High Rates Of Suicidal Behavior Research Articles

Suicidal Behavior of Australian Males, From an Ethnicity Perspective

Background Suicide is the 10th leading cause of death among Australian males. Despite the cultural diversity in Australia, there is a significant research gap in knowledge of suicidal behavior among Australian males from ethnically and culturally diverse backgrounds. The study aimed to estimate the prevalence and risk of suicidal behaviors among Australian males based on ethnicity, with an emphasis on those from ethnic-minority backgrounds. Methods We used data from the first wave of the Australian Longitudinal Study on Male Health. Multiple logistic regression models were used to determine the risk of suicidal behavior (lifetime suicide attempt, lifetime suicidal ideation, recent suicidal ideation) by ethnicity. Results Among ethnic minority males, Pacific Islander males also had the highest prevalence of lifetime suicide attempts (12.2%), while Middle Eastern (2.3%) and South-/North-East Asian males (2.9%) had the lowest rates. South American males had the highest recent suicidal ideation (18.2%), followed by Pacific Islanders (14.2%). The highest prevalence of lifetime suicidal thoughts was reported among males of mixed ethnicity (23.0%), followed by South American (14.6%) and Pacific Islander (13.5%) males. Most ethnic-minority groups had a lower risk of lifetime suicidal ideation compared with Australian males. Evidence regarding differences in recent suicidal ideation and lifetime suicide attempts between ethnic-minority and Australian-background males was inconclusive. Conclusion Evidence was found of differences in suicidal behaviors among Australian males based on ethnicity. Future research should use inclusive methodologies to confirm these associations and explore the underlying factors contributing to higher rates of suicidal behavior in specific populations.

Understanding the influence of Social Determinants of Health (SDH) on suicidal behaviors among HIV-positive men who have sex with men (MSM) in China: A population-based study

BackgroundHIV-positive men who have sex with men (MSM) are at high risk of suicide and experience intersectional inequalities. The Social Determinants of Health (SDH) framework provides valuable insights into how inequalities can lead to adverse outcomes. This study aimed to employ the SDH framework to identify factors that contribute to suicidal behaviors among this population. Methods1410 HIV-positive MSM were recruited using a web-based questionnaire, whose mean age was 30.77 ± 6.92 years old. Participants completed questionnaires including baseline information and psychological measurements, such as Suicidal Behaviors Questionnaire-Revised (SBQ-R). Logistic regression analysis was conducted to screen for risk factors associated with suicidal behaviors. ResultsMore than half of the participants (53.3 %, 752/1410) had an SBQ score of 7 or higher. Binary logistic regression analysis of structural and intermediary determinants (Model 3) revealed that sexual orientation, stigma (ORs: 1.018, 95 % CI: 1.005–1.032), interpersonal needs (ORs: 1.021, 95 % CI: 1.010–1.031), depression (ORs: 1.037, 95 % CI: 1.001–1.074) and entrapment (ORs: 1.018, 95 % CI: 1.004–1.032) were positively correlated with suicidal behaviors. Individuals with other or unknown sexual orientation had significantly higher rates of suicidal behaviors compared to those with a heterosexual sexual orientation (ORs: 5.021, 95 % CI: 1.529–17.640). LimitationsSampling of HIV-positive MSM posed challenges in data collection. It may introduce selection bias and affect generalizability. ConclusionThis study identified that sexual orientation, stigma, interpersonal needs, depression, and entrapment were significantly associated with suicidal behaviors among HIV-positive MSM. Additionally, these factors can be social determinants of health that contribute to suicidal behaviors.

Suicidal behavior and deliberate self-harm: A major challenge for youth residential care in Spain

The aim of this study was to characterize and determine the incidence of suicidal behavior and deliberate self-harm among youth in residential care in Spain, and to explore the perceived knowledge and competence of direct care professionals with regard to recognizing and managing suicide risk. The sample comprised 185 adolescents aged between 12 and 18 years (M = 15.41, SD = 1.58; 49.7 % male, 49.2 % female, and 1.1 % non-binary) and 225 direct care professionals (Mage = 34.58, SD = 13.72). We found a high rate of suicidal behavior (36.2 % of adolescents reported suicidal ideation and 26.5 % had made a lifetime suicide attempt), and only a third of young people who had thoughts about suicide had sought help. Half of the adolescent sample had engaged in deliberate self-harm. Among direct care professionals, there was a perceived lack of knowledge with respect to recognizing and managing suicide risk behavior. Adolescents in residential care are a risk population that should be targeted with specific interventions aimed at preventing suicidal behavior. Training for professionals is also needed to ensure they have the skills required to ask young people about suicidal thoughts or intentions and to engage them with appropriate support services.

