High Suicide Research Articles

The relationship between intersectional discrimination and mental health outcomes among LGBTQ+ Asians in New York City: an exploratory, mixed-methods study

ABSTRACT LGBTQ+ Asians face increased mental health risks due to intersectional discrimination and minority stress. This mixed-methods study examined associations between minority stress, intersectional discrimination, and mental health outcomes among LGBTQ+ Asians. Between 2022 and 2023, 136 LGBTQ+ Asian residents of New York City were surveyed. Adjusted logistic regression models compared the odds of clinically-significant depressive symptoms, anxiety symptoms, and suicide risk by self-reported measures of discriminatory experiences towards LGBTQ+ Asians. A subsample of 24 individuals completed semi-structured interviews in English, and thematic content analysis was utilised to understand contextual factors and discriminatory experiences influencing mental health. Individuals experiencing higher levels of everyday discrimination had increased odds of reporting clinically-significant depressive symptoms, anxiety symptoms, and high suicide risk. Individuals experiencing higher levels of racialised and LGBTQ-related microaggressions had increased odds of reporting clinically-significant depressive and anxiety symptoms. Interviews revealed themes including social isolation, anticipated stigma attributed to discriminatory experiences within LGBTQ+ and Asian communities, and pervasive impacts of racial and LGBTQ+ discrimination on mental health. These findings underscore mental health disparities among LGBTQ+ Asians associated with varying levels of discrimination and targeted microaggressions. More research is needed to understand the causal mechanisms by which intersectional discrimination impacts LGBTQ+ Asians’ mental health.

Implementing an Interactive Self-screening Psychological Distress Tool for Residents and Fellows.

Physicians have equivalent rates of depression and higher rates of suicide than other professions. While death by suicide is relatively rare, it is the leading cause of death in male resident physicians and the second leading cause of death in female resident physicians. Physicians who die by suicide are less likely to receive mental health treatment than non-physicians. The authors implemented a confidential, online, interactive screening program to help residents and fellow physicians gain awareness of their mental health, with the goal of reducing physician suicide. The authors implemented the American Foundation for Suicide Prevention's Interactive Screening Program (ISP). During the first 2years of ISP implementation (May 1, 2021-April 30, 2023), all trainees in 155 Accreditation Council for Graduate Medical Education-accredited residency and fellowship programs were invited to participate in the screening program. Of 1900 residents and fellows, 200 (10.5%) completed the self-screening tool. Of those who completed the screening, 197 (98.5%) were experiencing at least a moderate amount of distress (i.e., depressive symptoms, problems related to alcohol, drug use or eating behaviors, or indication that their symptoms made it somewhat difficult to function). The majority (161/200, 80.5%) logged back into the system to review their results and personalized recommendations. Physicians with psychological distress often suffer in silence. The ISP is a tool to help self-identify residents and fellows in distress and connect them to mental health resources with the goal of improving physician well-being.

The Effect of Forkhead Box O1 Single Nucleotide Polymorphisms on Cortical Thickness and White Matter Integrity in High Suicide Risk Patients.

Neuroinflammation's role is increasingly emphasized in the pathology of major depressive disorder (MDD), and its close association with the risk of suicide is being reported. The Forkhead Box O1 (FoxO1) gene is known to play a role in regulating mood and emotion and is associated with susceptibility to suicidality in relation to environmental stress. This research aims to explore the relationship between FoxO1 and the risk of suicide in individuals with MDD. We enrolled 127 healthy controls (HC) and 231 patients diagnosed with MDD, including 119 individuals with high suicide risk (HSR). All participants underwent the Hamilton Rating Scale for Depression Assessment and magnetic resonance imaging. Cortical thickness and white matter integrity were evaluated. In the HSR group, cortical thinning was observed in the left triangular part of the inferior frontal gyrus and right transverse frontopolar gyrus compared to HC. Additionally, fractional anisotropy (FA) values were decreased in the left posterior thalamic radiation, sagittal stratum, and uncinate fasciculus. Although no differences were observed based on allele variations for the two FoxO1 single nucleotide polymorphisms (SNPs), those with the minor allele of FoxO1 rs34733279, especially in the HSR group, displayed increased cortical thinning and reduced FA values in the left cingulum. Our study reveals close association between the minor allele of the FoxO1 gene rs34733279 and suicide risk in the left cingulum highlights the potential key role of the FoxO1 gene rs34733279 in the context of suicidal vulnerability. Further investigations are warranted to elucidate the underlying biological mechanisms.

