Reported Suicide Ideation Research Articles

Predicting future suicidal behaviour in young adults, with different machine learning techniques: A population-based longitudinal study

The predictive accuracy of suicidal behaviour has not improved over the last decades. We aimed to explore the potential of machine learning to predict future suicidal behaviour using population-based longitudinal data. Baseline risk data assessed within the Scottish wellbeing study, in which 3508 young adults (18-34 years) completed a battery of psychological measures, were used to predict both suicide ideation and suicide attempts at one-year follow-up. The performance of the following algorithms was compared: regular logistic regression, K-nearest neighbors, classification tree, random forests, gradient boosting and support vector machine. At one year follow up, 2428 respondents (71%) finished the second assessment. 336 respondents (14%) reported suicide ideation between baseline and follow up, and 50 (2%) reported a suicide attempt. All performance metrics were highly similar across methods. The random forest algorithm was the best algorithm to predict suicide ideation (AUC 0.83, PPV 0.52, BA 0.74) and the gradient boosting to predict suicide attempt (AUC 0.80, PPV 0.10, BA 0.69). The number of respondents with suicidal behaviour at follow up was small. We only had data on psychological risk factors, limiting the potential of the more complex machine learning algorithms to outperform regular logistical regression. When applied to population-based longitudinal data containing multiple psychological measurements, machine learning techniques did not significantly improve the predictive accuracy of suicidal behaviour. Adding more detailed data on for example employment, education or previous health care uptake, might result in better performance of machine learning over regular logistical regression.

Depressed mood, suicidal behaviors, and health risk behaviors among youths in the Commonwealth of the Northern Mariana Islands: the 2017 CNMI Youth Risk Behavior Survey

BackgroundThe current study investigated the prevalence of depressed mood, suicide ideation, suicide plan, and suicide attempt and their associations with health risk behaviors among high school adolescents in the Commonwealth of the Northern Mariana Islands (CNMI).MethodsThis is a cross-sectional study analyzing self-reported data from the 2017 CNMI Youth Risk Behavior Survey (n = 1943). Modified Poisson regression models were used to identify the associations between 17 health risk behavior variables, including violence-related behaviors, substance use behaviors, sexual behaviors, and early risk-taking behaviors, and four variables related to depressed mood and suicidal behaviors.Results40.7% adolescents reported being depressed, 25.0% reported suicide ideation, 22.8% reported formulating a suicide plan, and 13.6% attempted suicide. Female adolescents were more likely to report depressed mood and all included suicidal behaviors (p < 0.001). Being in a physical fight and forced sexual intercourse were associated with depressed mood, suicide ideation, suicide plan, and suicide attempt for both female and male adolescents. Use of “soft drugs” such as current smoking was associated with depressed mood (ARR = 2.33, 95% CI = 1.56–3.45, p < 0.001), suicide ideation (ARR = 1.23, 95% CI = 1.08–1.43, p < 0.001), suicide plan (ARR = 1.19; 95% CI = 1.05–1.35; p < 0.001), and suicide attempt (ARR = 1.18; 95% CI = 1.06–1.30; p < 0.001) for females, whereas use of “hard drugs” such as heroin was associated with depressed mood (ARR = 2.27, 95% CI = 1.37–3.85, p < 0.01), suicide ideation (ARR = 1.30, 95% CI = 1.01–1.67, p < 0.05), suicide plan (ARR = 1.82; 95% CI = 1.22–2.70; p < 0.01), and suicide attempt (ARR = 2.78; 95% CI = 1.47–5.26; p < 0.01) for male adolescents.ConclusionThe prevalence of depressed mood, suicide ideation, suicide plan, and suicide attempt among CNMI adolescents was high, especially in female adolescents. While there were gender differences, many of the health risk behaviors were associated with depressed mood and suicidal behaviors. As sociodemographic factors are difficult to change, modifiable factors should be targeted to improve the mental health of adolescents.

