History Of Suicidal Behavior Research Articles

Neurocognitive and clinical characteristics of elementary school-aged children with a history of suicidal thoughts and behaviors

BackgroundSuicidal thoughts and behaviors (STBs) in elementary school-aged youth have increased in recent years. Understanding the risks associated with childhood STBs is necessary for prevention efforts. MethodsThe current study examined clinical and neurocognitive characteristics of a community sample of elementary school-aged children with (STB+) and without (STB-) a history of STBs. The final sample included 93 families with children average age of 7.8 years (SD = 1.3). Children in this sample were racially diverse, evenly split by sex, and most identified as non-Hispanic. Neurocognitive functioning was assessed using computerized behavioral measures. Child clinical characteristics were assessed using self-report measures and STB history was assessed using semi-structured interviews. ResultsOf the 93 families, 64 STB- children and 29 STB+ children participated. On average, STB+ children were older, reported higher levels of depressive and anxiety symptoms, and were more likely to have a parental history of suicidal behavior (PH+). Regarding neurocognitive functioning, STB+ children exhibited lower raw scores for both the NIH Dimensional Change Card Sort Task (NIH-DCCS) and NIH Flanker Inhibitory Control and Attention Test (NIH-Flanker). Multivariable regression analyses revealed raw scores for NIH-DCCS and NIH-Flanker, PH+ status, and child age were associated with childhood STBs. LimitationsProspective data is needed to confirm cross-sectional findings. ConclusionsPoorer neurocognitive functioning and PH+ status may serve as risk markers for STBs in elementary school-aged children. Targeting prevention programming for these risks may reduce the likelihood of STBs in at-risk elementary school-aged youth.

Psychosocial Factors, Pro-Inflammatory Markers & Serum Lipids among Patients with Suicidal Ideation & Suicidal Attempts

Background: Suicide is a worldwide serious problem. It is a leading cause of death, accounting for 1.3% of all deaths worldwide in 2019 and Approximately 703,000 people die by suicide every year. We aimed to study the personal, cognitive, psychosocial, personality traits, psychopathological, pro-inflammatory markers & serum lipids differences between patients with suicidal ideation and patients with suicidal attempts and to assess predictor factors that make suicidal ideation convert to suicidal attempt.
 Subjects and Methods: This cross-sectional case control study was carried on participant aged 18 – 50 years, both sexes. Suicidal behavior of the study sample was assessed using Beck Scale for Suicidal Ideation (BSSI) & participants were classified into three equal groups according to their score in BSSI and their history of recent suicidal attempt (suicidal ideation group, suicidal attempt group & control group). Participants’ sociodemographic data were evaluated by a questionnaire designed by the researcher and reviewed by experts. Psychiatric assessment was done using the Mini-International Neuropsychiatric Interview (MINI). Socioeconomic status & cognitive functions were assessed by the socioeconomic status scale for health research in Egypt & the Montreal Cognitive Assessment (MoCA) test, respectively. Personality was assessed by short form of EPQ-R (Revised Eysenck Personality Questionnaire). Assessment of impulsivity & stress were done by using the Barratt Impulsiveness Scale (BIS-11) & the Hassles and Uplifts Scale (HUS), respectively. Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A) & the Positive and Negative Syndrome Scale (PANSS) were applied to determine the symptom severity in those diagnosed with depressive, anxiety & psychotic disorders.
 Results: Suicidal ideations & attempts were more common among psychiatric patients especially those suffering from depression. Suicidal behavior was associated with increased severity of depressive & anxiety symptoms. The most common method of suicidal attempts among females was drug overdose, while males used self-poisoning as the most popular method in attempting suicide. Risk of suicidal ideation & attempts increased in the following situations: younger age groups especially below 35 years, female gender, substance abuse, low socioeconomic level, past history & family history of suicidal behavior, neuroticism, psychoticism & introversion personality traits, impulsivity, high daily stress levels, increase in the severity of depressive & anxiety disorders, elevated [ESR, Hs-CRP & IL-6], lowered [total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL) & triglycerides (TG)]. The following factors protected from suicidal behaviors: marriage, work and having jobs, Family and social support, playing sports, having hobbies & higher socioeconomic levels.
 Risk factors for transition of participants from suicidal ideation to suicidal attempt included female gender, being unmarried & unemployed, low socioeconomic level, poor social support, past history of suicidal behavior, neuroticism personality traits, impulsivity, high stress levels, depressive disorders, elevated [Hs-CRP & IL-6], and low [TC, LDL & TG]. Protective factors against transition from suicidal ideation to attempt included playing sports & extraversion personality traits.
 Conclusion: The problem of suicide is a frequent and a multifaceted problem among the general population.

