Suicide Risk Assessment Research Articles

Examining optimism and flourishing as protective factors of suicidality across the adult lifespan: A cross-sectional investigation in three Spanish age groups

We examined optimism and flourishing as unique protective predictors of suicidality (viz., suicidal ideation and suicidal behaviors) in a cross-sectional study of young adults (18–35 years), middle-aged adults (36–55 years), and older adults (≥56 years). Young adults were found to have higher levels of suicidal ideation and suicidal behaviors compared to middle-aged and older adults. Controlling for depressive symptoms, the results of conducting regression analyses consistently implicated flourishing as a distinct predictor of lower suicidal ideation and suicidal behaviors in young adults and middle-aged adults. However, for older adults, only optimism was found to be a unique predictor of lower suicidal ideation and suicidal behaviors. Implications of the present findings for understanding the differential role of optimism and flourishing in accounting for suicidality across the adult lifespan are discussed.

Clinical utility of depression measures and symptoms: Implications for suicide risk assessment in high risk, resource limited youth populations.

Suicide risk for youth in resource- limited settings has been largely underrepresented in the literature and requires targeted examination of practical ways to address this growing public health concern. The present study focuses on the clinical utility of depression risk assessment tools addressing how and for whom suicide prevention intervention is most beneficial within a low-middle-income-country, high suicide risk youth sample. Youth who reported a previous suicide attempt versus those who did not were criterion to test the validity of depression and hopelessness symptom assessment tools. We used item analyses to identify depressive symptom endorsements that most informed youth suicide risk, which will better equip rural practitioners for targeted intervention and monitoring of youth with an already high risk for suicide. Findings demonstrated that practitioners may target symptoms of social anhedonia, depressed mood, concentration disturbance, feelings of worthlessness, sleep disturbance, and fatigue for suicide prevention-intervention efforts among high-risk youth. Study implications are for clinicians' use of the BDI-II and CES-D for depression symptom identification and suicide risk monitoring in settings with limited mental health infrastructure.

Sociodemographic and psychosocial risk factors of railway suicide a mixed-methods study combining data of all suicide decedents in the Netherlands with data from a psychosocial autopsy study

BackgroundRailway suicide has profound implications for the victims and their family, and affects train drivers, railway personnel, emergency services and witnesses. To inform a multilevel prevention strategy, more knowledge is required about psychosocial and precipitating risk factors of railway suicide.MethodsData from Statistics Netherlands of all suicides between 2017 and 2021 (n = 9.241) of whom 986 died by railway suicide and interview data from a psychosocial autopsy of railway suicide decedents (n = 39) were integrated. We performed logistic regression analyses to identify sociodemographic predictors of railway suicide compared to other methods of suicide. The Constant Comparative Method was subsequently employed on interview data from the psychosocial autopsy to identify patterns in psychosocial risk factors for railway suicide.ResultsThe strongest predictors of railway suicide compared to other suicide methods were young age (< 30 years old), native Dutch, a high educational level, living in a multi-person household (especially living with parents or in an institution), living in a rural area and a high annual household income of > 150.000 euros. Several subgroups emerged in the psychosocial autopsy interviews, which specifically reflect populations at risk of railway suicide. These subgroups were [1] young adult males with autism spectrum disorder who strived for more autonomy and an independent life, [2] young adult females with persistent suicidal thoughts and behaviours, [3] middle-aged males with a persistent mood disorder who lived with family and who faced stressors proximal to the suicide in personal and professional settings, [4] male out-of-the-blue suicides and [5] persons with psychotic symptoms and a rapid deterioration.Conclusionsbased on our findings we propose and discuss several recommendations to prevent railway suicide. We must continue to invest in a safe railway environment by training personnel and installing barriers. Additionally, we should adopt prevention strategies that align the needs of subgroups at increased risk, including young females who have attempted other methods of suicide and young males with autism spectrum disorder. Future research should determine the cost-effectiveness and feasibility of low-maintenance, automated interventions near crossings and psychiatric facilities.

