Experienced Suicidal Ideation Research Articles

(056) PSYCHOSOCIAL FACTORS IN NEUROPROLIFERATIVE VESTIBULODYNIA PATIENTS WHO UNDERWENT COMPLETE VESTIBULECTOMY

Abstract Introduction Neuroproliferative vestibulodynia (NPV) is characterized by severe allodynia and hyperalgesia during entry penetration. Multiple psychosocial factors may contribute to the experience of pain from NPV. Concerning psychologic factors, women afflicted with NPV report difficulty with mental health issues such as anxiety and depression, high rates of negative emotions, substantial difficulties with psychosocial adjustment, and experience suicidal ideation. Objective This study focuses on psychosocial factors identified in a cohort of patients diagnosed with NPV who underwent vestibulectomy. Methods This is a chart review of 65 patients, median age 26 years (IQR 23-31) clinically diagnosed and pathologically confirmed with NPV. They completed validated instruments administered including the Female Sexual Function Index (FSFI), Sexual Distress Scale-Revised (SDS-R), McGill Pain Questionnaire-Short Form (SF-MPQ), Perceived Stress Scale (PSS), and Patient Health Questionnaire-9 (PHQ-9). The sex therapy evaluation performed on initial patient intake assessed psychosocial issues including effect of symptoms on quality of life, self-image, past trauma, and past/current relationship(s). Patients identified as having significant psychosocial issues were advised to undergo pre-op and/or post-op therapy. Results Based on history, initial psychological assessment, and psychosocial experiences with vestibular pain, post-operative therapy was recommended to 94% of our study cohort to maximize post-operative outcome. Our study cohort exhibited high levels of anxiety (53.8%) and depression (50.8%). Sexual abuse, assault and/or incest had been experienced by 32.3%. Other psychological issues included eating disorder (10.8%), bipolar (6.2%) as well as suicidal ideation (4.6%). Problems revolving around personal relationships include panic attacks around sex/men (21.5%), not pursuing sexual relationships (9.2%), lack of attraction toward current partner (4.6%) or being attracted to unavailable people (3.1%). A total of 15.4% of this cohort had complaints of low desire and 9.2% had a history of drug or alcohol abuse. Median FSFI total score was 13/36 (<26), with distress (≥11) consistent with sexual dysfunction in 56 of 61 patients. Median FSFI pain domain was 0/6; median FSDS-R (n=61) was 35/52, indicative of significant distress; median PHQ-9 was 6.5/27 with 23 patients’ scores consistent with possible need for depression treatment based on clinical judgment and 14 patients with score consistent with warranting treatment for depression. Median PSS was 22/40 with the most common level of stress being moderate (n=54). SF-MPQ median results (n=63) were 15/33 for sensory, 3/12 for affective and 4/5 for present pain intensity. With 3-46 month follow-up, 86.3% of patients (44/51) reported improvement on the Patient Global Impression of Improvement with 72.5% (37/51) reporting significant improvement. Conclusions While NPV is a biologic diagnosis, psychological factors likely contribute to the development, continuation, and consequences of NPV. We believe that the significant mental health issues in this NPV patient population made recovery from vestibulectomy more protracted than typically experienced after surgery. Psychological therapy would be beneficial in this population and should be continued postoperatively, as needed, to address psychological concerns and enhance quality of life. Disclosure No.

Prevalence of and risk factors for suicidal ideation in adolescents during the COVID-19 pandemic: a cross-sectional study.

