Screening For Suicidal Ideation Research Articles

Implementation and improvement of a routine suicidal ideation screening process for an ambulatory, academic NCCN-designated center.

294 Background: From May – August 2021, outpatient suicidal ideation-related safety events nearly doubled from the three years prior at an academic NCCN center. This rise in events challenged staff and revealed improvement opportunities for suicide prevention, such as routine screening for suicidal ideation (SI) in the ambulatory setting. In addition, the COVID pandemic introduced an added layer of vulnerability to cancer patients, who are at an increased SI risk compared to the general population. Methods: From August 2021 - 2023, a multidisciplinary team developed and implemented a routine SI screening, intervention and escalation process that included a staff education program, a process-aligned EHR build, a metric dashboard, and a quality improvement-control plan. The vision was to identify all patients experiencing SI and support them with timely and compassionate care. A step-up metric target approach was used to set quarterly goals. The overarching goal was to screen at least 70% of eligible patients by the end of fiscal year 2024. The new process went live organization-wide on July 31, 2023. Following implementation, various improvement opportunities were identified with indicators including performance metrics, process audits, patient case reviews, and stakeholder feedback. Initial improvement efforts focused on clinics and sites that were screening < 25% between FY24 Q1 and Q2. Continued collaboration between Quality Improvement and clinic leaders revealed improvement opportunities in identifying eligible patients and staff screening practices. Impactful interventions addressed patient identification and staff coaching. Results: As a new process, the overall screening rate started at 0% and increased to 48% over FY24*. Conclusions: Overall, a new SI screening process was successfully implemented, and improved with diligent PDSA work, yet metric goals were not achieved. Many factors may have contributed to underperformance. Ongoing evaluation and collaboration with stakeholders are crucial for continued improvement. Beyond these efforts exists the social and cultural stigma of suicide, which may have limited the impact of improvement endeavors. Results may demonstrate further need for open and supportive discussion with staff, patients, and the larger healthcare community. Data time range: 7/31/23-5/21/24.* FY24 + Quarter Metric Goal Screening Rate Q1 40% 35.7% Q2 50% 34.5% Q3 60% 41.2% Q4 70% 47.8%

Development of a Subtle Screening for Suicidal Ideation: Psychometric Characteristics and Implications for Family Therapists

Development of a Subtle Screening for Suicidal Ideation: Psychometric Characteristics and Implications for Family Therapists

The association between urinary incontinence and suicidal ideation: Findings from the National Health and Nutrition Examination Survey.

Urinary incontinence (UI) might be linked to suicidal ideation, but we do not yet have all the relevant details. This study aimed to dig deeper into the connection between UI and suicidal ideation using data from the National Health and Nutrition Examination Survey (NHANES). We examined 31,891 participants aged ≥ 20 years from NHANES 2005-2018 who provided complete information. We used standardized surveys to check for UI and signs of suicidal ideation. To better understand this relationship, we used statistical tools such as multivariable logistic regression, subgroup analysis, and sensitivity analyses. Among the 31,891 participants, 28.9% reported UI and 10.7% reported suicidal ideation. Those with UI exhibited a significantly greater incidence of suicidal ideation (15.5%) than did those without UI (8.8%, P < 0.001). After adjusting for various factors, including age, sex, marital status, socioeconomic status, educational level, lifestyle factors, and chronic comorbidities, UI remained significantly associated with suicidal ideation (OR:1.54, 95% CI = 1.39-1.7, P < 0.001). Among all types of UI, MUI participants were more likely to experience suicidal ideation. Compared with no UI, higher odds of suicidal ideation suffered from MUI (OR:2.11, 95%CI:1.83-2.44, P < 0.001), SUI (OR:1.4, 95%CI:1.19-1.65, P < 0.001), UUI(OR:1.37,95%CI:1.16-1.62, P < 0.001) after full adjustment. With the exception of individuals living with a partner, the remaining subgroups exhibited a positive correlation between urinary incontinence and suicidal ideation, considering that factors such as age, sex, and prevalent comorbidities such as hypertension, depression, and diabetes did not reveal any statistically significant interactions (all P > 0.05). Sensitivity analyses, incorporating imputed missing covariates, did not substantially alter the results (OR: 1.53, 95% CI: 1.4-1.68, P < 0.001). Urinary incontinence may correlate with increased suicidal ideation risk, priority screening for suicidal ideation and timely intervention are essential for individuals with urinary incontinence, but prospective studies are needed to verify the results.

