High Risk For Suicidal Behavior Research Articles

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.

Therapy Strategies for Late-life Depression: A Review

Depression in the elderly requires different treatment options because therapies that are commonly used for depression in younger patients show different effects later in life. Treatment options for late-life depression (LLD) are summarized in this article. A literature search in Medline/PubMed performed in June 2020 identified 83 relevant studies. Pharmacotherapy with selective serotonin reuptake inhibitors can be an effective first-line treatment in LLD, but >50% of elderly patients do not adequately respond. Switching to other selective serotonin reuptake inhibitors or augmenting with mood stabilizers or antipsychotics is often effective in achieving a therapeutic benefit. Severely depressed patients with a high risk of suicidal behavior can be treated with electroconvulsive therapy. Psychotherapy provides a measurable benefit alone and when combined with medication. LLD remains an underrepresented domain in research. Paucity of data concerning the effect of specific therapies for LLD, heterogeneity in the quality of study designs, overinterpretation of results from meta-analyses, and discrepancies between study results and guideline recommendations were often noted. Treating LLD is complex, but there are several treatment options with good efficacy and tolerability. Some novel pharmaceuticals also show promise as potential antidepressants, but evidence for their efficacy and safety is still limited and based on only a few trials conducted to date.

Диагностика и профилактика риска суицидального поведения обучающихся юношеского возраста в образовательной организации

Russia is one of the ten states with high suicidal activity of the population. Adolescence and early adolescence are traditionally considered as periods of manifestation of suicidal attempts and completed suicides, which determines the need to identify the psychological determinants of personality to prevent and correct the risk of suicidal behavior students. We carried out a psychological study of suicidal tendencies and predisposition to self-destructive behavior in early adolescence; formed an experimental group of students based on the screening of students with a high risk of suicidal behavior. The propensity for risky and suicidal behavior, as well as such qualities as aggressiveness, social dependence, anxiety, self-esteem at the ascertaining and control stages were studied. The revealed in the study data on suicidal tendencies and predisposition to destructive behavior in people of early adolescence complement the theoretical and empirical ideas about this phenomenon. A complex combination of a high level of aggressiveness, personal anxiety, social dependence and inadequacy of self-esteem in the structure of suicidal tendencies and a predisposition to destructive behavior in people of early adolescence has been reliably identified. The results obtained are important for the development of preventive measures, competent and reasonable construction of psycho-correctional and psychotherapeutic work with this category of students.

Common and differential risk factors behind suicidal behavior in patients with impulsivity-related disorders: The case of bulimic spectrum eating disorders and gambling disorder.

Mental disorders with high levels of impulsivity such as bulimic spectrum eating disorders (BSED) and gambling disorder (GD) are associated with high risk of suicidal behavior. The aim of the present study was to identify the common and differential vulnerability factors behind suicide attempts in a sample of patients with BSED compared to patients with GD. A total of 6,077 adults who sought treatment and met criteria either for BSED (n = 2,391) or GD (n = 3,686) were assessed at a specialized hospital unit. Personality traits, psychopathological symptomatology, lifetime history of suicide attempts and socio-demographic variables were evaluated. The prevalence of suicide attempts was higher for BSED patients (26.2%) compared to GD patients (7.1%) being anorexia nervosa (Binge/Purge type) and bulimia nervosa the most affected subtypes. In the predictive model, the transdiagnostic vulnerability factors with the highest contribution to the risk of suicidal behavior both in BSED and GD were unemployment, early age of onset of the disorder, worse psychopathological state, and self-transcendence personality trait. However, specific risk factors for suicidal acts were identified in each disorder: longer duration of the disorder, lower education levels and reward dependence were exclusively associated with BSED while female gender, older age, and higher harm avoidance were associated with GD. Patients with GD and BSED share certain vulnerability factors although certain factors are exclusive to each disorder. Interventions need to pay special attention to both common and specific vulnerability factors to mitigate the risk of suicidal acts in these disorders.

