Lifetime Suicide Research Articles

Heightened vigilance and its associations with suicidal ideation and suicide attempt among 285 Korean transgender and nonbinary adults: Effect modification by connectedness to the LGBTQ+ community.

Anti-transgender stigma presents threats of discrimination to transgender and nonbinary (TGNB) individuals, prompting them to stay vigilant. Using a longitudinal data of 285 South Korean TGNB adults, we examined vigilance and its associations with suicidal ideation and suicide attempt and explored the protective role of connectedness to the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community. Data were collected in October 2021 (baseline) and October 2022 (follow-up). Vigilance was measured using the 4-item Heightened Vigilance Scale at baseline. At follow-up, 12-month suicidal ideation and suicide attempt, and connectedness to the LGBTQ+ community were measured. Having heightened levels of vigilance was associated with increased prevalence of suicidal ideation (Prevalence Ratio [PR]: 1.33, 95% Confidence Interval [CI]: 1.09-1.62) and suicide attempt (PR: 2.18, 95% CI: 1.23-3.86), after adjusting for covariates including anti-transgender discrimination experiences and lifetime suicidality at baseline. When stratified by connectedness to the LGBTQ+ community, the associations between vigilance and suicidality remained statistically significant among those with low connectedness whereas no statistically significant association was observed among those with high connectedness. The study provides empirical evidence for policies and interventions that ensure safety of TGNB individuals from discrimination and promote connectedness to the LGBTQ+ community to reduce the suicide risk among TGNB individuals.

Absence of nonfatal suicidal behavior preceding suicide death reveals differences in clinical risks.

Nonfatal suicidality is the most robust predictor of suicide death. However, only ~10% of those who survive an attempt go on to die by suicide. Moreover, ~50% of suicide deaths occur in the absence of prior known attempts, suggesting risks other than nonfatal suicide attempt need to be identified. We studied data from 4,000 population-ascertained suicide deaths and 26,191 population controls to improve understanding of risks leading to suicide death. This study included 2,253 suicide deaths and 3,375 controls with evidence of nonfatal suicidality (SUI_SI/SB and CTL_SI/SB) from diagnostic codes and natural language processing of electronic health records notes. Characteristics of these groups were compared to 1,669 suicides with no prior nonfatal SI/SB (SUI_None) and 22,816 controls with no lifetime suicidality (CTL_None). The SUI_None and CTL_None groups had fewer diagnoses and were older than SUI_SI/SB and CTL_SI/SB. Mental health diagnoses were far less common in both the SUI_None and CTL_None groups; mental health problems were less associated with suicide death than with presence of SI/SB. Physical health diagnoses were conversely more often associated with risk of suicide death than with presence of SI/SB. Pending replication, results indicate highly significant clinical differences among suicide deaths with versus without prior nonfatal SI/SB.

Assessing the Impact of the Different Psychiatric Disorders on the Profiles of Psychiatric Hospitalization: A descriptive study in a Greek Hospital

IntroductionThe prevalence of psychiatric re-admission ranges from 15% to 60%, escalating even more in the first year after admission, affecting the patients’ quality of life. Furthermore, the diagnosis of psychotic or affective disorders represents a risk factor of psychiatric re-admission, highlighting the diagnosis impact to the “profile” of psychiatric hospitalization.ObjectivesTo compare the different “Hospitalization Profiles” in association to the patients’ diagnostic categories.MethodsOverall, 1,633 records of psychiatry inpatients were examined retrospectively throughout the 10-year records of the Psychiatry Department of Papanikolaou General Hospital in northern Greece. The research was conducted between 2013 and August 2023. The sample was divided into subgroups according to gender, diagnoses - according to the International Classification of Diseases (ICD-10)-, and year of hospitalization. A bivariate analysis was performed to examine relationships between the variables: (a.) place of residence; (b.) age; (c.) type of admission; (c.) hospitalization duration; (d.) number of lifetime hospitalizations; (e.) lifetime prosecutor’s orders for coercive examination; (f.) lifetime suicide attempts.Results Developmental disorders (F80-89) stood for the youngest average age of hospitalization (26 years) and lowest average hospitalization duration (7 days). Neurodegenerative disorders (F00-09) represented the diagnostic category with the oldest mean age of hospitalization (66 years). Intellectual disorders (F70-79) yielded the longest average hospitalization duration (21 days). Patients with intellectual disorders were found to be facing homelessness at a higher rate (4.76%) than patients of any other diagnostic entity (p=0.096). Psychotic and substance use disorder patients obtained equivalently (p=0.18) the highest rates of coercive hospitalizations (63% and 71%, respectively); compared to other diagnostic categories (p=0.0008). Dual diagnosis and anxiety disorders projected equivalently (p=0.9) the highest rate of premature voluntary discharge (6.9% and 6.4%, respectively). Dual diagnosis, personality disorders, and affective disorders also recorded the highest rates of suicidality (11-15%; with no significant statistical difference among the three diagnostic entities p>0.1) among hospitalized patients of all diagnostic categories (p<0.05).Conclusions Interestingly, the study’s results reveal the pathologies of the Greek society, with the most representative example being this of patients suffering from intellectual disorders simultaneously presenting the highest risk of homelessness. Further studies are needed, focusing on the sub-populations of psychiatric patients as well as their status in terms of social security, health care providing, quality of life and life expectancy.Disclosure of InterestNone Declared

