Discrimination, Self‐Compassion, and Family Factors in Suicide Risk Among Asian Young Adults

This study evaluated the impact of structured training in evidence-based risk assessment for suicide. Forty-five psychiatry and psychology trainees participated in a workshop on evidence-based risk assessment. A comparison group of ten psychiatry trainees participated in a different workshop on the application of evidence-based medicine to psychiatry that was not focused specifically on risk assessment. Before and after each workshop, participants rated their skills in assessing patients' risk of suicide and wrote progress notes regarding clinical vignettes that included the assessment of and plan regarding suicide risk. Researchers systematically rated the progress notes. Participation in risk assessment training predicted improvement on specific indicators of documentation quality, ratings of the overall quality of documentation of suicide risk, and self-rated competence in suicide risk assessment. Structured clinical training in evidence-based risk assessment can improve documentation of assessment and management of patients' risk of suicide.

Despite the distinctly high risk of suicide among patients with psychiatric disorders, little is known regarding the nationwide rates and risk factors for suicide among individual subgroups of patients with psychiatric disorders. This study aimed to assess differences in suicide rates and identify risk factors for suicide across multiple psychiatric diseases using data from a nationally representative cohort in Korea. Six groups of incident patients with psychiatric disorders, namely those with drug use disorder (DUD), alcohol use disorder (AUD), schizophrenia (SCZ), bipolar disorder (BD), depressive disorder (DD), or other affective disorders (OADs), were extracted from the National Health Information Database and followed up. Suicide rates and risk factors were then determined for each disease group. Patients with psychiatric disorders had higher suicide rates than did the general population, with standardized mortality ratios (SMRs) ranging from 2.5 to 16.6. In particular, patients with DUD showed markedly higher suicide rate (584.0 per 100,000 person-years [PYs]; SMR, 16.6) than did patients with affective disorders, including DD (119.8 per 100,000 PYs; SMR, 3.1). AUD, DUD, SCZ, and BD showed lower male/female suicide rate ratios (1.1-1.4) than did depressive and OADs (2.2-2.4). Old age increased the risk for suicide among those with DUD and OADs, while medical aid recipients exhibited the lowest suicide risk among those with the AUD and SCZ. Male sex and the presence of multiple psychiatric comorbidities were consistently identified as suicide risk factors across mental illness subgroups. The current study observed substantial variations in suicide rates and risk factors across psychiatric disorders and patient characteristics, which have significant implications for suicide prevention strategies.

Hispanic/Latino adults, particularly Spanish speakers, are underserved in mental healthcare, and little is known about the day-to-day variation in their suicide risk. Smartphones have the potential to overcome geographical and linguistic barriers to mental health assessment and intervention. The purpose of the current study was to examine (a) the feasibility/acceptability of smartphone-based ecological momentary assessment (EMA) to assess suicide ideation and suicide risk factors among high-risk Spanish-speaking adults and (b) the degree of within-person variation of suicide ideation and suicide risk in this population. Sixteen primary Spanish-speaking psychiatry outpatients completed EMA measures of suicide ideation and suicide risk factors four times a day for 14 days. A majority of participants consented to active and passive remote assessments and reported the acceptability of study procedures. Adherence to EMA was high and not associated with symptom severity. EMA instances completed were not associated with symptom severity at follow-up. Average point-to-point variability in suicide ideation and risk factors were moderate to high, respectively. EMA captured more dramatic changes than standard baseline and follow-up assessments. Results provide preliminary support for the feasibility and acceptability of using smartphones to assess suicide risk in a real-time and real-world setting among high-risk Spanish-speaking adults.

Background-Community attitudes about suicide and their relationship to suicidal behavior have not been adequately investigated in low-and middle-income countries.