How do teens with a history of suicidal behavior and self-harm interact with social media?

This study examines how engagement with depression-related social media content varies by teens who report suicidal ideation, suicide attempts, and nonsuicidal self-injury (NSSI) versus those who had not experienced each behavior. Teens aged 15-17 years old (N = 93) were recruited from social media platforms from October 2016 toAugust 2018. Participants were asked three open-ended questions about the advantages and disadvantages of networking about depression-related content on social media. We conducted a qualitative analysis to capture themes in responses by question item. Univariate analyses were conducted to compare differences in the frequency of themes endorsed among the behavioral groups versus their counterparts. Among participants (female, 73%; non-White, 45%; sexual minority, 57%), most (93%, n = 87) endorsed depressive symptoms. Sixty-five percent (n = 60) endorsed suicidal ideation within the past year, who were more likely to indicate unhelpful social interactions (p = .02) as a disadvantage of following depression content than peers who did not endorse suicidal ideation within the past year. Eighty percent(n = 74) endorsed lifetime experience of NSSI, who were more likely to indicate negative impact on relationships (p = .01) from posting depression content than peers who did not experience NSSI. Fifty-eight percent (n = 54) endorsed a lifetime suicide attempt, who were more likely to mention offering solutions (p = .03) to someone posting concerning content than peers who did not endorse a lifetime suicide attempt. This study provides diverse and unique perspectives on how engagement with depression-related social media varies by mental health behaviors and informs the use of social media for recruitment and outreach for teens.

The Brief Adolescent Depression Screen: A Brief Screening Tool for Depression and Suicidal Behavior in Inpatient Adolescents.

In clinical settings, there is significant need for brief, easily-administered assessment tools for adolescent depression that can be used by mental health clinicians from a variety of training backgrounds. Existing depression screening tools do not assess for duration and consistency of symptoms, two key indicators of pathological depression. The Brief Adolescent Depression Screen (BADS) was developed to screen for major and persistent depressive disorders in adolescents in order to meet the assessment needs in an inpatient setting, and the validity of this tool was tested. The current study used a sample of 396 inpatient adolescents to assess the screening utility of the BADS for detecting whether the adolescent meets criteria for a depressive diagnosis according to a well-validated semi-structured interview, as well as detecting a positive history of suicidal behavior. Further, the screening utility of this measure was compared to the utility of an established depression rating scale. Analyses first determined the duration of depressive symptoms on the BADS that optimally screened for the presence of Major Depressive Disorder and Persistent Depressive Disorder. Findings indicated that, using these optimal screening cut-offs, the BADS showed a strong screening utility, resulting in a sensitivity and specificity for identifying full depressive diagnoses and a positive history of suicidal behavior with similar or greater accuracy than an established rating scale. These findings provide initial evidence to suggest that the BADS may be a helpful screening tool for adolescent depressive disorders in inpatient settings.