Sociodemographic and Clinical Determinants of Psychiatric Hospitalization in Northern Greece: A descriptive study

IntroductionAccording to data, psychiatric re-admissions rates vary from 10%-80%, while they negatively affect the patients’ quality of life and life expectancy. The limitation of multiple psychiatric hospitalizations represents a clinical challenge for all mental health professionals.ObjectivesTo investigate risk factors of hospitalization in a sample of psychiatric patients in Northern Greece.Methods 1,633 records of psychiatry inpatients were examined retrospectively throughout the 10-year records of the Psychiatry Department of Papanikolaou General Hospital in northern Greece. The research was conducted between 2013 and August 2023. The sample was divided into subgroups according to gender, diagnosis, and year of hospitalization. A bivariate analysis was performed to examine relationships between the examined variables: (a.) place of residence; (b.) age; (c.) type of admission; (c.) hospitalization duration; (d.) number of lifetime hospitalizations; (e.) lifetime prosecutor’s orders for coercive examination; and (f.) lifetime suicide attempts.Results A fairly equivalent number of males and females was included in the study (M: 874; F: 759).The mean age of the sample was 44.7 years with males being younger than females (males 43.23; females 46.39). Males residing out of the co-capital as well as females residing within the co-capital of Greece, Thessaloniki, disclosed higher odds of being hospitalized (p<0.03). Coercive hospitalizations represented 47% of cases, bore the highest duration (20.7 days), and involved the youngest patients. Coercively hospitalized male patients outnumbered their female counterparts (p<0.001). Voluntary urgent hospitalizations duration was estimated at 17.04 days, followed by outpatient admissions (12.64 days) and transfers from other clinics (11.35 days). 37% of patients experienced psychosis while 35% experienced affective disorders. Males were more affected by psychosis (Odds Ratio: 1.35; p<0.001). Females were more liable to affective disorders (OR: 1.78; p<0.001). 7% of the sample had committed suicide attempts, with single suicide attempts being ten times higher than multiple suicide attempts (p<0.001). Females were more than twice as likely as males to commit a suicide attempt (p<0.001). Females tended more to be hospitalized self-willingly (p=0.0015) and to voluntarily terminate hospitalizations prematurely (p=0.0014). Patients with a single hospitalization were seven-fold compared to those with multiple hospitalizations (p<0.001). The average lifetime hospitalization number for a patient was one hospitalization, while the average for a patient with previous hospitalizations was three.ConclusionsBeing in position to identify the patients in high-risk for hospitalization -as well as for suicide attempt- the clinician can proceed to initiatives such as treatment modifications or further involving the patient’s family.Disclosure of InterestNone Declared

Why Are Autistic People More Likely to Experience Suicidal Thoughts? Applying the Integrated Motivational-Volitional Model with Autistic Adults.

