High Risk For Suicidal Behavior Research Articles

Digital phenotypes of real-time suicidal ideation: Correlates and consequences.

Suicidal ideation variability refers to within-day fluctuations in suicidal ideation, and has recently been proposed as an indicator of suicide risk. However, not much is known yet about its correlates and clinical relevance. We examined characteristics of real-time suicidal ideation using Ecological Momentary Assessment in 82 individuals with current active suicidal ideation. Data were collected four times daily over 21 days. Latent profile analysis was used to identify subtypes of suicidal ideation. We further examined sociodemographic and clinical correlates of the profiles, and their association with the occurrence of suicide attempts during a 1-year follow-up. We identified three "digital" phenotypes of suicidal ideation that differed on the frequency, intensity and variability of ideation. The profiles were: high frequency, high intensity, moderate variability (Phenotype 1), moderate/high frequency, moderate intensity, high variability (Phenotype 2), and moderate frequency, low intensity, low variability (Phenotype 3). Phenotypes 1 and 2 were associated with a worse clinical profile at baseline (higher suicidal ideation and depressive symptom severity), and increased odds of suicide attempt during follow-up, compared to Phenotype 3. Phenotype 1 was further characterized by repeated suicidal behavior. Two phenotypes of real-time suicidal ideation were identified that appear to confer a higher risk of suicidal behavior in the near future (12 months). These phenotypes were characterized by higher variability of suicidal ideation-and also higher intensity and frequency of ideation. Considering the small sample size, the clinical usefulness of the profiles remains to be demonstrated.

Sexual violence, suicide, depression, self-esteem, and satisfaction with life among university students in Spain with a gender perspective: implications for social work

ABSTRACT Current research aims to relate both categories by investigating sexual violence as a risk factor for suicide among college students in Spain (N = 2004). Overall, 13.7% reported having suffered sexual violence in the last year and 3.3% completed sexual penetration. Having suffered sexual violence and lower perceived social support are associated with higher risk of suicidal behaviors. Incorporation of preventive measures against sexual violence in the university environment, as well as the promotion of supportive actions on university campuses in Spain, as well as in other countries. Policy and social work implications are discussed.

A Secondary Analysis of the Complex Interplay between Psychopathology, Cognitive Functions, Brain Derived Neurotrophic Factor Levels, and Suicide in Psychotic Disorders: Data from a 2-Year Longitudinal Study.

Identifying phenotypes at high risk of suicidal behaviour is a relevant objective of clinical and translational research and can facilitate the identification of possible candidate biomarkers. We probed the potential association and eventual stability of neuropsychological profiles and serum BDNF concentrations with lifetime suicide ideation and attempts (LSI and LSA, respectively) in individuals with schizophrenia (SCZ) and schizoaffective disorder (SCA) in a 2-year follow-up study. A secondary analysis was conducted on a convenience sample of previously recruited subjects from a single outpatient clinic. Retrospectively assessed LSI and LSA were recorded by analysing the available longitudinal clinical health records. LSI + LSA subjects consistently exhibited lower PANSS-defined negative symptoms and better performance in the BACS-letter fluency subtask. There was no significant association between BDNF levels and either LSI or LSA. We found a relatively stable pattern of lower negative symptoms over two years among patients with LSI and LSA. No significant difference in serum BDNF concentrations was detected. The translational viability of using neuropsychological profiles as a possible avenue for the identification of populations at risk for suicide behaviours rather than the categorical diagnosis represents a promising option but requires further confirmation.

Can life events predict first-time suicide attempts? A nationwide longitudinal study.

The prevention paradox describes circumstances in which the majority of cases with a suicide attempt come from a population of low or moderate risk, and only a few from a 'high-risk' group. The assumption is that a low base rate in combination with multiple causes makes it impossible to identify a high-risk group with all suicide attempts. The best way to study events such as first-time suicide attempts and their causes is to collect event history data. Administrative registers were used to identify a group at higher risk of suicidal behaviour within a population of six national birth cohorts (N = 300,000) born between 1980 and 1985 and followed from age 15 to 29 years. Estimation of risk parameters is based on the discrete-time logistic odds-ratio model. Lifetime prevalence was 4.5% for first-time suicide attempts. Family background and family child-rearing factors were predicative of later first-time suicide attempts. A young person's diagnosis with psychiatric or neurodevelopmental disorders (ADHD, anxiety, depression, PTSD), and being a victim of violence or sex offences contributed to the explanatory model. Contrary to the prevention paradox, results suggest that it is possible to identify a discrete high-risk group (<12%) among the population from whom two thirds of all first-time suicide attempts occur, but one third of observed suicide attempts derived from low- to moderate-risk groups. Findings confirm the need for a combined strategy of universal, targeted and indicated prevention approaches in policy development and in strategic and practice responses, and some promising prevention strategies are presented.

