Charting suicide risk in Latina adolescents: A qualitative system dynamics approach.

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Depressive Disorders

A Suicide-Specific Diagnosis – The Case Against

Suicide is a major public health concern accounting for 800 000 deaths globally each year. Although there have been many advances in understanding suicide risk in recent decades, our ability to predict suicide is no better now than it was 50 years ago. There are many potential explanations for this lack of progress, but the absence, until recently, of comprehensive theoretical models that predict the emergence of suicidal ideation distinct from the transition between suicidal ideation and suicide attempts/suicide is key to this lack of progress. The current article presents the integrated motivational–volitional (IMV) model of suicidal behaviour, one such theoretical model. We propose that defeat and entrapment drive the emergence of suicidal ideation and that a group of factors, entitled volitional moderators (VMs), govern the transition from suicidal ideation to suicidal behaviour. According to the IMV model, VMs include access to the means of suicide, exposure to suicidal behaviour, capability for suicide (fearlessness about death and increased physical pain tolerance), planning, impulsivity, mental imagery and past suicidal behaviour. In this article, we describe the theoretical origins of the IMV model, the key premises underpinning the model, empirical tests of the model and future research directions.

At the American Association of Suicidology’s (AAS) 46th Annual Conference in Austin, Texas (http://www.suicidology.org/web/guest/education-and-training/annualconference), participants were challenged to address why there has not been more progress in reducing the rates of completed suicides (Berman, 2013). A draft of recommendations from the National Action Alliance for Suicide Prevention’s Research Prioritization Task Force was presented at the meeting and subsequently published in this journal (National Action Alliance for Suicide Prevention [NAASP], 2013a, 2013b). The purpose of this commentary is to address this challenge by emphasizing the importance of employing a disease etiology strategy that integrates molecular data with clinical data, environmental data, and health outcomes in a dynamic, iterative fashion. The recommendations of the Research Prioritization Task Force tackle important public health program issues and are embedded within seven key questions, summarized as: 1. Why do people become suicidal? 2. How do we better detect/predict risk? 3. What interventions prevent suicidal behavior? 4. What are the effective services for treating suicidal persons and preventing suicidal behavior? 5. How do we reduce stigma? 6. What are the suicide prevention interventions outside of health-care settings? 7. Which existing and new infrastructure needs are required to further reduce suicidal behavior? (NAASP, 2013b; Silverman et al., 2013)

S17 * ALCOHOL DEPENDENCE AND SUICIDAL BEHAVIOR - AN INTERNATIONAL PERSPECTIVE

The Acceptability of Suicide Among Rural Residents, Urban Residents, and College Students from Three Locations in China

The COVID-19 pandemic of 2020 is a major global health challenge. At the time of writing, over 11.6 million people around the world had been registered as infected and 538,000 had died (Worldometers, 2020, accessed July 7, 2020). Public health responses to COVID-19 need to balance direct efforts to control the disease and its impact on health systems, infected people, and their families with the impacts from associated mitigating interventions. Such impacts include social isolation, school closure, health service disruption stemming from reconfiguring health systems, and diminished economic activity. The primary focus of both the United Nations (UN) and the World Health Organization (WHO) has been on addressing COVID-19 as a physical health crisis, but the need to strengthen mental health action, including suicide prevention, is increasingly recognized, as is the need for mental health research to be an integral part of the recovery plan (UN, 2020a). The impacts of the pandemic on physical and mental health will unfold differently over time and will vary depending on the duration and fluctuating intensity of the disease. Research is needed to help ensure that decision-making regarding all aspects of health, including mental health (Holmes et al., 2020), is informed by the best quality data at each stage of the pandemic. The pandemic poses a prolonged and unique challenge to public mental health, with major implications for suicide and suicide prevention (Gunnell et al., 2020; Reger, Stanley, & Joiner, 2020). A rise in suicide deaths in the wake of the pandemic is not inevitable. There is consensus, however, that the mitigation of risk will be contingent upon a proactive and effective response involving collaborative work between the state, NGOs, academia, and local governments and coordinated leadership across government ministries, including health, education, security, social services, welfare, and finance. Countries have responded in different ways to the pandemic, effectively creating a series of natural experiments. Thus, regions of the world affected later in the pandemic can draw on lessons from countries, such as China and Italy, affected in its early phase. Likewise, lessons learned early in the pandemic (e.g., on the impact of lockdown and physical distancing measures) can be used to inform responses to any future surges in the incidence of COVID-19. Although there are important parallels between countries in the course of the pandemic, some stressors, responses, and priorities are likely to differ between high- and low–middle-income countries and between cultures and regions. As COVID-19 appears to be disproportionately affecting Black, Asian, and minority ethnic communities, the response – and suicide prevention research carried out to inform the response – needs to be sufficiently granular and account for the complexity of risks in these groups (O'Connor et al., 2020). Throughout this editorial, when we refer to suicide and suicidal behavior, we mean to include both fatal and nonfatal suicidal behaviors and self-harm.

A Suicide-Specific Diagnosis – The Case For

Rumination in relation to suicide risk, ideation, and attempts: Exacerbation by poor sleep quality?

