Prevention Of Suicide Attempts Research Articles

Dealing With a Stressful Extra Duty: The Intrapersonal Conflict Experiences of Nurses Caring for Survivors of Suicide Attempts on Medical-Surgical Wards.

Nurses are the frontline professionals caring for patients who have attempted suicide. When clinical nurses learn from medical records or nursing handover, or are proactively informed by patients or family members, that the patients they are caring for have suicidal tendencies, they often experience pressure and face challenges. However, little attention has been given to the experiences of the nurses caring for patients with suicidal intent on medical and surgical wards. We aimed to address this knowledge gap. The purpose of this study was to explore medical and surgical nurses' experiences, especially the internal conflicts they might experience while caring for patients who have a history of attempted suicide. A qualitative descriptive design and semi-structured interviews were used in this study. Twenty-three nurses were recruited and interviewed individually. Data were analysed by qualitative content analysis. The focus of this paper is to examine the emergent theme of intrapersonal conflict experienced by the participants. Nurses' experiences can be clustered into two themes: (1) Pity and annoyance and (2) Hard work does not necessarily pay off. Intrapersonal conflict was identified by participants as considerable fear and anxiety about the possibility of a patient's suicide, as well as a mixture of pity for and annoyance with the patients. Nurses feel sorry for such patients, but they are also annoyed by the extra work required to prevent suicide attempts in the ward. Additionally, having limited time and ability, they see that their hard work does not necessarily pay off and may sometimes lead to punishment. Our findings raise serious concerns about the adequacy of the knowledge of the nurses, their competence and their difficulties in caring for such patients. In addition, there is a need to provide them with appropriate on-the-job education and immediate emotional support relevant to caring for survivors of suicide attempts.

Protective and Risk Factors for Suicidal Behaviour in Self-Declared LGBTIQ+ Adolescents

Background: Adolescents who identify as sexual minorities often face social stigmatisation, which can lead to increased adversity and a higher risk of suicidal behaviours. However, there are also protective factors that may promote resilience to these risk behaviours. This study aims to identify factors that predict resilience in sexual minority adolescents with high suicidal vulnerability. Methods: The study sample comprised 78 self-reported LGBTIQ+ adolescents aged between 13 and 18 years old (M = 16.11, SD = 1.56) who had previously attempted suicide. They completed several psychosocial instruments to measure risk and protective variables related to suicidal vulnerability. Results: Entrapment was found to be the most predictive risk variable for suicide attempts. However, protective variables promoting resilience were also found, such as adequate parental communication, life satisfaction, and cognitive reframing. Discussion: The findings related to prevention of suicide attempts are discussed and we highlight the urgent need to enhance certain internal and contextual protective factors to promote resilience in the face of suicidal vulnerability in certain clinical subpopulations exposed to highly adverse situations.

Prediction of suicidal ideation with associated risk factors among university students in the southern part of Bangladesh: Machine learning approach

BackgroundThe prevalence of suicidal ideation has become an urgent issue, particularly among adolescents. The primary objective of this research is to determine the prevalence of suicidal ideation among students in the southern region of Bangladesh and to predict this phenomenon using machine learning (ML) models. MethodsThe data collection process involved using a simple random sampling technique to gather information from university students located in the southern region of Bangladesh during the period spreading from April 2022 to June 2022. Upon accounting for missing values and non-response rates, the ultimate sample size was determined to be 584, with 51.5 % of participants identifying as male and 48.5 % female. ResultsA significant proportion of students, precisely 19.9 %, reported experiencing suicidal ideation. Most participants were female (77 %) and unmarried (78 %). Within the machine learning (ML) framework, KNN exhibited the highest accuracy score of 91.45 %. In addition, the Random Forest (RF), and Categorical Boosting (CatBoost) algorithms exhibited comparable levels of accuracy, achieving scores of 90.60 and 90.59 respectively. LimitationsUsing a cross-sectional design in research limits the ability to establish causal relationships. ConclusionMental health practitioners can employ the KNN model alongside patients' medical histories to detect those who may be at a higher risk of attempting suicide. This approach enables healthcare professionals to take appropriate measures, such as counselling, encouraging regular sleep patterns, and addressing depression and anxiety, to prevent suicide attempts.

Psychometric properties, predictive utility and diagnostic capacity of the Persian version of the Scale of Resilience to Suicide Attempts in army conscripts.

