Objective Adolescents who experience a peer or relative’s suicidal behavior can feel alienated from their peers and are at increased risk of suicidal thoughts and attempts. However, it is unclear whether loneliness is a risk factor for suicidal behavior in this vulnerable group. Method We analyzed data from 5,259 participants in the US National Longitudinal Study of Adolescent to Adult Health (Add Health) reporting past-year experience of the suicide or suicide attempt of a friend or relative at either Wave I or II. We examined the longitudinal association between past-week loneliness (exposure, captured at cohort entry) and suicidal ideation and attempt (outcomes, captured in subsequent waves, to Wave IV) among adolescents. Results Loneliness was significantly associated with probability of later suicidal ideation (odds ratio [OR] = 1.95, 95% CI [1.46, 2.60], p < 0.001) and attempt (OR = 1.72, 95% CI [1.10, 2.68], p = 0.017), also when adjusted for sociodemographic variables (adjusted OR [AOR] = 2.01, 95% CI = [1.50, 2.68], p < 0.001; AOR = 1.76, 95% CI [1.11, 2.80], p = 0.016, respectively) but these associations were non-significant in our final models accounting for baseline depression (AOR = 1.17, 95% CI [0.83, 1.64], p = 0.377; AOR = 1.22, 95% CI [0.70, 2.11], p = 0.468, respectively). A priori interaction tests suggested that the influence of loneliness on suicidal ideation was more pronounced at one-year follow-up than after 6–13-year follow-up. Conclusions These findings emphasize the need for targeted strategies to address loneliness in adolescents who experience the suicidal behavior of a close contact, with a focus on proactive early intervention to address loneliness and depression to reduce suicidal distress.

Background Self-harm is a multifaceted public health issue attributed to psychiatric and non-psychiatric factors that prevail all over the world. However, the rate of psychiatric disorders in self-harm in South Asia has yet to be assessed. Objective We aimed to assess the prevalence of psychiatric morbidity in individuals with self-harm in South Asia. Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic search across three databases: Medline, PsycINFO, and Embase for peer-reviewed studies published from 1990 to 2024. Articles with estimates of psychiatric disorders in individuals with self-harm within South Asia were included. Results Fifty three studies with 8,254 persons with self-harm met the criteria and were included in this systematic review. The studies were hospital-based, mostly cross-sectional, where participants were female and married individuals aged 15–34 years. The prevalence of psychiatric disorders was 61.3%. Depression and adjustment disorders were the most frequent diagnoses among persons with self-harm. Interpersonal conflicts and financial difficulties were noted as non-psychiatric factors. Conclusion The revealed prevalence of psychiatric disorders among persons with self-harm in South Asia underscores the need for targeted mental health interventions to prevent self-harm and suicidal behavior in the region.

Objective Suicide is a leading cause of death in prisons worldwide. The objective of this study was to describe the sociodemographic, clinical and criminal characteristics of people incarcerated in France who died by suicide, as well as the circumstances surrounding each suicide. Method We included all cases of suicide by people incarcerated in France (i.e., European and overseas territories) over the period 2017–2021. The National Prison Service provided sociodemographic and criminal data, as well as data on the circumstances surrounding the suicides. Health data were collected by health units located in all the country’s prisons using a standardized questionnaire. Results We included 598 suicide cases in the study. Mental disorders were more prevalent during (63.7%) than before (47.8%, p < 0.001) incarceration. In the week before suicide, 60% of cases had visited their prison’s health unit and a traumatic criminal-, prison-, familial- or health-related event was identified in 61% of all cases. Persons who died during the SARS-CoV2 pandemic were more likely to have children (77.7% vs 61.1%, p = 0.001). The overall suicide rate was 17.5 [CI95% 16.1–18.9] per 10,000 person-years. It increased (p < 0.05) with age, was twice as high during pretrial incarceration and six times higher during the first week of imprisonment. In terms of gender, it was 9.9 [9.1–10.7] and 41.0 [27.0–59.7] times higher among men and women, respectively, than among their counterparts in the general population. Conclusions Suicide in prisons is a major health issue. Suicide prevention measures must be reinforced.

