Psychological Pain in Suicidal and Non-Suicidal Populations: Findings from the Translated German Mee-Bunney Psychological Pain Assessment Scale

Background: Oxidative stress markers are found to be linked with depression and suicide attempts in bipolar disorder (BD), although the role of DNA damage as a marker of suicidal ideation and attempt has yet to be determined. We aim to investigate the association between DNA damage and suicidal behaviour, i.e., suicidal ideation and suicide attempt, among suicidal ideators in BD patients while accounting for clinical and psychosocial risk factors.Methods: A cross-sectional study was conducted in the Universiti Kebangsaan Malaysia Medical Centre on 62 consecutive BD patients diagnosed using the M.I.N.I. Neuropsychiatric Interview and 26 healthy control participants. Socio-demographic and clinical assessments were performed using the Columbia Suicide Severity Rating Scale (C-SSRS) for lifetime suicidal ideation and attempt, Quick Inventory of Depressive Symptomatology (QIDS) for depression severity, Clinical Global Impression for Bipolar Disorder (CGI-BD) for illness severity [both mania (CGI-Mania) and major depressive episode (CGI-MDE)], Social Readjustment Rating Scale (SRRS) for change in life events, and Barratt Impulsiveness Scale (BIS) for behavioural impulsivity. The degree of DNA damage in peripheral blood samples was determined using a standard protocol of comet assay.Results: Multivariable logistic regression revealed higher scores of CGI-MDE as the sole significant factor for lifetime suicidal ideation (OR = 1.937, 95% CI = 1.799–2.076). Although initial bivariate analysis showed a significant association between DNA damage, malondialdehyde (MDA), catalase (CAT), and suicidal behaviour, the findings were not seen in multivariable logistic regression. Bivariate subgroup analysis showed that moderate and severe DNA damage (p = 0.032 and p = 0.047, respectively) was significantly associated with lifetime suicide attempts among lifetime suicidal ideators. The study is the first to look at the connexion between DNA damage and suicidal risk in bipolar patients. It is limited by the small sample size and lack of information on illicit substance use.Conclusions: More severe DNA damage was significantly associated with lifetime suicide attempts among lifetime suicidal ideators in BD. However, the severity of depression was found to be independently associated with lifetime suicidal ideation per se rather than DNA damage in BD. Larger prospective studies are required to ascertain the potential of DNA damage as a biomarker for the transition from suicidal ideation to a suicide attempt.

Suicidality in patients with primary diagnosis of panic disorder: A single-rate meta-analysis and systematic review

BackgroundSuicide death rates in Australia are higher in rural than urban communities however the contributors to this difference remain unclear. Geographical differences in suicidal ideation and attempts were explored using two datasets encompassing urban and rural community residents to examine associations between socioeconomic, demographic and mental health factors. Differing patterns of association between psychiatric disorder and suicidal ideation and attempts as geographical remoteness increased were investigated.MethodsParallel cross-sectional analyses were undertaken using data from the 2007 National Survey of Mental Health and Wellbeing (2007-NSMHWB, n = 8,463), under-representative of remote and very remote residents, and selected participants from the Australian Rural Mental Health Study (ARMHS, n = 634), over-representative of remote and very remote residents. Uniform measures of suicidal ideation and attempts and mental disorder using the World Mental Health Composite International Diagnostic Interview (WMH-CIDI-3.0) were used in both datasets. Geographic region was classified into major cities, inner regional and other. A series of logistic regressions were undertaken for the outcomes of 12-month and lifetime suicidal ideation and lifetime suicide attempts, adjusting for age, gender and psychological distress. A sub-analysis of the ARMHS sample was undertaken with additional variables not available in the 2007-NSMHWB dataset.ResultsRates and determinants of suicidal ideation and suicide attempts across geographical region were similar. Psychiatric disorder was the main determinant of 12-month and lifetime suicidal ideation and lifetime suicide attempts across all geographical regions. For lifetime suicidal ideation and attempts, marital status, employment status, perceived financial adversity and mental health service use were also important determinants. In the ARMHS sub-analysis, higher optimism and better perceived infrastructure and service accessibility tended to be associated with a lower likelihood of lifetime suicidal ideation, when age, gender, psychological distress, marital status and mental health service use were taken into account.ConclusionsRates and determinants of suicidal ideation and attempts did not differ according to geographical location. Psychiatric disorder, current distress, employment and financial adversity remain important factors associated with suicidal ideation and attempts across all regions in Australia. Regional characteristics that influence availability of services and lower personal optimism may also be associated with suicidal ideation in rural communities.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-244X-14-208) contains supplementary material, which is available to authorized users.

