Characteristics Of Suicidal Behavior Research Articles

Clinical characteristics of suicidal behavior in first hospitalization and drug-naïve patients with major depressive disorder

BackgroundMajor depressive disorder (MDD) is a major and common cause of suicide. The purpose of this article is to report the clinical characteristics and patterns of co-morbid suicidal behavior (SB) in first hospitalized and drug-naïve MDD patients.MethodsA total of 345 patients with first hospitalization and drug-naïve MDD with SB were included in this study, while 183 patients without SB were included as a control group. We collected socio-demographic, general clinical data and common biochemical indicators of all participants and assessed their clinical symptoms.ResultsCompared to patients without SB, MDD with SB had more severe clinical symptoms and worse metabolic indicators. Duration of disease, depressive symptom scores, and thyroid stimulating hormone (TSH) levels was risk factors for SB and its number.ConclusionsMDD patients with SB suffered more severe clinical symptoms and worse metabolic indicators, and risk factors for SB in this population were identified, which may provide beneficial insight and reference for clinical prevention and intervention of SB in MDD patients.

Клинико-психологические и социодемографические факторы суицидального поведения и риска его хронификации: обзор исследований

<p><strong>Relevance.</strong> The article presents an overview of studies on clinical, psychological and socio–demographic factors of suicidal behavior and the risk of its chronicity. According to the WHO, 800,000 people die each year by suicide, and many others seek help from medical centers after a suicide attempt. Suicide and suicide attempts are a medical, social and psychological problem. <strong>Purpose of the study</strong>. Evaluation of the role of various factors in the chronification of suicidal behavior and an increase in its risk. <strong>Results.</strong> According to numerous studies, most often repeated suicide attempts are made by people with borderline personality disorder and other personality disorders, often in combination with depressive and anxiety symptoms. The motives for suicide in this group of patients may be emotional regulation, coping with dissociation, stress, and more often do not contain the desire to die. This group of patients tend to self-cut in the limbs or attempt self-poisoning. A distinctive feature of suicide attempts in individuals with schizophrenia, severe depression and bipolar disorder is the intention to die, combined with more severe methods of self-harm, in contrast to patients with personality disorders. The risk of chronification of suicidal behavior is higher in people of working age who have experience in the use of psychoactive substances, low social status and wealth, and the unemployed. This group of patients needs to be provided with medical, psycho-social assistance, since without treatment and psychological support, the risk of chronification of suicidal behavior, an increase in symptoms of depression and the completion of suicide increases. <strong>Conclusions.</strong> Chronic suicidal behavior requires active interdisciplinary team work with patients based on a biopsychosocial model already at the stage of the first hospital admission after a suicide attempt. It is important to take into account the specifics and characteristics of suicidal behavior, work styles may differ depending on the diagnoses, age and motives of suicidal behavior.</p>

Urgent care and suicidal behavior in the child and adolescent population in a psychiatric emergency department in a Spanish province during the two COVID-19 states of alarm.

IntroductionThe COVID-19 outbreak and lockdown may have an impact in mental health among youth, but reports of psychiatry emergency department encounters in young Spanish population are scarce. The aim of this study is to characterize the reasons for psychiatric urgent care of youth during COVID-19 pandemic in our hospital.Material and methodsThis cross-sectional study compare visits to the psychiatry emergency department and their characteristics in young patients in the province of Lleida before and after the pandemic with special attention to the two states of alarm and suicidal behavior. Information regarding sociodemographic status, chief complaints, diagnosis, characteristics of suicidal behavior, and other data were obtained from the electronic medical records.ResultsWithin the total psychiatric emergency attendances, youth patients increased a 83.5% in the second state of alarm (p = 0.001). In this period patients were younger (p = 0.006), had less psychiatric history (p = 0.017) and their living conditions changed with an increase of those living with relatives (p = 0.004). Suicidal ideation care increased without statistical significance (p = 0.073). Multiple logistic regression identifies independent risk factors for suicidal behavior being female (OR: 2.88 [1.39–5.98]), living with relatives (OR: 3.49 [1.43–8.54]), and having a diagnosis of depression (OR: 6.34 [3.58–11.24]).ConclusionsThe number of young people seen in psychiatric emergencies during the chronic stage of the pandemic increased, and these were getting younger and without previous psychiatric contact. The trend to higher rates of suicidal ideation indicates that youth experienced elevated distress during these periods, especially women, living with relatives and presenting depression.

