Risk Of Suicidal Behavior Research Articles

Suicidal Behaviour Prior to First Episode Psychosis: Wider and More Widespread Grey-Matter Alterations

Introduction The prodromal phase preceding the onset of First Episode Psychosis (FEP) is associated with an increased risk of Suicidal Behaviors (SBs). The aim of this study was to identify specific structural brain abnormalities linked to SBs that occur prior to the onset of FEP. Methods Voxel-based morphometry analyses were used to investigate differences in brain Grey Matter (GM) volume using the CAT12 toolbox within SPM12. Covariates, including gender, age, handedness, intracranial volume, depression severity, and global cognitive functioning, were controlled for as confounding factors. Results Significant reductions in GM were observed in the left superior temporal gyrus, dorsal posterior cingulate cortex, precuneus, cuneus, anterior cerebellum (p-FWE corrected < 0.05, k > 50) as well as in the right amygdala (0.96 ± 0.06 vs. 1.01 ± 0.05; F = 4.78; p < 0.05) and left amygdala (0.97 ± 0.06 vs. 1.02 ± 0.05; F = 8.97; p = 0.01). Conclusions History of SB prior to the onset of the psychotic disorder was related to wider and more widespread brain GM alterations. The regions identified are involved in cognitive and emotional processes such as emotional regulation, social cognition, perseverative thinking, and pain tolerance. These findings suggest that structural brain abnormalities related to SB occurring before FEP onset may serve as early biomarkers for identifying individuals at increased risk of suicide.

Associations between antidepressants and risk of suicidal behaviour and violent crimes in personality disorder.

Associations between antidepressants and risk of suicidal behaviour and violent crimes in personality disorder.

The Presence of Externalizing Diagnoses Increases the Risk of Suicidal Thoughts and Behaviors in Youth Enriched for Early Onset Depression

The Presence of Externalizing Diagnoses Increases the Risk of Suicidal Thoughts and Behaviors in Youth Enriched for Early Onset Depression

Self-regulation in adults with intermittent explosive disorder and a history of suicide attempts.

Both suicide attempts and aggression aim to cause harm and are associated with numerous personal and societal consequences but differ on intended targets. Aggression towards others is associated with increased risk of suicidal behavior. Research has demonstrated commonalities with impulsiveness and affect regulation for both. This study's purpose was to compare self-regulation between those meeting criteria for a psychiatric condition characterized by unplanned aggression (intermittent explosive disorder [IED]), a lifetime history of a suicide attempt (SA), and those with both (IED+SA), as well as compared to participants meeting criteria for non-aggressive psychopathology (PC) or no psychiatric disorder (HC). Adult community participants (n=735) completed diagnostic assessments and self-report measures on suicidal behaviors, aggression, trait anger, impulsivity, and affect regulation as part of a larger aggression research program. Pairwise comparisons found IED+SA was associated with the highest scores on all outcome variables except compared to IED on anger. IED had higher aggression and anger scores than SA but did not differ on general impulsivity and affect regulation scores. PC did not differ from SA on anger or from IED and SA on affect regulation; PC scored lower on aggression and anger than IED+SA and IED. HC scored lowest on all variables. Such results imply IED with past suicidal behavior may be associated with heightened self-regulation difficulties overall compared to IED alone and non-aggressive psychopathology. Future research may build upon this by further recruiting for both unplanned aggression and suicidal behavior, as well as including comparisons with other impulsivity-related diagnoses.

Suicide and suicide attempt in users of GLP-1 receptor agonists: a nationwide case-time-control study.

Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are extensively evaluated for the risk of suicidal behaviors or ideation; the influence of psychiatric history or obesity on this potential effect remains to be investigated. Therefore, we aimed to assess the association between GLP-1 RA and suicide or suicide attempt, considering these factors. Patients ≥18y who died by suicide or were hospitalized for suicide attempt (2013-2021) with at least one GLP-1 RA dispensing within the 180 preceding days were selected from the French National Health Data System (SNDS). A case-time-control design compared, for each patient, GLP-1 RA exposure in the 30 days preceding the outcome (composite of suicide or suicide attempt) to three earlier 30-day reference periods. Potential exposure trend bias was controlled using up to five time-controls matched on age, sex, psychiatric history, obesity, calendar time. Analyses were adjusted for time-varying confounders. Finally dipeptidyl peptidase-4 (DPP-4) inhibitors were studied as negative controls for potential biases. This study included 1102 cases and 5494 controls. Mean case age was 57.4 years (SD 11.4); 44.6% were male, 67.6% had a recent psychiatric history and 51.3% had obesity. GLP-1 RA use was not associated with an increased risk of suicide or suicide attempt (OR, 0.62; 95% CI, 0.51-0.75), with consistent results for DPP-4 inhibitors (0.75; 0.67-0.84). Results obtained according to recent psychiatric history and obesity were comparable. This large nationwide case-time-control study provides reassurance about the short-term psychiatric safety of GLP-1 RA, showing no specific risk for patients with psychiatric disorders or obesity. French Medicines Agency.

Psychological autopsy: Overview of equivocal deaths, suicides and homicide-suicides.

Psychological autopsy studies are a method to understand the causes of equivocal deaths. Suicides and homicide-suicide are the result of various events. The understanding of an individual's life before their death, by interviewing the next of kin, provides some insight into the causes. The research articles dealing with psychological autopsy studies through case studies of suicide or homicide-suicide instances, obtained from different search engines, shed light on the mental health, Alcohol use disorder (AUD), and Drug use disorders (DUD) of individuals before death. The primary characteristic of suicides in a population of late twenties to early fifties was romantic relationship conflicts. In contrast, suicides in the teenage years and early twenties were characterized primarily by a lack of familial acceptability and, to a lesser extent, self-acceptance. Simultaneously, there was a high risk of suicidal behavior and commission of acts among the DUD patients, getting treatment without psychiatric diagnosis and therapy. Over time, the psychological autopsy technique has shown to be quite helpful in determining the risk factors for suicidal behavior. The study helps to develop multiple rehabilitation and mental awareness that need to be created among various populations so that the suicide and homicide-suicide rates can be reduced.

Examining Risk and Protective Factors for Suicidal Behaviors: A Cross-Sectional Study Among Portuguese Male Inmates

Background/Objectives: Prison inmates face a significantly higher risk of acting on suicidal thoughts than the general population. However, Portuguese studies distinguishing inmates who think about suicide from those who attempt it remain scarce. Given this ideation-to-action distinction, the current cross-sectional study aimed to examine risk and protective factors for suicidal ideation, suicide attempts, and the transition from one outcome to another. Methods: A total of 411 male inmates (M = 37.94 years, SD = 10.91) from 16 Portuguese prisons participated in the study. Data were collected between 2020 and2024 using four instruments: (1) Sociodemographic Questionnaire; (2) Social and Emotional Competencies Questionnaire (SEC-Q); (3) Predictive Antisocial Spectrum Questionnaire; and (4) Health Risk Behavior Checklist. Results: Among the total sample, 29.1% reported a lifetime history of suicidal ideation, and 19.4% had attempted suicide. Impulsivity/irresponsibility emerged as a key risk factor for suicidal ideation, whereas social and emotional competencies of self-management and motivation were protective factors against suicide attempts. Previous self-harm behavior was the only risk factor for both suicidal ideation and suicide attempts. Conclusions: Our findings provide important insights into risk and protective factors for suicidal behaviors among male inmates, offering key information for policy and practice efforts aimed at reducing mortality in this high-risk population.

Using Smartphone GPS Data to Detect the Risk of Adolescent Suicidal Thoughts and Behaviors

