High Suicide Research Articles

A Suicide Attempt Multicomponent Intervention Treatment (SAMIT Program): study protocol for a multicentric randomised controlled trial.

Suicide has become a first-order public health concern, especially following the negative impact of COVID-19 on the mental health of the general population. Few studies have analysed the effects of early psychotherapeutic interventions on subjects who have attempted suicide, and even fewer have focused on those hospitalized in non-psychiatric units after a Medically Serious Suicide Attempt (MSSA). The main aim of this study is to describe the protocol designed to evaluate the effectiveness of individual psychological treatment for patients hospitalized after an MSSA. The secondary objectives of the study are: (1) to evaluate the impact on quality of life and other psychosocial variables of patients with a recent MSSA who receive early psychological intervention; (2) to analyse the biological, psychological, and clinical impact of early psychotherapeutic treatment on subjects hospitalized after an MSSA. A longitudinal randomised controlled trial will be conducted with patients over 16 years of age admitted to two general hospitals. The case intervention group will enrol for 8-sessions of individual psychotherapy, Suicide Attempts Multi-component Intervention Treatment (SAMIT), combining Dialectical Behaviour Therapy (DBT), Mentalization-Based Therapy (MBT), and Narrative approaches, while the control group will receive a treatment-as-usual intervention (TAU). Longitudinal assessment will be conducted at baseline (before treatment), post-treatment, and 3, 6, and 12 months after. The main outcome variable will be re-attempting suicide during follow-up. Some psychotherapeutic interventions, usually implemented in outpatient, have proven to be effective in preventing suicidal behaviours. The combination of some of these may be a powerful treatment for preventing future SA in patients hospitalised after an MSSA, which is the most severely suicidal subgroup. Moreover, assessment of the biological, clinical and psychometric impact of this new intervention on patients during the first year after the attempt may help understand some of the multi-level factors associated with the effectiveness of psychotherapeutic interventions in MSSAs. The prevalence of high suicide rates requires the design of effective psychological interventions for their prevention, and also in order to design new pharmacological and psychological treatments. ClinicalTrials.gov ID: NCT06238414. Date of registration: 1st February 2024, final update is protocol version 3.0, 19th March 2024.

Suicide Rates by Age and Time Among American Indian and Alaskan Native Veterans.

Although recent work has highlighted high rates of suicide among American Indian and Alaska Native individuals who served in the US military, to date, a comprehensive evaluation of age-specific suicide rates, over time, has yet to be conducted. Population-based retrospective cohort study. Average annual suicide rates (2005-2020) were computed. The cohort included 207,955 Native Veterans who were alive as of January 1, 2005, and separated from military service on or before December 31, 2020. Suicide was identified via National Death Index codes. Between 2005 and 2020, average annual, age-specific suicide rates among Native Veterans ranged from 16.32/100,000 (55+ y) to 64.49/100,000 (18-34y). Compared with other age-related cohorts, the rate among those in the youngest age cohort (18-34y) was the highest between 2005 and 2018. The 2019-2020 average annual rate for 18- to 34-year-olds (41.86/100,000) dropped below that of the middle-aged cohort (35-45y; 44.66/100,000). Across all age cohorts, firearms were the most used method of suicide [57.2% (18-34 and 35-54y) to 66.17% (55+y)]; however, a notable percentage of Veterans died by suffocation, 16.54% (55y and older), 26.71% (35-54y), and 33.21% (18-34y). Findings highlight differences in suicide rates by age groups overtime for Native Veterans irrespective of Veterans Health Administration use and across service eras, as well as means of suicide, which also differed across groups. Increased efforts are needed to identify culturally and age-relevant intervention strategies, as well as factors associated with risk, to reduce deaths among Native Veterans.

Validation of the Spanish Version of the Nurses' Global Assessment of Suicide Risk Scale (NGAR) in Nonclinical Settings.

To validate the Nurses' Global Assessment of Suicide Risk (NGASR) in Spanish for an early detection identification of the risk of suicide. A descriptive cross-sectional survey design was used for this work through face-to-face clinical interviews with each participant. Following EQUATOR TRIPOD checklist, the index was translated and administered to a sample of 30 mental health experts and 151 university students. To examine the psychometric properties of the NGASR, the questionnaires also included other standardised scales such as BDI, SBQ and SEEQ. The research was conducted between 2022 and 2023. The content validity index-scale (CVI-S) was 81% and the NGASR presented high reliability with a Kuder-Richardson coefficient of 0.83. Exploratory factor analysis (EFA) returned a six-factor structure for the NGASR items. The results showed that 21.7% of the students assessed had an intermediate to very high suicide risk. This study also revealed that people with mental health problems and depression had a higher risk of suicide. Beyond the sociolinguistic Spanish validation of the scale, it should be noted that it is carried out on a young population in a nonclinical environment, something that many authors have been requesting in their previous validations. The NGASR is a useful prevention tool in university educational settings.