Socioeconomic deprivation and suicide in Appalachia: The use of three socioeconomic deprivation indices to explain county-level suicide rates.

West Virginia's (WV) suicide rate is 50% higher than the national average and is the highest in the Appalachian Region. Appalachia has several social factors that have contributed to greater socioeconomic deprivation, a known contributor of suicide. Given WV's high prevalence of suicide and poverty, the current study aims to examine the relationship between socioeconomic deprivation and suicide rates in WV. The Townsend Deprivation Index (TDI), Social Deprivation Index (SDI), and Social Vulnerability Index (SVI) measured socioeconomic deprivation. Negative binomial regression models assessed the relationship between socioeconomic deprivation scores, individual index items, and suicide rates. Model comparisons evaluated the indices' ability to assess suicide rates. A backward selection strategy identified additional key items for examining suicide rates. There was a significant increase in suicide rates for every 10% increase in TDI (β = 0.04; p < 0.01), SDI (β = 0.03; p = 0.04), and SVI scores (β = 0.05; p < 0.01). Household overcrowding and unemployment had a positive linear relationship with suicide in TDI (β = 0.04, p = 0.02; β = 0.07, p = 0.01), SDI (β = 0.10, p = 0.02; β = 0.01, p<0.01), and the SVI (β = 0.10, p = 0.02; β = 0.03, p<0.01). The backwards selection strategy identified additional key items included by the SVI when assessing suicide. Greater socioeconomic deprivation, measured by the TDI, SDI, and SVI, was significantly associated with higher suicide rates. Expanding unemployment benefits and increasing the availability of affordable housing, especially in rural areas, may be useful in reducing suicide rates. Our results suggest racial and ethnic minorities and adults living with a disability may benefit from targeted suicide prevention strategies.

Improving Mental Health Literacy Among Law Enforcement: A Pilot Study on Mental Health First Aid for Public Safety

Mental Health First Aid (MHFA) is an 8-h curriculum conducted in various communities to improve mental health literacy. Given the high rates of suicide among law enforcement professionals and the frequency of interactions between police and corrections officers with the severely mentally ill, mental health literacy is a relevant concept for the law enforcement field. This study examined the effectiveness of MHFA in improving mental health literacy in a small sample (n = 56) of law enforcement employees. A preexperimental one-group posttest-only design using nonprobability convenience sampling was used to analyze secondary data from courses taught by the author. The sample was comprised of law enforcement officers in various law enforcement agencies, including community police departments and corrections employees. Based on the posttest, the course improves participants’ confidence in recognizing signs of mental illness, asking about suicide, being aware of personal views, and assisting people in obtaining support.

Suicide prevention via telemental health services: insights from a randomized control trial of crisis response plan and self-guided safety planning approaches