Pandemic-related life changes may have had a deleterious impact on suicidal behaviours. Early detection of suicidal ideation and identification of subgroups at increased risk could help prevent suicide, one of the leading causes of death among adolescents worldwide. Here, we aimed to investigate the prevalence of and risk factors for suicidal ideation in adolescents using a population-based sample from Switzerland, two years into the pandemic. Between December 2021 and June 2022, adolescents aged 14 to 17 years already enrolled in a population-based cohort study (State of Geneva, Switzerland) were asked about suicidal ideation over the previous year. In addition to a regression model, we conducted a network analysis of exposures which identified direct and indirect risk factors for suicidal ideation (i.e. those connected through intermediate risk factors) using mixed graphical models. Among 492 adolescents, 14.4% (95% CI: 11.5-17.8) declared having experienced suicidal ideation over the previous year. Using network analysis, we found that high psychological distress, low self-esteem, identifying as lesbian, gay or bisexual, suffering from bullying, extensive screen time and a severe COVID-19 pandemic impact were major risk factors for suicidal ideation, with parent-adolescent relationship having the highest centrality strength in the network. Our results show that a significant proportion of adolescents experience suicidal ideation, yet these rates are comparable with pre-pandemic results. Providing psychological support is fundamental, with a focus on improving parent-adolescent relationships.

Evaluating the Safety of Assessing and Factors Associated With Suicidality and Self-Injury Within a Remote Online Assessment Among Sexual Minority Men in the United States

Research suggests that sexual minority individuals are at increased risk of suicide compared with the general population. As technology continues to develop in sophistication and accessibility, a growing number of research and therapeutic interventions utilize web-based assessments. To facilitate future research on assessing and responding to suicidal thoughts and behaviors, we describe the implementation of procedures for doing so in the context of a limited-interaction, remote cohort study. We describe factors associated with suicidal thoughts and behaviors among sexual minority men (SMM) that can guide risk/benefit assessments in future studies. Descriptive statistics were used to characterize the sample in terms of self-injury/suicidality. Bivariate χ2tests were conducted to explore differences in these indicators by age, race and ethnicity, sexual orientation, health insurance, region, education, and self-ranked socioeconomic status. Additionally, logistic regressions were used to examine associations between demographic characteristics, various psychosocial syndemic factors, and the four measures of self-injury/suicidality. In addition, we describe the experiences completing the suicidality follow-up protocol within the study. We conducted a nationwide study of 10,607 participants and found that 27.8% had a history of self-injury, 5.6% in the past year, 21.0% had attempted suicide, 18.2% experienced suicidal ideation, and 9.4% had thoughts of killing themselves. Logistic regressions revealed that depression, everyday discrimination based on sexual orientation, childhood sexual assault, and intimate partner violence were the strongest predictors of self-injury and suicidality. Study participants experienced high rates of self-injury and suicidality. Effective protocols can be developed to assess and respond to suicide risk in web-based SMM studies.

Depression and suicidal ideation among Black individuals in Canada: mediating role of traumatic life events and moderating role of racial microaggressions and internalized racism.

Although suicidal ideation (SI) is a serious concern in Canada, its prevalence and related factors among Black individuals are poorly documented. Using data from the Mental Health of Black Communities in Canada project (BeCoMHeal), this study aimed to assess the prevalence of SI in Black individuals aged 15-40 years old in Canada, the mediating role of traumatic life events in the association between depression and SI, and the moderating role of racial microaggressions and internalized racism. Eight hundred and sixty participants aged between 15 and 40 years (Mage =24.96, SD = 6.29) completed the online questionnaire assessing sociodemographic data, depression symptoms, traumatic life events, racial microaggressions, internalized racism, and SI. Findings showed that 25.7% of the participants reported having experienced SI (26.5% women, 22.7% men, 𝛘2 = 1.08, p = .299). The moderated-mediation model revealed that traumatic life events fully mediated the association between depression and SI (B = 0.12, p = .004; 95% CI, [0.04, 0.20]) and that racial microaggressions (B = - 0.03, p = .042; 95% CI [-0.07, - 0.00]) and internalized racism (B = 0.06, p = .006; 95% CI [0.02, 0.10]) moderated this relationship. These findings underscore the importance of addressing racial microaggressions and internalized racism in therapy contexts among Black individuals to mitigate the potential negative impacts on their mental health. They also emphasize the need to develop effective, culturally sensitive, and racially adapted suicide prevention and intervention programs for Black communities in Canada.

