Suicide In Adults Research Articles

The role of anxiety and depression in suicidal thoughts for autistic and non-autistic people: A theory-driven network analysis.

Autistic adults experience more frequent suicidal thoughts and mental health difficulties than non-autistic adults, but research has yet to explain how these experiences are connected. This study explored how anxiety and depression contribute to suicidal thoughts according to the Interpersonal Theory of Suicide for autistic and non-autistic adults. Participants (autistic adults n=463, 61% female; non-autistic n=342, 64% female) completed online measures of anxiety, depression, thwarted belonging, and perceived burdensomeness. Network analysis explored whether: (i) being autistic is a risk marker for suicide; and (ii) pathways to suicidal thoughts are consistent for autistic and non-autistic adults. Being autistic connected closely with feeling like an outsider, anxiety, and movement, which connected to suicidal thoughts through somatic experiences, low mood, and burdensomeness. Networks were largely consistent for autistic and non-autistic people, but connections from mood symptoms to somatic and thwarted belonging experiences were absent for autistic adults. Autistic people experience more life stressors than non-autistic people leading to reduced coping, low mood, and suicidal thoughts. Promoting belonging, reducing anxiety, and understanding the role of movement could inform suicide prevention for autistic people. Research should accurately capture autistic lived experience when modeling suicide to ensure suicide prevention meets autistic needs.

Precipitating Circumstances Associated With Intimate Partner Problem–Related Suicides

In 2020, suicide was the 12th leading cause of death among adults in the U.S. Previous research has shown that one common precipitating circumstance among adult suicide decedents is experiencing intimate partner problems (IPPs), such as divorce, separation, romantic break-ups, arguments, conflicts, and intimate partner violence. This study examines how precipitating factors differ between IPP- and non-IPP-related suicides. In 2022, this study analyzed National Violent Death Reporting System data from adult suicide decedents in 48 states and 2 territories between 2003 and 2020. Multivariable logistic regression models were used to compare precipitating circumstances between IPP- and non-IPP-related suicides, controlling for sociodemographic characteristics. Of the 402,391 suicides, 20% (n=80,717) were known to be IPP-related. Circumstances that significantly increased the odds of IPP-related suicides included a history of suicidal thoughts and attempts and mental health problems (depressed mood, alcohol problem, mental health diagnosis), life stressors (interpersonal violence perpetration and victimization, arguments, financial problems, job problems, family problems), and recent legal problems. Non-IPP-related suicides were more likely to occur among older individuals and to be precipitated by a physical health problem or crime. The findings can inform prevention strategies that build resiliency and problem-solving skills, strengthen economic support, and identify and assist people at risk for IPP-related suicides. The Centers for Disease Control and Prevention's Suicide Resource for Action and Intimate Partner Violence Prevention resource packages highlight the best available evidence for policies, programs, and practices related to preventing suicides and IPP.

A systematic review of the relationship between death anxiety, capability for suicide, and suicidality

This systematic review aimed to examine the relationship between death anxiety and suicidality in adults, and the impact of death anxiety interventions on the capability for suicide and suicidality. MEDLINE, PsycINFO, PubMed, and Web of Science were extensively searched using purpose-related keywords from the earliest to July 29th, 2022. A total of 376 participants were included across four studies which met inclusion. Death anxiety was found to relate significantly and positively with rescue potential, and although weak, negatively with suicide intent, circumstances of attempt, and a wish to die. There was no relationship between death anxiety and lethality or risk of lethality. Further, no studies examined the effects of death anxiety interventions on the capability for suicide and suicidality. It is imperative that future research implements a more rigorous methodology to establish the relationship between death anxiety and suicidality and establish the impacts of death anxiety interventions on the capability for suicide and suicidality.

Reasons for Suicide in Black Young Adults: A Latent Class Analysis.

Suicides have increased among Black youth in the US, though it remains unclear if these trends persist into young adulthood. Further, even less is known about the reasons why individuals begin to consider suicide as a viable option. The current study aims to redress these gaps by identifying specific reasons for suicide among a sample of 264 Black young adults who reported experiencing suicidal thoughts within the past 2weeks. Participants were recruited from an online panel. Reasons for suicide were measured using eight individual items/indicators. Latent class analysis was used to detect underlying patterns in Black young adults' reasons for considering suicide. The most commonly reported reason for considering suicide among the entire sample was feeling hopeless about the future. Black women were more likely to report considering suicide because they could not live up to other's expectations and because they felt lonely and sad. Findings for the 3-class model were retained. The first class is described as the "Somewhat hopeless and other reasons" class (n = 85; 32%). The second class is "Accomplished but extremely lonely and sad" (n = 24; 9%). The third class is described as "Pronounced feelings of failure, hopelessness, being overwhelmed, and lack of accomplishment" and includes 59% of the sample (n = 155). Culturally grounded clinical treatments and interventions are needed to meet the specific mental health needs of Black young adults. A particular focus on identifying factors that drive feelings of hopelessness and failure is warranted.