Suicidal behavior and all-cause mortality in depressed older adults aged 75+ treated with electroconvulsive therapy: A Swedish register-based comparison study.

Electroconvulsive therapy (ECT) is effective in treating late-life depression. There is limited research on suicidal behavior and all-cause mortality in the oldest old after ECT. Older adults aged 75years and above who had been inpatients for moderate to severe depression between January 1, 2011, and December 31, 2017, were included in the study. We used exact and propensity score matching to balance groups. We compared suicidal behavior (fatal and non-fatal) and all-cause mortality in those who had received ECT and those with other depression treatments. Of the study population, 1802 persons who received ECT were matched to 4457 persons with other treatments. There were no significant differences in the risk of suicidal behavior between groups, (within 3months: odds ratio 0.73; 95% confidence intervals (CI), 0.44-1.23, within 4months to 1year: aOR 1.34; 95% CI, 0.84-2.13). All-cause mortality was lower among ECT recipients compared to those who had received other treatments, both within 3months (aOR, 0.35; 95% CI, 0.23-0.52), and within 4months to 1year (aOR 0.65; 95% CI, 0.50-0.83). Compared to other depression treatments, ECT is not associated with a higher risk of suicidal behavior in patients aged 75 and above. ECT is associated with lower all-cause mortality in this age group, but we advise caution regarding causal inferences.

Effect of early intervention for early-stage psychotic disorders on suicidal behaviours - a systematic review protocol.

The early stages of psychotic disorders correspond to the early phases of the disease and include the prodromal phase and first-episode psychosis; they constitute a period at high risk of suicidal behaviour. A long duration of untreated psychosis (DUP) is among the risk factors of suicidal behaviour identified in this early period. Many studies have shown the effectiveness of early interventions on the overall prognosis of psychotic disorders in the early stages, and early intervention strategies have been developed and tested worldwide. Several authors reported an improvement in suicidal behaviours; however, all these data have not been systematically analysed yet. The main objective of this systematic review was to collect evidence on the effect on suicidal behaviour of early interventions for patients in the early stages of psychotic disorders. We will carry out a systematic review of the literature according to the PRISMA criteria by searching articles in five databases (PubMed, Cochrane, PsycINFO, Scopus, EMBASE), without restriction on the publication date. The selection criteria are: articles (any type; e.g. prospective, retrospective, controlled or uncontrolled, and literature reviews) on early interventions for psychotic disorders in the early stages with data on suicide attempts, death by suicide, suicidal ideation; articles written in English or French. Exclusion criteria are: articles on suicidal behaviours in patients with psychotic disorders in the early stages, but without early intervention, and articles on early-stage psychotic disorders without data on suicidal behaviours. If this review confirms the effectiveness on suicidal behaviours of early interventions for young patients with psychotic disorders, the development/implementation of such intervention programmes should be better promoted. https://www.crd.york.ac.uk/prospero/, identifier CRD42021237833.

Exploring the readiness of youth education institutions with high‐risk students to implement a suicide prevention gatekeeper intervention: A nationwide observational survey study in Denmark

AbstractDanish schools offering “preparatory basic education and training” (FGU schools) have students that are characterized by having different academic, social, or personal problems. In addition, many FGU students are at high risk of suicidal behavior. Many young people with suicide behavior do not seek help and early identification is important for suicide prevention. Teachers are in a position where it could be relevant to implement a gatekeeper intervention. To ensure successful implementation of an intervention, it is important to establish organizational readiness for change, including its innovation‐specific capacity, which are the facilitating requirements in the organization specific to the intervention. We aimed to explore the innovation‐specific capacity to implement a gatekeeper intervention at FGU schools in Denmark. This study is based on an online survey completed by teaching staff (n = 251) at FGU schools to explore their overall knowledge about and experience with students' suicidal behavior. Limited knowledge of suicide prevention was found among teaching staff. Most knowledge was from personal experience. There is a need for teaching staff to be educated about suicidal behavior. There is a lack of innovation‐specific capacity to implement a gatekeeper intervention.