Homicides committed by women with mental disorders: A descriptive study conducted in a French secure unit

Women remain a small minority of homicide offenders and appear to be understudied in the scientific literature. Gender-specific characteristics are however identified by existing studies. The aim of the study was to explore homicides committed by women with mental disorders, by analyzing their sociodemographic, clinical features, and criminological circumstances of the homicide. We conducted a retrospective and descriptive study among all female homicide offenders with mental disorders hospitalized in a French high-secure unit over a 20-year period (n= 30). We found that the female patients we studied were a diverse group in terms of their clinical profiles, backgrounds, and criminological characteristics. Confirming previous studies, we observed an over-representation of young women, unemployed, with a destabilized family situation and history of adverse childhood experiences. Prior self- and hetero-aggressive behavior were frequent. We found a history of suicidal behavior in 40% of cases. Their homicidal acts often occurred impulsively at home, in the evening or at night and were mainly directed toward family members (60%), especially their child(ren) (46.7%), then acquaintances (36.7%), and rarely a stranger. We found symptomatic and diagnostic heterogeneity: schizophrenia (40%), schizoaffective disorder (10%), delusional disorder (6.7%), mood disorders (26.7%), and borderline personality disorder (16.7%). Mood disorders were exclusively unipolar or bipolar depressions, often with psychotic features. The majority of patients had received psychiatric care prior to the act. We identified four subgroups, according to psychopathology and criminal motives: delusional (46.7%), melancholic (20%), homicide-suicide dynamic (16.7%), and impulsive outbursts (16.7%). We consider that further studies are necessary.

СУИЦИДАЛЬНОЕ ПОВЕДЕНИЕ ПОДРОСТКОВ В ПЕРИОД ПАНДЕМИИ НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ

Researches on respiratory viral infections has established an association between infection and risk of suicide. Several reports informed on the impact of the COVID-19 pandemic on adolescent mental health, manifesting as depression and anxiety, suicide and self-harm. In particular, mood disorders are associated with the presence of antibodies against influenza A and B viruses and the coronavirus strain (HCov-NL63). We retrospectively examined 113 adolescents who had COVID-19 at the age of 11 to 14 years (78 girls, 35 boys), mean age 12 ± 2 years, who had a history of suicidal behavior. All adolescents noted on average after 3–4 months after they have suffered COVID-19, an increase in despondency with the gradual addition of apathy, unwillingness to do anything; a significant decrease or complete lack of motivation for any type of activity was revealed. Within 6 months after the infection, suicidal thoughts and tendencies arose. These circumstances require further study in order to develop effective methods of treatment and rehabilitation measures.

ASSESSING THE PSYCHOMETRIC PROPERTIES OF THE GERIATRIC SUICIDE IDEATION SCALE (GSIS) IN MIDDLE-AGED AND OLDER MEN

Abstract Middle-aged and older men have high rates of suicide, necessitating focused risk detection. We developed the Geriatric Suicide Ideation Scale (GSIS; Heisel & Flett, 2006) as an age-specific, multidimensional suicide risk assessment tool. The GSIS has shown strong psychometric properties in clinical, community, and residential samples (see Heisel & Flett, 2016), yet research has lagged investigating its utility with middle-aged and older men. The purpose of the present study was thus to assess the psychometric properties of the GSIS administered to 82 men, 55 years and older (M=63.3, SD=4.6 years), who participated in a meaning-centered psychological intervention group for those concerned about or struggling with the transition to retirement (Heisel et al., 2020). Psychometric analyses included investigation of participant response characteristics, internal consistency, and construct validity. Findings demonstrated acceptable internal consistency for GSIS totals (α =.88) and for its Suicide Ideation, Death Ideation, Loss of Personal and Social Worth, and Perceived Meaning in Life subscales (α =.62-.81). Positive associations between the GSIS and negative psychological factors (depression, anxiety, hopelessness, loneliness, perceived lack of mattering to others, and history of suicidal behavior; r =.30 to .51) and negative associations with positive factors (life satisfaction, psychological well-being, perceived support, and meaning in life; r = -.21 to -.51) supported its construct validity. These and other findings will be discussed in the broader context of upstream population level approaches to suicide risk detection and prevention.

