Past Suicide Attempts Research Articles

A CASE OF DAPSONE-INDUCED METHEMOGLOBINEMIA

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Dapsone is an antibiotic used with relative frequency for dermatological illnesses and opportunistic infection prophylaxis. A known complication of this drug is methemoglobinemia, a condition that can be both difficult to identify and potentially fatal. Here we present the case of a patient diagnosed with and treated for dapsone-induced methemoglobinemia. CASE PRESENTATION: A 40-year-old Caucasian female with a history of depression complicated by past suicide attempt and chronic autoimmune urticaria treated with dapsone presented to the emergency department with suicidal ideation. She reported taking 45 pills of 100mg dapsone and 27 pills of 300mg gabapentin prior to arrival. Physical exam was remarkable for cyanosis noted in the perioral area. Her initial course was complicated by oxygen desaturation to 83% with no identified pulmonary process. She was found to have methemoglobinemia with initial methemoglobin level of 39.9% on VBG. She was treated with 50mg IV methylene blue in the Emergency Department then transferred to the Intensive Care Unit. Throughout her admission, she was given a total of 300mg IV methylene blue with eventual resolution of methemoglobinemia and symptoms. DISCUSSION: Acquired methemoglobinemia is thought to be due exposure to oxidizing agents such as dapsone and other commonly used medications. These agents accelerate the oxidization of hemoglobin at a rate that overwhelms endogenous reduction capacities. This results in an inability of hemoglobin to bind oxygen, ultimately leading to reduced oxygen delivery throughout the body and diffuse tissue hypoxia. Methylene blue, a common antidote to methemoglobinemia, works within the NADH-Methemoglobin reductase system to reduce methemoglobin to hemoglobin. Clinically, cyanosis resistant to oxygen therapy will typically occur at methemoglobin levels of 15% or higher. As methemoglobin levels increase, symptoms such as headache, fatigue and tachycardia become more common. Arrhythmias, seizures and coma typically occur at levels above 60%, with death possible over 70%. Diagnosis of methemoglobinemia can be somewhat challenging and requires a degree of clinical suspicion. Standard pulse oximetry does not detect methemoglobin and can reflect a falsely elevated or falsely decreased oxygen saturation depending on concentration. Co-oximetry can help with diagnosis but is not as definitive as arterial blood gas in the hospital setting. Patients diagnosed with methemoglobinemia should be treated with high-dose oxygen as well as methylene blue for fractions greater than 30% or symptomatic hypoxia. For patients with G6PD deficiency, however, methylene blue is contraindicated. Hyperbaric oxygen and exchange transfusions are safe alternatives and useful for severe or refractory cases. CONCLUSIONS: Methemoglobinemia is a potentially life-threatening condition. Clinicians should be aware of the signs, symptoms and treatment options. Reference #1: Pereira, R.O. and Costa, J., 2008. Methemoglobinemia: from diagnosis to treatment. Revista brasileira de anestesiologia, 58(6), pp.651-664. Reference #2: Longo, D. and Fauci, A., 2013. Poisoning and drug overdose. Harrison's manual of medicine. (pp. 177). McGraw Hill Professional. Reference #3: Marino, P. (2014). Oximetry and capnometry. The ICU Book (pp. 409-413). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. DISCLOSURES: No relevant relationships by Abigail Go, source=Web Response No relevant relationships by Stephen Osmon, source=Web Response No relevant relationships by Maria Srour, source=Web Response

Sexual behavior and suicide attempts among adolescents aged 12–15 years from 38 countries: A global perspective