Risk and protective factors for suicidal ideation and attempt: comparing gender diverse and cisgender youth

Transgender and gender diverse adolescents are at especially high risk for suicidal behavior compared with cisgender peers. Based on ideation-to-action models of suicide, study aims were to compare transgender and gender diverse (TGD) and cisgender youth on suicide risk and protective factors and identify gender differences in the strength of the associations between protective factors and suicide-related outcomes. Participants were n = 26,887 (n = 1352 TGD youth; n = 12,529 cis boys; n = 13,006 cis girls) 8th and 11th grade respondents on a state-representative school-based survey in Oregon in 2019. Consistent with prior studies, TGD youth more often reported suicidal ideation (45%) than cisgender boys (12%) and girls (24%). TGD youth demonstrated higher odds of risk factors (depression, bullying, parental rejection) and lower levels of protective factors (adult support, problem solving) than cisgender peers. These differences did not fully explain TGD adolescents’ higher odds of suicidal thoughts and behaviors. Results support the need for targeted prevention efforts for TGD youth.

Associated Factors of Suicidal Behavior Among Persons with Physical Disability: A Systematic Review.

Suicide is common among persons with physical disabilities as they face several physical, social, psychological, and economic problems. They are at risk for suicidal thoughts, behaviors, and death by suicide. We aimed to systematically review empirically published articles and identify the associated factors of suicidal ideation and suicide attempts in persons with physical disabilities. A systematic search was carried out on the literature published from January 1, 2000 to January 19, 2023 in PubMed, Cochrane, Web of Science, Google Scholar, Shodh Ganga, and so on. All the synonyms of keywords or MeSH terms for suicidal ideation, suicide attempt, and physical disability were used. Two hundred thirty-six articles were found, and after following inclusion and exclusion criteria, 12 remained. The associated factors of suicidal behavior were disability status (11/12 studies), burdensomeness (8/12 studies), felt stigma (4/12 studies), depressive symptoms (6/12 studies), loneliness (2/12 studies), lack of social and emotional connectedness (2/12 studies), long-term physical or mental disability (2/12 studies), congenital disability (1/12 studies), and aggression (1/12 studies). Timely, evidence-based, low-cost interventions can provide great assistance and address the specific needs of this vulnerable population as they have higher risk for suicidal behavior.

Influence of Alcohol Dependence on the Clinical and Dynamic Characteristics of Bipolar Disorder with Their Comorbidity in Psychiatric Hospital Patients

Background: numerous studies indicate a high level of comorbidity of bipolar disorder with other psychiatric disorders. Alcohol dependence is one of the most common comorbid pathologies, along with anxiety disorders and personality disorders. Objective: determination of the frequency of comorbidity of BAR with alcohol dependence in patients of a specialized psychiatric hospital and identiашcation of clinical and dynamic features of BAR with this comorbidity. Patients and methods: in the psychiatric unit, 188 patients with bipolar disorder diagnosed according to ICD-10 (136 women and 52 men) were examined. The age of female patients was 41.6 ± 14.4 years, male — 39.4 ± 14.0 years. Depending on the current affective disorder, patients were distributed as follows: a depressive episode — 62.2 % (n = 117), a hypomanic episode — 2.7 % (n = 5), a manic episode (ME) — 1.6 % (n = 3), mixed episode — 33.5 % (n = 63). A comparative assessment of the clinical and dynamic characteristics of bipolar disorder was carried out in 2 groups of patients: with bipolar disorder and comorbid alcohol dependence — 30 individuals (14 women and 16 men), aged 43 years [29; 55] and without comorbidity with alcohol dependence — 59 individuals (39 women and 20 men), age 36 years [29; 50]. During the study, clinical-psychopathological, clinical-catamnestic, psychometric, statistical methods were used. Results and discussion: the level of comorbidity of bipolar disorder with alcohol dependence was determined — 15.9 %. It was found that in BD with comorbid alcohol dependence, compared with BD without alcohol dependence, patients have an early onset age of BD, more often have mixed episodes during an affective disorder. In addition, such patients have a higher risk of suicidal behavior, bipolar-I, and exacerbation of affective symptoms. It has also been shown that alcohol dependence makes it difficult to recognize bipolar disorder during the primary visit to specialized psychiatric care. Conclusion: addition of alcohol dependence to bipolar disorder affects negatively its main clinical and dynamic parameters and delays the terms of its diagnostics.