Use of hormonal contraceptives and antidepressants and risks of suicidal behavior and accidents among women with premenstrual disorders: a nationwide cohort study

BackgroundWomen with premenstrual disorders (PMDs) are at increased risks of suicidal behavior and accidents. However, the effect of PMD first-line treatment on such risks have not been assessed.MethodsTo study the association between use of hormonal contraceptives or antidepressants and subsequent risks of suicidal behavior and accidents among women with PMDs. We conducted a nationwide register-based cohort study with between- and within-individual analyses in Sweden. All women with a clinical diagnosis/indication of PMDs recorded in the Patient Register and the Prescribed Drug Register during 1987–2011 were included (n = 23 029, age 15–52 years). Information on hormonal contraceptives and antidepressants prescribed for these women was obtained from the Prescribed Drug Register. Events of suicidal behavior (complete suicide and suicide attempt) and accidents were separately identified through the Patient and the Causes of Death Registers. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of suicidal behavior and accidents after use of hormonal contraceptives or antidepressants were estimated in between-individual and within-individual analyses (i.e., comparing the risk between use and no use in the same individual) using Poisson regression.ResultsWomen with PMDs were followed for a median of 6.2 years. Compared to no use of hormonal contraceptives, use of hormonal contraceptives was associated with a lower risk of suicidal behavior in both between-individual (IRR 0.76, 0.43–1.34) and within-individual analyses (IRR 0.65, 0.51–0.83). These risk reductions were primarily restricted to combined products (IRR 0.18, 0.07–0.47 and 0.19, 0.08–0.42 in between- and within-individual analyses) and observed among women with/without psychiatric comorbidities (p for interaction 0.830 and 0.043 in between- and within-individual analyses). Yet, the use of hormonal contraceptives was not consistently associated with risk of accidents between between-individual (IRR 1.13, 1.01–1.27) and within-individual analyses (IRR 1.01, 0.92–1.11). Use of antidepressants was associated with a higher risk of suicidal behavior and accidents in both between- and within-individual analyses.ConclusionsOur findings suggest that use of hormonal contraceptives, particularly combined products, is associated with reduced rates of suicidal behaviors, but not accidents, among women with PMDs. The estimates for antidepressants may be biased by indication.

The risk of early suicide and diagnostic issues in Cotard's syndrome associated to self-starvation.

Cotard's syndrome is a rare neuropsychiatric disorder in which the patient holds nihilistic delusions concerning his/her own existence, including the conviction of being dead or having lost parts of the body. There are occasional reports of Cotard's syndrome being accompanied by nutritional deficiencies or self-starvation. The authors describe the peculiar case of a 40-year-old man who developed severe malnutrition within a few months. At first, a diagnosis of anorexia nervosa was made. The man was admitted to the hospital where other significant psychopathological symptoms emerged. One of the consequences of Cotard's syndrome is self-starvation because of negation of existence of self. The presented case points out that, although Cotard's syndrome has been reported to be associated with various organic conditions and other forms of psychopathology, loss of appetite and nutritional deficits can erroneously lead to mistake this diagnosis for anorexia nervosa, thus underestimating the high risk of these patients of committing suicide following hospital discharge. Taking into account its rarity and possible subdiagnosis, as a distinct clinical entity the aim of this case report is to emphasize that these patients may initially be addressed to general practitioners, due to the dysmetabolic consequences of malnutrition, rather than to psychiatrists. An early recognition of signs indicative of Cotard's syndrome can be vital to prevent the situation from worsening. In fact, missed diagnoses can put these patients at an higher risk of suicidal behaviour.

Deconstructing resilience in patients at high risk for suicidal behavior

BackgroundResilience represents coping abilities to overcome exposure to psychopathological risk. In the context of risk factors for suicidal behavior, it is unknown if this attribute is deficient in suicide attempters, how it relates to other measures of risk, and where it may overlap with other risk factors associated with suicidal behavior. MethodsThe present study examined the performance on the Connor-Davidson Resilience Scale (CD-RISC) in three groups of individuals with familial risk for both mood disorder and suicidal behavior, as well as a healthy comparison group. Other risk factors for suicidal behavior, such as depression severity, hopelessness, and lifetime impulsiveness were examined as well to determine if these mediated group differences in CD-RISC scores. ResultsCD-RISC scores differed between groups, with lowest scores in the past attempter group. However, CD-RISC scores were strongly correlated with other common risk factors for suicide attempt, including hopelessness, subjective depression, and reasons for living, which together explained 68 % of the CD-RISC variance. Group differences in CD-RISC scores were eliminated when the model included these covariates. LimitationsSample sizes were modest, and depression severity was low overall and significantly higher in the past suicide attempter group. ConclusionsThe CD-RISC has demonstrated utility for predicting risk for depression, but appears to overlap with other known risk factors for suicidal behavior, especially hopelessness and subjective depression. Though it encapsulates variance from multiple risk factors in a single scale, it may not provide additional predictive power above and beyond these other risk factors for suicidal behavior.