Association of atopic dermatitis with suicide risk among 788,411 adolescents: A Korean cross-sectional study

BackgroundAtopic dermatitis (AD) is known to negatively influence the mental health of patients. However, only a few studies have explored the influencing factors for psychiatric problems among adolescents with AD. ObjectiveTo assess the association of AD and suicidal behaviors among adolescents by analyzing data from the 3rd through the 13th annual Korean Youth Risk Behavior Web-based Surveys (completed from 2007 to 2017). MethodsSurvey data were obtained from a stratified, multistage, clustered sample. Students self-reported AD if they had received a diagnosis of AD by a physician. Influencing factors for suicidal behaviors were tested by logistic regression models. ResultsA total of 788,411 adolescents completed the survey. The proportion of participants with AD was 22.2%. Those reporting suicide ideation and suicide attempts were 19.0%, and 4.5%, respectively. Compared with adolescents without AD, those with AD were more likely to be female, to skip breakfast less frequently, to exercise less frequently, to drink less alcohol, and to not be current smokers and were statistically significantly more likely to have negative mental health states. In the multivariable model, perceived unhappiness and suicidal ideation were the strongest influencing factors for suicidal ideation (adjusted odds ratio, 4.90; 95% CI, 4.31-5.57) and for suicidal attempts (adjusted odds ratio, 48.01; 95% CI, 42.69-53.09), respectively. ConclusionAdolescents with AD had a meaningful prevalence of suicidal behaviors. Although further research is needed to clarify this association, adolescents with AD with influencing factors for negative mental health state may need intervention from practitioners who use a multidisciplinary team approach to prevent suicide.

A Quasi-Experimental Analysis of Lethal Means Assessment and Risk for Subsequent Suicide Attempts and Deaths.

Counseling on access to lethal means is highly recommended for patients with suicide risk, but there are no formal evaluations of its impact in real-world settings. Evaluate whether lethal means assessment reduces the likelihood of suicide attempt and death outcomes. Quasi-experimental design using an instrumental variable to overcome confounding due to unmeasured patient characteristics that could influence provider decisions to deliver lethal means assessment. Kaiser Permanente Colorado, an integrated health system serving over 600,000 members, with comprehensive capture of all electronic health records, medical claims, and death information. Adult patients who endorsed suicide ideation on the Patient Health Questionnaire-9 (PHQ-9) depression screener administered in behavioral health and primary care settings from 2010 to 2016. Provider documentation of lethal means assessment in the text of clinical notes, collected using a validated Natural Language Processing program. Main outcome was ICD-9 or ICD-10 codes for self-inflicted injury or suicide death within 180days of index PHQ-9 event. We found 33% of patients with suicide ideation reported on the PHQ-9 received lethal means assessment in the 30days following identification. Lethal means assessment reduced the risk of a suicide attempt or death within 180days from 3.3 to 0.83% (p = .034, 95% CI = .069-.9). Unmeasured suicide prevention practices that co-occur with lethal means assessment may contribute to the effects observed. Clinicians should expand the use of counseling on access to lethal means, along with co-occurring suicide prevention practices, to all patients who report suicide ideation.

Intimate Partnerships, Suicidal Ideation and Suicide-Related Hospitalization Among Young Kenyan Men.

The first study focused on a three-month chart review containing information on suicide attempts (n = 34) admitted to a local mission hospital in Meru County, Kenya. The second study utilized a cross-sectional survey administered to men 18-34years old (n = 532) residing in rural Kenya. Data posit intimate partnership discord as salient to suicide ideation and behavior. Men who reported their partner status was "divorced" had four-times the odds of reporting suicide ideation than other partnership states, an association significantly mediated by loneliness. Violent conflict tactics predicted suicidal ideation, mediated by loneliness and decreased marital satisfaction.

Análisis de las narrativas de sujetos traumatizados por abuso

The subject of the research is the traumatic ordeal caused by moral and sexual abuse during childhood, and its long-term consequences. Life stories of four adult individuals (one man and three women) between 36 and 60 years old were analyzed. The research is qualitative and the method of analysis is based on the Narrative Identity Theory. The stories have some coincident points: moral or sexual abuse; escape from their family nucleus; repetitive abuse, and current affliction due to relived experience. In the specific case of women, there are reports of suicide ideation and attempts. . It is concluded that the trauma and the rejection are consistent with the construction of an “existential no-place”.