Suicidality, gender identity-related stressors, and psychological flexibility among transgender and non-binary adults

Transgender and nonbinary (TGNB) individuals are at increased risk for suicidality, with gender identity-related distal (i.e., external) and proximal (i.e., internal) stressors (e.g., discrimination and internalized cissexism) potentially contributing to risk. Psychological flexibility and inflexibility have served as protective and risk factors for suicidality among the general population but has yet to be investigated among TGNB individuals and their unique stressors. The current study examined whether psychological flexibility and inflexibility moderated the relationship between minority stressors and suicidality. Participants (n = 333) were recruited from Reddit, Facebook, and organizations that serve gender diverse individuals. Psychological flexibility and inflexibility did not moderate relationships between stressors and suicidality. Exploratory analyses demonstrated that psychological inflexibility contributed to the prediction of suicidality over and above stressor and demographic variables, supporting its importance in a TGNB population. Implications of findings are discussed.

An International Classification of Functioning, Disability and Health Model-Based Analysis of Suicidal Ideation among 9920 Community-Dwelling Korean Older Adults.

Many complex factors contribute to suicide in older adults. The suicidal ideation that precedes suicide is an especially direct predictor of suicide. This study aimed to identify the effects between variables affecting suicidal ideation among older adults using the International Classification of Functioning, Disability and Health (ICF) model and understand the causal relationships to systematize complex factors. This study used data from 9920 community-dwelling older adults who completed a national survey in 2020 to classify predictors of suicidal ideation (e.g., depression, subjective health status, sociodemographic factors, health factors, social support, instrumental activities of daily living (IADL), and social participation) by using the ICF model. To determine the causal relationship between variables, this study examined significance based on the critical ratio (C.R.) and squared multiple correlation (SMC) by using a path model. Gender, education level, economic level, age, IADL, relationship satisfaction with a child, depression, and the number of chronic diseases significantly affected suicidal ideation, while age, employment status, participation in social groups, formal and informal support, satisfaction with a friend/neighbor relationship, and subjective health status did not significantly influence it. Moreover, depression mediated the relationship between each of these variables and suicidal ideation. It was found that depression was the most direct and mediating factor in suicidal ideation among many factors affecting the suicidal ideation of community-dwelling older adults. Additional studies should be conducted to develop community-level strategies based on these factors and understand causal relationships.

Implicit or explicit self-associations with life and death? Predicting short-term self-injurious thoughts and behaviors among adolescents

Implicit self-association with death, measured by the Death/Suicide-Implicit Association Test (D/S-IAT), predicts short-term Self-Injurious Thoughts and Behaviors (SITBs) among adolescents. However, comparing the predictive utility of the D/S-IAT with explicit (i.e. self-report) self-association with life and death was not examined previously. The current study sought to examine whether the D/S-IAT and explicit self-association with life and death predict current and prospective SITBs, and to examine the association between the two measures. One-hundred and thirty-one Jewish Israeli adolescents with SITBs, aged 10-18 years (74.8% female) were assessed at clinic intake. Participants completed D/S-IAT, depression, attitudes toward life and death and suicide risk assessment at intake and one-month follow-up. Implicit, rather than explicit, attitudes toward life and death predicted SITBs at one-month follow-up, beyond depression and past SITBs. The implicit and explicit measures were not significantly related at intake, indicating that they might capture different aspects of SITBs.

Prediction of suicidal ideation among preadolescent children with machine learning models: A longitudinal study

BackgroundMachine learning (ML) has been widely used to predict suicidal ideation (SI) in adolescents and adults. Nevertheless, studies of accurate and efficient models of SI prediction with preadolescent children are still needed because SI is surprisingly prevalent during the transition into adolescence. This study aimed to explore the potential of ML models to predict SI among preadolescent children. MethodsA total of 4691 Chinese children (54.89 % boys, Mage = 10.92 at baseline) and their parents completed relevant measures at baseline and the children provided 6-month follow-up data for SI. The current study compared four ML models: Random Forest (RF), Decision Tree (DT), Support Vector Machine (SVM), and Multilayer Perceptron (MLP), to predict SI and to identify variables with predictive value based on the best-performing model among Chinese preadolescent children. ResultsThe RF model achieved the highest discriminant performance with an AUC of 0.92, accuracy of 0.93 (balanced accuracy = 0.88). The factors of internalizing problems, externalizing problems, neuroticism, childhood maltreatment, and subjective well-being in school demonstrated the highest values in predicting SI. ConclusionThe findings of this study suggested that ML models based on the observation and assessment of children's general characteristics and experiences in everyday life can serve as convenient screening and evaluation tools for suicide risk assessment among Chinese preadolescent children. The findings also provide insights for early intervention.