Nonsuicidal Self-Injury Thoughts and Behavior in Adolescents: Validation of SITBI-NSSI.

The lack of knowledge about Nonsuicidal Self-Injury (NSSI) in Spanish adolescents, especially NSSI thoughts may be due to the paucity of NSSI assessment instruments with validity evidence in this sample. The aim of this study was to assess NSSI thoughts and behavior. In addition, the study examined the association between various NSSI features and suicidal behavior and included a preliminary validation of the new Self-Injurious Thoughts and Behaviors Interview - Non-Suicidal Self-Injury (SITBI-NSSI). 685 Spanish adolescents between 13 and 18 years old (M = 15.58, SD = 1.08; 60.9% girls) completed measures of NSSI features and suicidal behavior. Among adolescents, 19% thought about self-injury, and 16.8% presented NSSI behaviors. The girls had higher levels of NSSI, as well as greater frequency, number of functions, methods, and suicidal thoughts and desire. Some of the functions, methods, and precipitants differed by sex. Those with ANS had a higher risk of suicidal behavior than the comparison group. The association of SITBI-NSSI with other measures supports the validity of the data. Most features of NSSI are similar to those found in Spanish and internationally. The SITBI-NSSI could facilitate the evaluation of NSSI in Spanish adolescents.

The Suicidal Ideation Attributes Scale-Modified (SIDAS-M): Development and preliminary validation of a new scale for the measurement of suicidal ideation in autistic adults.

Autistic people may be at higher risk of suicidal behavior than people in the general population. Suicidal behavior may include thinking about suicide or attempting to end one's own life by suicide. It is important to identify autistic people who may be thinking about suicide. People who are at risk of suicidal behavior can be identified by asking questions about whether they have been thinking about suicide. A specially designed questionnaire, or screening instrument, can help someone ask the best questions to find out if someone has been thinking about suicide. This information can help to identify supports to be put in place to prevent suicidal behavior, such as a suicide attempt. However, autistic people may interpret questions differently than non-autistic people. It is important to use screening tools that have been designed with, and for autistic people. In this study, we examined the Suicidal Ideation Attributes Scale (SIDAS). The SIDAS is an existing tool that was developed to screen for suicidal thinking in the general population. We modified SIDAS for use with autistic adults. We involved autistic people in the process of modifying SIDAS. We called the modified instrument the SIDAS-M. The results of our study showed SIDAS-M may be useful for screening for suicidal thinking in autistic adults who do not have an intellectual disability.

Enduring Effects of Early Life Traumas on Adult Suicidal Ideation.

Exposure to traumas early in life has been found to have a range of negative health effects later in adulthood, including a higher risk for suicidal behavior. Using data from the Waves I (1994/95) and IV (2008) of the National Longitudinal Study of Adolescent to Adult Health (N = 14,385; 49.35% female; Mage in Wave IV = 29), this study examines the effects of exposure to three different types of early life traumas-emotional abuse, physical abuse, and sexual abuse before the age of 18-on adult suicidal ideation. Guided by the stress process model incorporated with a life-course perspective, potential mediating roles of psychological distress, subjective powerlessness, and perceived social rejection were also investigated. A series of regression and Karlson-Holm-Breen (KHB) mediation analyses were performed using Stata 14 to assess the total, direct, and indirect effects. All three early life trauma measures were found to be significantly and independently associated with a higher risk of suicidal ideation in adulthood. A substantive portion (between 30 and 50%) of the effects was mediated by psychological distress (i.e., depression and anxiety), subjective powerlessness, and perceived social rejection. The general policy implications of this study include evaluating suicidal individuals for prior childhood abuse experiences and assessing abuse survivors for suicidality.

