Suicidal Ideation In Adults Research Articles

State Anhedonia and Suicidal Ideation in Adolescents.

Background: Recent work suggests that state anhedonia and its social aspect of loss of interest in people was an important predictor of suicidal ideation in adults. Aim: The current study investigated the relationship between state anhedonia, trait anhedonia, suicidal ideation, and suicide attempts in adolescents. Method: State anhedonia was assessed using the anhedonia subscale from the Child Mood and Feelings Questionnaire, while trait social anhedonia was assessed using the Adolescent Anticipatory and Consummatory Interpersonal Pleasure Scale and the Temporal Experience of Pleasure Scale. Results: Results indicated that state anhedonia was associated with suicidal ideation but not associated with past suicide attempts after controlling for depressive symptoms. Academic stressful events moderated the relationship between state anhedonia and suicidal ideation. Symptom-level analyses revealed that loss of interest in friends was most highly predictive of suicidal ideation compared with the other anhedonia components. Limitations: The current investigation was limited by its reliance on student samples and data from a single time point. Conclusion: The current study indicated that state anhedonia and its social component may be more informative of near-term suicidal ideation than trait anhedonia in adolescents.

Ketamine for suicidal ideation in adults with psychiatric disorders: A systematic review and meta-analysis of treatment trials.

Ketamine may reduce suicidal ideation in treatment-resistant depression. But it is not known how quickly this occurs and how long it persists. We undertook a systematic review and meta-analysis to determine the short- and long-term effectiveness of ketamine for suicidality. CENTRAL, EMBASE, Medline, and PsycINFO were searched until 12 December 2018. Randomised controlled trials of ketamine or esketamine reporting data on suicidal ideation, self-harm, attempted or completed suicide in adults diagnosed with any psychiatric disorder were included. Two reviewers independently extracted data, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. Standardised mean difference was used for continuous outcomes. Twenty-five reports from 15 independent trials, with a total of 572 participants diagnosed with predominately affective disorders, were included. The evidence was rated moderate to low. In most trials, ketamine was administered at 0.5 mg/kg via a single intravenous infusion over a 30- to 45-minute period. Only a single trial of intranasal esketamine was identified. At 4 hours post-infusion, treatment with ketamine was associated with a significant reduction in suicidal ideation scores (standardised mean difference = -0.51, 95% confidence interval = [-1.00, -0.03]), which persisted until 72 hours post-infusion (time points between 12 and 24 hours: standardised mean difference = -0.63, 95% confidence interval = [-0.99, -0.26]; between 24 and 72 hours: standardised mean difference = -0.57, 95% confidence interval = [-0.99, -0.14]), but not thereafter. However, there was marked heterogeneity of results. In a single trial of esketamine, marginal effects on suicidal ideation were observed. In terms of actual suicidal behaviour, there were virtually no data on effects of ketamine or esketamine. A single infusion of ketamine may have a short-term (up to 72 hours) beneficial impact on suicidal thoughts. While confirmation of these results in further trials is needed, they suggest possible use of ketamine to treat acute suicidality. Means of sustaining any anti-suicidal effect need to be found.

Dementia-related anxiety and coping styles associated with suicidal ideation

Objective: Dementia-related anxiety is associated with general anxiety and depression, which are risk factors for suicidal ideation. Consequently, dementia-related anxiety may be associated with suicidal ideation. When faced with a negative event (e.g. developing dementia), individuals primarily employ monitoring or blunting styles of coping. The present study investigated whether dementia-related anxiety and coping styles were associated with suicidal ideation in adults and whether coping styles moderated the relation between dementia-related anxiety and suicidal ideation.Methods: Online Mturk participants (n = 330) completed the Miller Behavioral Style Scale, Dementia Worry Scale, and Patient Health Questionnaire-9. Suicidal ideation was assessed with the Patient Health Questionnaire.Results: Dementia-related anxiety and monitor/blunter coping styles were independently associated with suicidal ideation in a multiple logistic regression; coping styles did not moderate the relation between dementia-related anxiety and suicidal ideation.Discussion: Greater dementia-related anxiety and less use of monitoring coping style were associated with suicidal ideation. Interventions to decrease suicide risk may benefit from taking into account individual differences in dementia-related anxiety and coping styles.

Tinnitus, depression, and suicidal ideation in adults: A nationally representative general population sample

Tinnitus, depression, and suicidal ideation in adults: A nationally representative general population sample

Mediating Effects of Social Support on Depression and Suicidal Ideation in Older Korean Adults With Hypertension Who Live Alone.

