Recent Suicide Research Articles

Exploring the role of mTOR signaling pathway in ketamine's therapeutic effects on suicide risk in depression: Insights into circadian dysregulation mechanisms

Depression is a common psychiatric condition with a substantial number of patients, who fail to achieve response or remission despite index antidepressant treatment. Insomnia and circadian misalignment are established and modifiable suicide risk factors. In recent years suicide rates have significantly increased. Commonly used methods (lithium, clozapine, or dialectical behavioral therapy and cognitive-behavioral therapy) reduce the long-term suicide risk but are inefficient in emergencies. Ketamine is a non-competitive N-methyl-D-aspartate receptor novel agent with rapid-acting antidepressant and anti-suicidal properties. Yet, anti-suicidal effects are only partially mood-dependent, implying other pathways are involved in the reduction of suicidal ideation. Ketamine induces an increase in mammalian target of ramapycin and brain-derived neurotrophic factor expression, influencing circadian dysregulation and stimulating synaptogenesis and restoring the synaptic integrity. In addition, ketamine seems to improve sleep and alter circadian clock gene expression (i.e., Bmal1, CLOCK, PER1, PER2, PER3, Cry 1, Cry 2). Objective estimates in nocturnal electroencephalography show an increase in slow wave sleep, total sleep time and rapid eye movement sleep. It may be hypothesized that ketamine’s anti-suicidal properties stem from the improvement in both sleep and circadian dysregulation. Further studies should investigate the relationship between ketamine, sleep, circadian rhythms and suicidality. The aim of the paper is to put forward a hypothesis about circadian dysregulation in depression and suicidality via ketamine use in mood disorders.

Predicting suicide attempts among Norwegian adolescents without using suicide-related items: a machine learning approach.

Research on the classification models of suicide attempts has predominantly depended on the collection of sensitive data related to suicide. Gathering this type of information at the population level can be challenging, especially when it pertains to adolescents. We addressed two main objectives: (1) the feasibility of classifying adolescents at high risk of attempting suicide without relying on specific suicide-related survey items such as history of suicide attempts, suicide plan, or suicide ideation, and (2) identifying the most important predictors of suicide attempts among adolescents. Nationwide survey data from 173,664 Norwegian adolescents (ages 13-18) were utilized to train a binary classification model, using 169 questionnaire items. The Extreme Gradient Boosting (XGBoost) algorithm was fine-tuned to classify adolescent suicide attempts, and the most important predictors were identified. XGBoost achieved a sensitivity of 77% with a specificity of 90%, and an AUC of 92.1% and an AUPRC of 47.1%. A coherent set of predictors in the domains of internalizing problems, substance use, interpersonal relationships, and victimization were pinpointed as the most important items related to recent suicide attempts. This study underscores the potential of machine learning for screening adolescent suicide attempts on a population scale without requiring sensitive suicide-related survey items. Future research investigating the etiology of suicidal behavior may direct particular attention to internalizing problems, interpersonal relationships, victimization, and substance use.

Gender differences in the association between body mass index and recent suicide attempts in Chinese patients with first-episode drug-naïve major depressive disorder

Controversial evidence exists on the relationship between body mass index (BMI) and suicide attempts (SA) in patients with major depressive disorder (MDD). This cross-sectional study aimed to explore the association between BMI and SA in first-episode drug-naïve (FEDN) MDD patients in China. The study was conducted from 2016 to 2018 in Taiyuan, China. Univariate and multivariate logistic regression analyzed the BMI–SA association, with subgroup analysis for gender. Threshold effects were examined using two-piecewise regression. In males, BMI was significantly associated with SA (OR = 0.84, 95% CI 0.74–0.94, P = 0.003) after full adjustment, but not in females (OR = 0.97, 95% CI 0.89–1.06, P = 0.541). The interaction with gender was significant (P for interaction < 0.05). Smoothing plots revealed an L-shaped BMI–SA relationship in both genders, with BMI inflection points at 27.3 kg/m2 in males and 21.4 kg/m2 in females. Below the inflection points, BMI is negatively associated with SA in males (OR = 0.75, 95% CI 0.66–0.86, P < 0.001) and females (OR = 0.48, 95% CI 0.32–0.72, P < 0.001). Above the inflection points, no association existed for both genders (all P > 0.05). Results showed an L-shaped nonlinear BMI–SA relationship in FEDN MDD patients but differing BMI inflection points between genders, thus contributing to effective prevention programs for suicide.