Suicide among army conscripts represents a poorly understood and complex public health issue that has escalated in recent decades. The early identification of individuals at risk holds the potential to significantly contribute to the effective prevention of suicide attempts. To address this, the Scale of Resilience to Suicide Attempts-18 (SRSA-18) has been developed to assess protective factors related to suicide attempts. The present study aimed to develop a Persian version of SRSA-18 (P-SRSA) and examine its psychometric properties and predictive utility within a sample of the Iranian Army. The initial study sample consisted of 400 male conscripts from the Iranian Army grand forces (M=19.86, SD=1.40). Subsequently, for the follow-up stage, 296 participants (M=19.83, SD=1.39) were recruited. The participants were assessed using various measures of resilience, social support, suicide and hopelessness at baseline and a 6-month follow-up. In contrast to the original version, both exploratory and confirmatory factor analyses supported an 18-item two-factor model of the P-SRSA (root mean square error of approximation=0.076; 95% CI (0.069 to 0.086), comparative fit index=0.943, Tucker-Lewis index=0.936). P-SRSA strongly correlated with convergent/divergent measures and demonstrated satisfactory internal consistency (α=0.82). Furthermore, regression analysis revealed that the P-SRSA significantly predicted suicide reattempts at baseline and during a 6-month follow-up period. The study confirms that the P-SRSA, comprising a two-factor, 18-item solution, is a reliable measure of resilience, displaying robust discriminant and predictive validity. These findings provide substantial support for implementing P-SRSA in samples from the Iranian Army, highlighting its potential to identify suicidal conscripts effectively.

Is combined antidepressant medication (ADM) and psychotherapy better than either monotherapy at preventing suicide attempts and other psychiatric serious adverse events for depressed patients? A rare events meta-analysis.

Antidepressant medication (ADM)-only, psychotherapy-only, and their combination are the first-line treatment options for major depressive disorder (MDD). Previous meta-analyses of randomized controlled trials (RCTs) established that psychotherapy and combined treatment were superior to ADM-only for MDD treatment remission or response. The current meta-analysis extended previous ones by determining the comparative efficacy of ADM-only, psychotherapy-only, and combined treatment on suicide attempts and other serious psychiatric adverse events (i.e. psychiatric emergency department [ED] visit, psychiatric hospitalization, and/or suicide death; SAEs). Peto odds ratios (ORs) and their 95% confidence intervals were computed from the present random-effects meta-analysis. Thirty-four relevant RCTs were included. Psychotherapy-only was stronger than combined treatment (1.9% v. 3.7%; OR 1.96 [1.20-3.20], p = 0.012) and ADM-only (3.0% v. 5.6%; OR 0.45 [0.30-0.67], p = 0.001) in decreasing the likelihood of SAEs in the primary and trim-and-fill sensitivity analyses. Combined treatment was better than ADM-only in reducing the probability of SAEs (6.0% v. 8.7%; OR 0.74 [0.56-0.96], p = 0.029), but this comparative efficacy finding was non-significant in the sensitivity analyses. Subgroup analyses revealed the advantage of psychotherapy-only over combined treatment and ADM-only for reducing SAE risk among children and adolescents and the benefit of combined treatment over ADM-only among adults. Overall, psychotherapy and combined treatment outperformed ADM-only in reducing the likelihood of SAEs, perhaps by conferring strategies to enhance reasons for living. Plausibly, psychotherapy should be prioritized for high-risk youths and combined treatment for high-risk adults with MDD.

Warning signs for suicide attempts in psychiatric inpatients: Patient and informant perspectives

ObjectiveWarning signs can help prevent suicide attempts and death. It is important to develop an evidence base for warning signs that considers both self-perspectives (i.e., those at risk for suicide) and informant-perspectives (i.e., those who observe individuals at risk for suicide). MethodsA questionnaire assessing a diverse set of 80 potential warning signs (“present in the minutes, hours, or days before the suicide attempts”) was developed based on literature searches, lived experience consultations, and the American Association of Suicidology (AAS) expert consensus list. This questionnaire was administered to two samples: psychiatric inpatients who had attempted suicide (n = 476), and informants identified as friends, family, or caretakers of patients (n = 120). ResultsHopelessness, anxiousness, and unbearable pain were each endorsed as warning signs by >80% of inpatients and informants. Warning signs were similar across patient and informant perspectives, and across sociodemographic and clinical characteristics. Some AAS warning signs were endorsed by few patients and informants (risky behaviors, alcohol or drug use, seeking revenge) and may warrant re-evaluation. ConclusionsFindings are consistent with models of suicide risk emphasizing pain, hopelessness, and anxiousness. Existing lists of warning signs may benefit from revision as the evidence base continues to develop.