ABOUT CAUSES OF SUICIDAL BEHAVIOR AMONG ADOLESCENTS

The article analyzes the concept of adolescent suicide, deviant forms of behavior, discusses the features and causes of suicidal behavior in adolescence, features of self-esteem and propensity to risky behavior in adolescents, the main characteristics of suicidal behavior. The importance of participation of parents and school psychologist is noted. The article considers the directions of the concept of suicide. In addition, this article discusses ways to prevent suicide of adolescents, notes the importance of the formation of anti-suicidal factors, considered and analyzed approaches to this problem. At the end of the article, a psychological Test "Gorge" Propensity to depression is proposed. This test will help determine the current state of the teenager.

PHENOMENOLOGICAL ANALYSIS OF SUICIDAL BEHAVIOR IN PATIENTS WITH COGNITIVE IMPAIRMENT IN RECURRENT DEPRESSIVE DISORDER

The aim of the study was to determine the characteristics of suicidal behaviour (SB) in patients with cognitive impairment in recurrent depressive disorder (RDD). Materials and methods: The article presents a phenomenological analysis of suicidal behavior in 123 patients with recurrent depressive disorder. The study of cognitive dysfunctions in patients with recurrent depressive disorder included an analysis of the severity of cognitive impairment and the characteristics of cognitive processes, executive functions, and the specifics of social functioning. The study of the features of suicidal behavior included an analysis of the severity of suicidal risk, diagnosis of symptoms, stress level, suicidal behavior in the past, communication capabilities, reactions of significant others, and the severity of autoaggressive predictors. A complex of research methods was used: clinical-psychopathological, psychometrical, psychodiagnostical and statistical. Results: It was determined that patients with recurrent depressive disorder have specific characteristics of suicidal behavior, which included: a moderate to low level of suicidal risk; the severity of symptoms of depression, tension, anxiety, guilt, hopelessness and exhaustion; repeated visits to doctors for help; presence and recurrence of stress factors; anamnestic burden; violation of communications; the presence of autoaggressive predictors. Conclusions: It was found that a weak level of cognitive deficit, a tendency to catastrophisation and self-blame, low switchability and increased focus on negative stimuli in patients with recurrent depressive disorder was associated with a high risk of their suicidal behavior.

Association of alcohol dependence syndrome with clinical and psychological characteristics of suicidal behavior in individuals with organic mental disorders and aggressive behavior (moral and ethical features) (part 2)

Association of alcohol dependence syndrome with clinical and psychological characteristics of suicidal behavior in individuals with organic mental disorders and aggressive behavior (moral and ethical features) (part 2)

Suicide in the paradigm of social addiction and Psychology of Law

The article reflects one of the fundamental directions of scientific research conducted of the Institute of State and Law of the Russian Academy of Sciences in the field of Philosophy, Sociology and Psychology of Law in the context of the history of Russian civilization, the Russian State and the theory of law. The article attempts to theoretically comprehend the phenomenon of suicide from the standpoint of socio-legal addictions (addictions) and deviations (deviations from norms), firstly, as a medical and psychological phenomenon, and secondly, as a person’s reaction to personal adversity, social circumstances, moral, material and other plans. Formulations revealing the essence of suicide are given in the works of ancient thinkers, philosophers, sociologists and jurists of other times. The quantitative and qualitative characteristics of suicidal behavior, the extent of the spread of suicide in the history of various civilizations, including the Slavic-Russian-Russian, are summarized. On this basis, the author's idea of suicide is given, based on philosophical, legal and theological teachings, the results of sociological research, official statistics and the conclusions of modern researchers.

PSİXOLOGİYADA SUİSİDAL DAVRANIŞ VƏ ONUN TƏDQİQİNƏ DAİR NƏZƏRİ YANAŞMALAR

The author has made a socio-psychological analysis of the psychological characteristics of suicidal behavior, as well as the phenomenon of suicide. The author examines the causes of suicide in society, emphasizes that suicide is associated not only with health problems, but also with social factors in society, and reflects the different approaches to the study of suicide.