Background. Suicide is one of the leading causes of mortality worldwide, particularly among young people. The United Nations and the World Health Organization (WHO) have identified reducing suicide-related mortality as one of the global targets for 2030. The relevance of this issue is linked to the impact of food insecurity (FI) on mental health. Studies indicate a correlation between FI and increased levels of stress, depression, suicidal ideation, and behavior, particularly among adolescents. Food insecurity during childhood can have long-term negative consequences, including social and academic difficulties as well as heightened risks of mental disorders. Investigating this issue is crucial for developing effective preventive measures. Purpose – of this study is to analyze existing research on the impact of food security on the mental health of schoolchildren, particularly in relation to suicidal behavior risks, and to identify prevention strategies and methods through improved food security. Materials and Methods. A systematic analysis of scientific publications was conducted using the databases PsycINFO, PubMed, SciELO, Embase, and Web of Science (2019–2024). The search employed terms characterizing FI (e.g., «food insecurity», «food scarcity», «involuntary hunger») in combination with suicidal behavior («suicidal ideation», «suicide attempts») among schoolchildren. The study utilized systematic literature review methods, content analysis, and an interdisciplinary approach for a comprehensive examination of the issue. Results. Research confirms a correlation between FI and suicidal behavior among schoolchildren across different countries. A review of the literature allowed for several generalizations. FI is recognized as both a biological and psychological stressor contributing to suicidal behavior in school-aged children and adolescents. FI has been identified as an independent risk factor for suicidal behavior (SB) among schoolchildren. FI is considered a modifiable risk factor for suicide. FI has only recently been included among the socio-demographic risk factors for adolescent suicide. The relationship between FI and other socio-demographic risk factors for SB in adolescents remains insufficiently studied. Understanding the cumulative impact of FI alongside other socio-demographic suicide risk factors in adolescents is crucial for advancing research in school-based suicidology. A high prevalence of SB is observed among schoolchildren experiencing food insecurity, hunger, or forced food deprivation. Food insecurity extends beyond physical hunger and encompasses challenges related to accessing food through socially acceptable means, limited dietary diversity, and anxiety about potential food shortages. The suicidal risks associated with food insecurity or its severe decline among schoolchildren remain inadequately explored. Existing studies employ heterogeneous methodologies, complicating the comparability of their results. Furthermore, no domestic studies on this issue have been conducted. Despite a declining trend in food security levels in Ukraine, research on potential medical and social risks-particularly suicide risks in school populations-has not been undertaken, hindering the development of scientifically grounded national security policies in this area. Conclusions. An analysis of existing research confirms that food insecurity is a significant risk factor for the mental health of schoolchildren, increasing the likelihood of suicidal ideation and behavior. Developing integrated suicide prevention strategies that consider socio-economic factors and food security is of paramount importance. Future research should focus on designing effective intervention programs for children and adolescents experiencing food insecurity.

Background: The reasons behind suicide are multifactorial, complex, and poorly understood. Despite decades of research, suicide rates remain elevated both during hospitalization as well as shortly after discharge. Clinically relevant knowledge and tools for suicide risk assessments to guide decision-making processes in acute settings are needed. Objectives: The thesis objective was to examine and improve understanding of the complex relationship between psychotic depression and suicide behaviour. We also examined risk factors of clinical relevance in hospital settings, both during treatment, and after discharge. Methods: This research project used a sequential exploratory strategy, commencing with a qualitative part (paper 1-2), followed by a quantitative part (paper 3-4). In paper 1 and 2, we conducted qualitative interviews with nine patients diagnosed with psychotic depression as part of uni- or bipolar disorder. Papers 3 and 4 used data from the naturalistic prospective cohort study Suicidality in Psychiatric Emergency Admissions. In paper 3, we included all patients with depression (N= 1846) in a representative sample to identify risk factors for suicide using a cox regression analysis. Paper 4 investigated a mixed diagnostic sample of 7000 acutely admitted inpatients to identify imminent- and short-term risk factors for suicide. The findings from all four papers were combined into a secondary analysis, where we thematically synthesized the perspectives of patients’ experiences with the main findings from the prospective cohort study based on clinical assessment. Results thematic summarized: Our main finding was that psychotic symptoms in depression are associated with increased suicide risk, both short- and long-term (Paper 3). A possible mechanism to explain this association is the combination of intense emotional suffering and cognitive impairment which may motivate impulsive behaviour in psychotic depression (Papers 1 and 2). Depressed mood including overvalued ideas and delusions of self-blame and guilt predicted suicide the first following week after admission (Paper 4). The association of intense affective states with both imminent and long-term suicide risk factors was supported by patient experiences of sleeplessness and intense anxiety as warning signs for suicidal behaviour (Paper 1 and 2). In further support of this, depression severity assessed by the Health of the Nation Scale item 7 predicted suicide the first following week after admission (Paper 4). We found higher short-term suicide rates in patients diagnosed with psychotic depression as compared to those without psychotic symptoms at all follow-up points (Paper 3). A diagnosis of psychotic depression and depression severity assessed by MADRS depression scale as independent predictors of suicide provided knowledge on the long-term perspective (median 5.5 years follow-up). Also of clinical importance is our finding that self-report of suicidal ideation is not a good measure of imminent, short- or long-term suicide risk. Our qualitative findings indicate that shame, psychotically motivated paranoid ideation and impulsivity motivated underreporting of both suicidal ideation and psychotic symptoms in themselves. This may partly explain why, despite reporting less suicidal ideation/planning on admission, the suicide rate was higher for patients with psychotic symptoms on admission than for those without such symptoms (Paper 3). Although reported suicidal ideation was less relevant for clinical risk assessment, paper 3 and 4 identified male gender and recent suicide attempt as significant risk factors for completed suicide. The last main finding was that patients found both security measures and a treatment approach focusing on modifying psychotic experiences, intense anxiety and sleeplessness was helpful during hospitalization. Taking the time to talk to establish good patient relations is essential for optimal treatment conditions. Conclusions: The periods of acute inpatient treatment and immediately post- discharge are associated with the highest suicide risk. High symptom load as well as a diagnosis of psychotic depression, especially the presence of overvalued ideas and delusions of self-blame and guilt, appear to indicate especially high suicide risk regardless of time horizon. Identifying delusions and other psychotic symptoms is thus of the utmost importance. Psychosis- and depression-focused interventions and treatment approaches aiming specifically to reduce both psychotic and affective symptom load may act as a suicide prevention strategy for psychotic depressed patients. We found self-report of suicidal ideation of limited relevance when assessing suicide risk. Such assessments should thus always be combined with thorough clinical assessment by trained staff. This is especially true when assessing patients with psychotic depression, but especially given the frequent underreporting of psychotic symptoms, it remains important with any patient admitted for a depressive episode. Structured depression rating scales for clinician use may meaningfully contribute to suicide risk assessments. When assessing acute admission patients, we recommend paying particularly close attention to males, and patients with prior and recent suicide attempts.

