Rates Of Suicide Attempts Research Articles

Transgender Identity and Suicide Attempts and Mortality in Denmark

ImportancePrior studies have suggested that transgender individuals may be a high-risk group with respect to suicide attempt and mortality, but large-scale, population-based investigations are lacking.ObjectiveTo examine in a national setting whether transgender individuals have higher rates of suicide attempt and mortality than nontransgender individuals.Design, Setting, and ParticipantsNationwide, register-based, retrospective cohort study on all 6 657 456 Danish-born individuals aged 15 years or older who lived in Denmark between January 1, 1980, and December 31, 2021.ExposureTransgender identity was determined through national hospital records and administrative records of legal change of gender.Main Outcomes and MeasuresSuicide attempts, suicide deaths, nonsuicidal deaths, and deaths by any cause during 1980 through 2021 were identified in national hospitalization and causes of death registers. Adjusted incidence rate ratios (aIRRs) with 95% CIs controlling for calendar period, sex assigned at birth, and age were calculated.ResultsThe 6 657 456 study participants (50.0% assigned male sex at birth) were followed up during 171 023 873 person-years. Overall, 3759 individuals (0.06%; 52.5% assigned male sex at birth) were identified as transgender at a median age of 22 years (IQR, 18-31 years) and followed up during 21 404 person-years, during which 92 suicide attempts, 12 suicides, and 245 suicide-unrelated deaths occurred. Standardized suicide attempt rates per 100 000 person-years were 498 for transgender vs 71 for nontransgender individuals (aIRR, 7.7; 95% CI, 5.9-10.2). Standardized suicide mortality rates per 100 000 person-years were 75 for transgender vs 21 for nontransgender individuals (aIRR, 3.5; 95% CI, 2.0-6.3). Standardized suicide-unrelated mortality rates per 100 000 person-years were 2380 for transgender vs 1310 for nontransgender individuals (aIRR, 1.9; 95% CI, 1.6-2.2), and standardized all-cause mortality rates per 100 000 person-years were 2559 for transgender vs 1331 for nontransgender individuals (aIRR, 2.0; 95% CI, 1.7-2.4). Despite declining rates of suicide attempts and mortality during the 42 years covered, aIRRs remained significantly elevated in recent calendar periods up to and including 2021 for suicide attempts (aIRR, 6.6; 95% CI, 4.5-9.5), suicide mortality (aIRR, 2.8; 95% CI, 1.3-5.9), suicide-unrelated mortality (aIRR, 1.7; 95% CI, 1.5-2.1), and all-cause mortality (aIRR, 1.7; 95% CI, 1.4-2.1).Conclusions and RelevanceIn this Danish population-based, retrospective cohort study, results suggest that transgender individuals had significantly higher rates of suicide attempt, suicide mortality, suicide-unrelated mortality, and all-cause mortality compared with the nontransgender population.

(053) Multidisciplinary Treatment of Transgender Woman with Severe Gender Dysphoria and Comorbid Psychiatric Disorders - Case Report