Autistic people are at considerably greater risk of suicidality than non-autistic people, and the reasons behind this are not fully understood. Current suicide theories may be useful to help further our understanding of the mechanisms behind autistic suicidality. We aimed to test the key predictors of suicidal ideation-defeat and entrapment-as described in the integrated motivational-volitional (IMV) model of suicide behavior, in an autistic group. We also looked to extend the IMV model by including autism-related constructs of camouflaging and intolerance of uncertainty (IU). We recruited 374 autistic adults from the community (female 42.5%; 18-63 years of age), who completed a cross-sectional online survey between August 2020 and January 2021. We collected data on lifetime suicidality, depression symptoms, defeat, entrapment, camouflaging, and IU. We found that entrapment significantly mediated the relationship between defeat and suicidal ideation. Camouflaging and IU were not found to moderate this pathway but were found to be significantly associated with suicidal ideation. We found that entrapment mediates the relationship between defeat and suicidality in autistic adults. This is consistent with the predictions in the motivational phase of the IMV model of suicidal behavior, suggesting that this model is useful for understanding autistic suicidality. We did not find evidence that camouflaging and IU act as moderators within the mediated model. Nevertheless, there is some evidence that camouflaging and IU are worthwhile constructs to be aware of for future work researching autistic suicidality.

Impulsivity in Depression: Its Relation to Suicidality.

Impulsivity is an important risk for suicidality, which is common in patients with major depressive disorder (MDD). The goal of this study was to examine multiple facets of impulsivity in depressed patients compared with healthy controls and to assess their relationship to suicidality. Outpatients diagnosed with MDD using the Structured Clinical Interview for DSM-IV were recruited. Two groups were constituted as "MDD in remission" (n=32) and "MDD" (n=71). The "healthy control" group (n=30) consisted of individuals who had never been diagnosed with any psychiatric disorder. Impulsivity was assessed with the Barratt Impulsivity Scale (BIS), a self-rating measure, and with the following behavioral tasks: Go/No-go Task, Iowa Gambling Task, and Balloon Analogue Risk Task. The scores of the 3 groups (n=133) were compared to evaluate the effect of MDD. The scores were also analyzed and compared in the patients in the 2 MDD groups (n=103) with respect to their current and lifetime suicidality. There was no difference in the 3 groups in task scores, but nonplanning BIS was correlated with the severity of depressive symptoms. Patients with suicidal ideation (SI) had higher BIS total and attention impulsivity scores and more commission errors on the Go/No-go Task, reflecting failure in response inhibition, compared with the patients without SI. Failure to show differences in impulsivity-related tasks suggests that there might be no relationship between the state of depression and impulsivity. However, these findings confirm that there is an association between SI and response inhibition and the attention facet of impulsivity in depression.

Retrospectively assessed childhood trauma experiences are associated with illness severity in mental disorders adjusted for symptom state

Converging evidence suggests that childhood trauma is a causal factor in schizophrenia (SZ) and in bipolar disorders (BD). Here, we investigated whether retrospective reports are associated with severity of illness, independent of current symptom state in a large sample of participants with SZ or BD.We included 1260 individuals (SZ [n = 461], BD [n = 352]), and healthy controls; HC [n = 447]) recruited from the same catchment area. A history of childhood trauma was obtained with the Childhood Trauma Questionnaire (CTQ). Diagnosis and episodes were obtained with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Clinical symptoms (state) were assessed with the Positive and Negative Syndrome scale (PANSS), the Calgary Depression Scale (CDSS). Trait related illness characteristics were assessed with age at illness onset, number of episodes, and lifetime suicide attempts.Patients who reported multiple types of childhood trauma experiences had significantly more severe illness course including an earlier illness onset, more mood episodes, and increased risk of at least one suicide attempt, also after adjusting for current symptom state.Retrospective assessed childhood trauma experiences are associated with illness severity in mental disorders adjusted for symptom state. Our results strengthen the role of childhood trauma in development of psychopathology.

Mental disorders and suicidality among Opioid Agonist Treatment service users in Nepal: A cross sectional study