Проблема суицидального поведения в подростковом возрасте

The article examines the problems of suicidal behavior in adolescents, as well as ways to prevent and counteract this destructive behavior. This is due today to the great urgency of this social problem, both for the Russian and for the world community. In the study, the tasks were set to study the characteristics of suicidal behavior in adolescents; the study of the social significance of adolescent suicide in the public consciousness in order to determine ways to solve the problem of suicidal behavior in adolescents to reduce suicidal moods among young people. Among the causes of suicidal behavior in adolescents, interpersonal and intrapersonal conflicts are considered, as well as economic and socio-political conditions. Particular attention is paid to measures to counteract suicidal behavior with the help of the adolescent's immediate environment: parents, teachers, other closest social agents by forming a social position on suicide in the latter (preventive work).
 The purpose of this article is to study the problems of adolescent suicide, its social significance and to identify ways and mechanisms to reduce the risks of suicide among children and adolescents.
 The subject of research in this article is suicidal behavior, its causes and characteristics of its appearance.

Suicide in late life: A viewpoint

Suicide in old age represents a sad public health concern. Despite the global decline in rates of suicide and the general amelioration of quality of life and access to health care for older adults, their rates of suicide remain the highest virtually in every part of the world. With the aging of the world population and the growing number of mononuclear families, the risk of an increase in isolation, loneliness and dependency does not appear ungrounded. The Covid-19 pandemic is claiming the life of many older persons and creating unprecedented conditions of distress, particularly for this segment of the population. This article briefly examines the main characteristics of suicidal behavior in late life, including observations deriving from the spread of the Sars-2 coronavirus and possible strategies for prevention.

A systematic review of suicidal behaviour in men: A narrative synthesis of risk factors.

Suicides by men outnumber those by women in every country of the world. To date, there has not been a comprehensive systematic review of risk factors for suicidal behaviour in men to better understand the excess deaths by suicide in men. The present systematic review seeks to determine the nature and extent of the risk factors to predict suicidal behaviour in men over time. A range of databases (CINAHL, PsycINFO, Web of Science Core Collection, Pubmed, Embase, and Psychology and Behavioural Sciences Collection) were searched from inception to January 2020 for eligible articles. The findings were collated through a narrative synthesis of the evidence. An initial 601 studies were identified. Following the inclusion and exclusion criteria, there were 105 eligible studies (62 prospective and 43 retrospective) identified. Overall, the risk factors with the strongest evidence predicting suicidal behaviour in men were alcohol and/or drug use/dependence; being unmarried, single, divorced, or widowed; and having a diagnosis of depression. In the prospective studies, the most consistent evidence was for sociodemographic factors (19 risk factors), mental health/psychiatric illness (16 risk factors), physical health/illness (13 risk factors), and negative life events/trauma (11 risk factors). There were a small number of psychological factors (6 factors) and characteristics of suicidal behaviour (3 factors) identified. The findings from the retrospective studies provided further evidence for the risk factors identified in the prospective studies. This systematic review has highlighted the wide range of risk factors for suicidal behaviour in men, in this review alone 68 different risk factors were identified. Many factors can interact and change in relevance throughout an individual's life. This review has identified extensive gaps in our knowledge as well as suggestions for future research.

Suicidal behaviour and quality of life in Slovene prisons

ABSTRACT Prisoners are an extremely vulnerable group regarding suicidal behaviour, with a consistently higher prevalence of suicide when compared to the general population. However, the characteristics of suicidal behaviour for this group are understudied in Slovenia. We wanted to investigate the characteristics of suicidal behaviour and suicide-related factors in male prisoners of this country and recruited 419 male prisoners. These individuals filled-in a package of questionnaires which included demographic characteristics, medical history, WHOQOL-BREF, Five Well-Being Index, Paykel’s questions on suicidal behaviour, Depression, Anxiety and Stress Scale, and the Interpersonal Needs questionnaire. Study results showed that 10.3% of participants reported being at current risk for suicide, with these inmates reporting more severe mental health problems, lower quality of life and lower well-being levels. Lack of social contacts did not affect mental health as much as the quality of social support, where perceived belongingness and acceptance by others represented a protective factor for suicidal behaviour.