BackgroundAlthough telemental health can make suicide prevention treatments more scalable and accessible, limited evidence demonstrates successful reductions in suicidality when interventions are administered through telehealth platforms. To address this limitation, the current work investigated the effects of two suicide prevention treatments – a clinician-guided Crisis Response Plan and a self-guided Safety Planning approach.MethodsAfter completing the screening process, 82 participants with high suicide ideation and/or a lifetime history of suicidal behavior were randomly assigned across the two groups. Trained research clinicians administered the interventions using a videoconferencing platform. After the intervention delivery was complete, participants reported the therapeutic alliance they experienced with their clinician using an online survey. Participants also reported their overall suicidality 45 days after receiving the intervention. In addition, participants’ perceived usefulness of the received intervention and actual use of the plan were recorded. Linear and logistic regression models predicted how suicidality, perceived utility, and actual use of their intervention protocols varied depending on the high (Crisis Response Plan) versus low (self-guided Safety Planning) level of clinician-led collaboration the two treatments entailed.ResultsBoth Crisis Response Plan and self-guided Safety Planning were found to lower suicidality after receiving them via telehealth services. At the same time, those who received the Crisis Response Plan (the more collaborative form of therapy) reported experiencing a stronger therapeutic alliance with the clinician, utilizing the plan more often and perceiving it as more useful. These findings demonstrate the additional benefits of adopting a more collaborative approach because of its effectiveness and perceived utility, which has implications for suicide-related distress reduction in the short and long term.ConclusionsEvidence from this randomized control trial suggests that Crisis Response Plan is a suitable candidate for delivering suicide prevention via telehealth platform because of its effectiveness in reducing suicidality and its collaborative approach to building a strong therapeutic alliance, perceived usefulness, and actual utility in everyday life.Trial registrationThis paper was part of a registered RCT: https://clinicaltrials.gov/study/NCT04888845. Registration date: Date: 2021-04-22.

The Relationship Between Sensory Processing, Substance Abuse and Impulsivity With Suicide in Schizophrenia: A Narrative Review

Background and Objectives: Schizophrenia is a debilitating and complex mental health disorder characterized by symptoms, such as delusions, hallucinations, and cognitive impairments. A high comorbidity rate is observed between substance abuse, schizophrenia and impulsivity. Given the higher rate of suicide among individuals with schizophrenia, this research aims to investigate the correlation between three factors, sensory processing, substance abuse and impulsivity, concerning suicide in individuals diagnosed with schizophrenia. Methods: Research was conducted on PubMed, Google Scholar and Web of Science using the keywords “schizophrenia,” “substance use disorder (SUD),” “sensory processing,” “suicide” and “impulsivity.” Sixteen articles were selected as the most recent and relevant studies for reporting. Results: The reviewed studies demonstrated a high prevalence of suicide in patients with schizophrenia, particularly during the early stages of the illness. Impulsivity plays a contributing role in the elevated rates of suicide and substance abuse, with substance abuse directly influencing the incidence of suicide. Moreover, sensory processing difficulties can lead to self-harm and suicide. Therefore, the presence of these three factors in patients can increase the risk of suicide. Conclusion: Studies have addressed these risk factors to a considerable extent, less attention has been given to sensory processing, impulsivity, and substance abuse, which are significant factors in self-harm and suicide, as well as their predictive value for suicide. Further studies in this area are recommended.

Unravelling the complexity of suicidality: a network analysis of theory-driven and culturally relevant suicide risk factors in a country with high suicide rates

Purpose This study aimed to explore whether individual theory-based constructs are sufficient in explaining suicidality in a culture marked by high suicide rates and whether, if any, culturally relevant factors need to be considered additionally. Methods The study used a community sample of 1873 Lithuanian adults (age M = 43.61 SD = 16.96, 69.1% female). A survey using online and pen-and-paper formats was conducted, measuring suicidality, the main constructs from two predominant theories of suicide (thwarted belongingness, perceived burdensomeness, acquired capability for suicide, and defeat and entrapment), and culturally relevant factors (gender role expectations, attitudes towards help-seeking, perfectionism, negative social comparisons, alcohol use, child-parent relationships and childhood experiences). Network analysis method was used in the analysis. Results From the key factors identified in the two theories perceived burdensomeness had stronger links with self-perceived risk for suicide compared to thwarted belongingness and entrapment. Acquired capability to suicide had no direct links with other factors in the network apart from a weak link with history of suicidal behavior. In the network some of the culturally relevant variables (reasons for alcohol use, experience of sexual abuse, emotional neglect, and cultural norms representing restricted emotionality and attitudes towards psychological help) had direct relationships with suicidality, not only via key theory based factors. Conclusions The results suggest the need to consider cultural context when applying universal suicide theories.

National Incidence of Nurse Suicide and Associated Features.