The longitudinal association between lifetime mental disorders and first onset or recurrent suicide ideation

BackgroundAlthough the cross-sectional association between mental disorders and suicide ideation is well studied, less is known about the prospective association. In this paper, we estimated among those without 12-month suicide ideation at baseline, the association between a wide variety of common mental disorders at baseline and suicide ideation within the 6-year follow-up period, after controlling for history of other mental disorders and demographic variables.MethodsData were used from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a prospective representative adult cohort study with baseline (n = 6646) with a 6-year follow-up period. Lifetime mental disorders were assessed at baseline with the Composite International Diagnostic Interview 3.0. Within the longitudinal design, participants with first time or recurrent suicide ideation were defined follows: having no suicide ideation in the 12 months before the baseline assessment, and reporting to have had seriously thought about suicide between baseline and the 6-year follow-up period. Multiple logistical regression was used to estimate the longitudinal association between suicide ideation and a specific mental disorder while controlling for comorbidity and baseline variables. To account for the prevalence of a disorder in the population, for each disorder, the population attributable risk proportion (PARP) was calculated.Results2.9% (n = 132) of the participants that did not report suicide ideation in the past 12 months at baseline reported suicide ideation at follow-up. Of these 132 cases, 81 (61%) experienced suicide ideation for the first time in their lives and could be viewed as first onset cases. 51 (39%) reported recurrent suicide ideation. After controlling for comorbidity, the only two disorders that were significantly related to suicide ideation at follow-up were lifetime major depressive disorder (MDD) and generalized anxiety disorder (GAD). PARP for MDD was 47.8 and 16.6% for GAD.ConclusionsAfter controlling for all other mental disorders, a lifetime history of MDD and GAD were related to suicide ideation at follow-up. For clinical practice, this indicates that patients with a history of MDD or GAD stay vulnerable for suicide ideation, even though they did not report suicide ideation in the past year.

The Independent and Cumulative Effects of Sibling and Peer Bullying in Childhood on Depression, Anxiety, Suicidal Ideation, and Self-Harm in Adulthood.

Sibling and peer bullying are reported as the most frequent forms of violence experienced across childhood. There is now ample evidence indicating an association between sibling and peer bullying, with those reporting sibling bullying at an increased risk of peer bullying. While there is convincing evidence of a causative association between peer bullying and a range of mental health outcomes, sibling bullying continues to receive far less attention. The aim of this study was to explore whether sibling bullying roles (non-involved, victim, bully-victim, bully) in middle childhood were independently associated with clinical diagnoses of depression and anxiety and reports of suicidal ideation and self-harm in early adulthood. We further tested whether there was a cumulative relationship between involvement in sibling and peer bullying victimization. This study was based on up to 3,881 youth from the Avon Longitudinal Study of Parents and Children, a prospective birth-cohort based in the United Kingdom. Sibling and peer bullying was assessed via self-report when youth were 12 years of age, while depression, anxiety, suicidal ideation, and self-harm were assessed via self-administered computerized interviews at 24 years of age. Involvement as a sibling bully-victim was associated with clinical diagnosis of depression (OR = 1.91, 95% CI: 1.33–2.72), while sibling victims were at increased odds of both suicidal ideation (OR = 1.52; 95% CI, 1.16–1.98) as well as suicidal self-harm (OR = 2.20, 95% CI, 1.36–3.58) in early adulthood, even after accounting for concurrent peer bullying and a range of other pre-existing childhood confounders. Sibling and peer bullying were further associated in a homotypic manner. A dose–response relationship of bullying in the home and school across mental health outcomes was found. Youth victimized by both their siblings and peers displayed the highest odds of developing clinical depression, suicidal ideation, and self-harm. Children bullied at home and at school had no safe place to escape the bullying and torment. Our findings highlight the need for intervention studies tailored toward reducing sibling bullying, as these may hold large promise for alleviating a range of adverse outcomes, including the prevention of peer bullying, which may be contingent on early bullying experiences in the home environment.

An Empirical Analysis of Delayed Monthly Bill Payments as an Early Risk Factor of Increased Suicidal Behavior.