Antisocial and borderline personality traits and childhood trauma in male prisoners: Mediating effects of difficulties in emotional regulation

ObjectiveTo investigate the prevalence of probable antisocial personality disorder (ASPD) and borderline personality disorder (BPD) among prisoners, and further examine the mediating effect of difficulties in emotional regulation (ER) between childhood trauma and symptoms of ASPD and BPD. MethodsA total of 1491 male participants (35.4 ± 9.69 years) were recruited from a prison in Guangdong, China. The symptoms of ASPD and BPD, childhood trauma, difficulties in ER, and suicidal behaviors were measured by self-administered structured questionnaires. Logistic regressions were performed to investigate the associations of ASPD and BPD with suicidal behaviors. Path analysis was used to examine the mediating effects of difficulties in ER between childhood trauma and symptoms of ASPD and BPD. ResultApproximately, 21.2 % and 11.2 % of the participants were screened as ASPD and BPD, respectively. Probable ASPD and BPD were associated with higher risk of suicidal behaviors. Childhood trauma and difficulties in ER were significantly associated with suicidal behaviors in prisoners with probable ASPD and BPD. Path analyses showed that partial mediating effects of difficulties in ER were significant in the dimensions of clarity and strategies on ASPD, and in the dimensions of clarity, impulse, and strategies on BPD. ConclusionASPD and BPD are two of the common personality disorders in prisoners. Difficulties in ER are key to understanding the relationships between childhood trauma and personality disorders.

Relapse Prevention Intervention after Suicidal Event (RISE): Feasibility study of a psychotherapeutic short-term program for inpatients after a recent suicide attempt.

Recent research suggests that treating only mental disorders may not be sufficient to reduce the risk for future suicidal behavior in patients with a suicide attempt(s). It is therefore necessary to pay special therapeutic attention to past suicidal acts. Thus, the newly developed RISE (Relapse Prevention Intervention after Suicidal Event) program was built on the most effective components of existing psychotherapeutic and psychosocial interventions according to our current meta-analysis. The RISE program consists of five individual sessions designed for the acute psychiatric inpatient setting. The main goals of the treatment are to decrease future suicidal events and to improve patients' ability to cope with future suicidal crises. In the present study, feasibility and acceptance of the RISE program were investigated as well as its clinical effects on suicidal ideations, mental pain, self-efficacy and depressive symptoms. We recruited a sample of 27 inpatients of the Department of Psychiatry and Psychotherapy, University Hospital Jena, Germany. The final sample consisted of 20 patients hospitalized for a recent suicide attempt, including 60 percent of multiple attempters. The data collection included a structured interview and a comprehensive battery of questionnaires to evaluate the feasibility and acceptance of the RISE program as well as associated changes in clinical symptoms. A follow-up examination was carried out after 6 months. Considering the low dropout rate and the overall positive evaluation, the RISE program was highly accepted in a sample of severely impaired patients. The present study also demonstrated that the levels of suicidal ideations, mental pain, depressive symptoms, and hopelessness decreased significantly after RISE. Since all of these clinical parameters are associated with the risk of future suicidal behavior, a potential suicide-preventive effect of the intervention can be inferred from the present findings. The positive results of the follow-up assessment after 6 months point in the same direction. In addition, RISE treatment increased self-efficacy in patients, which is an important contributor for better coping with future suicidal crises. Thus, present study demonstrate that RISE is a suitable therapy program for the treatment of patients at high risk for suicidal behavior in an acute inpatient setting.

School Year and Suicidal Behaviors Among Youth: Insight From a National Dataset.

Objective: To compare suicidal behaviors that occur during the school year with those during school break and to examine demographic characteristics and comorbidities of the suicidal behaviors by time period.Methods: This retrospective cross-sectional analysis of a nationwide US sample included 74,385 inpatients (aged 10-18 years) who were admitted to the hospital with primary ICD-9 codes of suicidal ideation or suicide and self-inflicted injury including poisoning between January and December 2014. For this study, the sample was further subgrouped based on school year (September to May) and school break (June to August).Results: Suicidal behaviors were higher during the school year (average of 6,761/month) compared to school break (average of 4,512/month). Prevalence of suicidal behaviors was highest in October for both hospitalization and primary diagnosis of mood disorder. Among the school year cohort, the rate of suicidal behaviors was higher in youth with mood disorders (91.6% vs 90%). During school break, the suicidal behavior rate was higher for youth with disruptive behavior disorders (34.6% vs 31.5%) and comorbid alcohol (7.9% vs 5.7%) and other substance use disorders (21.7% vs 18.4%).Conclusions: Suicidal behaviors were higher (1.5 times) during the school year compared to school break. Given the finding that suicidal behaviors are higher among students with mood disorders during the school year, schools should implement universal depression and suicide screening. Youth with disruptive behavior disorders and substance use disorders are at higher risk for suicidal behaviors during school break, thus increased outreach and monitoring during extended breaks seems warranted for these high-risk youth during unstructured times.