Suicide rates among adolescents continue to rise, but there are a lack of clinical tools to predict when youths may be at risk for suicidal behaviors. To identify whether geolocation metrics, assessed through an app installed on adolescents' personal smartphones, could detect the risk of next-week suicidal events and clinically meaningful suicidal ideation. This case series study included high-risk adolescents aged 13 to 18 years reporting a current affective and/or substance use disorder, oversampled for suicidal thoughts and behaviors (STB). Participants were recruited from the greater New York City and Pittsburgh communities through psychiatric outpatient programs, emergency departments, medical center research registries, and social media. Participants installed the Effortless Assessment Research System (EARS) software application onto their personal smartphones, which obtained passive sensor data, including geolocation metrics (via the global positioning system [GPS]), as well as weekly experience sampling data probing STB for the duration of the 6-month study. Adolescents also completed clinical assessments at baseline as well as during the 1-, 3-, and 6-month follow-up assessments. Statistical analysis was performed from March 2023 to November 2024. Repeated measures mixed-effects logistic models estimated whether weekly aggregates of geolocation features (ie, entropy, homestay, distance traveled) were associated with next-week suicidal events (ie, suicide attempts, psychiatric hospitalizations, emergency department visits for suicide concerns) and clinically meaningful ideation (via weekly experience sampling). Overall, 186 participants were included in this study (148 [79.6%] female; 19 [10.2%] Asian, 23 [12.4%] Black, and 106 [57.0%] White), with a mean (SD) age of 16.4 (1.7) years. Greater homestay (amount of time spent at home) on a given week, relative to one's own mean, was associated with 2-fold greater odds of suicidal events during the subsequent week (odds ratio, 1.99 [95% CI, 1.15-3.45]). Results were not significant for entropy and distance traveled metrics. However, using leave-future-out validation, the accuracy of the homestay model was modest (area under the receiver operating characteristic curve, 0.64 [95% CI, 0.50-0.78]). Advancements in smartphone technology afford unique opportunities to capture affective and behavioral dynamics that presage suicide risk. This case series study found that greater homestay obtained through smartphone GPS data over the course of a week, relative to one's own mean, was associated with greater odds of a suicidal event in the subsequent week. Although accuracy was modest, these findings offer a novel starting point for suicide prevention research, particularly as smartphone sensor data may have the capacity to identify who is at risk while also providing an opportunity to deliver clinical tools when that risk is greatest.

Natural disasters and suicidal behaviour: An updated systematic review.

This systematic review aims to update and extend the findings of an earlier review on the suicidogenic impact of natural disasters. A systematic search of research published in 17 bibliographic databases was conducted (PROSPERO CRD42020216722). The review following PRISMA checklist identified 64 primary studies, published between 2012 and 2022, investigating the association between natural disasters and suicidal behaviour and ideation. The majority of studies related to natural disasters in Japan, China, USA, India and Australia. Over half the studies (n = 39) investigated the impact of earthquakes. Other disasters included hurricanes, floods, tsunamis, droughts, wildfires, tornadoes and multiple disasters. Concerning suicide mortality (the most studied suicide-related outcome), there was variability in the suicidogenic impact of earthquakes depending on location, age, sex and time elapsed since the event. While suicide mortality appeared to increase following drought, investigations of hurricanes/tornadoes and floods found no evidence of a similar association. Findings relating to other suicide-related outcomes are more consistent, suggesting that exposure to droughts, hurricanes, tsunamis, floods, and other natural disasters is associated with increased risk of suicidal ideation and non-fatal suicidal behaviour. This association, however, is dependent on other factors, including the level of structural adversity in the exposed population (e.g., unemployment, poverty, food insecurity), individual vulnerabilities (e.g., physical and mental health), local resources, and availability of support. Publications in languages other than English, French, Spanish, Italian and Portuguese may have been missed. The heterogeneity and methodological weakness of primary studies limited our ability to provide definitive responses to our research questions. The considerable inconsistency in the findings reported across these studies, particularly relating to suicide mortality, is noteworthy. While this may be an artefact of methodological limitations, it is possible that there are substantive ('real') differences in the impact of natural disasters on suicidal behaviour linked to the type of disaster, the socioeconomic and sociocultural context, the type of suicidal behaviour, or other explanatory factors.

Toxoplasma gondii, suicidal behaviour and suicide risk factors in US Veterans enrolled in mental health treatment.

