A Daily Diary Study of How Affective States Are Associated with and Predict Suicidal Ideation in Adults Seeking Intensive Outpatient Treatment

Consequences of Psychological Distress in Adolescents with Acne

Background:To study the role of social disparities on the effect of risk factors on suicidal ideation (SI) and suicide attempt (SA) among commercially insured youth and adults in the US.Methods:A national level retrospective cohort study was conducted using health insurance claims data from four major insurance companies in the US. The cohort was defined by patients having a mental health or substance use disorder (MH/SUD) related outpatient encounter (index encounter). We used Cox proportional hazards models to evaluate the impact of social disparities on the effect of risk factors on patients’ future SI and SA. Risk factors considered in the models consist of a mix of long-, mid-, and short-term prior comorbidities and prescriptions that are identified as important factors for predicting SA by Simon et al. 2018. Social disparities were summarized by the social deprivation index (SDI) at patients’ zip code level, and then categorized into five quintiles; higher SDI quintiles indicated higher levels of social deprivation. Patients were censored if they did not have an SI or SA diagnosis before 9/30/2015 (ICD-9 to ICD-10 switch date) or until the last day of the insurance plan enrollment, whichever came first.Results:Between 2014-2015, we identified 317,383 patients <65 years old with an index encounter. Among them, 124,424 aged <25 (youth and young adults; hereinafter youth) and 192,959 aged between 25-64 (other adults; hereinafter adults). Prevalence of SI and SA were both higher in youth (7.09% and 1.86%, respectively, vs. 3.00% and 0.79% in adults). Survival analysis showed that SDI impacted the behaviors of SI and SA differently for youth and adults. Among youth, SDI impacted the effects of risk factors for both SI and SA after controlling for demographic variables. For SI, SDI impacted the effects of age, alcohol use disorder diagnosis in the past 3 years, SA in the past year, and MH emergency department (ED) visits in the past 3 months. Overall, the effect of age on SI decreased as SDI quintile increased. Alcohol use disorder diagnosis in the past 3 years had a positive impact on SI for patients from neighborhoods in the 2nd SDI quintile (HR=1.25). SA in the past year had a negative impact on SI for patients from neighborhoods in the 3rd SDI quintile (HR=0.55). MH ED visits in the past 3 months had a positive impact on SI for patients from neighborhoods in the 2nd and 4th SDI quintiles (HR=1.30 and 1.63, respectively). For SA, SDI impacted the effects of SA in the past 3 years, SA and schizophrenia in the past 3 years, MH ED visits in the past year, and Benzodiazepine prescription in the past 3 months. Overall, the effect of SA in the past 3 years on SA increased as SDI increased. SA and schizophrenia in the past 3 years had a positive impact on SA for patients from neighborhoods in the 2nd SDI quintile (HR=3.09). MH ED visits in the past year had a positive impact on SA for patients from neighborhoods of 1st SDI quintile (HR=1.60). Benzodiazepine prescription in the past 3 months had a positive impact on SA for patients from neighborhoods in the 2nd SDI quintile (HR=1.91). Among adults, patients in poorer neighborhoods were positively associated with having SI (HRs=1.09, 1.13, 1.19, and 1.25 for SDI quintiles 2nd, 3rd, 4th, 5th vs. 1st), however having SA was not affected by the social deprivation level of patients’ neighborhoods (p=0.21).Discussion:Among commercially insured patients in the US, youth had higher prevalence of SI and SA when compared to adults. Neighborhood level social disparities impacted the behaviors of SI and SA differently for youth and adults. Among youth, social disparities nonlinearly impacted the effects of risk factors for both SI and SA. Among adults, social disparities were significantly associated with SI, but not with SA.Table:Comparison of data: Olanzepine Vs Olanzepine + Acetyl L carnitine.Scales1st Visit (T0), Score Mean2nd Visit (T1), Score MeanP value of OLZ group1st Visit (T0), Score Mean2nd Visit (T1), Score Meanp value of OLZ+ALC GROUPComparison of OLZ vs OLZ + ALC groupPositive Symptoms27.4621.9< .001 (1.5995E-15)28.7321.76< .001 (9.551E-15)> .05 (0.452407)Negative Symptoms19.7614.8< .001 (1.1478E-12)14.816.1< .001 (4.9443E-17)> .05 (0.094423)GP Score53.9635.86< .001 (1.9421E-11)58.6639.13< .001 (4.9998E-14)> .05 (0.250954)Total PANSS Score101.272.56< .001 (3.2389E-17)108.4377< .001 (1.9657E-20)> .05 (0.23467)MoCA Score18.921.7< .001 (4.7181E-10)1921.86< .001 (1.5028E-07)> .05 (0.452272)

