Self-harm Ideation Research Articles

Identify adolescents' help-seeking intention on suicide through self- and caregiver's assessments of psychobehavioral problems: deep clustering of the Tokyo TEEN Cohort study

Psychopathological and behavioral problems in adolescence are highly comorbid, making their developmental trajectories complex and unclear partly due to technical limitations. We aimed to classify these trajectories using deep learning and identify predictors of cluster membership. We conducted a population-based cohort study on 3171 adolescents from three Tokyo municipalities, with 2344 pairs of adolescents and caregivers participating at all four timepoints (ages 10, 12, 14, and 16) from 2012 to 2021. Adolescent psychopathological and behavioral problems were assessed by using self-report questionnaires. Both adolescents and caregivers assessed depression/anxiety and psychotic-like experiences. Caregivers assessed obsession/compulsion, dissociation, sociality problem, hyperactivity/inattention, conduct problem, somatic symptom, and withdrawal. Adolescents assessed desire for slimness, self-harm, and suicidal ideation. These trajectories were clustered with variational deep embedding with recurrence, and predictors were explored using multinomial logistic regression. Five clusters were identified: unaffected (60.5%), minimal problems; internalizing (16.2%), persistent or worsening internalizing problems; discrepant (9.9%), subjective problems overlooked by caregivers; externalizing (9.6%), persistent externalizing problems; and severe (3.9%), chronic severe problems across symptoms. Stronger autistic traits and experience of bullying victimization commonly predicted the four "affected" clusters. The discrepant cluster, showing the highest risks for self-harm and suicidal ideation, was predicted by avoiding help-seeking for depression. The severe cluster predictors included maternal smoking during pregnancy, not bullying others, caregiver's psychological distress, and adolescent's dissatisfaction with family. Approximately 40% of adolescents were classified as "affected" clusters. Proactive societal attention is warranted toward adolescents in the discrepant cluster whose suicidality is overlooked and who have difficulty seeking help. Japan Ministry of Health, Labor and Welfare, Japan Agency for Medical Research and Development, and Japan Science and Technology Agency.

Taking advocacy upstream with interventions to eliminate violence against women

Violence against women, particularly intimate partner violence and sexual violence, is a major public and clinical health problem and a violation of women's human rights. Globally, one in three women experiences physical and/or sexual violence in their lifetime, mostly by an intimate partner. This is a stark reminder of the scale of gender inequality and discrimination against women. The 16 days of activism against violence against women runs from 25th November to 10th December 2023 and seeks to address upstream prevention interventions to zero violence against women. Violence and abuse adversely affect the physical, emotional, and mental health and well-being of women, children, and communities. Vulnerabilities include poverty, dispossession, wars and conflicts, persistent gender inequalities, harmful cultural practices, illiteracy, infectious diseases, infertility, natural and humanitarian crises, substance abuse, and addiction. Perpetrations are often by intimate partners or others and may take overlapping forms, including physical, sexual, and emotional violence, control, and neglect. For some, they pay the ultimate price of death. For individuals that survive, it causes injury, reproductive health problems, harm from drug abuse and addiction, anxiety, depression, post-traumatic stress disorder, self-harm, and suicidal ideation or acts. During pregnancy, it may lead to miscarriage, induced abortion, stillbirth, low birth weight, preterm delivery, and aggravated violence. Unfortunately, imprints in the children born into this environment may carry on this vice in their later years, contributing to social delinquency. For communities and society, it leads to a lack of urgency, limited participation, and loss of economic productivity. We must do more in the quest for 50-50 gender equality by 2030! A mind-shift and action toward prevention and health promotion of zero violence against women require upstream evidence-based interventions, including promotion of women disclosure with access to interventions for survivors and planning subsequent averting mechanisms with intergeneration long-term follow-up. Normative environments and their implementation require regular review, gender mainstreaming, and the upholding of human rights. In addition, embracing these practices in multisector policies is necessary to eliminate harmful cultural practices such as forced marriages and female genital mutilation and cutting. There is also a need to eliminate violence against all women and girls in the public and private spheres, including trafficking, sexual, technologically driven violations, and other types of exploitation. Placing increased attention on displaced communities during war and conflicts, crises, and among migrant populations, valuing unpaid care, and promoting shared domestic responsibilities are necessary. The provision of universal access, effective coverage, promotion, protection, and fulfillment of sexual and reproductive rights are also required. Eradication of obstetric violence is possible through respectful, ethical, and professional care for girls and women within a supportive health system.