ABSTRACTBackground:Older adults who live alone are less physically and emotionally healthy and report higher levels of depression relative to those who do not live alone. Suicide is the most problematic health issue reported by older adults who live alone. In particular, vulnerable older adults who live alone experience difficulty obtaining self-care and medical services; therefore, early detection of depression is difficult, and there are few opportunities to implement suicide prevention strategies in this population. In addition, social support for depression is an important factor affecting illness and economic vulnerability in older adults who live alone.Purpose:This study aimed to examine the relationship between depression and suicidal ideation in vulnerable older Korean adults with hypertension and to explore the mediating effect of social support on this relationship.Methods:The study used a cross-sectional design. Vulnerable older adults who were 65 years old or older with hypertension and who received home visit services from a public health center were invited to participate. The participants completed structured questionnaires, including the 15-item Short-Form Geriatric Depression Scale, 12-item Multidimensional Scale of Perceived Social Support, and 19-item Scale for Suicidal Ideation, and provided information regarding their demographic characteristics, health status, and economic status. Descriptive and correlation analyses were performed to examine the correlations among these variables. The three-step regression analysis method proposed by Baron and Kenny was used to examine the mediating effect of social support.Results:The mean depression, social support, and suicidal ideation scores of participants were 23.64 (± 2.04), 35.94 (± 15.40), and 7.80 (± 7.73), respectively. In addition, depression was negatively correlated with social support (r = −.27) and positively correlated with suicidal ideation (r = .21), whereas social support was negatively correlated with suicidal ideation (r = −.35). Social support mediated the relationship between depression and suicidal ideation (Z = 2.69).Conclusions:Social support was identified as an important variable for older adults with chronic illness who lived alone. Interventions that include social support hold the potential to reduce depression and suicidal ideation in this population.

Efficacy of a transdiagnostic, video-based online program for reducing depression, anxiety, and suicidal ideation in adults: Protocol for a randomised controlled trial.

BackgroundTransdiagnostic online interventions have the potential to overcome help seeking barriers, address symptom comorbidity, and increase accessibility to evidence-based treatments. However, there is currently a lack of high quality studies examining brief transdiagnostic interventions, as well as research examining optimal methods for screening and providing members of the community with access to these interventions. This randomised controlled trial will compare a brief, video-based transdiagnostic online intervention (FitMindKit) to an attention matched control condition (HealthWatch).AimsThe aims of the study are to (1) examine the efficacy of FitMindKit in reducing depression symptoms, anxiety symptoms, suicidal ideation, and disability relative to HealthWatch and (2) compare uptake of the program via the Internet with uptake via general practices and pharmacies (methods used in a parallel implementation study).MethodsA two-arm randomised controlled trial will be conducted with adults residing in the Australian Capital Territory, Australia. Participants will be recruited online via social media advertisements, screened, and randomised to receive one of two four-week programs: FitMindKit (12-module psychotherapeutic intervention) or HealthWatch (12-module program providing general health information). Participants will be assessed at baseline and 4 weeks post-baseline.ResultsFindings from the trial will provide important knowledge regarding the utility and optimal implementation of brief transdiagnostic interventions for depression and anxiety in the community.ConclusionsThis trial has strong potential to increase access to evidence-based treatments in the community by directly addressing several factors that impede this access, such as symptom comorbidity and a lack of knowledge regarding optimal implementation pathways.Trial registrationThis trial is registered with the Australian New Zealand Clinical Trials Registry (number ACTRN12618001688279).

Emotional Intelligence Moderates Anhedonia and Suicidal Ideation in Depressed Patients.

The rising rate of suicidal ideation in adults is a growing concern in the world. In an effort to understand the prevalence of suicidal ideation, and what can be done to prevent it, this study was designed to examine the associations among anhedonia, emotional intelligence, and suicidal ideation. Emotional intelligence was evaluated as a moderator in the relationship between anhedonia and suicidal ideation among Iranian depressed adults. The participants were 217 depressed inpatients at five hospitals in Tehran, Iran, ranging age from 45 to 79 years. Structural equation modeling demonstrated that adult patients suffering from depression that exhibited higher levels of anhedonia and lower levels of emotional intelligence were predisposed to suicidal ideation. Multigroup analysis indicated emotional intelligence as a moderator in the relationship between anhedonia and suicidal ideation. The results emphasize the role of emotional intelligence in mitigating the devastating effects of anhedonia on suicidal ideation.