The effect of the SAFE intervention on post-discharge suicidal behavior: a quasi-experimental study using propensity score matching

ObjectivesThe risk of suicidal behavior after discharge from psychiatric admission is high. The aim of this study was to examine whether the SAFE intervention, an implementation of a systematic safer discharge procedure, was associated with a reduction in suicidal behavior after discharge.MethodsThe SAFE intervention was implemented at Mental Health Center Copenhagen in March 2018 and consisted of three systematic discharge procedures: (1) A face-to-face meeting between patient and outpatient staff prior to discharge, (2) A face-to-face meeting within the first week after discharge, and (3) Involvement of relatives. Risk of suicide attempt at six-month post-discharge among patients discharged from the SAFE intervention was compared with patients discharged from comparison mental health centers using propensity score matching.Results7604 discharges took place at the intervention site, which were 1:1 matched with discharges from comparison sites. During the six months of follow-up, a total of 570 suicide attempts and 25 suicides occurred. The rate of suicide attempt was 11,652 per 100,000 person-years at the SAFE site, while it was 10,530 at comparisons sites. No observable difference in suicide attempt 1.10 (95% CI: 0.89–1.35) or death by suicide (OR = 1.27; 95% CI:0.58–2.81) was found between sites at 6-month follow-up.ConclusionNo difference in suicidal behavior between the sites was found in this pragmatic study. High rates of suicidal behavior were found during the 6-months discharge period, which could suggest that a preventive intervention should include support over a longer post-discharge period than the one-week follow-up offered in the SAFE intervention.

Personality disorder and suicide risk among patients in the veterans affairs health system.

Among veterans in Veterans Health Administration (VHA) care, patients with mental health and substance use conditions experience elevated suicide rates. However, despite previously demonstrated high rates of suicidal behavior, little is known regarding suicide rates among veteran VHA users with personality disorders (PDs) as a whole, or by PD clusters (A: Eccentric; B: Dramatic; C: Fearful; and PD-not otherwise specified). PD prevalence and suicide rates were assessed through 2017; overall and by clusters for 5,517,024 veterans alive as of 12/31/2013 and with more than 2 VHA encounters in 2012-2013. In all, 46,050 (.83%) had a PD diagnosis in 2012-2013. Suicide risk was examined using proportional hazards regressions adjusted for age, sex, veteran status, clustering within a geographic region, and other mental health diagnoses. Patients with PDs had greater suicide risk than those without (156.5 vs. 46.7 per 100,000 person-years). Individuals in Cluster B, which includes borderline and antisocial PDs, were at the highest risk (178.5 per 100,000 person-years), followed by PD-not otherwise specified and Cluster C (152.6 and 121.4 per 100,000 person-years, respectively). Rates of PDs in the VHA system were lower than those usually found in community samples. Veterans with a PD diagnosis had an increased risk of suicide, which was especially elevated for those with Cluster B diagnoses. Study findings document the importance of enhancing diagnosis and treatment for veterans with PDs and targeted suicide prevention services. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

How to target disturbed identity in borderline patients? Self-identification program: A case study

Borderline personality disorder (BPD) is a severe and relatively prevalent psychiatric disorder, responsible for high rates of suicidal behaviors. Disturbed identity appears as at the very core of this disorder, being inter-related with all other BPD features. Notably, from a dimensional perspective on mental disorders, one should realize that it is from our usual self-representation that we live all our daily experiences. Then, if the understanding of self-concept (or identity) is impaired, all the interventions implemented to decrease the self's suffering will subsequently be impaired. The purpose of the present case study was to illustrate the nine identity diffusion categories described by Jørgensen & Bøye (2022) and how the level of identity function can be improved in a third-wave cognitive and behavioral therapy targeting progressive correct self-identification.