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.

A Suicide-Specific Diagnosis – The Case For

Background: Suicidal ideation and attempt are more frequent in HIV patients than general population Objective: The aim of this study was to assess the suicidal ideation and attempt among HIV patients in Omdurman National Voluntary Counseling and Testing Center, Khartoum state, Sudan. Methods: Descriptive cross-sectional institutional based study was conducted among HIV patients attending Omdurman national voluntary counseling and testing Center. Systematic random sampling technique was used to select 235 participants from March to May 2021, data was collected by using a questionnaire consisted of sociodemographic and clinical characteristics and validated tool (Mini international neuropsychiatric interview for suicidality- the Arabic version), data was analyzed using SPSS 26 edition and Chi squire test, the t test and Multivariate test were used for the associations between variables Results: Suicidal ideation in the last month was (14.5%), suicidal attempt in the last month was (0.4%) and lifetime suicidal attempt was (4.3%). Suicide risk were high in (2.5%), moderate in (10.6%) and low in (12.7%). Marital status, occupation, duration of diagnosis, WHO stages and opportunistic infections were significantly associated with suicidal ideation, whereas opportunistic infections and marital status were significantly associated with suicidal attempt. Conclusion: The suicidal ideation and attempt in the HIV patients in the last month were 14.5% and 0.4% respectively, and the lifetime suicidal attempt was 4.3%. There is significant association between suicidal ideation and attempt and some sociodemographic and clinical characteristics of the patients.

Racial/ethnic and sex disparities in suicide ideation and attempts are well established, with higher risk of suicide ideation and attempt among US racial/ethnic minority school-aged youths (than their White peers) and girls and women (than boys and men). The suicide-related risk of racial/ethnic minority young adults, especially young women, may be strongly influenced by adverse childhood experiences, known early determinants of suicide ideation and attempts. To assess lifetime and past-year prevalence estimates of suicide ideation and suicide attempt and to examine sex differences in the role of adverse childhood experiences as a prospective risk factor for Puerto Rican young adults from 2 sociocultural contexts. Data in this longitudinal cohort study are from 4 waves of the Boricua Youth Study, a population-based cohort study of Puerto Rican children from San Juan and Caguas, Puerto Rico, and the South Bronx, New York, 5 to 17 years of age (N = 2491; waves 1-3: 2000-2004) and 15 to 29 years of age (wave 4: 2013-2017). Data analysis was performed from February 26, 2019, to October 16, 2020. Adverse childhood experiences were assessed by interview in childhood and early adolescence (waves 1-3) and included child maltreatment (physical, sexual, and emotional abuse and neglect), exposure to violence, parental loss (separation, divorce, and death), and parental maladjustment (mental health problems, substance or alcohol abuse, intimate partner violence, and incarceration). Lifetime and past-year suicide ideation and attempt were assessed in young adulthood (wave 4) using the World Health Organization Composite International Diagnostic Interview. Among 2004 Puerto Rican young adults (80.4% of the original cohort; mean [SD] age, 22.9 [2.8] years; 1019 [50.8%] male), young women compared with young men had a higher prevalence of lifetime suicide attempt (9.5% vs 3.6%) and lifetime suicide ideation (16.4% vs 11.5%), whereas past-year suicide ideation (4.4% vs 2.4%) was not statistically different. Logistic regression models, adjusting for demographics and lifetime psychiatric disorders, found that young women but not young men with more adverse childhood experiences had higher odds of suicide ideation (lifetime; odds ratio [OR], 2.44; 95% CI, 1.54-3.87; past year: OR, 2.56; 95% CI, 1.18-5.55). More adverse childhood experiences were also prospectively associated with lifetime suicide attempt (OR, 1.16; 95% CI, 1.04-1.29), irrespective of sex. The findings of this cohort study suggest that, among Puerto Rican young adults from 2 different sociocultural contexts, adverse childhood experiences were relevant to understanding suicide attempt and suicide ideation, the latter specifically among young women. The prevention of cumulative adverse childhood experiences could reduce later risk of suicide attempts and, among young women, for suicide ideation.

