Suicidal Ideation Research Articles

Suicidal thoughts are associated with reduced source attribution of emotion.

Approximately 9% of people think about suicide during their lifetime. Suicidal thoughts are consistently associated with perceived failures in emotion regulation. However, factors contributing to these perceptions remain insufficiently clear. New evidence suggests that when people know little about the cause of their emotions (i.e., low source attribution of emotion), they perceive themselves as less successful in regulating them. Therefore, emotion regulation deficits in people with suicidal thoughts might be related to lower knowledge about sources of emotions. We examined this question in two ecological momentary assessment studies (N₁ = 396, N₂ = 195). We found that participants with current suicidal thoughts knew less about the sources of their emotions compared to participants with no suicidal thoughts history (Studies 1 and 2), and even when compared to controls with similar levels of psychiatric symptoms but no history of suicidal thoughts (Study 2). Using language processing, we found that written descriptions of the source of participants' emotions were less concrete among those with suicidal thoughts compared to participants with no suicidal thoughts history. Among suicidal participants, suicidal thoughts were more likely to be present in moments when participants knew less than usual about the source of their negative emotions (Study 2), and low knowledge of the source was associated with more frequent and prolonged suicidal thoughts (Studies 1 and 2). Finally, lower perceived success in emotion regulation mediated the association between source attribution of emotion and the occurrence of suicidal thoughts. Findings suggest that reduced knowledge about the source of negative emotions might increase the risk for suicidal thinking. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Predicting the Transition From Depression to Suicidal Ideation Using Facebook Data Among Indian-Bangladeshi Individuals: Protocol for a Cohort Study.

Suicide stands as a global public health concern with a pronounced impact, especially in low- and middle-income countries, where it remains largely unnoticed as a significant health concern, leading to delays in diagnosis and intervention. South Asia, in particular, has seen limited development in this area of research, and applying existing models from other regions is challenging due to cost constraints and the region's distinct linguistics and behavior. Social media analysis, notably on platforms such as Facebook (Meta Platforms Inc), offers the potential for detecting major depressive disorder and aiding individuals at risk of suicidal ideation. This study primarily focuses on India and Bangladesh, both South Asian countries. It aims to construct a predictive model for suicidal ideation by incorporating unique, unexplored features along with masked content from both public and private Facebook profiles. Moreover, the research aims to fill the existing research gap by addressing the distinct challenges posed by South Asia's unique behavioral patterns, socioeconomic conditions, and linguistic nuances. Ultimately, this research strives to enhance suicide prevention efforts in the region by offering a cost-effective solution. This quantitative research study will gather data through a web-based platform. Initially, participants will be asked a few demographic questions and to complete the 9-item Patient Health Questionnaire assessment. Eligible participants who provide consent will receive an email requesting them to upload a ZIP file of their Facebook data. The study will begin by determining whether Facebook is the primary application for the participants based on their active hours and Facebook use duration. Subsequently, the predictive model will incorporate a wide range of previously unexplored variables, including anonymous postings, and textual analysis features, such as captions, biographic information, group membership, preferred pages, interactions with advertisement content, and search history. The model will also analyze the use of emojis and the types of games participants engage with on Facebook. The study obtained approval from the scientific review committee on October 2, 2023, and subsequently received institutional review committee ethical clearance on December 8, 2023. Our system is anticipated to automatically detect posts related to depression by analyzing the text and use pattern of the individual with the best accuracy possible. Ultimately, our research aims to have practical utility in identifying individuals who may be at risk of depression or in need of mental health support. This initiative aims to enhance engagement in suicidal ideation medical care in South Asia to improve health outcomes. It is set to be the first study to consider predicting participants' primary social application use before analyzing their content to forecast behavior and mental states. The study holds the potential to revolutionize strategies and offer insights for scalable, accessible interventions while maintaining quality through comprehensive Facebook feature analysis. DERR1-10.2196/55511.

Self-harm, suicidal ideation, depression and peer relationships in transgender and gender diverse adolescents accessing specialist mental health services.