BackgroundHigh lifetime prevalence of major mental disorders and suicidality are common among Opioid Agonist Treatment (OAT) service users and impact on the outcomes of OAT programs. Despite the known detrimental effects across personal, social and economic aspects of life these associations and implications remain under-studied in resource poor settings. The aim of this study was to identify common mental disorders among OAT service users in Kathmandu valley and to explore factors associated with lifetime suicidality and major depressive disorder. MethodsA cross-sectional study was conducted among 231 participants from five OAT centers in the Kathmandu valley. Participants were administered a semi-structured questionnaire, the Nepalese version of the Kessler 6 Psychological Distress Scale (K6), and the Mini International Neuropsychiatric Interview (M.I.N.I.) 7.0.2. Bivariate and multivariate analyses were employed to identify associations between lifetime suicidality and lifetime major depressive disorder with socio-demographic variables, other mental disorders, and substance use related variables. ResultsAmong OAT service users, 16.5% reported a history of mental disorder and one in four had a Kessler-6 psychological distress score ≥13 within the last four weeks. Using M.I.N.I lifetime suicidality was observed in 26.0% and lifetime major depressive disorder in 24.2%. Lifetime suicidality were significantly higher among participants with lifetime psychotic disorder (AOR ​= ​5.94; 95% CI:1.66, 21.34, p ​= ​0.006), lifetime antisocial personality disorder (AOR ​= ​2.60; 95% CI:1.0, 6.71, p ​= ​0.049) and having a Kessler-6 score ≥13 (AOR ​= ​2.45; 95% CI:1.13, 5.29, p ​= ​0.023). Lifetime major depressive disorder was independently associated with a Kessler-6 score ≥13 (AOR ​= ​5.38; 95% CI:2.49, 11.62, p ​< ​0.001). ConclusionThis study revealed a high prevalence of mental disorders and lifetime suicidality among OAT service users. Reviewing initial screening and assessment protocols for OAT, and routine use of brief screening tools to ensure better identification of those at risk is warranted, including suicidality risk assessment.

Sexual Orientation Change Efforts Do Not Increase Suicide: Correcting a False Research Narrative.

Sexual orientation change efforts (SOCEs) signify activities designed to change or reduce homosexual orientation. Recent studies have claimed that such therapies increase suicide risk by showing positive associations between SOCE and lifetime suicidality, without excluding behavior that pre-dated SOCE. In this way, Blosnich et al.'s (2020) recent analysis of a national probability sample of 1518 sexual minority persons concluded that SOCE "may compound or create…suicidal ideation and suicide attempts" but after correcting for pre-existing suicidality, SOCE was not positively associated with any form of suicidality. For suicidal ideation, Blosnich et al. reported an adjusted odds ratio (AOR) of 1.92 (95% CI 1.01-3.64); the corrected AOR was .44 (.20-.94). For suicide planning, Blosnich et al.'s AOR was 1.75 (1.01-3.06); corrected was .60 (.32-1.14). For suicide attempts, Blosnich et al.'s AOR was 1.75 (.99-3.08); corrected was .74 (.36-1.43). Undergoing SOCE after expressing suicidal behavior reduced subsequent suicide attempts from 72 to 80%, compared to those not undergoing SOCE, when SOCE followed a prior expression of suicidal ideation (AOR .17, .05-.55), planning (AOR .13, .04-.45) or intention (AOR .10, .03-.30); however, SOCE following an initial suicide attempt did not significantly reduce further attempts. By violating the principle that a cause cannot occur after an effect, Blosnich et al. misstated the correct conclusion. Experiencing SOCE does not result in higher suicidality, as they claim, and may sharply reduce subsequent suicide attempts. Restrictions on SOCE will not reduce suicidal risk among sexual minorities and may deprive them of an important resource for reducing suicide attempts.

Needs of forensic psychiatric patients with schizophrenia in five European countries

AimsThe purpose was to compare the frequency of needs of patients with schizophrenia in forensic services across five European countries as assessed by both the patients and their care staff.MethodsPatients with schizophrenia and a history of significant interpersonal violence were recruited from forensic psychiatric services in Austria, Germany, Italy, Poland and England. Participants’ needs were assessed using the Camberwell Assessment of Needs—Forensic Version (CANFOR). Multiple linear regression analyses were used to identify predictors of numbers of needs.ResultsIn this sample, (n = 221) the most commonly reported need according to patients (71.0%) and staff (82.8%) was the management of psychotic symptoms. A need for information was mentioned by about 45% of staff and patients. Staff members reported a significantly higher number of total needs than patients (mean 6.9 vs. 6.2). In contrast, staff members reported a significantly lower number of unmet needs than patients (mean 2.0 vs. 2.5). Numbers of total needs and met needs differed between countries. Unmet needs as reported by patients showed positive associations with the absence of comorbid personality disorder, with higher positive symptom scores and lifetime suicide or self-harm history. Significant predictors of unmet needs according to staff were absence of comorbid personality disorder and higher positive as well as negative symptom scores according to PANSS.ConclusionsStaff rated a significantly higher number of total needs than patients, while patients rated more unmet needs. This indicates that patients’ self-assessments of needs yield important information for providing sufficient help and support.