This study examines the potential of delayed monthly bill payments as a predictor of suicidal behavior in South Korea with the highest suicide rate among developed countries. Using the Korea Welfare Panel Study, multivariable logistic regressions examined the association between suicide ideation/attempts and the frequency of late payments on utility bills or National Health Insurance premium during last three years. Confounding factors such as past depression and suicide ideation/attempts history were adjusted for. Among 10,988 individuals, 2.7% reported suicide ideation and 0.11% attempted suicide in the past year, while 7.1% reported they paid late once or more during the last three years. Adults with two or more delayed payment had 2.32 times increased odds of suicidal ideation and 10.99 times increased odds of suicide attempts, compared to having no late payments. Adjusting for other socio-economic characteristics rarely changed the relationship between late payments and suicide ideation/attempts (for suicidal ideation, OR = 2.11; for suicide attempts: OR = 7.44), suggesting the independent effect of late payments on suicide behavior. With these findings, it can be suggested that late payment is an important factor, preemptively signaling suicide behavior with serious consequences in health and life.

Male-Dominated Occupations, Employment Status, and Suicidal Behaviors Among Australian Men.

Background: Suicide rates are higher among unemployed men as well as those employed in male-dominated occupations such as construction. There has been less research on whether these patterns are similar for suicide ideation and attempt. Aims: In a cohort of 13,892 Australian males, this study examined the relationship between employment status and occupational gender ratio on reported thoughts of suicide and suicide attempts. Method: Men reporting suicide ideation or attempts at Wave 1 were removed from the sample. Logistic regression was used to examine Wave 1 employment status and occupational gender ratio and Wave 2 reported suicide ideation and attempts, controlling for confounders (measured in Wave 1). We conducted a sensitivity analysis controlling for mental health status. Results: Those who were unemployed or not in the labor force had elevated rates of suicide ideation (unemployed OR = 1.91, 95% CI [1.30, 2.82], p = .001; not in the labor force OR=1.68, 95% CI [1.09, 2.60], p = .020). Those who were not in the labor force had greater odds of attempts (OR = 2.32, 95% CI [1.05, 5.12], p = .037). There was no association between occupational gender ratio and suicide ideation or attempt. Limitations: We only had single item measures of ideation and attempts. Conclusion: There is a need for further investigation into risk factors for suicide among males, both when they are in and out of employment.

Faces of HPPD: Hallucinogen Persisting Perception Disorder Patient Survey Results and a Descriptive Analysis of Patient Demographics, Medical Background, Drug Use History, Symptoms, and Treatments

Objective: The purpose of the present study was to obtain patient information across a wide geography about medical history, drug use, symptoms, and treatments of individuals diagnosed with hallucinogen persisting perception disorder (HPPD). Methods: The study was an internet survey that yielded 26 HPPD patients from North America (81%), Europe (12%), and South America (almost 8%), predominantly male (73%), white (92%), with a median age of 24.5 (range, 18 to 63) years, who have been living with HPPD from a period of <1 year to well over 10 years. Results: History of preexisting mood disorders was reported (100%). Previous hallucinogen drugs used include lysergic acid diethylamide, psilocybin, 3,4-methylenedioxymethamphetamine, and mescaline in highest frequencies. There is a high percentage of current use of benzodiazepines (34.6%) and dependency (78% of those using). Current marijuana use is present for 19%, of which all claim dependency. All patients reported experiencing long-term and ongoing symptoms such as depersonalization (92.3%), visual snow, floaters, trailing afterimages and anxiety (96.2% for each factor). Suicide ideation was pronounced (over 69%). HPPD treatments included benzodiazepines (50%), neuroleptics (23%), anticonvulsants (35%), and receiving counseling (62%). Conclusions: HPPD is an understudied mental disorder that has a complex and unpredictable nature with overlapping psychiatric, psychological, and neurological symptoms. Controlled, evidence-based clinical studies are needed for improvements in diagnosing and treating HPPD. There is concern for patients’ well-being, particularly concerning high reported suicide ideation and dependency on drugs currently used (even if they are prescribed). Improved education for health care professionals and patients is also needed.

Violent victimization and perpetration as distinct risk factors for adolescent suicide attempts

ABSTRACTThis study examined associations among violent victimization, perpetration, and suicide attempts in youth reporting suicide ideation, within an ideation-to-action framework of suicide. Data on 821 youth (Mage = 16.20, SD = 1.66) were drawn from the National Longitudinal Study of Adolescent to Adult Health, with information regarding violent victimization and perpetration, history of suicide ideation and attempts, non-violent delinquency, depressive symptoms, and substance use. Hierarchical regression analyses indicated that greater experiences of violent victimization and the interaction of violence perpetration by victimization were associated with greater frequency of suicide attempts. Consistent with an ideation-to-action framework, results indicate that violent experiences (victimization or perpetration) may increase the capability for suicide.