Association between adverse childhood experiences and the number of suicide attempts in lifetime

IntroductionAdverse childhood experiences (ACEs), defined as abuse, neglect, or a dysfunctional household in childhood, have been associated with suicidality (Fjeldsted et al., 2020). Every type of ACE has a direct impact on suicide ideation, self-harm and/or suicide attempt (Angelakis et al., 2019).ObjectivesWe aim to quantify the association between types of ACEs (including emotional, physical, sexual abuse, and emotional and physical neglect) and the number of suicide attempts in lifetime.MethodsWe included 748 patients who attempted suicide at least once. They were asked to complete the Columbia-Suicide Severity Rating Scale (CSSRS), and the Childhood Trauma Questionnaire-Short Form (CTQ-SF). Logistic regression models were run to assess the association between each ACE type and the number of suicide attempts.ResultsPoisson univariate regression analyses show a linear trend in the relationship between having a higher number of suicide attempts and having suffered every ACE type in childhood (p<0.05). Our results show a lower percentage of previous suicide attempts among participants without ACEs, and an increasing tendency among patients with various types of ACEs. The rate of ACEs types is significantly higher in the group with previous suicide attempts than in the first-attempt group (p=0.000).Image:Image 2:ConclusionsThis study contributes to clarify the role of childhood trauma in the number of suicide attempts in lifetime. This has important implications for reducing suicide rates, and preventing future re-attempts. Further studies analysing every construct of childhood trauma may contribute to the detection of suicidal behaviour.FundingsThis work was supported by the Instituto de Salud Carlos III (grant number: PI19/00941 SURVIVE) and co-funded by the European Union (grant numbers: COV20/00988, PI17/00768), the European Union’s Horizon 2020 research and innovation programme Societal Challenges (grant number: 101016127), and the Fundación Española de Psiquiatría y Salud MentalAcknowledgementsSURVIVE project (PI19/00941)KeywordsSuicide attempt, Adverse Childhood ExperiencesReferencesAngelakis, I., Gillespie, E. L., & Panagioti, M. (2019). Childhood maltreatment and adult suicidality: A comprehensive systematic review with meta-analysis. Psychological Medicine, 49(7), 1057-1078. https://doi.org/10.1017/S0033291718003823Fjeldsted, R., Teasdale, T. W., & Bach, B. (2020). Childhood trauma, stressful life events, and suicidality in Danish psychiatric outpatients. Nordic Journal of Psychiatry, 74(4), 280-286. https://doi.org/10.1080/08039488.2019.1702096Disclosure of InterestNone Declared

Mental Health Services Utilization among Suicidal Patients: Comparing the Impact of Co-Occurring Opioid or Other Substance Use Disorders

IntroductionPrior literature establishes bidirectional associations between suicide and substance use disorders (SUDs), particularly opioid use disorder (OUD). However, the context of mental health services utilization remains under-investigated. This analysis examined patterns of mental health services utilization in patients with SUDs and suicidality, identified associated risk factors, and evaluated the impact of patient engagement on subsequent mental health outcomesObjectivesSee above.MethodsElectronic health records (EHRs) derived from 7 health systems across New York City between 2010-2019 were analyzed. Suicidality was identified as any ICD-9/10 diagnosis of suicide attempt, suicidal ideation, or self-harm injury. SUDs were identified as any opioid, cannabis, cocaine, hallucinogen, inhalant, sedative/hypnotic/anxiolytic, amphetamine, or other substance abuse or dependence. Quasi-Poisson regression adjusted for age, gender, and chronic diseases was used to model associations between OUD exposure and the frequency of encounters and estimate the relative risk (RR) of significant covariates.ResultsA total of 6977 adults with suicidality and any comorbid SUD were selected, including 2203 (31.6%) with a diagnosis of OUD and 4774 (68.4%) without a diagnosis of OUD. Most patients were male (54.8%) and aged between 25-64 years (79.3%). Many (61.3%) had over 3 chronic diseases, including depression (80.8%), hypertension (60.6%), anemia (43.0%), and hyperlipidemia (41.9%). Compared to patients with other SUDs, those with OUD had higher odds of self-harm injury [OR: 1.26 (95% CI: 1.13-1.41)], depressive disorders [1.47 (1.29-1.67)], anxiety disorders [1.65 (1.48-1.84)], psychotic disorders [1.23 (1.11-1.37)], personality disorders [1.30 (1.16-1.48)], and post-traumatic stress disorder [1.37 (1.20-1.57)]. Patients with OUD were more likely to utilize all-cause outpatient (RR: 1.16), emergency department (ED) (RR: 1.43), and inpatient (RR: 1.60) services (p<0.001). Among OUD patients, males were less likely to have outpatient visits (RR: 0.79) and inpatient hospitalizations (RR: 0.88), and older age was protective against ED admissions (RR range: 0.62-0.71). Additionally, individuals with OUD were more likely than those with other SUDs to have SUD-related encounters, as well as suicide-related ED admissions and inpatient hospitalizations (p<0.0001). Those who had more mental health outpatient visits were less likely to have suicide-related ED admissions (RR: 0.85), however this association was weaker among younger or male patients with comorbid OUD.ConclusionsAmong suicidal adults with comorbid SUDs, those with a diagnosis of OUD were more likely to utilize mental health services and have psychiatric comorbidity. Males and older adults were less likely to utilize services.Disclosure of InterestNone Declared