Abstract Introduction Gender dysphoria is a distress a person feels due to incongruence between their gender identity and their birth assigned sex. Transgender people have higher rates of mood disorders, suicidal ideations and suicide attempts as well as poorer general health. They often abuse psychoactive substances. There is also a correlation between perceived stigma and discrimination. Objectives The purpose of this case report is to show the treatment process of a transgender person born as a man using multidisciplinary approach based on the bio-psycho-social model, taking sex history, comorbid psychiatric disorders, social constraints and psychological needs into account. Methods A 45-year old male came to the Transgender clinic in Ljubljana, Slovenia. He wanted to transition from male to female. At that time, his appearance, sex and gender was male. He was a miner, married to a woman and lived with his wife in the countryside. His family was ashamed of him because he would go on nights out in public dressed as a woman and had a drinking problem. In the diagnostic phase we confirmed alcohol dependency and severe depression and had him join the addiction treatment programme, which proved successful as he reached stable abstinence. Having overcoming alcohol addiction he still tried very hard to repress his desire to become a woman. His wife tried to get pregnant but he avoided sexual intercourse. He had serious problems with erection and painful sex ascribed to phimosis and eventually got circumcised. He also confessed that he still dressed as a woman in secret, that he wanted to become a woman and consequently started referring to himself as ‘a she’. The wife demanded a divorce. Clinical psychological assessment showed no psychiatric contraindications to start with hormone therapy, first with antiandrogens and a year later with oestrogens, which successfully reduced her gender dysphoria. She reached emotional stability and stopped taking antidepressants. She did not need any otorhinolaryngological procedures or voice therapy. She had face laser therapy and genital epilation as well as nose operation, breast augmentation and genital reconstructive surgery. She received support from the Slovenian non- government organisations and other transgender women. She got a permanent new job in the same firm. Her family of the origin finally accepted her. Results Treatment, which lasted for ten year, resulted in a complete medical and social transition without any regrets. She now lives as a woman, uses dilatators and wants to have a biological male partner. She is on permanent therapy with oestradiol, aldactone, dutasteride, and vitamin D. She does not drink alcohol, has no comorbid psychiatric disorders neither gender dysphoria. She is emotionally stable with positive body image and self-esteem. She wears a wig because of hair loss. Conclusions Treatment, which lasted for ten year, resulted in a complete medical and social transition without any regrets. She now lives as a woman, uses dilatators and wants to have a biological male partner. She is on permanent therapy with oestradiol, aldactone, dutasteride, and vitamin D. She does not drink alcohol, has no comorbid psychiatric disorders neither gender dysphoria. She is emotionally stable with positive body image and self-esteem. She wears a wig because of hair loss. Disclosure No.

Evaluation of a Community Suicide Prevention Project (Roots of Hope): Protocol for an Implementation Science Study.

Roots of Hope (RoH) is a multisite Canadian community-based suicide prevention initiative developed by the Mental Health Commission of Canada (MHCC), which is based on evidence for intervention effectiveness and World Health Organization recommendations. Seven communities developed local activities in the following 5 pillars: specialized supports, training and networks, public awareness, means safety, and evaluation research. We aim to use an implementation research approach to understand the RoH model for reducing suicidal behaviors and their impacts in communities, and the lessons learned for the equitable development and implementation of RoH in different contexts. Moreover, we want to understand how the program is implemented in relation to the context, the causal pathways, and the factors influencing successful implementation. The evaluation includes assessments of short-term and intermediate effects at each site and overall. The principal investigator (PI) developed a consensus among local research coordinators on common approaches and indicators through ongoing participation in an online community of practice, and regular virtual and in-person meetings. At the completion of the pilot phase, the PI will summarize evaluation results across sites and conduct pooled analyses. The RoH theory of change and evaluation model shows how evaluation activities from the planning phase through the implementation of activities in each of the pillars can help clarify the viability of the RoH model and identify factors that facilitate and inhibit effective and equitable implementation in different contexts. Beginning with a situational analysis to identify resources in each community and local specificities, we will examine the implementation characteristics of conformity, dosage, coverage, quality, utility, equity, appreciation, facilitators, and impediments. Evaluation of short-term effects will focus on changes in knowledge, attitudes, behaviors, help-seeking, service use, stigma, media reports, empowerment, and care experiences. Intermediate effects, long-term effects, and impact will include assessments of the changes in suicides, suicide attempt rates, and suicide risk indicators. A variety of data sources, both quantitative and qualitative, will be used. The quantitative and qualitative data from all sites will be summarized by the PI in March 2023 to draw conclusions to help the MHCC in its improvements to the RoH model, and to inform communities about how to better implement RoH. Since the COVID-19 pandemic occurred at the beginning of program implementation, its impact and influence will be documented. The validity of RoH in contributing to the prevention of suicides and suicidal behaviors will be clarified in a variety of contexts. The final evaluation report will be available in September 2023. The evaluation results, including the identification of factors that facilitate and inhibit the implementation of RoH and the adaptations to challenges, will be useful to the MHCC, current RoH communities, and those considering adopting the RoH model. DERR1-10.2196/39978.

Examining the Influence of the Neighborhood Environment on Stress Among Black American Adolescents: A Scoping Review

The prevalence of mental health challenges continues to worsen among adolescents, with Black American adolescents experiencing rates of suicide attempts that are increasing faster than any other racial and ethnic groups. Research has found that the neighborhood environment impacts mental health through the type and level of stress that people experience generally. More is yet to be known, however, about the biological and psychological impacts of the neighborhood environment on stress among Black American adolescents. This study used a scoping review to explore the neighborhood environment’s contribution to stress among Black American adolescent’s, specifically. Seven bibliographic databases were used to identify relevant studies. Ten articles met eligibility criteria and were included in this review. Findings reveal that the biological stress response to neighborhood poverty and community violence has implications for mental and behavioral health functioning in adolescence. Implications for future research and interventions are discussed.