First-episode psychosis and autism spectrum disorder: a scoping review and a guide to overcome diagnostic challenges

Background Undiagnosed Autism Spectrum Disorder (ASD) may represent a diagnostic challenge in people who refer to specialized services for first-episode psychosis (FEP). Similarly, individuals with ASD can present newly-onset psychotic symptoms. Aims The present review aimed to summarize the literature available on ASD and FEP to guide differential diagnosis between the two conditions and discuss the impact of ASD-FEP comorbidity on recovery. Methods The PRISMA-ScR guidelines were followed. After conducting a comprehensive literature search, we screened 204 papers including participants with: (1) a comorbid diagnosis of FEP and ASD; (2) FEP and autistic traits; (3) separate groups of FEP and ASD. Results A total of 18 studies were discussed and confirmed the high prevalence of ASD or autistic traits in people referring to FEP services (up to 9% and 35% of FEP, respectively), which could negatively impact pathways to care, clinical presentation, and outcomes. Due to some similarities in ASD and FEP presentation (e.g., difficulties in social functioning), a differential diagnosis could be challenging. The features more suggestive of ASD rather than a primary FEP include illogical and concrete thinking, and a longstanding social interaction difficulty. Aberrant salience and suspiciousness can manifest in ASD, but are usually more transient, and stress-related than in FEP. Also, perceptual abnormalities are due to altered sensory processing rather than pathological hallucinations. The co-occurrence of ASD symptoms is associated with a reduced probability of clinical and functional recovery in FEP, a higher risk of suicidal behaviors, and higher unemployment rates. Conclusions The kaleidoscopic manifestations of FEP require an adequate differential diagnosis that should include ASD. FEP services ought to be equipped for an adequate assessment and diagnostic formulation, which can result particularly challenging should symptoms of autism be present in adult patients.

Development and evaluation of a predictive algorithm and telehealth intervention to reduce suicidal behavior among university students.

Suicidal behaviors are prevalent among college students; however, students remain reluctant to seek support. We developed a predictive algorithm to identify students at risk of suicidal behavior and used telehealth to reduce subsequent risk. Data come from several waves of a prospective cohort study (2016-2022) of college students (n = 5454). All first-year students were invited to participate as volunteers. (Response rates range: 16.00-19.93%). A stepped-care approach was implemented: (i) all students received a comprehensive list of services; (ii) those reporting past 12-month suicidal ideation were directed to a safety planning application; (iii) those identified as high risk of suicidal behavior by the algorithm or reporting 12-month suicide attempt were contacted via telephone within 24-h of survey completion. Intervention focused on support/safety-planning, and referral to services for this high-risk group. 5454 students ranging in age from 17-36 (s.d. = 5.346) participated; 65% female. The algorithm identified 77% of students reporting subsequent suicidal behavior in the top 15% of predicted probabilities (Sensitivity = 26.26 [95% CI 17.93-36.07]; Specificity = 97.46 [95% CI 96.21-98.38], PPV = 53.06 [95% CI 40.16-65.56]; AUC range: 0.895 [95% CIs 0.872-0.917] to 0.966 [95% CIs 0.939-0.994]). High-risk students in the Intervention Cohort showed a 41.7% reduction in probability of suicidal behavior at 12-month follow-up compared to high-risk students in the Control Cohort. Predictive risk algorithms embedded into universal screening, coupled with telehealth intervention, offer significant potential as a suicide prevention approach for students.