Antidepressants and Suicidal Behavior: Cause or Cure?

The association between suicidality and treatment with Selective Serotonin Reuptake Inhibitors in older people with major depression: a systematic review

Suicide remains a leading cause of adolescent morbidity and mortality. Despite identification of risk factors and protective factors for suicidal behavior, we have limited understanding of the mechanisms underlying risk for suicide attempt. Adolescence is a time of high risk for suicidal behavior, as well as a time that intervention and treatment may have the greatest impact because of structural brain changes and significant psychosocial development during this period. Functional magnetic resonance imaging (fMRI) studies have promise to yield markers of risk for suicidal behavior in adolescents because they can help identify neurobiological underpinnings of pathophysiologic mechanisms that are not observable at the behavioral level, and can also provide targets for future neurobiological interventions. Markers of risk for suicidal behavior are beginning to be elucidated, but as yet have not been applied to the clinical management of adolescents at risk for suicide. Neuroimaging studies indicate neural circuitry abnormalities in adult suicide attempters. One study in adult suicide attempters reported lower glucose uptake in the prefrontal cortex and dorsal anterior cingulate gyrus in high vs low lethality suicide attempters (Oquendo et al, 2003). With regard to emotion processing, vulnerability to suicidal behavior has been associated with differences in response to negative emotion. Specifically, adult male suicide attempters showed greater activity in the right lateral orbitofrontal cortex and decreased activity in the right superior frontal gyrus to intense angry vs neutral faces relative to healthy and depressed non-attempter controls. In addition, cognitive inflexibility (inability to change strategy) is well documented in studies of adult patients with a history of suicide attempt (Jollant et al, 2005). However, few studies have explored the neural circuitry underlying adolescent suicidal behavior. This is an important oversight because suicide is one of the leading causes of death in adolescence, and the developing brain may provide a window into risk for suicidal behavior and allow for earlier intervention to prevent suicide. Our functional neuroimaging studies indicate differences in emotion processing in adolescents with history of depression and suicide attempt relative to healthy control adolescents. Here, we have shown differences in the attention and salience networks (Pan et al, 2013). Our findings differ from those in adult males with depression, in whom the functional connectivity of the striatal-anterior cortical midline structures circuit is implicated in suicidal ideation (Marchand et al, 2012). Specifically, we have shown increased attentional control network activity and decreased functional connectivity between the dorsal anterior cingulate gyrus, implicated in attentional control of emotion, and the insula, a neural region associated with interoceptive processing of emotion, when viewing angry faces in adolescents with a history of depression and suicide attempt compared with healthy controls and depressed adolescent non-attempters (Figure 1). In contrast, adolescents with a history of depression and suicide attempt showed no abnormalities in levels of performance accuracy or dorsal anterior cingulate activity and attentional control network activity on tasks of cognitive control and learning in the context of risk (Pan et al, 2011, 2013). Together, these findings suggest that abnormal functioning of the salience and attention networks in the setting of emotion processing, with normal function in these networks in the absence of emotional stimuli, may represent markers of past suicide attempt. These networks are thus promising foci for future neuroimaging studies aiming to identify markers of risk for future suicide attempt in adolescent populations.

Each year approximately 1,000,000 people die by suicide, accounting for nearly 3% of all deaths and more than half (56%) of all violent deaths in the world (Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002). Suicide ideation and suicide attempts are strongly linked to death by suicide and powerfully predict further suicidal behavior (Institute of Medicine, 2002). There are an estimated 100–200 suicide attempts for each completed suicide in young people, and 4 attempts for each completed suicide in the elderly (Institute of Medicine, 2002). Emergency departments (EDs) are the most important site, epidemiologically speaking, for treating those who make suicide attempts. EDs in the United States, for example, record over 500,000 suicide-related visits annually (Larkin, Smith, & Beautrais, 2008). The majority of suicide attempt patients are discharged after medical stabilization and psychosocial evaluation, but carry a significant risk of recidivism (Larkin, Smith, & Beautrais, 2008). Similarly, ED patients who present with suicide ideation (without attempt) have risks of returning to the ED with further ideation or with suicide attempts which are as high as those who present with attempts (Larkin, Beautrais, Gibb, & Laing, 2008). In addition, a significant fraction of those who present to EDs for nonmental health reasons often have occult or silent suicide ideation (estimated at 8–12%) (Claassen & Larkin, 2005). The worldwide economic tsunami and sky-rocketing healthcare costs have ensured that mental health-related visits and presentations for suicidal behavior will continue to rise in the foreseeable future. The closure of psychiatric inpatient facilities, reductions in inpatient beds, moves to treat people in the community, and increased costs of general practitioner visits have coincided with – and likely account for – increased ED attendances by psychiatric and suicidal patients who previously might have been admitted or seen in primary care. The ED is now the default, de facto option for urgent and acute contact for suicidal patients within the health system – and in many countries the ED is the only access to 24/7 healthcare (Fields et al., 2001).

A Global Call for Action to Prioritize Healthcare Worker Suicide Prevention During the COVID-19 Pandemic and Beyond.

Sleep problems and suicidal behaviors in college students