Prevalence and influencing factors of suicide in first-episode and drug-naive young major depressive disorder patients with impaired fasting glucose: a cross-sectional study.

An association exists between major depression disorder (MDD), suicide attempts, and glucose metabolism, but suicide attempts in young MDD patients with comorbid impaired fasting glucose (IFG) have been less well studied. The purpose of this study was to examine the prevalence and risk factors for suicide attempts in young, first-episode, drug-naive (FEDN) MDD patients with comorbid IFG. We recruited 917 young patients with FEDN MDD, 116 of whom were judged to have combined IFG because their blood glucose was >6.0. We collected anthropological and clinical data on all of them. The Hamilton Depression Scale (HAMD) score, the Hamilton Anxiety Scale (HAMA) score and the Positive and Negative Syndrome Scale (PANSS) positive subscale score were used to assess their clinical symptoms. Blood glucose, plasma thyroid function and lipid indicators were measured. The prevalence of suicide attempts in young MDD patients with IFG was 32.8% (38/116). Furthermore, among young MDD patients with comorbid IFG, suicide attempters had more severe depression and anxiety symptoms, more comorbid psychotic symptom, higher levels of antibody of thyroid stimulating hormone and thyroid peroxidases (TPOAb), and more severe lipid metabolism disorders than those without suicide attempts. In addition, HAMA scores and TPOAb were independently associated with suicide attempts in young patients with FEDN MDD. Our study suggests that young MDD patients with IFG have a high rate of suicide attempts. Some clinical symptoms and thyroid function parameters may be the risk factor for suicide attempts in young MDD patients with impaired glucose metabolism.

Predictors of current suicidal ideation in a multi-diagnostic sample of individuals with eating disorders

BackgroundIndividuals with eating disorders (EDs) have high rates of suicidal ideation (SI) and attempts (SA). Fasting, body dissatisfaction, binge eating and purging have been associated with SI in non-clinical samples, individuals with anorexia nervosa or low-weight EDs, and a multi-diagnostic sample. However, few studies have examined how ED symptoms contribute to risk for SI in conjunction with other well-established risk factors, such as nonsuicidal self-injury (NSSI) and past SA. The aim of this study was to examine which ED symptoms contribute unique risk for current SI in a multi-diagnostic, clinical sample when statistically adjusting for gender, NSSI, past SA, and past SI.MethodsWe conducted a chart review of 166 individuals who presented for ED treatment at an outpatient facility and signed informed consent. Initial intake interviews were coded for the presence versus absence of fasting, fear of weight gain, binge eating, purging, excessive exercise, restriction, body checking, self-weighing, and body dissatisfaction, as well as NSSI, past SA, past SI, and current SI.ResultsA total of 26.5% of the sample endorsed current SI. In a logistic regression analysis, identifying as male (n = 17) or having a non-binary gender identity (n = 1), the presence of fasting, and past SI were all significantly associated with increased odds of current SI, whereas excessive exercise significantly decreased odds of current SI. Fasting was equally common across all diagnostic groups.ConclusionsFuture research should establish the temporal relationship between fasting and SI to better inform intervention.

Impact of different interventions on preventing suicide and suicide attempt among children and adolescents in the United States: a microsimulation model study.