Parasuicidal behavior in early stages of psychosis

IntroductionPsychotic experiences (PE) are strongly associated with non-suicidal self-harm (NSA). NSA are present throughout life, but are more frequent during adolescence and young adulthood. Early psychotic episodes (PEP) are a particularly vulnerable group compared to later phases of psychosis psychosis.ObjectivesAnalyze risk factors for suicide attempts and NSA, in order to improve early detection and prevention of suicides in adolescents and young adults with PDMethodsReview in the literature of the different risk factors associated with parasuicidal behaviors in early psychosisResults•Presence of positive psychotic symptoms: auditory hallucinations, Delusional ideation.•Social isolation•Longer duration of untreated psychosis.•Comorbid symptoms: irritability, depression, anxiety, psychotic distress, insomnia.•Traumatic events in childhood•Difficulty in regulating emotional, impulsivity and sensitivity to reward.•Consumption of substances.•Psychosocial stress.ConclusionsWe consider essential the inclusion of early intervention programs aimed at the prevention of suicide and NSA, evaluating all risk factors for suicide and NSA among individuals with a PEP and high-risk mental states.Initial assessment and ongoing assessments of suicide risk and parasuicidal behaviors, positive psychotic symptoms, depression, and the other related risk factors mentioned are required. Integrating trauma management into PEP care is critical.Bibliography:1.- Honings S, et al. Psychotic experiences and risk of self-injurious behaviour in the general population: a systematic review and meta-analysis. Psychol Med. 2016;46(02):237–51. doi: 10.1017/S00332917150018412.- Honings S, et al. Psychotic experiences and incident suicidal ideation and behaviour: Disentangling the longitudinal associations from connected psychopathology. Psychiatry Res. 2016;245:267–75. doi: 10.1016/j.psychres.2016.08.0023.- Nishida A, et al. Risk for suicidal problems in poor-help-seeking adolescents with psychotic-like experiences: Findings from a cross-sectional survey of 16,131 adolescents. Schizphr Res. 2014;159(2–3):257–62. doi: 10.1016/j.schres.2014.09.030 39.Disclosure of InterestNone Declared

Duloxetine: an effective treatment for fibromyalgia syndrome?