Evaluation of a national clinical programme for the management of self-harm in hospital emergency departments: impact on patient outcomes and the provision of care

BackgroundEmergency departments are important points of intervention, to reduce the risk of further self-harm and suicide. A national programme to standardise the management of people presenting to the emergency department with self-harm and suicidal ideation (NCPSHI) was introduced in Ireland in 2014. The aim of this study was to evaluate the impact of the NCPSHI on patient outcomes and provision of care.MethodsData on self-harm presentations were obtained from the National Self-Harm Registry Ireland from 2012 to 2017. The impacts of the NCPSHI on study outcomes (3-month self-harm repetition, biopsychosocial assessment provision, admission, post-discharge referral, and self-discharge) were examined at an individual and aggregate (hospital) level, using a before and after study design and interrupted time series analyses, respectively. The 15 hospitals that implemented the programme by January 2015 (of a total of 24 between 2015 and 2017) were included in the analyses.ResultsThere were 31,970 self-harm presentations during the study period. In hospitals with no service for self-harm (n = 4), risk of patients not being assessed reduced from 31.8 to 24.7% following the introduction of the NCPSHI. Mental health referral in this hospital group increased from 42.2 to 59.0% and medical admission decreased from 27.5 to 24.3%. Signs of a reduction in self-harm repetition were observed for this hospital group, from 35.1 to 30.4% among individuals with a history of self-harm, but statistical evidence was weak. In hospitals with a pre-existing liaison psychiatry service (n = 7), risk of self-discharge was lower post-NCPSHI (17.8% vs. 14.8%). In hospitals with liaison nurse(s) pre-NCPSHI (n = 4), medical admission reduced (27.5% vs. 24.3%) and there was an increase in self-harm repetition (from 5.2 to 7.8%. for those without a self-harm history).ConclusionThe NCPSHI was associated with improvements in the provision of care across hospital groups, particularly those with no prior service for self-harm, highlighting the need to consider pre-existing context in implementation planning. Our evaluation emphasises the need for proper resourcing to support the implementation of clinical guidelines on the provision of care for people presenting to hospital with self-harm.

Addressing Suicide Risk Among Immigrant Women Survivors of Intimate Partner Violence

Intimate partner violence (IPV) is a significant public health problem contributing to multiple morbidities. Immigrant women who experience IPV may be disproportionately vulnerable to poor mental health outcomes, including self-harm and suicidal ideation, due to cultural experiences and contextual factors that prevent them from accessing services. While existing studies identify the risks for suicidal ideation amongst survivors of IPV, there is limited knowledge on how to tailor strategies to support immigrant women survivors of IPV who experience suicidal ideation. This study was conducted as part of the formative phase of a longitudinal research project designed to develop and evaluate a safety planning intervention for immigrant women survivors of IPV. Using qualitative in-depth interviews, we explored the perspectives of immigrant women survivors of IPV (n = 46) from various countries of origin, ages, and educational backgrounds on effective strategies for supporting immigrant women who disclose suicidal ideation. Study participants discussed various strategies for supporting survivors including building trust, providing encouragement, strengthening social support networks, and reminding survivors of parental responsibilities. Participants also pointed to the importance of the following services: domestic violence support, faith-based health resources, supportive immigration programs, mental health support, and emergency and medical treatment. These findings are informative for researchers and practitioners who work with immigrant women survivors of IPV, and they can be used to develop appropriate safety protocols and support strategies for survivors who are experiencing or have previously experienced suicidal ideation to mitigate the risk of self-harm.

Risk Factors for Self-Harm Ideation Among Persons Treated With Opioids for Chronic Low Back Pain.