Suicide in Military and Veteran Populations: A View Across the Five Eyes Nations

Objective This commentary highlights challenges and opportunities in suicide prevention across the military and veteran populations of the Five Eyes nations. Methods Trends in suicides and suicidality in military and veteran populations are outlined, as well as identified risk and protective factors, and approaches to suicide prevention. Results Suicide risk is higher in veterans compared to current serving and community samples. Despite extensive research, the causation, prediction, and prevention of suicide, is still not well understood. We propose areas for further attention in prevention strategies. Conclusion Suicide and suicidality are issues of concern in military and veteran populations. Suicide prevention requires commitment to continuous improvement through research, analysis, and incorporation of evolving best practice.

Machine Learning-Based Prediction of Suicidality in Adolescents With Allergic Rhinitis: Derivation and Validation in 2 Independent Nationwide Cohorts.

Given the additional risk of suicide-related behaviors in adolescents with allergic rhinitis (AR), it is important to use the growing field of machine learning (ML) to evaluate this risk. This study aims to evaluate the validity and usefulness of an ML model for predicting suicide risk in patients with AR. We used data from 2 independent survey studies, Korea Youth Risk Behavior Web-based Survey (KYRBS; n=299,468) for the original data set and Korea National Health and Nutrition Examination Survey (KNHANES; n=833) for the external validation data set, to predict suicide risks of AR in adolescents aged 13 to 18 years, with 3.45% (10,341/299,468) and 1.4% (12/833) of the patients attempting suicide in the KYRBS and KNHANES studies, respectively. The outcome of interest was the suicide attempt risks. We selected various ML-based models with hyperparameter tuning in the discovery and performed an area under the receiver operating characteristic curve (AUROC) analysis in the train, test, and external validation data. The study data set included 299,468 (KYRBS; original data set) and 833 (KNHANES; external validation data set) patients with AR recruited between 2005 and 2022. The best-performing ML model was the random forest model with a mean AUROC of 84.12% (95% CI 83.98%-84.27%) in the original data set. Applying this result to the external validation data set revealed the best performance among the models, with an AUROC of 89.87% (sensitivity 83.33%, specificity 82.58%, accuracy 82.59%, and balanced accuracy 82.96%). While looking at feature importance, the 5 most important features in predicting suicide attempts in adolescent patients with AR are depression, stress status, academic achievement, age, and alcohol consumption. This study emphasizes the potential of ML models in predicting suicide risks in patients with AR, encouraging further application of these models in other conditions to enhance adolescent health and decrease suicide rates.

Suicidal ideation prediction based on social media posts using a GAN-infused deep learning framework with genetic optimization and word embedding fusion

Suicidal ideation prediction based on social media posts using a GAN-infused deep learning framework with genetic optimization and word embedding fusion

Occurrence and predictors of lifetime suicidality and suicidal ideation in autistic adults.

Over the past few years, more and more research is showing that many autistic people are at an increased risk for suicide. In this study, we asked participants from the Netherlands Autism Register, which is longitudinal register including individuals with autism, about their possible experiences with thoughts and feelings about suicide. Specifically, we looked at whether these thoughts and feelings in their lifetime and in the past month were related to various factors (such as their age, gender, and having psychiatric disorder diagnoses). We found that 80% of the participants had experienced thoughts about or even attempted to take their own life at least once throughout their lifetime. Furthermore, in a subgroup of participants, we found that the presence of a psychiatric disorder diagnosis, feelings of loneliness, and a higher number of autistic traits were associated with experiencing suicidal thoughts and feelings in their lifetime. For those who experienced these suicidal thoughts in the past month, we found that having (multiple) psychiatric disorder diagnoses and a higher number of autistic traits were related to more severe and frequent thoughts about suicide in the past month. Our findings show that additional factors in autistic individuals should be considered when assessing the suicide risk, and it brings us one step closer to understanding why suicide is more common for autistic people.