Association of metabolic syndrome and its components with suicidal ideation and depression in adults: A nationally representative sample of the Korean population

BackgroundFew studies have evaluated the association of depressive symptoms and suicidal ideation with metabolic syndrome (MetS) and its components. This study examined the associations of MetS and its components with suicidal ideation and depression and determined the mediation effect of self-rated health (SRH) on these associations. MethodsThis study was conducted using cross-sectional data on 9867 people (aged ≥ 19 years old) collected in 2014 and 2016 from a nationally representative sample of the Korean National Health and Nutrition Examination Survey. The associations of MetS with suicidal ideation and depression were estimated after adjusting for potential confounding factors using logistic regression analyses, and a mediation analysis by Hayes and Preacher was used to estimate the mediation pathway between such associations through SRH. ResultAfter adjusting for confounding factors, suicidal ideation was associated with MetS. Depressive symptoms and suicidal ideation were associated with two components of MetS: high triglyceride level and high fasting plasma glucose level. In the mediation analysis, we found a significant mediating effect of SRH on the association between high triglyceride level and suicidal ideation. LimitationsWe cannot elucidate causal relationships because of the cross-sectional design. ConclusionOur study provides the implication that a high triglyceride level and elevated fasting plasma glucose level may contribute suicidal risk and depressive symptoms in adults and that SRH may contribute to the development of suicidal ideation in adults via the apparent interaction with one of the components of MetS—high triglyceride level.

Directionality of change in obsessive compulsive disorder (OCD) and suicidal ideation over six years in a naturalistic clinical sample✰

BackgroundObsessive compulsive disorder (OCD) is associated with elevated suicide risk, but the directionality of the association between OCD severity and suicidal ideation has not been established, which was the goal of this study. MethodsParticipants (n = 325) were adults with either a current or past diagnosis of Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) OCD who were assessed annually for suicidal ideation and OCD symptom severity for six years. Cross-lagged panel analyses statistically compared unidirectional and bidirectional models over time. Serious suicide-related adverse events were reported. ResultsThe best-fitting and most parsimonious model included paths predicting suicidal ideation from OCD symptom severity, but not vice versa. These results were confirmed by comparing a model with cross-lagged paths constrained equal to a freely estimated model. Higher OCD symptom severity in a given year was associated with a higher suicidal ideation severity in the subsequent year. Five suicide-related adverse events were reported throughout the duration of the study, including two suicide deaths and three suicide attempts. LimitationsThe study relied on a single-item, annual measure of suicidal ideation in adults, with substantial variability in severity of suicide risk, and missing data increased with later observations in the study. DiscussionOCD symptom severity predicted next year suicidal ideation severity. In contrast, suicidal ideation severity in a given year did not predict next-year OCD symptom severity in this OCD sample. Thus, rather than waiting for suicidal ideation to resolve, clinicians should consider providing empirically supported treatments for OCD.

Associations among inflammation, mental health, and quality of life in adults with metabolic syndrome

BackgroundMetabolic syndrome (MetS), a pro-inflammatory state, has become increasingly common worldwide and is a major risk factor for type 2 diabetes mellitus and cardiovascular disease. Recently, studies on the relationships among inflammation, mental health, quality of life, and other diseases have been conducted.MethodsWe investigated the relationship between serum high-sensitivity C-reactive protein (hs-CRP) levels, as an indicator of inflammation, and the quality of life and psychiatric symptoms of Korean adults with MetS. The analysis used data from the Korean National Health and Nutrition Examination Survey, a cross-sectional survey of Korean civilians conducted from January to December 2015. Data from 1600 participants were analyzed in this study. Quality of life was assessed using the EuroQol 5-dimension (EQ-5D) instrument.ResultsSerum hs-CRP levels showed a significant inverse correlation with the EQ-5D index of the overall quality of life. High serum hs-CRP levels were positively associated with mobility problems and suicidal ideation in adults with MetS (multivariate-adjusted odds ratio [OR] 1.66, 95% confidence interval [CI] 1.03–2.66, p = 0.036; and multivariate-adjusted OR 2.48, 95% CI 1.23–4.99, p = 0.011).ConclusionsThese findings suggest that the elevated inflammatory status in MetS is associated with decreased quality of life and mental health problems. Further prospective studies are needed to confirm the impact of inflammation on the quality of life and mental health of adults with MetS.