Characteristics of depressed suicide attempters with remitted substance use disorders

Substance use disorder (SUD) comorbidity in mood disorders increases suicide risk. Suicide attempters with active SUD appear to have distinct characteristics but little is known whether these characteristics persist during remission and if they are related to different aspects of suicidal behavior. In this study, suicide attempters with a DSM mood disorder and remitted SUD (AT+SUD) (N = 135) were compared to those without lifetime SUD (AT-SUD) (N = 219) in terms of demographic, clinical and suicidal behavioral characteristics. Factor analyses were conducted to generate subjective distress and impulsivity/aggression factors – previously identified by our group to predict suicide risk in mood disorders. Associations between these traits and SUD history and suicidal behavior characteristics were then tested. Compared with AT-SUD, AT+SUD were more likely to be male, less educated and to have a Cluster B personality disorder. AT+SUD individuals had greater impulsivity/aggression factor scores, but comparable subjective distress scores. AT+SUD made a greater number of suicide attempts, with higher lethality, despite comparable suicide intent and degree of planning with AT-SUD. Impulsivity/aggression was higher in multiple versus single attempters, but did not correlate with suicide attempt lethality. Among suicide attempters with mood disorders, a history of lifetime SUD was associated with more frequent and more lethal suicide attempts. Among other correlates of lifetime SUD in this sample, impulsive/aggressive traits may explain greater frequency of suicide attempts. The results underscore that persons with mood disorders and lifetime SUD are at particularly high risk of frequent and lethal suicide attempts where more intensive prevention efforts are warranted.

Non-suicidal self-injury and its co-occurrence with suicidal behavior: An epidemiological-study among adolescents and young adults.

Non-suicidal self-injury (NSSI) comprising thoughts and behaviors is common and often co-occurring with suicidal behavior like ideation, plan, and attempt. As limited data are available for adolescents and young adults, this study aims to present prevalence estimates for lifetime NSSI, its co-occurrence with suicidal behavior, conditional probabilities and their association with socio-demographic characteristics, severity characteristics of suicidal behavior, and health service utilization. The epidemiological Behavior and Mind Health (BeMIND) study assessed in 2015/16 a random-community sample of N=1180 aged 14-21years from Dresden, Germany, regarding lifetime NSSI via self-administered questionnaire and suicidal behaviors via standardized interview. Any lifetime NSSI was reported by 19.3% (thoughts: 18.0%, behaviors: 13.6%) of the sample with higher prevalence in females (OR=2.7, 95% CI 1.9-3.8, P<0.001). Lifetime prevalence of co-occurring NSSI and suicidal behavior was 7.7%. Females had a 3.3- to 8.8-fold odds of co-occurrence than males. Among those with any NSSI, 39.6% endorsed suicidal behavior, and 66.3% of those with any suicidal behavior reported NSSI. 42.3% of those with any NSSI reported to have used mental healthcare services at any time during their life with higher rates in those with co-occurring suicidal behavior (62.3%). Non-suicidal self-injury and co-occurring suicidal behavior is common in adolescents and young adults-especially females. The limited utilization of mental healthcare services underpins the need for improving recognition of NSSI and suicidal behavior as well as the accessibility of mental healthcare services during adolescence and emerging adulthood.

The Catalonia Suicide Risk Code: A secondary prevention program for individuals at risk of suicide

BackgroundSuicide prevention is an emerging priority for public health systems. Here, we present the Catalonia Suicide Risk Code (CSRC), a secondary suicide prevention program that provides a systematic approach to follow-up care for patients at risk. We describe the care pathway of the CSRC and characteristics of the patients enrolled in the program. MethodsObservational study based on data extracted from the Catalan health care system between the years 2014 and 2019. The following patient-related data were obtained: sociodemographic and clinical characteristics, characteristics of suicidal behaviour, and pathway of care. ResultsA total of 12,596 individuals (64.1% women) were screened for suicide risk and 8,403 (66.7%) were subsequently enrolled in the CSRC. Adherence data show that most patients (81.9%) attended a face-to-face appointment and most (67.1%) were successfully contacted by telephone afterwards. Most face-to-face appointments were performed within 10 days of enrolment for adults and 72 h for minors. Psychiatric disorders were significant risk factors for both men and women. Females were significantly more likely to report stressful life events, while males were more likely to report social problems. Compared to men, women were more likely to use poisoning. LimitationsAdherence to the CSRC care pathway might reflect obstacles to its implementation. Due to the observational study design, it is not possible to determine the effectiveness of the CSRC to reduce suicide re-attempts. ConclusionsAlthough the CSRC successfully provided follow-up care for many individuals at high risk of suicide, greater adherence to the CSRC care pathway is needed.