Duloxetine hydrochloride (duloxetine) is a powerful selective serotonin and norepinephrine reuptake inhibitor (SSRI), which in recent years has shown measurable success in treating a wide variety of disorders, including fibromyalgia syndrome (FMS). Among the clinical symptoms of FMS is the dysfunction of the monoamine systems in the nervous system, and since those are what duloxetine regulates, it is successful in managing its symptoms.1 Therefore, the United States Food and Drug Administration has cleared it for treating major depressive disorder, generalized anxiety disorder, for managing diabetic peripheral neuropathic pain and chronic musculoskeletal pain2. FMS is prevalent worldwide and affects nearly 1 in 20 people globally, including about 3 million adults in the United States3. Usually, patients diagnosed with FMS also have other chronic overlapping pain conditions and mental disorders, therefore it is uncommon to have FMS as an independent diagnosis4. Chronic stress exacerbates neuropathic pain by integrating stress affect–related information with nociceptive information in the amygdala’s central nucleus5,6. Its symptoms include restless sleep, fatigue, anxiety, depression, and problems regulating mood. There is a central magnification of pain signals, which evidence suggests is caused by the fact that both the ascending and descending pain pathways are functioning abnormally7. Although there is little evidence supporting this, it is believed that the symptoms are caused by neural over-sensitization, decreased conditioned pain modulation, combined with cognitive dysfunction, memory impairment, and altered information processing caused by negative events, stressful environments, or physical/emotional trauma8,9. Patients suffering from FMS have also been reported to experience a phenomenon known as fibrofog, which entails a decreased ability to think and process new information. The inference that disruptions in the perception of physiological pain, sleep, fatigue, cognition, and mood (hallmark symptoms of patients with FMS) may be consequences of abnormalities in serotonin and norepinephrine metabolism and transmission is supported by the fact they are both important regulators of these functions in healthy individuals10. Duloxetine works by reinforcing the serotonergic and adrenergic pathways involved in descending inhibition of pain at the dorsal horn of the spinal cord. The subsequent increased threshold for pain stimuli to reach the brain results in significant neuropathic pain relief. In a study, Write et al11 concluded that because the average FMS patient is on 3–6 medications to manage the symptoms, there may be an increased risk for the drug-to-drug interactions. Serotonin toxicities can develop from using serotonergic drugs and duloxetine simultaneously as it can lead to adverse drug-drug interactions12. Furthermore, little is known about how it may affect pregnancies or lead to complications for the mother and child before and after delivery. SSRIs increase the possibility of developing suicidality in children and young adults aged 18–24, which is one of its more tendentious side effects. Thus, the FDA has released a black box warning for duloxetine use13. Furthermore, duloxetine increases both levels of serotonin and norepinephrine, which directly results in tachycardia and hypertension14. Even though systematic reviews have proven its effectiveness in pain management, improving symptoms in up to 80% of patients, a careful examination of its adverse effects and advantages must be taken into consideration when prescribing SSRIs to any patient13,14. Diagnosis and eventual management of this disease are delayed because patients usually present with a variety of symptoms15. FMS patients must spend up to $35,920 on health care every year in the United States to treat the various symptoms of this disease16. Frequent physical therapy appointments to reduce stiffness, frequent blood work, and hospital visits take up significant time and place a financial strain on the patient. In a recent study, it was found that most patients with FMS view themselves as being moderate to severely disabled. The intensity of pain they experience and psychological factors (alexithymia and depression) were found to be the main reasons for this17. Clear, distinct guidelines for its diagnosis should be established so as not to delay the beginning of treatment, and awareness needs to be created among clinicians in third-world countries about this disease as well. Newer, more effective drugs need to be designed to not only improve the patient’s quality of life but to reduce the burden on the already overwhelmed health care systems as well. Ethical approval None. Sources of funding None. Authors’ contribution N.E.: wrote the article, suggested a topic, conducted a literature search A.E.: conducted a final review and corrections Conflicts of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor Naz Elahi.

Adapted suicide safety plans to address self-harm, suicidal ideation, and suicide behaviours in autistic adults: protocol for a pilot randomised controlled trial

BackgroundSuicide prevention is a national priority for the UK government. Autistic people are at greater risk of experiencing self-harm and suicidal thoughts and behaviours than the general population. Safety plans are widely used in suicide prevention but have not yet been designed with and for autistic people. We developed the first safety plan specifically targeting suicidality in autistic adults: the Autism Adapted Safety Plan (AASP). It consists of a prioritised list of hierarchical steps that can be used prior to or during a crisis to mitigate risk of self-harm and suicidal behaviour. This is a pilot study that aims to assess the feasibility and acceptability of the AASPs and the research processes, including the response rates, potential barriers and reach of AASPs, methods of recruitment, what comprises usual care, and economic evaluation methods/tools.MethodsThis is an external pilot randomised controlled trial of a suicide prevention tool aimed at mitigating the risk of self-harm and suicidal behaviour in autistic adults: AASPs. Participants will be assessed at baseline and followed up 1 month and 6 months later. Assessments include questions about self-harm, suicidality, service use, and their experience of the AASP/taking part in the study. Autistic adults who have a clinical autism diagnosis and self-reported history of self-harm, suicidal thoughts, or suicidal behaviours within the last 6 months will be invited to take part in the study. Informed consent will be obtained. Participants will be recruited via community and third sector services (including community settings, autism charities, and mental health charities). They may also “self-refer” into the study through social media recruitment and word of mouth. Ninety participants will be randomised to either develop an AASP or receive their usual care in a 1:1 ratio.DiscussionThe present study will provide an evaluation of the suitability of the processes that would be undertaken in a larger definitive study, including recruitment, randomisation, methods, questionnaires, outcome measures, treatment, and follow-up assessments.Trial registrationISRCTN70594445, Protocol v4: 8/2/22.