Comparative clinical utility of screening for Suicide Crisis Syndrome versus suicidal ideation in relation to suicidal ideation and attempts at one-month follow-up.

Suicidal ideation (SI) has numerous limitations in predicting suicidal behavior. The Suicide Crisis Syndrome (SCS) is proposed as an alternative method of detecting risk. This study compares the relative utility of SI and SCS in statistically predicting SI and behaviors at one-month follow-up. 382psychiatric patients (98 inpatients, 284 outpatients) completed baseline measures and provided information about suicide-related outcomes one month later. Participants were grouped based on responses to measures assessing SCS and SI. Rates of follow-up suicidal behavior were significantly higher among those reporting both SCS and SI (22.2%) than those reporting SI alone (6.0%) or neither SCS nor SI (0.9%). SCS alone (8.3%) had descriptively, but not statistically, higher rates of suicidal behavior than those with neither SCS nor SI, and did not differ from SI alone and the combination of SCS and SI. Those reporting SI-with and without SCS-had higher levels of follow-up suicidal thoughts than those without SI. The SCS was equivalent to SI, and incrementally informative alongside SI, in detecting individuals at risk of future suicidal behavior, whereas SI was more strongly related to future SI than SCS. The combination of SCS and SI may be clinically useful in detecting individuals who are at risk for suicide.

Bridging juvenile justice and behavioral health systems: development of a clinical pathways approach to connect youth at risk for suicidal behavior to care

BackgroundJustice-involved youth have high rates of suicidal behavior and co-morbid psychiatric disorders, yet low rates of service use. Implementation efforts aimed at supporting cross-agency linkage protocols may be useful components of interventions promoting behavioral healthcare service access for youths on probation. The purpose of this study was to develop clear referral Pathways for three suicide risk classifications of youth, across 10 counties in a single state through a community-academic partnership in New York state, a strategic planning process between county Probation departments and community Behavioral Health.ResultsWe sought to clarify service destinations for youth in three classes of risk for suicidal behavior: Class I (Crisis, Imminent Risk); Class II (Crisis, Non-Imminent Risk); and Class III (Non-Crisis but in Need of Service). Prior to Pathway Meetings, there was a low degree of agreement between Probation and Behavioral Health leadership for the appropriate service destination for youths in crisis, whether at imminent risk (Class I: 57.8% overlap) or at lower than imminent risk (Class II: 45.6% overlap). Options for referral destinations for Classes I and II decreased significantly (indicating greater overlap) as a result of Pathway Meetings [(Class I: from 2.5 to 1.1 (t(9) = 3.28, p < 0.01); Class II: from 2.8 to 1.3 (t(9) = 4.025, p < 0.003)]. Pathway Meetings allowed Behavioral Health and Juvenile Justice systems to make joint decisions regarding referral pathways, resulting in innovative solutions, such as the use of mobile crisis.ConclusionsThe community-academic partnership served to bring internal (Juvenile Justice) and external (Behavioral Health) contexts together to successfully generate agreed upon Pathways to care for youths demonstrating risk for suicidal behavior. Bridging Behavioral Health and Juvenile Justice systems together to agree to referral Pathways for each risk class can increase appropriate service use.Trial registrationClinicalTrials.gov, NCT03586895. Registered 21 June 2018, https://register.clinicaltrials.gov/prs/app/template/EditRecord.vm?epmode=Edit&listmode=Edit&uid=U0003B7I&ts=4&sid=S00080NN&cx=-n4kinh

Discrimination experienced by Aboriginal and Torres Strait Islander males in Australia: Associations with suicidal thoughts and depressive symptoms.