BackgroundThe aim was to investigate the relationship between sexual behaviors and suicide attempts by using data from 38 countries from four World Health Organization regions. MethodsCross-sectional data from 116,820 adolescents aged 12–15 years participating in the Global School-based Student Health Survey 2009–2016 were analyzed. Data on sexual behaviors were collected: (i) ever having had intercourse; among those who reported having had intercourse, (ii) multiple (≥2) lifetime sexual partners and (iii) condom use in last sexual intercourse and past 12-month suicide attempts were self-reported. Associations were analyzed using multivariable logistic regression. ResultsThe prevalence of sexual intercourse and suicide attempts were 13.2% and 9.1%, respectively. A positive association between sexual intercourse and suicide attempts was found in 32 of the 38 countries (pooled OR for whole sample 2.12 [95% CI 1.98–2.27]). Having had multiple sexual partners was associated with increased odds of suicide attempts (pooled OR for whole sample 1.58 [1.27–1.96]). Condom non-use was only associated with suicide attempts among boys in the Americas (OR: 1.75 [1.25–2.45]). ConclusionEngaging in sexual intercourse was associated with increased risk of suicide attempt. Moreover, having had multiple sexual partners may also increase the risk of suicide attempts.

Non-suicidal self-injury, suicide ideation, and past suicide attempts: Comparison between transgender and gender diverse veterans and non-veterans

BackgroundTransgender and gender diverse (TGD) individuals, especially veterans, experience elevated rates of non-suicidal self-injury (NSSI) and suicide related behaviors compared to gender majority individuals. Research has yet to compare TGD veterans to non-veterans or look at correlates of NSSI and related behaviors to suicide related outcomes. This study examines prevalence and suicide related correlates of NSSI among TGD veterans and TGD non-veterans. MethodData analyzed in the were part of the Trans Lifeline Mental Health Survey. Both TGD veterans (N = 313) and non-veterans (N = 3,972) completed an online, cross-sectional survey that included self-report measures of NSSI, suicidal ideation (SI), and suicidal attempt (SA) along with lifetime hospitalization and avoidance of care due to NSSI. ResultsResults of this paper indicate that prevalence of NSSI, SI, and SA are elevated in both the TGD veterans and non-veteran subpopulations. Further, veterans compared to non-veterans have a lower prevalence of NSSI but higher prevalence of hospitalization when self-harm is inflicted, reflecting more healthcare utilization or increased severity of NSSI episodes. Additionally, veterans were less likely to avoid care due to NSSI. Further, veteran status seemed to be a protective factor against demographic differences that increased rates of NSSI history in non-veteran TGD individuals. LimitationsThe limitations of this study include its cross-sectional study design, one question assessing SA, and few TGD male veterans. ConclusionNSSI is an important risk factor in future suicide related outcome such as SI and SA. Further, differences in healthcare utilization among TGD veterans and non-veterans are apparent.

Bipolar depression and suicidal ideation: Moderators and mediators of a complex relationship

IntroductionNot all patients with bipolar depression have suicidal ideation (SI). This study examines some factors that link bipolar depression to SI. Methods482 individuals with bipolar I or II were randomized to either lithium or quetiapine plus adjunctive personalized therapy in a 24 week comparative effectiveness trial. Severity of depression and SI were assessed with the Bipolar Inventory of Symptoms Scale (BISS). We examined potential moderators (age, gender, age of illness onset, bipolar type, comorbid anxiety, substance use, past suicide attempts, childhood abuse and treatment arm) and mediators (severity of anxiety, mania, irritability, impairment in functioning (LIFE-RIFT) and satisfaction and enjoyment of life (Q-LES-Q)) of the effect of depression on SI. Statistical analyses were conducted using generalized estimating equations with repeated measures. ResultsBipolar type and past suicide attempts moderated the effect of depression on SI. Life satisfaction mediated the effect of depression and SI. The relationship between anxiety, depression and SI was complex due to the high level of correlation. Treatment with lithium or quetiapine did not moderate the effect of depression on SI. LimitationsSuicide assessment was only done using an item on BISS. Patient population was not specifically chosen for high suicide risk. DiscussionIndividuals with Bipolar II experienced more SI with lower levels of depression severity. A history of suicide predisposed patients to higher levels of SI given the same severity of depression. Reduced life satisfaction mediates the effect of depression on SI and may be a target for therapeutic interventions.