Co-occurring suicidal ideation and alcohol-related problems: An intersectional analysis of Native American and White adults with minoritized sexual identities

BackgroundDisparities in suicidal ideation (SI) and alcohol use disorder (AUD) are evident in both Native American and minoritized sexual identity groups, relative to non-Hispanic White and heterosexual groups. However, Native Americans report lower drinking and binge drinking rates than White adults. Persons with intersecting identities, specifically Native Americans with minoritized sexual identities, may be at greater risk for SI and drinking, binge drinking, and AUD than White and Native American heterosexual adults. MethodsFive years (2015–2019) of National Survey of Drug Use and Health data were combined (N = 130,157). Multinomial logistic regressions tested racial (Native American vs White) and sexual identity (lesbian/gay/bisexual vs heterosexual) differences in odds of SI, drinking, and co-occurring SI + drinking, versus neither SI/drinking. Subsequent analyses examined SI + binge drinking, and SI + AUD. ResultsCompared to White heterosexual adults, Native American heterosexual adults reported lower co-occurring SI + drinking odds, whereas Native American sexual minoritized adults reported higher odds. Native American sexual minoritized groups showed greater co-occurring SI + binge drinking odds and greater co-occurring SI + AUD odds compared to White heterosexual adults. Native American sexual minoritized adults showed greater SI only compared to White sexual minoritized adults. Sexual minoritized Native Americans showed higher odds of co-occurring SI + drinking, binge drinking, and AUD than White heterosexual adults. ConclusionsNative American sexual minoritized groups showed higher likelihood of co-occurring SI + drinking, binge drinking, and AUD relative to both White and Native American heterosexual adults. Disparities warrant outreach for suicide and AUD prevention for Native American sexual minoritized adults.

Young Adult Outcomes Associated With Adolescent Suicidality: A Meta-analysis.

Suicide is one of the leading causes of death among adolescents worldwide. Adolescents who present with suicidality may be at an increased risk for future mental illness and suicidality in young adulthood. The objective of this study was to systematically assess the relationship between adolescent suicidal ideation and suicide attempts (suicidality) and young adult psychopathological outcomes. Medline, Embase, and PsychInfo (OVID Interface) were searched for articles published before August 2021. Included articles were prospective cohort studies that compared young adult (19-30 years) psychopathological outcomes between suicidal and nonsuicidal adolescents. We extracted data related to suicidality in adolescence, mental health outcomes in young adulthood, and covariates. Outcomes were analyzed via random-effect meta-analyses and reported using odds ratios. Of 9401 references screened, we included 12 articles comprising over 25 000 adolescents. Four outcomes were meta-analyzed: depression, anxiety, suicidal ideation, and suicide attempt. Adjusted meta-analyses showed that adolescent suicidal ideation was associated with young adult suicide attempt (odds ratio [OR] = 2.75, 95% confidence interval [CI]:1.70-4.44), depressive disorders (OR = 1.58, 95% CI: 1.20-2.08), and anxiety disorders (OR = 1.41, 95% CI: 1.01-1.96), whereas adolescent suicide attempts were associated with young adult suicide attempt (OR = 5.71, 95% CI: 2.40-13.61), and young adult anxiety disorders (OR = 1.54, 95% CI: 1.01-2.34). Results for young adult substance use disorders were mixed. Significant heterogeneity between studies was observed because of differences in timing, method of assessments, and covariate adjustment. Adolescents experiencing suicidal ideation or with a history of suicide attempt may have increased odds of further suicidality or mental disorders in young adulthood.

34. Suicidality and Psychiatric Comorbidities in Sexual Minority Adolescents and Young Adults Hospitalized for Eating Disorders

34. Suicidality and Psychiatric Comorbidities in Sexual Minority Adolescents and Young Adults Hospitalized for Eating Disorders

Negative Urgency, (Lack of) Premeditation, and Sensation Seeking: Indirect Relationships with Suicidal Ideation through Thwarted Interpersonal Needs