Despite considerable investment in suicide prevention since 2001, there is limited evidence for the effect of suicide prevention interventions among children and adolescents. This study aimed to estimate the potential population impact of different interventions in preventing suicide-related behaviors in children and adolescents. A microsimulation model study used data from national surveys and clinical trials to emulate the dynamic processes of developing depression and care-seeking behaviors among a US sample of children and adolescents. The simulation model examined the effect of four hypothetical suicide prevention interventions on preventing suicide and suicide attempt in children and adolescents as follows: (1) reduce untreated depression by 20, 50, and 80% through depression screening; (2) increase the proportion of acute-phase treatment completion to 90% (i.e., reduce treatment attrition); (3) suicide screening and treatment among the depressed individuals; and (4) suicide screening and treatment to 20, 50, and 80% of individuals in medical care settings. The model without any intervention simulated was the baseline. We estimated the difference in the suicide rate and risk of suicide attempts in children and adolescents between baseline and different interventions. No significant reduction in the suicide rate was observed for any of the interventions. A significant decrease in the risk of suicide attempt was observed for reducing untreated depression by 80%, and for suicide screening to individuals in medical settings as follows: 20% screened: -0.68% (95% credible interval (CI): -1.05%, -0.56%), 50% screened: -1.47% (95% CI: -2.00%, -1.34%), and 80% screened: -2.14% (95% CI: -2.48%, -2.08%). Combined with 90% completion of acute-phase treatment, the risk of suicide attempt changed by -0.33% (95% CI: -0.92%, 0.04%), -0.56% (95% CI: -1.06%, -0.17%), and -0.78% (95% CI: -1.29%, -0.40%) for reducing untreated depression by 20, 50, and 80%, respectively. Combined with suicide screening and treatment among the depressed, the risk of suicide attempt changed by -0.27% (95% CI: -0.dd%, -0.16%), -0.66% (95% CI: -0.90%, -0.46%), and -0.90% (95% CI: -1.10%, -0.69%) for reducing untreated depression by 20, 50, and 80%, respectively. Reducing undertreatment (the untreated and dropout) of depression and suicide screening and treatment in medical care settings may be effective in preventing suicide-related behaviors in children and adolescents.

Prevalence and clinical profile of abnormal glucose in first-episode and drug-naïve patients with major depressive disorder with comorbid abnormal thyroid function: a large-scale cross-sectional study

BackgroundThe associated factors of abnormal glucose in patients with major depressive disorder (MDD) with comorbid abnormal thyroid function (ATF) remain unclear. To the best of our knowledge, this is the first study with a large sample size that examines the risk factors of abnormal glucose in first-episode drug-naïve (FEDN) MDD patients comorbid with ATF and includes clinical correlates and thyroid hormone levels.MethodsA total of 1718 FEDN MDD patients were recruited. The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and Positive and Negative Syndrome Scale (PANSS) positive subscale were used to evaluate the symptoms of patients. Fasting blood glucose concentration and thyroid hormone levels were measured.ResultsThe prevalence of abnormal glucose in MDD patients with comorbid ATF was 47.3%, which was 4.25 times higher than that in MDD patients without ATF (17.4%). Compared to those ATF patients without abnormal glucose, ATF patients with abnormal glucose scored higher on HAMD, HAMA and PANSS positive subscale, had a higher rate of suicide attempts, severe anxiety and psychotic symptoms, and had higher levels of thyroid-stimulating hormone (TSH), and thyroid peroxidases antibody (TPOAb) which were also correlated with abnormal glucose in MDD patients comorbid ATF (all P < 0.05). The combination of HAMD score and TSH could differentiate abnormal glucose from ATF. Further, TSH was independence-related with the concentration of fasting blood glucose in MDD patients with comorbid ATF.ConclusionOur results demonstrate a high prevalence of abnormal glucose in MDD patients with comorbid ATF. Some clinical and thyroid function-related variables may be associated with abnormal glucose in MDD patients with comorbid ATF.

The Pattern of Injuries in the Emergency Room during the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has obviously caused a remarkable change in patients' emergency department (ED) visits; however, data from multicenter studies are lacking. We aimed to present a comprehensive analysis of injury-related ED visits in Republic of Korea before and during the COVID-19 pandemic. Data from 23 tertiary hospitals based on Emergency Department-based Injury In-depth Surveillance were used for this retrospective cross-sectional study. A total of 541,515 ED visits (age ≥ 20 years) between 1 January 2018 and 31 December 2020 were included, and the trend of injuries related to motor vehicular accidents, falls, self-harm and suicide, assault, and poisoning were compared between the pre-COVID-19 time period and during the COVID-19 pandemic. In the first year of the COVID-19 period, a decline in the number of ED visits was observed (41,275, 21%) compared to the previous year. Injuries caused by motor vehicles (36,332 in 2019 vs. 27,144 in 2020), falls and slips (61,286 in 2019 vs. 49,156 in 2020), assaults (10,528 in 2019 vs. 8067 in 2020), and poisonings (7859 in 2019 vs. 7167 in 2020) decreased, whereas self-harm and suicide (8917 in 2019 vs. 8911 in 2020) remained unchanged. The hospitalization (16.6% in 2019 vs. 18.8% in 2020) and ED mortality rate (0.6% in 2019 vs. 0.8% in 2020) also increased. The COVID-19 pandemic led to a decline in the overall number of trauma patients seeking medical care; however, the proportion of patients requiring hospitalization or intensive care unit admission increased, indicating more severe injuries among those who did seek care. Suicide attempt rates remained unchanged, highlighting the need for targeted care and support for vulnerable patients. During the pandemic, EDs had to continue to provide care to patients with medical emergencies unrelated to COVID-19, which requires a delicate and adaptable approach to ED operations. To manage the increased stress and workload caused by the pandemic, increased resources and support for healthcare workers were needed.