Suicide Screening, Risk Assessment, and Lethal Means Counseling During Zero Suicide Implementation.

The authors measured implementation of Zero Suicide (ZS) clinical practices that support identification of suicide risk and risk mitigation, including screening, risk assessment, and lethal means counseling, across mental health specialty and primary care settings. Six health care systems in California, Colorado, Michigan, Oregon, and Washington participated. The sample included members ages ≥13 years from 2010 to 2019 (N=7,820,524 patients). The proportions of patients with suicidal ideation screening, suicide risk assessment, and lethal means counseling were estimated. In 2019, patients were screened for suicidal ideation in 27.1% (range 5.0%-85.0%) of mental health visits and 2.5% (range 0.1%-35.0%) of primary care visits among a racially and ethnically diverse sample (44.9% White, 27.2% Hispanic, 13.4% Asian, and 7.7% Black). More patients screened positive for suicidal ideation in the mental health setting (10.2%) than in the primary care setting (3.8%). Of the patients screening positive for suicidal ideation in the mental health setting, 76.8% received a risk assessment, and 82.4% of those identified as being at high risk received lethal means counseling, compared with 43.2% and 82.4%, respectively, in primary care. Six health systems that implemented ZS showed a high level of variation in the proportions of patients receiving suicide screening and risk assessment and lethal means counseling. Two opportunities emerged for further study to increase frequency of these practices: expanding screening beyond patients with regular health care visits and implementing risk assessment with lethal means counseling in the primary care setting directly after a positive suicidal ideation screening.

A Pilot Predictive Model for Indirect Assessment of Suicidal Ideation

IntroductionIn recent years, there has been a concerning increase in suicidal thoughts and, in some countries, completed suicides, amplified by the COVID-19 pandemic. Screening for suicidal ideation (SI) in the general population is limited due to ethical, effectiveness, and feasibility concerns. Identifying individuals at risk of suicide remains a complex challenge. Our study aimed to develop a predictive model using COVID-19 data, gathering psychometric information from 1790 respondents in Slovenia via an online survey conducted between July 2020 and December 2020, with a second wave of data (ne=1200) collected from January 2022 to February 2022.ObjectivesWith 9.7% of respondents reporting recent SI in the first wave of data, our primary goal was to estimate SI indirectly using SIDAS. We examined changes in habits, demographics, coping strategies, and satisfaction in key life aspects to discreetly identify potential risk factors.MethodsWe employed four machine learning algorithms (logistic regression, random forest, XGBoost, and support vector machines) and assessed model performance using the area under the receiver operating characteristic curve (AUC). Initial assessment used a held-out dataset, followed by validation with a new cohort of 1,200 users from the late COVID-19 period.ResultsLogistic regression, random forest, and XGBoost achieved comparable AUCs, reaching 0.83 on unseen data. Our analysis revealed significant associations between Brief-COPE subscales and SI. Self-Blame emerged as a strong SI indicator, followed by increased Substance Use, reduced Positive Reframing, Behavioral Disengagement, dissatisfaction with relationships, and younger age, in both 2020 and 2022 models. The model consistently performed well, even with varying population characteristics.Conclusions These results suggest that SI presence can be reasonably estimated using selected indicators, offering promise for developing an indirect screening tool without explicit questioning about suicidal thoughts. However, individuals flagged as at-risk should undergo clinical examination, as this model serves as an initial step in identifying SI risk factors in the context of the stressful event’s (COVID-19 pandemic) impact on mental health.Disclosure of InterestNone Declared

IJCM_334A: The struggle within: suicidal ideation and its risk factors among the undergraduate medical students