A sex-disaggregated analysis of how emotional violence relates to suicide ideation in low- and middle-income countries.

In recent years, research has increasingly focused on examining the relationship between one type of child maltreatment -- emotional violence -- and suicidal behaviors. However, the growing body of empirical evidence supporting these associations has been mostly limited to high-income contexts. This study examines how exposure to emotional violence is associated with suicide ideation in childhood and adolescence in low- and middle-income countries (LMICs), and whether this association differs by sex. We employ nationally representative samples of 13-24 year-old males and females from the Violence Against Children Surveys in Tanzania (conducted in 2009), Kenya (2010), and Haiti (2012). We use logistic regressions to estimate the odds of ever reporting suicide ideation, separately, for each country; models control for self-reported exposure to emotional violence, physical violence from a caregiver, physical violence by an adult in the community, sexual violence, intimate partner violence, and age. Formal moderation by sex for each form of child maltreatment is tested using interaction terms. We find the odds of suicide ideation are consistently and significantly greater for adolescents who report ever exposure to emotional violence. This same consistency is not observed for any other form of maltreatment across countries. The size of the relationship between emotional violence and suicide ideation is statistically significantly larger for males in Kenya only. Research in LMICs should explore the mediating factors linking emotional abuse in childhood and adolescence to suicide ideation in adolescence, paying special attention to whether these pathways might operate differently by sex.

Behavioral Health Resource Utilization of Emergency Department Patients Presenting from Mass Gathering Events

Introduction:Behavioral health needs of attendees at mass gathering events who require emergency department (ED) evaluation are poorly understood. Appropriate resource allocation of mental health staff and other behavioral interventions necessary to support this patient population are also unclear.Aim:To describe behavioral characteristics and psychiatric resource utilization of patients presenting to a tertiary academic medical center emergency department from mass gathering events.Methods:Single-center retrospective study evaluating attendees at mass gathering events who presented to a Chicago ED. Electronic medical records for patients presenting between October 13, 2013, and December 31, 2015, were reviewed and descriptive analyses performed.Results:209 distinct records were reviewed. Most patients presented from large outdoor concerts (n = 186, 89%). Forty-two (20.1%) reported a mental health complaint at presentation, including concerns related to pre-existing psychiatric disturbances or onset of new symptoms. Twenty-seven of the total cohort (12.9%) endorsed a prior psychiatric history. Thirty-five (16.7%) reported use of prescribed psychotropic medications, including antidepressants, stimulants, mood stabilizers, and others. Diagnostic testing among the total sample included serum ethanol measurement (31.1%), urinary toxicology (25.4%), acetaminophen (6.2%), aspirin (5.3%), and creatine kinase measurements (11%). Computed brain tomography was ordered for 20 patients (9.6%). Twelve patients (5.7%) received an anxiolytic (lorazepam) and 113 (54.1%) received intravenous fluids. An antipsychotic (olanzapine) was administered to one patient (0.5%). There were no reports of suicidal ideation, but physical restraints for agitation were employed in 13 patients (6.2%). Police consultation occurred in 10 cases (4.8%). No formal psychiatric consultations were requested by ED providers.Discussion:Patients presenting to the emergency department from mass gathering events frequently endorse behavioral complaints requiring directed use of diagnostic and other emergency department resources for their ailments. The need for physical restraints and limited use of anxiolytics and antipsychotics in our sample suggest that psychiatric consultation is underutilized.

Risk factors of suicidal ideation in Huntington's disease: literature review and data from Enroll-HD.

Suicide is a leading cause of death in Huntington's disease (HD), following pneumonia. Up to one-fifth of individuals with HD report suicidal ideation. Identifying the risk factors of suicidal ideation in this clinical population is thus pivotal. Here, we review the literature on prevalence rates and risk factors of suicidal ideation in premanifest and manifest patients and re-evaluate them using the largest currently existing clinical dataset from the ongoing observational study "Enroll-HD" (N = 5709). Large scale studies yielded important insights regarding suicidal ideation in HD. However, estimated prevalence rates vary among studies and risk factors are still poorly understood. According to the Enroll-HD data, pre- and manifest disease stages are associated with current (5.8-10%) and a history of suicidal ideation (18.6-30.9%). Throughout the course of HD, a history of suicidal ideation and the presence of depressive symptoms were strongly associated with current suicidal ideation. However, while for premanifest individuals, socio-demographics and activities of daily living appear to be important, in manifest patients, suicidal ideation is more closely linked to anxiety, irritability, psychosis, and apathy. These results highlight the importance of treating depressive symptoms in patients with HD and addressing potential suicidal ideation during clinical monitoring. The relevance of risk factors may differ among premanifest and manifest patients.