Depressive symptoms and suicidality among individuals with epilepsy enrolled in self-management studies: Results from the US Centers for Disease Control and Prevention Managing Epilepsy Well (MEW) Network

Depression is a common comorbidity in people with epilepsy (PWE) that negatively affects self-management and a variety of health outcomes. Suicidal ideation is also more common among PWE than the general population. We examined correlates of depressive symptoms and suicidal ideation in adults using pooled data from epilepsy self-management studies conducted by sites in the Centers for Disease Control and Prevention (CDC) Research Center's Managing Epilepsy Well (MEW) Network that assessed depression severity with the 9-item Patient Health Questionnaire (PHQ-9). Of the 770 subjects in the analysis (mean age 42.4 ± 13.0 years), the mean total PHQ-9 score was 9.4 ± 6.6 and 334 subjects (43.4%) had moderate to severe depressive symptoms (PHQ-9 ≥ 10). Only ongoing seizures and low education were associated with moderate–severe depressive symptoms in multiple logistic regression analysis. Suicidality (PHQ-9, item 9 score ≥ 1) was endorsed by 155 subjects (20.1%). Only nonsuicidal depressive symptoms were associated with suicidality in multiple variable logistic regression analysis. We show in this large and regionally diverse dataset that both depression and suicidal ideation are common among PWE enrolled in self-management studies. Future studies are needed to examine whether suicidality exists independently of other depressive symptoms in some populations with epilepsy and investigate other correlates of suicidality that may inform screening practices.

Characteristics Associated with Non-Disclosure of Suicidal Ideation in Adults.

Suicide prevention efforts often depend on the willingness or ability of people to disclose current suicidal behavior. The aim of this study is to identify characteristics that are associated with non-disclosure of suicidal ideation. Data from the Dutch cross-sectional survey Health Monitor 2016 were used, resulting in 14,322 respondents (age 19+). Multiple logistic regression analyses were conducted to assess the strength of the associations between demographics and health-related characteristics as independent variables, and non-disclosure of suicidal ideation as the dependent variable. The mean age of the respondents was 60 years (SD 16.7) and 45% were male. Of these adults, 5% (n = 719) reported suicidal ideation in the past year, nearly half of which (48%) did not disclose suicidal ideation. Non-disclosure was significantly associated with social loneliness (OR = 1.29). Inverse significant associations were found for age (35–49 years, OR = 0.53), poor health status (OR = 0.63), frequent suicidal ideation (OR = 0.48), and severe psychological distress (OR = 0.63). The accuracy of this model was fair (AUC = 0.73). To conclude, non-disclosure is a substantial problem in adults experiencing suicidal ideation. Adults who do not disclose suicidal ideation are more likely to have few social contacts, while they are less likely to experience poor (mental) health and frequent suicidal thoughts.

Tinnitus, depression, and suicidal ideation in adults: A nationally representative general population sample

Tinnitus is strongly associated with psychiatric symptoms, including depression and suicidality. We aimed to further investigate the association of tinnitus with depressive mood and/or suicidal ideation, and explore the shared risk factors for these within a representative sample of the adult general population. We also investigated potential mediation pathways among tinnitus, suicidal ideation, depression, shared risk factors, and perceived stress levels. We analysed data from 28,930 adults (aged ≥19 years) from the fourth and fifth Korea National Health and Nutrition Examination Surveys (KNHANES) conducted from 2008 to 2012 in South Korea. We investigated the presence and severity of tinnitus, depressive mood, suicidal ideation, perceived usual stress level, and socioeconomic and health-related variables. We conducted logistic regression and mediation analyses. Tinnitus and its severity were significantly associated with depressive mood and suicidal ideation. Tinnitus, depressive mood, and suicidal ideation shared common socioeconomic and health-related risk factors. Tinnitus significantly mediated the association of shared risk factors for depressive mood and suicidal ideation. Perceived usual stress level mediates the association of tinnitus with depressive mood and suicidal ideation. The correlation of perceived usual stress levels with depression and suicidal ideation was also mediated by tinnitus. Our findings implicate that tinnitus may contribute substantially to the development of depressive symptom and suicidal ideation in adults via apparent interactions with shared risk factors and stress levels.

Brief Report: Social Support, Depression and Suicidal Ideation in Adults with Autism Spectrum Disorder.