Risk for Suicidal Behavior After Psychiatric Hospitalization Among Sexual and Gender Minority Patients

The months following inpatient psychiatric hospitalization are a period of high risk for suicidal behavior. Sexual and gender minority (SGM) individuals have elevated risk for suicidal behavior, but no prior research has examined whether SGM inpatients have disproportionate risk for suicidal behavior following discharge from psychiatric hospitalization. To evaluate whether SGM patients have elevated risk for suicidal behavior following discharge from psychiatric hospitalization compared with heterosexual and cisgender patients and to examine whether differences in risk across groups were accounted for by demographic characteristics and clinical factors known to be associated with suicidal behavior. This prospective cohort study was conducted from August 2017 to July 2021 among inpatients aged 18 to 30 years who were voluntarily enrolled during psychiatric hospitalization. The study was conducted at an inpatient psychiatric hospital, with prospective data collected via follow-up visits and electronic health records. Onset and/or recurrence of suicidal behavior following discharge from psychiatric hospitalization, assessed at follow-up visits and through electronic health records. A total of 160 patients were included, with 56 sexual minority (SM) and 15 gender minority (GM) patients. The median (IQR) age of the patients was 23.5 (20.4-27.6) years, 77 (48%) reported male sex assigned at birth, and 114 (71%) identified their race as White. During the follow-up period, 33 suicidal behavior events occurred (among 21% of patients). SM (hazard ratio [HR], 2.02; 95% CI, CI, 1.02-4.00; log-rank P = .04) and GM (HR, 4.27; 95% CI, 1.75-10.40; log-rank P < .001) patients had significantly higher risk for suicidal behavior compared with their heterosexual and cisgender counterparts, respectively, in bivariable analyses. Risk between SM and heterosexual patients was not different after controlling for demographic characteristics and clinical factors associated with suicidal behavior. GM patients exhibited elevated risk during the 100 days following discharge even after controlling for demographic and clinical characteristics (HR, 3.80; 95% CI, 1.18-11.19; P = .03). Within this cohort study of psychiatric patients, SGM patients had higher risk for suicidal behavior than non-SGM patients following discharge. While SM patients' risk was accounted for by clinical characteristics, GM patients' risk for suicidal behavior was not accounted for by their acute psychiatric state on admission. Future studies with larger subsamples of GM individuals are needed, and inpatient clinicians must attend to the unique needs of SGM individuals to ensure they receive affirming services.

The moral injury, posttraumatic stress disorder, and suicidal behaviors in health professionals 1 year after the COVID-19 pandemic peak in China.

Moral COVID-19 pandemic. This study aims to explore the relationship between moral injury (MI), posttraumatic stress disorder (PTSD), and suicidal behaviors approximately 1 year after the pandemic peaked in mainland China. An online survey was conducted from March 27 to April 26, 2021, across mainland China. A total of 3,465 health professionals completed the Chinese version of the MI Symptoms Scale-Health Professional, Suicidal Behaviors Questionnaire-Revised, and PTSD Checklist for DSM-5 (PCL-5). The prevalence of PTSD and suicidal behavior among health professionals were 26.9% and 24.2%, respectively. MI is associated with a higher risk of PTSD (OR =3.52, 95% CI [3.01, 4.13]), and a higher risk of suicidal behaviors (OR= 2.13, 95% CI [1.81, 2.50]) under the controlling of sociodemographic variables. And the interaction of PTSD and MI was associated with a significantly increased risk of suicidal behaviors (ORinteraction = 1.61, 95% CI [1.29, 2.02]). The MI symptoms are associated with a higher risk of PTSD, and suicidal behaviors among health professionals 1 year after the peak of the COVID-19 pandemic in China. The findings underscore the importance of identifying and treating MI as one way to manage PTSD and suicidal behaviors among health professionals during the postpandemic period. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Determinants of suicidal behavior in dementia: A Swedish national register-based study.