Chronic pain is a significant health concern that adversely affects all aspects of life, including emotional well-being. Opioids are prescribed for the management of refractory, severe chronic pain, although they have been associated with adverse effects, including addiction and overdose. The aim of this study was to examine factors that predict thoughts of self-harm among adults with chronic pain who are prescribed opioids. Seven hundred sixty-five (N=765) persons with opioid-treated chronic lower back pain completed the Current Opioid Misuse Measure (COMM) and other validated questionnaires as part of a larger study. Response to 1 question from the COMM ("How often have you seriously thought about hurting yourself?") was used to assess suicide risk on a 5-point scale (0=never; 4=very often). Participants were categorized into 3 groups according to their responses to the self-harm question: never (N=628; 82.1%), seldom or sometimes (N=74; 9.7%), and often or very often (N=63; 8.2%). Multivariate adjusted odds ratio (aOR) analyses indicated that reports of alcohol or drug overuse within the past month (aOR=1.41,[95% CI 1.11-1.78]), posttraumatic stress (PTSD; aOR=1.24,[1.07 to 1.44]), pain catastrophizing (aOR=1.03,[1.01 to 1.05]), not loving oneself (aOR=0.99,[.98-1.00]) and poor perceived mental health (aOR=0.94,[.92 to 97]) were most associated with thoughts of self-harm. Importantly, the ideation frequency of self-harm was highest among individuals treated with higher daily doses of opioids. These results support the need for continued monitoring of adults treated with opioids for chronic pain, particularly among those on high-dose opioids who present with increased negative affect and concerns of substance misuse.

Does Multidimensional Self-Concept Mediate the Relationship of Childhood Sexual Abuse and Bullying Victimization on Deliberate Self-Harm and Suicidal Ideation Among Adolescent Girls?

Does Multidimensional Self-Concept Mediate the Relationship of Childhood Sexual Abuse and Bullying Victimization on Deliberate Self-Harm and Suicidal Ideation Among Adolescent Girls?

Misophonia, self-harm and suicidal ideation.

Misophonia is a sound sensitivity disorder characterized by an unusually strong aversion to a specific class of sounds-often human bodily sounds (e.g., chewing). These sounds can cause intense negative emotions which can cause profound difficulties in everyday life. The condition is linked with higher rates of anxiety and depression, and here we ask whether it co-occurs with elevated self-harm and suicidal thinking. We measured self-harm and misophonia in the general population by examining a birth cohort sample from the Avon Longitudinal Study of Parents and Children (ALSPAC). We screened them for misophonia as adults, then analyzed their earlier data on well-being, self-harm, and suicidal thinking. Adults with misophonia had significantly higher rates of self-harm and suicidal ideation, as well as poorer well-being in a number of different measures at ages 16-17 and 23-24 years. Female misophonics were particularly at risk, from as early as their teenage years, though males, too, show elevated self-harm at 24 years compared to nonmisophonic peers. Our data provide evidence of elevated risks of self-harm associated with misophonia and suggest the need for greater recognition and treatment pathways.

Anxiety, Depression, Perceived Stress, and Burnout Among Chinese Researchers: A Cross-Sectional Nationwide Study.

Depression and anxiety have a significant impact on an individuals' work and personal life alike. The mental health of researchers is a significant concern worldwide. This study investigated the mental health status of Chinese researchers specifically and explored the moderating effects of perceived stress on the influence of low self-accomplishment on anxiety and depression. The online survey platform "Survey Star" was used to create a questionnaire to be distributed to researchers, with 949 questionnaires retrieved. The general information questionnaire, 10-item Perceived Stress Scale (PSS-10), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Maslach Burnout Inventory General Survey (MBI-GS) were used for this investigation. Pearson's correlation analysis was performed to investigate correlations among the relevant variables. Model 8 of PROCESS 3.3 program was used to analyze the moderating effects of perceived stress. Among the 949 participants, 570 (60.1%) reported symptoms of depression and 431 (45.4%) had symptoms of anxiety, with about one in six reporting symptoms of self-harm or suicidal ideation. Perceived stress was found to moderate the effect of low self-accomplishment on depression and anxiety. Here we show that researchers exhibit a high rate of depression and anxiety symptoms. Perceived stress is also shown to play a moderating role on the influence of low self-accomplishment on anxiety and depression. Thus, reducing perceived stress levels can help to improve the mental health of researchers.