Impulsivity and Suicidal Behavior.

Suicide is the leading cause of injury mortality in the United States and the second-leading cause of death in people aged 10-34years. While many long-term risk factors are known, the short-term prediction of suicidal behavior remains elusive. Many characteristics of suicidal behavior cut across diagnoses, but suicide is increased in recurrent psychiatric disorders, addictive disorders, and trauma-related disorders. Suicide results from the interaction of short-term and long-term behavioral regulation. The shorter the time-course of the mechanism, the closer it is to actual suicidal behavior, and the harder it is to prevent. We will discuss the manner in which impulsivity, a major determinant of short-term suicide risk, interacts with longer-term risk factors, especially sensitization to addictive or traumatic stimuli. Impulsivity predisposes to sensitization; in turn, impulsivity is a prominent component of sensitized behavior. Impulsivity can be described as a general pattern of behavior ("trait" impulsivity), as responses that are not conformed to their context (action-impulsivity), or as inability to delay reward or to take future consequences into account (choice-impulsivity). Each of these contributes to suicidal behavior. The neural mechanisms of impulsivity and sensitization are analogous, and sensitization can produce rapidly fluctuating patterns of impulsive behavior, arousal, and anhedonia. In order to recognize and prevent suicidal behavior, it is necessary to identify factors associated with susceptibility to bouts of impulsive behavior in people at elevated long-term risk.

Prevalence, Onset, and Course of Suicidal Behavior Among Adolescents and Young Adults in Germany

Suicidal behavior is a leading cause of death among adolescents and young adults. In light of the ideation-to-action framework, the delineation of frequency and temporal characteristics of such behavior during this developmental period is crucial. To provide lifetime and 12-month prevalence estimates of suicidal behavior, including ideation, plan, and attempt, in adolescents and young adults of the general population, and to provide information about age at onset, temporal characteristics of suicidal behavior, including duration (number of years between onset and last occurrence) and frequency (number of episodes), and transition patterns across suicidal behaviors. A cross-sectional epidemiological study was conducted in a random community sample of 1180 adolescents and young adults aged 14 to 21 years assessed in 2015 to 2016 in Dresden, Germany. Data analysis was performed from October 2018 to March 2019. Lifetime and 12-month suicidal behavior (ideation, plan, and attempt) were assessed with a standardized diagnostic interview (Munich-Composite International Diagnostic Interview) by trained clinical interviewers. The onset, frequency, and duration of suicidal behavior were assessed by questionnaire. Of the 1180 participants (495 male [weighted percentage, 51.7%]; mean [SD] age, 17.9 [2.3] years), 130 participants (10.7%; 95% CI, 9.0%-12.8%), 65 participants (5.0%; 95% CI, 3.9%-6.5%), and 41 participants (3.4%; 95% CI, 2.4%-4.7%) reported lifetime suicidal ideation, plan, and attempt, respectively. Any lifetime suicidal behavior was reported by 138 participants (11.5%; 95% CI, 9.7%-13.7%). Age-specific cumulative incidence estimates indicated an increase in suicidal behavior during adolescence, starting at age 10 years (<1%), increasing slightly until the age of 12 years (2.2%), and then increasing sharply thereafter until age 20 years (13.5%). There were different patterns among female and male participants for ideation, plan, and attempt, with an overall higher incidence among female participants for ideation (hazard ratio, 1.51; 95% CI, 1.02-2.22; P = .04), for plan (hazard ratio, 3.31; 95% CI, 1.72-6.36; P < .001), and, among those older than 14 years, for attempt (hazard ratio, 3.07; 95% CI, 1.11-8.49; P = .03). Of those with suicidal ideation, 66.0% reported persistent or recurrent ideation over more than 1 year with 75.0% reporting more than 1 episode. Of the participants with lifetime suicidal ideation, 47.0% reported a suicide plan and 23.9% reported a suicide attempt. The transition to suicide plan or attempt occurred mainly in the year of onset of suicidal ideation or plan; of those who transitioned, 74.9% transitioned from ideation to plan, 71.2% transitioned from ideation to attempt, and 85.4% transitioned from plan to attempt in the same year. There is an urgent public health need for timely identification of suicidal behavior in adolescents and young adults to terminate persistent or recurrent suicidal tendencies and to interrupt the ideation-to-action transition.