South Korea’s existential public health emergency: Tackling the low birth rate, loneliness, and suicide crisis

South Korea is facing a critical public health emergency characterized by a rapidly declining birth rate, increasing loneliness, and high suicide rates. The fertility rate dropped to 0.72 children per woman in 2023, significantly below the OECD average. This decline is attributed to economic burdens, gender inequality, and changing societal norms. If these trends continue, the youth population could halve by 2040 compared to 2023, severely impacting the nation’s economy and demographic structure. Simultaneously, loneliness has become a significant issue, with over a third of Koreans living alone and a rise in deaths from isolation, particularly among middle-aged and older men. South Korea also faces a severe mental health crisis, marked by high rates of depression and the highest suicide rate among OECD countries for the past 25 years. Troublingly, recent trends indicate an increase in suicides among younger age groups. Efforts to address these issues have included government initiatives for mental health support, but these remain underfunded and insufficient compared to international standards. Additionally, the stigma surrounding mental health persists. South Korea can learn from countries like Japan and the UK, which have implemented successful interventions focusing on social integration and mental health. Addressing these intertwined crises requires collective action and a robust policy response to ensure a sustainable future for South Korea.

Association of veteran suicide risk with state-level firearm ownership rates and firearm laws in the USA

BackgroundVeterans have higher suicide rates than matched non-veterans, with firearm suicides being especially prevalent among veterans. We examined whether state firearm laws and state firearm ownership rates are important risk...

Development of a Clinical Guideline for Suicide Prevention in Psychiatric Patients Based on the ADAPTE Methodology.

Suicide is a significant public health issue, with South Korea having the highest suicide rate among Organisation for Economic Cooperation and Development countries. This study aimed to develop clinical guidelines for suicide prevention in psychiatric patients in Korea using the ADAPTE methodology. The development process involved a comprehensive review of literature, expert consultations, and consensus-building using the Nominal Group Technique and Delphi method. The guidelines focus on evidence-based psychiatric treatments, including both pharmacological and non-pharmacological approaches, tailored to the Korean context. Key findings underscoring the need for standardized treatment protocols for patients with major psychiatric disorders, including bipolar disorder, major depressive disorder, and schizophrenia. The guidelines incorporate treatments like lithium, clozapine, atypical antipsychotics, electroconvulsive therapy, and cognitive behavioral therapy, which have shown effectiveness in suicide prevention. Applicability and acceptability within Korea's healthcare system were addressed, ensuring feasibility given the country's medical insurance coverage and accessibility. The guidelines were validated through expert reviews and Delphi rounds, achieving consensus on the final recommendations. The developed guidelines provide a structured, evidence-based approach to reducing suicide rates among psychiatric patients in Korea. Future research will focus on expanding these guidelines to include screening protocols for high-risk groups.

Single-dose psilocybin for U.S. military Veterans with severe treatment-resistant depression – A first-in-kind open-label pilot study

BackgroundThe enduring and severe depression often suffered by Veterans causes immense suffering and is associated with high rates of suicide and disability. This is the first study to evaluate the efficacy and safety of psilocybin in Veterans with severe treatment-resistant depression (TRD). Methods15 Veterans with severe TRD (major depressive episode failing to respond to ≥5 treatments, or lasting >2 years) received 25 mg of psilocybin. Primary outcome was change in Montgomery-Åsberg Depression Rating scale (MADRS) at 3 weeks posttreatment. Response was defined s ≥ 50 % reduction in MADRS, and remission as ≤10 MADRS score. Psychedelic experience was assessed using the Five-Dimensional Altered States of Consciousness scale (5D-ASC). Safety measures included assessment of suicidality and adverse events. Participants on antidepressants were tapered to avoid drug interactions. ResultsOf 15 participants, 60 % met response and 53 % met remission criteria at Week 3. At 12 weeks, 47 % maintained response, and 40 % remission. Co-morbid PTSD did not significantly influence study outcomes. The psychedelic experience reported in 5D-ASC did not correlate with response. Participants judged to need antidepressants were restarted and considered non-responders from that timepoint (n = 4). No unexpected adverse events occurred. LimitationsLimitations include the small sample size, and the uncontrolled and unblinded nature of the study. ConclusionsIn this first study on psilocybin for Veterans with severe TRD, a surprising response and remission was seen. Many Veterans had PTSD though no moderating impact of response was observed. The degree of psychedelic experience did not correlate with depression changes. Further study is warranted.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04433858.