2.1 Global Comparison of Pediatric Emergency Department Visits for Self-Harm, Suicide Attempt, and Suicidal Ideation Prior to and During the COVID-19 Pandemic

2.1 Global Comparison of Pediatric Emergency Department Visits for Self-Harm, Suicide Attempt, and Suicidal Ideation Prior to and During the COVID-19 Pandemic

Developing Suicide Prevention Tools in the Context of Digital Peer Support: Qualitative Analysis of a Workshop With Multidisciplinary Stakeholders.

Suicide is the fourth leading cause of death among young people aged 15-29 years worldwide and suicide rates are increasing. Suicide prevention strategies can be effective but young people face barriers to accessing them. Providing support digitally can facilitate access, but this can also pose risks if there is inappropriate or harmful content. Collaborative approaches are key for developing digital suicide prevention tools to ensure support is appropriate and helpful for young people. Tellmi (previously MeeToo) is a premoderated UK-based peer-support app where people aged 11-25 years can anonymously discuss issues ranging from worries to life challenges. It has procedures to support high-risk users, nevertheless, Tellmi is interested in improving the support they provide to users with more acute mental health needs, such as young people struggling with suicide and self-harm ideation. Further research into the best ways of providing such support for this population is necessary. The aim of this study is to explore the key considerations for developing and delivering digital suicide prevention tools for young people aged 18-25 years from a multidisciplinary perspective, including the views of young people, practitioners, and academics. A full-day, in-person workshop was conducted with mental health academics (n=3) and mental health practitioners (n=2) with expertise in suicide prevention, young people with lived experience of suicidal ideation (n=4), and a computer scientist (n=1) and technical staff from the Tellmi app (n=6). Tellmi technical staff presented 14 possible evidence-based adaptations for the app as a basis for the discussions. A range of methods were used to evaluate them, including questionnaires to rate the ideas, annotating printouts of the ideas with post-it notes, and group discussions. A reflexive thematic analysis was performed on the qualitative data to explore key considerations for designing digital suicide prevention tools in the context of peer support. Participants discussed the needs of both those receiving and providing support, noting several key considerations for developing and delivering digital support for high-risk young people. In total, four themes were developed: (1) the aims of the app must be clear and consistent, (2) there are unique considerations for supporting high-risk users: (subtheme) customization helps tailor support to high-risk users, (3) "progress" is a broad and multifaceted concept, and (4) considering the roles of those providing support: (subtheme) expertise required to support app users and (subtheme) mitigating the impact of the role on supporters. This study outlined suggestions that may be beneficial for developing digital suicide prevention tools for young people. Suggestions included apps being customizable, transparent, accessible, visually appealing, and working with users to develop content and language. Future research should further explore this with a diverse group of young people and clinicians.

Childhood contact with social services and self-harm and suicidal ideation in young adulthood: A population-wide cohort study in Northern Ireland