Globally, Indigenous populations have higher rates of suicidal behavior and psychological distress compared to non-Indigenous populations. Indigenous populations also report high rates of exposure to discrimination, which could potentially contribute to poor mental health outcomes. The objectives of this paper were to estimate the prevalence of discrimination among Aboriginal and Torres Strait Islander males in Australia and to examine the role of discrimination in the association between Aboriginal and Torres Strait Islander status and suicidal thoughts and depressive symptoms. We used cross-sectional data on 13,697 males aged 18-55 years from the Australian Longitudinal Study on Male Health. We undertook a Poisson regression with robust standard error analyses to examine Aboriginal and Torres Strait Islander status and self-perceived exposure to discrimination in the past 2 years as correlates of recent suicidal ideation. We used zero-inflated negative binomial regression to assess Aboriginal and Torres Strait Islander status and self-perceived exposure to discrimination as correlates of recent depressive symptoms. Aboriginal and Torres Strait Islander males have a twofold higher prevalence of self-perceived discrimination (39.2% vs 19.3%, p < 0.001), suicidal ideation (21.8% vs 9.4%, p < 0.001) and moderate or worse depressive symptoms (24.0% vs 12.2%, p < 0.001) as compared to their non-Indigenous counterparts. After adjusting for sociodemographics and substance use, Aboriginal and Torres Strait Islander status was significantly associated with suicidal thoughts (odds ratio = 1.49, p = 0.019) and depressive symptoms (prevalence rate ratio = 1.19, p = 0.018). About 15.3% and 28.7% of the association between Aboriginal and Torres Strait Islander status and suicidal thoughts and depressive symptoms, respectively, was explained by discrimination. Our analyses add to evidence that discrimination is a contributor to mental health disparities between Aboriginal and Torres Strait Islander and non-Indigenous populations in Australia. Reducing discrimination ought to be considered as part of strategies to improve the social and emotional well-being of Aboriginal and Torres Strait Islander people.

Psychological predictors of bipolarity in panic disorder.

BACKGROUNDPanic disorders frequently occur with affective disorders, particularly bipolar disorder. Patients with panic disorder and bipolar disorder are more likely to present with severe symptoms, such as high rates of suicidal behavior, poor symptomatic and functional recovery, and poor drug responses.AIMTo investigate the psychological characteristics of panic disorder patients related to bipolarity.METHODSA total of 254 patients (136 men and 118 women, mean age = 33.48 ± 3.2 years) who were diagnosed with panic disorder were included in the study. Panic disorder with bipolarity (BP+) was defined as a score of ≥ 7 on the Korean version of the Mood Disorder Questionnaire (K-MDQ), and a score lower than 7 was considered as a panic disorder without bipolarity (BP-). Self-report questionnaires were analyzed to examine their association with bipolarity. Psychological tests used in the study were the Mood Disorder Questionnaire (MDQ), Panic Disorder Severity Scale, Beck Depression Inventory, State-Trait Anxiety Inventory (STAI), Temperament and Character Inventory (TCI), and Minnesota Multiphasic Personality Inventory (MMPI). Statistical analyses were performed to evaluate the correlation between bipolarity of panic disorder patients and various psychological test results indicative of psychological characteristics.RESULTSPatients with a K-MDQ score of 7 or more were considered to have a history of manic or hypomanic episodes (BP+ group, n = 128), while patients with K-MDQ scores below 7 were defined as those without bipolarity (BP- group, n = 126). The BP+ group were more likely to be unmarried (single 56.2% vs 44.4%, P = 0.008) and younger (30.78 ± 0.59 vs 37.11 ± 3.21, P < 0.001). Additionally, the BP+ group had significantly higher scores on psychological assessment scales, such as the hypochondriasis, psychopathic deviate, masculinity-femininity, psychasthenia, schizophrenia, and hypomania (Ma) in MMPI, and novelty seeking, harm avoidance and self-transcendence in TCI, and STAI (state and trait) compared to the BP- group. In logistic regression analysis, depression in MMPI, self-directedness in TCI, and age were negatively associated with MDQ score, meanwhile, Ma in MMPI and STAI (trait) were positively associated with MDQ score.CONCLUSIONThe result of this study suggests that almost 50% of patients with panic disorder are likely to have hypomanic or manic symptoms, and certain psychological factors are associated bipolarity in panic disorder.