Prevalence of youth experiencing homelessness and its association with suicidal thoughts and behaviors: Findings from a population-based study

Although various studies have examined factors associated with suicidal behaviors among youth, few studies have investigated the association between youth experiencing homelessness (YEH) and suicidal thoughts and behaviors (STBs) using a large nationally representative sample. The objectives of this study were to investigate prevalence of YEH and its association with STBs. Data for this study came from the 2021 Youth Risk Behavior Survey. An analytic sample of 17,033 youth aged 14–18 (51.7 % male) was analyzed using binary logistic regression. Of the 17,033 youth examined, 3 % experienced homelessness during the past 30 days, 21.3 % experienced suicidal ideation, 17.3 % made a suicide plan, and 10.9 % attempted suicide during the past 12 months. Controlling for demographic characteristics and feeling sad or hopeless, YEH was associated with 2.48 times higher odds of experiencing suicidal ideation (AOR=2.48, p<.001), 2.46 times higher odds of making a suicide plan (AOR=2.46, p<.001), and 4.38 times higher odds of making a suicide attempt (AOR=4.38, p<.001). The findings of this study highlight the importance of identifying youth who are at risk of experiencing homelessness to ensure early interventions are put in place to prevent suicidal behaviors.

Psychological and socio-ecological correlates of 12-month suicide behavior among junior high school students in the greater Accra region of Ghana.

In Ghana, we know little about the epidemiology of suicide ideation, plan and attempts among junior high school (JHS) students in Ghana including the years preceding high school. This study explores the onset, characteristics, and recent patterns of 12-month suicide behavior among Ghanaian junior high school (JHS) students. Paper-based surveys were administered to a sample (n = 800) of junior high school students in the Greater Accra region of Ghana. Self-reported measures on suicide ideation, plan and attempt as well as several psychological and psychosocial factors related to mental health, substance use, poverty, sexual behavior, interpersonal relationships, and family structure were employed. Bi-variate, multivariate and logistic regression analyses were performed using Statistical Package for the Social Sciences (SPSS version 25). This study found that 1 out of 5 adolescents have experienced suicide ideation in the last 12months. Girls had significantly higher 12-month (χ2 = 3.5, p < 0.05) suicide ideation rates than boys. More importantly, the study found stress significantly increasing the odds of suicide behaviors in the last 12months (β = 1.14; CI = 1.05-1.24, p < 0.05) and parental support significantly reducing the odds of suicide behaviors in the last 12months (β = 0.86; CI = 0.81-0.91, p < 0.05). Additionally, we found significant associations between sexual intercourse, dating, hunger, substance use, suicide stigma and suicide behaviors. This finding highlights a potential emerging suicide crisis among preteens which warrants attention. Additional studies are needed to observe these increasing trends and identify risk, protective and precipitating factors to help prevent suicide among these children.

Experiences of suicide survivors of sharing their stories about suicidality and overcoming a crisis in media and public talks: a qualitative study

BackgroundMedia stories of hope and recovery from suicidal ideation have been found to have a positive impact on the audience, but little is known about how individuals who share their own experiences perceive the effects of their storytelling. This study aimed to assess qualitatively, through focus groups, how individuals who shared their personal story of hope and recovery in the media and public talks experienced the process, and which aspects they perceived as important in sharing their coping story.MethodsThree focus groups were conducted with a total of n = 12 individuals. These included n = 5 participants with experience of suicidal ideation or a suicide attempt, n = 4 individuals who had been bereaved through suicide, and n = 3 participants who experienced both. Participants were recruited from the American organisation “Suicide Survivors United”. Thematic analysis was used to assess the participants’ perception and experiences of sharing their story.ResultsParticipants shared that the intention to help others was the main motivation to share their story of hope and recovery. Participants noted many positive effects of their storytelling on themselves and also received positive feedback from the audience, such as improved help-seeking attitudes. The participants offered recommendations for those who want to share their story of hope and recovery, including careful personal preparation and media training before going public. They also discussed media recommendations for talking about suicide in the media.ConclusionsSharing a personal story of hope and recovery may have a beneficial impact on the storytellers. Storytelling requires a careful preparation and training before going public and support and guidance is crucial in all stages of the storytelling, particularly to help unexperienced storytellers in going public and using their personal narratives to help prevent suicide.