A structural test of the three-step theory (3ST) of suicide in the Iranian population: From ideation to action.

Suicide is one of the leading causes of death, especially in adolescents and young adults. This study aimed to perform a structural test of the three-step theory(3ST) of suicide in the Iranian population. The research population included Iranian people over 18 years of age. The participants were 600 persons selected through convenience sampling. The data in this study were collected using the Suicide Attempt Questionnaire, the Suicide Behaviors Questionnaire-Revised, the Interpersonal Needs Questionnaire, the Impulsiveness Scale, the Depressive Symptom-Suicidality Subscale, ACSSACSS-Fearlessness About Death, the Psychache Scale, the Beck Hopelessness Scale, and the Suicide Capacity Scale. Data analysis showed that pain and positive helplessness (β = 0.45; p < 0.05) positively interact with suicidal behavior. Moreover, pain and negative helplessness significantly interact with suicidal ideation (β = 0.65; p < 0.001). The data also showed that the absence of interpersonal needs plays a protective role. A comparison of the three suicidal capacity factors indicated that only the practical capacity differentiates the ideation and action subgroups. The insights from this study provide a clear picture of the underlying causes of suicidal ideation and behavior and can help counselors and other human health professionals working with people with suicidal thoughts and behavior to prevent suicide attempts. Following functional models, they can also make serious efforts to perform therapeutic interventions to eliminate or reduce suicidal thoughts and feelings.

Cognitive behavioral therapy following esketamine for major depression and suicidal ideation for relapse prevention: The CBT-ENDURE randomized clinical trial study protocol

In 2020, esketamine received a supplemental indication as a therapy for major depression with suicidal ideation (MDSI), based on protocols enrolling hospitalized patients. Given the high risk of suicide following hospital discharge and the high relapse rates following discontinuation of esketamine, the optimal long-term treatment approach remains unclear. Cognitive behavioral therapy (CBT) is highly effective in relapse prevention and has been shown to prevent suicide attempts in high-risk populations. Here we describe the study protocol for the CBT-ENDURE trial: Cognitive Behavioral Therapy Following Esketamine for Major Depression and SUicidal Ideation for RElapse Prevention. Patients with depression (N = 100) who are admitted to hospital or are outpatients with clinically significant suicidal ideation will be enrolled in the study. All patients will receive esketamine (twice weekly for four weeks) and will be randomly assigned (1:1 ratio) to receive a 16-week course of CBT plus treatment as usual (CBT group) or treatment as usual only (TAU only group). Patients are followed for a total of 6 months. Supported under a funding announcement from NIMH to conduct safety and feasibility trials for patients at high risk for suicide, the primary outcome of the CBT-ENDURE study is feasibility (as measured by recruitment and retention), with a key secondary outcome being relapse among those who experience substantial benefit following two weeks of esketamine.

Psychological disorders and suicide attempts in youths during the pre-COVID and post-COVID era in a Taiwan pediatric emergency department.

The COVID-19 pandemic has had a significant impact on pediatric patients, increasing their vulnerability to psychological fragility. The aim of this study was to investigate the epidemiology and clinical spectrum of pediatric psychological fragility and suicide attempts in the emergency department (ED) before and after the onset of the COVID-19 outbreak. A total of 340 pediatric patients admitted to the ED for psychological fragility between 2019 and 2022 were retrospectively collated and categorized according to three periods: pre pandemic, pandemic, and post pandemic. Epidemiological and clinical information were analyzed and compared among the three groups. Moreover, patients with suicidal ideation or suicidal attempts and types of substance use disorders in children with suicidal attempts sent to the ED were analyzed. The proportion of psychological fragility increased during the pandemic period (0.4%) and the post-pandemic period (0.8%) compared to that in the pre-pandemic period (0.28%). Suicide ideation was the highest before the pandemic period (0.04%), while suicidal attempts were the highest in the post pandemic period (0.42%). Significantly elevated trends in suicide attempts involving overdose and injury were observed among the three groups (p < 0.05). Intensive care unit (ICU) admission rates increased significantly after the COVID-19 outbreak (p < 0.05), and major depressive disorder was the most common psychological fragility in the ED in all three groups. An increase in the proportion of pediatric psychological fragility in the ED was noted in the post pandemic period than before or during the pandemic. With higher rates of ICU admissions and an increase in suicide attempts among children and adolescents during the pandemic compared to before or after the pandemic, it is of utmost importance to provide mental health support to this vulnerable population in order to prevent suicide attempts in the event of a new global outbreak of infectious diseases.