Background: Suicide is one of the top three causes of death among the adults worldwide, which is increasingly seen among students. Medical education is often considered highly stressful, in addition to the usual psychological issues in the youth. Mental health issue is a subject of taboo even among the medical students leading to non-help seeking behaviour. Studies report a high prevalence of suicidal ideation among medical students in India, ranging from 1.8% to 53.6%. Objectives: 1. To assess the prevalence of ‘suicidal ideation’ and associated risk factors among undergraduate medical students Methodology: A descriptive cross-sectional study was conducted among Phase 2 and 3 undergraduate students of a government medical college after taking IEC approval. Information on socio demographic details along with known risk factors was obtained. Beck scale for suicide ideation was used for screening and assessment of suicidal ideation. Data was analysed as proportions and percentages and chi square was applied to test the significance of association. Results: Out of the total 192 participants 118 (61.4%) were boys and 74 (38.6%) were girls. History of mental illness was present among 33 (16.6%) students. Fourteen students (7.2%) had high BSS score on screening. Within this subgroup of students reporting suicide ideation (n=14), 9 students (69.2%) had seriously contemplated suicide, while 2 students (15.3%) had attempted suicide at least once in their life time. Students who had previous history of mental illness showed higher prevalence of suicide ideation which was statistically significant (p&lt;0.001). However, no significant associations were identified between gender of the student, mother’s occupation, or a history of mental illness among family members and suicide ideation among the medical students. Conclusion: Medical students need to be assessed for their mental health and appropriate care and support should be provided to the needy to prevent fatal outcomes among them.

Effect of drug treatment changes and seizure outcomes on depression and suicidality in adults with drug-resistant focal epilepsy.

To investigate changes in depressive and suicidality status and their relationship with seizure outcomes after the addition or substitution of another antiseizure medication (ASM) in adults with drug-resistant focal epilepsy. Seven hundred seventy consecutively enrolled patients were assessed and followed prospectively for seizure outcome and depressive status over a 6-month period after starting treatment with a newly introduced ASM. The Neurological Disorders Depression Inventory for Epilepsy (NDDIE) was used to screen for depression and suicidality. Correlations of NDDIE results with clinical and treatment-related variables were assessed by using a stepwise logistic regression model. At baseline, 50% of patients had a positive screening test result for depression and 13% had a positive screening test result for suicidal ideation. A psychiatric comorbidity at baseline was associated with a 2.3 times increased risk of an initially negative NDDIE screening result becoming positive at re-assessment after 6 months. In addition, the number of ASMs taken at baseline correlated with an increased risk of a change in depression screening test results from negative to positive during follow-up, whereas no association was identified with sociodemographic and epilepsy-related variables, including seizure outcomes. Approximately 6% of patients who were initially negative at screening for suicidal ideation became positive at the 6-month re-assessment. The risk of switch from a negative to a positive screening test result for suicidal ideation was increased more than two-fold in individuals who screened positive for depression at baseline, and was unrelated to the type of ASM introduced, sociodemographic variables, or seizure outcomes. Almost 1 in 5 adults with drug-resistant focal epilepsy who screen negative for depression become positive when re-assessed 6 months after a treatment change. At re-assessment 6 months later, 6.1% who screen initially negative for passive suicidal ideation become positive. These changes in screening status are independent of type of ASM introduced or seizure outcomes but correlate with psychiatric status at baseline.

Intramuscular ketamine vs. midazolam for rapid risk-reduction in suicidal, depressed emergency patients: Clinical trial design and rationale

Emergency department (ED) visits for suicidal ideation or behavior have been increasing in all age groups, particularly younger adults. A rapid-acting treatment to reduce suicidal thinking, adapted for ED use, is needed. Previous studies have shown a single dose of ketamine can improve depression and suicidal ideation within hours. However, most studies used 40 min intravenous infusions which can be impractical in a psychiatric ED. The ER-Ketamine study we describe here is a randomized midazolam-controlled clinical trial (RCT; NCT04640636) testing intramuscular (IM) ketamine's feasibility, safety, and effectiveness to rapidly reduce suicidal ideation and depression in a psychiatric ED. A pre-injection phase involves screening, informed consent, eligibility confirmation, and baseline assessment of suicidal ideation, depression, and comorbidities. The randomized double-blind IM injection is administered in the ED under research staff supervision, vital sign monitoring, pharmacokinetic blood sampling, and clinical assessments. The post-injection phase occurs on a psychiatric inpatient unit with follow-up research assessments through four weeks post-discharge. Outcome measures are feasibility, safety, and effects on suicidal ideation and depression at 24 h post-injection, and through follow-up. The target sample is N = 90 adults in a major depressive episode, assessed by ED clinicians as warranting hospitalization for suicide risk. Here we report design, rationale, and preliminary feasibility and safety for this ongoing study. Demographics of the 53 participants (ages 18 to 65 years) randomized to date suggest a diverse sample tending towards younger adults.