Suicidality in patients with obsessive-compulsive and related disorders (OCRDs): A meta-analysis

IntroductionPrevious meta-analyses showed that OCD is associated with a substantial risk of suicidal behaviours. Conclusive rates of suicidal ideation (current and lifetime) and suicide attempts based on pooled prevalence rates have not so far been calculated using meta-analysis for the other DSM-5 Obsessive-Compulsive and Related Disorders (OCRDs). ObjectivesThis meta-analysis aims to separately calculate the pooled prevalence rates of lifetime suicide attempts and current or lifetime suicidal ideation in BDD, Hoarding Disorder (HD), Skin Picking Disorder (SPD) and Trichotillomania (TTM) and to identify factors associated with increased suicide rates. MethodsOur protocol was pre-registered with PROSPERO (CRD42020164395). A systematic review and meta-analysis following PRISMA reporting guidelines was performed by searching in PubMed/Medline, PsycINFO, Web of Science and CINAHL databases from the date of the first available article to April 20th, 2020. Stata version 15 was used for the statistical analysis. Given the small number of studies in TTM and SPD, the two grooming disorders were grouped together. Meta-analyses of proportions based on random effects (Der-Simonian and Laird method) were used to derive the pooled estimates. ResultsThirty-eigth studies (N = 4559 participants) were included: 23 for BDD, 8 for HD, 7 for Grooming Disorders. For BDD, the pooled prevalence of lifetime suicide attempts, current and lifetime suicidal ideation was, respectively 35.2% (CI:23.4–47.8), 37.2% (CI:23.8–51.6) and 66.1% (CI:53.5–77.7). For HD, the pooled prevalence of lifetime suicide attempts, current and lifetime suicidal ideation was 24.1% (CI:12.8–37.6), 18.4% (CI:10.2–28.3) and 38.3% (CI:35.0–41.6), respectively. For Grooming Disorders, the pooled prevalence of lifetime suicide attempts and current suicidal ideation were 13.3% (CI:5.9–22.8) and 40.4% (CI:35.7–45.3), respectively (no data available for lifetime suicidal ideation). ConclusionsThe OCRDs as a group are associated with relatively high rates of suicidal behaviour. Through indirect comparisons, we infer that BDD has the greatest risk. Comorbid substance abuse, possibly reflecting poor underlying impulse control, is associated with higher rates of suicidal behaviour in BDD. Our data emphasize the need for clinicians to consider the risk of suicidal behaviour in the management of patients presenting with all forms of OCRDs.

Comorbidities Increase Suicide Risk in People With Autism

Comorbidities Increase Suicide Risk in People With Autism

Experience of Chest Dysphoria and Masculinizing Chest Surgery in Transmasculine Youth.

Transmasculine individuals, those assigned female sex at birth but who identify as masculine, have high rates of suicidal behavior and often suffer from chest dysphoria (discomfort and distress from unwanted breast development). Growing numbers of transmasculine youth are pursuing definitive treatment with masculinizing chest surgery (MCS), and adult studies reveal marked benefits of MCS, although little is known about the impact of chest dysphoria on transmasculine youth or the optimal timing of MCS. In this study, we aimed to explore youth experiences of chest dysphoria and the impact of MCS. Transmasculine youth aged 13 to 21 were recruited from a pediatric hospital-based gender clinic. Participants completed a semistructured qualitative interview exploring the experience of chest dysphoria and thoughts about or experiences with MCS. Interview transcripts were coded by 3 investigators employing modified grounded theory, with the median interrater reliability at κ = 0.92. Subjects (N = 30) were a mean age of 17.5 years, and 47% had undergone MCS. Youth reported that chest dysphoria triggered strong negative emotions and suicidal ideation, caused a myriad of functional limitations, and was inadequately relieved by testosterone therapy alone. All post-MCS youth reported near or total resolution of chest dysphoria, lack of regret, and improved quality of life and functioning. We observed consensus that chest dysphoria is a major source of distress and can be functionally disabling to transmasculine youth. MCS performed during adolescence, including before age 18, can alleviate suffering and improve functioning. Additional research is needed to develop patient-reported outcome measures to assess the impact of chest dysphoria and MCS.

Suicidal Ideation and Behaviors Among Irish Travellers Presenting for Emergency Care.