Six-Month Clinical and Ecological Momentary Assessment Follow-Up of Patients at High Risk of Suicide

Objective: In this study, we combined ecological momentary assessment (EMA) with traditional clinical follow-up to explore correlates of suicidal relapse in patients with a history of suicidal behavior. Methods: Over 6 months, we followed up with 393 patients who completed baseline and follow-up interviews and were monitored through smartphone-based EMA via the MEmind app. Recruitment was conducted between February 2018 and March 2020. We recorded the occurrence of clinical suicidal events and EMA suicidal events, the latter defined as extreme scores on questions on passive suicide ideation. Results: Fifteen percent of participants had a new clinical suicidal event during follow-up (9.2% suicide attempt ; 5.9% emergency referral for suicidal ideation ). Of the 319 participants who installed the MEmind app, 20.7% presented with EMA suicidal events. EMA suicidal events were statistically significantly associated with clinical suicidal events at 2-month follow-up but not at 6-month follow-up. In the Cox multivariate regression model, 5 factors were independently associated with clinical suicidal events: number of previous SAs, SA in the past year, SA in the past month (risk factors), female gender, and age (protective factors). Conclusions: Our study confirms some of the risk factors classically associated with risk of suicide reattempt, such as history of suicidal behavior, while questioning others, such as female gender. Risk factors associated with EMA events differed from risk factors associated with traditional clinical suicide events, supporting the existence of distinct suicidal phenotypes.

The role of substance use disorders in the transition from suicide attempt to suicide death: a record linkage study of a Swedish cohort.

Suicidal behavior and substance use disorders (SUDs) are important public health concerns. Prior suicide attempts and SUDs are two of the most consistent predictors of suicide death, and clarifying the role of SUDs in the transition from suicide attempt to suicide death could inform prevention efforts. We used national Swedish registry data to identify individuals born 1960-1985, with an index suicide attempt in 1997-2017 (N = 74 873; 46.7% female). We assessed risk of suicide death as a function of registration for a range of individual SUDs. We further examined whether the impact of SUDs varied as a function of (i) aggregate genetic liability to suicidal behavior, or (ii) age at index suicide attempt. In univariate models, risk of suicide death was higher among individuals with any SUD registration [hazard ratios (HRs) = 2.68-3.86]. In multivariate models, effects of specific SUDs were attenuated, but remained elevated for AUD (HR = 1.86 95% confidence intervals 1.68-2.05), opiates [HR = 1.58 (1.37-1.82)], sedatives [HR = 1.93 (1.70-2.18)], and multiple substances [HR = 2.09 (1.86-2.35)]. In secondary analyses, the effects of most, but not all, SUD were exacerbated by higher levels of genetic liability to suicide death, and among individuals who were younger at their index suicide attempt. In the presence of a strong predictor of suicide death - a prior attempt - substantial predictive power is still attributable to SUDs. Individuals with SUDs may warrant additional suicide screening and prevention efforts, particularly in the context of a family history of suicidal behavior or early onset of suicide attempt.

Advancing Clozapine Use in a Community Health System.

Advancing Clozapine Use in a Community Health System.

Risk factors for suicidal behavior: A Romanian mixed methods study.

This study had two purposes: to explore the main socio-demographic and medical characteristics of the psychiatric patients with a history of suicidal behavior, and to identify the main risk factors underlying the suicidal ideation and acts among psychiatric patients, in the light of two recent theories of suicidal behavior. The study is based on a mixed methodological design. During 2019 to 2021, 65 hospitalized psychiatric patients, who committed at least one non-lethal suicide attempt, were investigated using a questionnaire a scales for data collection. Medical records were used to gather data about certain socio-demographic characteristics and the health status of the respondents. Patients also participated in a narrative interview aimed at disclosing their subjective experiences about their past suicidal behavior. The typical psychiatric patient with a history of suicidal behavior, as highlighted by the quantitative analysis, portraits a young old male from an urban environment, childless, educated, having experienced employment problems, being involved in religious activities. The clinical picture of the patient with suicidal antecedents included a moderate or severe level of depression, the presence of socio-emotional loneliness, the manifestation of frequent and long episodes of suicidal ideation, and the intention of committing suicide in order to stop the pain, whose acts resulted in minor injuries. Findings from the qualitative data revealed four major risk factors for the non-lethal suicidal attempts: family disruptions and social problems; economic burdens; a mixture of psychiatric pathologies; and, to a lesser extent, somatic pathologies. This study is the first to explore the triggers of suicide acts conducted in a clinical environment in the Balkan region. Implications of the pandemic are also discussed. The findings are useful for designing prevention strategies based on individual psychotherapy and therapeutic or support groups, addressing the main risk factors behind the suicidal ideation and gestures.