The Lack of Contemporary Death Education in China and Its Impact on Public Awareness

China lacks three categories of education: sex education, education of love, and death education, which correspond to the integrity of the body, the abundance of the soul, and the value of life, but they have become forbidden, obscure, and taboo. In recent years, self-mutilation, suicide, and violence are becoming infantilization, which has a growing negative impact on teenagers. Through literature review, the main arguments of this paper are 1) the social influences caused by the lack of death education 2) the process of developing public awareness of death from 1928 until the present, and 3) the discussion on the first-hand data from the primary questionnaire. Therefore, this paper investigates in-depth domestic death education in China, aiming to find the correlation between whether people have received death education before and their awareness of death.

The re‐emerging suicide crisis in the U.S.: Patterns, causes and solutions

AbstractThe suicide rate in the United States has risen nearly 40% since 2000. This increase is puzzling because suicide rates had been falling for decades at the end of the 20th century. In this paper, we review important facts about the changing rate of suicide. General trends do not tell the story of important differences across groups—suicide rates rose substantially among middle‐aged persons between 2005 and 2015 but have fallen since. Among young people, suicide rates began a rapid rise after 2010 that has not abated. We review empirical evidence to assess potential causes for recent changes in suicide rates. The economic hardship caused by the Great Recession played an important role in rising suicide among prime‐aged Americans. Among those under 25, nearly all the increase in suicide mortality during the 2010s can be explained by an increase in the prevalence of depression. Bullying victimization of LGBTQ youth could also account for part of the rise in suicide. The evidence that access to firearms or opioids are major drivers of recent suicide trends is less clear. We end by summarizing evidence on the most promising policies to reduce suicide mortality.

EEG wakefulness regulation in transdiagnostic patients after a recent suicide attempt

ObjectiveDecades of research have not yet produced statistically reliable predictors of preparatory behavior eventually leading to suicide attempts or deaths by suicide. As the nature of suicidal behavior is complex, it is best investigated in a transdiagnostic approach, while assessing objective markers, as proposed by the Research Domain Criteria (Cuthbert, 2013). MethodsA 15-min resting-state EEG was recorded in 45 healthy controls, and 49 transdiagnostic in-patients with a recent (<6 months) suicide attempt. Brain arousal regulation in eyes-closed condition was assessed with the Vigilance Algorithm Leipzig (VIGALL) (Sander et al., 2015). ResultsA significant incline of median vigilance and vigilance slope was observed in patients within the first 3-min of the EEG recording. Additionally, a significant positive correlation of self-reported suicidal ideation with the vigilance slope over 15-min recording time, as well as a significant negative correlation with EEG vigilance stage A1 during the first 3-min was found. ConclusionsTransdiagnostic patients with a recent suicide attempt show a distinct vigilance regulation pattern. Further studies including a control group consisting of patients without life-time suicide attempts are needed to increase the clinical utility of the findings. SignificanceThese findings might serve as potential objective markers of suicidal behavior.

Decreased beta 1 (12-15 Hertz) power modulates the transfer of suicidal ideation to suicide in major depressive disorder.