Suicide risk in transition-aged autistic youth: The link among executive function, depression, and autistic traits.

Autistic people are more likely to consider suicide than non-autistic people, with transition-aged youth (ages 16-21 years) at potentially the highest risk. Research has also shown that difficulties with executive functioning (e.g., difficulties with organization, sequencing, and decision-making) may heighten suicide risk among non-autistic people, but it is not clear whether this is also true for autistic people. This study explored this question by asking 183 transition-aged autistic youth about their experience with suicidal behavior and examining the relationship between their responses and additional measures of depression, autistic traits, and executive function skills. About one-third of autistic transition-aged youth (33.3%) said that they had experienced thoughts of hurting themselves with the intent to end their lives (i.e., suicidal ideation). Both depression and executive function challenges predicted suicide risk (i.e., participants who experienced depression were more likely to have had suicidal thoughts than those who had not, and participants who had more difficulty with executive function skills were more likely to have had suicidal thoughts than those who had less difficulty). These findings suggest that executive functioning, a common area of difficulty among autistic people, is an important indicator of suicide risk in this population.

The effects of childhood trauma on stress-related vulnerability factors and indicators of suicide risk: An ecological momentary assessment study

BackgroundChildhood trauma is experienced by approximately one third of young people in the United Kingdom and has been shown to confer an increased risk for mental health difficulties in adulthood. Understanding the associations between these factors before negative health outcomes manifest in adulthood is imperative to help inform the development of interventions. The aims of this study were two-fold; first, to investigate the effects of childhood trauma on daily stress-related vulnerability factors over a period of 7 days and to test whether any observed relationships were moderated by protective or risk factors. Second, to explore the indirect effects of childhood trauma on reasons for living, optimism, daily suicide ideation, defeat and entrapment through the daily stress-related vulnerability factors. Methods212 participants were recruited to an ecological momentary assessment study to complete three diaries per day for a 7-day period. Participants completed daily measures of stress, hassles, executive functioning, impulsivity, sleep quality (stress-related vulnerability factors) as well as measures of reasons for living, optimism, daily thoughts of suicide, defeat and entrapment. The Childhood Trauma Questionnaire was also completed at baseline. ResultsAnalyses found that childhood trauma was significantly associated with higher scores on the daily stress-related vulnerability factors and positively related to each of the daily indicators of suicide risk. The study also uncovered key pathways whereby trauma had indirect effects on reasons for living, optimism, daily thoughts of suicide, defeat and entrapment through executive functioning, impulsivity, sleep quality and stress. LimitationsThe measures of executive function and sleep were self-reported and future research ought to replicate the current findings using more objective methods. DiscussionThe findings from this study highlight the complexity of childhood trauma and its damaging effects on stress-related vulnerability factors and poorer mental health outcomes. Greater understanding of pathways by which trauma may impact later health outcomes is essential for development of interventions.

Sociodemographic inequalities of suicide: a population-based cohort study of adults in England and Wales 2011-21.

The risk of suicide is complex and often a result of multiple interacting factors. Understanding which groups of the population are most at risk of suicide is important to inform the development of targeted public health interventions. We used a novel linked dataset that combined the 2011 Census with the population-level mortality data in England and Wales. We fitted generalized linear models with a Poisson link function to estimate the rates of suicide across different sociodemographic groups and to identify which characteristics are independent predictors of suicide. Overall, the highest rates of suicide were among men aged 40-50 years, individuals who reported having a disability or long-term health problem, those who were unemployed long term or never had worked, and those who were single or separated. After adjusting for other characteristics such as employment status, having a disability or long-term health problem, was still found to increase the incidence of suicide relative to those without impairment [incidence rate ratio minimally adjusted (women) = 3.5, 95% confidence interval (CI) = 3.3-3.6; fully adjusted (women) 3.1, 95% CI = 3.0-3.3]. Additionally, while the absolute rate of suicide was lower in women compared with men, the relative risk in people reporting impairments compared with those who do not was higher in women compared with men. The findings of this work provide novel population-level insights into the risk of suicide by sociodemographic characteristics in England and Wales. Our results highlight several sociodemographic groups who may benefit from more targeted suicide prevention policies and practices.