Objective In 2018, Veterans Health Administration (VHA) mandated adoption of the Columbia-Suicide Severity Rating Scale (C-SSRS) for health system suicide screens. This study evaluates the predictive validity of C-SSRS screens in VHA specialty mental health (SMH) and emergency department (ED) settings. Methods For 867,023 patients screened in SMH clinics from 10/1/2018-11/30/2020 and 1,035,317 screened in EDs from 11/1/2019-11/30/2020, proportional hazards analyses evaluated whether C-SSRS screens (rated as minimal, low, moderate, or high risk) were associated with non-fatal suicide attempts and with suicide deaths within the subsequent 7, 30, and 365 days. Analyses adjusted for patient characteristics, prior year mental health treatment, prior year suicide attempts, and most recent VHA REACH VET suicide prediction algorithm risk score. Results For the SMH cohort, 61.27% of those who died by suicide and 78.29% of those who attempted suicide within a year initially screened as low, moderate, or high risk; for the ED cohort, 15.39% of those who died by suicide and 46.29% of those who attempted suicide within a year initially screened low, moderate, or high. In both settings, C-SSRS risk level was positively associated with risk of suicide attempts and deaths (hazard ratios ranged from 1.76 to 6.62 depending on outcome, setting, and risk level), adjusting for covariates. Conclusion In VHA SMH and ED populations, the C-SSRS identifies patients who are at increased risk of suicide deaths and attempts. Follow-up should be completed for patients who screen at low risk or higher on the C-SSRS, particularly in EDs.

Objective The aim of this study is to examine the relationships between defeat, entrapment, and suicidal ideation among emerging adults (operationally defined as ages 18–26) within the framework of the Motivational Phase of the Integrated Motivation-Volitional (IMV) Model and to test the moderating roles of self-critical rumination and social ostracism and its forms (ignored and excluded) in these relationships. Method The study used a cross-sectional design with self-report data from 503 emerging adults in Türkiye. Mediation and moderating analyses were conducted using IBM SPSS 22 (PROCESS macro). Results In the association between defeat and suicidal ideation, entrapment functioned as a partial mediator. In the association between defeat and entrapment, self-critical rumination functioned as a buffering moderator. In the association between entrapment and suicidal ideation, being ignored functioned as a reinforcing moderator, whereas excluded and social ostracism did not moderate this association. Conclusions The motivational stage of the IMV Model is empirically validated in the emerging adult sample in Türkiye and provides a functional framework for explaining the process leading to suicidal ideation. The study adds an additional cognitive layer to the model through self-critical rumination, revealing the dynamics of the defeat-entrapment relationship in a more nuanced way. Furthermore, by examining social ostracism and its forms (ignored and excluded), it makes an important contribution to how social threats and relational vulnerabilities intersect with the motivational processes conceptualized in the model.

Objective Males are at increased risk for suicide, yet less likely to seek and maintain professional help. This discrepancy suggests that current healthcare services may not be adequately tailored to males’ needs. This study explores the experiences, barriers, and needs of healthcare providers (HCPs) in supporting males with suicidal ideation and behaviors to inform gender-sensitive mental healthcare practices. Methods A mixed-method design was used, combining quantitative data from questionnaires, with qualitative data from focus groups, interviews and open-ended questionnaire responses. Results A total of 128 HCPs from diverse professions and settings in Flanders (Dutch-speaking part of Belgium) filled in the questionnaires, eight participated in interviews or focus groups. The findings revealed gender differences in various aspects of treatment. HCPs reported more difficulty discussing suicidal ideation (59.4%) and underlying emotions (77.1%) with males. Males were perceived to prefer practical, goal-oriented interventions and to require more motivational interviewing (46.9%) and psychoeducation (46.9%). Qualitative analyses provided further insight into possible mechanisms behind these gender differences, emphasizing the influence of societal stigma and traditional gender norms on males’ socialization and emotional expression. HCPs noted that males often sought care only during acute suicidal crises. Conclusions This mixed-method study provides valuable insights into the needs and experiences of HCPs in supporting males with suicidal thoughts. The findings underscore the importance of gender-responsive practices in mental healthcare to address systemic barriers faced by males with suicidal ideation. Tailored interventions, destigmatization efforts, and enhanced HCP training are essential to improve engagement and outcomes for this high-risk group.

Background In a recent Norwegian regional suicide prevention media campaign, we found small and inconclusive results regarding changes in attitudes to suicide and help-seeking. In this exploratory study we add the data from two other Norwegian regional campaigns, aiming to generate clearer results through a larger sample. Methods We compared the attitudes to suicide, mental illness and help-seeking before and after a media campaign carried out in the three regions of Mid-, West-, and South-Norway at different time periods in 2022 and 2023. In total, 3234 adults sampled from the general population and stratified according to sex, age, and geographical location participated in two surveys before and after the campaigns. Results When analyzing the entire sample, there was no overall change in attitudes to suicide, mental illness and help-seeking from pre to post campaign. In the subgroup of men who had noticed the campaign (n = 644, 10% of the sample), however, there was a significant reduction in two out of ten undesirable attitudes to suicide. No such changes were seen in the female respondents who had noticed the campaign. For all the statistically significant changes, the effect sizes were small. Conclusion Although we found no overall change in attitudes after suicide preventive media campaigns, small changes, such as increased suicide preventive and mental health literacy, occurred in the male subgroup of those who have been exposed to the campaigns. Future suicide prevention media campaigns should consider targeting subgroups with elevated risk for suicide instead of the entire population. In addition, there are methodological aspects of the current exploratory study that should be investigated further.