BackgroundSuicidal ideation predicts suicide behaviors; however, research is needed on risk factors for suicidal ideation in adults, a common developmental period for first suicide attempts.AimsTo examine childhood and concurrent predictors of suicidal ideation among 340 adult offspring of depressed and matched control parents.MethodParents were assessed at baseline, and adult offspring were assessed 23 years later.ResultsOffspring who reported past-month suicidal ideation (7%) had parents who, 23 years earlier, reported suicidal ideation, psychological inflexibility and use of avoidance coping. Offspring experiencing suicidal ideation were more likely to be unemployed and more depressed, consumed more alcohol and had more drinking problems. They were more anxious and inflexible, had weaker social ties and less cohesive families and had more negative life events and used more avoidance coping. A childhood risk index predicted offspring's suicidal ideation above and beyond concurrent factors.ConclusionsAlong with concurrent risk factors, poor parental functioning may confer long-term risk for adult suicidal ideation. Interventions to prevent the transmission of suicidal ideation to offspring should focus on ameliorating parental risk factors.

More than a year has passed since World Health Organization (WHO) declared COVID-19 as a pandemic, and during this period over 237 million cases and more than 4.8 million deaths have occurred worldwide due to COVID-19.1 This unprecedented pandemic not only has burdened health systems but it also constitutes a major stressful event both due to the threat of illness and death that it poses, and to the drastic impact on human relations, financial activity, access to health services, etc. Additional factors that may contribute to stress include the protection measures against COVID-19, social distancing, and mobility restrictions. The impact of the pandemic on suicidal behavior, especially on the Greek population, is of critical importance, due to the increase in suicidality during the recent financial crisis in the country.2 The impressive decline in the GDP during the first months of the COVID-19 pandemic (-9% of GDP),3 unemployment, isolation, reduced social contacts, problems in accessing mental health services, and also the limitations in terms of psychological support may increase the risk of suicidal behavior.4 With a view to investigating the psychosocial effects of the COVID-19 pandemic, an online questionnaire was developed in March 2020 by the Second Department of Psychiatry of the National and Kapodistrian University of Athens (NKUA) and the Postgraduate Program "Liaison Psychiatry: Integrated Care of Physical and Mental Health" of NKUA. This questionnaire included items regarding demographic characteristics, physical and mental health data, and issues related to the pandemic and the imposed restriction measures, such as perceived changes in participants' biorhythms, habits, and relationships with their colleagues, friends, and family. In addition, participants were asked to complete psychometric scales with regard to anxiety, depression and suicidal ideation, family functioning, anger and resilience. During the first national lockdown in Greece (April 7 to May 3) a total of 5,748 adults from the community participated in the survey by anonymously completing the aforementioned questionnaire on a secure website of NKUA. A considerable effort was devoted to make the sample as representative as possible and to include members of the community who do not usually participate in such surveys, as individuals of older age or individuals with health conditions. The 5.20% two-week prevalence of suicidal ideation found in our study is an intermediate rate with respect to the 2.4% one-month prevalence in 2008, the 6.7% in 2011 and the 2.6% prevalence in 2013.5 Among the respondents, 14.1% were potential cases of anxiety, while 26.5% of depression. Independent risk factors for suicidal ideation included anxiety, depression, impaired family functioning, being unmarried or divorced, having a mental health history, as well as a poor perceived quality of physical health. In contrast, higher resilience, positive feelings with regard to the lockdown measures, relationship with friends, and faith in a Supreme Being emerged as protective factors for suicidal ideation.6 Investigating the risk and protective factors for suicidal ideation is especially important during this difficult period of the pandemic. There was an additional significant finding in this study: individuals who completed the questionnaire during the last two weeks of the first lockdown reported statistically significantly higher suicidal ideation, depression, and anxiety than those who completed it in the previous two weeks, while a similar finding was revealed in a study from USA.7 Therefore, we were looking forward to the results of our survey conducted during the second lockdown.8 From the 5,116 individuals who had fully completed our questionnaire with respect to suicidal ideation during the first lockdown, 811 fully completed it for the second time from November 22 to December 21, 2020. Suicidal ideation was not found significantly different compared to the first lockdown. Independent risk factors for suicidal ideation during the second lockdown were depression, anxiety, living with a person with frail health and vulnerable for COVID-19 and suicidal ideation during the first lockdown. It is noted that during the second lockdown the rates of potential depression cases remained unchanged, whereas anxiety rates increased. Greater accessibility to health services, state financial support and increased mobility might have contributed to the stability of suicidal ideation despite the greater severity of the second wave of the COVID-19 pandemic. The aforementioned studies determined the prevalence of suicidal ideation and its association with various demographic, clinical, social, familial, and psychopathological factors in a cohort context at different stages of the COVID-19 pandemic, with the relevant literature being rather poor. We consider that the provision of such data is critical for the plans of health system in pandemic conditions, while this longitudinal study is in progress during the subsequent waves of the pandemic.