Explorando la salud mental en prisión: un análisis en el Programa de Atención Integral al Enfermo Mental (PAIEM)

Around 3.6% of the 11 million people incarcerated worldwide suffer from psychotic disorders, representing a prevalence four times higher compared to the general population. This phenomenon is linked to high rates of suicide among inmates, an increased risk of premature death after release, and a heightened likelihood of reoffending. In response to this reality, Spanish Penitentiary Institutions initiated a program in 2009 aimed at the comprehensive care of inmates with Severe Mental Disorders. The objective of this pilot study is to explore how anxiety, depression, and trauma-related disorders can affect inmates in two prisons in Lugo, gathering initial data to better understand the mental health challenges facing this population. The results revealed significant differences in the variables of anxiety, depression, and experiences of abuse, highlighting the importance of considering these factors in mental health care within the prison environment. These findings lay the groundwork for future research and advocate for more effective policies and programs to ensure adequate care in prisons.

The Impact of Pain, Threat Perception and Emotional Distress on Suicide Risk in Individuals with Colorectal Cancer.

Colorectal cancer (CRC) can significantly impact mental health, increasing suicide risk. Variables such as pain and threat perception may be crucial. This study aims to identify predictors of suicide risk in individuals with CRC. A total of 71 participants (76.06% men) aged 27 to 88 years (M = 65.18, SD = 12.02) were assessed using the SF-36 for pain, the Brief Illness Perception Questionnaire (B-IPQ) for threat perception, the Hospital Anxiety and Depression Scale (HADS) for emotional distress, and the Plutchik suicide risk scale for suicide risk. Descriptive, comparative, and correlational analyses were performed, followed by a linear regression analysis. Nearly 20% of participants exhibited high suicide risk. There was a moderate-to-high association between suicide risk and the perception of threat, pain, and emotional distress. The linear regression model explained 39% of the variance in suicide risk, with threat perception, pain, and emotional distress as significant predictors. These results indicate the need for multidisciplinary care for individuals with CRC, including emotional support from health psychologists, and holistic, human-centered care from nursing and medical professionals. Future research is necessary to further explore these relationships and improve patient care strategies.

Suicidality, perceived chronic stress, and stress-induced cortisol changes of individuals with schizophrenia.

The associations of suicidality with stress are poorly studied in schizophrenia. The study aimed to determine whether suicidality was correlated with perceived chronic stress and the cortisol fluctuations under stress tasks in schizophrenia. High suicidality was defined as a lifetime history of suicide attempts or suicidal ideation in the past 2weeks. Individuals with schizophrenia and high suicidality (SZ-HS, n=59), with low suicidality (SZ-LS, n=207), and healthy controls (HC, n=196) finished the Perceived Stress Scale. Then, they participated in an experiment that induced stress using the Paced Auditory Serial Addition Task and the Mirror Tracing Persistence Task. Negative affect was measured at baseline and after finishing each task. The salivary cortisol was collected before-, after 20min, and after 40min of the tasks. SZ-HS had elevated perceived stress than SZ-LS and HC. Mixed effect models showed that stress tasks induced cortisol changes in all groups; cortisol of SZ-LS was reduced more than HC, but SZ-HS and SZ-LS did not differ in cortisol fluctuations. SZ-HS and SZ-LS experienced similar negative affect changes during tasks and the difference in withdrawal rates was nonsignificant. SZ-HS had an increased error rate than SZ-LS. In conclusion, suicidality was correlated with high-level perceived stress but did not result in differences in cortisol reactivities under stress tasks. It suggests the inconsistency between appraisal of stress and biological stress system disturbance among SZ-HS compared to SZ-LS.