Suicidal ideation, plan and attempt among adolescents in Houston Texas: a trend and cross-sectional analysis of the youth risk behavior survey 2011-2019 in the United States.

We evaluated the trends in the prevalence of suicidal ideation, plan, and attempts among adolescents in Houston, Texas, USA, from 2011 to 2019. Furthermore, we assessed the risk factors associated with suicidal ideation, plan, and attempt among adolescents in Houston in 2019. A cross-sectional analysis of Houston district's Youth Risk Behavior Survey (YRBS) from 2011 to 2019. It included 11,178 adolescents aged 11-15 years in Houston middle schools. The overall and stratified (by gender, race, and ethnicity) prevalence rates were evaluated between 2011and 2019. Factors associated with suicidal ideation, plan, and attempts in 2019 were assessed using multiple logistic regression. Suicidal ideation among adolescents increased by 2.74 % from 23.14 % in 2011-25.88 % in 2019. In 2019, we observed a 4.40 % increase in the prevalence of suicidal ideation from 2017 (21.48 %). The prevalence of suicidal plan increased by 3.76 % in 2019 (17.69 %) from 2011 (13.93 %) and by 3.99 % from 2017 (13.70 %). Suicide attempts among adolescents in Houston fluctuated from 2011 to 2019. However, there was a 1.19 % increase in prevalence in 2019 (11.62 %) compared to 2017 (10.43 %). Suicidal ideation, plan, and attempt were significantly associated with being female, Black, or African American, having ever carried a weapon, being bullied on school property, being bullied online, having ever had a cigarette, having ever had alcohol, having taken cocaine, and having used prescription pain medicine illegally/inappropriately. This study found increasing rates of suicide ideation, plan, and attempts among Houston adolescents in middle schools between 2011 and 2019.

Suicide in Global Mental Health.

We review recent research on the epidemiology and etiology of suicide in the global context. We focus on data from low- and middle-income countries (LMIC), with the goal of highlighting findings from these under-researched, over-burdened settings. Prevalence of suicide in LMIC adults varies across region and country income-level, but is, on average, lower than in high-income countries. Recent gains in suicide reduction, however, have been smaller in LMIC compared to global rates. LMIC youth have much higher rates of suicide attempts than youth from high-income countries. Females as well as people with psychiatric disorders, those living with HIV, those who are LGBTQ + , and those with poor socioeconomic status are highly vulnerable populations in LMIC. Limited and low-quality data from LMIC hinder clear interpretation and comparison of results. A greater body of more rigorous research is needed to understand and prevent suicide in these settings.

Systematic Review of Interventions to Reduce Suicide Risk in Transgender and Gender Diverse Youth.

Transgender youth experience high rates of suicidal ideation and suicide attempts. This systematic review sought to examine interventions for suicide prevention in transgender children and adolescents. Literature related to suicide in the transgender population was systematically collected in accordance with PRISMA criteria. Searches identified studies with at least one suicide prevention method for participants ages 24years or younger with gender identity and sex clearly defined. Primary outcomes include suicide-related thoughts and behaviors. A total of 1558 citations were identified with 17 articles meeting inclusion criteria. Interventions with potential effectiveness included a gender-affirming crisis hotline, medical care via interdisciplinary gender clinics, online media-based outreach, safety and connectedness in schools, and family system-based interventions. In the included studies, the overall quality of evidence was low and the risk of bias high. Further high-quality studies are needed.