Associations of Childhood Maltreatment With Suicidal Behavior Among Chinese Adolescents: Does It Differ Based on Gender and Biological Rhythm?

BackgroundThe impact of biological rhythm disorder (BRD) on the association of childhood maltreatment (CM) and suicidal behavior in adolescents remains unclear. CM increases the risk of suicidal ideation (SI), suicidal planning (SP), and suicidal attempts (SAs). There is less investigation on gender differences in CM's effects on suicidal behavior. It is unknown whether the impacts vary with different levels of BRD.AimsTo identify gender differences in CM's effects on suicidal behavior and to investigate these impacts at different levels of BRD.MethodThe analysis is based on data from 7,986 adolescents recruited from three cities in China between October and December 2019. All participants, aged 14.7 ± 2 years, filled out standard questionnaires involving CM, BRD, and suicidal behavior.ResultsA total of 22.9, 10.8, and 4.7% of the adolescents reported SI/SP/SAs in the past year. Girls are more likely to engage in SI and SP when exposed to the highest level of CM; boys are more likely to engage in SAs than girls. A significant relationship between moderate levels of CM and SI/SP/SAs was only observed in girls exposed to low BRD. Moderate CM is only significantly associated with SI in boys exposed to low BRD. The percentage of low-BRD adolescents who experienced high CM was 31.4%, whereas 58% of high-BRD adolescents experienced high CM in SI. Adolescents with high BRD were more likely to experience high levels of CM in SP and SAs.ConclusionsAdolescents at high risk of suicidal behavior in relation to CM should be targeted accordingly. Improving biological rhythm in adolescents who experience CM could help prevent them from engaging in suicidal behavior.

Correlates of suicidal behaviour among adults in Guyana

This study aimed to determine the prevalence and correlates of suicidal behaviour (SB) among adults in Guyana. Secondary data were analysed from the national cross-sectional 2016 Guyana STEPS survey, which sampled 2 662 adults aged 18-69 years (female = 59.9%; East Indian = 42.3%; median age = 37.4 years). Following logistic regression analyses, results indicated that the prevalence of past 12-month SB was 4.6% (ideation 4.4%, suicide plan 1.5%, and/or suicide attempt 1.1%). Mixed and other ethnicities, childhood physical abuse, childhood sexual abuse, adult sexual abuse, experience of threats, exposure to violent injuries, family history of suicide attempts, and history of heart attack, angina, or stroke were associated with a high risk of SB. Being male sex and higher education were associated with lower risk for SB. In addition to psychosocial distress, considering a history of cardiovascular disorder is essential in devising population-based suicide prevention strategies in Guyana.

Emotional abuse and perceived stress: The most relevant factors in suicide behavior in first-episode psychosis patients

People with a mental disorder have a higher risk of suicidal behavior. Little research has examined the role of childhood trauma in suicide behavior, and even fewer studies have assessed the specific relevance of subtypes of childhood trauma and suicidal behavior in first-episode psychosis (FEP). The aims of the present study were: 1) to compare suicide behavior between FEP and HC; 2) to study the relationship between the five types of ChT and suicide risk in FEP controlling for confounding sociodemographic, clinical, and psychosocial variables. 95 patients diagnosed with FEP and 92 healthy control (HC) were recruited as a part of the PROFEP study. ChT was evaluated using The Childhood Trauma Questionnaire-Short Form (CTQ) and suicide behavior through The Suicide Risk Scale of Plutchik (SRSP). Our results showed that patients with FEP presented more suicide behavior (ideation, attempt, and suicide risk) than HC. Emotional abuse was the most relevant type of ChT in suicide ideation and suicide risk. After controlling for other relevant variables, perceived stress seemed to play an important role in suicide ideations, suicide attempt, and suicide risk. The results highlight the importance of assessing and considering in the clinical practice ChT and the perceived stress.

Inequities in Mental Health Care Quality and Clinical Outcomes Among Inpatients with Depression Within a Tax-Financed Universal Health Care System.