Suicide Risk: Navigating the Failure Modes

ObjectiveAlthough risk factors for nonfatal suicidal behavior in mood disorders have been vastly investigated, rate and risk factors of suicide deaths are less well known. Extensive health care and other population registers in the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) allow national-level studies of suicide rates and risk factors. This systematic review examined Nordic studies of suicide in mood disorders.MethodsNational Nordic studies published after 1.1.2000 reporting on suicide mortality or relative risk in diagnosed unipolar depression or bipolar disorder treated in psychiatric settings; temporal variations in suicide risk after discharge, or risk factors for suicide were systematically reviewed.ResultsAltogether 16 longitudinal studies reported on rate and risk of suicide in depression. They found 2%–8% of psychiatric inpatients with depression to have died by suicide. However, in Finland suicide risk among depressive inpatients halved since the early 1990s. Nine studies investigated suicide risk in bipolar disorder, finding 4–8% of patients having died by suicide in long term. The relative risk of suicide was consistently found extremely high (SMR > 100) during the first weeks postdischarge, declining steeply over time to approximately SMR of five after five years. Male gender, preceding suicide attempts, high severity of depression and substance abuse were found risk factors for suicide in depression, with only minor gender differences in risk factors, but major differences in lethal methods. Three studies investigated risk factors for suicide in bipolar disorder, finding male gender, preceding suicide attempts, and depressive episodes and psychiatric comorbidity to be associated with risk.ConclusionsOverall, of psychiatric inpatients with depressive of bipolar disorders in the Nordic countries, 2%–8% have died by suicide in the last few decades, but current rates may be lower. Suicide risk is approximately similar or somewhat higher among patients with bipolar disorder, risk factor studies of whom are fewer. Risk of suicide is remarkably high immediately after discharge, and higher among males than females, those with preceding suicide attempts, high severity of depression, or concurrent substance abuse. Generalizability of findings from these Nordic studies to other countries need to be investigated, and their methodological limitations understood.

The risk of suicide is elevated among patients with treatment-resistant depression (TRD). Risk factors for suicide and suicide attempts among cases and controls with TRD were investigated using data from nationwide Swedish registers. Among 119,407 antidepressant initiators with a diagnosis of depression, 15,631 patients who started a third sequential treatment trial during the same depressive episode were classified with TRD. A nested case-control study compared cases with suicide and suicide attempts with up to three closely matched controls. Sociodemographic and clinical risk factors were assessed using conditional logistic regression analyses. In all, 178 patients died by suicide and 1,242 experienced a suicide attempt during follow-up. History of suicide attempts, especially if <1 year after the attempt, was a significant independent risk factor for suicide (adjusted odds ratio [aOR], 8.9; 95% confidence interval [CI], 5.1–15.7) as were 10 to 12 years of education compared to lower education (aOR, 1.69; 95% CI, 1.02–2.81). For attempted suicide, the strongest independent risk factors were history of suicide attempts (<1 year aOR, 5.1; 95% CI, 4.0–6.5), substance abuse (aOR, 2.6; 95% CI, 2.2–3.1), personality disorders (aOR, 1.9; 95% CI, 1.5–2.3), and somatic comorbidity (aOR, 2.0; 95% CI, 1.04–3.9). Suicide attempts, especially if recent, are strong risk factors for completed suicide among patients with TRD. Established risk factors for suicide attempts were confirmed for patients with TRD.