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Aim:To assess the prevalence and correlates of metabolic syndrome in patients with depression admitted to psychiatry inpatient unit.Methodology:By using retrospective study design, the treatment records data of 476 consecutiveadmitted patients diagnosed with depressive disorders (first episode or recurrent depressive disorder) as per the ICD-10, were reviewed and data for metabolic syndrome was extracted.Results:Slightly less than half (45.8%) of the patients fulfilled the criteria for metabolic syndrome as per the consensus definition. The mean age of the study participants was 46.22 (SD: 16.87) years and the mean number of years of education was 11.19 (SD: 4.70) years. The mean duration of illness was 110.47 (SD: 107.93) months with the mean duration of current episode at the time of collection of data was 10.44 (SD: 9.76) months. Higher proportion of those with metabolic syndrome were older in age, were more educated, of female gender, had longer duration of illness, were more often diagnosed with recurrent depressive disorder and had presence of physical comorbidities. Lifetime Suicidality had significant association with abnormal blood pressure and raised blood glucose level. However, presence of absence of metabolic syndrome had no association with metabolic syndrome.Conclusions:The high prevalence of metabolic syndrome in patients with depressive disorders, suggests that there is a need to closely monitor the patients with depressive disorders for metabolic syndrome.

The Interpersonal-Psychological Theory of Suicide in Medical Students: Comparisons of Individuals without Suicidality, Ideators, and Planners.

The aim of this study was to explore the interpersonal–psychological theory of suicide (IPTS) in medical students. Higher levels of thwarted belongingness and perceived burdensomeness were expected in medical students with suicidality compared with medical students without suicidality, and a high level of acquired capability was expected in planners compared with ideators. Recruited for the study were 178 undergraduate medical students at the Université Libre de Bruxelles (ULB): 95 subjects without suicidality, 24 subjects with lifetime suicidality, 28 subjects with recent suicidal ideation, and 26 planners. An ad hoc questionnaire evaluated the risk of suicide as well as the “Suicidal thoughts and wishes” item of the BDI-II. The Interpersonal Needs Questionnaire (INS) measured thwarted belongingness (TB) and perceived burdensomeness (PB). The Acquired Capability for Suicide Scale (ACSS) measured notably fearlessness of death or pain tolerance and depression was rated using the revised version of the Beck Depression Inventory (BDI). Cognitive–affective symptoms of depression (CA-BDI) were assessed using six items of the BDI. Analyses of variance showed significant differences between groups for TB and PB but not for ACSS. Analyses of covariance, controlling for the CA-BDI scores, confirmed the significance of differences in TB and PB. Post hoc tests showed that (1) high levels of TB were characteristic of subjects with recent suicidal ideation and planners compared with subjects without suicidality; and (2) high levels of PB were characteristic of planners compared with the three other groups. Among the three characteristics of the IPTS, PB could be a strong predictor of severe suicide risk in medical students.

“Time does not heal all wounds”: mental health impact of sexual victimisation in old age

Abstract Background Sexual violence (SV) has an important impact on mental health. Childhood sexual abuse is linked to internalizing disorders in later life. In older adults, SV occurs more often than previously believed. Moreover, health care workers lack the skills to adequately address SV in later life. Studies researching the mental health impact of lifetime SV, i.e. SV that happened during childhood, adulthood and old age, are currently lacking. In this study we research the association between lifetime sexual victimization and adverse mental health outcomes in older adults, and its moderators. Methods Between July 2019 and March 2020, 513 older adults living in Belgium participated in a structured face-to-face-interview. Selection occurred via a cluster random probability sampling with a random walk finding approach. Depression, anxiety and post-traumatic stress syndrome (PTSD) were measured using validated scales. Suicide attempts and self-harm were questioned during lifetime and in the past 12-months. SV was measured using behaviorally specific questions based on a broad definition of SV. Results Over 44% experienced lifetime SV, 8% in the past 12-months. Rates for depression, anxiety and PTSD were 27%, 26% and 6%. Almost 2% committed suicide, 1% reported self-harm in the past 12-months. Lifetime SV was linked to depression (p =.001), anxiety (p =.001), and PTSD in participants with a chronic illness/disability (p = .002) or no/lower education (p &amp;lt;.001). We found no link between lifetime SV and suicide attempts or self-harm in the past 12-months. Conclusions Lifetime SV is linked to mental health problems in late life. Tailored mental health care for older SV victims is necessary. Therefore, capacity building of professionals and development of clinical guidelines and care procedures are urgently needed. Key messages The mental health impact of sexual victimisation continues into old age. Tailored mental health care for older SV victims and capacity building of professionals are of the utmost importance.