Factors associated with suicidal attempts in female patients with mood disorder.

This study aims to establish a nomogram model to predict the relevance of SA in Chinese female patients with mood disorder (MD). The study included 396 female participants who were diagnosed with MD Diagnostic Group (F30-F39) according to the 10th Edition of Disease and Related Health Problems (ICD-10). Assessing the differences of demographic information and clinical characteristics between the two groups. LASSO Logistic Regression Analyses was used to identify the risk factors of SA. A nomogram was further used to construct a prediction model. Bootstrap re-sampling was used to internally validate the final model. The Receiver Operating Characteristic (ROC) curve and C-index was also used to evaluate the accuracy of the prediction model. LASSO regression analysis showed that five factors led to the occurrence of suicidality, including BMI (β = -0.02, SE = 0.02), social dysfunction (β = 1.72, SE = 0.24), time interval between first onset and first dose (β = 0.03, SE = 0.01), polarity at onset (β = -1.13, SE = 0.25), and times of hospitalization (β = -0.11, SE = 0.06). We assessed the ability of the nomogram model to recognize suicidality, with good results (AUC = 0.76, 95% CI: 0.71-0.80). Indicating that the nomogram had a good consistency (C-index: 0.756, 95% CI: 0.750-0.758). The C-index of bootstrap resampling with 100 replicates for internal validation was 0.740, which further demonstrated the excellent calibration of predicted and observed risks. Five factors, namely BMI, social dysfunction, time interval between first onset and first dose, polarity at onset, and times of hospitalization, were found to be significantly associated with the development of suicidality in patients with MD. By incorporating these factors into a nomogram model, we can accurately predict the risk of suicide in MD patients. It is crucial to closely monitor clinical factors from the beginning and throughout the course of MD in order to prevent suicide attempts.

Association between COVID-19 and self-harm: a nationwide retrospective ecological spatiotemporal study in metropolitan France (Preprint)

Association between COVID-19 and self-harm: a nationwide retrospective ecological spatiotemporal study in metropolitan France (Preprint)

Folic acid prescription and suicide attempt prevention: effect of past suicidal behaviour, psychiatric diagnosis and psychotropic medication.

We previously showed that folic acid prescriptions for any indication were associated with lower rates of suicidal behaviour. Given that future randomised clinical trials are likely to focus on psychiatric disorders carrying elevated risk for suicide, we now report on the moderating effects of prior suicidal behaviour, psychiatric diagnoses and psychotropic medications on potential antisuicidal effects of folic acid. Data were obtained from the MarketScan Commercial Claims and Encounters databases that cover 164 million insured persons from 2005-2017, from which a cohort of 866 586 patients was derived. Analysis revealed no significant moderation effects on the antisuicidal effect of folic acid. These findings indicate that the potential benefit of folic acid for preventing suicidal behaviour is comparable in psychiatric populations at higher risk of suicide and that it may be additive to any benefit from psychotropic medications.

Vitamin D - a key to reducing the risk of suicide?