The aim of this study was to estimate the national incidence of nurse suicide. Nurses are at a higher risk of suicide than nonnurses; however, data have been limited since 2018. This study used a retrospective cohort design using 2017-2021 National Violent Death Reporting System suicides. Female nurses had higher suicide rates than female nonnurses in 2018 (incidence rate ratio, 1.21 [95% confidence interval (CI), 1.05-1.39]), 2019 (1.41 [95% CI, 1.23-1.60]), 2020 (1.26 [95% CI, 1.08-1.45]), and 2021 (1.35 [95% CI, 1.17-1.55]), whereas male nurses were comparable with male nonnurses. Nurses had higher odds of mental health problems (adjusted odds ratio, 1.28 [95% CI, 1.13-1.46], P < .001), job problems (1.60 [95% CI, 1.33-1.92], P < .001), and use of poisoning (1.54 [95% CI, 1.37-1.74], P < .001). Nurses had higher odds of using opioids, cardiovascular/diabetic agents, and drugs not prescribed for home use. Female nurses are at a higher risk of suicide than other females. Multimodal nurse suicide prevention strategies remain indicated.

Can large language models be sensitive to culture suicide risk assessment?

Suicide remains a pressing global public health issue. Previous studies have shown the promise of Generative Intelligent (GenAI) Large Language Models (LLMs) in assessing suicide risk in relation to professionals. But the considerations and risk factors that the models use to assess the risk remain as a black box. This study investigates if ChatGPT-3.5 and ChatGPT-4 integrate cultural factors in assessing suicide risks (probability of suicidal ideation, potential for suicide attempt, likelihood of severe suicide attempt, and risk of mortality from a suicidal act) by vignette methodology. The vignettes examined were of individuals from Greece and South Korea, representing countries with low and high suicide rates, respectively. The contribution of this research is to examine risk assessment from an international perspective, as large language models are expected to provide culturally-tailored responses. However, there is a concern regarding cultural biases and racism, making this study crucial. In the evaluation conducted via ChatGPT-4, only the risks associated with a severe suicide attempt and potential mortality from a suicidal act were rated higher for the South Korean characters than for their Greek counterparts. Furthermore, only within the ChatGPT-4 framework was male gender identified as a significant risk factor, leading to a heightened risk evaluation across all variables. ChatGPT models exhibit significant sensitivity to cultural nuances. ChatGPT-4, in particular, offers increased sensitivity and reduced bias, highlighting the importance of gender differences in suicide risk assessment. The findings suggest that, while ChatGPT-4 demonstrates an improved ability to account for cultural and gender-related factors in suicide risk assessment, there remain areas for enhancement, particularly in ensuring comprehensive and unbiased risk evaluations across diverse populations. These results underscore the potential of GenAI models to aid culturally sensitive mental health assessments, yet they also emphasize the need for ongoing refinement to mitigate inherent biases and enhance their clinical utility.

Religiosity, Spirituality, Meaning-Making, and Suicidality in Psychiatric Patients and Suicide Attempters: A Systematic Review and Meta-Analysis.

After participating in this CME activity, the psychiatrist should be better able to:• Explain current understanding of how religiosity, spirituality, and meaning-making (R/S/M) affect patients with psychiatric diagnoses. R/S/M generally protect against suicidality and suicide. Thus far, reviews on the topic have largely been descriptive, and there are no meta-analyses focused on psychiatric patients. This study systematically evaluates all empirical evidence on R/S/M's potential influences on suicidality for psychiatric patients and recent suicide attempters. A systematic PROSPERO preregistered search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was performed in MEDLINE and PsycInfo. Quantitative studies until 31 December 2022 on R/S/M and suicidality in psychiatric populations and recent suicide attempters were selected; psychological autopsy studies were excluded. The search identified 4,374 studies for screening. This resulted in 108 eligible studies for the systematic review and 75 studies for the meta-analysis, including 231 effect sizes (ES) and 17,561 subjects. Research focused mainly on the emotional, moral, and ritual aspects of R/S/M. Most research was cross-sectional; repeated R/S/M assessments were rarely reported. A combined significant and negative ES (Fisher Z = -0.13, p = .006, equivalent to Cohen's d = -0.26) was found for all good- and fair-quality studies. Overall, R/S/M was associated with lowering suicidality. Maladaptive-distressing dimensions of R/S/M correlated with higher rates of suicidality (e.g., religious struggles). The explanatory value was limited by the predominantly cross-sectional nature of ESs. PROSPERO registration 2023 CRD42023398692; there was no funding involved.