Adults with autism spectrum disorder (ASD) are at increased risk of suicide compared to the general population. Research has yet to identify the mechanisms underlying this increased risk. This study examined perceived social support as a potential protective factor for depressive symptoms and suicidal ideation in 76 adults with ASD. Twenty-five percent of participants were in the clinical range for depression, and 20% reported recent suicidal ideation. Social support in the form of appraisal and belonging was not associated with depression or ideation; however the perceived availability of tangible (material) support indirectly acted on ideation through depression. The findings suggest that tangible support, but not appraisal or belonging, may act as an indirect protective factor against suicidality in ASD.

Predictors of daily life suicidal ideation in adults recently discharged after a serious suicide attempt: A pilot study

The aims of the study are to examine the predictive role of fluctuations in daily life mood, social contexts, and behavior on subsequent suicidal ideation (SI); and to identify clinical and psychological factors associated with the general frequency of SI in a high-risk sample. The sample comprised 42 adults (73.8% female) hospitalized for a suicide attempt. Immediately following hospital discharge, they used Ecological Momentary Assessment for seven consecutive days, providing repeated measures of SI, environmental, contextual, and behavioral factors. Controlling for prior SI, a number of contextual variables were associated with subsequent SI. Being at home or at work were both associated with an increased probability of SI, while being in the home of close others, or in a festive or leisure environment decreased SI probability. Working, passive leisure and inactivity all increased the likelihood of SI. Being alone increased SI while being with close others significantly reduced this risk. Finally, no overall effect for stressful events was found but negative family events specifically were associated with increased likelihood of SI (γ = 0.448, t = 2.255, df = 29, p < 0.05). The findings provide preliminary results regarding proximal environmental and behavioral factors associated with the occurrence of suicidal ideation in a high-risk sample.

Victimization in childhood as a suicide risk factor in adults

ObjectiveLittle is known about the predictive association between victimization among children and adolescents with depression and suicidal ideation in adults. The aim of our study was to examine whether victimization in childhood and early adolescence increases the likelihood of self-harming in adults.MethodThe sample consisted of 82 patients, 65 females and 17 males, aged 38.02 ± 11.05 years on average, hospitalized in Daily hospital. The juvenile victimization questionnaire (JVQ), defense style questionnaire (DSQ) and Beck depression inventory were applied in 48 patients following suicide attempt and in 34 patients who were on psychotherapeutic treatment due to various life crises not resulting in suicide attempt. According to indication, we excluded patients with psychosis, substances abuse and dementia. The examinees of both groups were matched by age, education, professional and marital status. Comparison of the patient groups was done by t-test.ResultsThe suicide attempters were depressed (Beck depression inventory 19.13 ± 10.20), using immature defense mechanisms (P &lt; 0.005). The JVQ established statistically differences in two general areas: Peer and Sibling Victimization (P &lt; 0.001) and sexual victimization (P &lt; 0.05).ConclusionEven after controlling for lifetime factors known to increase the risk of suicidal behavior, adults who reported peer and sibling and sexual victimization in childhood were still more likely than other adults to attempt suicide later in life. Psychotherapists must understand that history of childhood victimization is important to put suicide attempt in a psychodynamic context which can help them in their work with patients’ psychotherapeutic crisis intervention following suicide attempt.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

The effects of childhood-adolescence trauma on the suicidal ideation in adults: Focusing on moderating effects of posttraumatic growth

The effects of childhood-adolescence trauma on the suicidal ideation in adults: Focusing on moderating effects of posttraumatic growth

Influencing and protective factors of suicidal ideation among older adults.

Suicide is a global issue, but few studies have explored the triggers and psychological feelings of suicidal ideation in older adults. A qualitative design with face-to-face semistructured interviews examined the experience of suicidal ideation in adults aged 65years and older. A purposive sampling of 32 outpatients with suicidal ideation from a medical centre in northern Taiwan participated. Interview data identified three themes: triggers for suicidal ideation, contributing psychological changes, and factors of adaptive response. The triggers for suicidal ideation included physical discomfort, loss of respect and/or support from family, impulsive emotions due to conflicts with others, and painful memories. Psychological changes contributed to suicidal ideation: feelings of loneliness, a sense of helplessness, or lack of self-worth. Participants described adaptive responses that acted as protective factors of suicidal ideation: support from family and friends, control of emotions, establishing a support network, comfort from religion, medication, and focussing on the family. Mental health nurses and clinicians should incorporate evaluations of stressful life events and psychological changes into a screening scale for older adults to improve detection of those at risk for suicide. Teaching coping strategies could provide timely interventions to secure the safety of this older population of adults.