Background: Suicide is a significant public health issue, contributing to the global burden of the disease. According to the World Health Organization (WHO), one person dies by suicide every 40 seconds, with over 800,000 deaths annually. In India, suicide rates have reached an all-time high, with more than 100,000 deaths reported in 2021. Despite the increasing awareness and destigmatization efforts, suicidal ideation and attempts remain underreported, posing a significant challenge to the healthcare system. Objectives: This study aims to assess the sociodemographic, psychological, and clinical factors influencing suicidal ideation and attempts in individuals presenting to a tertiary care centre. Methods: A hospital-based cross-sectional study was conducted on individuals presenting with suicidal ideation or attempts. Data on sociodemographic characteristics, psychiatric comorbidities, psychosocial stressors, and personality traits were collected and analyzed. Standardized suicide risk assessment tools were used to classify the severity of ideation and the likelihood of transition to suicidal behavior. Results: Preliminary findings indicate a rising trend in suicide attempts, particularly among younger individuals, females, and those with psychiatric comorbidities such as depression, substance use disorders, and impulse control disorders. Sociodemographic determinants, stressful life events, and personality traits play a crucial role in suicide risk. Findings suggest that a significant proportion of individuals experiencing suicidal ideation transition to attempts within the first year of onset. Conclusion: Understanding the psychosocial and clinical determinants of suicidality is essential for targeted interventions and suicide prevention strategies. This study highlights the urgent need for comprehensive mental health screening, early intervention, and policy-driven approaches to suicide prevention in India. 1. Vijayakumar L, Chandra PS, Kumar MS, et al. The national suicide prevention strategy in India: context and considerations for urgent action. Lancet Psychiatry 2022;9(2):160-168. doi:10.1016/S2215- 0366(21)00152-8 2. World Health Organization. Suicide - India. Accessed April 22, 2025. https://www.who.int/india/health-topics/suicide 3. Bhatia G, Pal A, Sharma P, Parmar A. India’s National Suicide Prevention Strategy, 2022: A Critical Appraisal. Indian J Soc Psychiatry 2024;40(3):311-316. doi: 10.4103/ijsp.ijsp_97_23 4. Banandur P, Hasiruvalli Gangappa V, Koujageri JM, et al. Youth and suicidality: Correlates among clients attending youth mental health promotion clinics in India. Int J Soc Psychiatry 2022;69(1):146-155. doi:10.1177/00207640211070399 5. Krishnan M. Exploring Suicide Trends in India: An Analysis of Recent National Crime Records Bureau Data. Indian J Psychiatr Nurs 2023;20(2):179-180. doi: 10.4103/iopn.iopn_18_23 6. Government of India. The Mental Healthcare Act, 2017. Ministry of Law and Justice. Published April 7, 2017. Accessed April 22, 2025. https:// www.indiacode.nic.in/handle/123456789/2249 7. Sood P, Bindra S. Modified Kuppuswamy socioeconomic scale: 2022 update of India. Int J Community Med Public Health 2022;9(10):3841- 3844. doi:10.18203/2394-6040.ijcmph20222581 8. World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 1992. Accessed April 22, 2025. https://iris.who.int/handle/10665/37958 9. Loranger AW, Sartorius N, Andreoli A, et al. The International Personality Disorder Examination. The World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration international pilot study of personality disorders. Arch Gen Psychiatry 1994;51(3):215-224. doi:10.1001/archpsyc.1994.03950030051005 10. Naina CM, Gupthan L, Michael JP. Socio-demographic factors and life events associated with high suicidal intent in youth with intentional self-harm: A cross-sectional study at a tertiary care centre in Kerala, India. Kerala J Psychiatry 2024;37(1):13-19. doi:10.30834/ KJP.37.1.2024.435 11. Selvaraj M, Sarkar S, Rajkumar RP. Suicidal ideation, suicide attempts and sexual harassment among transgender people in Puducherry, South India: a cross-sectional analytical study. Int J Community Med Public Health 2023;10(11):4126-4132. doi:10.18203/2394-6040. ijcmph20233157 12. van Ballegooijen W, Rawee J, Palantza C, et al. Suicidal ideation and suicide attempts after direct or indirect psychotherapy: A systematic review and meta-analysis. JAMA Psychiatry 2025;82(1):31-37. doi:10.1001/jamapsychiatry.2024.2854 13. Klonsky ED, May AM, Saffer BY. Suicide, suicide attempts, and suicidal ideation. Annu Rev Clin Psychol 2016; 12:307-330. doi:10.1146/ annurev-clinpsy-021815-093204 14. Brent DA, Melhem N. Familial transmission of suicidal behavior. Psychiatr Clin North Am 2008;31(2):157-177. doi: 10.1016/j. psc.2008.02.001 15. Muralidharan A, Peeples A, Lucksted A. Health behavior change processes among adults with serious mental illness engaged in illness self-management. Qual Health Res 2021;31(6):1155-1168. doi:10.1177/1049732321992049 16. Arya V, Page A, Vijayakumar L, et al. Changing profile of suicide methods in India: 2014-2021. J Affect Disord 2023; 340:420-426. doi: 10.1016/j.jad.2023.08.010 17. Vadlamani LN, Gowda M. Practical implications of Mental Healthcare Act 2017: Suicide and suicide attempt. Indian J Psychiatry 2019;61(Suppl 4): S750-S755. doi: 10.4103/psychiatry.IndianJPsychiatry_116_19