Rates, Patterns, and Predictors of Follow-up Care for Adolescents at Risk for Substance Use Disorder in a School-Based Health Center SBIRT Program

PurposeTo examine rates, patterns, and predictors of follow-up care for adolescents screened as being at risk for substance use disorder (SUD) in a school-based health center (SBHC) Screening, Brief Intervention and Referral to Treatment (SBIRT) program. MethodsElectronic health records were extracted of adolescents who received health care services from one of three high school-based health centers implementing SBIRT. Patterns and predictors of engagement in follow-up care within 8 weeks following the week of a positive SUD risk screen were analyzed using item response theory (IRT) modeling. ResultsOut of 1,327 adolescents receiving SBHC services, 81.2% completed a health screening questionnaire. Of screened adolescents, 17.7% were positive for SUD risk. Across the 8-week follow-up period, 65.4% of adolescents at risk for SUD received at least one follow-up visit. IRT modeling indicated that high levels of engagement in follow-up care were characterized by contact with a behavioral health care (BHC) provider. The percentage of adolescents having follow-up contact with a BHC provider increased significantly after the onset of the COVID-19 pandemic. Engagement in follow-up care was predicted by risk for depression, history of suicidal behavior, being female, and previous sexual activity. DiscussionSBHCs provide a favorable setting for screening and detecting adolescents at risk for SUD. Adolescents at risk for SUD should receive follow-up contact with a BHC provider. Enhanced follow-up engagement efforts may be warranted for adolescents at risk for SUD without risk for depression or suicidal history, as well as for females and those with previous sexual activity.

GamReg Sweden-Protocol for a systematic cohort data collection for improved clinical knowledge in specialized gambling disorder treatment.

BackgroundGambling disorder is the first non-substance-related addiction which is recognized as a diagnostic entity and assessed in treatment settings. However, in many clinical settings, assessment, and structured treatment for this condition is severely under-developed, and treatment seeking in many settings is low. This is a protocol paper describing the rationale and structure of a recently established quality register, allowing for structured monitoring of treatment seeking, treatment needs and treatment provision in Swedish health care settings, for gambling disorder and associated conditions.MethodsSince 2019, a Swedish quality register is in use for the systematic data collection from patients receiving treatment in specialized health care. The register is held by Region Skåne, and approved for national use. Swedish quality registers allow for the clinical monitoring of treatment uptake and needs, for quality improvement purposes, and collect systematic cohort data for these purposes. In addition, these quality registers potentially allow for future research projects, after separate ethics applications, allowing for clinical follow-up studies based on non-identified quality register data. Clinical challenges and research knowledge gaps are addressed in the present register, including mental health comorbidity, history of suicidal behavior, comorbid alcohol, drugs and gaming behaviors, and fundamental psycho-social variables such as violence victimization, concerned significant others including children's situation in families of problem gamblers, and main income and involvements with social services and enforcement agency. In addition, patient flows, including rates of referral from primary care and other treatment settings, can be followed. The overall quality register project is registered at clinicaltrials.gov (NCT05276193).DiscussionThe present protocol paper will allow for systematic reporting and future projects addressing knowledge gaps in clinical treatment for gambling disorder, and highlight the importance for evidence-based treatment in a behavioral addiction. Importantly, the current data will contribute to a better understanding of which patient groups may be less likely to seek or to be referred to treatment, and thereby may shape future initiatives to increase screening and referral in targeted, vulnerable groups.

A risk calculator to predict suicide attempts among individuals with early-onset bipolar disorder.