Relationship of the number of days of participation in school physical education classes in a week with body mass index, number of hospital treatments for school violence, and mental health status among Korean male adolescents

School sports activities may help address obesity, school violence and mental health issues, which can be considered the biggest issues related to adolescents. However, previous research has not examined the relationship between participation in school physical education classes and obesity, school violence and mental health among adolescents by focusing on the number of days adolescents participate in school physical education classes. Therefore, this study investigated the association of the number of days of participation in physical education classes in a week with body mass index, number of hospital treatments for school violence, and mental health status among Korean male adolescents. Data of 25,749 male Korean adolescents were collected from the 2022 Korea Youth Risk Behavior Survey. Data collected were analyzed using frequency analyses, chi-square analyses and multivariate logistic regression analyses. The results showed that the more Korean male adolescents participate in physical education classes in a week, the more likely they are to become healthy, overweight and obese. The more they participate in physical education classes in a week, the less often they are treated in hospitals for school violence. The more they participate in school physical education classes in a week, the less likely they are to experience suicidal ideation but more likely to feel lonely. Overall, increasing the number of physical education classes can help solve adolescents’ health problems, but they must participate actively and voluntarily in the classes. Efforts must be made to increase their active and voluntary participation.

What Is Helpful and What Is Challenging for the Caregivers of Young People Receiving Interventions to Prevent Suicide? Caregivers' Perspectives-A Rapid Scoping Review.

(1) Background: Suicide is a leading cause of death among young people. Preventing suicide in young people is a priority. Caregivers play a vital role in ensuring interventions for young people experiencing suicide ideation and/or attempts are implemented, and that they are maintained over time. Despite this, little is known about what caregivers find helpful and challenging in relation to suicide prevention interventions. This rapid scoping review is the first to address this gap. (2) Methods: Searches were completed on six electronic databases using keywords relating to 'suicide prevention, 'young people', and 'caregivers'. Ten studies-using both qualitative and quantitative methods, and involving >1400 carers from the United States and Europe-were selected for inclusion. (3) Results: The review shows that caregivers value interventions that are delivered by non-judgmental clinicians, that are suitable to the particular needs of their child, that are available when needed, and that support their confidence and communication. Caregivers experience difficulties with interventions that require their attendance at specific times, and that fail to recognize and/or address their own mental health needs. (4) Conclusions: The findings can be used to inform and improve the intervention design, with the aim of improving outcomes for caregivers and young people.

Implying implausibility and undermining versus accepting peoples' experiences of suicidal ideation and self-harm in Emergency Department psychosocial assessments.

Patients seeking emergency care for self-harm and suicidality report varying experiences from being believed and taken seriously to not being believed and taken seriously. Epistemic injustice provides a conceptual framework to explore how peoples' experiences of self-harm and suicidality are believed or not. We use an empirical method -conversation analysis - to analyze epistemics in clinical communication, focusing on how knowledge is claimed, contested and negotiated. In courtroom, police and political interaction, conversation analysis has identified communication practices implying implausibility in a person's story to contest and recharacterize their accounts. To investigate communication practices in Emergency Department (ED) biopsychosocial assessments that may (1) undermine, imply implausibility and recharacterize or (2) accept peoples' experiences of suicidal ideation and self-harm. Using conversation analysis, we micro-analyzed verbal and non-verbal communication in five video-recorded biopsychosocial assessments with people presenting to the ED with self-harm or suicidal ideation, and conducted supplementary analysis of participants' medical records and post-visit interviews. We present three cases where experiences were not accepted and undermined/recharacterized and two cases where experiences were accepted and validated. When peoples' experiences of suicidality and self-harm were not accepted or were undermined, questioners: did not acknowledge or accept the person's account; asked questions that implied inconsistency or implausibility ("Didn't you tell your GP that you were coping okay?"); juxtaposed contrasting information to undermine the person's account ("You said you were coping okay before, and now you're saying you feel suicidal"); asked questions asserting that, e.g., asking for help implied they were not intending to end their life ("So when you called 111 what were you expecting them to do"); and resistinged or directly questioned the person's account. Multiple practices across the assessment built on each other to assert that the person was not suicidal, did not look or act like they were suicidal; that the person's decision to attend the ED was not justified; that an overdose was impulsive and not intended to end life; asking why the person didn't take a more harmful medication to overdose; that self-harming behaviors were not that serious and should be in the person's control. Alternative characterizations were used to justify decisions not to provide further support or referrals to specialist services. At times, these practices were also delivered when speaking over the patient. When peoples' experiences were accepted, practitioners acknowledged, accepted, validated suicidality/self-harm and introduced a shared understanding of experiences that patients found helpful. Non-verbal feedback such as nodding and eye contact was central in acceptance of patients' accounts. These findings advance our understanding of how peoples' experiences of suicidality or self-harm are undermined or accepted in mental health encounters in the ED. They have important clinical implications: patients report that when their experiences are not accepted or undermined, this makes them more distressed, less hopeful about the future and discourages future help-seeking when in crisis. Conversely, acknowledging, accepting and validating suicidality/self-harm and introducing a new ways of understanding peoples' experiences may make people less suicidal and more hopeful, generates shared understanding and encourages future help-seeking.