To examine predictors of suicidal behavior (SB) in adults aged 75 years and above with dementia. Longitudinal national register-based study. Swedish residents aged ≥75 years with dementia identified in the Swedish Dementia Registry (SveDem) between 1 January 2007 and 31 December 2017 (N = 59 042) and followed until 31 December 2018. Data were linked with numerous national registers using personal identity numbers. Outcomes were nonfatal self-harm and suicide. Fine and Gray regression models were used to investigate demographics, comorbidities, and psychoactive medications associated with fatal and nonfatal SB. Suicidal behavior was observed in 160 persons after dementia diagnosis; 29 of these died by suicide. Adjusted sub-hazard ratio (aSHRs) for SB was increased in those who had a previous episode of self-harm (aSHR = 14.42; 95% confidence interval [CI] = 7.06-29.46), those with serious depression (aSHR = 4.33, 95%CI = 2.94-6.4), and in those born outside Sweden (aSHR = 1.53; 95% CI = 1.03-2.27). Use of hypnotics or anxiolytics was also associated with a higher risk of SB; use of antidepressants was not. Milder dementia and higher frailty score also increased risk of SB. Risk was decreased in those who received home care (aSHR = 0.52; 95%CI = 0.38-0.71) and in the oldest group (aSHR = 0.35; 95%CI = 0.25-0.49). In addition to established targets for suicidal behavior prevention (improved identification and treatment of depression and previous self-harm), several new risk factors were suggested. There is a need for innovative public health strategies to meet the needs of older dementia patients with a foreign background. Home care may have a potential positive effect to prevent SB in people with dementia, but this needs to be further explored.

Association of markers of inflammation and intestinal permeability in suicidal patients with major mood disorders

BackgroundPatients with major mood disorders are at high risk of suicidal behavior compared to the general population. Suicide is a public health concern, accounting for around 1.2% of deaths worldwide. Understanding its underlying mechanisms may help identify predictive biomarkers and design novel targeted treatments. Immune dysfunctions, in particular affecting the gut-brain axis, are of interest given their dual involvement in mood disorders and suicidal behavior. We thus explored the possible relationships between suicide attempt (SA) and circulating biomarkers of intestinal permeability and systemic inflammation in patients with major depressive disorder (MDD) or bipolar disorder (BD) with and without a history of SA. Method137 patients with BD and 168 with MDD were included, and among them, 133 had a history of SA and 172 did not. Among them, 104 were males (34%) and 201 females (66%). Depressive symptoms were evaluated using the Inventory of Depressive Symptomatology clinical scale (IDS-C30). Circulating levels of intestinal fatty acid binding protein (IFABP), calprotectin, apolipoprotein E (ApoE), lipopolysaccharides binding protein (LBP), lipopolysaccharides (LPS), soluble beta-2-microglobulin (B2m), and C-reactive protein (CRP), were determined. Multivariate linear regressions were performed according to the gender status given the proportion of the herein studied male and female individuals and the higher propensity of females to experience SA as compared to males. ResultsAfter adjusting for confounding variables, patients in the SA group had significantly higher CRP, and lower IFABP levels in comparison to the NSA group. LimitationsThe unavailability of confounding variables such as dietary habits, should be noted. In addition, the cross-sectional nature of the study hampers the identification of causative effects. ConclusionAlthough preliminary, our observations revealed associations between markers of inflammation and intestinal permeability in patients with suicidal behavior warranting further confirmation in larger cohorts.

Predicting suicide attempts among people with diabetes using a large multicenter electronic health records dataset.

People with diabetes have a higher risk of suicidal behaviors than the general population. However, few studies have focused on understanding this relationship. We investigated risk factors and predicted suicide attempts in people with diabetes using Least Absolute Shrinkage and Selection Operator (LASSO) regression. Data was retrieved from Cerner Real-World Data and included over 3 million diabetes patients in the study. LASSO regression was applied to identify associated factors. Gender, diabetes-type, and depression-specific LASSO regression models were analyzed. There were 7764 subjects diagnosed with suicide attempts with an average age of 45. Risk factors for suicide attempts in diabetes patients were American Indian or Alaska Native race (β = 0.637), receiving atypical antipsychotic agents (β = 0.704), benzodiazepines (β = 0.784), or antihistamines (β = 0.528). Amyotrophy was negatively associated with suicide attempts in males (β = 2.025); in contrast, amyotrophy significantly increased the risk in females (β = 3.339). Using a MAOI was negatively related to suicide attempts in T1DM patients (β = 7.304). Age less than 20 was positively associated with suicide attempts in depressed (β = 2.093) and non-depressed patients (β = 1.497). The LASSO model achieved a 94.4% AUC and 87.4% F1 score. To our knowledge, this is the first study to use LASSO regression to identify risk factors for suicide attempts in patients with diabetes. The shrinkage technique successfully reduced the number of variables in the model to improve the fit. Further research is needed to determine cause-and-effect relationships. The results may help providers to identify high-risk groups for suicide attempt among diabetic patients.