Markers of chronic infection Toxoplasma gondii (Nicolle et Manceaux, 1908) have been associated with suicidal self-directed violence (SSDV). We present the results of the first study relating T. gondii IgG serology with suicide attempts and suicidal ideation in United States Veterans, known to have higher suicide rates than members of the general population. We also related T. gondii serology to SSDV risk factors, including valid and reliable measures of trait impulsivity, aggression, self-reported depression, and sleep disturbance. We recruited 407 Veterans enrolled at three Veterans Affairs Medical Centers with mean (S.D.) age = 45.6 (11.6) years; 304 men (74.7%); 203 with a history of SSDV and 204 with no history of any self-directed violence (SDV). Seropositivity and serointensity, categorised as high (top quartile) or low (lower three quartiles), were analysed in relationship to SSDV, suicidal ideation and clinical risk factors using age and gender-adjusted linear and logistic methods, after transformations and nonparametric tests when appropriate. Associations between seropositivity and SSDV and its risk factors were not significant in all groups. High serointensity, while not associated with SSDV or repeat suicide attempts, was positively associated with suicidal ideation, depression, impulsivity, and daytime dysfunction due to sleepiness (p < 0.05), but only in Veterans with a history of SSDV. In Veterans without a history of SDV, no associations were significant. These associations remained significant after adjustment for certain socioeconomic factors (i.e., income, homelessness, military rank). Including education in the model downgraded the statistical significance of suicidal ideation and depression to statistical trends, but the significance of associations with impulsivity and daytime dysfunction due to sleepiness remained. Major limitations include the cross-sectional design, overall low seropositivity within the sample, and potentially spurious results due to multiple comparisons. Thus, the results of this report need to be replicated in larger samples, ideally longitudinally.

Proinflammatory gene expression is associated with prospective risk for adolescent suicidal thoughts and behaviors over twelve months.

Recent theories have implicated inflammatory biology in the development of psychopathology and maladaptive behaviors in adolescence, including suicidal thoughts and behaviors (STB). Examining specific biological markers related to inflammation is thus warranted to better understand risk for STB in adolescents, for whom suicide is a leading cause of death. Participants were 211 adolescent females (ages 9-14 years; Mage = 11.8 years, SD = 1.8 years) at increased risk for STB. This study examined the prospective association between basal levels of inflammatory gene expression (average of 15 proinflammatory mRNA transcripts) and subsequent risk for suicidal ideation and suicidal behavior over a 12-month follow-up period. Controlling for past levels of STB, greater proinflammatory gene expression was associated with prospective risk for STB in these youth. Similar effects were observed for CD14 mRNA level, a marker of monocyte abundance within the blood sample. Sensitivity analyses controlling for other relevant covariates, including history of trauma, depressive symptoms, and STB prior to data collection, yielded similar patterns of results. Upregulated inflammatory signaling in the immune system is prospectively associated with STB among at-risk adolescent females, even after controlling for history of trauma, depressive symptoms, and STB prior to data collection. Additional research is needed to identify the sources of inflammatory up-regulation in adolescents (e.g., stress psychobiology, physiological development, microbial exposures) and strategies for mitigating such effects to reduce STB.

Alcohol Use Disorders and Suicidal Behaviour: A Narrative Review.

Alcohol Use Disorders (AUD), affective disorders, and personality disorders are among the most prevalent mental health conditions observed in individuals exhibiting suicidal behavior, encompassing both completed and attempted suicides. A robust association between AUD and suicidal behavior has been established through retrospective and prospective cohort studies. Research on the relationship between alcohol consumption and self-harm has predominantly focused on Western and high-income countries, whereas approximately one-third of the global population, including half of the world's countries, lacks accessible suicide data. This study aims to present an updated review of empirical evidence regarding the risk of suicide associated with AUD in both developed and developing nations. We identified published meta-analyses, reviews, systematic reviews, randomized controlled trials, clinical studies, clinical trials, controlled clinical trials, observational studies, and case reports written in English and published between January 2004 and June 2024. Our search yielded a total of 312 papers. After reviewing titles and abstracts, 232 articles were excluded from the initial records. Following full-text review of the remaining 80 articles, a qualitative synthesis was conducted, highlighting the most representative 41 papers for inclusion in this overview. Our analysis indicates that alcohol abuse is a significant risk factor for all forms of suicidal behavior. Alcohol consumption functions as both a predisposing and precipitating factor, contributing to maladaptive behaviors in both developing and developed countries. The clinical condition is exacerbated by alcohol use, which in turn increases the risk of suicide. Further research is essential to develop targeted psychological and pharmacological interventions aimed at preventing and treating these conditions, with the goal of reducing the risk of suicidal behavior associated with AUD. In developing countries, integrating public health and clinical strategies is crucial for effectively addressing suicide prevention.