Clinical presentations of suicidality in relation to medical assistance in dying.

This study explores the assessments of mental health clinicians working with suicidal patients who requested access to medical assistance in dying (MAiD). A sample of convenience completed an online questionnaire about their experiences with suicidal patients. Respondents described their encounters with 227 suicidal patients: 44 requested access to MAiD, and 183 did not. Data were analyzed using chi-squared and simple t-test to identify differences between the respondents' descriptions of the two groups. Results noted differences between patients who experience suicide ideation and request MAiD (SPM), and those who experience suicide ideation and do not (SP). Overall, the SPM group was older, more physical health concerns, chronic pain, existential distress, and less hope. Many had experienced several episodes of mental health care and medication trials, though unlike the SP group, they had a split between accessing a little care and a lot of care. They also engaged in less suicide planning, and some had no history of suicide attempts. It is important that mental health clinicians learn to differentiate between MAiD requests due to an ongoing and irremediable mental disorder, and MAiD requests in response to circumscribed psychological suffering that could be relieved via a change in circumstances and/or access to different treatment options amenable to the patient.

Suicide ideation in older people: a qualitative review and Meta-aggregation of Asian studies.

To appraise and synthesize qualitative studies examining older Asian people's experiences of suicidal ideation. Qualitative review and meta-aggregation. Four databases were accessed to retrieve papers published between 1990 and 2022 including the grey literature, hand-searching of reference lists of retrieved papers and key journals. The phenomenon of interest included participants older than 60 years old, must have experienced a form of suicidal ideation and/or an unsuccessful attempt, had actively thought about harming themselves and be of Asian ethnicity. This review was conducted according to Consolidated Criteria for Reporting Qualitative Research and the Joanna Briggs Institute's System for the Unified Management of the Assessment and Review of Information. Of the 289 potential studies, seven papers met the inclusion criteria. Two synthesized findings resulted from this review-The Suffering Situation: A Life without Meaning in Older Age and The Healing Situation: A Life Worth Living. The experiences of older Asian people varied from feelings of loneliness, despair and isolation to wanting to live a fruitful life into old age. Suicidal ideation in the older person is a growing concern especially with the rise in suicide in this age group. Rising health care costs and erosion of traditional family values means that the older person views themselves as a burden. However, because of the limited number of qualitative studies from an Asian perspective it is difficult to ascertain the full extent of the issues surrounding suicide in older people.