Suicidal Ideation in Elite Schools: A Test of the Interpersonal Theory and the Escape Theory of Suicide.

The present study compared the ability of two contemporary theories of suicidal behavior-the interpersonal and escape theories of suicide-to predict suicidal ideation. The interpersonal theory proposes that the interaction of perceived burdensomeness and thwarted belongingness predicts suicidal ideation. The escape theory proposes that feelings of failure predict suicidal ideation and that escape motivation mediates this relationship. The present study intended to determine which of the two theories more successfully explains suicidal ideation. A sample of 306 students from elite schools in Morocco (193 women, Mage =21.21years, predominantly Muslims) completed a questionnaire assessing feelings of failure and escape motivation, perceived burdensomeness and thwarted belongingness, suicide ideation, and control variables. In line with previous research, separate tests revealed support for the two theories. Interestingly, when entered simultaneously in a multiple regression analysis, the two frameworks explained a unique and cumulative part of the variance in suicidal ideation. Moreover, the effects remained significant after controlling for past suicide attempts, depression, hopelessness, and stress. The findings suggest that combining the interpersonal and escape theories of suicide could help better explain the emergence of suicidal ideation among college students.

Suicidal Ideation in Pregnant and Postpartum Women Veterans: An Initial Clinical Needs Assessment.

Pregnancy and postpartum, or the perinatal period, are times when women are particularly vulnerable to mental health concerns, including suicidal ideation. Risk factors for suicidal ideation during this period of a woman's life are depression and exposure to trauma, the latter of which may occur during military operations. The number of women veterans in the United States continues to rise, as does their use of maternity benefits. In this pilot study, we examined the feasibility of recruiting pregnant veterans for longitudinal research. We hypothesized that hopelessness and depressive symptoms would be related to suicidal ideation during the perinatal period, and we investigated a possible relationship between post-traumatic stress symptoms (PTSS) and suicidal ideation. Using the designated Veterans Affairs (VA) maternity care coordinator's census, we contacted pregnant women veterans for assessment during the 3rd trimester of pregnancy and 6 weeks postpartum at the San Diego VA. Between September 2017 and October 2018, 28 women volunteers completed the following measures: the Columbia-Suicide Severity Rating Scale (C-SSRS); the Beck Hopelessness Scale (BHS); the Edinburgh Postnatal Depression Scale (EPDS); and the PTSD Checklist for DSM-5 (PCL-5). We used correlational analyses and descriptive statistics to determine associations among the measures. As gathered from the C-SSRS, over 30% of the veteran women had past lifetime suicide attempts, and over 10% of the veterans had suicidal ideation in the perinatal period. Both depression and PTSS rates neared 30% during pregnancy and postpartum. Hopelessness and depressive symptoms were positively correlated at both time points. While the intensity of lifetime suicidal ideation was correlated with postpartum depressive symptoms, there was no correlation with current suicidal ideation and depressive symptoms. PTSS correlated with both depressive symptoms and hopelessness, but not suicidal ideation, at both time points. There was no correlation between hopelessness and suicidal ideation during the perinatal period in this cohort. It is important to understand the mental health needs of perinatal veterans given their vulnerability to develop mental health concerns, including suicidal ideation. The unpredicted pattern of correlations determined in this study implies the need for multifaceted measures for safety-related mental health assessment of perinatal veterans, including assessment for PTSS. Strengths of this study include its longitudinal assessment and a sampling from a general population of veterans. Limitations include small sample size, a single gestational time point, and loss of participants who did not return for their postpartum assessment. We demonstrated the feasibility of longitudinal research with pregnant and postpartum veterans, but additional assessment points during the perinatal period could help identify critical times for mental health intervention in this population.

Prevalence and correlates of past 12-month suicide attempt among in-school adolescents in Guatemala.