ObjectivesChildhood contact with social services is associated with adult suicide risk, but little is known about self-harm and suicidal ideation, which are recognised predictors of suicide. This study compares self-harm (SH) and suicidal ideation (SI) in young adults with childhood history of social services contact to unexposed peers.
 MethodA longitudinal, population-wide study of all children born 1985-1993 in Northern Ireland (NI) linking primary care registrations to social services data (1985-2015) and a national registry capturing all SH and SI presentations to the 12 Emergency Departments in NI (2012-2015). Multilevel logistic regression models estimated the association between level of contact with social services in childhood (no contact; referred but assessed as not in need (NIN); child in need (CIN); and child in care (CIC)) and SH, SI and any SH/SI, accounting for confounders and the amount of variation attributable to clustering by Health and Social Care Trust.
 ResultsThe cohort comprised 253,495 individuals (ages 18-30 years) alive and registered with a general practitioner during follow-up. Of the cohort, 4,026 presented with SH and 1,669 with SI. Individuals with a childhood history of social services contact comprised 10.8% of the cohort (2.9% NIN; 6.5% CIN; and 1.4% CIC) yet accounted for 40.9% of SH/SI cases. Likelihood of SH, SI, and any SH/SI increased stepwise with level of contact with social services. After full adjustment, young adults deemed NIN in childhood were three times more likely to present with SH/SI (OR 3.45 [95% CI 3.07-3.88]), former CIN five times more likely (OR 5.33 [95% CI 4.97-5.74]), and former CIC ten times more likely (OR 10.49 [95% CI 9.45-11.66]), relative to those with no contact.
 ConclusionAdults with a childhood history of social services contact, including those assessed as not in need, account for a disproportionate number of self-harm and suicidal ideation cases. Timely and targeted interventions aimed at this population have the potential to reduce the burden of self-harm and suicide

Increased risk of postpartum depression in women with lactational mastitis: a cross-sectional study.

A high incidence of lactational mastitis mainly occurs during the first month of breastfeeding. It may cause severe pain, frustration, fatigue, stress, and breastfeeding concerns. However, few studies investigated the effects of lactational mastitis on postpartum depression. This study investigated the potential association between lactational mastitis and postpartum depression. We examined the associations of lactational mastitis with postpartum depression in 1,551 Chinese women. Lactational mastitis was diagnosed by breast specialists. The presence of depression symptoms was evaluated by the Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire 9 (PHQ9) at 6 weeks after delivery. Multiple linear regression analysis and multivariable log-binomial regression analysis were performed to estimate the association between lactational mastitis and postpartum depression. Among the 1,551 mothers, 147 (9.5%) experienced lactational mastitis diagnosed by breast specialists during the postpartum period. Compared with women without lactational mastitis, the proportion of women with depression symptoms was significantly higher (38.1% vs. 27.4%, p = 0.008), and the risk of postpartum depression increased by 68% (RR = 1.68, 95% CI, 1.18, 2.40) in women who had experienced lactational mastitis. In addition, the risk of self-harm or suicidal ideation increased by 89% (RR = 1.89, 95% CI, 1.08, 3.29) in women who experienced lactational mastitis. In stratified analysis, the associations of lactational mastitis with postpartum depression appeared stronger among women aged ≥35 years, with maternal comorbidities, and who delivered a female neonate. The study results suggest that lactational mastitis is a risk factor for depression during the postpartum period. The impact of lactational mastitis on maternal mental health requires further attention. chictr.org.cn, ChiCTR2000041519.

Implying implausibility and undermining versus accepting peoples' experiences of suicidal ideation and self-harm in Emergency Department psychosocial assessments.