Cortisol Regulation among Women Who Experience Suicidal Ideation during Pregnancy

BackgroundSuicidal thoughts occur in up to one third of pregnant women. Suicidal ideation (SI) has been linked to hypothalamic-pituitary-adrenal (HPA) axis dysregulation in other populations and could underlie SI during pregnancy when the HPA axis undergoes gestational transformation. However, no studies have evaluated the HPA axis in prenatal suicide risk, including regulation of cortisol. We examined whether SI is associated with distinct features of cortisol regulation among women during the 3rd trimester of pregnancy. MethodsSixty-four women completed measures of SI and provided 8 saliva samples across 2 consecutive days for cortisol assay. Three cortisol metrics were assessed in separate linear regression models (awakening response, diurnal slope, and area under the curve), along with selected covariates. ResultsWomen with SI (n=10) had a dampened diurnal cortisol slope in contrast to other women (β = -.32, p = .005; η2p =.094). Cortisol levels decreased from waking to 45 minutes after waking (.33ug/dL to .27ug/dL) rather than increasing as found for women without SI (.38ug/dL to .51ug/dL). Their cortisol also rose from 4pm to sleep (.09ug/dL to .31ug/dL) in contrast to a decrease among women without SI (.12ug/dL to .09ug/dL; F = 6.26 (4,59), p=.015). LimitationsThe small number of women with SI may have reduced the power to detect significant effects. ConclusionsFindings for women with SI differ from the expected pattern of cortisol secretion across the day and indicate circadian rhythm dysfunction. Further research can build on these results to clarify mechanisms underlying perinatal suicidality, with improved assessment and intervention targets as the goal.

A mixed methods analysis of U.S. military veterans’ suicidal ideation experiences during the COVID-19 pandemic: Prevalence, correlates, and perceived impact

This mixed methods study sought to increase understanding of veterans’ experiences of suicidal ideation (SI) during the COVID-19 pandemic, including prevalence, correlates, and perceived impact. A national survey of veterans (n=567) was conducted from 12/2020 to 2/2021. Quantitative analyses (weighted to the veteran population) examined SI prevalence and correlates. Qualitative thematic analysis of veterans’ free text responses was used to examine veterans’ lived experiences regarding the perceived impact of the pandemic. Among veterans, 9.6% (95% CI: 6.8, 12.5) experienced past-year SI, and 5.0% (95% CI: 2.8, 7.3) experienced past-month SI, estimates of prevalence during the early phase of the pandemic. Additionally, 3.1% (95% CI: 1.4, 4.7) reported experiencing increased SI frequency, and 2.2% (95% CI: 0.7, 3.6) reported experiencing increased SI intensity, during the pandemic. SI (past-year, past-month, and increased frequency during the pandemic) was more prevalent among veterans who were younger, Black, had minor(s) at home, screened positive for posttraumatic stress disorder, screened positive for depression, obtained lifetime mental health treatment, and accessed past-year outpatient mental health care. In qualitative analyses, Veterans with increased SI frequency described multi-faceted negative impacts of the pandemic, including in regard to their mental health, employment, and family. Negative perceptions of the personal impact of the pandemic were strongly associated with SI (past-year, past-month, and increased frequency). Supporting veterans who have been negatively impacted by the pandemic, including with respect to mental health and family functioning, may be particularly important to addressing SI in the aftermath of the COVID-19 pandemic and for prevention in future pandemics.

“I Just Want to be Acknowledged”: Suicidal Ideation Experiences among Sexual Minority Students at a Religiously Affiliated University

ABSTRACT Research finds that sexual minority university students experience considerable psychological and emotional distress. Furthermore, a recent study at Brigham Young University (BYU)—a university affiliated with The Church of Jesus Christ of Latter-day Saints—found that suicidality prevalence and severity were twice as high among sexual minority students compared to their heterosexual peers. To better understand this finding, we interviewed ten sexual minority students at BYU who reported clinically significant current or previous suicidality. A coding team and auditors then analyzed and categorized the transcripts of these interviews using the Consensual Qualitative Research methodology. Five domains emerged related to suicidality among sexual minority students: deterrents from suicidal ideation and intent; contributors to suicidal ideation and intent; religious and spiritual experiences; experiences with BYU; and suggested improvements. We found patterns consistent with previous literature, including relational and belonging factors contributing to suicidality; we also found that certain doctrinal interpretations were related to increased suicidality. The primary improvement requested by participants was feeling better understood and accepted (rather than ignored or marginalized). We discuss study limitations (including small sample size and low generalizability,), future directions for research, and implications for religious university campuses.