Background: Suicide is a serious problem in the Traveller community, with rates estimated at 11%: over 6 times that of the general population. Aims: We aimed to establish the prevalence and correlates of suicidal ideation (SI) and self-harm (SH) among Irish Travellers. Method: This was an observational cross-sectional cohort study of patients presenting with SH and SI to a tertiary hospital in Ireland, in an area with a large local Traveller population. Data were analyzed from the anonymized database (n=2,016), comparing characteristics of Travellers and the general population. Results: This study found that Travellers (1.6% of the local population) represent 4.3% of the population seen in hospital with SH and SI, and 14.8% of episodes. There was a significant difference in SH methods used: Travellers were significantly more likely to present following attempted hanging (OR = 21.8; p = .004). Travellers were more commonly diagnosed with depression or substance abuse, referred from critical care, and transferred for inpatient psychiatric treatment. Limitations: Limitations include the use of retrospective data from a service activity database rather than clinical information collected prospectively. Conclusion: There are significant differences in patterns of suicidal behaviors between Irish Travellers and the general population. Further research is required to understand and address the high rates of suicidal behaviors in this population.

Association of Child Placement in Out-of-Home Care With Trajectories of Hospitalization Because of Suicide Attempts From Early to Late Adulthood

Children placed in out-of-home care (OHC) have higher rates of suicidal behaviors, including suicide attempts, compared with those who grow up in their family of origin. Several studies have shown that this elevated risk persists into young adulthood. Yet, our knowledge about any longer-term associations of OHC with suicide attempts is limited. To examine how childhood experiences of placement in OHC are associated with trajectories of hospitalization because of suicide attempts (HSA) from early into late adulthood. This prospective birth cohort study that was conducted in Stockholm, Sweden, and analyzed in March 2020 included 14 559 individuals born in 1953 who were living in the greater metropolitan of Stockholm in November 1963 and followed through registers up until December 2016. Childhood experiences of OHC based on information from the Social Register (age 0-19 years). Hospitalization because of suicide attempts based on in-patient care data from the National Patient Register. Group-based trajectory modeling was used to cluster individuals according to their probabilities of HSA across adulthood (age 20-63 years). In this cohort of 14 559 individuals (7146 women [49.1%]), 1320 individuals (9.1%) had childhood experiences of OHC, whereas 525 individuals ( 3.6%) had HSA. A Cox regression analysis showed a substantially higher risk of HSA among those with childhood experiences of OHC (hazard ratio, 3.58; 95% CI, 2.93-4.36) and after adjusting for a range of adverse childhood living conditions (hazard ratio, 2.51; 95% CI, 2.00-3.15). Those with at least 1 HSA were grouped into 4 trajectories: (1) peak in middle adulthood (66 [12.6%]), (2) stable low across adulthood (167 [31.8%]), (3) peak in early adulthood (210 [40.0%]), and (4) peak in emerging adulthood (82 [15.6%]). A multinomial regression analysis suggested that those with experiences of OHC had higher risks of following any of these trajectories (trajectory 1: relative risk ratio [RRR], 2.91; 95% CI, 1.61-5.26; trajectory 2: RRR, 3.18; 95% CI, 2.21-4.59; trajectory 3: RRR, 4.32; 95% CI, 3.18-5.86; trajectory 4: RRR, 3.26; 95% CI, 1.94-5.46). The estimates were reduced after adjusting for adverse childhood living conditions. The findings suggest that the elevated risk of suicide attempts among former child welfare clients does not cease after young adulthood, indicating the necessity for clinical attention to childhood experiences of OHC as a risk marker for suicidal behavior across the life span.

MTHFR Ala222Val polymorphism and clinical characteristics confer susceptibility to suicide attempt in chronic patients with schizophrenia

Patients with schizophrenia (SCZ) exhibit higher suicide rates than the general population. However, the molecular mechanism responsible for the high rate of suicidal behavior in SCZ remains poorly understood. MTHFR Ala222Val (C677T; rs 1801133) polymorphism has repeatedly demonstrated to play a pathological role in numerous mental disorders, but none of these studies focused on the susceptibility of suicidal behavior in SCZ. In the present cross-sectional study, we recruited 957 chronic inpatients with SCZ and 576 healthy controls to assess the psychopathological symptoms of SCZ and compare the frequency of the MTHFR Ala222Val genotype in both suicide attempters and non-attempters. Our results demonstrated no significant differences in MTHFR Ala222Val genotype and allele distributions between the SCZ patients and controls (p > 0.05), but showed a statistical significance in the distribution of Ala/Val genotype between suicide attempters and non-attempters (p < 0.05). Further logistic regression analysis showed that MTHFR Ala222Val genotype, psychopathological symptoms, number of cigarettes smoked per day and drinking status were related to suicide attempts in SCZ (p < 0.05). Our study demonstrated that MTHFR Ala222Val polymorphism and some clinical characteristics might confer susceptibility to suicide in patients with SCZ.