Suicide prevention for major depressive disorder (MDD) is a worldwide challenge, especially for suicide attempt (SA). Viewing suicide as a state rather than a lifetime event provided new perspectives on suicide research. This study aimed to verify and complement SAs biomarkers of MDD with a recent SA sample. This study included 189 participants (60 healthy controls; 47 MDD patients with non-suicide (MDD-NSs), 40 MDD patients with suicide ideation (MDD-SIs) and 42 MDD patients with SA (MDD-SAs)). MDD patients with an acute SA time was determined to be within 1 week since the last SA. SUICIDALITY Part in MINI was applied to evaluate suicidality. Absolute powers in 14 frequency bands were extracted from subject's resting-state electroencephalography data and compared within four groups. The relationship among suicidality, the number of SA and powers in significant frequency bands were investigated. MDD-SIs had increased powers in delta, theta, alpha and beta band on the right frontocentral channels compared to MDD-NSs, while MDD-SAs had decreased powers in delta, beta and gamma bands on widely the right frontocentral and parietooccipital channels compared to MDD-SIs. Beta 1 power was the lowest in MDD-SAs and was modulated by the number of SA. The correlation between suicidality and beta 1 power was negative in MDD-SAs and positive in MDD-SIs. Reduced beta 1 (12-15 Hz) power could be essential in promoting suicidal behaviour in MDD. Research on recent SA samples contributes to a better understanding of suicide mechanisms and preventing suicidal behaviour in MDD.

Ecological Momentary Assessments and Passive Sensing in the Prediction of Short-Term Suicidal Ideation in Young Adults

Advancements in technology, including mobile-based ecological momentary assessments (EMAs) and passive sensing, have immense potential to identify short-term suicide risk. However, the extent to which EMA and passive data, particularly in combination, have utility in detecting short-term risk in everyday life remains poorly understood. To examine whether and what combinations of self-reported EMA and sensor-based assessments identify next-day suicidal ideation. In this intensive longitudinal prognostic study, participants completed EMAs 4 times daily and wore a sensor wristband (Fitbit Charge 3) for 8 weeks. Multilevel machine learning methods, including penalized generalized estimating equations and classification and regression trees (CARTs) with repeated 5-fold cross-validation, were used to optimize prediction of next-day suicidal ideation based on time-varying features from EMAs (affective, cognitive, behavioral risk factors) and sensor data (sleep, activity, heart rate). Young adult patients who visited an emergency department with recent suicidal ideation and/or suicide attempt were recruited. Identified via electronic health record screening, eligible individuals were contacted remotely to complete enrollment procedures. Participants (aged 18 to 25 years) completed 14 708 EMA observations (64.4% adherence) and wore a sensor wristband approximately half the time (55.6% adherence). Data were collected between June 2020 and July 2021. Statistical analysis was performed from January to March 2023. The outcome was presence of next-day suicidal ideation. Among 102 enrolled participants, 83 (81.4%) were female; 6 (5.9%) were Asian, 5 (4.9%) were Black or African American, 9 (8.8%) were more than 1 race, and 76 (74.5%) were White; mean (SD) age was 20.9 (2.1) years. The best-performing model incorporated features from EMAs and showed good predictive accuracy (mean [SE] cross-validated area under the receiver operating characteristic curve [AUC], 0.84 [0.02]), whereas the model that incorporated features from sensor data alone showed poor prediction (mean [SE] cross-validated AUC, 0.56 [0.02]). Sensor-based features did not improve prediction when combined with EMAs. Suicidal ideation-related features were the strongest predictors of next-day ideation. When suicidal ideation features were excluded, an alternative EMA model had acceptable predictive accuracy (mean [SE] cross-validated AUC, 0.76 [0.02]). Both EMA models included features at different timescales reflecting within-day, end-of-day, and time-varying cumulative effects. In this prognostic study, self-reported risk factors showed utility in identifying near-term suicidal thoughts. Best-performing models required self-reported information, derived from EMAs, whereas sensor-based data had negligible predictive accuracy. These results may have implications for developing decision algorithms identifying near-term suicidal thoughts to guide risk monitoring and intervention delivery in everyday life.