"And you feel like you're suffocating … how the fuck am I going to get out of all this?" Drivers and experiences of suicidal ideation in the Australian construction industry.

This research was designed to generate understandings of drivers and experiences of suicidal ideation and distress among Australian Construction Industry (ACI) workers, as well as what helped during these experiences. Fifteen participants, from a variety of ACI or closely associated roles, with an average age of 45 years (29-66), engaged in individual, semi-structured interviews. Interviews were audio-recorded with consent and analyzed using descriptive thematic analysis. Eight themes relating to what may drive the presence of suicidal ideation and distress were identified; 1) challenges of working within the ACI, 2) relationship and family issues, 3) social disconnection, 4) personal financial hardship, 5) perceived lack of support, 6) alcohol and drug use, 7) child custody/access and legal issues, and 8) experience of mental health challenges, trauma, or a significant adverse life event. Four themes relating to experience and expression of suicidal ideation and distress were identified: 1) suicidal thoughts, 2) impaired thinking, 3) observable expressions of suicidal distress, and 4) lack of observable expressions of suicidal distress. Six themes relating to what helped during experiences and well as what can be done by the ACI to help mitigate experiences, were identified: 1) presence of colleague and managerial support, 2) MATES in Construction, 3) engagement with non-work activities and social support, 4) personal skills and knowledge relating to suicide and mental health, 5) high level industry integration and engagement with support programs, and 6) work hours and expectations changes. Findings highlight several industry and personal related challenges that may drive experiences, with many potentially mitigatable by ACI changes and focused prevention strategies. Participant suicidal thought descriptions align with previously identified constructs deemed central in suicidal trajectories. While findings highlight several observable expressions of suicidal ideation and distress, challenges associated with identifying and assisting individuals in the ACI who may be struggling were also reported. Several factors that helped ACI workers during their experiences, as well as what the ACI can do to mitigate future experiences, were identified. Recommendations are made based on these findings, encouraging a more supportive work environment, as well as continued development and increased awareness of support and education systems.

Influencing factors of suicidal ideation in lung cancer patients in Midland China: A mixed-method study.

The suicide risk of lung cancer patients is higher than that of patients with other cancers. However, as China is a large country for lung cancer, there are no relevant reports on lung cancer suicides. This study aimed to investigate the prevalence of suicidal ideation and explore its influencing factors in lung cancer patients. In this cross-sectional study, between July to November 2019, 366 lung cancer patients from the oncology department of a general hospital in Wuhan were chosen as participants. Of these, eight with lung cancer and suicidal ideation were selected for in-depth interviews. A total of 22.68% of lung cancer patients reported suicidal ideation. Sex, cancer stage, number of uncomfortable symptoms, and satisfaction with treatment were independently associated with suicidal ideation. This qualitative study found that the experience of suicidal ideation in lung cancer patients includes physiological (heavy burden of symptoms),psychological (bad mood, thwarted belongingness, perceived burdensomeness, and stigma), and social factors (high economic pressure and negative life events). These findings suggest that the incidence of suicidal ideation in lung cancer patients is higher than that of other cancers and is affected by many factors. Therefore, there should be routine screening and assessment of suicidal ideation among lung cancer patients, and related mental health and suicide prevention education should be provided.

Revisiting the factor structure of the suicide-related coping scale: Results from two samples of Australian online help-seekers