Gendered Racial Microaggressions and Self-Silencing Associated with Suicidality Among Black Women Living with HIV.

Black women represent the majority of women living with HIV in the USA and their risk for suicide may be linked to the impact of psychosocial stressors experienced at the intersection of race and gender such as gendered racial microaggressions (GRMS) and silencing the self (to maintain harmony). However, little research has been done on the relationship between microaggressions, self-silencing, and suicidality among BWLWH. As part of an intervention development study, 119 BWLWH in the Southeastern USA completed a baseline assessment consisting of a clinical interview (e.g., Mini-International Neuropsychiatric Interview) to assess suicidality, the gendered-racial microaggressions scale (GRMS), and the Silencing the Self-Scale. Multivariate linear regression analyses controlling for age and education indicated that higher microaggression appraisal scores on the GRMS scale (β = 2.80, p < .01) was associated with current suicidality and higher self-silencing was associated with current suicidality (β = 1.05, p < .01) and lifetime suicidality (β = 1.03, p < .01). Additional analyses that included major depression indicated that self-silencing uniquely contributed to suicidality above and beyond depression. Our findings support the importance of understanding how gender and race specific factors may relate to suicidality. Future research is needed to examine potential moderating factors (e.g., coping strategies) that may be enhanced through interventions and structural changes are needed to decrease acts of microaggressions.

Multi-environment gene interactions linked to the interplay between polysubstance dependence and suicidality

Substance dependence diagnoses (SDs) are important risk factors for suicidality. We investigated the associations of multiple SDs with different suicidality outcomes, testing how genetic background moderates these associations. The Yale-Penn cohort (N = 15,557) was recruited to investigate the genetics of SDs. The Army STARRS (Study to Assess Risk and Resilience in Servicemembers) cohort (N = 11,236) was recruited to evaluate mental health risk and resilience among Army personnel. We applied multivariate logistic regression to investigate the associations of SDs with suicidality and, in the Yale-Penn cohort, we used the structured linear mixed model (StructLMM) to study multivariate gene–environment interactions. In Yale-Penn, lifetime polysubstance dependence was strongly associated with lifetime suicidality: having five SDs showed an association with suicidality, from odds ratio (OR) = 6.77 (95% confidence interval, CI = 5.74–7.99) for suicidal ideation (SI) to OR = 3.61 (95% CI = 2.7–4.86) for suicide attempt (SA). In Army STARRS, having multiple substance use disorders for alcohol and/or drugs was associated with increased suicidality ranging from OR = 2.88 (95% CI = 2.6–3.19) for SI to OR = 3.92 (95% CI = 3.19–4.81) for SA. In Yale-Penn, we identified multivariate gene–environment interactions (Bayes factors, BF > 0) of SI with respect to a gene cluster on chromosome 16 (LCAT, p = 1.82 × 10–7; TSNAXIP1, p = 2.13 × 10−7; CENPT, p = 2.32 × 10−7; PARD6A, p = 5.57 × 10−7) for opioid dependence (BF = 12.2), cocaine dependence (BF = 12.1), nicotine dependence (BF = 9.2), and polysubstance dependence (BF = 2.1). Comorbidity of multiple SDs is a significant associated with suicidality and heritability of suicidality is partially moderated by multivariate gene interactions.

Childhood trauma and suicidality in bipolar disorder: The mediatory role of impulsivity