PurposeThe objective was to examine potential socioeconomic inequities in guideline recommended quality of care as well as several clinical outcomes among first-time inpatients with major depressive disorder (MDD) in a tax-financed universal health care system.Patients and MethodsA nationwide cohort study was performed based on individual-level record linkage of public registers in Denmark. The study included all adult incident inpatients with MDD at Danish psychiatric hospitals in the period 2011–2017 (n=10,949). Socioeconomic position was assessed according to the level of education and income. Outcomes included quality of depression care for inpatients as reflected by the fulfillment of guideline recommended quality of care measures as well as clinical outcomes in terms of all-cause mortality, suicidal behavior, readmission for depression and all-cause readmission.ResultsPatients with low-level education or low-level income were statistically significantly less likely to receive high quality of in-hospital care, defined as fulfillment of at least 70% of relevant performance measures (adjusted relative risk (RR) 0.92 and 0.87, respectively). In addition, the same patients had a higher all-cause mortality (adjusted RR 1.22 and 1.41, respectively). Patients with low education or middle income were associated with a higher risk of suicidal behavior (adjusted RR 1.28 and 1.19, respectively). While no differences were found in the risk of all-cause readmission, low-level education and income was associated with a lower risk of readmission due to MDD (adjusted RR 0.91 and 0.87, respectively).ConclusionInequities in quality of care and clinical outcomes were observed among MDD inpatients in a tax-financed universal health care system, indicating that lack of access to care and insurance is not the only explanation for inequity in health.

Suicidal Behavior in Adolescent Girls with Eating Disorders

IntroductionEating disorders are associated with suicidal behavior in adolescents. But the relationship between subthreshold eating disorders and suicidality is not well understood.ObjectivesTo examine suicidal behavior in adolescent girls with eating disorders (ED) and subthreshold eating disorders (SED).MethodsThe study of 917 girls aged 12–17 used the Body Image and Eating Distress scale (Koskelainen et al., 2001) and questions about intentional self-harm (burns or cuts), suicidal thoughts and suicidal attempts. Adolescents were divided into three groups: girls with ED (n = 20); girls with SED (n = 88); and control group (CG, n = 809).ResultsSelf-harm was reported by 55% of girls with ED, 35.2% of girls with SED and 20.2% of CG girls (χ2 = 15.82, p &lt;0.001). Suicidal ideation was reported by 65% of girls with ED, 51.1% of girls with SED and 27.2% of CG girls (χ2 = 21.86, p &lt;0.001). Suicidal attempts were reported by 45% of girls with ED, 17.1% of girls with SED and 7.5% of the CG. There were no differences in the prevalence of self-harm and suicidal ideation between the ED and SED groups, rates of suicide attempts were 2.6 times higher in the ED group.ConclusionsGirls with both ED and SED have a high risk of suicidal behavior: 2.7-4.5 times higher rates of self-harm, 1.9-2.4 times higher rates of suicidal ideation, and 2.3-6 times higher rates of suicidal attempts. Management of such adolescents should include assessment of the risk of suicide.DisclosureThe study was supported by the Russian Science Foundation grant # 21-15-00033.

Depressions with religious experiences

IntroductionDespite a significant number of studies devoted to the relationship between depression and religiosity, the diagnosis of depression in religious patients is complicated due to the insufficiently studied psychopathology and the peculiarities of the patient’s experiences.ObjectivesTo determine the specific features of psychopathology and phenomenology of depression, masked by a “religious facade”, for timely diagnostics and prevention of suicidal behavior.MethodsOne hundred and fifteen religious (orthodox) inpatients (41 male, 74 female) with depression (F31.3, F31.4, F 32.1., F 32.2, F 33.1, F 33.2 according to ICD-10) were examined. Psychopathological method, HAM-D, SIDAS and statistical analysis were applied.ResultsFive types of depression were specified, which differed in psychopathological structure and content of the religious experiences. Overvalued ideas of guilt and sinfulness were predominant in melancholic depressions, ideas of God-forsakenness and the loss of “living” faith - in apathetic. Depressions with overvalued doubts whether the right faith and confession has been chosen accompanied with anxiety, melancholy and apathy. It should be specially mentioned apathetic and melancholic depressions characterized by “spiritual hypochondria” with specific cenesto-hypochondrical symptomatology. Melancholic depressions characterized by high suicidal risk prevailed (65%) over the other depressions.ConclusionsDepressions masked by a “religious facade” often are not recognized due to specifical content, which results in lack of timely diagnostics and creates a high risk of suicidal behavior.DisclosureNo significant relationships.