Sex-Specific Factors Associated with Suicidal Ideation among Patients with Cancer in Korea: A Population-Based Study.

Given the higher rate of suicide among patients with cancer, which exhibits different patterns and rates according to sex, this study aimed to examine the prevalence of suicidal ideation in Korean patients with cancer and to explore sex-specific factors with suicidal ideation. This cross-sectional study analyzed a nationally representative sample derived from the 2020 Korea Health Panel Survey, which encompassed 14,741 participants surveyed in 2019 and 2020. A weighted sample of cancer patients who reported on their suicidal ideation was analyzed (N = 511). Multinomial logistic regression analysis was employed to assess the relationships between sex-specific factors and suicidal ideation. Among cancer patients, 8.6% had suicidal ideation, which was slightly higher in females (8.7%) than males (8.5%) (p < 0.001). Cancer patients' suicidal ideation factors varied by sex: males' suicidal ideation was associated with older age, lower education, unemployment, being unmarried, bed-ridden, underweight, comorbidities, and better self-rated health; females' suicidal ideation was associated with younger age, being married, employed, higher body mass index, and worse self-rated health (all p-values < 0.001). Pain/discomfort and depression were more strongly associated with male cancer patients, while anxiety was more strongly related to female cancer patients; however, all these factors were linked to increased suicidal ideation in both groups. Suicidal ideation among male cancer patients increased with low financial status, whereas suicidal ideation among female cancer patients was influenced by poor health status and social burden. Given that the factors associated with suicidal ideation differ by sex, healthcare providers need to consider sex-specific differences when assessing suicide risk among patients with cancer, particularly those experiencing pain, depression, or anxiety. Further research is needed to better understand these sex-based differences and their implications for cancer care.

Prefrontal cortex engagement during an fMRI task of emotion regulation as a potential predictor of treatment response in borderline personality disorder.

Borderline personality disorder (BPD) is a severe mental illness, with high rates of co-morbid depression and suicidality. Despite the importance of optimizing treatment in BPD, little is known about how neural processes relate to individual treatment response. This study examines how baseline regional brain blood oxygen level dependent (BOLD) activation during a functional magnetic resonance imaging (fMRI) task of emotion regulation is related to treatment response following a six-month randomized clinical trial of Dialectical Behavior Therapy (DBT) or Selective Serotonin Reuptake Inhibitor (SSRI) treatment. Unmedicated females with BPD (N = 37), with recent suicidal behavior or self-injury, underwent an fMRI task in which negative personal memories were presented and they were asked to distance (i.e., downregulate their emotional response) or immerse (i.e., experience emotions freely). Patients were then randomized to DBT (N = 16) or SSRI (N = 21) treatment, with baseline and post-treatment depression and BPD severity assessed. BOLD activity in prefrontal cortex, anterior cingulate, and insula was associated with distancing. Baseline BOLD during distancing in dorsolateral, ventrolateral, and orbital prefrontal cortex (dlPFC, vlPFC, OFC) differentially predicted depression response across treatment groups, with higher activity predicting better response in the SSRI group, and lower activity predicting better response in the DBT group. All female samples. Findings indicate that greater prefrontal engagement during emotion regulation may predict more antidepressant benefit from SSRIs, whereas lower engagement may predict better response to DBT. These results suggest different mechanisms of action for SSRI and DBT treatment, and this may allow fMRI to guide individualized treatment selection.

Single Question for Screening Suicide Risk in Patients With Cancer in Nursing Routine Work: A Retrospective Cross-Sectional Study.