‘How can you not be traumatised’: Experience of paramedics occupationally exposed to suicide

Background: Exposure to suicide is widely recognised as a major occupational hazard for mental health professionals due to the impacts this can have on their professional and personal lives. Less research has focused on paramedics, who are often the first responders to suicide-related callouts and who also have higher suicide rates themselves. Aims: This article explores the lived experiences of paramedics exposed to suicide in the line of their work, unpacking the impacts and consequences of this exposure on their mental well-being. Method: Interpretative Phenomenological Analysis (IPA) was used to examine the lived experiences of nine paramedics in New Zealand. Data were collected through in-depth semi-structured interviews. Results: Four themes were developed: (1) It's complex and challenging work, as suicide events required different skills from those utilised in other work, leading paramedics to rely on intuition and experience to manage the scenario in the absence of specific protocols; (2) Feeling frustrated and helpless, explored suicide encounters experienced as distressing due to the high volume of calls and lack of perceived responsiveness in the broader health system; (3) The conflict between emotions and ethos, describing suicide exposure as a challenge to maintain their emotional control in the scenes, and perceiving this lack of control as a threat to their competence; (4) Living with the consequences: How can you not be traumatised?, focused on how occupational exposure to suicide impacted participants’ personal relationships and well-being. Conclusion: The challenges posed by occupational exposure to suicide can lead to negative consequences among paramedics. Research should focus on how to diminish the impacts of this traumatic experience on this occupational group.

The BRIDGE project: a feasibility randomised controlled trial of brief, intensive assessment and integrated formulation for young people (age 14-24) with features of borderline personality disorder (Protocol).

Borderline personality disorder (BPD) is a severe mental disorder that is characterised by a pervasive pattern of instability of interpersonal relationships, self-image, and mood as well as marked impulsivity. BPD has its peak incidence and prevalence from puberty through to emerging adulthood. BPD is a controversial diagnosis in young people. Commonly, young people with BPD are under-diagnosed, untreated, are not in employment or training and are estranged from their families. Yet, they have complex needs and are at high suicide risk. To assess the feasibility of conducting a randomised controlled trial (f-RCT) of a BRIDGE, a brief intervention programme for young people (age 14-24) with BPD symptoms (sub-threshold or threshold) in a community sample from Scotland, UK. Forty young people (age 14-24) meeting criteria for BPD symptoms, will be randomised in a 1:1 ratio to receive either a) the BRIDGE intervention plus service-as-usual or b) service-as-usual alone. Follow up will be 12 weeks and 24 weeks post-intervention. The study is carried out between 2021 to 2024. The two primary outcomes of the MQ funded, BRIDGE project (f-RCT) are i. recruitment rates and ii. retention rates. The study will present the acceptability and appropriateness of our putative outcome measures for a future definitive randomised controlled trial (d-RCT). Young people with BPD benefit from good clinical care and targeted intervention, however are regularly missed or mislabelled. The community based feasibility trial would provide initial evidence of variable needs of young people with complex needs, who maybe missed or excluded from services as they don't "fit" a model/diagnosis. Workable multi-agency service model proposed in the trial would be a major advance in understanding care pathways regardless of trial outcome. ClinicalTrial.gov, identifier NCT05023447.

Study on the interventional effects of Chlamydomonas reinhardtii peptides on chronic unpredictable mild stress-induced depressive-like model mice through metabolomics and microbiota

Depression is a progressive neurodegenerative disease characterized by high prevalence, high suicide rate and high recurrence rate. In this study, the protein from Chlamydomonas reinhardtii was extracted and neutral protease hydrolysate (NPH) was obtained. Its in vitro MAO-A (Monoamine oxidase A) inhibitory activity and in vivo anti-depressive effects in chronic unpredictable mild stress (CUMS) model mice were investigated. The results demonstrated that NPH can improve depressive behaviour in CUMS model mice by elevating neurotransmitter levels and alleviating hippocampal tissue structure damage. The metabolomic analysis of brain and serum samples showed that their common metabolic pathways associated with anti-depressive effects are mainly alanine, aspartate, and glutamate metabolism, glycerophospholipid metabolism, tryptophan metabolism, and caffeine metabolism. Then, the gut microbiota analysis of feces indicated that 8 species with significant changes were associated with anti-depressive effects. Finally, 5 pairs of highly correlated metabolite-bacterium pairs were identified to modulate depressive behaviours. Taken together, the present data suggests that Chlamydomonas reinhardtii-derived hydrolysate could be used for development of functional foods with potential to improve depression.