The Prevalence of Suicidal Behaviors in Childhood, Adolescent and Young Adults Cancer Survivors: A Systematic Review and Meta-Analysis

BackgroundMany studies have shown that Childhood, adolescent and young adult cancer (CAYAC) survivors have an increased risk of late physical and mental health effects. However, comprehensive data on the risks of suicidal behaviors in CAYAC survivors are still lacking. We investigated the evidence of suicidal behaviors in CAYAC survivors. MethodsWe performed a systematic review and meta-analysis. The literature search was conducted using MEDLINE, Embase, CINAHL, PsycINFO, the Cochrane Database, and reference lists from previous relevant reviews. We summarized the characteristics of eligible studies on suicidal behavior. We performed meta-analysis with random-effect model for available data of them and calculated pooled prevalences with 95% confidence intervals (CI). ResultsWe identified 1108 articles from the search and 22 articles from previous review. We identified 38 eligible studies. 26 cohort studies and 12 cross-sectional studies were compromised. The meta-analysis showed pooled prevalence of suicide was 0.152% (95% CI: 0.103-0.209), suicide attempt was 2.2% (95%CI; 1.9-2.6) and suicidal ideation was 9.2% (95%CI: 7.8-10.6). Some studies identified specific CAYAC survivors at risk of suicide as age, type of cancer and treatments. LimitationsOutcome measures could not be identified in some studies in the meta-analysis. ConclusionsThe findings revealed prevalence of suicidal behaviors in CAYAC survivors. Greater awareness and monitoring are needed of these risks, and of issues that affect support to prevent suicidal behaviors in CAYAC survivors.

Social Support and Depression Mediate the Relationship Between Childhood Trauma and Nonsuicidal Self-Injury.

Nonsuicidal self-injury (NSSI), which involves the deliberate destruction of body tissue without suicidal intent, is strongly associated with an increased risk of later suicidal behaviour. Disclosing the risk factors for NSSI is therefore vital to prevent the progression to suicide. While documented evidence links NSSI to childhood trauma, depression, social support, a comprehensive perspective that integrates these factors together is lacking. To bridge this gap, we leveraged a chain-mediating model in this study, to examine the mediating effect of social support and depression on the relationship between childhood trauma and NSSI. As expected, NSSI behaviours were positively correlated with depression scores (r = 0.492, padj < 0.001), childhood trauma scores (r = 0.306, padj < 0.001), and negatively correlated with the social support scores (r = -0.168, padj = 0.020). Importantly, in the chain-mediating model, increased childhood trauma was associated with decreased social support (β = -0.532, t = -9.086, p < 0.001), which in turn was linked with increased depressive symptoms (β = -0.193, t = -2.957, p < 0.01), ultimately contributing to greater odds of NSSI behaviours. Our findings elucidated the complex psychological mechanisms underlying the interplay between childhood trauma, social support and depression severity, suggesting that improving social support and intervening early in depression may be potential ways to reduce the risk of NSSI.

Evaluation of Suicidal Symptoms in Adult Depressive In-Patients at Birat Medical College and Teaching Hospital