Introduction: Vitamin D has a major positive impact on human health. Its daily supplementation regulates calcium metabolism, inflammatory and neuromodulatory processes. More importantly, vitamin D may be an important factor in reducing the risk of suicide among psychiatric patients. This review aims to describe the potential positive effect of vitamin D supplementation in preventing suicide attempts. Method: The literature review was conducted by search of articles in English and Polish languages on PubMed, Medline, and Google Scholar, published from 1974 to the 1st of April 2023, following SANRA requirements. The search utilized the following keywords: vitamin D, vitamin D deficiency, vitamin D supplementation, suicide, depression, bipolar disorder, schizophrenia, ADHD, anxiety, and autism. The analysis encompassed original studies, meta-analyses, randomized controlled trials, and review articles. Results: There is a limited number of studies investigating the impact of vitamin D supplementation on suicide risk in individuals with mental illness. Several studies suggest that vitamin D may have a beneficial effect on symptoms of mental illnesses. However, the exact mechanism through which vitamin D exerts its therapeutic effects on mental health remains unclear. Incorporating vitamin D into the treatment of the mental disorders such as depression, schizophrenia, bipolar disease, ADHS, autism spectrum disorder, and anxiety, as well as supplementing it during pregnancy and throughout life, could potentially be an effective therapeutic adjunct for suicide prevention approach. Conclusions: According to all the research and gathered data, there is a correlation between Vitamin D supplementation and a decrease in suicide risk among patients suffering from mental disorders. Several lines of evidence have shown a positive impact on mental health in patients suffering from mental diseases. However, further research is needed to establish the mechanisms of the therapeutic effect of Vitamin D. Keywords: vitamin D, vitamin D supplementation, suicide, psychiatric disorders

Spatiotemporal clustering of suicide attempt in Kermanshah, West-Iran.

A suicide attempt is a major societal problem because it imposes high costs on societies worldwide. This paper analyses the spatiotemporal clustering of suicide attempt in Kermanshah, Iran from 2006-14. This study draws on 18,333 individuals (7,234 males and 11,097 females) who attempted suicide across the Kermanshah province. Data was collected from the records of individuals registered in hospitals across the Kermanshah province between 2006 and 2014. Mean Center, Standard Deviational Ellipse (SDE), Moran's I and Kernel Density Estimation (KDE) in Arc/GIS10.6 software were used for the analysis of the spatial distribution of suicide attempt, while the chi-squared test in SPSS was used to examine the different demographic variables between groups within/outside spatial clusters of suicide. The results show that a total of 18,331 suicide attempts (39.46% male and 60.53% female) were reported between 2006 and 2014 in the Kermanshah province. The spatial pattern of suicide attempts was clustered in 16 clusters (6 high clusters and 10 low clusters) and statistically significant differences were found within and outside the hotspots of suicide attempts. Most hot spots were formed in and around cities. Younger people were at a greater risk. The rate of suicide attempts reduced in illiterate people and increased in people with university degrees. Unmarried people were associated with a higher risk of suicide attempt than was married status for both males and females. The results of this study could help public health practitioners and policymakers in Iran prioritize resources and target efforts for suicide attempt prevention.

Dynamic Fall Detection Using Graph-Based Spatial Temporal Convolution and Attention Network

The prevention of falls has become crucial in the modern healthcare domain and in society for improving ageing and supporting the daily activities of older people. Falling is mainly related to age and health problems such as muscle, cardiovascular, and locomotive syndrome weakness, etc. Among elderly people, the number of falls is increasing every year, and they can become life-threatening if detected too late. Most of the time, ageing people consume prescription medication after a fall and, in the Japanese community, the prevention of suicide attempts due to taking an overdose is urgent. Many researchers have been working to develop fall detection systems to observe and notify about falls in real-time using handcrafted features and machine learning approaches. Existing methods may face difficulties in achieving a satisfactory performance, such as limited robustness and generality, high computational complexity, light illuminations, data orientation, and camera view issues. We proposed a graph-based spatial-temporal convolutional and attention neural network (GSTCAN) with an attention model to overcome the current challenges and develop an advanced medical technology system. The spatial-temporal convolutional system has recently proven the power of its efficiency and effectiveness in various fields such as human activity recognition and text recognition tasks. In the procedure, we first calculated the motion along the consecutive frame, then constructed a graph and applied a graph-based spatial and temporal convolutional neural network to extract spatial and temporal contextual relationships among the joints. Then, an attention module selected channel-wise effective features. In the same procedure, we repeat it six times as a GSTCAN and then fed the spatial-temporal features to the network. Finally, we applied a softmax function as a classifier and achieved high accuracies of 99.93%, 99.74%, and 99.12% for ImViA, UR-Fall, and FDD datasets, respectively. The high-performance accuracy with three datasets proved the proposed system’s superiority, efficiency, and generality.