Psychological Distress and Suicidal Behavior Among Medical Students at Khartoum State Universities, 2021-2022

Introduction: Psychological distress and suicidal behavior are mental health problems among students and necessitate research to inform strategies for prevention in this population. Although depressive symptoms and suicidal ideation are common in medical students, few programs address this problem, which is needed it to determine the prevalence of psychological distress and suicidal behavior among medical students. Methods: this is a cross sectional faculty-based study . we used Snowballing sampling technique and Kessler 10-item Questionnaire to assess psychological distress. We used SBQ-R (suicidal behavioral questionnaire _Revised) to assess suicidal behavior .The participants were students from 12 medical colleges in Khartoum state, from all academic levels. Results: among 525 undergraduate medical students 136 (25.9%) were males and 389 (74.1%) were females, 23.3% were well, 18.7% had mild mental disorder, 19.2%had moderate mental disorder and 38.8% had severe mental disorder at the last 30 days. The higher of psychological distress was slightly significant among student in preclinical years than clinical years (P=0.08), 72% have poor risk for suicidal ideation and 28% have higher risk of suicidal behavior more significant among students in preclinical years (p= 0.02). Conclusion: Psychological distress and suicidal behavior were more evident in pre-clinical years along with other many factor including, marital status, bad habits, chronic disease, and university type either public or private. We recommend implementing psychological and academic support programs across different undergraduate levels to enhance mental wellbeing, academic performance and prevent suicidal behavior.

Demoralization and Suicidal Ideation in Chronic Pain Patients.

The literature has clearly stressed that patients suffering from chronic pain are at high risk of suicidal behavior (SB). Hence the need to improve the characterization of this behavior risk profile in these patients. Some findings indicate a possible relationship between demoralization and pain, with functional disability found to be correlated with demoralization. The primary objective of this study was to investigate the relationship between demoralization and suicidal ideation (SI) in patients with chronic pain. The secondary objective was to verify whether demoralization can occur independently of depression in these patients. Inclusion criteria were patients with chronic pain, with SI or not, matched for age and gender, aged > 18 years. Seventy patients with SI and 70 patients without SI were included. Between-group difference was statistically significant (F=1.064; t= 7.21, p<0.001, d=1.22), confirming the presence of numerous and intense depressive symptoms in the patients of the SI group. Regarding the Demoralization Scale (DS), the difference between the two groups was statistically highly significant (F=1.49; t=9.44; p<0.001, d=1.6). There was also a strong positive correlation between DS and Beck Depression Inventory (BDI-II) (R=0.749; p<0.001 for the study group and R=0.704; p<0.001 for the control group). Furthermore, there was a strong positive correlation between the DS and the Scale for Suicide Ideation (SSI) in the SI patients group, meaning that high demoralization is associated with higher suicidal ideation as well. Our findings did not allow us to distinguish between the notions of depression and demoralization, since the two constructs show almost the same strong positive correlation with suicidal thoughts, the two also being strongly correlated with each other.

CAUSAS MÚLTIPLAS DE ÓBITOS RELACIONADOS ÀS LESÕES AUTOPROVOCADAS E A PANDEMIA DE COVID-19

The covid-19 pandemic simultaneously generated and amplified personal, social, medical, political, and economic crises, generating indirect health impacts, such as psychopathologies. In this context, a higher risk of suicidal behavior by vulnerable individuals is suggested. To better understand this new scenario of morbidity and mortality, this study was made using data available at Datasus.&nbsp;The multiple causes of death related to self-harm were used. It is compared as death notifications of the ICD-10 X60-X84 group, corresponding to intentionally self-harm units, in the year 2020 with the average of notifications in the five years prior to the pandemic (2015-2019). As main results, there was an increase in reports of “self-intoxication by and intentional exposure to other drugs, medicines and biological substances and to unspecified ones” and “intentional self-harm by hanging, strangulation and suffocation”; reduction of “intentional self-harm by falling from a height” and maintenance&nbsp;of “voluntary alcohol self-intoxication” as a cause with more proportional notifications as “basic cause” and “diagnostic mentions”. The data show that the pandemic has changed the patter of self-harm injuries. In addition, they contribute to the literary structuring about self-harm lesions.