BackgroundThe aim of this investigation was to estimate the prevalence of past 12-month suicide attempts and associated factors among in-school adolescents in Guatemala.MethodsCross-sectional data from the 2014 “Global School-based Health Survey (GSHS)” included 4,274 students (median age 14 years, interquartile range=2 years) that were representative of all middle school students in Guatemala.ResultsThe prevalence of past 12-month suicide attempt was 16.6%, 12.2% among boys and 20.2% among girls. Among students with a suicide attempt in the past year, 52.8% had a suicide plan in the past year. In adjusted logistic regression analysis, male sex and loneliness were associated with past 12-month suicide attempt, and among boys, none of the variables, and among girls, loneliness and current alcohol use were associated with past 12-month suicide attempt.ConclusionA high prevalence and several specific factors associated with suicide attempt were identified which can help in guiding preventive strategies.

Impaired Conflict Detection Differentiates Suicide Attempters From Ideating Nonattempters: Evidence From Event-Related Potentials

BackgroundExisting research suggests that inhibitory control deficits may differentiate individuals who think about suicide from those who make a suicide attempt. However, no available research, to our knowledge, has examined whether suicidal behaviors are associated with disruptions in the ability to determine when inhibitory control is needed or the ability to engage inhibition of an inappropriate or maladaptive behavior. The current study utilized event-related potentials to investigate specific facets of inhibitory control and their associations with suicide attempt history among a heterogeneous clinical sample who reported current suicidal ideation. MethodsIdeators with no past suicide attempts (n = 46) and those with a history of suicide attempts (n = 22) completed a complex go/no-go task. Raw waveforms and temporospatial principal components analysis were used to index conflict detection (i.e., ΔN2) and motor inhibition (i.e., ΔP3a). Behavioral performance indices were also examined. ResultsSuicide attempters exhibited deficits in detecting the need for inhibitory control, as indexed by a more positive ΔN2 factor, than did ideating nonattempters, even when accounting for psychiatric comorbidity and age. However, these results only emerged in the principal components analysis–derived latent factor. No differences in behavioral performance or ΔP3a amplitude emerged. ConclusionsA relative inability to detect when to inhibit a maladaptive behavior, but not the ability to engage motor inhibition to stop that behavior, may distinguish suicide ideators who make a suicide attempt from those who do not. However, future research with prospective designs are needed to determine how conflict detection deficits may contribute to the emergence or escalation of a suicidal crisis.

Anxiety Symptom Severity and Long-term Risk for Suicidal Behavior in Depressive Disorders.

We have previously shown that the severity of anxiety symptoms during major depressive episodes is associated in a linear fashion with the proportion of weeks in depressive episodes during a subsequent 25years of follow-up. Here, we test whether the negative prognostic implications of anxiety comorbidity extend to higher likelihoods of suicidal behavior. We used the NIMH Collaborative Depression Study (CDS) cohort to test both the severity of eight anxiety symptoms and the presence or absence of four anxiety disorders as risk factors for suicide attempts or completions over a mean (SD) follow-up of 16.6 (8.5) years. Separate analyses tested potential predictors of events that occurred within 2years and those that occurred later. None of the baseline anxiety manifestations were significantly associated with overall risks for past or future suicide attempts. Only the diagnosis of phobic disorder was overrepresented in the 36 who committed suicide. Psychic anxiety was a risk factor for suicide attempts beyond 2years of follow-up, and phobic anxiety was protective of suicides within this period. These results did not show anxiety comorbidity to be an important risk factor for suicide attempts or completions.