Adopting a multi-level approach, this study examined risk factors for adolescent suicidal ideation, with specific attention to (a) hypothalamic-pituitary-adrenal (HPA) axis stress responses and (b) the interplay between HPA-axis and other risk factors from multiple domains (i.e., psychological, interpersonal and biological). Participants were 138 adolescent females (M(age) = 14.13 years, SD = 1.40) at risk for suicidal behaviors. At baseline, lifetime suicidal ideation and a number of risk factors were assessed (i.e., depressive symptoms, impulsiveness, pubertal status and peer stress). Participants were exposed to a psychosocial stress task and HPA-axis responses were assessed by measuring cortisol levels pre- and post-stressor. At 3 months post-baseline, suicidal ideation again was assessed. Using group-based trajectory modeling, three groups of cortisol stress-response patterns were identified (i.e., hyporesponsive, normative, and hyperresponsive). As compared to females in the normative and hyporesponsive group, females in the hyperresponsive group were more likely to report a lifetime history of suicidal ideation at baseline, above and beyond the effects of the other predictors. Moreover, as compared to females in the normative group, females in the hyperresponsive group were at increased risk for reporting suicidal ideation 3 months later, after controlling for prior ideation. No interactions between cortisol group and the other risk factors were significant, with the exception of a non-significant trend between impulsiveness and cortisol group on lifetime suicidal ideation. Findings highlight the importance of HPA-axis responses to acute stressors as a risk factor for suicidal ideation among adolescents.

Investigating suicide risk factors is critical for socioeconomic and public health, and many researchers have tried to identify factors associated with suicide. In this study, the risk factors for suicidal ideation were compared, and the contributions of different factors to suicidal ideation and attempt were investigated. To reflect the diverse characteristics of the population, the large-scale and longitudinal dataset used in this study included both socioeconomic and clinical variables collected from the Korean public. Three machine learning algorithms (XGBoost classifier, support vector classifier, and logistic regression) were used to detect the risk factors for both suicidal ideation and attempt. The importance of the variables was determined using the model with the best classification performance. In addition, a novel risk-factor score, calculated from the rank and importance scores of each variable, was proposed. Socioeconomic and sociodemographic factors showed a high correlation with risks for both ideation and attempt. Mental health variables ranked higher than other factors in suicidal attempts, posing a relatively higher suicide risk than ideation. These trends were further validated using the conditions from the integrated and yearly dataset. This study provides novel insights into suicidal risk factors for suicidal ideations and attempts.