Objective Differences in how impulsivity is conceptualized, along with a myopic focus on impulsivity’s relationship with historical suicidal behaviors, have resulted in limited implications made from prior research regarding impulsivity and suicidal thoughts and behaviors. The current study investigated the indirect effect facets of impulsivity may have on suicidal ideation, specifically, through thwarted interpersonal needs. Methods Participants were N = 424 undergraduate students who completed a cross-sectional survey. Participants completed the Urgency, Premeditation, Perseverance, Sensation Seeking, Impulsive Behavior Scale (UPPS), the Adult Suicide Ideation Questionnaire (ASIQ), and the Interpersonal Needs Questionnaire (INQ). Parallel mediation models were run to examine the relation between facets of impulsivity, perceived burdensomeness, thwarted belongingness, and suicidal ideation. Results Thwarted belonginess and perceived burdensomeness significantly accounted for the variance in the relation between negative urgency and suicidal ideation. Neither thwarted belongingness nor perceived burdensomeness significantly explained variance in the relation between (lack of) premeditation and suicidal ideation. Conversely, perceived burdensomeness and thwarted belonginess significantly explained the inverse relation between sensation seeking and suicidal ideation (i.e., greater sensation seeking was related to lower perceived burdensomeness and thwarted belongingness and in turn lower suicidal ideation). Conclusion Negative urgency, in particular, is related to suicidal ideation through thwarted interpersonal needs. Future research should continue to differentiate between various types of impulsivity and its relationship with both suicidal ideation and behaviors utilizing both cross-sectional and ambulatory assessments of these constructs. HIGHLIGHTS Negative urgency is related to suicidal ideation. Negative urgency is related to thwarted interpersonal needs. Thwarted interpersonal needs partially explain the relation between negative urgency and suicidal ideation.

The increase in suicide risk in older adults in Taiwan during the COVID-19 outbreak

BackgroundStudies from Western countries indicated that older adults were more resilient than younger ones to deteriorating mental health during the COVID-19 pandemic. As high late-life suicide rates have been reported in East Asia, it is possible that the pandemic impact might differ between East and West. We investigated the pandemic impact on age-specific suicide patterns in Taiwan. MethodsInterrupted time-series analysis was used to model the overall, and age-stratified, monthly suicide rates before (January 1st, 2017 to December 31st, 2019) and after (January 1st 2020 to December 31st 2021) the COVID-19 outbreak. Associations between confirmed COVID-19 deaths and suicide rates were also assessed. ResultsThere was a significant decrease in overall suicide rates after the COVID-19 outbreak (p < 0.01) (annual average rates per 100,000 population of 16.4 prior, 15.2 after). The overall decrease was driven by fewer suicide deaths in the young- and older-middle-aged groups (25–44 and 45–64 years). However suicide rates in younger-age group (<25 years) were already increasing pre-pandemic, a trend which continued after the outbreak. Suicide rates for older people (≥65 years) also increased along with the increasing number of COVID-19 deaths during the pandemic period. LimitationsUnder-reporting and/or misclassification of suicides were possible. ConclusionsThe overall suicide rates in Taiwan did not change after the COVID-19 outbreak; however, suicide in older adults increased. Public health measures to reduce COVID-19 infections may have unintended and adverse consequences on the psychological wellbeing of older citizens.

PSYCHOPATHOLOGICAL DISTRESS AND SUICIDE AMONG ADULTS WITH MAJOR DEPRESSIVE DISORDER: THE MODERATING ROLE OF RESILIENCE AND MEDIATING ROLE OF DELIBERATE SELF-HARM

Background and Purpose: In the past year, 6.6% of patients with major depressive disorders attempted suicide. Suicidal ideation and behavior may be protected by resilience. Despite decades of research on suicide risk factors in young people, our understanding of the phenomenon has not improved significantly. Therefore, the current study aimed to investigate the relationship between Psychopathological Distress and Suicide in Adults with Major Depressive Disorder. The current study also examines Moderating Role of Resilience and Mediating role of Deliberate Self-Harm among Adults with Major Depressive Disorder.&#x0D; &#x0D; Methodology: Correlational research design was used in the present study. Data was taken from (n=300) adults with major depressive disorder through purposive sampling strategy. Attitude toward deliberate self-harm questionnaire, Columbia suicide screener, brief resilience scale, depression anxiety stress scale and beck depression inventory-II were used as an assessment measure.&#x0D; &#x0D; Findings: The result showed that psychopathological distress (r = .04, p &lt; .005) with suicide, and, resilience significant negative (r = -.11, p &lt; .004) relationship with suicide. However, deliberates self-harm (r = .21, p = .001) showed a significant positive relationship with suicide. Regression findings found that all models were significant. In the first step (ΔR2 = .02, F (1, 298) = .51, p = .000) psychopathological distress was a statistically significant predictor (β = .04, p = .000), In the second model (ΔR2 = -.06, F (2, 297) = 2.23, p &lt; .004) resilience (β = -.11, p = .004) was significant predictor of suicide. In the third model (ΔR2 = -.03, F (3, 296) = 4.95, p &lt; .001) deliberate self-harm (β = .23, p = .001) was significant predictor of suicide. In addition, mediation analysis revealed that deliberate self-harm was a significant (p = .05) mediator between psychopathological distress and suicide. Moderating findings showed significant interaction effect of psychopathological distress x resilience (B= -1.42, p= .00) and it revealed that resilience play a significant (p = .05) moderating role between psychopathological distress and suicide.&#x0D; &#x0D; Contributions. The study concludes that higher level of psychopathological distress and deliberate self-harm leads toward higher level of suicide which cause severe level of major depressive disorder. The present study will help to understand to enhance the resilience which reduce deliberate self-harm and suicide act among adults with major depressive disorder.&#x0D; &#x0D; Keywords: Psychopathological distress, resilience, deliberate self-harm, suicide, adults, major depressive disorder.&#x0D; &#x0D; Cite as: Qamar, T. (2023). Psychopathological distress and suicide among adults with major depressive disorder: The moderating role of resilience and mediating role of deliberate self-harm. Journal of Nusantara Studies, 8(1), 226-245. http://dx.doi.org/10.24200/jonus.vol8iss1pp226-245