Childhood trauma (CT) is correlated with suicidality among patients with bipolar disorder (BD). However, it has not been adequately investigated if a third factor, for instance impulsivity, mediates the effect of CT on suicidality in BD. This study aimed to explore potential mediatory effects of impulsivity in the pathway from CT to suicidality in BD. CT was assessed with the Early Trauma Inventory Self Report-Short Form (ETI-SR-SF), impulsivity with the Barratt Impulsivity Scale-11 (BIS-11) while lifetime suicidality was investigated with the Suicidal Behaviors Questionnaire-Revised (SBQ-R). The effect of childhood trauma on suicidality and impulsivity as well as the effect of impulsivity on suicidality were examined with multiple linear regressions, including gender, age and diagnosis (BD-I, BD-II) as covariates. Structural equation models were built and path analyses were performed (with AMOS 25 software and using bootstrapping in 1000 samples) for the examination of the mediatory role of BIS-11 and its subtypes in the effect of childhood trauma and its subtypes on suicidality. We included 78 BD euthymic patients (60.3% female, 67.9% BD-I). ETI-SR-SF significantly predicted SBQ-R (p=0.004) and BIS-11 (p<0.001), while BIS-11 significantly predicted SBQ-R (p=0.001). In a model including ETI-SR-SF and BIS dimensions, only ETISR-SF physical abuse (p=0.012) and BIS attentional (p<0.001) subscales significantly predicted SBQ-R. In structural equation models, the indirect effect of childhood trauma on suicidality via impulsivity was significant (p=0.003) while the direct effect of childhood trauma on suicidality was non-significant (complete mediation of the effect of childhood trauma on suicidality via impulsivity). In specific, both the indirect effect of physical abuse on suicidality via attentional impulsivity (p=0.002) and the direct effect of physical abuse on suicidality (p=0.013) were statistically significant (partial mediation of the effect of physical abuse on suicidality via attentional impulsivity). Childhood trauma predicts suicidality and impulsivity, while impulsivity predicts suicidality. More specifically, physical abuse and attentional impulsivity predict suicidality. The mediatory role of impulsivity completely explained the effect of childhood trauma on suicidality. Moreover, attentional impulsivity partially mediated the effect of physical abuse on suicidality. Therefore, management of impulsivity and especially of attentional impulsivity is crucial for the prevention and management of suicidality among BD patients with a history of childhood trauma.

Intermittent explosive disorder subtypes in the general population: association with comorbidity, impairment and suicidality.

Intermittent explosive disorder (IED) is characterised by impulsive anger attacks that vary greatly across individuals in severity and consequence. Understanding IED subtypes has been limited by lack of large, general population datasets including assessment of IED. Using the 17-country World Mental Health surveys dataset, this study examined whether behavioural subtypes of IED are associated with differing patterns of comorbidity, suicidality and functional impairment. IED was assessed using the Composite International Diagnostic Interview in the World Mental Health surveys (n = 45 266). Five behavioural subtypes were created based on type of anger attack. Logistic regression assessed association of these subtypes with lifetime comorbidity, lifetime suicidality and 12-month functional impairment. The lifetime prevalence of IED in all countries was 0.8% (s.e.: 0.0). The two subtypes involving anger attacks that harmed people ('hurt people only' and 'destroy property and hurt people'), collectively comprising 73% of those with IED, were characterised by high rates of externalising comorbid disorders. The remaining three subtypes involving anger attacks that destroyed property only, destroyed property and threatened people, and threatened people only, were characterised by higher rates of internalising than externalising comorbid disorders. Suicidal behaviour did not vary across the five behavioural subtypes but was higher among those with (v. those without) comorbid disorders, and among those who perpetrated more violent assaults. The most common IED behavioural subtypes in these general population samples are associated with high rates of externalising disorders. This contrasts with the findings from clinical studies of IED, which observe a preponderance of internalising disorder comorbidity. This disparity in findings across population and clinical studies, together with the marked heterogeneity that characterises the diagnostic entity of IED, suggests that it is a disorder that requires much greater research.

Sexual Orientation Change Efforts (Soce) Strongly Reduce Suicidality: a Critique of Blosnich Et Al., 'Sexual Orientation Change Efforts, Adverse Childhood Experiences, and Suicide Ideation and Attempt Among Sexual Minority Adults, United States, 2016–2018', AJPH 110(7): 1024-1030