Association between the mood stabilizing treatment of bipolar disorder and risk of suicide attempts: A self-controlled case series study

Bipolar disorder (BPD) is associated with high rates of suicide attempts but the anti-suicidal effect of mood stabilizing agents remains unclear. This study aimed to examine the association between mood stabilizing agents (lithium, valproate, lamotrigine, carbamazepine or antipsychotics) and risk of suicide attempts in patients with BPD using self-controlled case series study design.Among 14,087 patients with BPD who received mood stabilizing agents from 2001 to 2020 in Hong Kong, 1316 patients had at least one suicide attempts during the observation period. An increased risk of suicide attempts was observed 14 days before treatment initiation compared to non-exposed period. Following treatment initiation, an increased risk with smaller magnitude was found with the use of mood stabilizing agents. A lower risk was observed with lithium and antiepileptics while the risk remained attenuated with decreasing magnitude with antipsychotics. During 30-day post-treatment period, the risk was elevated. Therefore, this study suggests that use of mood stabilizing agents is not causally associated with an increased risk of suicide attempts. Indeed, there are potential protective effects of lithium and antiepileptics against suicide attempts. Assiduous monitoring of symptoms relapse and warning signs of suicide should be part of the management plan and discussed between clinicians, caregivers and patients.

Suicidal ideation and attempts in trichotillomania

Trichotillomania is characterized by chronic pulling out of one's hair. Given the negative sequelae of trichotillomania, we examined rates of suicidal ideation and suicide attempts. Of the 219 adults (mean age = 29.5 years; 88% female) recruited, 40 (18.3%) reported lifetime suicidal ideation, and 5 (2.3%) reported a lifetime suicide attempt. Those with histories of suicidal ideation were significantly more likely to have major depressive disorder. Our findings suggest that suicidal ideation and attempts are common in trichotillomania and support the idea that comorbid depression should be considered a risk factor for suicidality.

Health Behavior and Mental Health of Adolescents in Multicultural Families Compared to Non-multicultural Families

Purpose: This study aims to compare the health behaviors and mental health of adolescents from multicultural and non-multicultural families, and to determine the effect of multicultural families on adolescents' health behaviors and mental health. Methods: The study employed a cross-sectional design, utilizing data from the Korea Youth Risk Behaviour Web-based Survey 2020 and 2021. The sample comprised 9,828 multicultural adolescents and 13,389 non-multicultural adolescents. Results: Adolescents from multicultural families showed significant differences in their experiences with alcohol (x2=9.55) and substance use (x2=11.37), as well as suicidal ideation (x2=4.57) and suicidal attempts (x2=34.19), compared to their non-multicultural peers. Logistic regression analysis revealed that adolescents from multicultural families had a 1.19 times higher rate of recent alcohol experience, a 1.14 times higher rate of stress, and a 1.55 times higher rate of suicidal attempts. However, the rates of smoking and alcohol use were 0.80 times and 0.75 times lower, respectively, among adolescents from multicultural families compared to their non-multicultural peers. Conclusion: The findings suggest that health promotion programs are needed to help adolescents from multicultural families adapt socially, cultivate preventive health behaviors, and improve their mental health. These interventions should take a multifaceted approach that encourages family participation in the programs.

Risk of non-fatal self-harm and premature mortality in the three years following hospitalization in adolescents and young adults with an eating disorder: A nationwide population-based study.

Eating disorders (ED) are associated with high rates of suicide attempts and premature mortality. However, data in large samples of adolescents and young adults are limited. This study aims to assess the risk of self-harm and premature mortality in young people hospitalized with an ED. Individuals aged 12 to 25 years old hospitalized in 2013-2014 in France with anorexia nervosa and/or bulimia nervosa as a primary or associated diagnosis were identified from French national health records. They were compared to two control groups with no mental disorders, and with any other mental disorder than ED. The main outcomes were any hospitalization for deliberate self-harm and mortality in the 3 years following hospitalization. Logistic regression models were used. This study included 5, 452 patients hospitalized with an ED, 14,967 controls with no mental disorder, and 14,242 controls with a mental disorder other than an ED. During the three-year follow-up, 13.0% were hospitalized for deliberate self-harm (vs. 0.2 and 22.0%, respectively) and 0.8% died (vs. 0.03 and 0.4%). After adjustment, hospitalization with an ED was associated with more self-harm hospitalizations (hazard ratio [HR] = 46.0, 95% confidence interval [32.3-65.3]) and higher all-cause mortality (HR = 12.6 [4.3-37.3]) relative to youths without any mental disorder; less self-harm hospitalizations (HR = 0.5 [0.5-0.6]) but higher mortality (HR = 1.6 [1.0-2.4]) when compared to youths with any other mental disorder. Young patients hospitalized with an ED are at high risk of self-harm and premature mortality. It is urgent to evaluate and implement the best strategies for post-discharge care and follow-up. We found that the risk of being hospitalized for a suicide attempt is 46 times higher and mortality 13 times higher than the general population in adolescents and young adults during the 3 years following hospitalization with an eating disorder. Eating disorders are also associated with a 1.5 higher risk of premature mortality relative to other mental disorders. This risk is particularly high in the 6 months following hospitalization. It is therefore crucial to implement careful post-discharge follow-up in patients hospitalized for eating disorders.