20세 이상 성인의 수면시간과 자살생각과의 관련성

본 연구의 목적은 우리나라 일반 성인과 정신건강 문제를 가진 성인의 수면시간과 자살생각과의 관련성을 파악하는 것이다. 본 연구는 질병관리본부가 실시한 제 5기 국민건강영양조사의 원시자료를 사용하여 SPSS 21.0 프로그램으로 복합표본분석을 하였다. 본 연구의 대상자는 6,199명으로 이중 880명(13.7%)이 자살 생각을 하고 있었다. 우울을 경험한 적이 있는 성인은 846명(13.3%)이었으며 이중 329명(43.1%)이 자살생각을 하고 있었으며, 정신건강 상담을 받은 적이 있는 성인은 164명(2.7%)으로 이 중 63명(40.2%)이 자살 생각을 하고 있었다. 6시간 이상 수면을 취하는 경우와 비교해서 1~5시간의 짧은 수면을 취할 때, 일반성인 그룹에서는 자살생각을 할 위험이 1.33배 높았으며, 우울을 겪은 그룹에서는 자살생각의 위험이 1.92배, 정신건강 상담을 받은 적 있는 그룹에서는 자살생각을 할 위험이 7.10배 높았다. 본 연구를 통해서 짧은 수면시간이 우울 경험이나 정신건강 문제를 매개하지 않아도 자살의 위험요인임이 확인되었다. 따라서 우울 등 정신건강 문제를 가진 성인뿐 만 아니라 일반 성인의 수면장애도 자살예방 차원에서 중재되어야 할 것이다. The purpose of this study was to identify association between total sleep time and suicidal ideation in adults with mental problems and without. The data were derived from the fifth Korea national health and nutrition examination survey and analyzed using the IBM SPSS Statistics version 21.0 software package considering complex samples analysis. The subjects were 6,199 adults. The rate of suicidal ideation was 13.7% (880 people). 13.3% (846 people) of the subjects had experienced depression and out of whom 43.1% (329 people) have had suicidal ideation. 2.7% (164 people) of the subject had received the mental health counseling, and out of whom 40.2% (63 people) have had suicidal ideation. Comparing to group having sleep over 6 hours of more, the group of short sleep had 1.33 times high risk of suicidal ideation among general adults, 1.92 times high risk of suicidal ideation among group who had experienced depression and, 7.10 times high risk of suicidal ideation among group who had received the mental health counseling. Therefore, these results indicate that general adults with short sleep time as well as adults with depression or mental health problems have to be managed to prevent suicide.

Secondhand Smoke Exposure, Depression Symptoms, and Suicidal Ideation in Adults.

Secondhand smoke, also called 'environmental tobacco smoke,' is a combination of smoke emitted from the burning end of a cigarette and smoke exhaled by a smoker. Many epidemiological studies have suggested that secondhand smoke exposure (passive smoking) is related to an increased prevalence of cardiovascular diseases and several cancers including lung, breast, and pancreatic cancer. Recent research has revealed that secondhand smoke exposure may contribute to mental health issues in adults.1) Some studies have suggested that secondhand smoke exposure is associated with depression symptoms. However, there is a lack of studies investigating the relationship between secondhand smoke exposure and suicidal ideation. In the present issue, Gim et al.2) evaluated the effect of secondhand smoke on depressive symptoms and suicidal ideation in Korean adults. The authors obtained the data from 2010–2012 Korea National Health and Nutrition Examination Survey, which consisted of 13,006 participants who were exposed to secondhand smoke in the office or at home, and 3,037 non-exposed participants. The authors found that the exposure to secondhand smoke was associated with an increase in depressive symptoms and suicidal ideation among adults. These results are similar to the findings from previous research that secondhand smoke may increase the risk of depressive symptoms.3,4) However, the unique finding of this study is that secondhand smoke may be associated with suicidal ideas. Following the enactment of the National Health Promotion Act in Korea in 1995, many public areas such as government buildings, large restaurants, public parks, streets, and bus stations were designated as non-smoking areas. However, according to the 2006 report of the Surgeon General,5) eliminating smoking in indoor spaces fully protects nonsmokers from exposure to secondhand smoke. Separating smokers from nonsmokers, cleaning the air, and ventilating the buildings cannot eliminate exposure of nonsmokers to secondhand smoke. A more powerful enactment may be needed.