To examine the efficacy of the Single Suicide Question, a tactful single-item tool, in assessing suicide risk among cancer patients. Suicide risk screening in cancer patients faces challenges such as cultural, the degree of attention given and the complexity and diversity of assessment methods. An efficient and simple suicide screening tool is needed within the nursing and treatment process. A retrospective cross-sectional study. All data utilised in this study were obtained from assessments conducted by researchers at our institution between March 2018 and August 2023. Retrospectively analysed Single Suicide Question scores from 9703 patients (March 2018-August 2023), with 229 undergoing additional using other established tools (the Patient Health Questionnaire-9, Generalised Anxiety Disorder-7, Distress Thermometer) alongside the Mini International Neuropsychiatric Interview Suicidal Subscale (MINI Suicidal Subscale). These 229 patients were divided into the cut-off determination dataset (174/229) and the validation dataset (55/229) to analyse, validate and compare the screening efficacy, consistency and optimal cut-off points of the tools relative to the MINI Suicidal subscale (golden standard). K-fold cross-validation was employed to assess the stability of the Single Suicide Question and to revalidate its screening efficacy. In cut-off determination dataset, the Single Suicide Question exhibited good screening efficacy and substantial agreement relative to the MINI Suicidal subscale, as validated in the validation dataset, outperforming other tools. The optimal cut-off points of Single Suicide Question for screening moderate or higher and high suicide risk as 2 and 3 respectively. Its stability in K-fold cross-validation further supported its screening efficacy. The Single Suicide Question shows potential as a preliminary screening tool for suicide risk. Furthermore, it has also demonstrated the potential of a simple, tactful, culturally fitting question in assessing suicide risk, providing insight for the development of relevant tools in different cultural and linguistic backgrounds. Our study demonstrates the potential of the Single Suicide Question as a screening tool for identifying suicide risk among cancer patients, which may facilitate efficient suicide screening. Furthermore, it reveals that tactful, culturally fitting, yet simple tools can achieve good screening efficacy, providing insights for the development of similar tools in different cultural and linguistic contexts. This study investigated the effectiveness of using a culturally contextualised, specific single question to screen for suicide risk in Chinese cancer patients, demonstrating high screening efficacy and stability. With further research, this method may provide a tactful, culturally informed and efficient suicide screening approach to address the critical issue of suicide risk in cancer care, and it also serves as a reference for developing similar tools in diverse cultural and linguistic contexts. The study followed the STROBE checklist guidelines for cross-sectional studies. The data provided by patients were the foundation of this study. Nurses played a central role in conducting the majority of assessments and contributing to the research design in this study.

Factors Influencing Suicidal Ideation in Young and Middle-aged Adults in Korea: A Nationwide Study

Abstract Objectives This study aims to analyze various factors influencing suicidal ideation among young (19-39 years) and middle-aged (40-64 years) adults using nationwide longitudinal data in South Korea, which has the highest suicide rate among OECD countries for more than 20 years. Methods An analysis was conducted using the WAVE II data (2016-2017) from a nationwide longitudinal study on the mental health of suicide survivors (LoSS). The sample included 2,002 participants (1,290 young adults, 712 middle-aged adults) recruited through stratified proportional quota sampling. Multiple regression analysis was performed to identify factors influencing suicidal ideation in each age group. Results In young adults, being female, having a high school education or lower, being unmarried/divorced/widowed, and having higher levels of depression were positively associated with suicidal ideation. Higher levels of social support and better subjective physical health were negatively associated with suicidal ideation. In middle-aged adults, being unemployed, living alone, drinking alcohol more than once a week, and having higher levels of depression were positively associated with suicidal ideation, while higher levels of social support were negatively associated with suicidal ideation. Conclusions Factors influencing suicidal ideation differ between young and middle-aged adults. Age-specific suicide prevention strategies considering these factors are needed to promote social health and stability in South Korea. Key messages • Different factors influence suicidal ideation in young and middle-aged adults in South Korea. • Age-specific suicide prevention strategies are necessary to effectively address suicidal ideation and promote social health and stability in South Korea.