Epidemiology of Suicide by Hanging in Fars Province, Iran (2011-2019): A Population-based Cross-sectional Study.

Hanging is a common method of attempted suicide. This study investigated the epidemiological profile of attempted and completed suicides by hanging in southern Iran. This cross-sectional study was performed on 1167 suicide attempts by hanging between 2011 and 2019. All data related to suicide attempts by hanging were collected from the Fars Suicide Surveillance System. The trends in suicide cases and the mean age of attempted and completed suicides were plotted. The chi-square test was used to identify suicide-related factors. Crude rates of incidence, mortality, and standardized fatality during the study period were calculated. Finally, logistic regression was used to identify the predictors of death in individuals who attempted suicide. The mean age of those who attempted suicide was 33.21±16.82 years; the majority were male (80.5%). The rate of attempted and completed suicide by hanging were 3.50 and 2.79 per 100 000 people, respectively. The case-fatality rate was calculated as 79.34%. The results of our study indicated an increasing trend in suicide attempts by hanging. The likelihood of death was 2.28 times higher in individuals with a previous history of suicide attempts and 1.85 times higher in those with a psychological disorder. The findings of this study suggest an increasing trend in attempted and completed suicide by hanging, especially among individuals with a history of suicide attempts and psychological disorders. It is necessary to take action to reduce the rate of suicide attempts and identify the underlying causes of suicide attempts by hanging.

Are the relationships between mental health issues and being left-behind gendered in China: A systematic review and meta-analysis.

While most existing studies reveal left-behind children (LBC) are prone to suffering from mental health issues, some other literature fails to develop a statistical significance between being left-behind and facing mental health dilemmas. In further detail, it is noteworthy that suicide ideation is a gendered issue. Here girls, relative to their male counterparts, are more likely to experience emotional and affective challenges, alongside a higher risk of suicide ideation. Aside from suicide ideation, the rate of suicide attempts is also higher among Chinese female than among male LBC. However, Chang et al. counter-argue that, within the LBC cohorts, it is not statistically significant to state that girls were more likely for suicide attempts than boys. In this paper, a systematic review of relevant literature and a meta-analysis of all qualified randomised controlled trial (RCT) studies were conducted. The authors aim to examine all relevant studies with similar methodologies to observe the nuanced relationships between being left-behind and mental health issues in Chinese contexts. Specifically, the authors will, grounded on the findings from the systematic review and meta-analysis, assess whether the relationship between mental health issues and being left-behind is gendered in Chinese contexts by analysing all relevant findings derived from similar methodologies and the same method (i.e., RCT). Aside from Wanjie et al.'s studies, it is noticeable that the rest of the studies share similar point estimates and their CIs overlapped to a large extent. As per the I2, given the presence of Wanjie et al.'s studies that demonstrate an observably higher degree of heterogeneity than the rest of the studies, the I2 values, each for the measurement of anxiety and depression, are 74.8 percent and 34.7 percent respectively. This shows that there is a considerable heterogeneity level for anxiety, while the heterogeneity level for depression is moderate. However, both p-values for the I2 statistics are larger than 0.05. Therefore, at the 0.05 significance level, it is statistically insignificant to reject the null hypothesis that there is no heterogeneity between individual studies in both the subgroups of anxiety and depression. Therefore, the concern of the potentially substantial heterogeneity should be irrelevant in this meta-analysis. Beyond the discussion from the forest plot, when looking at the single study addressing the relationship between being left-behind and having suicide attempts (note: LBC-OR is 1.22; 95 percent CI is 1.22 -and NLBC-OR is 1.42; 95 percent CI is 1.09-1.86 -at the p-value of 0.34), the findings demonstrate that such a relationship per se is not gendered at the 0.05 statistical significance level. However, when examining the relationship between being resilient and left-behind, such an association is gendered where the OR of female left-behind university students being resilient, relative to male left-behind university students, is slightly higher than that of female non-left-behind university students being resilient, relative to their male non-left-behind university student counterparts. It is noteworthy that this study focuses on studying left-behind and non-left-behind samples who entered universities. Since a raft of LBC are socially, educationally disadvantaged, they lack the opportunities to receive higher education. Therefore, the findings of this study might not be indicative of the LBC population at large. While the findings of this meta-analysis project fail to reflect any gendered issues statistically, the authors are aware of the fact that the data included in this project were collected based on perception. Here samples, or their parents and teachers, were responsible for answering the questions with respect to samples' mental health status and demographic details. In China, especially in less developed rural regions, the discourse on mental health challenges might continue to be seen as taboo, so individuals giving responses might, consciously or not, tend to give socially desirable answers to avoid any potential social stigmatisation. Therefore, there is some extent of reservation regarding the validity of the included studies' data.