First-onset and persistence of suicidal ideation in university students: A one-year follow-up study

Background: Longitudinal evidence about risk and protective factors for suicidal ideation among university students is limited.Methods: 12-month first-onset and persistence of suicidal ideation (SI) among Spanish first-year university students were estimated using baseline (T1) and 12-month follow-up (T2) online surveys. Information about STBs, childhood/adolescence adversities, positive relationships, mental disorders, recent stressful experiences, and university sense of membership was assessed. Logistic regression analysis was used to study risk/protective factors of first-onset and persistence of suicidal ideation (SI).Results: A total of 1,248 respondents (58.9% response) were included. Mean age at baseline was 18.7 (SD = 1.3) and 56.0% were female. 7.3% reported 12-month SI at T2. Incidence of new SI cases was 3.4% and, among students with SI at T1, 21.2% also reported SI at T2 (persistence). Risk factors of T2 SI included 12-month mood disorder at T2 both without (aOR = 12.08 95% CI 5.45–26.80) or with (aOR = 7.2 95% CI 2.91–17.80) lifetime mood at T1, past lifetime suicide attempt (aOR = 8.79 95% CI 2.37–32.64) and plan without attempt (aOR = 4.72 95% CI 2.32–9.61), and 12-month physical or sexual assault (aOR = 3.28 95% CI 1.13–9.46). Twelve-month mood at T2 withoutT1 lifetime mood (aOR = 11.27 95% CI 3.02–42.14) and childhood/adolescence emotional abuse or neglect (aOR = 3.41 95% CI 1.10–10.57) or having been bullied (aOR = 3.2 95% CI 1.08–9.53) were associated with first-onset of SI. Twelve-month mood at T2 either without (aOR = 13.92 95% CI 3.76–51.59) or with (aOR = 8.03 95% CI 2.13–30.29) were associated to T2 SI persistence.University sense of membership was protective for overall 12-month SI at T2 (aOR = 0.25 95% CI 0.12–0.53 for middle tertile), first-onset SI (aOR = 0.1 95% 0.02–0.55 for middle tertile) and persistence (aOR = 0.3 95% CI 0.11–0.81 for middle tertile).Limitations: Analysis was based on self-report data focusing on SI only, and conclusions about the direction of the associations are limited.Conclusions: High proportion of SI suggests the need of suicide prevention strategies. The potential role of university sense of membership in reducing suicidal behaviour among university students deserves further investigation.

Psycho-Oncology: Cancer patients with past suicide attempts, or a family history of suicide.

e23173 Background: “The suicide rate in cancer patients is twice that observed in the general population in the United States” (JNCI vol 100, 24, page 1750, 2008). This paper focuses ona population with great psychological risk: cancer patients (Pt) with previous suicide attempts (SA) or a family history of suicide (FS); both grouped under SAFS for the purpose of this study. Methods: Between 9/26/2012 and 11/28/2018 all new patients (Pt) admitted to IOHM filled out a Past Medical History Form (PMHF) (ASCO 2013 ABST. e17539) with their preexisting clinical conditions. The database was locked and anonymized. Those with a history of SAFS before cancer diagnosis were selected. Results: Out of 15,617 Pt, 184 Pt (1.2%) were SAFS(141 Pt were SA, 39 Pt were FS and 4 Pt were both). The relative risk ofSA was ten times larger for those with FS. Psychiatric Medication: Antipsychotics: 15Pt (8%), Antidepressants: 23 Pt (12%) and Benzodiazepines 45 Pt(24%), No treatment 101 Pt (55%). Population Characteristics: Sex: F:144 Pt . M: 40 Pt. Age: 56y (r = 26-88). Tumor Dx: Breast (65 Pt ) - Gastrointestinal (24 Pt) - Urological (21 Pt ) - Lung (21 Pt ) -Gynecological (19 Pt) - Hematological (11 Pt) -Head &Neck (8 Pt) - Endocrine (7 Pt) - Other (8 Pt). Stages: Early (0-I-II-III): 130 Pt, Advanced: 54 Pt. Ob-Gyn history:25 Pt (17%) nulliparous, 18 Pt (12%) with one child, 77 Pt (53%) with 2 or 3 children and 24 Pt (17%) with more than 3 children; 62 Pt (43%) had previous abortions. Average severe comorbidities (respiratory and psychiatric) was 3 per Pt (r = 0-18). Toxic habits: Smoking: 120 Pt (65%), Alcohol: 37 Pt (20%) and Illicit Drugs: 4 Pt (2%). Follow-up: 19 months (r = 0-70). No Pt had any SA, or commited suicide, during the follow-up.Living patients:177 (96%). Conclusions: 1) In our vast cohort, 184 Pt (1.2%) were identified as highly vulnerable psychiatric Pt due to SAFS. 2) Given the high psychological risk and stressful cancer diagnosis, 83 Pt (45%) were prescribed psychiatric drugs. 3) Follow-up of SAFS Pt by a multidisciplinary team is requiredfor adequate Pt and family support.