The U.S. military veteran population experiences elevated rates of suicide relative to demographically matched community samples. Understanding suicide risk factors in veterans is therefore of critical importance. Accordingly, the Veterans Health Administration (VHA) has implemented elevated vigilance for suicidal ideation in its health care. One potential risk factor for suicidal ideation or behavior may be attention-deficit/hyperactivity disorder (ADHD), which is frequently characterized by impaired impulse control and experience of intense emotions. To determine whether ADHD, as diagnosed by VHA assessment, may represent an independent or interactive risk factor for suicidal ideation or suicide attempt, we examined potential linkages between VHA-assessed symptomatology of ADHD and suicide attempts or ideation, either with or without the presence of comorbid VHA-assessed psychiatric symptomatology. In a retrospective chart review, we compared severity of clinician-rated suicide risk in 342 veterans (82.5% male) referred to a VHA medical center for ADHD assessment, of whom 198 were diagnosed with ADHD. Contrary to our preregistered hypotheses, there were no main or additive effects of ADHD in terms of increased suicidal ideation, clinician-rated suicide risk or in incidence of lifetime suicide attempt. Motoric impulsivity in neurocognitive testing also showed no relationship with suicide risk or attempts. Rather, consistent with previous literature, presence of a mood disorder or other non-ADHD psychopathology was linked to suicide risk ratings and attempts, irrespective of presence of ADHD symptoms. These data suggest that once comorbid symptomatology such as depression is controlled for, ADHD alone is not associated with elevated suicidal ideation or attempts in veterans. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: To evaluate sleep continuity, timing, quality, and disorder in relation to suicidal ideation and attempts among college students. Participants: Eight hundred eighty-five undergraduates aged 18–25 in the southwestern United States. Methods: Participants completed questionnaires on sleep, suicide risk, mental health, and substance use. Differences in sleep variables were compared by lifetime and recent suicidal ideation and suicide attempts using covariate-adjusted and stepwise regression models. Results: A total of 363 (41.0%) individuals reported lifetime suicidal ideation, of whom 172 (47.4%) reported suicidal ideation in the last 3 months and 97 (26.7%) had attempted suicide in their lifetime. Sleep disturbances were prevalent among those with lifetime suicidal ideation or a lifetime suicide attempt. Insomnia was identified as the best predictor of recent suicidal ideation, but this relationship did not survive adjustment for covariates. Conclusions: Sleep continuity, quality, and sleep disorders are broadly associated with suicidal thoughts and behaviors among college students.

