RCS assessed the relationship between CDAI and CVM or ACM.

Among 30,976 participants aged over 20, 1,154 (3.72%) had suicidal ideation. Higher CDAI levels (Quartile 4) were associated with a 28% reduction in suicidal ideation compared to lower levels (Quartile 1). Over an average follow-up of 89 months, 3,267 participants (7.6%) died, including 808 (1.8%) from cardiovascular causes. Higher CDAI levels were linked to a 30, 68, and 28% reduction in ACM in the total population, those with suicidal ideation, and those without, respectively. CVM was reduced by 40% in the total population and by 41% in those without suicidal ideation.

CDAI is negatively associated with suicidal ideation and correlated with reduced ACM and CVM among participants with and without suicidal ideation.

Few studies have explored the correlation between overactive bladder (OAB) and suicidal ideation. This study aims to investigate the association between OAB and suicidal ideation, as well as the relationship between OAB and all-cause mortality among individuals with suicidal ideation.

Data from the 2005-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed using cross-sectional and cohort study designs. Weighted multivariable logistic regression models were used to examine the association between OAB and suicidal ideation. Kaplan-Meier curves and weighted multivariable Cox proportional hazards models assessed the relationship between OAB and all-cause mortality among those with suicidal ideation. Interaction analyses on subgroups were conducted to validate the findings. Mediation analysis was performed to examine the effect of depression on the relationship between OAB and suicidal ideation.

Among 33,426 participants aged ≥ 20 years, 1,290 (3.8%) reported suicidal ideation. After adjusting for potential confounders, participants with OAB were 2.57 times more likely to have suicidal ideation (P < 0.001). Over an average follow-up of 87 months, 197 participants with suicidal ideation died. The Cox model revealed that participants with OAB had a 3.08 times higher risk of death (P = 0.006). Kaplan-Meier curves indicated higher survival rates for non-OAB participants. Mediation analysis indicates that depression significantly mediates the relationship between OAB and suicidal ideation, with a mediation proportion of 75.25% (P < 0.001).

OAB is positively associated with the incidence of suicidal ideation and all-cause mortality among participants with suicidal ideation. Additionally, the association between OAB and suicidal ideation is mediated by depression.

The World Health Organization and the Global Burden of Disease study estimate that almost 800 000 people die from suicide yearly. The role of non-traditional risk factors such as climate and high-altitude exposure are poorly understood.

This study aims to determine a potential relationship between altitude exposure and suicide rates among 221 cantons located at different altitudes ranging from 0 to 4300 m.

We conducted an 11-year, country-wide, population-based analysis on age- and gender-standardised suicide rates in Ecuador, based on the official data from the National Institute of Statistics, using all available self-harm death codes (ICD-10 codes X60-X84).

A total of 11 280 cases of suicide were reported during 2011-2021. Suicide rates were higher among men (11.48/100 000). In terms of elevation, suicide rates were significantly higher among people from high-altitude cantons (3.7/100 000) versus those from low-altitude cantons. When applying the International Society Mountain Medicine categorisation, suicide rates were significantly higher at moderate- (4.3/100 000), high- (3.6/100 000) and very-high-altitude cantons (4.4/100 000) when compared with low-altitude locations (2.5/100 000).

Ecuador is one of the few countries that has a vast range of cantons located at different altitudes. We found that living at higher elevations is positively associated with greater suicide rates. Although the rates are significantly greater as elevation increases, a clear linear relationship is not apparent, likely because of the interplay of socioeconomic factors, including urbanicity. The effect of chronic hypobaric hypoxia on mood cannot be ruled out, although the existence of causal mechanisms remains to be elucidated.