Electroencephalogram Resting State Frequency Power Characteristics of Suicidal Behavior in Female Patients With Major Depressive Disorder.

Difficulties in predicting suicidal behavior hamper effective suicide prevention. Therefore, there is a great need for reliable biomarkers, and neuroimaging may help to identify such markers. Electroencephalography (EEG) was used to investigate resting state spatial-frequency power characteristics of female patients with major depressive disorder (MDD); 19 were recent suicide attempters (within the previous 30 days), 36 were suicide ideators, and 23 were nonsuicidal. Patients were enrolled at neuroCare Clinic Nijmegen (Nijmegen, the Netherlands) between May 2007 and November 2016, and the primary diagnosis of nonpsychotic MDD was confirmed using the Mini-International Neuropsychiatric Interview, DSM-IV criteria, and a score of ≥ 14 on the 21-item Beck Depression Inventory. Nonparametric, cluster-based permutation tests were applied to detect robust power differences between the study groups on the EEG broadband signal (2-100 Hz). Furthermore, a nonadaptive distributed source imaging method (eLORETA) was utilized to examine if these suicide-based frequency characteristics are localized in brain areas previously reported in the neuroimaging literature. When compared to nonsuicidal depressed patients, attempters and ideators displayed both decreased beta and low gamma activity in the frontal regions. Moreover, ideators had increased alpha activity over the posterior regions and increased high beta, low gamma activity over the left occipital region when compared to psychiatric controls. Attempters had reduced beta and low gamma activity over the right temporal region when compared to ideators. In addition, eLORETA localized attempter and ideator reduced frontal activity within the orbito-, medial-, middle-, superior-, and inferior-frontal areas and the anterior cingulate cortex. In attempters, reduced right temporal activity was localized within the right inferior-, middle-, and superior-temporal cortices and the fusiform gyrus. Frequency power characteristics of attempters and ideators are consistent with findings from the neuroimaging literature concerning suicide, implying EEG resting state assessment could become a potential biomarker to predict suicide risk.

Quality of Internalized Object Representations and Suicidality in Individuals With Anaclitic and Introjective Personality Styles.

Research has shown differences in the characteristics of suicidal behavior in individuals with dependent (anaclitic) versus self-critical (introjective) personality styles. Questions remain, however, as to what factors distinguish suicidal from nonsuicidal individuals within each personality style. The current study examined clinical and interpersonal correlates of suicidality in 124 patients attending residential treatment for complex psychiatric disorders, with the aim of clarifying how social cognition and quality of internalized object representations relate to suicidality in individuals with anaclitic versus introjective personality organizations. Higher anaclitic and lower introjective traits each predicted higher frequency of prior attempts. Furthermore, higher anaclitic and lower introjective traits interacted with the affective-interpersonal quality of object representations to predict prior attempts, such that each trait was associated with more frequent past attempts in the context of poorer quality of object relations. The treatment implications of these findings are discussed, and areas for future research are considered.

Who dies and who survives? Investigating the difference between suicide decedents and suicide attempters

BackgroundIn spite of mounting evidence, it is still unclear whether suicide decedents and attempters represent overlapping or completely different populations of suicidal behavior subphenotypes. Hence, the present study aims to investigate the sociodemographic and suicidal behavior variables and the difference between suicide decedents and suicide attempters.MethodsOne hundred fifty suicide attempters and key informants of 206 suicide decedents were interviewed for sociodemographic and suicidal behavior characteristics using a semi-structured interview schedule. The statistical analysis was performed in SPSS ver. 20.ResultsThe sociodemographic and suicidal behavior variables that distinguish suicide and suicide attempt in the multivariate logistics model were higher age (OR, 95% CI = 1.06, 1.032–1.09, p < 0.001), male gender (OR, 95% CI = 2.46, 1.39–4.34, p = 0.002), low socioeconomic status (OR, 95% CI = 0.94, 0.90–0.98, p = 0.005), occurrence in autumn season (OR, 95% CI = 2.53, 1.16–5.50, p = 0.019), and usage of violent suicide method (OR, 95% CI = 17.82, 7.33–43.32, p < 0.001).ConclusionSuicide decedents were more likely to be older males, economically weaker, and commit suicide in an autumn season using violent suicide method. These findings emphasize the significance of distinct suicide prevention strategies for suicide decedents and suicide attempters.