INTRODUCTION Suicide is a critical public health concern and a leading cause of death globally, particularly among individuals with major depressive disorder (MDD). Understanding the prevalence and correlates of suicidal symptoms in hospitalized depressive patients is crucial for effective intervention and prevention strategies. This study aimed to evaluate the prevalence, severity, and associated factors of suicidal symptoms in adult depressive in-patients at Birat Medical College and Teaching Hospital, focusing on gender differences and clinical predictors. MATERIAL AND METHODS A descriptive, cross-sectional study was conducted over a 1-year period (July 2022 - June 2023). A total of 120 adult in-patients diagnosed with MDD according to DSM-5 criteria were selected using purposive sampling. Data were collected using a structured proforma and the Hamilton Depression Rating Scale (HDRS). Statistical analyses included descriptive statistics, independent t-tests, Spearman’s correlation, and regression analysis. RESULTS Of the 120 patients, 54% reported suicidal ideation, with a higher prevalence among females (68%) compared to males (44%). Significant positive correlations were found between HDRS scores and suicidal symptoms (r = 0.74, p &lt; 0.001). Regression analysis indicated that HDRS scores and duration of illness were significant predictors of suicidal symptoms (R² = 0.68, p &lt;0.01). CONCLUSION Suicidal symptoms are highly prevalent among depressive in-patients, especially in females. The severity of depression and longer duration of illness are associated with an increased risk of suicidal behavior. These findings highlight the importance of routine screening and targeted interventions in hospitalized patients with MDD.

Risk and Protective Factors for Suicidal Thoughts and Behaviors Among Asian American Young Adults: A Systematic Review.

Background: Asian American (AA) young adults, including AA college students, may experience more suicidal thoughts and behaviors (STBs) compared to other racial and ethnic groups of the same age. To the best of our knowledge, this study is the first systematic review of the risk and protective factors for STBs with a focus on AA young adults. Methods: Informed by the social-ecological perspective and the cultural model and theory of suicide, this study systematically reviews the risk and protective factors for STBs among AA young adults. Based on 22 research articles published between 1998 and 2023, we analyzed and discussed the effects of 37 risk and 15 protective factors at the individual, relationship, community, societal, and cultural levels. Results: Most risk factors are at the individual level (e.g., depressive symptoms and hopelessness), followed by factors at the cultural level (e.g., acculturation and acculturative stress), the relationship level (e.g., family problems and romantic relationship problems), the community level (e.g., verbal threats on campus), and the societal level (e.g., public stigma about mental health). Also, most protective factors are at the individual level (e.g., self-reliance and fear of suicide), followed by the relationship level (e.g., social support and family responsibilities), the community level (e.g., religious affiliations), and the cultural level (desire not to burden others). Conclusions: This systematic review emphasizes the need for future research to explore cultural factors, subgroup differences, and longitudinal designs, while advocating for culturally specific prevention and intervention strategies to improve mental health outcomes for AAYAs.

A Model of Bystander Helping to Prevent Suicide: Examining and Extending the Theory of Planned Behavior

Research documents alarmingly high suicidal behavior risk among adolescents and young adults in the United States. A related concern is similarly high rates of exposure to the self-directed violence (SDV) of others. The current study examined how components of the Theory of Planned Behavior explain factors related to helping social network members engaging in SDV. Baseline data ( N = 4,982) from the longitudinal study, Project Lift Up, were analyzed cross-sectionally. Young people, ages 13 to 22, were recruited through social media platforms; sexual and gender minority youth were oversampled. Participants answered questions about exposure to other people’s SDV and measures of key constructs related to the Theory of Planned Behavior for helping reduce SDV including perceptions of what others think about helping and behavioral control. Three outcomes were assessed: Intent to help someone, proactive behavior to promote the other person’s mattering, and proactive behavior to prevent SDV. Measures showed adequate reliability and validity (Cronbach’s alphas above .70). Overall, regression analyses across the three outcomes partially supported the Theory of Planned Behavior. Attitudes and confidence explained variance in intent to help and proactive behavior outcomes, whereas intent and social norms showed more mixed associations with the three outcomes. While the Theory of Planned Behavior is useful to explain gatekeeper outcomes for suicide prevention, specific significant factors within the model vary by the specific outcome being examined. Further research to unpack nuances in gatekeeper behaviors is needed and may help design prevention strategies.

Role of depression, suicide attempt history and childhood trauma in neutrophil-to-lymphocyte ratio dynamics: A 30-week prospective study.