Epidemiology of mental health comorbidity in patients with psoriasis: An analysis of trends from 1986 to 2019

BackgroundThe prevalence of mental disorders such as depression, anxiety, and suicide has increased in patients with psoriasis, although no study has systematically analyzed the epidemiology worldwide. ObjectiveTo explore the prevalence and incidence of psoriasis with comorbid mental disorders (i.e., depression, anxiety, and suicide). MethodsFive databases from establishment through May 2022 were searched. Stata SE 15.1 was used for the data analysis. Subgroup, meta-regression, and sensitivity analyses were used to evaluate the heterogeneity of pooled studies. ResultsWe evaluated 56 studies in our research. The prevalence of depression, anxiety, and suicide in adults with psoriasis was 20%, 21%, and 0.77%. Patients with psoriasis in North America had a higher prevalence of depression and suicide, whereas those in South America had a higher prevalence of anxiety. The incidence of depression, anxiety, and suicide was 42.1, 24.7, and 2.6 per 1000 person-years in adults with psoriasis, respectively. LimitationsAll of the included studies were published in Chinese and English, causing a degree of selection bias. ConclusionThese findings demonstrate the incidence and prevalence of comorbid mental disorders in patients with psoriasis, which may raise awareness among physicians and patients regarding the mental problems associated with psoriasis.

State Gun Regulations and Reduced Gun Ownership are Associated with Fewer Firearm-Related Suicides Among Both Juveniles and Adults in the USA

BackgroundFew studies have investigated the relationship between specific gun regulations and gun ownership with the firearm-related suicide rate among juveniles and adults across U.S. states. Therefore, this study seeks to determine if gun ownership rates and gun restrictions are related to the firearm-related suicide rate in both the pediatric and adult populations. MethodsFourteen measures of state gun law restrictions and gun ownership were collected. These included Giffords Center ranking, gun ownership percentages, and 12 specific firearm laws. Unadjusted linear regressions modeled the relationship between each individual variable and the rate of firearm-related suicides for adults and children across states. This was repeated using a multivariable linear regression adjusting for poverty, poor mental health, race, gun ownership, and divorce rates by state. P values of <0.004 were considered significant. ResultsIn the unadjusted linear regression, 9 of 14 firearm-related measures were statistically associated with fewer firearm-related suicides in adults. Similarly, 9 of 14 measures were found to be associated with fewer firearm-related suicides in the pediatric population. In the multivariable regression, 6 of 14 vs. 5 of 14 measures were statistically associated with fewer firearm-related suicides in the adult and pediatric populations, respectively. ConclusionsUltimately, this study found that increased state gun restrictions and lower gun ownership rates were associated with fewer firearm related suicides among juveniles and adults in the US. This paper provides objective data to help lawmakers as they create gun control legislation that can potentially decrease the rate of fire-arm related suicide. Levels of EvidenceII

Vitamin D and suicidality: a Chinese early adolescent cohort and Mendelian randomization study.