Objective Bisexual + people experience higher rates of suicidality and self-harm compared to heterosexual and lesbian/gay people. We examined the association between sexual violence (SV) and suicidality, current urges to self-harm, and current suicidal intent among bisexual + college students. We tested whether posttraumatic stress disorder (PTSD) symptoms would explain these links and whether discrimination due to sexual minority identity (i.e., heterosexism) would exacerbate the association between SV severity and PTSD symptoms. Method Students were recruited from two large, public minority-serving universities. A subsample of 454 bisexual + students (ages 18–25; 73.6% cisgender women, 15.4% gender minority, 10.8% cisgender men; 50.2% White, 22.2% Black, 15.9% Asian; 21.8% Hispanic/Latino/a/x) were selected for the current study. Two indirect effects models were tested examining: (1) suicidality in the full sample, and (2) current urges to self-harm and suicidal intent in a subsample of 244 bisexual + students who screened positive for suicide risk. Results There was no interaction between SV severity and heterosexism. Both SV severity and heterosexism had direct associations with greater PTSD symptoms. In turn, greater PTSD symptoms explained the associations of SV severity and heterosexism with greater suicidality and likelihood to report current urges to self-harm and current suicidal intent. Conclusions SV severity and heterosexism appear to be important risk factors for suicidality and self-harm via PTSD symptoms among bisexual + young adults. Results suggest the need for prevention and public health intervention efforts to reduce risk for SV and discrimination due to sexual identity in addition to individual-level interventions to reduce PTSD symptoms.

Background Post-discharge phone interventions have shown efficacy in reducing suicide attempts during the high-risk period following psychiatric hospitalization. However, few studies have examined the feasibility and cost-effectiveness of such interventions in transitional age youth (TAY; ages 18–25), a group at elevated risk for suicidal behavior post-discharge. Methods TAY hospitalized psychiatrically for suicidal ideation or suicide attempt (n = 389) received a brief post-discharge telephone intervention consisting of three phone contacts within two weeks. Calls assessed suicidality and reinforced safety planning. Feasibility and costs were examined, along with predictors of outcomes (rehospitalization and suicide attempts within three months). Exploratory analyses compared the intervention cohort with a non-concurrent control group (n = 479) to tentatively examine outcome differences. Results Among TAY for whom an intervention attempt was made, 60.5% had at least one contact with intervention staff, with low intervention costs (<$60/person). Confidence in the safety plan on the day after discharge predicted suicidal behavior at 90 days. Exploratory analyses indicated similar rates of suicide attempts but higher rehospitalization rates in the intervention cohort versus control cohort. Discussion Brief, phone-based suicide prevention interventions are feasible and low-cost in real-world settings for TAY. They may help identify high-risk individuals (e.g., those with low confidence in the safety plans) to tailor additional supports. Exploratory results suggest potential benefits and feasibility, warranting further study through randomized controlled trials.

Objective There is a need to better understand, among people experiencing suicidal ideation (SI), who is at greatest risk of transitioning to suicide attempts. The present study assessed the moderating role of emotion dysregulation in the association of SI intensity and suicide attempts among participants experiencing distress. Method Linear, logistic, and hurdle negative binomial models tested associations in a high-risk sample of crisis hotline callers cross-sectionally and longitudinally over a two-week follow-up. Both the likelihood of attempting suicide and the number of suicide attempts were examined. Results Emotion dysregulation did not moderate the association of SI intensity with the likelihood of ever attempting suicide. However, higher SI intensity was cross-sectionally associated with more suicide attempts at lower levels of emotion dysregulation. Higher SI intensity prospectively predicted higher odds of a suicide attempt at the two-week follow-up. Conclusions Individuals with more intense SI are more likely to attempt suicide. However, among those with intense SI and a history of attempting, better emotion regulation was unexpectedly associated with more attempts. Further research is needed to disentangle the complex interrelations between SI intensity, suicide attempts, and emotion dysregulation.