Crippled with Remorse and Judgment of Others: A Phenomenological Study of Suicide Attempts in Men Dealing with Substance Use

Background: Suicide is one of the biggest concerns of the World Health Organization. Every year, around 703,000 people end their lives. Objectives: The purpose of this study is to provide a phenomenological study of suicide attempts in men dealing with substance use. Methods: This is a qualitative study with a hermeneutic phenomenological approach. The participants of this study were 12 men who had a history of substance use and suicide attempts. The participants were chosen through an objective sampling method to participate in semi-structured interviews. The collected data were analyzed by the seven-stage Diekelmann et al. (1989) analysis method. Results: The participants' experiences were analyzed on two separate themes. The first theme was "inefficient personality traits," having the two sub-themes of "impulsive behavior" and "emotional instability." The second theme was "the stigma related to addiction." Furthermore, this study resulted in a constitutive pattern known as crippled with remorse and judgment of others. Conclusions: Inefficient personality traits and the stigma related to addiction drive men with substance use to suicide attempts, and they are prone to commit suicide again if these conditions continue to prevail. Mental health consultants and psychiatrists can take effective measures to reduce and prevent suicide attempts if they consider this study's findings.

The role of parents’ and friends’ support in preventing suicide attempts among French sexual minority adolescents

ObjectivesFrench sexual minority adolescents are at higher risk for suicide attempts than their heterosexual peers. However, little is known about the role of parents’ and friends’ support among French lesbian, gay and bisexual (LGB) youth. This study aimed to research the role of their support in preventing suicide attempts among LGB adolescents in France. Materials and MethodsData were drawn from a French cross-sectional study entitled “Portraits d'adolescents”. Parental support was defined by satisfactory relations between participants and their parents. Friends’ support was defined by satisfactory relations between participants and their friends. Chi-square and multiple logistic regression analyses were used to estimate and identify associated factors of suicide attempts in LGB as opposed to heterosexual youth. ResultsData from a sample of 14,265 French adolescents aged 13 to 20 were analyzed. Among them, 637 (4.47%) identified as LGB. Attempted suicide was independently associated with sexual orientation (30.7% vs 10.6%; OR = 2.59 [2.11–3.18]; p < 0.0001). Both parents’ and friends’ support appeared to be protective factors in suicide attempts among heterosexuals (adjusted ORs = 0.40 [0.35–0.46] and 0.61 [0.51–0.75], respectively), whereas in the LGB group, only parental support was significant (adjusted OR = 0.42 [0.27–0.65]), independently of other variables. DiscussionPrevention efforts might be carried out by identifying within-group differences among French adolescents with different sexual orientations. The supportive role of family members should be strengthened. Positive resources and salutary support systems may effectively prevent suicide attempts. ConclusionsFrench LGB adolescents have a higher risk for suicide attempts than their heterosexual peers. Parental support was reconfirmed as a major protective factor against suicide attempts in sexual minority adolescents.

Efficacy of a regional systems intervention for suicide prevention (SUPREMOCOL) in Noord-Brabant, the Netherlands

IntroductionWorldwide, annually more than 800,000 suicides occur. In the Netherlands, suicide rates rose from 8.6 per 100,000 in 2007 to 11.4 per 100,000 in 2016. Rates in the province of Noord-Brabant were consistently higher than the national average. Noord-Brabant is a province in the south of the Netherlands covering an area of over 4700 km2 with 2.5 million inhabitants. Although Noord-Brabant has five specialised mental healthcare institutions (SMHIs), and 90% of suicides are deemed related to mental disorders, 60% of those who died by suicide did not receive mental health treatment. However, with good access to treatment, suicide could be preventable.ObjectivesTo evaluate whether the systems intervention compared to the regular care approach led to a reduction in suicides in Noord-Brabant. We aimed to attain a reduction in suicides of at least 20%.MethodsCo-design and development of a digital monitoring system and decision aid. Stepwise implementation per subregion of the systems intervention by the five specialized mental healthcare institutions (SMHIs) and their chain partners. Pre-post analysis for the whole province (Exact Rate Ratio Test, Poisson count).ResultsThe SUPREMOCOL systems intervention consisted of four pillars, which were all supported by a digital decision aid and monitoring system. This was provided via a desktop computer with a secured login. The data were kept on a secured encrypted server. The number of professionals accessing the system was limited to two per SMHI or other chain partner. They could only see patients in their subregion, not in the whole of the province. The pillars of our systems intervention for suicide prevention are:1. Swift identication of people at risk for suicide by triage on the spot after a non-fatal suicide attempt.2. Provision of swift access to specialised mental health care for those at risk3. Accommodating transitions in care following a collaborative care approach4. Prevention of suicidal attempts after discharge or treatment dropout by 12 months telephone follow-up.Suicide rates dropped 17.8% (p=.013) from baseline (2017) to implementation in 2018 and 2019. This is a significant reduction (p=0.043) compared to the non-significant drop in the rest of the Netherlands. Suicide rates dropped further by 21.5% (p = 0.002) in 2021.Noord-Brabant also dropped in the relative rank of the number of suicides, from second place in 2015 to third in 2018.ConclusionsDuring the SUPREMOCOL systems intervention, over a period of 4 years, there was a sustained and significant reduction of suicides in Noord-Brabant. We attained a reduction of 21,5% in total. Noord-Brabant dropped in the relative rank of the number of suicides, from second place in 2015 to third in 2018. This is a result that warrants further research and implementation into system interventions for suicide prevention with digital support such as SUPREMOCOL.Disclosure of InterestC. Van Der Feltz-Cornelis Grant / Research support from: The Netherlands Organisation for Health Research and Development, I. Elfeddali: None Declared, M. Metz: None Declared, S. de Jong: None Declared, M. Bakker: None Declared, C. van Nieuwenhuizen: None Declared