Previous cross-sectional and case-control studies have proposed that decreased vitamin D levels are positively correlated with the risk of suicidality in adults. However, limited studies have examined the association between vitamin D and suicidality in adolescents. This study aimed to investigate the relationship between serum vitamin D and suicidality risk among early adolescents. Data were obtained from a Chinese early adolescent cohort. In this cohort, seventh-grade students from a middle school in Anhui Province were invited to voluntarily participate in the baseline assessments and provide peripheral blood samples (in September 2019). The participants were followed up annually (in September 2020 and September 2021). Serum 25-hydroxyvitamin D [25(OH)D] and vitamin D-related single-nucleotide polymorphisms at baseline were measured in November 2021. Traditional observational and Mendelian randomization (MR) analyses were performed to examine the relationship between serum 25(OH)D at baseline and the risk of baseline and incident suicidality (i.e., suicidal ideation [SI], plans and attempts). Traditional observational analysis did not reveal a significant linear or non-linear association of serum 25(OH)D concentration with the risks of baseline and 2-year incident suicidality in the total sample (P>.05 for all). Sex-stratified analysis revealed a non-linear association between the 25(OH)D concentration and the risk of baseline SI in women (Poverall=.002; Pnon-linear=.001). Moreover, the risk of baseline SI in the 25(OH) insufficiency group was lower than that in the 25(OH) deficiency group in the total sample (odds ratio [OR]=0.69, 95% confidence interval [CI]=0.51-0.92, P=.012). This difference remained significant in women (OR=0.59, 95% CI=0.40-0.87, P=.008) but not in men (OR=0.78, 95% CI=0.53-1.15, P=.205). Additionally, both linear and non-linear MR analyses did not support the causal effect of serum 25(OH)D concentration on the risk of baseline, 1-year and 2-year incident suicidality (P>.05 for all). This study could not confirm the causal effect of vitamin D on suicidality risk among Chinese early adolescents. Future studies must confirm these findings with a large sample size.

Transition to retirement impact on risk of depression and suicidality: results from a longitudinal analysis of the Survey of Health, Ageing and Retirement in Europe (SHARE).

Depression is among the main contributors to older adults' mental health burden. Retirement, one of the major life transitions, has been claimed to influence mental health substantially. Following up on a previous meta-analysis, the study aims to assess from a longitudinal perspective short- and long-term impacts of transitioning to retirement on depression risk and suicidality in older adults across Europe. We conducted a longitudinal study using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), collected between 2004 and 2020 in 27 European countries plus Israel. To estimate relative risks (RR) and 95% confidence intervals (95% CIs) for depression and suicidality at seven time intervals before and after retirement, we fitted adjusted generalized estimating equation models for repeated measures. We included 8,998 individuals employed at baseline and retired at follow-up (median follow-up time: 9years; maximum: 16years). Compared to the year of retirement, the risk of depression was 11% lower in the following year (RR 0.89; 95% CI 0.81-0.99), 9% lower after 2years (RR 0.91; 95% CI 0.82-1.00) and after 3years (RR 0.91; 95% CI 0.81-1.01). Significant estimates remained among females, married individuals, those with an intermediate or higher level of education, former manual workers and those who retired at or before their country's median retirement age. A significant increase in depressive symptoms emerged from the tenth year after retirement among former non-manual workers (RR 1.21; 95% CI 1.05-1.40) and late retirees (RR 1.37; 95% CI 1.16-1.63). No heterogeneity emerged among strata. As for suicidality, we reported an increase in risk only 5years or more after retirement, namely +30% 5-9years after retirement (RR 1.30; 95% CI 1.04-1.64) and +47% 10 or more years after retirement (RR 1.47; 95% CI 1.09-1.98). Sensitivity analyses excluding subjects who reported a diagnosis of depression over the study period and those retirees who declared to receive a disability pension confirmed the results obtained in the overall analysis. Longitudinal adjusted data suggest an independent effect of retiring associated with a reduction in depression and suicidality risk in the short run, with its effect decreasing in the long run. Such trends are particularly evident among selected subgroups of elderly populations. If greater flexibility in pensionable age may help prevent depression late in life, the transition to retirement is to be accompanied by targeted health promotion interventions. In an ageing society, welfare policies should be evaluated, considering their long-term impact on mental health.

Development of an IEC resource (brochure) on suicide prevention for college students: A qualitative study in the Indian context.

Information Education Communication (IEC) materials play a vital role in behavior change by raising awareness about health issues. In India, suicide is the leading cause of death in the age group of 15-39 years, exemplifying the pressing need for raising awareness about suicide prevention. This study aimed to develop a brochure on suicide prevention for young adults with the help of scientific methodology. A cross-sectional qualitative research design was used in the study, and purposive sampling was used to collect the data. The study analyzed the awareness level and existing knowledge gap about suicide prevention among college students with the help of focus group discussions (FGDs) conducted independently among mental health experts, college teachers, and college students. Based on the findings from the FGDs, a comprehensive brochure was developed. The qualitative data collected by FGDs were analyzed using direct content analysis. The findings of the FGDs helped identify the knowledge gaps with regard to young adult suicide prevention, and a brochure was prepared to address the same. The development of young adult suicide prevention IEC resources pertinent to Indian settings is crucial. To bridge the knowledge gap on suicide prevention among college students and raise awareness, a brochure was developed based on scientific findings of the FGDs.