ObjectiveWe investigated risk factors for suicidal ideation and behavior among currently depressed patients with major depressive disorder (MDD), major depressive episode (MDE) in bipolar disorder (BD), or MDE with comorbid borderline personality disorder (MDE/BPD). We compared current and lifetime prevalence of suicidal ideation and behavior, and investigated dimensional measures of BPD or mixed affective features of the MDE as indicators of risk.MethodsBased on screening of 1,655 referrals, we recruited 124 psychiatric secondary care outpatients with MDE and stratified them into three subcohorts (MDD, BD, and MDE/BPD) using the Structured Clinical Interview for DSM-IV I and II. We examined suicidal ideation and behavior with the Columbia Suicide Severity Rating Scale (CSSRS). In addition, we quantified the severity of BPD symptoms and BD mixed features both categorically/diagnostically and dimensionally (using instruments such as the Borderline Personality Disorder Severity Index) in two time frames.ResultsThere were highly significant differences between the lifetime prevalences of suicide attempts between the subcohorts, with attempts reported by 16% of the MDD, 30% of the BD, and 60% of the BPD subcohort. Remarkably, the lifetime prevalence of suicide attempts in patients with comorbid BD and BPD exceeded 90%. The severity of BPD features was independently associated with risk of suicide attempts both lifetime and during the current MDE. It also associated in a dose-dependent manner with recent severity of ideation in both BPD and non-BPD patients. In multinominal logistic regression models, hopelessness was the most consistent independent risk factor for severe suicidal ideation in both time frames, whereas younger age and more severe BPD features were most consistently associated with suicide attempts.ConclusionsAmong patients with major depressive episodes, diagnosis of bipolar disorder, or presence of comorbid borderline personality features both imply remarkably high risk of suicide attempts. Risk factors for suicidal ideation and suicidal acts overlap, but may not be identical. The estimated severity of borderline personality features seems to associate with history of suicidal behavior and current severity of suicidal ideation in dose-dependent fashion among all mood disorder patients. Therefore, reliable assessment of borderline features may advance the evaluation of suicide risk.

BackgroundSleep disturbances are an underestimated risk factor for suicidal ideation and behavior. Previous research provided preliminary support of a temporal relationship between sleep disturbances and suicidal ideation. The present study therefore sought to investigate the prospective association between sleep disturbances, passive and active suicidal ideation, and further psychological risk factors, such as state impulsivity and depression.MethodsSeventy-three psychiatric inpatients (71% female) with unipolar depressive disorder and current or lifetime suicidal ideation took part in an ecological momentary assessment (EMA). Participants filled out a baseline assessment and data were collected via smartphones over a 6-days period. Multilevel analyses with sleep disturbance as predictor for active and passive suicidal ideation, state impulsivity, and depression were carried out.ResultsPatients with sleep disturbance experienced more active suicidal ideation, but no passive suicidal ideation, the following day. Of the four state impulsivity items, one item was significantly associated with sleep disturbance. Sleep disturbance had no effect on next-day depression. Limiting factors are the small and homogeneous sample along with the rather short observation period in an inpatient setting.ConclusionsThe micro-longitudinal study provides preliminary support for sleep disturbance as a proximal risk factor for next-day active suicidal ideation. Clinically, results indicate to consider the evaluation and treatment of sleep disturbances for an improved risk assessment and prevention of suicide.

We used US nationwide commercial insurance claims data (2011–2015) to study the effect of social deprivation on clinical and demographic risk factors for suicidal ideation (SI) and suicide attempts (SA) among US youth and adults < 65 years, after having a mental health or substance use disorder-related outpatient encounter. Neighborhood social deprivation level was summarized by the quintile of social deprivation index (SDI) at individuals’ zip code level. Cox proportional hazard models were used to evaluate the effect of social deprivation on demographic and clinical risk factors for SI and SA. The study cohort consisted of 317,383 individuals < 65 years, with 124,424 aged < 25 (youth) and 192,959 aged between 25 and 64 (adults). Neighborhood social deprivation impacted risk factors for SI and SA differently for youth and adults. Among youth, SDI interacted with multiple risk factors for both SI and SA. The effects of the risk factors were larger on youth from middle socioeconomic neighborhoods. Among adults, risk of SI was the strongest in the most deprived neighborhoods, but risk of SA did not vary by neighborhood deprivation level. Our findings suggest community-based suicide prevention initiatives should be tailored according to neighborhood deprivation level and the targeted individual’s age to maximize the impact.