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

Background and Objective Suicide attempts are 10-20X more common than completed suicide and an important risk factor for death by suicide, yet most people who attempt suicide do not die by suicide. The process of recovering after a suicide attempt has not been well studied. The Reasons to go on Living (RTGOL) Project, a narrative web-based study, focuses on experiences of people who have attempted suicide and made the decision to go on living, a process not well studied. Narrative research is ideally suited to understanding personal experiences critical to recovery following a suicide attempt, including the transition to a state of hopefulness. Voices from people with lived experience can help us plan and conceptualize this work. This paper reports on a secondary research question of the larger study: what stories do participants tell of the positive role/impact of the mental health system. Material and Methods A website created for The RTGOL Project ( www.thereasons.ca ) enabled participants to anonymously submit a story about their suicide attempt and recovery, a process which enabled participation from a large and diverse group of participants. The only direction given was “if you have made a suicide attempt or seriously considered suicide and now want to go on living, we want to hear from you.” The unstructured narrative format allowed participants to describe their experiences in their own words, to include and emphasize what they considered important. Over 5 years, data analysis occurred in several phases over the course of the study, resulting in the identification of data that were inputted into an Excel file. This analysis used stories where participants described positive involvement with the mental health system (50 stories). Results Several participants reflected on experiences many years previous, providing the privilege of learning how their life unfolded, what made a difference. Over a five-year period, 50 of 226 stories identified positive experiences with mental health care with sufficient details to allow analysis, and are the focus of this paper. There were a range of suicidal behaviours in these 50 stories, from suicidal ideation only to medically severe suicide attempts. Most described one or more suicide attempts. Three themes identified included: 1) trust and relationship with a health care professional, 2) the role of friends and family and friends, and 3) a wide range of services. Conclusion Stories open a window into the experiences of the period after a suicide attempt. This study allowed for an understanding of how mental health professionals might help individuals who have attempted suicide write a different story, a life-affirming story. The stories that participants shared offer some understanding of “how” to provide support at a most-needed critical juncture for people as they interact with health care providers, including immediately after a suicide attempt. Results of this study reinforce that just one caring professional can make a tremendous difference to a person who has survived a suicide attempt.

BackgroundPrevious research has highlighted the importance of understanding which psychosocial factors distinguish between those with suicide thoughts compared to those who attempt suicide. This study aims to investigate these distinguishing factors further within an ideation-to-action framework and to explore sex differences in suicide risk.MethodsParticipants (n = 7546, aged 16+) were from the cross-sectional Adult Psychiatric Morbidity Survey (APMS; 2014) of England. Face-to-face and self-completion questionnaires assessed lifetime suicidal ideation, lifetime suicide attempts, demographic characteristics, life experiences, social support, health and mental illness. Multinomial logistic regression examined factors differentiating between those with suicidal ideation only and suicide attempt histories (with or without suicidal ideation) in men and women.ResultsOverall men were less likely to report suicidal thoughts and attempts, compared to females. More factors differentiated between suicidal thoughts and attempts in women compared to in men; these included hospital admission for mental illness, below degree level qualifications, being single and childhood adversity. In men, factors which significantly differentiated between suicidal thoughts and attempts included self-report of professional diagnosis of mental illness and childhood adversity. Higher levels of social support were associated with being in the suicidal thoughts group v. in the attempts group in men.ConclusionThis study identified some key differences between men and women in factors associated with suicide attempts compared to suicidal thoughts. The findings support the use of the ideation-to-action framework to investigate sex differences in suicidal behaviour. Future research should examine the extent to which these factors are associated with suicide risk over time.