To build a one-year risk calculator (RC) to predict individualized risk for suicide attempt in early-onset bipolar disorder. Youth numbering 394 with bipolar disorder who completed ≥2 follow-up assessments (median follow-up length=13.1 years) in the longitudinal Course and Outcome of Bipolar Youth (COBY) study were included. Suicide attempt over follow-up was assessed via the A-LIFE Self-Injurious/Suicidal Behavior scale. Predictors from the literature on suicidal behavior in bipolar disorder that are readily assessed in clinical practice were selected and trichotomized as appropriate (presence past 6months/lifetime history only/no lifetime history). The RC was trained via boosted multinomial classification trees; predictions were calibrated via Platt scaling. Half of the sample was used to train, and the other half to independently test the RC. There were 249 suicide attempts among 106 individuals. Ten predictors accounted for >90% of the cross-validated relative influence in the model (AUC=0.82; in order of relative influence): (1) age of mood disorder onset; (2) non-suicidal self-injurious behavior (trichotomized); (3) current age; (4) psychosis (trichotomized); (5) socioeconomic status; (6) most severe depressive symptoms in past 6months (trichotomized none/subthreshold/threshold); (7) history of suicide attempt (trichotomized); (8) family history of suicidal behavior; (9) substance use disorder (trichotomized); (10) lifetime history of physical/sexual abuse. For all trichotomized variables, presence in the past 6months reliably predicted higher risk than lifetime history. This RC holds promise as a clinical and research tool for prospective identification of individualized high-risk periods for suicide attempt in early-onset bipolar disorder.

Smartphone-based Ecological Momentary Intervention for secondary prevention of suicidal thoughts and behaviour: protocol for the SmartCrisis V.2.0 randomised clinical trial

IntroductionSuicide is one of the leading public health issues worldwide. Mobile health can help us to combat suicide through monitoring and treatment. The SmartCrisis V.2.0 randomised clinical trial aims to...

How Residing in a Long-Term Care Facility Affects Suicidal Risk in Patients With Dementia: A Systematic Review.

This study aims to review the current literature regarding the association between suicide risk in patients aged 65 years or over with dementia residing in long-term care facilities (LTCs). We also evaluate the most common methods of suicide and protective versus risk factors of nursing home (NH) life on suicide behavior in patients with dementia.Following preferred reporting items for systematic reviews and Meta-Analyses (PRISMA) guidelines, we performed a systematic review of the relevant free full-text articles found in PubMed, Pub Psych, Cochrane library, and Science Direct up until April 4, 2022. Medical Subject Heading (MeSH) terms and keywords (nursing home, long-term care facility, suicide, self-injurious behavior, dementia), were used to search for full-text randomized clinical trials (RCTs), cross-sectional, case-control, cohort studies, systematic reviews, and studies published in the English language in the last 12 years, focused on human subjects 65 years and older were selected based on predefined eligibility criteria. The search yielded 57,909 articles, of which 12 studies met our inclusion criteria. The articles were subjected to quality appraisal by two reviewers. We used the Newcastle Ottawa scale (NOS) for quality assessment with a mean score of six for 12 observational studies used in this paper.Of the included reports, six were cross-sectional, five were cohort, and one was case-control. Four articles carefully examine the relationship between dementia and suicide, and all confirm the hypothesis that staying in LTCs reduces the risk of suicide in patients with dementia. However, the rest of the articles generally determine a higher risk of suicide in demented patients and describe male gender, non-Hispanic white race, younger age, newly diagnosed with dementia within one-year, mild dementia, comorbidities, depression, previous history of suicidal behavior, low social support and unstable family relationship as the risk factors of suicide in this population. In comparison, extended stay in NHs and other kinds of LTCs, severe dementia with impaired insight, older age, comorbid schizophrenia, physical disability with limitation and more difficulty preparing and executing a suicide plan, positive and robust social relationships, access to professional caregivers and high frequency of visits from relatives marked as the protective factors.Existing research on suicide risk in long-term care facility residents with dementia is limited. However, due to the increase in dementia rates that require people to reside in NHs and on the other hand, considering the multiple risk factors of suicide in the elderly living in such places, the need for a screening system for identifying people at suicide risk and performing preventive therapeutic and behavioral interventions is well felt.