Suicide research is directed at understanding social, economic, and biological causes of suicide thoughts and behaviors. (1) Background: Worldwide, certain countries have high suicide mortality rates (SMRs) compared to others. Age-standardized suicide mortality rates (SMRs) published by the World Health Organization (WHO) plus numerous bibliographic records of the Web of Science (WoS) database provide resources to understand these disparities between countries and regions. (2) Methods: Hierarchical clustering was applied to age-standardized suicide mortality rates per 100,000 population from 2000-2019. Keywords of country-specific suicide-related publications collected from WoS were analyzed by network and association rule mining. Keyword embedding was carried out using a recurrent neural network. (3) Results: Countries with similar SMR trends formed naturally distinct groups of high, medium, and low suicide mortality rates. Major themes in suicide research worldwide are depression, mental disorders, youth suicide, euthanasia, hopelessness, loneliness, unemployment, and drugs. Prominent themes differentiating countries and regions include: alcohol in post-Soviet countries; HIV/AIDS in Sub-Saharan Africa, war veterans and PTSD in the Middle East, students in East Asia, and many others. (4) Conclusion: Countries naturally group into high, medium, and low SMR categories characterized by different keyword-informed themes. The compiled dataset and presented methodology enable enrichment of analytical results by bibliographic data where observed results are difficult to interpret.

Suicide is a major public health concern. Recently, suicide rates have increased among traditionally low-risk groups (e.g., white, middle-aged males). Suicide risk assessments and prevention strategies should be tailored to specific at-risk populations. This systematic review examines suicide risk detection and management in primary care, focusing on treatments to reduce suicide rates and improve prevention efforts.

A systematic review was conducted following PRISMA guidelines. Literature was collected and analyzed using Boolean operators with relevant keywords in databases (e.g., PubMed, Google Scholar, PsycINFO) to identify randomized and non-randomized studies focusing on suicide risk factors and management strategies in primary care, published in the past 10 years. The risk of bias 2.0 and Newcastle Ottawa scale was used to assess risk of bias, and data from moderate-quality studies were synthesized.

Thirteen moderate-quality studies were reviewed. Key findings include the need for assessing modifiable risk factors like substance use and mental health. General practitioner (GP) engagement post-suicide attempt (SA) improves outcomes and reduces repeat SAs. Effective strategies include comprehensive risk assessments, collaborative treatment, and enhanced GP support. Barriers to effective suicide prevention include insufficient information, judgmental communication, lack of positive therapeutic relationships, and inadequate holistic assessments. These findings highlight the need for tailored suicide prevention strategies in primary care. However, the evidence sample size is small with reduced statistical power that limits generalizability. The included studies were also regional examinations, which restrict their broader relevance.

Significant risk factors, barriers, and effective strategies for suicide prevention were identified. For children aged 12 or younger, preexisting psychiatric, developmental, or behavioral disorders, impulsive behaviors, aggressiveness, and significant stressful life events within the family were critical. For adults, loneliness, gaps in depression treatment, and social factors are significant. Barriers to suicide prevention included insufficient information, judgmental communication, lack of positive therapeutic relationships, inadequate holistic risk assessments, lack of individualized care, insufficient tangible support and resources, inconsistent follow-up procedures, variability in risk assessment, poor communication, stigma, and negative attitudes. Effective methods include the Postvention Assisting Bereaved by Suicide training program, continued education, comprehensive clinical assessments, individualized care, and community-based interventions like the SUPRANET program.

https://www.crd.york.ac.uk/PROSPERO, identifier CRD42024550904.

Despite a plethora of research on the topic, there is still no solid evidence that pharmacological treatment actually reduces the risk of suicide in patients with mental illness. In this study, we aimed to assess the effect of psychotropic medications on suicidal ideation in patients with major depressive disorder (MDD) and bipolar disorder (BPD) in two age groups: less than 25 years and 25 years and older.

We analyzed 312 patients with mood disorders with current suicidal thoughts or recent suicide attempts. We followed the participants from baseline for 6 months and assessed changes in suicidal ideation with Columbia-Suicide Severity Rating Scale (C-SSRS). The effect of psychotropic drug administration on suicidal ideation over time was analyzed using a linear mixed model.

In patients aged 25 years and older with mood disorders, suicidal ideation was more severe when using psychotropic drugs than when not using them. However, suicidal ideation decreased rapidly over time. The time-dependent reduction in suicidal ideation was accelerated when using antidepressants and sedatives/hypnotics in adult MDD, and when using mood stabilizers in adult BPD. However, this effect was not observed in participants aged less than 25 years.

Adequate psychotropic medication may reduce suicidal ideation in patients with mood disorders aged 25 years and older. Additional research on psychotropic drugs is needed to effectively reduce the risk of suicide among children and adolescents with mood disorders.