Objective: Dementia-related anxiety is associated with general anxiety and depression, which are risk factors for suicidal ideation. Consequently, dementia-related anxiety may be associated with suicidal ideation. When faced with a negative event (e.g. developing dementia), individuals primarily employ monitoring or blunting styles of coping. The present study investigated whether dementia-related anxiety and coping styles were associated with suicidal ideation in adults and whether coping styles moderated the relation between dementia-related anxiety and suicidal ideation.Methods: Online Mturk participants (n = 330) completed the Miller Behavioral Style Scale, Dementia Worry Scale, and Patient Health Questionnaire-9. Suicidal ideation was assessed with the Patient Health Questionnaire.Results: Dementia-related anxiety and monitor/blunter coping styles were independently associated with suicidal ideation in a multiple logistic regression; coping styles did not moderate the relation between dementia-related anxiety and suicidal ideation.Discussion: Greater dementia-related anxiety and less use of monitoring coping style were associated with suicidal ideation. Interventions to decrease suicide risk may benefit from taking into account individual differences in dementia-related anxiety and coping styles.

Individuals with Attention-Deficit Hyperactivity Disorder (ADHD) are at an increased risk of suicidal ideation and attempts compared to the general population. However, the mechanisms underlying suicidal behaviors in this group remain poorly understood. The role of childhood trauma, which frequently co-occurs with ADHD, and emotional dysregulation in suicidal behaviors remains unclear. This study employs a case-control design to investigate the impact of childhood trauma and emotional dysregulation on suicidal tendencies in adults with ADHD. A total of 160 adults diagnosed with ADHD who presented to the Adult Neurodevelopmental Disorders Clinic at Selçuk University, along with 107 typical controls, were included in the study. Participants were assessed using the Structured Clinical Interview for DSM-5, Adult ADHD Self-Report Scale, Suicidal Ideation Scale, Childhood Trauma Questionnaire, and the Difficulties in Emotion Regulation Scale-Short Form. Regression and mediation models were conducted to examine factors influencing suicidal tendencies, controlling for sociodemographic and clinical variables. Compared to controls, individuals with ADHD exhibited significantly higher levels of suicidal ideation, childhood trauma, and emotional dysregulation. Regression analysis revealed a positive association between childhood trauma, emotional dysregulation, and suicidal ideation. However, ADHD symptoms did not directly contribute to increased suicidal ideation; rather, their effect was mediated through childhood trauma and emotional dysregulation. Additionally, the presence of depression was significantly associated with both suicide attempts and suicidal ideation. These findings suggest that childhood trauma and difficulties in emotion regulation play critical roles in suicidal ideation among individuals with ADHD. In addition to depression treatment, comprehensive interventions targeting childhood trauma and emotional dysregulation may serve as promising strategies for reducing suicidal behaviors.