Longitudinal Associations Between Perceived Discrimination and Suicidality in Youth

Research among adults reveals robust associations between discrimination and suicidality. However, the relationship between discrimination and suicidality is understudied in youth. Participants in the Adolescent Brain Cognitive Development study (n = 10 312) completed a measure of discrimination based on multiple attributes. The Kiddie Schedule for Affective Disorders and Schizophrenia was administered 1 year later to assess depressive disorders and suicidality (ideation and behavior). Logistic regressions, adjusting for age, sex, race/ethnicity, family income, lifetime depressive disorders, and body composition were conducted. Adjusting for covariates, discrimination based on weight (OR: 2.19), race/ethnicity/color (OR: 3.21), and sexual orientation (OR: 3.83) were associated with greater odds of reporting suicidality 1year later (ps<0.025). Nationality-based discrimination was not significantly associated with suicidality. Compared with those reporting no discrimination, youths reporting discrimination based on 2 or more attributes had nearly 5 times greater odds of recent suicidality (OR: 4.72; P<.001). The current study highlights the deleterious impacts of discrimination on mental health among youths reporting multiple forms of discrimination.

EEG source functional connectivity in patients after a recent suicide attempt

ObjectiveElectroencephalogram (EEG) based frequency measures within the alpha frequency range (AFR), including functional connectivity, show potential in assessing the underlying pathophysiology of depression and suicide-related outcomes. We investigated the association between AFR connectivity, suicidal thoughts and behaviors, and depression in a transdiagnostic sample of patients after a recent suicide attempt (SA). MethodsLagged source-based measures of linear and nonlinear whole-brain connectivity within the standard AFR ([sAFR], 8–12 Hz) and the individually referenced AFR (iAFR) were applied to 70 15-minute resting-state EEGs from patients after a SA and 70 age- and gender-matched healthy controls (HC). Hypotheses were tested using network-based statistics and multiple regression models. ResultsResults showed no significant differences between patients after a SA and HC in any of the assessed connectivity modalities. However, a subgroup analysis revealed significantly increased nonlinear connectivity within the sAFR for patients after a SA with a depressive disorder or episode ([DD], n = 53) compared to matched HC. Furthermore, a multiple regression model, including significant main effects for group and global nonlinear connectivity within the sAFR outperformed all other models in explaining variance in depressive symptom severity. ConclusionsOur study further supports the importance of the AFR in pathomechanisms of suicidality and depression. The iAFR does not seem to improve validity of phase-based connectivity. SignificanceOur results implicate distinct neurophysiological patterns in suicidal subgroups. Exploring the potential of these patterns for treatment stratification might advance targeted interventions for suicidal thoughts and behaviors.

Prevalence of substance use and mental health problems among transgender and cisgender U.S. adults: Results from a national probability sample

Transgender individuals experience numerous health disparities relative to cisgender individuals. However, most transgender-health studies have focused on convenience samples with limited generalizability. This study utilized data from the 2016–2018 TransPop Study, the first national probability sample of transgender adults (n=274) with a cisgender comparison sample (n=1162). Using multivariable logistic regression, adjusted for demographics, we compared the prevalence of hazardous drinking, problematic drug use, serious psychological distress, suicidality, and non-suicidal self-injury between transgender and cisgender individuals and among transgender men (n=78), transgender women (n=120), and transgender nonbinary individuals (n=76). Among transgender individuals, 28.2% (95%CI 21.2–35.2) and 31.2% (95%CI 23.8–38.7) reported hazardous drinking and problematic drug use, respectively; 44.4% (95% CI 35.8–53.0) reported recent suicidal ideation, 6.9% (95% CI 2.3–11.5) reported a recent suicide attempt, and 21.4% (95% CI 14.5%-28.4%) reported recent non-suicidal self-injury. In their lifetime, 81.3% (95%CI 75.1–87.5) of transgender respondents had suicidal ideation, 42.0% (95%CI 34.2–49.8) had attempted suicide, and 56.0% (95% CI 48.2–63.8) reported non-suicidal self-injury. Most (81.5%; 95%CI 75.5–87.5) had utilized formal mental health care and 25.5% (95%CI 18.5–32.4) had sought informal mental health support. There were no differences in alcohol or drug-use outcomes between transgender and cisgender adults. Compared to cisgender adults, transgender adults had higher odds of serious psychological distress (aOR=3.1; 95%CI 1.7–5.7), suicidal ideation (recent: aOR=5.1, 95%CI 2.7–9.6); lifetime: aOR=6.7, 95%CI 3.8–11.7), lifetime suicide attempts (aOR=4.4, 95%CI 2.4–8.0), and non-suicidal self-injury (recent: aOR=13.0, 95%CI 4.8–35.1); lifetime: aOR=7.6, 95%CI 4.1–14.3). Transgender nonbinary adults had the highest odds for all outcomes, including substance use outcomes. Findings from these national probability samples support those of earlier convenience-sample studies showing mental health disparities among transgender adults relative to cisgender adults, with nonbinary individuals at highest risk. These findings also highlight variations in risk across sub-groups of transgender individuals.