Suicide Attempts After a Diagnosis of Polycystic Ovary Syndrome : A Cohort Study.

Limited evidence exists about suicide risk in persons with polycystic ovary syndrome (PCOS). To assess suicide risk in persons with PCOS, accounting for psychiatric comorbid conditions and age group. Cohort study. Data from the Taiwanese nationwide database from 1997 to 2012. A cohort of 18 960 patients diagnosed with PCOS, each matched with control participants in a 1:10 ratio on the basis of age, psychiatric comorbid conditions, urbanization level, and income. Suicide attempts were evaluated using Cox regression models. Suicide risk with hazard ratios (HRs). Participants with PCOS had a notable 8.47-fold increase in risk for suicide attempt compared with the control group (HR, 8.47 [95% CI, 7.54 to 9.51]), after adjustment for demographic characteristics, psychiatric comorbid conditions, Charlson Comorbidity Index scores, and frequency of all-cause clinical visits. The elevated risk was evident across the adolescent (HR, 5.38 [CI, 3.93 to 7.37]), young adult (<40 years; HR, 9.15 [CI, 8.03 to 10.42]), and older adult (HR, 3.75 [CI, 2.23 to 6.28]) groups. Sensitivity analyses involving the exclusion of data from the first year or the first 3 years of observation yielded consistent results. Potential underestimation of PCOS and mental disorder prevalence due to use of administrative claims data; lack of clinical data, such as body mass index and depressive symptoms; and no assessment of a confounding effect of valproic acid exposure. This study underscores the heightened risk for suicide attempt that persons with PCOS face, even after adjustment for demographics, psychiatric comorbid conditions, physical conditions, and all-cause clinical visits. This suggests the importance of routine monitoring of mental health and suicide risk in persons diagnosed with PCOS. Taipei Veterans General Hospital, Yen Tjing Ling Medical Foundation, and Ministry of Science and Technology of Taiwan.

Transcriptional Patterns of Brain Structural Covariance Network Abnormalities Associated With Suicidal Thoughts and Behaviors in Major Depressive Disorder

BackgroundAlthough brain structural covariance network (SCN) abnormalities have been associated with suicidal thoughts and behaviors (STBs) in individuals with major depressive disorder (MDD), previous studies have reported inconsistent findings based on small sample sizes, and underlying transcriptional patterns remain poorly understood. MethodsUsing a multicenter magnetic resonance imaging dataset including 218 MDD patients with STBs, 230 MDD patients without STBs, and 263 healthy control participants, we established individualized SCNs based on regional morphometric measures and assessed network topological metrics using graph theoretical analysis. Machine learning methods were applied to explore and compare the diagnostic value of morphometric and topological features in identifying MDD and STBs at the individual level. Brainwide relationships between STBs-related connectomic alterations and gene expression were examined using partial least squares regression. ResultsGroup comparisons revealed that SCN topological deficits associated with STBs were identified in the prefrontal, anterior cingulate, and lateral temporal cortices. Combining morphometric and topological features allowed for individual-level characterization of MDD and STBs. Topological features made a greater contribution to distinguishing between patients with and without STBs. STBs-related connectomic alterations were spatially correlated with the expression of genes enriched for cellular metabolism and synaptic signaling. ConclusionsThese findings revealed robust brain structural deficits at the network level, highlighting the importance of SCN topological measures in characterizing individual suicidality and demonstrating its linkage to molecular function and cell types, providing novel insights into the neurobiological underpinnings and potential markers for prediction and prevention of suicide.

Thwarted Belonging and Perceived Burdensomeness During Middle and Older Adulthood: The Role of Generativity.

Using a sample of middle-aged and older adults, this research explores associations between generativity and two key risk factors for suicide: thwarted belonging (T.B.) and perceived burdensomeness (P.B.). These variables are typically studied as predictors of suicide; the current study is unique in examining their psychosocial correlates. Erikson described, generativity as a psychosocial construct that characterizes adult well-being in mid-life, conceptualized as the sense one has successfully guided and contributed to the younger generation through mentoring. Using the Midlife in the United States Survey (MIDUS), the current analyses indicate that generativity is associated with lower levels of P.B. and T.B., even after accounting for measures of hopelessness, depressive symptoms, financial stability, perceived neighborhood quality, chronic health conditions, and respondent's demographic characteristics including gender and age. Results are discussed in terms of applications for suicide-risk prevention, and with regard to the promotion of positive psychosocial development across the lifespan.