Anticipated Self and Public Stigma in Suicide Prevention Professionals.

BackgroundStigma about mental illness—both public and self—is one of the most important factors hindering help-seeking. Stigma can occur during an acute episode of mental illness or be anticipatory. One group affected by stigma, but often neglected, is mental health professionals. This study examined the anticipated form of mental-illness and help-seeking self-stigma and the anticipated form of public stigma of suicidal behavior among members of the International Association for Suicide Prevention. We hypothesized that suicidologists with a history of suicidality or mental illness would anticipate greater stigma from the public and self.MethodsThe study received ethical approval from the Commission for Medical Ethics of the Republic of Slovenia. Data from 83 participants who completed an online survey (February to May 2020) with informed consent were analyzed using path analysis. We tested a model predicting help-seeking self-stigma based on (i) personal experience of mental illness using anticipated self-stigma of mental illness as a mediating variable and (ii) history of suicidal behavior using anticipated public stigma of suicidal behavior as a mediating variable.ResultsPersonal experience of mental illness predicted anticipation of self-stigma of mental illness (β = 0.26). History of suicidality predicted anticipation of public stigma of suicidal behavior (β = 0.29). Anticipated self-stigma of mental illness proved to be a stronger predictor of help-seeking self-stigma (β = 0.40) than anticipated public stigma of suicidal behavior (β = 0.07).ConclusionsIt is important to intentionally support the mental health of suicide prevention professionals, as they are not immune to mental illness or various types of stigma. Because our sample was small and diverse, further research to better understand stigma concepts in this population is warranted.

Working with a Patient With Personality Disorder: A Case Report and Reflection on My Experience

AimsEmotionally unstable personality disorder (EUPD) accounts for up to 20% of diagnoses in the inpatient psychiatry population. The assessment, diagnosis, and treatment of any personality disorder may be challenging, and its classification remains debatable. Here I will describe a case of a dual diagnosis of EUPD and schizotypal personality disorder. Through the case report I will also reflect on my first experience of working with a patient with personality disorder, as a Psychiatry Foundation Fellowship doctor with little previous exposure to the psychiatry specialty.MethodsThe patient was a female in her thirties, previously diagnosed with EUPD, who had not benefitted from a number of psychological treatments. She had a history of suicidal behaviour and previous admissions but presented differently this time. She had short hair that was dyed in a vivid colour, was paranoid that she was being spied upon from an alternative universe and had suicidal plans to join the alternative universe. She also had auditory and visual hallucinations. On exploration it became apparent that she had similar episodes in the past, each lasting no more than a day. An additional diagnosis of schizotypal personality disorder was made, and she responded well to risperidone. Unfortunately, she was transferred to another ward for bed management reasons, whereupon the diagnosis reverted to EUPD and antipsychotics were stopped.ResultsThis case highlights how in mixed personality disorders, features of one personality disorder may be more predominant than another at different times. It also contradicts the notion that people with schizotypal personality disorder rarely present to mental health services. The inconsistency of diagnosis and lack of continuity of care caused immense distress to the patient, prolonging the acute episode. This highlights the importance of a good formulation in order to tailor care for the patient.ConclusionAs a newly qualified doctor, working with patients with personality disorders was a meaningful experience. Through ward rounds and the seemingly trivial conversations along the corridor, I thought about the effect of transference and countertransference for the first time, which is applicable to any interpersonal interaction. I witnessed the harm caused by the lack of continuity of care. I reflected on the intricate balance between the advantage of establishing a diagnosis for the patient, and the drawback of the diagnosis leading to labelling. It made me face the stereotypes I held and allowed me to learn about the patient as an individual.