Nationwide trends in the suicide mortality among the disabled in Korea from 2006 to 2017

Abstract Aims The disabled are one of the priority populations at risk of suicide, but there has been no study of the factors influencing suicide mortality among the disabled in South Korea. Methods To analyze age-standardized suicide mortality (ICD-10 Codes, X60-84) for each year according to the presence, severity and type of disability, we linked three population datasets (National Health Insurance Claims Database, Disability Registry, and Deaths by Cause). Our dataset covers the entire population of South Korea, extended over a 12-year period from 2006 to 2017. The analyses were stratified by sex, and hazard ratios for suicide were determined by multivariate logistic regression after adjustment for socio-demographic and clinical variables. Results The suicide rate among the disabled was 2.24 times higher than among the non-disabled in 2017. The highest suicide rates were observed among intellectual or mental disabled, and severe disabled. In the disabled group, suicide rates were higher among those with medical benefits, older age (over 70 years), and depressive disorders in both male and female. Conclusions Although the disabled people’s suicide is often seen as an individual problem, it actually affects their families, communities and society. Therefore, government must strive to emphasize the broad view of the disabled population - not just the health of individuals, and track suicide trends and identifying risk and protective factors for suicidal behavior. From this information, suicide prevention strategies for the disabled people should be evaluated to identify the most effective interventions. Financial support: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (No. 2022R1I1A3070074, and 2022R1I1A1A01068449), and a grant of Patient-Centered Clinical Research Coordinating Center funded by the Ministry of Health &amp; Welfare, Republic of Korea (No. HC23C016500). Key messages • The suicide rate among the disabled was 2.24 times higher than among the non-disabled in 2017. • In the disabled group, suicide rates were higher among those with medical benefits, older age (over 70 years), and depressive disorders in both male and female.

Exploring Patient Empowerment in Major Depressive Disorder: Correlations of Trust, Active Role in Shared Decision-Making, and Symptomatology in a Sample of Italian Patients.

Background/Objectives: Empowerment in medicine and psychiatry involves patients gaining control over health-related decisions, improving treatment adherence, outcomes, and satisfaction. This concept is especially significant in psychiatric care due to the complex challenges of mental health conditions, including stigma and impairment of emotional and cognitive functioning. We aim to investigate the correlations between patient trust, decision-making involvement, symptom severity, and perceived empowerment among individuals with Major Depression. Methods: Patients with Major Depressive Disorder were recruited in the "Policlinico G. Rodolico" psychiatry outpatient clinic from November 2022 to June 2023. Inclusion criteria: ages 18-65, ability to consent, stable condition, psychiatric medication history, and recent consultation. Exclusion criteria: psychotic features, bipolar disorder, substance abuse, high suicide risk, and severe comorbidities. Measures included the User Scale for Measuring Empowerment in Mental Health Services (SESM), Trust in Oncologist Scale (TiOS), Clinical Decision-Making Style for Patients (CDMS-P), and Hamilton Depression Rating Scale (HAM-D). Analysis used Kendall's Tau correlation and Two-One-Sided Tests procedure. Results: Seventy-three patients completed the study. No relationship was found between decision-making involvement and perceived empowerment (τ = -0.0625; p = 0.448), or between trust in psychiatrists and empowerment (τ = 0.0747; p = 0.364). An inverse correlation existed between patient involvement in therapy management and trust (τ = -0.2505; p = 0.002). Depression severity inversely correlated with empowerment (τ = -0.2762; p = <.001), but not with trust or decision-making involvement. Conclusions: The lack of significant correlations suggests that decision-making involvement and trust alone may not suffice to enhance empowerment. Trust may encourage patient passivity, while skepticism might drive active involvement. Higher empowerment is associated with less depressive symptoms, highlighting its potential connection with patient outcomes.

Outcomes of the effect of exercise on cognitive function in patients with depression: A meta-analysis.