Although suicide is one of the leading causes of death worldwide, there is a need for studies to identify variables that can differentiate patients with suicide ideation at risk of transitioning to an attempt. In this study, we assessed suicide ideation and attempts, non-suicidal self-injury (NSSI), hopelessness, borderline symptoms and meaning in life in a sample of 348 patients with different diagnoses of mental disorders. We divided the sample into four subgroups: patients without suicide ideation or suicide attempts; patients with current suicide ideation; patients with lifetime suicide attempts and patients with a suicide attempt in the previous year. The group with suicide attempts in the previous year showed higher levels of hopelessness, borderline symptoms and NSSI, and lower levels of meaning in life than the other groups. Groups were composed of unequal numbers of patients, and in some of them, the sample size was small. The sample was composed mainly of women with eating disorders. The study design was retrospective, and so the results must be considered in terms of correlates. Our results suggest that hopelessness, borderline symptoms-including NSSI-and meaning in life play a key role in suicide attempts. Thus, psychotherapeutic interventions should focus on managing NSSI, searching for meaning and managing emptiness, loss of control and feelings such as self-contempt in patients with suicide ideation. Copyright © 2016 John Wiley & Sons, Ltd. Recent suicide attempters show higher levels of hopelessness, borderline symptoms and NSSI than lifetime attempters and suicide ideators. Clinicians should focus attention on assessing hopelessness, borderline symptoms and NSSI in those with suicide ideation. Lower levels of meaning in life are related to recent suicide attempts. Levels of hopelessness differentiate between recent and lifetime suicide attempters.

BackgroundRural populations experience a higher suicide rate than urban areas despite their comparable prevalence of depression. This suggests the identification of additional contributors is necessary to improve our understanding of suicide risk in rural regions. Investigating the independent contribution of depression, and the impact of co-existing psychiatric disorders, to suicidal ideation and suicide attempts in a rural community sample may provide clarification of the role of depression in rural suicidality.Methods618 participants in the Australian Rural Mental Health Study completed the Composite International Diagnostic Interview, providing assessment of lifetime suicidal ideation and attempts, affective disorders, anxiety disorders and substance-use disorders. Logistic regression analyses explored the independent contribution of depression and additional diagnoses to suicidality. A receiver operating characteristic (ROC) analysis was performed to illustrate the benefit of assessing secondary psychiatric diagnoses when determining suicide risk.ResultsDiagnostic criteria for lifetime depressive disorder were met by 28% (174) of the sample; 25% (154) had a history of suicidal ideation. Overall, 41% (63) of participants with lifetime suicidal ideation and 34% (16) of participants with a lifetime suicide attempt had no history of depression. When lifetime depression was controlled for, suicidal ideation was predicted by younger age, being currently unmarried, and lifetime anxiety or post-traumatic stress disorder. In addition to depression, suicide attempts were predicted by lifetime anxiety and drug use disorders, as well as younger age; being currently married and employed were significant protective factors. The presence of comorbid depression and PTSD significantly increased the odds of reporting a suicide attempt above either of these conditions independently.ConclusionsWhile depression contributes significantly to suicidal ideation, and is a key risk factor for suicide attempts, other clinical and demographic factors played an important role in this rural sample. Consideration of the contribution of factors such as substance use and anxiety disorders to suicidal ideation and behaviours may improve our ability to identify individuals at risk of suicide. Acknowledging the contribution of these factors to rural suicide may also result in more effective approaches for the identification and treatment of at-risk individuals.