Sparks of Light, Sparks of Life

This article examines the critical issue of Indigenous mental health in Canada, focusing on First Nations, Inuit, and Métis. It underscores the urgency in addressing Indigenous mental wellness challenges, particularly the high rates of suicide, amid their rapid population growth. The study centers on the role of frontline responders in managing mental health and suicidal distress in these communities, and their work to promote life and mental wellness. Through a synthesis of psychological, critical, and Indigenous perspectives, the article reviews Canadian literature on Indigenous mental health and suicide prevention. The article then highlights reflexive insights derived from a knowledge-sharing event with 33 Indigenous mental health professionals, focusing on the unique challenges and opportunities in this field and the importance of life-affirming dialogues in suicide prevention. The article aims to integrate these insights into broader discussions on Indigenous mental wellness, health, and life promotion systems, proposing enhanced wellness and suicide prevention strategies and frameworks tailored to the needs and aspirations of Indigenous communities.

Impact of Training on Addressing Farmer Mental Health in Occupational Therapy Practice.

Farmers experience high rates of mental health conditions and suicide. It is within occupational therapy's scope to address mental health conditions in patients as it pertains to their participation in meaningful occupations. The aim of this study is to assess the efficacy of training provided to occupational therapy practitioners and students on addressing farmer mental health. Participants were directly recruited from occupational therapy state associations and graduate programs in the American Midwest to attend a 1-hour presentation and complete pre- and post-training surveys. A total of 119 participants completed the pre- and post-training surveys. Both occupational therapy practitioners and students significantly increased their confidence in assessing and addressing mental health concerns and providing resources to farmers following the training. Occupational therapy-specific training can increase therapists' confidence in addressing farmer mental health. Further research should assess multi-faceted interventions related to farmers' mental health in occupational therapy practice.

Para/texts for the movie Archie’s Final Project: navigating stigma and profit imperatives to discuss suicide and human connections

In light of the high suicide rates among youth in the United States and the role that media can play in educating the public about it, this paper examines how the independent film Archie’s Final Project (2009) navigated the lingering stigma attached to suicidality. On the one hand, the film as a text advances the conversation around both teen suicide and the teen experience by defying the silence that the stigma of suicide often imposes. On the other, some of the film’s paratexts such as posters and titles appear to have been negatively influenced by the stigma of suicide. This situation allows for a discussion of movie advertising material as a contested territory. Among the several negotiations between various social players, the trade-off between allure and accuracy in the advertising material is examined both from the filmmakers’ perspective and indirectly from the audience’s perspective, on the basis of interviews with the filmmakers and a close readings of the movie paratexts.

The correlation of inflammation, tryptophan-kynurenine pathway, and suicide risk in adolescent depression.

Accumulating evidence suggests a role for the tryptophan-kynurenine pathway (TKP) in the psychopathology of major depressive disorder (MDD). Abnormal inflammatory profile and production of TKP neurotoxic metabolites appear more pronounced in MDD with suicidality. Progress in understanding the neurobiology of MDD in adolescents lags significantly behind that in adults due to limited empirical evidence. Aims of this study was to investigate the association between inflammation, TKP, and suicidality in adolescent depression. Seventy-three adolescents with MDD were assessed for serum levels of interleukin (IL)-1β, IL-6, IL-18, IL-10, tumor necrosis factor-α (TNF-α), tryptophan (TRP), kynurenine (KYN), 3-hydroxykynurenine (3-HK), and kynurenine acid (KA). Correlations between cytokines and TKP measures were examined. Patients were divided into high- (n = 42) and non-high-suicide-risk groups (n = 31), and serum levels of cytokines and TKP metabolites were compared. Significant negative correlations were found between TRP and IL-8 (r = - 0.27, P < 0.05) and IL-10 (r = - 0.23, P < 0.05), while a significant positive correlation was observed between 3-HK and IL-8 (r = 0.39, P < 0.01) in depressed adolescents. The KYN/TPR (index of indoleamine 2,3-dioxygenase, IDO) was positively correlated with IL-1β (r = 0.34), IL-6 (r = 0.32), IL-10 (r = 0.38) and TNF-α (r = 0.35) levels (P < 0.01); and 3-HK/KYN (index of kynurenine3-monooxidase, KMO) was positively correlated with IL-8 level (r = 0.31, P < 0.01). Depressed adolescents at high suicide risk exhibited significantly higher levels of IL-1β (Z = 2.726, P < 0.05), IL-10 (Z = 2.444, P < 0.05), and TNF-α (Z = 2.167, P < 0.05) and lower levels of 3-HK (Z = 2.126, P < 0.05) compared to their non-high suicide risk counterparts. Our findings indicated that serum inflammatory cytokines were robustly associated with IDO and KMO activity, along with significantly decreased serum level of TRP, increased level of 3-HK, and higher suicide risk in adolescent depression.