Attempted Suicide Among Adolescents in Military Families: The Mediating Role of Adverse Childhood Experiences.

Research has shown that adolescents in military families have higher rates of suicidal behaviors compared to their nonmilitary peers. This is typically attributed to military-specific stressors, but exposure to adverse childhood experiences (ACEs) may also play a role. Our primary research objective was to determine whether cumulative exposure to ACEs mediates the relationship between military family involvement and attempted suicide. A two-stage cluster random sampling design was used to randomly sample 5,336 students from 98 high schools. Students were asked whether a parent or other adult in their home was serving on active duty in the military and attempted suicide in the past 12 months was assessed. Six measures of childhood abuse and household dysfunction were summed, and the ACE score was categorized as 0, 1, 2, and 3-6 ACEs. Weighted logistic regression and multinomial regression were used to assess differences in ACEs and attempted suicide, controlling for sex, age, race/ethnicity, rurality, and qualification for free/reduced lunch. To investigate potential mediation effects of ACEs on the relationship between military family and attempted suicide, we conducted path analyses controlling for demographics. Compared to their peers, students in military families had higher exposure to ACEs (1 ACE: adjusted odds ratio [AOR] = 1.49, 95% confidence interval [CI] = [0.88, 2.53], 2 ACEs: AOR = 2.07, 95% CI = [1.23, 3.48], and 3-6 ACEs: AOR = 2.57, 95% CI = [1.54, 4.27]) and twice the odds of attempting suicide in the past 12 months (AOR = 2.16, 95% CI = [1.30, 3.61]). Mediation analyses showed that cumulative exposure to ACEs completely mediated the relationship between military family involvement and attempted suicide. The study results highlight the need for trauma-informed approaches to mental health promotion with military families.

Relationship of the high proportion of suicidal acts involving ingestion of pesticides to the low male-to-female ratio of suicide rates in China.

The 2014 World Health Organization report on global suicide identified large differences in the male-to-female ratio of suicide rates between countries: most high-income countries (HICs) report ratios of 3:1 or higher while many low- and middle-income countries (LMICs) - including China and India - report ratios of less than 1.5:1. Most authors suggest that gender-based social-cultural factors lead to higher rates of suicidal behaviour among women in LMICs and, thus, to relatively high female suicide rates. We aim to test an alternative hypothesis: differences in the method and case-fatality of suicidal behaviour - not differences in the rates of suicidal behaviour - are the main determinants of higher female suicide rates in LMICs. A prospective registry of suicide attempts treated in all 14 general hospitals in a rural county in China was established and data from the registry were integrated with population and mortality data from the same county from 2009 to 2014. There were 160 suicides and 1010 medically-treated suicidal attempts in the county; 84% of female suicides and 58% of male suicides ingested pesticides while 73% of female attempted suicides and 72% of male attempted suicides ingested pesticides. The suicide rate (per 100 000 person-years of exposure) was 8.4 in females and 9.1 in males (M:F ratio = 1.08:1) while the incidence of 'serious suicidal acts' (i.e. those that result in death or received treatment in a hospital) was 81.5 in females and 47.7 in males (M:F ratio = 0.59:1). The case-fatality of serious suicidal acts was higher in males than in females (19 v. 10%), increased with age, was highest for violent methods (92%), intermediate for pesticide ingestion (13%) and lowest for other methods (5%). The incidence of medically serious suicidal behaviour among females in rural China was similar to that reported in HICs, but the case-fatality was much higher, primarily because most suicidal acts involved the ingestion of pesticides, which had a higher case-fatality than methods commonly used by women in HICs. These findings do not support sociological explanations for the relatively high female suicide rate in China but, rather, suggest that gender-specific method choice and the case-fatality of different methods are more important determinants of the demographic profile of suicide rates. Further research that involves ongoing monitoring of the changing incidence, demographic profile and case-fatality of different suicidal methods in urban and rural parts of both LMICs and HICs is needed to confirm this hypothesis.