Patients seeking emergency care for self-harm and suicidality report varying experiences from being believed and taken seriously to not being believed and taken seriously. Epistemic injustice provides a conceptual framework to explore how peoples' experiences of self-harm and suicidality are believed or not. We use an empirical method -conversation analysis - to analyze epistemics in clinical communication, focusing on how knowledge is claimed, contested and negotiated. In courtroom, police and political interaction, conversation analysis has identified communication practices implying implausibility in a person's story to contest and recharacterize their accounts. To investigate communication practices in Emergency Department (ED) biopsychosocial assessments that may (1) undermine, imply implausibility and recharacterize or (2) accept peoples' experiences of suicidal ideation and self-harm. Using conversation analysis, we micro-analyzed verbal and non-verbal communication in five video-recorded biopsychosocial assessments with people presenting to the ED with self-harm or suicidal ideation, and conducted supplementary analysis of participants' medical records and post-visit interviews. We present three cases where experiences were not accepted and undermined/recharacterized and two cases where experiences were accepted and validated. When peoples' experiences of suicidality and self-harm were not accepted or were undermined, questioners: did not acknowledge or accept the person's account; asked questions that implied inconsistency or implausibility ("Didn't you tell your GP that you were coping okay?"); juxtaposed contrasting information to undermine the person's account ("You said you were coping okay before, and now you're saying you feel suicidal"); asked questions asserting that, e.g., asking for help implied they were not intending to end their life ("So when you called 111 what were you expecting them to do"); and resistinged or directly questioned the person's account. Multiple practices across the assessment built on each other to assert that the person was not suicidal, did not look or act like they were suicidal; that the person's decision to attend the ED was not justified; that an overdose was impulsive and not intended to end life; asking why the person didn't take a more harmful medication to overdose; that self-harming behaviors were not that serious and should be in the person's control. Alternative characterizations were used to justify decisions not to provide further support or referrals to specialist services. At times, these practices were also delivered when speaking over the patient. When peoples' experiences were accepted, practitioners acknowledged, accepted, validated suicidality/self-harm and introduced a shared understanding of experiences that patients found helpful. Non-verbal feedback such as nodding and eye contact was central in acceptance of patients' accounts. These findings advance our understanding of how peoples' experiences of suicidality or self-harm are undermined or accepted in mental health encounters in the ED. They have important clinical implications: patients report that when their experiences are not accepted or undermined, this makes them more distressed, less hopeful about the future and discourages future help-seeking when in crisis. Conversely, acknowledging, accepting and validating suicidality/self-harm and introducing a new ways of understanding peoples' experiences may make people less suicidal and more hopeful, generates shared understanding and encourages future help-seeking.

A Cross-Sectional Study on Outcomes of Hospitalization in Patients with Borderline Personality Disorder After Six Months

Background: Borderline Personality Disorder (BPD) is a serious psychiatric disorder that is characterized by unstable affect, mood, behavior, object relations, and self-image. In this study, a 6-month follow-up was performed to evaluate the outcomes of hospitalization in terms of symptoms severity, suicidal attempts, self-harm behaviors, substance use, and anger expression.
 Methods: This cross-sectional study was performed on 60 patients hospitalized with BPD in Iran Psychiatric Hospital in the first 6 months of 2018. Demographic information of patients was collected at the time of admission. Patients were assessed by initial psychiatric evaluations with the Structured Clinical Interview for DSM-IV [Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-1), Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-2)], the Borderline Evaluation of Severity over Time (BEST), the Spielberger’s state-trait anger expression inventory and Depression Anxiety Stress Scale (DASS). Medical comorbidities, self-harm and suicide ideations and attempts, high-risk behaviors, and substance use disorders were also assessed and recorded. Three months after discharge, the patients were reassessed by BEST questionnaire and after 6 months, they were reassessed using DASS, BEST, SCID-2, and Spielberger’s state-trait anger expression inventory.
 Results: The repeated measures analysis of changes in quantitative variables including the scores of the severity of symptoms in BEST, DASS, and Spielberger tools showed that the scores of DASS decreased significantly during the study (p=0.020), while no significant change was observed in the scores of Spielberger and BEST inventory.
 Conclusion: In patients with BPD, hospitalization was correlated with reduced depression, anxiety, and stress 6 months after discharge. Regular follow-ups along with regular patient visits can form an effective therapeutic relationship with the patients and help to improve monitoring of their drug usage, self-harming acts, and suicidal thoughts.

Using electronic health record data to predict future self-harm or suicidal ideation in young people treated by child and youth mental health services.

Identifying young people who are at risk of self-harm or suicidal ideation (SHoSI) is a priority for mental health clinicians. We explore the utility of routinely collected data in developing a tool to aid early identification of those at risk. We used electronic health records of 4610 young people aged 5-19 years who were treated by Child and Youth Mental Health Services (CYMHS) in greater Brisbane, Australia. Two Lasso models were trained to predict the risk of future SHoSI in young people currently rated SHoSI; and those who were not. For currently non-SHoSI children, an Area Under the Receiver Operating Characteristics (AUC) of 0.78 was achieved. Those with the highest risk were 4.97 (CI 4.35-5.66) times more likely to be categorized as SHoSI in the future. For current SHoSI children, the AUC was 0.62. A prediction model with fair overall predictive power for currently non-SHoSI children was generated. Predicting persistence for SHoSI was more difficult. The electronic health records alone were not sufficient to discriminate at acceptable levels and may require adding unstructured data such as clinical notes. To optimally predict SHoSI models need to be tested and validated separately for those young people with varying degrees of risk.