Animal-Assisted Stress Management for Veterinary Staff.

High levels of stress have a detrimental impact on veterinary staff, negatively influencing their mental health and contributing to high rates of suicide. Veterinary social workers are tasked with providing interventions to reverse these consequences and support the professional's health and well-being. Twenty-one veterinary staff participated in a study to evaluate the impact of animal-assisted support. Over three months, participants attended one or two therapy dog visits per month, interacting with therapy dogs for a minimum of 10 minutes each session. Pre- and postmeasures of blood pressure, heart rate, and self-reported stress were taken at each session. A measure to assess compassion fatigue and satisfaction was administered at the end of each session, and at the conclusion of the study participants' thoughts about the visits from the therapy dogs were assessed. Significant reductions in systolic and diastolic blood pressure were found as well as significantly lower ratings of self-reported stress. Additionally, participants looked forward to these visits stating they made them happy, helped them feel better, and took their mind off their troubles. Considering the growing utilization of therapy dogs, this timely study adds to the body of evidence, highlighting the benefits of animal-assisted interventions with veterinarian staff.

Global Suicide Mortality Rates (2000-2019): Clustering, Themes, and Causes Analyzed through Machine Learning and Bibliographic Data.

Suicide research is directed at understanding social, economic, and biological causes of suicide thoughts and behaviors. (1) Background: Worldwide, certain countries have high suicide mortality rates (SMRs) compared to others. Age-standardized suicide mortality rates (SMRs) published by the World Health Organization (WHO) plus numerous bibliographic records of the Web of Science (WoS) database provide resources to understand these disparities between countries and regions. (2) Methods: Hierarchical clustering was applied to age-standardized suicide mortality rates per 100,000 population from 2000-2019. Keywords of country-specific suicide-related publications collected from WoS were analyzed by network and association rule mining. Keyword embedding was carried out using a recurrent neural network. (3) Results: Countries with similar SMR trends formed naturally distinct groups of high, medium, and low suicide mortality rates. Major themes in suicide research worldwide are depression, mental disorders, youth suicide, euthanasia, hopelessness, loneliness, unemployment, and drugs. Prominent themes differentiating countries and regions include: alcohol in post-Soviet countries; HIV/AIDS in Sub-Saharan Africa, war veterans and PTSD in the Middle East, students in East Asia, and many others. (4) Conclusion: Countries naturally group into high, medium, and low SMR categories characterized by different keyword-informed themes. The compiled dataset and presented methodology enable enrichment of analytical results by bibliographic data where observed results are difficult to interpret.

Next-generation precision medicine for suicidality prevention

Suicidality remains a clear and present danger in society in general, and for mental health patients in particular. Lack of widespread use of objective and/or quantitative information has hampered treatment and prevention efforts. Suicidality is a spectrum of severity from vague thoughts that life is not worth living, to ideation, plans, attempts, and completion. Blood biomarkers that track suicidality risk provide a window into the biology of suicidality, as well as could help with assessment and treatment. Previous studies by us were positive. Here we describe new studies we conducted transdiagnostically in psychiatric patients, starting with the whole genome, to expand the identification, prioritization, validation and testing of blood gene expression biomarkers for suicidality, using a multiple independent cohorts design. We found new as well as previously known biomarkers that were predictive of high suicidality states, and of future psychiatric hospitalizations related to them, using cross-sectional and longitudinal approaches. The overall top increased in expression biomarker was SLC6A4, the serotonin transporter. The top decreased biomarker was TINF2, a gene whose mutations result in very short telomeres. The top biological pathways were related to apoptosis. The top upstream regulator was prednisolone. Taken together, our data supports the possibility that biologically, suicidality is an extreme stress-driven form of active aging/death. Consistent with that, the top subtypes of suicidality identified by us just based on clinical measures had high stress and high anxiety. Top therapeutic matches overall were lithium, clozapine and ketamine, with lithium stronger in females and clozapine stronger in males. Drug repurposing bioinformatic analyses identified the potential of renin-angiotensin system modulators and of cyclooxygenase inhibitors. Additionally, we show how patient reports for doctors would look based on blood biomarkers testing, personalized by gender. We also integrated with the blood biomarker testing social determinants and psychological measures (CFI-S, suicidal ideation), showing synergy. Lastly, we compared that to machine learning approaches, to optimize predictive ability and identify key features. We propose that our findings and comprehensive approach can have transformative clinical utility.