Continuity of care after attempted suicide: the primary care physicians' role.

Suicide prevention is an important public health concern, and primary care physicians (PCPs) often serve as the first point of contact for individuals at risk. Few interventions in the primary care setting have been linked to reduced suicide attempt (SA) rates. The Continuity of Care (COC) protocol was developed to improve the primary care treatment of high-risk suicidal patients. This study examined PCPs' awareness of the COC protocol, its perceived effectiveness, and PCPs' attitudes towards post-SA-discharge visits. A survey was administered to 64 PCPs who had a recent office visit with a patient who had attempted suicide. Data were collected between May and July 2021 and analyzed anonymously. Thirty of the 64 PCPs answered the questionnaires, giving a response rate of 47%. Most were unaware of the COC protocol. Seventeen physicians (57%) felt that the visit strengthened their physician-patient relationship, and while nearly half of the physicians (47%, n = 14) agreed they had the knowledge and tools to manage a post-SA-discharge visit, 43% of them (n = 13) preferred that the visit would have been handled by a mental health professional rather than a PCP. Analysis of open-ended questions uncovered three themes: knowledge gap, system limitation, and the PCP's role in maintaining the COC. The findings of this study highlighted the important role PCPs can play to prevent future SAs, as well as exposed gaps in the knowledge and system constraints that impede them from carrying out this role as effectively as possible.

Prevalence and correlates of destructive behaviors in the US Naval Surface Forces from 2010–2020

PurposeTo estimate the prevalence of domestic violence, sexual assault, and suicide for United States Navy (USN) personnel between 2010 and 2020 and identify potential associated factors.MethodsOfficial report data were used to calculate prevalence rates and odds ratios, accounting for sample and general USN population demographic data to assess differences in over- or underrepresentation of destructive behaviors.ResultsDomestic violence and sexual assault offenders tended to be younger lower-ranked males. For sexual assaults, offenders were three times more likely to be senior to the victim, which was not the case for domestic violence. Females were overrepresented in terms of suicidal ideation and attempts relative to the USN population, while males accounted for more actual suicides. The relative rates of suicidal ideation and attempts for females exceeded those for males (i.e., comparing the sample rate against the USN male and female populations), but the sample proportion for completed suicides (compared to the USN population) were greater for males than for females. Those in the junior enlisted (E1–E3) paygrades exhibited greater odds of suicide attempts versus suicidal ideations relative to those in the Petty Officers (E4–E6) paygrades, although E4–E6s completed more suicides.ConclusionThe descriptive profile of destructive behaviors in a representative sample of USN personnel provides an overview of the possible factors associated with destructive behaviors and includes an exploration of the relational dynamics and nature of the incidents. The results suggest that sexual assault and domestic violence are characterized by unique relational dynamics and that these destructive behaviors should not necessarily be classified together as male-oriented aggressions (i.e., mainly perpetrated by males against female victims). Those in the E1–E3 and E4–E6 paygrades displayed different patterns in suicidal ideation, attempts, and actual suicides. The results highlight individual characteristics to help inform the development of targeted policies, practices, and interventions for military and other hierarchical organizations (e.g., police).