Does Suicide Risk Screening Improve the Identification of Primary Care Patients Who Will Attempt Suicide Versus Depression Screening Alone?

The effectiveness of suicide risk screening relative to depression screening alone among primary care patients has not been tested rigorously. This study compared the performance of multiple depression screening methods (Patient Health Questionnaire [PHQ]-2, PHQ-8, and PHQ-9) and multiple suicide risk screening methods (PHQ-9 item 9 and suicide-focused screening of "thoughts of killing yourself" during the entire lifespan, within the past month, and within the past week) in a convenience sample of primary care patients. A total of 2,744 patients (military personnel, family members, and retirees) from six military primary care clinics completed the PHQ-9 and screening for suicidal ideation (SI) during routine clinic visits. Follow-up phone interviews were conducted for one year post-baseline to assess the incidence of suicide attempts, the study's primary outcome. Sensitivity, specificity, accuracy, and F1 statistics were calculated for each screening method for identifying patients who attempted suicide. More than 65% of patients who screened positive for SI also screened positive for depression on the PHQ-9. Depression screening with the PHQ-9 correctly identified more patients who attempted suicide during follow-up than the PHQ-2, past week SI, and past month SI. The PHQ-9 correctly identified more patients who attempted suicide within 3 months than lifetime SI, but lifetime SI correctly identified more patients who attempted suicide within 6 and 12 months. Depression screening with the PHQ-9 was the most effective strategy for identifying patients who attempted suicide in the near term. Universal suicide risk screening is unlikely to meaningfully improve identification of higher-risk patients beyond PHQ-9 depression screening.

P99: Mental Health wellbeing among older adults in nursing homes

Background:Loneliness is a subjective phenomenon. It is experienced a lack of satisfying relationship to others, whether because the subject has too few relationships or because their existing relationships do not provide the desired form of closeness (Svenderson, 2017). As defined by Peplou and Perlman (1982), the definitions of loneliness share the same concept: an unpleasant, subjective experience resulting from inadequate social relationships. Loneliness and rumination are remarkable risk factors of depression among the elderly in the both community and nursing homes (Gan at al.,2015). A Norwegian study found that 56% of nursing home residents are feeling lonely (Dragaset et al.,2011). The study from Poland found that depression was observed in 33.8% long term care facility (Horwath, Scerbinska,2017). Furthermore, another study from China shown that 14.9% residents in long term facility reported suicidal ideation (Zhang at al.,2020). Associated with one being depressed in nursing homes include pain, risk of stroke, risk of heart attack, decreased cognitive function and is also linked to increased morbidity in nursing home residents, a relationship it has been also suggested for medical inpatients (Zammit, Fiorini, 2015).Methodology:The scoping review has been selected as the appropriate methodology for this study. The general purpose for conducting scoping reviews is to identify and map the available evidence (Arskley,O’Malley, 2005). Scoping reviews can be useful tools to investigate the design and conduct of research on a particular topic and conducted to review current research an identify knowledge gaps on the topic (Munn at al.,2018). According to Arksey and O’Malley (2005) the scoping review methodology is divided into six steps framework: identifying the research question, searching for relevant studies, selecting studies, charting the data, collecting the data, summarizing and reporting results and consulting with stakeholders to inform or validate study findings.Results:A total of 27 studies were included in the final synthesis, mixed designed studies (n=7) including questionnaires, surveys, Geriatric depression Scales, Satisfaction with life Scale, Loneliness Scale, face to face interviews and observations. Furthermore, were included quantitative studies (n=10) included one longitudinal study with 6 years follow up. Finally, were also included qualitative studies (n=10), the studies used a mixture of approach of interviews an observation. The majority of the participants were from long-term facilities (n=24), medical students and nurses were included (n=1) study and mixture of participants such as residents, family members and staff were included in (n=1) study. The most of the studies are from Norway (n=7), China (n=3), Finland (n=2), Turkey (n=2), Poland (n=2), US (n=2), Belgium (n=1), Sri Lanka (n=1), South Korea and Japan (n=1), Hong Kong (n=1), Malta (n=1), Taiwan (n=1), Iran (n=1), New Zealand (n=1) and Sweden (n=1). In Table 1, we provide a summary of the individual studies.Discussion:This scoping review highlights the importance to continue support residents’ well-being in the long-term care facilities, support their mental health and also to continue educate and support healthcare staff as they have the major impact on resident’s welfare. Previous studies indicated the correlation between loneliness and depression with demographics factors such as being married, unmarried or widowed for that reason it was recommended by Mahammadi et al. (2016) pay more attention on reducing feeling of loneliness and anxiety by increasing their life satisfaction. We found that only one study was focused on resident’s suicidal ideation (Zhang et al., 2020) who concluded from his cross-sectional study with 538 participants, age above 60 years old, from 37 nursing homes in China that 14.9% reported current suicidal ideation but we are worried that this number could be higher and we believe that needs to be done more research for the future to prevent any risk of suicide among elderly. One reason for the lack of information on suicide risk in long term facilities is that prior 2010, universal screening for suicidal ideation in these facilities had not been widely adopted nor recommended as an approach to prevent suicide (Mezuk et al.,2014).