Suicide risk, related factors and the impact of COVID-19 amongst suicide prevention helpline callers: A network analysis

BackgroundThe COVID-19 pandemic brought along many known risk factors for suicide. It is important to map out contributing and protective factors for suicide risk and examine possible changes in these associations during pandemics such as COVID-19. The current study aimed to examine how information on risk and protective factors obtained through a suicide prevention helpline is linked to the assessed suicide risk and the possible impact of the COVID-19 pandemic. MethodsData on 9474 calls registered by operators of the suicide prevention helpline of Flanders (i.e., part of Belgium) were analysed using network analysis. Using network analyses allowed for a data-driven examination of direct and indirect pathways through which risk and protective factors are associated to perceived suicide risk. The network before and during COVID-19 were compared to examine the possible impact of the pandemic. ResultsOur findings suggest that different vulnerability and protective factors contribute to perceived suicide risk. Experiencing a break-up, abuse, previous attempt(s), experienced difficulties with the healthcare system and availability of resources were directly and uniquely associated with perceived suicide risk before and during COVID-19. LimitationsMain limitations of this study are the possible bias of operator assessment accuracy, absence of several important psychological risk factors and the use of cross-sectional data. ConclusionsThe current study provides insight in the effect of COVID-19 on suicidality and its risk and protective factors amongst suicide prevention helpline users, a population with high risk of suicide. Implications for suicide prevention helplines are discussed.

REAKSI BERDUKA PADA PENYINTAS KEHILANGAN BUNUH DIRI: LAPORAN KASUS

World Health Organization reported that there were more than 700,000 deaths due to suicide each year. Suicide incidents were like stones thrown into calm lakes, causing widespread ripples. Levi-Belz, in his study, stated that each suicide case affected an average of five family members and up to 135 individuals, including partners, colleagues, and the community. Suicide loss survivors were at a higher risk of experiencing complicated grief, depression, and suicide compared to the bereaved due to causes. Stigmatisation of suicide behavior and suicide loss survivors made them reluctant to disclose themselves, leading to less access to the help they needed. This case report described a 51-year-old woman experiencing grief reactions due to her daughter's suicide. She exhibited denial, anger, guilt, and self-blame. Her decision not to disclose her condition to family and relatives forced her to face emotional and mental turmoils on her own. This patient is still in the acute phase of grief reactions and is receiving psychological intervention in an individual setting. The assessment of suicide risk and ongoing observation of persistent psychological symptoms should be conducted periodically.

Childhood Bullying as a Predictor of Suicidality in Young Adults in a Nationwide Population-Based Health Examination Study

Objective Having been bullied at school in childhood links to suicidality. We aimed at verifying earlier findings and delivering diverse data from a representative population-based sample of young adults to characterize the impacts beyond childhood. Method A random sample of adults, aged 18–28 years and representative of the general population living in Finland, participated in a nationwide health examination study. Adverse childhood experiences before the age of 16 years were analyzed for 779 participants in relation to lifetime suicidality (suicidal ideation, suicide attempts), current suicidal thoughts (HSCL-25), mental disorders (self-reports for lifetime, M-CIDI for DSM-IV during the past 12 months), current usage of mental health services, current usage of prescription medicines (ATC codes), current psychological distress (GHQ-12), and current work capacity and work ability. Results Having been bullied in childhood contributed to greater suicidality (p < 0.001), more frequent current usage of antipsychotics (p < 0.001) as well as antidepressants (p < 0.001), greater current psychological distress (p < 0.001), and poorer current work capacity (p < 0.001) as well as work ability (p < 0.001). Of the self-reported mental disorders on lifetime basis, psychosis had the strongest association (p = 0.03) with having been bullied, whereas the interview-based diagnosis of mental disorders during the past 12 months had no significant association. Conclusions Having been bullied at school before the age of 16 years was independently associated not only with suicidality, but also with the self-report of psychosis as well as a range of indicators of poorer mental health at the age of 18–28 years.