Studying the biology of suicidal behaviour and developing blood-based biomarkers may help stratify individuals with suicidal behaviors into clinically relevant categories. Literature suggests that people diagnosed with mood disorders and suicidal behaviour show an increased neutrophil to lymphocyte ratio (NLR). For the first time, we investigated NLR variability in mood disorders, a critical aspect of biomarker development. Our study provides a result on the influence of our variables on the NLR and also on the intrinsic properties of the ratio. Consequently, our objective was to analyse the differences in NLR between healthy subjects and patients diagnosed with mood disorder with suicidal behaviour or mood disorder without suicidal attempt. A prospective study was conducted on 97 healthy subjects, 63 patients with mood disorder without suicidal behaviour and 61 patients with mood disorder with suicidal behaviour (mean age [SD] = 44.2 [14.31]; 66.1 % female). Participants were assessed four times over 30 weeks, where blood samples and clinical data were collected. After controlling for confounding factors such as smoking and medical history, we found that NLR stability was low but NLR was significantly associated with a history of suicide attempt (mixed linear model, F = 4.044; p = 0.018). We also observed a significant interaction between NLR values and childhood trauma (p = 0.002). Furthermore, our results demonstrate that NLR is influenced by childhood trauma, including in controls (p = 0.014). Finally, NLR expression differs between patients with and without suicidal behaviour, but only in those without a history of childhood trauma (p = 0.026). Despite its variability over time, our data suggest that NLR may be a promising biomarker for identifying individuals at high risk of suicidal behaviour among patients with mood disorders.

Occupational groups and risk of suicidal behavior in men: a Swedish national cohort study during 2002–2019

IntroductionThe risk of suicide has been shown to vary by occupation. We aim to identify contemporary occupational groups at greatest risk for suicidal behaviour (fatal and non-fatal), in Swedish men of working-age.MethodsA population-based cohort study of male conscripts without history of self-harm who enlisted during 1968–2001 and were followed-up during 2002–2019 (n = 1 542 665). Occupational groups and suicidal behaviours were identified using national registers. Incidence rate ratios (IRR) for suicidal behaviour at ages 25–65 were calculated among occupational groups, and compared to the incidence rate of the whole cohort.ResultsMajor occupational groups with increased risk for suicidal behavior included elementary occupations, building and manufacturing, service, care and shop sale and mechanical manufacturing and transport. Subgroup analyses revealed particularly high risks for assistant nurses, other service workers not elsewhere classified, building frame and related trades workers and cleaners and helpers.ConclusionsMen with elementary occupations as well as personal care and building and manufacturing workers were at greatest risk. This study provides a comprehensive description of risks for suicidal behaviour among occupational groups in men of working-age. These results suggest occupational groups that should be targeted for general suicide prevention intervention.

Factors associated with gender specific adolescent presentations to the emergency department for suicide risk behaviors during the COVID-19 pandemic.

Adolescent presentations to the emergency department (ED) for suicide-related thoughts and behaviors (SRTBs) increased during the COVID-19 pandemic. Gender expansive youth were particularly impacted by the loss of gender-specific services, however, data examining ED pandemic presentations of gender expansive youth for SRTBs are scarce. Data were collected at a tertiary care center in Canada. Adolescents aged 12 to 17 presenting with SRTBs were recruited during two periods: March 2018 - March 2020 (pre-pandemic) and March 2021 - May 2023 (during pandemic). Patient demographics, mental health symptoms, and pre-ED visit healthcare utilization were examined. We identified 202 adolescents (70 pre-pandemic; 132 during pandemic), with a mean age of 14.3 years. Compared with pre-pandemic, during pandemic adolescents were more likely to identify as gender expansive [pre: 5.7% versus during: 24.2%; p = .01] and were of European descent [pre: 28.6% versus during: 59.1%; p < .01]. During the pandemic, gender expansive adolescents, on average, exhibited higher suicidal ideation, measured by Suicide Ideation Questionnaire Junior scores, compared with cisgender adolescents [gender expansive: mean = 64.3 (standard deviation = 12.1) versus cisgender participants: mean = 58.0 (standard deviation = 14.5); p = .03]. There were no differences in demographics, healthcare utilization, depression or anxiety symptom severity between gender expansive and cisgender adolescents. Adolescents presenting to the ED with SRTBs during the pandemic were more likely to identify as gender expansive than those presenting pre-pandemic. Gender expansive adolescents exhibited increased suicidal ideation compared to cisgender adolescents during the pandemic.