The Suicide-Related Coping Scale (SRCS) measures how well a person manages suicidal thoughts through the use of internal and external coping strategies. Many studies using SRCS, including the original scale validation, used samples of treatment-engaged military veterans or personnel, which may limit the generalizability of study findings to other help-seeking and cultural contexts. The present study evaluated factor structure, internal consistency, convergent and divergent validity of SRCS in two Australian online help-seeking samples: visitors to a mental health website with experience of suicidal ideation (N = 1,266) and users of a suicide safety planning mobile app (N = 693). Factor analyses found a reduced 15-item version of the scale (SRCS-15) provided the best fit in both samples, with three factors found: Internal Coping, External Coping and Perceived Control. Internal consistency was good (α = 0.89). Strong negative associations were found between SRCS-15, recent suicidal ideation and future suicide intent. Perceived Control demonstrated the strongest associations with suicidal ideation and future suicide intent (negative) and distress tolerance (positive). External Coping demonstrated the strongest associations with help-seeking (positive). Items relating to means restriction and hospital location knowledge were dropped from SRCS-15 due to low factor loadings but may still contain clinically relevant information. SRCS-15 appears to be reliable and valid in capturing aspects of self-efficacy and belief-based barriers to coping, making it a useful additional outcome measure for suicide-related services and interventions.

Acute Emergence of Suicidal Thoughts Following Lemborexant Initiation: An Adverse Reaction Case Report

AbstractThis is a case report highlighting the side effect of suicidal ideation with lemborexant, a novel agent approved for the treatment of insomnia. A 22-year-old man received care at an outpatient psychiatrist for the treatment of major depressive disorder, persistent depressive disorder, generalized anxiety disorder, social phobia, and insomnia. The patient also has a diagnosis of Loeys-Dietz syndrome, a connective tissue disorder. Following numerous medication trials for both depression and insomnia that resulted in partial remission of mood symptoms without improvement in sleep, he was initiated on lemborexant to address insomnia. He was noted to be denying suicidal ideation at the appointment when lemborexant was prescribed. The patient did not take lemborexant until three days after the appointment, at which time he took the recommended dose of 5 mg at bedtime for insomnia. The patient experienced drowsiness immediately following taking this dose; however, he woke up two hours later with new-onset suicidal ideation. The patient was brought to the hospital for this complaint, and the following evening had attempted suicide by hanging in his hospital room. Laboratory investigations showed normal findings in blood chemistries, complete blood count, thyroid stimulating hormone, vitamin B12 level, vitamin D level, and urine illicit drug screening. Differential diagnosis includes acute reaction to insomnia, medication-induced side effect, and major depressive disorder. He had completed trials for insomnia with zolpidem, hydroxyzine, quetiapine, nortriptyline, and trazodone prior to beginning lemborexant. The patient had no history of suicide attempts in the past, but did experience suicidal ideation following a trial of nortriptyline. In the hospital, the lemborexant was discontinued, and clonidine and clonazepam were initiated at bedtime to address insomnia and ruminative thoughts. The patient was discharged with follow-up at his outpatient psychiatrist after his suicidal ideation was in remission, as well as noted improvement in insomnia. This case highlights new-onset suicidal ideation with subsequent suicide attempt after first use of lemborexant in a patient with major depressive disorder. This case is important given lemborexant is a new medication with limited information about its efficacy and safety in major psychiatric disorders.FundingNo Funding

Contribution of veterans' initial post-separation vocational, financial, and social experiences to their suicidal ideation trajectories following military service.

Veterans' success with navigating the challenges of transition from military service may contribute to their risk for suicidal outcomes. The concept of well-being can help to conceptualize and assess successful navigation of reintegration challenges and may serve as an optimal target for public health-oriented suicide prevention. The relationship between US veterans' psychosocial well-being and experiences of suicidal ideation (SI) during the first 3 years following military separation was evaluated using multinomial logistic regression predicting SI trajectories over time in a population-based, longitudinal, post-9/11 veteran cohort. At 3-months post-separation, veterans reported on their socio-material conditions, functioning, and satisfaction with respect to vocational, financial, and social domains. SI frequency was assessed at 3-, 9-, 15-, 21-, and 27-months post-separation using the Patient Health Questionnaire-9. Veterans' vocational, financial, and social well-being were associated with their SI trajectories, even after accounting for mental health. Socio-material conditions, functioning, and satisfaction all emerged as important predictors of SI trajectories, although results varied across domains. Effects were largest for social well-being. Suicide prevention efforts may benefit from a holistic approach that considers veterans' needs for support across their vocational, financial, and social well-being, inclusive of their socio-material conditions, functioning, and satisfaction within each domain.