Major depressive disorder is a common mental disorder, characterized by a high rate of suicide and recurrence, which is frequently accompanied by cognitive impairments, particularly in executive function, memory, attention, and information processing speed. As such, improving the cognitive function in patients with depression and enhancing their quality of life are urgent issues. To perform a systematic review and meta-analysis of the effects of exercise on cognitive function in patients with depression. The PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Medical, VIP, and Biomedical Databases for randomized controlled trials (RCTs) databases were searched (from inception to October 19, 2023) for studies investigating improvements in cognitive function in patients with depression through exercise. Tools recommended by the Cochrane Handbook for RCT evaluation, and GRADEpro and Stata17 software, were employed for risk of bias assessment, evidence grading, forest plot construction, subgroup and sensitivity analyses, and assessment of publication bias. Seventeen RCTs (1173 patients with depression) were included. Exercise had a small but significant positive effect on attention, with an effect size of 0.21, 95%CI: 0.07-0.34, P < 0.01. Specifically, aerobic exercise regimens of 30-60 minute/session, thrice a week, at moderate intensity, and sustained over 3-12 weeks, were associated with the most pronounced benefits (P < 0.05), with effect sizes for executive function, memory, and information processing speed of 0.11, 95%CI: -0.11-0.32, P = 0.34; 0.08, 95%CI: 0.00-0.16, P = 0.05; and 0.14, 95%CI: 0.04-0.25, P = 0.01, respectively. The evidence levels for attention, information processing speed, and memory were rated as 'low,' whereas that for executive function was rated as 'very low'. Exercise could improve attention and information-processing speed in patients with depression, although improvements in executive function and memory are not significant.

Inuit mental health service utilisation in Manitoba: results from the qanuinngitsiarutiksait study

ABSTRACT Despite decades of Inuit accessing services in Manitoba, Inuit-centric services remain scant and have only begun to emerge. This article reports on Inuit utilisation of mental health services in Manitoba. In this study, we focused on two interrelated cohorts: Inuit living in Manitoba and Inuit from the Kivalliq region who come to Winnipeg to access specialised services. We used administrative data routinely collected by Manitoban agencies. The study was conducted in partnership with the Manitoba Inuit Association, and Inuit Elders from Nunavut and Manitoba. Our results show that mental health-related consults represent between 1 in 5 and 1 in 3 of all consults made by Inuit in Manitoba. Rates of hospitalisation for mental health conditions are considerably lower than those of residents from the Manitoba northern health authority. Given that Nunavut has the highest rate of suicide in the world, our results suggest underserved needs rather than lower needs. Kivalliq and Manitoba Inuit utilise mental health services in Manitoba extensively, yet these services for the most part remain western-centric. Epistemological accommodations in the provision of mental health services have yet to be implemented. This is now the focus of our work.

Neme priče: mikrozgodovinski pogled na samomor v sodnih spisih prve polovice 20. stoletja

Based on the archival materials from the Celje and Maribor District Courts (Kreisgerichte) and the specific cases from the Trbovlje County Court (Bezirksgericht), referring to the areas with the highest suicide rates in the Drava Banate, this article examines suicide in the first half of the 20th century. Based on individual cases from judicial practice, as well as newspaper reports, the article sheds light on the social, economic and regional conditions in the considered areas in the first half of the 20th century, as well as the position of women in society and the prevalence of family and sexual violence. At the time when the increasing suicide rates were attributed to the aftermath of World War I, the effects of the economic crisis, and alcoholism, the article analyses the presence and gradual dominance of psychological and psychiatric discourse in determining the causes of individual suicides. By analysing the individual cases, the author presents the attitude towards suicide in rural areas – the shame and stigma still felt by the family members when a relative of theirs commits suicide. The author analyses cases where either the suicide could not be identified or when the corps of the deceased was not found, as well as cases of suicide due to fear and/or shame due to crimes committed. Furthermore, the article focuses on the phenomenon of female suicide and, in this context, on the examples of murder-suicide and the role of women in them, analyses the contemporaneous media discourse, and describes the course of the investigations in the cases where it was not clear whether the death had resulted from suicide or murder.