Examining Risk Factors for Suicidality in Adolescents and Adults Experiencing Their First Episode of Psychosis.

This narrative review aimed to identify the risk factors associated with suicidality in adolescents and adults with first-episode psychosis. The review included studies that examined various factors such as psychiatric, familial, and social factors, as well as previous self-harm, suicidal ideation, and comorbid mental health disorders. A comprehensive literature search was conducted across three publicly available databases (Embase, American Psychological Association PsycINFO, and PubMed) using specific search terms related to first-episode psychosis, suicide, self-harm, and children/adolescents and adults. The inclusion criteria included original articles focusing on prospective and retrospective cohort trials, with substantial data on first-episode psychosis and self-harm, measuring both suicidal intent and outcome. Non-original studies, case reports, case series, non-English-language publications, and studies examining violence and self-harm related to substance-induced psychosis were excluded. After manual screening and removing duplicate articles, 13 articles met the established criteria for inclusion in this review. Included studies adhered to similar inclusion and exclusion criteria, had long-term follow-up, and assessed outcomes at least twice. The findings suggest that depressive symptoms, substance use disorders, previous self-harm or suicidal ideation, and longer duration of untreated psychosis are associated with an increased risk of suicidality. However, insights into psychosis and premorbid intellectual functioning did not show a direct association with suicidality.

Understanding the utility of "Talk-to-Me" an online suicide prevention program for Australian university students.

Australian university students are at risk of experiencing poor mental health, being vulnerable to self-harm and suicidal ideation. "Talk-to-Me" is a suicide ideation prevention Massive open online course (MOOC) previously showing it can support Western Australian university students' knowledge of identifying and responding to suicide ideation in themselves and others. A multi-site one-group pre-test/post-test design with a 12-week follow-up explored the efficacy of "Talk-to-Me" for university students Australia-wide, evaluating the influence of COVID-19 and location. Overall, 217 students (55% female; mage = 24.93 years [18, 60]) enrolled in this study from 2020 to 2021. Participants' responses to suicidal statements, mental health literacy, generalized self-efficacy, help-seeking behavior, and overall utility of the program were collected at baseline, post-MOOC (10 weeks from baseline) and 12-week follow-up. The effect of time and location interaction was explored using a random-effects regression model. Findings indicated significant improvement in participants' knowledge of positive mental health support strategies (ES = 0.42, p < 0.001) and recognizing appropriate responses to suicidal statements (ES = 0.37, p < 0.001) at 10-weeks, with further improvement at 12 weeks follow-up (ES = 0.47 and 0.46, p < 0.001). Students reported higher generalized self-efficacy at the 12-week follow-up compared to baseline (ES = 0.19, p = 0.03) and an increased tendency to seek professional help for mental health issues (ES = 0.22, p = 0.02). These findings provide preliminary evidence of the efficacy of the "Talk-to-Me" program in supporting ‎university students across Australia to increase their suicide-related knowledge and skills, ‎general self-efficacy, and overall mental fitness.

Psychotic experiences, suicidality and non-suicidal self-injury in adolescents: Independent findings from two cohorts.