Feasibility of Brief, Hypnotic Enhanced Cognitive Therapy for SCI-related Pain During Inpatient Rehabilitation

Objectives(1) Adapt evidence-based hypnosis-enhanced cognitive therapy (HYP-CT) for inpatient rehabilitation setting; and (2) determine feasibility of a clinical trial evaluating the effectiveness of HYP-CT intervention for pain after spinal cord injury (SCI). Study DesignPilot non-randomized controlled trial. SettingInpatient rehabilitation unit. ParticipantsEnglish-speaking patients admitted to inpatient rehabilitation after SCI reporting current pain of at least 3 on a 0-10 scale. Persons with severe psychiatric illness, recent suicide attempt or elevated risk, or significant cognitive impairment were excluded. Consecutive sample of 53 patients with SCI-related pain enrolled, representing 82% of eligible patients. InterventionUp to 4 sessions of HYP-CT Intervention, each 30-60 minutes long. MethodsParticipants were assessed at baseline and given the choice to receive HYP-CT or Usual Care. Main Outcome MeasuresParticipant enrollment and participation and acceptability of intervention. Exploratory analyses examined the effect of intervention on pain and cognitive appraisals of pain. ResultsIn the HYP-CT group, 71% completed at least 3 treatment sessions and reported treatment benefit and satisfaction with the treatment; no adverse events were reported. Exploratory analyses of effectiveness found pre-post treatment pain reductions after HYP-CT with large effect (P<.001; β=-1.64). While the study was not powered to detect significant between-group differences at discharge, effect sizes revealed decreases in average pain (Cohen's d=-0.13), pain interference (d=-0.10), and pain catastrophizing (d=-0.20) in the HYP-CT group relative to control and increases in self-efficacy (d=0.27) and pain acceptance (d=0.15). ConclusionsIt is feasible to provide HYP-CT to inpatients with SCI, and HYP-CT results in substantial reductions in SCI pain. The study is the first to show a psychological-based nonpharmacologic intervention that may reduce SCI pain during inpatient rehabilitation. A definitive efficacy trial is warranted.

Study of Suicidal Behavior Among Admitted First-Episode Schizophrenia Patients From South India.

Objective: The range of suicidal behavior in first-episode schizophrenia in the early phases of the disease is both understudied and unclear. The objective of this study was to investigate suicidal behavior in first-episode schizophrenia inpatients after admission.Methods: The current study was conducted with 102 patients with first-episode schizophrenia aged 15 to 45 years who were admitted to a 300-bed psychiatry hospital in Southern India over a period of 18 months between January 1, 2016, and June 30, 2017. Patients completed a semistructured questionnaire, the Brief Psychiatric Rating Scale, and the Columbia-Suicide Severity Rating Scale for assessment of sociodemographic profile, psychopathology, and suicide risk. Patients were then divided into 2 groups: suicidal and nonsuicidal.Results: Recent suicidal ideation and behavior were present in 37.25% and 22.54% of the first-episode schizophrenia patients, respectively. Recent suicidal ideation was 15.8 times more likely in first-episode schizophrenia patients with lifetime suicidal ideation, and recent suicide attempts were 8.6 times more likely in patients with lifetime suicide attempts.Conclusions: The study results show that suicidal behavior in the early phases of first-episode schizophrenia is more prevalent during admission. Lifetime suicidal ideation and behavior predicts the risk of recent suicidal ideation and behavior, respectively.Prim Care Companion CNS Disord 2023;25(3):22m03364.Author affiliations are listed at the end of this article.