Pharmaceutical toxicity is a common pattern of inpatient acute poisonings in Birjand City, East of Iran

Information on the pattern of acute poisonings in hospitals of Birjand city, Iran, is limited. This study aimed to address this knowledge gap by examining the admissions in a major poisoning center in eastern Iran. This cross-sectional study included patients admitted to the Imam Reza Hospital in Birjand over 12 months. Medical records of the poisoned patients were reviewed, and the study variables were used for data analysis. During the study period, 534 cases of acute poisonings were evaluated. The patient's ages ranged from 12 to 84 years, with a high rate of poisonings between 15 and 35 years. The female predominance in poisoning cases was 52.1%. Most cases of poisonings occurred in spring, and the common route of exposure was oral (93.1%). The incidence of poisoning in married couples, uneducated patients, and residents of urban areas was 56.5%, 90.1%, and 74.6%, respectively. Patients with a previous medical history experienced addiction and psychiatric disorders. Intentional poisoning accounted for 23.4% of acute poisoning cases referred to the hospital in the current study. The main groups of toxicants were pharmaceutical products (48.1%), narcotics (25.8%), chemical products (10.1%), envenomation (7.1%), and alcohol (1.7%). The mean hospital stay was 2.5 ± 3.0 days, and the final treatment outcome was complete recovery, except for one patient intoxicated by warfarin and alprazolam. Our results indicate that the high toxicity cases were related to pharmaceutical product and opioids abuse, especially methadone (8.4%), alprazolam (7.9%), clonazepam (7.5%), and acetaminophen (9.9%) taken orally and more commonly happened at home. Due to the high rate of deliberate poisonings, especially among young adults and students, monitoring drug distribution and exceptional attention to mental health should be seriously considered by national health authorities to prevent suicide attempts.

Naturally absorbed lithium may prevent suicide attempts and deliberate self-harm while eicosapentaenoic acid may prevent deliberate self-harm and arachidonic acid may be a risk factor for deliberate self-harm: The updated different findings in new analyses.

Since our previous investigation on the effects of trace lithium, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and arachidonic acid (AA) on deliberate self-harm and suicide attempts in 2018, to our knowledge, no replication study has been conducted on this topic. We increased 37 new patients and totally 234 patients were re-analyzed to further investigate the association of suicide-related behaviors with levels of trace lithium, EPA, DHA, and AA in a different way to avoid multicollinearity. Higher lithium levels were significantly associated with fewer suicide attempts and deliberate self-harm, higher EPA levels were significantly associated with fewer deliberate self-harm, and higher AA levels were significantly associated with more deliberate self-harm. Although the sample size was only slightly larger than the previous study, the present results were clearly different from the previous ones due to the use of different statistical analyses to avoid multicollinearity. The present findings suggest that naturally absorbed lithium may protect against suicide and deliberate self-harm, while naturally absorbed EPA may protect against deliberate self-harm. However, naturally absorbed AA may be a risk factor for deliberate self-harm.