Changes in suicide-related tweets before and during the COVID-19 pandemic in France: The importance of social media monitoring in public health prediction

IntroductionThe COVID-19 pandemic impacted mental health, as demonstrated by numerous studies. In recent years, especially during the pandemic, the use of social networks, including Twitter, increased. This suggests that this media could help with mental health monitoring, as attested by previous studies. MethodWe conducted a multidisciplinary study on French tweets that were posted between January 1, 2019, and December 31, 2021. We selected the tweets via the Twitter API (Application Programming Interface) using five keywords relating to suicide: want to die, suicidal ideation, commit suicide, suicidal, and suicide attempt. A word frequency analysis was performed, and the data were compared with the number of emergency visits for suicidal ideation before and during the COVID-19 pandemic as recorded by the French national suicide observatory. ResultsWe observed that 189,005 tweets were related to suicide in 2019, 261,993 in 2020 (+38.62% of that observed in 2019), and 301,177 in 2021 (+59.35% of that observed in 2019). We also observed an increase in the number of tweets containing control words in 2020 (+30.07% of that observed in 2019), but in 2021, the number almost fell back to the level of that in 2019 (+5.96% of that observed in 2019). Furthermore, the difference between both ratios (of suicide-related tweets and of tweets containing control words) was most significant during the third lockdown. The change in the number of suicide-related tweets followed a curve that overlapped with the change in the number of emergency visits following suicidal ideations, as reported by the French national suicide observatory. In conclusion, Twitter can be an adequate and reliable tool for screening for suicidal ideation in the general population.

Trajectories of perinatal suicidal ideation from early pregnancy to six weeks postpartum and their influencing factors: A prospective longitudinal study

Few studies focused on the trajectory of perinatal suicidal ideation from early pregnancy and covered whole routine perinatal periods. This study aimed to investigate the prevalence of suicidal ideation from early pregnancy to six weeks postpartum, and further explore the trajectories of perinatal suicidal ideation and their risk factors. A prospective longitudinal study was conducted in a comprehensive tertiary hospital in Hunan province, China among 1089 participants. Perinatal suicidal ideation and depression were assessed by item 9 of Patient Health Questionnaire 9 and the remaining eight items. Sociodemographic and psychological factors were collected by self-reported comprehensive questionnaires. Latent Growth Curve and Growth Mixture Modeling were used to identify the trajectories of suicidal ideation and logistic regression was used to explore risk factors of trajectories. A total of 629 participants were included. The prevalence of suicidal ideation was 16.4% from early pregnancy to six weeks postpartum, with 12.1% in pregnancy and 7.8% in postpartum. Two trajectories were identified: “persistent low levels of suicidal ideation” (92.9%) and “persistent high levels of suicidal ideation” (7.1%). 40.63% of women who screened positive for suicidal ideation during early pregnancy were in the “persistent high level of suicidal ideation” trajectory. A low level of neuroticism and anxiety symptoms during early pregnancy was associated with “persistent high levels of suicidal ideation”. In conclusion, suicidal ideation of women during the perinatal period was dynamic, Suicidal ideation screening and identification in early pregnancy should be addressed for perinatal women to facilitate timely early interventions.