Content and Process of Adolescent Suicide Ideation: Implications for Risk Assessment.

This study examined differences in the content and process of suicide ideation between adolescents presenting with recent suicide ideation or a suicide attempt in clinical settings. Across two combined study samples, adolescents (N = 229; 79% female; 73% Hispanic/Latine), ages 12-19, presenting with a recent suicide attempt, recent suicide ideation with a past suicide attempt history, or recent suicide ideation with no past suicide attempt history were interviewed in detail about the process and content of their suicide ideation. The group with suicide ideation and a past suicide attempt more often reported that their recent ideation lasted greater than 4h compared tothose with suicide ideation but no past suicide attempt history. The suicide attempt group more often considered ingestion as their first method of attempt, compared to the other two suicide ideation groups, and less often considered "other" methods (e.g., jumping from a height or onto train/traffic, hanging). Wish to die was lower in the ideation-only group, compared to both other groups. Separate analyses from Study 2 suggested that the majority of adolescents' suicide ideation contained imagery; however, a higher proportion of adolescents with suicide ideation and a past suicide attempt reported imagery in their ideation than those with ideation but no past attempt. Understanding what adolescents think about when they consider suicide and how they think about it may be informative about risk of a suicide attempt.

Temperament and adolescent suicide attempts: a case-control study with multi-ethnic Asian adolescents

BackgroundSuicide is the leading cause of death for adolescents in several parts of Asia, including Singapore. This study examines the relationship between temperament and youth suicide attempts in a sample of multi-ethnic Singaporean adolescents.MethodsA case-control design compared 60 adolescents (Mage = 16.40, SDage = 2.00) with a recent suicide attempt (i.e., past 6 months) with 58 adolescents (Mage = 16.00, SDage = 1.68) without any history of suicide attempts. Presence of suicide attempts was established using the semi-structured interviewer-administered Columbia Suicide Severity Rating Scale. Participants also completed self-report measures on temperament traits, psychiatric diagnoses, stressful life events, and perceived parental rejection in an interview-based format.ResultsPsychiatric comorbidity, recent stressful life events, perceived parental rejection, and all five “difficult temperament” traits, were significantly overrepresented among adolescent cases relative to healthy controls. Adjusted logistic regression models revealed significant associations between suicide attempt, MDD comorbidity (OR: 10.7, 95% Cl: (2.24–51.39)), “negative mood” trait (OR: 1.12–1.18, 95% Cl: (1.00–1.27)), and the interaction term of “positive mood” and “high adaptability” traits (OR: 0.943 – 0.955, 95% Cl: (0.900 − 0.986)). Specifically, “positive mood” predicted lower likelihood of a suicide attempt when “adaptability” was high (OR: 0.335 – 0.342, 95% Cl: (0.186 − 0.500)) but not low (OR: 0.968 – 0.993, 95% Cl: (0.797 − 1.31)).ConclusionTemperament screening may be important to identify adolescents at higher or lower risk of suicide at an early stage. More longitudinal and neurobiological research converging on these temperament findings will be helpful in ascertaining temperament screening as an effective suicide prevention methodology for adolescents.

Situational stress and suicide attempt behavior in Army soldiers and veterans: Insights from the Army Study to Assess Risk and Resilience in Servicemembers-Longitudinal Study.

Prevention of suicide-related behaviors is considered a top clinical priority within the Departments of Veterans Affairs and Defense. Despite previous literature attesting to the likely importance of situational stress as a key correlate of acute changes in suicide risk, longitudinal research into associations between situational stress and suicide-related outcomes among military personnel has been relatively limited. The current study examined associations between situational stress, recent suicide attempt, and future suicide attempt using data from 14,508 Army soldiers and recently discharged veterans enrolled in the Army Study to Assess Risk and Resilience in Servicemembers-Longitudinal Studies (STARRS-LS). Recent situational stress was more common among recently discharged veterans (vs. soldiers), those with a recent suicide attempt (vs. those without), and those with a subsequent suicide attempt (vs. those without). Job loss was more closely associated with suicide attempts among soldiers, whereas financial crisis, police contact, and death, illness, or injury of close others were more closely associated with suicide attempts among recently discharged veterans. Findings further highlight situational stress as a salient risk factor for suicide-related outcomes among military personnel, particularly among recently discharged veterans. Implications for screening and treatment of at-risk military personnel are discussed.