Background: Sexual Orientation Change Efforts (SOCE) signifies therapy activities designed to change or reduce homosexual orientation. Recent studies claim that such therapies increase suicide risk by showing positive associations between exposure to SOCE and current or lifetime suicidality. However, the suicidality may have occurred or begun before exposure to SOCE, thereby rendering this causal claim partly or wholly mistaken. The purpose of this study was to test this possibility. Method: We replicated a representative study, Blosnich and colleagues’ recent analysis of a population sample of 1518 sexual minority persons, which had concluded from logistic regression models that SOCE “may compound or create … suicidal ideation and suicide attempts” and thus had “insidious associations with suicide risk”. Using information on SOCE timing that was available in the data but unreported, we adjusted the models for the time order of SOCE and suicidality. Results: After controlling for pre-SOCE suicidality, SOCE was not positive associated with any form of suicidality. For suicidal ideation, Blosnich et al. reported an adjusted odds ratio (AOR) of 1.92 (95% CI 1.01-3.64); the adjusted AOR was .44 (.20-.94). For suicide planning, Blosnich et al.’s AOR was 1.75 (1.01-3.06); adjusted was .60 (.32-1.14). For suicide attempts, Blosnich et al.’s AOR was 1.75 (.99-3.08), adjusted was .74 (.36-1.43). The majority of cases labeled “experienced SOCE” by Blosnich et al. consisted of persons expressing suicidal ideation, planning and/or attempts prior to experiencing SOCE. For these, undergoing SOCE sharply reduced suicidality. Compared to those not experiencing SOCE, suicide attempts were reduced 82% to 91% when SOCE followed a prior expression of suicidal ideation (AOR .18, .05-.63) or planning (AOR .13, .04-.45), however SOCE following an initial suicide attempts did not significantly reduce further attempts. Effects were stronger for those who were adults rather than for minors when experiencing SOCE. Conclusion: By violating the principle of temporal precedence in scientific inference, i.e., that a cause cannot occur after an effect, Blosnich et al. reversed the correct conclusion in these data. Experiencing SOCE therapy does not encourage higher suicidality, as they claim; rather, experiencing higher suicidality appears to encourage recourse to SOCE, which in turn strongly reduces suicidality, particularly initial suicide attempts. Restrictions on SOCE deprive sexual minorities of an important resource for reducing suicidality, putting them at substantially increased suicide risk.

Is Camouflaging Autistic Traits Associated with Suicidal Thoughts and Behaviours? Expanding the Interpersonal Psychological Theory of Suicide in an Undergraduate Student Sample

The current study explored whether people who camouflage autistic traits are more likely to experience thwarted belongingness and suicidality, as predicted by the Interpersonal Psychological Theory of Suicide (IPTS). 160 undergraduate students (86.9% female, 18–23 years) completed a cross-sectional online survey from 8th February to 30th May 2019 including self-report measures of thwarted belongingness and perceived burdensomeness, autistic traits, depression, anxiety, camouflaging autistic traits, and lifetime suicidality. Results suggest that camouflaging autistic traits is associated with increased risk of experiencing thwarted belongingness and lifetime suicidality. It is important for suicide theories such as the IPTS to include variables relevant to the broader autism phenotype, to increase applicability of models to both autistic and non-autistic people.

Association of Childhood Attention Deficit Hyperactivity Disorder Symptoms with Academic and Psychopathological Outcomes in Indian College Students: a Retrospective Survey.

To survey the prevalence of retrospectively recalled clinically significant symptoms of attention deficit hyperactivity disorder (ADHD) in childhood and determine the association of ADHD symptoms in childhood with current academic achievement and psychopathological outcomes among college students in the state of Kerala, India. A self-administered questionnaire was distributed to 5784 students from 58 colleges selected by cluster random sampling. The Barkley Adult ADHD Rating Scale-IV was used for recollection of childhood ADHD symptoms; a total score of ≥60 (indicating the 99 percentile) was taken as the cut-off for clinically significant ADHD symptoms in childhood. The Alcohol, Smoking and Substance Involvement Screening Test was used to assess lifetime use of alcohol and tobacco. The Kessler Psychological Distress Scale was used to assess non-specific psychological distress. Lifetime suicidality and exposure to sexual abuse were assessed by asking relevant questions. Students who recalled having clinically significant ADHD symptoms in childhood were compared with those who did not. Of 5784 students, 639 (11.5%) did not complete the questionnaire. Of the remaining 5145 students, 1750 (34.8%) were men and 3395 (65.2%) were women, with a mean age of 19.4 years. 143 (2.8%) students reported clinically significant ADHD symptoms in childhood. Childhood ADHD symptoms were significantly more common in men and in those living in urban areas. In the bivariate analysis, those with clinically significant ADHD symptoms in childhood had significantly higher odds of poorer academic performance, alcohol use, tobacco use, psychological distress, suicidal thoughts, suicidal attempts, and contact and non-contact sexual abuse, after adjusting for sex and residence. Clinical evaluation and appropriate management may be warranted for adults who retrospectively recall clinically significant ADHD symptoms in childhood.