A National Survey of Pediatricians' Experiences and Practices With Suicide Prevention.

Describe pediatricians' experiences, attitudes, and practices around suicide prevention within primary care, and examine associations between pediatricians' experiences and practices. The nationally representative Periodic Survey of American Academy of Pediatrics members provided data on pediatricians' patient experience with suicide risk, perceived barriers to screening for suicidal ideation (SI), preparedness to counsel about suicide prevention, interest in learning more about suicide prevention strategies, and frequency of screening for and managing suicidal ideation. Multivariable analyses examined the effect of having a patient die by or attempt suicide on screening practices. A total of 41% responded to the survey with 377 respondents in the analytic sample. A total of 93% of pediatricians had a patient screen positive for SI and 81% had a patient attempt or die by suicide. A total of 61% always screened for SI and 63% reported using a standardized depression screening tool and 9% a suicide-specific tool. Respondents who had a patient attempt or die by suicide were more likely to screen for SI (OR, 2.05, 95% CI, 1.16-3.63) and use a standardized depression screening instrument (OR, 2.34, 95% CI, 1.29-4.24). Patient reluctance to discuss mental health was the most frequently cited barrier (51%) followed by lack of time (49%) and lack of treatment options (43%). Over 90% of respondents assessed for a plan and referred to mental health services when suicidal ideation was identified. Although pediatricians frequently see patients with suicide risk, 39% do not always screen for SI. Educational efforts are needed to improve pediatricians' assessment and management of suicide risk given new guidelines.

Brief Report: Task-Shifting "Gold Standard" Clinical Assessment and Safety Planning for Suicide Risk Among People Living With HIV: A Feasibility and Fidelity Evaluation in Tanzania.

Suicide is a leading cause of death among people living with HIV (PLWH) worldwide, with suicide deaths occurring twice as frequently among PLWH than among the general public. In Tanzania, resources for mental health care are sorely lacking, with 55 psychiatrists and psychologists providing treatment for 60 million people. In light of this shortage, nonspecialists play a crucial role. The objective of this study was to assess feasibility of implementing task-shifted screening, assessment, and safety planning for suicide risk among PLWH. Two adult HIV clinics in Kilimanjaro, Tanzania. Registered professional nurses in the HIV clinics were trained to administer brief screening of suicidal ideation in the past month. Patients experiencing suicidal ideation were referred to bachelor's-level counselors for further assessment and safety planning, supervised by specialist providers who reviewed audio recordings for quality assurance. During 180 days of implementation, nurses screened patients attending 2745 HIV appointments. Sixty-one (2.2%) endorsed suicidal ideation and were linked to further assessment and safety planning. We cross-checked screening with clinic attendance logs on 7 random days and found high fidelity to screening (206 of 228 screened, 90%). Quality assurance ratings demonstrated key assessment pieces were consistently completed (mean = 9.3/10 possible), with "Good" to "Excellent" counseling skills (mean = 23.7/28) and "Good" to "Excellent" quality (mean = 17.1/20), including appropriate referral for higher levels of care. Brief screening can be implemented and paired with task-shifted counseling to facilitate high-quality assessment of suicide risk. This model shows excellent potential to extend mental health services for PLWH in low-resource settings.