Reconsideration of the factorial structure of the Barratt Impulsiveness Scale (BIS-11): Assessment of impulsivity in a large population of euthymic bipolar patients

BackgroundImpulsivity is commonly assessed using the Barratt Impulsiveness Scale (BIS-11). Some studies challenged the reliability of its three dimensional structure and proposed a bi-dimensional structure. MethodsThe psychometric reliability of the BIS-11 scale was studied in a sample of 580 euthymic bipolar patients. An alternative structure of the scale was conceived, using confirmatory factorial analysis (CFA) in the first half (N = 290) and cross-validated in the second half of our sample. Associations between the newly defined shortened scale and predefined clinical variables were computed. ResultsThe original three dimensional structure did not fit in our sample according to statistical criteria in CFA. A 12 items Impulsivity Scale (IS-12) was designed with strong indices of fitting in the first half of our sample and replicated in the second half of our sample. The IS-12 evidences two dimensions: “behavioral impulsivity” and “cognitive impulsivity”. Associations between “behavioral impulsivity” and both presence of past suicide attempts and number of suicide attempts were observed. Substance misuse was strongly associated with both subscores of the new scale. LimitationsThe rating of the items assessing the two dimensions of the IS-12 is reversed. The population is restricted to euthymic bipolar patients. ConclusionsThe Impulsivity Scale assesses two distinct dimensions named behavioral and cognitive impulsivity. It was reliable and valid in our sample and associated with the existence of suicidal behavior and with substance misuse (alcohol and cannabis). Further studies are needed to demonstrate its predictive validity.

Consumption of carbonated soft drinks and suicide attempts among 105,061 adolescents aged 12–15 years from 6 high-income, 22 middle-income, and 4 low-income countries

Multinational studies on the relationship between consumption of sugar-sweetened beverages and suicidal behavior in youths are lacking. Thus, the goal of this study was to investigate the association between consumption of carbonated soft drinks and suicide attempts among adolescents from 6 high-income, 22 middle-income and 4 low-income countries. Cross-sectional data from the Global school-based student health survey (GSHS) were analyzed. Data on past 12-month suicide attempts and past 30-day carbonated soft drink consumption (number of times per day) were collected. Multivariable logistic regression and meta-analysis were conducted to assess associations. There were 105,061 adolescents (49.0% females) aged 12-15 years included in the analysis. The overall prevalence of suicide attempts and consumption of carbonated soft drinks ≥3 times/day were 10.2% and 10.7%, respectively. After adjustment for potential confounders (i.e., sex, age, food insecurity, alcohol consumption, smoking, physical activity, obesity, fruit and vegetable consumption, fast food consumption, country), compared to those who did not consume carbonated soft drinks, those who consumed 3 and≥4 times/day were 1.36 (95%CI=1.07-1.72) and 1.43 (95%CI=1.14-1.80) times more likely to have reported an attempted suicide in the past 12 months, respectively. Country-wise analyses showed that consumption of carbonated soft drinks ≥3 times/day (vs. <3 times/day) was associated with higher odds for suicide attempts (i.e., OR>1) in 22 of the 32 included countries with the pooled OR (95%CI) based on a meta-analysis being 1.20 (1.12-1.28; I2=28.6%). Our data indicate that there is a positive association between consumption of carbonated soft drinks and suicide attempts in the past 12 months. Further studies should confirm/refute our findings and investigate the potential underlying mechanisms.