Gender Differences in Barriers and Facilitators to Care among U.S. military Veterans at High Risk for Suicide: A Qualitative Study

Veteran engagement in care is imperative to suicide prevention. However, barriers to engaging veterans at risk for suicide in care remain a challenge, and women veterans may have unique experiences that promote or inhibit care-seeking behaviors. The goal of this study was to better understand barriers and facilitators to care among veterans at high risk for suicide and identify potential gender differences. We interviewed 25 women and 25 men veterans utilizing VHA health care across the United States (U.S.), who had a recent suicide attempt (6 months prior). Psychological safety was a dominant theme for veterans seeking and using VHA care. Women and men both needed to feel safe and comfortable in the VHA environment. Women described psychological safety as being able to let their guard down, while men desired to not feel judged for seeking care. Veterans felt a sense of comradery in the VHA environment; however, women did not always feel welcome as veterans. Findings suggest the need to attend to the psychological safety of women and men veterans at high risk of suicide in VHA. Strategies to attune VHA staff to trauma-informed care practices for women and expand trauma-informed care resources may facilitate care engagement.

Firearms Availability Among High-School Age Youth With Recent Depression or Suicidality.

Limiting firearm access is essential to decreasing teen suicide. Previous efforts have focused on household firearms; however, less is known about firearm access and possession among teens at increased suicide risk. Our objective was to estimate prevalence of firearm possession and access among high school-aged teens with recent depression and/or lifetime history of suicidality (DLHS). We conducted a probability-based, cross-sectional Web survey of 1914 parent-teen dyads between June 24, 2020, and July 22, 2020, with data weighted to generate a nationally representative sample of US teenagers (aged 14-18). Logistic regression analyses examined the difference between teens with and without DLHS for: (1) personal firearm possession, (2) perceived firearm access, and (3) method of firearm attainment. Among high school-aged teens, 22.6% (95% confidence interval [CI], 19.4-25.8) reported DLHS, 11.5% (95% CI, 8.7-14.3) reported personal firearm possession, and 44.2% (95% CI, 40.2-48.2) endorsed firearm access. Teens experiencing DLHS had increased perceived access (adjusted odds ratio, 1.56; 95% CI, 1.07-2.28) compared with non-DLHS peers. There was no association between DLHS and personal firearm possession (adjusted odds ratio, 0.97; 95% CI, 0.47-2.00). Among teens reporting firearm possession, those with DLHS were more likely to have acquired it by buying/trading for it (odds ratio, 5.66; 95% CI, 1.17-27.37) and less likely receiving it as a gift (odds ratio, 0.06; 95% CI, 0.01-0.36). High school-aged teens experiencing DLHS have higher perceived firearm access compared with lower-risk peers. Providers should speak directly to high school-aged teens at increased suicide risk about firearm access, in addition to counseling parents.

A Suicide-Specific Diagnosis – The Case Against

A Suicide-Specific Diagnosis – The Case Against

Health impairment allegations against doctors: Qualitative analysis and insights for Australian general practitioners.

A thematic analysis was conducted of semistructured interviews with 21 doctor-patients and four doctors' health experts. Doctor-patient participants had experienced a past or family psychiatric history, personal loss or trauma, access to drugs at work, workplace stress or recent patient death or suicide. Many avoided seeking care and were significantly unwell when notified to medical regulators. Regulatory processes caused distress, symptom relapse, suicidality, financial pressures and work difficulties. Doctor-patient participants sought assistance from GPs, doctors' health services, medical defence organisations, recovery groups and benevolent associations. When treating doctor-patients, GPs can consider targeted mental health screening, openly discussing mandatory reporting obligations and accessing advice from their medical defence organisation or local doctors' health service. Trust and clear communication benefits doctor-patients and the wider communities they serve.