Suicidal ideation and its relationship with mental health reported by different informants among children aged 6–12

BackgroundSuicidal ideation in children has received less attention than in adolescents. This study aimed to explore the self-reported prevalence of suicidal ideation among children aged 6–12 and to identify the relationship between self-reported suicidal ideation and children's mental health reported by different informants in Chinese setting. MethodThe study sample was 1479 children aged 6–12 from three elementary schools in Tianjin. Children completed the Dominic Interactive to report their mental health and suicidal ideation. Parents and teachers completed the Socio-Demographic Questionnaire and the Strengths and Difficulties Questionnaire (SDQ). ResultsThe prevalence of suicidal thoughts and death thoughts was 18.05 % and 16.90 %, respectively. Parent reported emotional symptoms, ADHD, and externalized problems were associated with death thoughts, and ADHD was associated with suicidal thoughts. For teacher's reports, emotional symptoms, and impact were associated with death thoughts, and ADHD, peer problems, internalized problems, and internalized and externalized comorbidity were associated with suicidal thoughts. All of the children's self-reported mental health problems were associated with suicidal thoughts and death thoughts. LimitationsCausality cannot be inferred in a cross-sectional study. ConclusionSuicidal ideation is not uncommon in Chinese children. The relationships between mental health problems and suicidal ideation varied in different informants. Suicide prevention in young children should be enhanced, and screening for suicidal ideation is recommended at the onset of different informants who reported specific mental health problems.

Influencing factors of suicidal ideation in lung cancer patients in Midland China: A mixed-method study.

The suicide risk of lung cancer patients is higher than that of patients with other cancers. However, as China is a large country for lung cancer, there are no relevant reports on lung cancer suicides. This study aimed to investigate the prevalence of suicidal ideation and explore its influencing factors in lung cancer patients. In this cross-sectional study, between July to November 2019, 366 lung cancer patients from the oncology department of a general hospital in Wuhan were chosen as participants. Of these, eight with lung cancer and suicidal ideation were selected for in-depth interviews. A total of 22.68% of lung cancer patients reported suicidal ideation. Sex, cancer stage, number of uncomfortable symptoms, and satisfaction with treatment were independently associated with suicidal ideation. This qualitative study found that the experience of suicidal ideation in lung cancer patients includes physiological (heavy burden of symptoms),psychological (bad mood, thwarted belongingness, perceived burdensomeness, and stigma), and social factors (high economic pressure and negative life events). These findings suggest that the incidence of suicidal ideation in lung cancer patients is higher than that of other cancers and is affected by many factors. Therefore, there should be routine screening and assessment of suicidal ideation among lung cancer patients, and related mental health and suicide prevention education should be provided.

Suicidal Ideation Among Patients with Gastrointestinal Cancer.

Mental illness (MI) and suicidal ideation (SI) often are associated with a diagnosis of cancer. We sought to define the incidence of MI and SI among patients with gastrointestinal cancers, as well as ascertain the predictive factors associated with SI. Patients diagnosed between 2004 and 2016 with stomach, liver, pancreatic, and colorectal cancer were identified from the SEER-Medicare database. County-level social vulnerability index (SVI) was extracted from the Centers for Disease Control database. Multivariable logistic regression was used to identify factors associated with SI. Among 382,266 patients, 83,514 (21.9%) individuals had a diagnosis of MI. Only 1410 (0.4%) individuals experienced SI, and 359 (0.1%) committed suicide. Interestingly, SI was least likely among patients with pancreatic cancer (ref: hepatic cancer; odds ratio [OR] 0.67, 95% confidence interval [CI] 0.52-0.86; p = 0.002), as well as individuals with stage III/IV disease (OR 0.59, 95% CI 0.52-067; p < 0.001). In contrast, male (OR 1.34, 95% CI 1.19-1.50), White (OR 1.34, CI 1.13-1.59), and single (OR 2.03, 95% CI 1.81-2.28) patientswere at higher odds of SI risk (all p < 0.001). Furthermore, individuals living in relative privilege (low SVI) had markedly higher risk of SI (OR 1.33, 95% CI 1.14-1.54; p < 0.001). Moreover, living in a county with a shortage of mental health professionals was associated with increased odds of developing SI (OR 1.21, 95% CI 1.04-1.40; p = 0.012). Oncology care teams should incorporate routine mental health and SI screening in the treatment of patients with gastrointestinal cancers, as well as target suicide prevention towards patients at highest risk.