Clinical and psychosocial factors associated with depression in patients with psychosis according to stage of illness.

This study investigated the clinical characteristics and psychosocial factors associated with depression in patients with early psychosis according to stage of illness. The present study includes patients who fulfil the DSM-5 criteria for schizophrenia spectrum and other psychotic disorders. Patients were divided into two groups according to illness stage (the acute stage of first-episode psychosis and stabilization phase of recent-onset psychosis). Clinically meaningful depression was defined as moderate or severe on the depression dimension of the Clinician-Rated Dimensions of Psychosis Symptom Severity scale in the DSM-5. In total, 340 (207 first-episode and 133 recent-onset) patients were recruited in this study. Patients with comorbid depression were characterized by frequent suicidal ideation, a past suicide attempt, and lower scores on the Subjective Well-being Under Neuroleptics and Brief Resilience Scale in both groups. Long duration of untreated psychosis and higher scores on the Early Trauma Inventory Self Report were associated with depression in the acute stage of first-episode psychosis. In the stabilization phase of recent-onset psychosis group, a monthly income and scores for sexual desire and on the Family Adaptability and Cohesion Evaluation Scale-III were significantly lower in patients with depression than in those without depression. Comorbid depression was associated with high suicidality, lower quality of life and poor resilience in patients with first-episode and recent-onset psychosis. Depression was associated with factors that had been present before the initiation of treatment in patients with first-episode psychosis and with environmental factors in those in the stabilization phase.

Bullying Victimization and Suicide Attempt Among Adolescents Aged 12-15 Years From 48 Countries.

Adolescent suicide is a global public health problem. Bullying is a risk factor for suicidality in adolescence; however, global data on its association with suicide attempts are lacking, and data from low- and middle-income countries and non-Western settings are scarce. Thus, this study assessed the association between bullying victimization and suicide attempts using data from 48 countries (predominantly low- and middle-income countries) across multiple continents. Data from the Global School-based Student Health Survey were analyzed. Data on past 12-month suicide attempts and past 30-day bullying victimization were collected. Multivariable logistic regression and meta-analysis with random effects were conducted to assess the associations. The final sample consisted of 134,229 adolescents 12 to 15 years of age. The overall prevalences of suicide attempts and bullying victimization were 10.7% and 30.4%, respectively. After adjustment for sex, age, and socioeconomic status, bullying victimization was significantly associated with higher odds for a suicide attempt in 47 of the 48 countries studied, with the pooled odds ratio being 3.06 (95% CI 2.73-3.43). A larger number of days bullied in the past month was dose-dependently associated with higher odds for suicide attempts. The past-year prevalence of suicide attempts ranged from 5.9% for the "no bullying" group up to 32.7% for the "being bullied for 20 to 30 days/month" group (odds ratio 5.51, 95% CI 4.56-6.65). Bullying victimization could be an important risk factor of suicide attempts among adolescents globally. Thus, there is an urgent need to implement effective and evidence-based interventions to address bullying to prevent suicides and suicide attempts among adolescents worldwide.

Suicide Crisis Syndrome: A review of supporting evidence for a new suicide-specific diagnosis.

Suicide is a major public health problem, and suicide rates are still on the rise. Current strategies for identifying individuals at risk for suicide, such as the use of a patient's self-reported suicidal ideation or evidence of past suicide attempts, have not been sufficient in reducing suicide rates. Recently, research groups have been focused on determining the acute mental state preceding a suicide attempt. The development of an acute suicidal diagnosis, the Suicide Crisis Syndrome (SCS), is aimed at capturing this state to better treat individuals. The SCS has five main evidence-based components-entrapment, affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal. The SCS may provide clinicians with the ability to identify individuals who are experiencing an acute pre-suicidal mental state, regardless of their self-reported suicidal ideation. Future research leading to the incorporation of this diagnosis into clinical practice could improve the quality of care and reduce the personal, societal, and legal burden of suicide.