There is limited data regarding the prevalence of suicidal risk among physicians during COVID-19, and the risk factors relating to it. Dominant risk factors for suicide among physicians are depression and burnout. Maladaptive perfectionism may also serve as a profound risk factor for suicidality among physicians and may aggravate symptoms of distress under the challenges of COVID-19. This study aims to evaluate current suicidal risk, suicidal ideation, depression, and burnout before and during COVID-19 among physicians in Israel, and to identify the best sets of correlates between perfectionism and burnout, depression and suicidal ideation, during these time periods. A sample of 246 Israeli physicians (160 before COVID-19 and 86 during COVID-19) completed online surveys assessing lifetime suicidal risk, suicidal ideation during the last year and current suicidal ideation, depression, burnout symptoms and maladaptive perfectionism. More than one-fifth of the sample (21.9%) reported high suicidal risk (Lifetime suicidal behaviors). More than one-fourth (27.2%) reported suicidal ideation during the last 12 months; and 13.4% reported suicidal ideation during the last 3 months. In addition, more than one-third (34.6%) exhibited moderate-severe levels of depressive symptoms and more than a half of the sample reported burnout symptoms. Maladaptive perfectionism was positively correlated with current suicidal ideation, burnout, and depression. Moderated serial mediation analysis demonstrated indirect effect of perfectionism on suicidal ideation by its impact on burnout and depression only during COVID-19. Before COVID-19, physicians were more likely to experience depressive symptoms. Physicians in Israel are at increased risk for depression and suicidal ideation, regardless of the COVID-19 pandemic. Maladaptive perfectionism was found to be a risk factor for burnout, depression, and suicidal ideation. During the first waves of the pandemic, physicians were less likely to experience depressive symptoms. However, among physicians who were characterized with high maladaptive perfectionism, depression served as a significant risk factor for suicidal ideation during the pandemic, which places these individuals at increased risk for suicidality. These results highlight the importance of implementing intervention programs among physicians to reduce suicidal risk and to better identify rigid perfectionism and depressive symptoms.

Background Although several studies have examined risk factors for suicidal ideation among veterans, little is known about risk and protective factors for suicidal ideation in high-risk veteran samples. Thus, this study examined a broad range of risk and protective factors associated with the development of suicidal ideation in a high-risk sample of U.S. veterans who screened positive for current posttraumatic stress disorder (PTSD) and/or major depressive disorder (MDD). Methods Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative, prospective cohort study of U.S. veterans. Veterans completed self-report measures to screen for PTSD and MDD and to assess for risk and protective factors. The sample included 222 veterans with PTSD and/or MDD who did not endorse suicidal ideation at baseline and completed at least one assessment over a seven-year follow-up period. A multivariable binary logistic regression analysis was conducted to examine baseline factors associated with incident suicidal ideation. Results Nearly one in three (27.1%) of veterans with PTSD and/or MDD developed suicidal ideation over the seven-year follow-up period. Non-Caucasian race and lower scores on measures of purpose in life, conscientiousness, and frequency of religious service attendance were independently associated with incident suicidal ideation. Lower purpose in life (52.3%) and conscientiousness (33.2%) explained the vast majority of variance in incident suicidal ideation. Conclusion Nearly 30% of veterans with PTSD and/or MDD who did not endorse suicidal ideation at baseline developed suicidal ideation over a seven-year period. Prevention and treatment efforts designed to bolster purpose in life and conscientiousness may help mitigate risk for suicidal ideation in this high-risk population.

Risk factors for suicidality among college students: A systematic review and meta-analysis.

Previous research provided preliminary support of a potential reinforcing effect of suicidal ideation demonstrating reduced negative affect and increased positive affect after thinking about suicide. The present study therefore sought to investigate the role of mood and affect as a proximal risk factor of suicidal ideation in a high-risk sample. Seventy-four psychiatric inpatients (72% female) with unipolar depression and current and/or lifetime suicidal ideation aged 18 to 85 years (M = 37.6, SD = 14.3) took part in an ecological momentary assessment (EMA) over 6 days. Multilevel analyses were calculated. Analyses revealed negative valence of mood and low positive affect to be predictors of subsequent intensity of suicidal ideation (active, passive) as well as predictors of change in suicidal ideation (active, passive) since the last measurement. High negative affect only predicted intensity of passive suicidal ideation. Suicidal ideation (active, passive) was prospectively associated with subsequent negative valence of mood and lower positive affect as well as with higher intensity of negative affect. Suicidal ideation (active, passive) also predicted the change in valence of mood, positive affect and negative affect since the last measurement. Mood and affect should be taken into account as important proximal risk factors of active and passive suicidal ideation. The results do not support the idea of a reinforcing effect of suicidal ideation. In fact, they show a pattern of reduced subsequent positive affect, negative valence of mood and increased negative affect. Replication studies with larger samples and longer EMA follow-ups are needed.