Prior studies have shown that psychotic experiences are prospectively associated with an increased risk of suicidality. However, it is unclear whether this association is causal or arises from shared risk factors. Furthermore, little is known about the association between psychotic experiences and non-suicidal self-injury (NSSI). We used data from two independent samples of young adolescents, which we analyzed separately. In a population-based cohort, data on hallucinatory experiences and suicidality were collected at ages 10 and 14years (N=3435). In a cross-sectional study of a population oversampled for elevated psychopathology levels, psychotic experiences, suicidality, and NSSI were assessed at age 15years (N=910). Analyses were adjusted for sociodemographic covariates, maternal psychopathology, intelligence, childhood adversity, and mental health problems. Psychotic experiences were prospectively associated with an increased risk of suicidality, even when considering self-harm ideation at baseline. Furthermore, persistent and incident, but not remittent, patterns of psychotic experiences were related to an increased burden of suicidality. Self-harm ideation was also prospectively associated with the risk for psychotic experiences, although of smaller magnitude and only by self-report. Among at-risk adolescents, psychotic experiences were cross-sectionally associated with a greater burden of suicidality and a higher frequency of NSSI events, with more extensive tissue damage. Psychotic experiences are longitudinally associated with suicidality beyond the effects of shared risk factors. We also found modest support for reverse temporality, which warrants further investigation. Overall, our findings highlight the importance of assessing psychotic experiences as an index of risk for suicidality and NSSI.

Association of severe maternal morbidity with bonding impairment and self-harm ideation: A multicenter prospective cohort study

BackgroundEvidence on the association between severe maternal morbidity (SMM) and mother-infant bonding and self-harm ideation is limited. We aimed to examine these associations and the mediating effect of Neonatal Intensive Care Unit (NICU) admission at one-month postpartum. MethodsThis multicenter, prospective cohort study was conducted in Japan (n = 5398). SMM included preeclampsia, eclampsia, severe postpartum hemorrhage, placental abruption, and a ruptured uterus. Lack of affection (LA) and Anger and Rejection (AR) were assessed using the Mother-Infant Bonding Scale (MIBS), and self-harm ideation was assessed using the 10th item of the Edinburgh Postnatal Depression Scale (EPDS). Linear and logistic regression models were used to examine the association between SMM and MIBS score and self-harm ideation. A structural equation model (SEM) was employed to examine the mediating effect of NICU admission on the association between SMM and mother-infant bonding and postpartum depressive symptoms. ResultsWomen with SMM had a 0.21 (95 % confidence interval [CI]: 0.03–0.40) point higher MIBS score and a decreasing trend in the risk of self-harm ideation (odds ratio 0.28, 95 % CI: 0.07–1.14) compared to those without SMM. SEM analysis revealed that SMM was associated with MIBS partially through NICU admission. LimitationsEPDS scores during pregnancy could be an unmeasured confounder. ConclusionsWomen with SMM had higher MIBS scores, particularly on the LA subscale, which was partially mediated by NICU admission. Psychotherapy to support parent-infant relationships is necessary for women with SMM.

Immigration Status, Legal Vulnerability, and Suicidal/Self-harm Ideation Disparities Among Immigrant-Origin Latinx Young Adults in the U.S.

Theories of suicidality typically center intrapersonal processes, with limited attention to social determinants of mental health disparities. Using a legal vulnerability framework, we examined the association between self/parental immigration status and suicidal and self-harm ideation (SI) disparities in three groups of immigrant-origin Latinx young adults attending college in the USA: undocumented students (n = 564), US citizens with undocumented parents (n = 605), and US citizens with lawfully present parents (n = 596). We also evaluated whether self/parental immigration status differences in SI could be accounted for by six dimensions of legal vulnerability and, based on prominent theories of suicidality, explored the role of campus belongingness as a protective factor. Participants completed self-report measures, and SI was assessed using one item from the Patient Health Questionnaire-9, a screening tool that assesses the severity of depression symptomatology. Rates of SI were significantly higher among undocumented students (23.1%) and US citizens with undocumented parents (24.3%) compared to US citizens with lawfully present parents (17.8%). Immigration policy-related social exclusion and discrimination-mediated self/parental immigration status differences in SI. Although food insecurity did not differ by self/parental immigration status, greater food insecurity was associated with higher likelihood of SI. Greater campus belongingness was associated with a lower likelihood of endorsing SI for all students regardless of immigration status or legal vulnerability factors. Findings underscore the importance of examining self and parental immigration status as a social determinant of SI and the value of investigating aspects of legal vulnerability as explanatory factors.