Predictors and outcomes in primary depression care (POKAL) – a research training group develops an innovative approach to collaborative care

BackgroundThe interdisciplinary research training group (POKAL) aims to improve care for patients with depression and multimorbidity in primary care.POKAL includes nine projects within the framework of the Chronic Care Model (CCM). In addition, POKAL will train young (mental) health professionals in research competences within primary care settings. POKAL will address specific challenges in diagnosis (reliability of diagnosis, ignoring suicidal risks), in treatment (insufficient patient involvement, highly fragmented care and inappropriate long-time anti-depressive medication) and in implementation of innovations (insufficient guideline adherence, use of irrelevant patient outcomes, ignoring relevant context factors) in primary depression care.MethodsIn 2021 POKAL started with a first group of 16 trainees in general practice (GPs), pharmacy, psychology, public health, informatics, etc. The program is scheduled for at least 6 years, so a second group of trainees starting in 2024 will also have three years of research-time. Experienced principal investigators (PIs) supervise all trainees in their specific projects. All projects refer to the CCM and focus on the diagnostic, therapeutic, and implementation challenges.ResultsThe first cohort of the POKAL research training group will develop and test new depression-specific diagnostics (hermeneutical strategies, predicting models, screening for suicidal ideation), treatment (primary-care based psycho-education, modulating factors in depression monitoring, strategies of de-prescribing) and implementation in primary care (guideline implementation, use of patient-assessed data, identification of relevant context factors). Based on those results the second cohort of trainees and their PIs will run two major trials to proof innovations in primary care-based a) diagnostics and b) treatment for depression.ConclusionThe research and training programme POKAL aims to provide appropriate approaches for depression diagnosis and treatment in primary care.

Comparison of screening for suicidal ideation in the year prior to death by suicide

• Screening for suicidality in patients who completed suicide • Improved suicidality screening in patients with office visits • Use of electronic records can help improve suicide screening • Screening for patients with risk factors was relatively high Screening for suicidality with a Patient Health Questionnaire-9 (PHQ-9) at our institution has previously been reported to occur 37.9% in the year prior to suicide death. Our institution has initiated practice changes aimed at increasing this screening rate. We reviewed patient records who died by suicide (cases) between January 16, 2013 and December 31, 2020. We compared these to age and gender matched controls for completion of PHQ-9 recorded in the electronic medical record in the year prior to suicide death or year prior to the date of the case matched death. We looked at whether there was evidence of suicidal ideation evidenced by a score higher than zero for question 9. Cases were more likely than controls to have a PHQ-9 done prior to death though only 28.4% of cases had a PHQ-9 completed. For cases who had a primary care visit done in the year before death, 64/93 (68.9%) had a PHQ-9 done compared to 43/143 (30%) of controls (p<0.0001). Cases were significantly more likely than controls to have a score greater than 0 for question #9 (46.3% vs 16.4%, p<0.0001). The data was collected from primary care visits at a single large institution and was from a highly structured dataset without a manual review of every visit. Screening for suicidal ideation in patients with suicide risk factors was improved through institutional based practice changes and overall screening was high for at-risk patients based on depression history or taking depression medications.

Association of vision impairment with suicide ideation, plans, and attempts among adults in the United States.

This study aims to investigate the relative strength of association between vision impairment (VI) and suicidal ideation, plans, and attempts among adults in the United States. The study sample consisted of 214,505 adults, aged 18 years and older. Researchers used data from the 2015-2019 National Survey on Drug Use and Health, in which respondents were asked whether they had any suicidal thoughts, plans, and attempts, in the past 12 months. Approximately, 4.4% of respondents reported experiencing VI, being blind, or having serious difficulty seeing. Compared to their sighted peers, a relatively high proportion of adults with VI had serious thoughts about suicide (9.0%), suicidal plans (3.0%), or suicidal attempts (1.6%) in the past year. The findings showed that individuals with VI may disproportionately experience suicidal ideation, plans, and attempts, after controlling potentially confounding variables (adjusted odds ratio[AOR] = 1.36; AOR = 1.27; AOR = 1.40, respectively). With findings demonstrating such a strong association between VI and suicide, this study suggests the importance of screening for suicidal ideation, plans, and attempts among adults with VI, and the strong need for developing behavioral health services which keep this correlation in mind.