Unextracted plasma oxytocin levels decrease following in-laboratory social exclusion in young adults with a suicide attempt history

Social exclusion is associated with greater suicide risk and more needs to be known about the biological processes contributing to this association. Oxytocin, a neuropeptide that regulates social interactions, may protect against the negative effects of exclusion by motivating social engagement. Oxytocin levels and desire for social engagement increase when non-psychiatric controls experience acute social exclusion. However, among individuals with borderline personality disorder and chronic depression, oxytocin levels decrease following exclusion. Both of these psychiatric illnesses are associated with high rates of suicidal behavior. No research has examined changes in oxytocin following social exclusion among individuals at risk for suicide. This quasi-experimental study examined differences in oxytocin levels and perceptions of social connectedness following an in-laboratory, acute social exclusion task among (a) individuals with no depression or suicide attempt histories, (b) individuals with current depression symptoms, and (c) individuals with current depression symptoms and suicide attempt histories. Young adults (N = 100) completed self-report measures and provided blood samples before and after an acute social exclusion task (Cyberball). Oxytocin was quantified via enzyme-linked immunosorbent assay. Mixed-design ANCOVAs were used to evaluate changes in unextracted and extracted oxytocin levels, desire for emotional support, thwarted belongingness, and perceived burdensomeness. Among suicide attempters, unextracted oxytocin levels decreased and desire for emotional support did not significantly change following exclusion. Among depressed and healthy controls, desire for emotional support increased and unextracted oxytocin levels did not significantly change. No significant changes in extracted oxytocin levels, thwarted belongingness and perceived burdensomeness emerged. Further research is needed to determine if dysregulated oxytocin-related processes biologically predispose individuals with suicide attempt histories to greater social disconnection and suicide risk.

The magnitude of suicidal ideation, attempts and associated factors of HIV positive youth attending ART follow ups at St. Paul's hospital Millennium Medical College and St. Peter's specialized hospital, Addis Ababa, Ethiopia, 2018.

BackgroundSuicide which is considered a psychiatric emergency, is a serious cause of mortality worldwide. Youth living with HIV/AIDS (YLWHA) have higher rates of suicidal behavior than the general public. This study aimed to assess the magnitude and associated factors of suicide ideation and attempt among the Human Immune deficiency Virus (HIV) positive youth attending anti-retroviral therapy (ART) follow up at St. Paul`s hospital Millennium Medical College and St. Peter`s specialized hospital, Addis Ababa, Ethiopia.MethodsIn this cross-sectional study, 413 HIV positive youth were recruited for interviews, using the systematic random sampling technique. The Composite International Diagnostic Interview (CIDI) was used to assess suicide. PHQ-9, the Oslo social support and HIV perceived stigma scale instruments were used to assess the factors. We computed bivariate and multivariable binary logistic regressions to assess factors associated with suicidal ideation and attempt. Statistical significance was declared at P-value <0.05.ResultThe magnitude of suicidal ideation and attempts were found to be 27.1% and 16.9%, respectively. In the multivariate analysis, female sex (adjusted odd ratio(AOR) = 3.1, 95% CI, 1.6–6.0), family death (AOR = 2.1, 95%CI 1.15–3.85), WHO clinical stage III of HIV (AOR = 3.1 95% CI 1.3–7.35), WHO clinical stage IV of HIV (AOR = 4.76, 95%CI, 1.3–7.35), co-morbid depression (AOR = 7.14, 95%CI, 3.9–12.9), and perceived HIV stigma (AOR = 4.2, 95%CI, 2.27–8.2) were significantly associated with suicidal ideation, whereas female sex (AOR = 4.12, 95%CI, 1.82–9.78), opportunistic infections (AOR = 3.1, 95%CI, 1.6–6.04), WHO clinical stage III of HIV (AOR = 3.1 95%CI 1.24–7.81), co-morbid depression (AOR = 5.6 95% CI, 2.8–11.1), and poor social support (AOR = 3.4, 95%CI, 1.2–9.4) were statistically significant with suicidal attempt. The result suggests that the magnitude of suicidal ideation and attempts among HIV positive youth were high. We recommend that clinicians consider youth with comorbid depression, perceived HIV stigma and poor social support.