Nonsuicidal self-injury, suicide ideation and suicide attempts in the National Guard

BackgroundAmong members of the National Guard, suicide rates are higher than age and sex matched civilian counterparts. Across many civilian samples, nonsuicidal self-injury has emerged as a particularly strong correlate of suicide risk. The current study describes the prevalence and correlates of NSSI and suicidal thoughts and behaviors among National Guard members. MethodsParticipants were 897 National Guard personnel recruited online who completed study measures anonymously. ResultsApproximately 6% of males and 14% of females reported a history of NSSI. Almost one third of the sample reported suicide ideation and 3% of men and 11% of women reported a suicide attempt. NSSI was strongly associated with a history of suicide ideation and attempts. Characteristics of NSSI were similar across men and women. DiscussionReliable access to effective interventions is essential for National Guard members in light of their risk for suicidal and nonsuicidal self-injurious behavior.

Exploring Suicide Ideation and Suicide Attempts Among HIV-Positive Patients During the First Six Months to One Year After Their Diagnosis

HIV-positive patients are at high risk of suicide behaviors. Because most previous studies have investigated suicide behaviors among HIV-positive patients during their first six months of diagnosis only, there is a current lack of understanding of suicide behaviors among this group. This study aimed at HIV-positive patients who had been diagnosed between six months and one year ago and examined their suicide ideation and suicide attempt profiles and the associated factors of suicide. This study adopted a cross-sectional design. A total of 114 HIV-positive patients were interviewed in the HIV clinics of a medical center in Taipei City. Information collections included demographic and HIV-related data and measurements of suicide ideation, suicide attempt, depression, body image, meaning in life, and social support. Independent samples t tests, chi square tests, and logistic regressions were conducted to examine the associated factors and predictors of suicide ideation and suicide attempt. Slightly over one-quarter (27.2 %) of the participants reported suicide ideation and 14.0% reported attempting suicide in recent one week prior the study interview. Duration since being diagnosed HIV-positive, level of education, and history of depression were each associated with suicide ideation, while only history of depression was associated with suicide attempt. Having a higher level of education and having a higher level of social (family) support were both predictors of lower risk of suicide ideation, while having a higher level of depression predicted a greater risk of suicide attempt. This study found high prevalences of suicide ideation and attempting suicide among HIV-positive patients during the six month to one year period after diagnosis. Moreover, the prevalence was similar to that among HIV-positive patients during the first six months of diagnosis. Suicide prevention should be a focus of care plans provided to HIV-positive patients during their first year after diagnosis. These results may be provided as a reference for developing suicide-prevention strategies for HIV-positive patients. Routine screening for depression, guiding families to increase their provision of social support, and giving assistance to individuals with higher levels of depression contribute to the effective prevention of suicide among HIV-positive patients.

Association of aggression and suicide behaviors: A school-based sample of rural Chinese adolescents

BackgroundTo determine the prevalence of suicide behaviors and the associations between aggression and suicide behaviors among a nationwide school-based sample of adolescents in rural China. MethodsA total of 16,271 students from 24 junior and 23 senior high schools in five provinces of China participated in a self-administered anonymous survey to report suicide ideation, plans, attempts, aggression and other related information. Multivariable logistic regression models were used to investigate the associations between aggression and the risks of suicide behaviors while controlling for potential confounders. ResultsThe prevalence of suicide ideation, plans, and attempts during the past one year was 15.1%, 7.2%, and 3.5% respectively. In the fully adjusted model, participants with high level of total aggression had 4.31 times (95% CI, 3.69–5.05), 4.10 times (95% CI, 3.26–5.11), and 3.29 times (95% CI, 2.62–4.93), higher risk of suicide ideation, plans, and attempts, respectively, compared with subjects who had low level of total aggression. Moreover, high levels of all the five dimensions of total aggression also had positive associations with suicide behaviors. LimitationsThis study was cross-sectional. Hence, the causal link between aggression and suicide behaviors should be verified in the future studies. ConclusionsThis study suggests that aggression may be a risk factor for suicide behaviors among rural Chinese adolescents. Our findings highlight the importance of aggression treatment in suicide prevention programs. Further longitudinal studies are needed to confirm these associations.