Assessing interpersonal and mood factors to predict trajectories of suicidal ideation within an inpatient setting

Les idéations suicidaires chez les nouveaux arrivants en maison d’arrêt

Background. Geriatric population is growing rapidly around the world. Suicidal behavior in older adults is an actual concern in both the public health and socio-economic field. The cause of suicidal behavior is represented by the interaction of biopsychosocial factors, the study of which is necessary for the development of programs for the prevention of suicidal behavior in older adults. The objective of this review is: to provide actual information of suicidal mortality in Russian Federation, to analyze the terminology describing auto-aggressive behavior, to consider the factors of suicidal risk and protective factors in older adults. Materials and methods. An extensive search was conducted on the following databases: https://pubmed.ncbi.nlm.nih.gov, https:// www.sciencedirect.com, https://www.scopus.com/search/form.uri, https://scholar.google.ru, https://cyberleninka.ru/. The number of cited sources — 65. Results: the literature review showed that the Russian Federation is one of the countries with an unfavorable suicidological situation. Suicide rates are higher among older adults compared to other age groups. This trend is typical for both sexes, but more pronounced in men. Among the elderly, the most important are risk factors associated with barriers to health care, stigma and discrimination, access to means of suicide, and abuse. The majority of older adults who attempt or die by suicide suffer from affective disorders, in the structure of which the symptoms of depression and anxiety are of particular importance. The presence of a physical illness, chronic pain syndrome, functional impairment and a feeling of helplessness significantly increase the suicidal risk, especially in combination with depression. Suicidal risk factors and protective factors have their own characteristics in the group under consideration, therefore, when developing prevention programs, older adults should be considered as a separate age risk group. Conclusion. The article presents a systematic review of scientific medical literature on the problem of suicidal behavior in older adults.

Suicide is an increasing public health crisis, especially impacting older adults and racial/ethnic minority groups. The aim of this study was to investigate risk and protective factors for suicidal ideation among Asian American adults by age, as well as differences in suicidal ideation and health care needs across age and subethnic groups. This cross-sectional study used data from the 2021-2022 California Health Interview Survey and included adults aged 18 and older who self-identified as Asian. Measured variables included age, sex, subethnicity (Chinese, Korean, Japanese, Vietnamese, Filipino, South Asian, Southeast Asian, Other Asian), suicide risk factors, mental health care barriers, and protective social environment indicators. Suicidal ideation and behavioral healthcare needs (i.e., for mental illness or substance use) were the outcomes of interest. Of 7240 participants, the largest subgroups were Chinese and Filipino respondents. Older adults reported lower levels of suicide ideation and behavioral healthcare needs compared to the younger age group. Among Asian subethnic groups, Other Asian and Korean Americans reported the highest levels of suicidal ideation (23.1% and 20.7%) and behavioral healthcare needs (20.5% and 18.4%). Healthcare discrimination was uniquely associated with suicidal ideation among older Asian adults (PR 4.19, p < .001). Other risk factors included a history of intimate partner violence, household mental health history, psychological distress, chronic pain, and healthcare costs. Findings identified significant age and subethnic differences in suicidal ideation. Despite having a lower overall risk, older Asian adults remain susceptible to healthcare discrimination and ongoing mental distress that elevates their risk for suicidality.

Reductions in Postdischarge Suicide After Deinstitutionalization and Decentralization: A Nationwide Register Study in Finland

The study sought to examine indigenous adolescents' suicidal behaviors and risk factors in a nationally representative sample and explore potential causes of disparities. The study analyzed the 1991-2013 Youth Risk Behavior Survey National Combined Datasets. Suicidal behavior outcomes included suicide consideration, planning, and attempts during the past 12months. Logit regressions were used to estimate the effects of potential suicide risk factors on these suicidal behaviors. The results showed that a high percentage of indigenous adolescents exhibited suicidal behaviors (consideration: 24.6%; planning: 20.7%; attempts: 16.2%). After adjusting for risk factors, indigenous adolescents were no more likely than other adolescents to consider or plan for suicide (consideration: OR 1.18, CI 0.96-1.45, p=0.125; planning: OR 1.16, CI 0.95-1.42, p=0.156); however, they remained significantly more likely to have made suicide attempts (OR 1.73, CI 1.32-2.26, p<0.001). Disparities in adolescent suicidal behaviors could be explained by the heterogeneous prevalence of suicidal risk factors across different races/ethnicities.