Factors associated with suicidal ideation in the French nationwide EPICOV study

IntroductionThe COVID-19 pandemic seems associated with a worsening in mental health issues as well as a widening of pre-existing social and health inequalities. Assessment of its impact on suicidal behavior might therefore be relevant.ObjectivesTo assess factors associated with suicidal ideation in the general population, using data from the French nationwide Epicov studyMethods In the nationally representative Epicov study, data on occurrence of suicidal ideation from November 2019 to November 2020 were available, including timing with respect to France’s lockdown periods. We studied the incidence of suicidal ideation among participants without a prior history of suicidal behavior, after May 11, 2020, when first COVID-19 related lockdown was suspended. Studied factors assessed sociodemographic and health status, including mental health, as well as COVID-19 related information such as symptom. Associations between selected factors and suicidal ideation were assessed in sex-stratified adjusted logistic regression models.Results In the Epicov study, prevalence of suicidal ideation was of 2,9%, as opposed to around 4% pre-pandemic. Among 48 702 female and 41 016 male participants, health or financial issues were associated with a higher incidence of suicidal ideation. Interestingly, Covid19-like symptoms were also associated with higher risk of suicidal ideation. While an impaired mental health has been observed in survivors of past pandemics, given the unprecedented context of the current pandemic, this association needs further investigation.ConclusionsWhile the COVID-19 pandemic might have lowered suicidal ideation, it’s aftermaths may reverse the trend. To prevent this rise, identification of vulnerable groups is crucial to promote tailored public health strategies.DisclosureNo significant relationships.

Life-Satisfaction, Engagement and Social Support: Do they Predict Depression Severity, Suicide Ideation, and History of Attempt in Late-life Depression?

<h3>Introduction</h3> Older adults are at the highest risk for death by suicide in almost all countries in the world. Certain protective factors, such as objective and subjective social support, have long been stated as protective factors for suicidal behavior in the elderly. Trait-level mindfulness, and life satisfaction and engagement have also been stated to be protective factors against suicide, however, their relationship with risk for suicide in late life has yet to be examined. We examined the effects of a combination of these protective factors in late life in a high suicide risk sample of depressed older adults. Specifically, we examined the effects of these protective factors on depression severity, presence and severity of suicidal ideation, and history of suicidal behavior. <h3>Methods</h3> Participants included 297 adults aged 55+ (mean age: 64.2, range: 55-90, 56.6% female, 84.5% White). We contrasted depressed participants (unipolar non-psychotic major depression as diagnosed by the Structured Clinical Interview for DSM Disorders) who had a history of suicide attempt (N=92) with depressed non-attempters (N=138) who had no history of suicidal behavior but may or may not have had ideation. In addition, 67 healthy controls (no lifetime history of psychiatric illness) served as a benchmark comparison group. We used the Beck Scale for Suicidal Ideation to measure the severity of suicidal ideation, and the Hamilton Depression Rating Scale to measure depression severity. We used a combination of 6 self-report scales (Flourishing Scale, Interpersonal Support Evaluation List [Tangible, Belonging, Self-esteem, and Appraisal support subscores], Mindfulness Attention Awareness Scale, Satisfaction with Life Survey, Life Engagement Test and the Social Network Index [network diversity, number of people in social networks, embedded networks subscores]). All variables were scaled and then averaged to calculate one overall protective factor value to represent levels of mindfulness, satisfaction and engagement with life, objective and subjective social support, and subjective well-being. We used this protective factor as the predictor variable and conducted binomial logistic regression to assess its relationship with presence of ideation and past attempt, and linear regression models for its relationship with depression and ideation severity. <h3>Results</h3> The overall protective factor value significantly predicted depression severity (p=0.003) and likelihood of ideation (p=0.030) but did not predict ideation severity (p=0.136) or likelihood of past suicide attempt (p=0.954). <h3>Conclusions</h3> Previously identified factors that have been associated with psychological resilience in late life may, in fact, be more predictive of depression severity and presence of ideation than severity of ideation or suicide attempt. Thus, interventions to decrease suicidal behavior in late-life depression may need to go beyond focusing on traditionally stated social support or life-satisfaction/engagement measures and consider other factors such as personality and cognitive capacity. <h3>This research was funded by</h3> NIMH R01-MH085651-10