Risk Factors for Suicidal Ideation and Attempts in Adolescents.

Objective:Although suicide is a serious public health concern for adolescents, there is a lack of studies that explore its risk factors in the Republic of Korea. The present study aims to investigate risk factors associated with suicidal behaviors in Korean adolescents.Methods:Participants consisted of 2258 middle and high school students who completed a series of questionnaires regarding suicide ideation or attempts, non-suicidal self-injuries, depression, impulsivity, drinking behaviors, and negative life events, including peer bullying.Results:Among the participants, 8.3% of students reported suicide ideation, while 3.2% reported a history of a suicide attempt in the past 12 months. Depression, peer-victimization, internet-related delinquency, and positive attitudes toward suicide were associated with suicidal ideations and attempts. Adverse life events were also associated with suicide ideation, but not attempts, while not living with both parents and poor family relationships were associated with suicide attempts, but not ideations. Non-suicidal self-injuries were associated with both suicide ideations and attempts. Students with suicidal ideations and attempts can be differentiated depending on the presence of self-injury.Conclusion:In addition to depression or behavioral problems, non-suicidal self-injuries and lack of support from family may also play significant roles in suicide attempts in adolescents. To facilitate the prevention of suicide in adolescents, longitudinal studies should be followed to confirm the risk factors identified in this study.

A Phase 3, Double-Blind, Randomized, Placebo-Controlled Study of Vilazodone in Adolescents with Major Depressive Disorder

BackgroundMajor depressive disorder (MDD) is a serious illness in children and adolescents. Vilazodone is a selective serotonin reuptake inhibitor approved for MDD in adults. This study evaluated the efficacy, safety, and tolerability of vilazodone in adolescent patients, ages 12–17 years, with MDD (NCT01878292).MethodsThis double-blind, randomized, placebo-controlled, parallel-group, fixed-dose study was conducted at 56 study centers in the United States and was 10 weeks in duration (a 1-week screening period, an 8-week double-blind treatment period, and a 1-week double-blind down-taper period). Outpatients with an MDD diagnosis based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria were included in the study. Clinical inclusion criteria required a Children’s Depression Rating Scale–Revised (CDRS-R) total score of ≥ 40 and Clinical Global Impressions–Severity (CGI-S) score of ≥ 4. Patients were randomized 1:1:1 to 8 weeks of double-blind treatment with placebo (n = 174), vilazodone 15 mg/day (n = 175), or vilazodone 30 mg/day (n = 180). The primary and secondary efficacy parameters were change from baseline to week 8 in CDRS-R total score and CGI-S score, respectively. Safety parameters included adverse events (AEs); clinical laboratory, vital sign, and electrocardiogram parameters; and the Columbia-Suicide Severity Rating Scale.ResultsApproximately 86% of patients completed double-blind treatment. There was no statistically significant difference between vilazodone 15 mg/day or 30 mg/day and placebo in change from baseline in CDRS-R score. Change in CGI-S score was not significant after adjustment for multiple comparisons. The most common treatment-emergent AEs were nausea, upper abdominal pain, vomiting, diarrhea, nasopharyngitis, headache, and dizziness. Reports of suicidal ideation (placebo, 33.3%; vilazodone 15 mg/day, 36.0%; vilazodone 30 mg/day, 31.1%) and suicidal behavior (placebo, 1.8%; vilazodone 15 mg/day, 1.1%; vilazodone 30 mg/day, 1.1%) were similar between treatment groups. There were no deaths in the study.ConclusionsThe efficacy of vilazodone for the treatment of MDD in adolescent patients could not be confirmed in this study. Vilazodone was generally safe and well tolerated, with treatment-emergent AEs similar to those in adult patients.Clinical Trial RegistrationNCT01878292.Electronic supplementary materialThe online version of this article (10.1007/s40272-018-0290-4) contains supplementary material, which is available to authorized users.