Media Use Is Linked to Lower Psychological Well-Being: Evidence from Three Datasets.

Adolescents spend a substantial and increasing amount of time using digital media (smartphones, computers, social media, gaming, Internet), but existing studies do not agree on whether time spent on digital media is associated withlower psychological well-being (including happiness, general well-being, and indicators of low well-being such as depression, suicidal ideation, and suicide attempts). Across three large surveys of adolescents in two countries (n= 221,096), lightusers (<1h a day) of digital media reported substantially higherpsychological well-being than heavyusers (5+ hours a day). Datasets initially presented as supporting opposite conclusions produced similar effect sizes when analyzed using the same strategy. Heavyusers (vs. light) of digital media were 48% to 171% more likely to be unhappy, to be in low in well-being, or to have suicide risk factors such as depression, suicidal ideation, or past suicide attempts. Heavyusers (vs. light) were twice as likely to report having attempted suicide. Lightusers (rather than non- or moderate users) were highest in well-being, and for most digital media use the largest drop in well-being occurred between moderate use and heavyuse. The limitations of using percent variance explained as a gauge of practicalimpact are discussed.

Leisure-time sedentary behavior and suicide attempt among 126,392 adolescents in 43 countries

BackgroundAdolescent suicide is a major global mental health problem. Exploring variables associated with suicide attempts is important for the development of targeted interventions. The aim of the current study was to explore associations between leisure-time sedentary behavior and suicide attempts. MethodsData from the Global School-based Student Health Survey were analyzed. Data on past 12-month suicide attempts and self-reported leisure-time sedentary time were collected. Multivariable logistic regression and meta-analysis were conducted to assess the associations. ResultsAmong 126,392 students from 43 countries (mean age 13.8 ± 0.96 years; 48.9% female), 10.6% had attempted suicide. The prevalence of suicide attempts increased with increasing sedentary leisure-time per day (from 9% at <1 h/day to 16.8% at >8 h/day). Compared to those engaging in <1 h/day sedentary during leisure-time, there was a dose-dependent increase in odds ratios (ORs) for suicide attempts, with the OR for >8 h/day being 1.45 (95% confidence interval=1.19–1.77). LimitationsThe study is cross-sectional, therefore the directionality of the relationships cannot be deduced. ConclusionsOur data suggest that leisure-time sedentary behavior is associated with increased odds for suicide attempt in adolescence. Future longitudinal data are required to confirm/refute the findings to inform public prevention campaigns.

NIHILISTIC DELUSION IN THE CONTEXT OF MAJOR DEPRESSIVE DISORDER WITH CATATONIC FEATURES IN A GERIATRIC PATIENT: A CASE REPORT AND REVIEW OF LITERATURE

NIHILISTIC DELUSION IN THE CONTEXT OF MAJOR DEPRESSIVE DISORDER WITH CATATONIC FEATURES IN A GERIATRIC PATIENT: A CASE REPORT AND REVIEW OF LITERATURE

The tide does turn: Predictors of remission from suicidal ideation and attempt among Canadians who previously attempted suicide

The objectives of this study were to identify factors that contribute to (1) remission from suicidal ideation, and (2) remission from suicide attempt, among Canadians with a lifetime history of suicide attempt. Data for this study came from Statistics Canada's nationally representative 2012 Canadian Community Health Survey-Mental Health. A sample of 769 adult respondents who had ever attempted suicide was analyzed with remission from past year suicidal ideation and remission from past year suicide attempt as outcome variables. Of the 769 respondents who had ever attempted suicide, more than two-thirds (69%) were free from suicidal ideation within the past year, and approximately 87% were free from suicide attempts within the past year. Compared to men, odds were 2.66 times greater for women to be free of suicide attempt and 2.65 times greater to be free of suicidal ideation in the past year. Older age, being free of sleep problems and major depressive episode, having no history of chronic childhood physical abuse, and having two or fewer previous suicide attempts were associated with higher odds of remission from both suicide attempt and ideation in the past year.