There are an estimated 25 million transgender and gender diverse (TGD) individuals worldwide, with 1.2%-2.7% of this population being under the age of 18. Community studies describe increased rates of mental health difficulties such as depression, self-harm, suicidal ideation and difficulties with peer relationships for TGD youth over cisgender peers. However, comparatively little is known about the mental health symptomatology of TGD youth attending specialist mental health services (CAMHS) in the UK. This cross-sectional study explored data from 170 young people participating in the Beating Adolescent Self-Harm (BASH) trial. Baseline data about self-harm, depression, and impact on daily life was compared for those who identified as TGD (n = 18) with those who identified as cisgender (n = 152). In the transgender group, 18 (100%) scored ≥27 on the MFQ suggesting severe depression and had total scores on the SDQ impact scale of ≥3, in the very high range. In comparison in the cisgender group, 140 (92.1%) scored ≥27 on the MFQ and 103 (67.8%) had total scores on the SDQ impact scale of ≥3. The TGD group reported higher rates of self-harm, poorer peer relationships, less prosocial behaviour and greater interference with friendships and leisure activities and impact in the classroom. Both groups reported similar symptoms of depression. Whilst this exploratory study has limitations, these results suggest that TGD youth attending CAMHS may experience greater mental health problems than their cisgender peers.

Active suicidal ideation in an adolescent with autism spectrum disorder receiving methylphenidate: a case report

BackgroundMethylphenidate is a psychostimulant treatment widely prescribed in children and adolescents with attention deficit hyperactivity disorder. Although published studies are reassuring regarding the safety and tolerability of this treatment in the short and long term, there are case studies that have reported the possibility of serious adverse effects following methylphenidate initiation in children and adolescents.Case presentationIn the present study, we illustrate the case of a 13-year-old adolescent, who was diagnosed with autism spectrum disorder, attention deficit hyperactivity disorder, and other psychiatric comorbidities. The patient developed active suicidal ideation a few weeks after initiating methylphenidate. He also presented irritability accentuation, insomnia, decreased appetite, and an increase in temper tantrums after initiation of this treatment. Psychiatric evaluation, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), did not reveal major psychiatric disorders that could explain them, particularly mood disorders. The risk of suicide was assessed as high indicating a hospitalization and the immediate discontinuation of this treatment. The evolution was marked by a disappearance of suicidal thoughts 2 days after discontinuation of methylphenidate and a clear decrease in symptoms of poor tolerance. The authors were unable to establish a cause-and-effect link between the prescription of methylphenidate and the appearance of suicidal thoughts in this patient, but the results of studies already published seem to provide clues that could explain this link.ConclusionsThe purpose of this work is to alert clinicians to the possibility that young people who have multiple neurodevelopmental disorders may experience suicidal thoughts after starting methylphenidate even in the absence of mood disorders. The link between the prescription of this treatment and the onset of suicidal ideation is not as clear and requires more controlled studies. This suggests particular attention, such as informing the young people and their families beforehand and planning rigorous psychiatric evaluations after the prescription.

Motivation for volunteering to provide online suicide prevention services in Israel

The widespread use of the internet has expanded volunteering opportunities, yet motivations driving online volunteers, particularly on suicide prevention hotlines, are not fully understood. This research note based on the multidimensional model of volunteer motivation, analyses data from an online survey of volunteers in Sahar, an Israeli non-profit organisation providing anonymous online support for individuals experiencing emotional distress and suicidal ideation. The research note reveals that the most important motivations of volunteers in online helpline organisations are values, understanding, and enhancement, while career and social motivations are less important and are similar among former and current volunteers. These findings have significant practical and policy implications, aiding organisations in designing effective recruitment and retention strategies for online suicide prevention hotlines.

Afektinės būsenos savižudybės procese: patirtys ir formavimosi prielaidos

The emergence of affective states during the process of suicide is regarded as a serious indicator of suicide risk. This study aims to describe the experience of affective states characteristic of the suicide process and to raise assumptions about how these affective states develop over a person’s lifetime. A qualitative approach was employed in this study, with the objective of retrospectively exploring individuals’ life experiences through in-depth semistructured interviews. The research sample comprises 12 participants (4 men, 1 person with a nonbinary gender identity, and 7 women) who had attempted suicide no more than one year prior to the study and were receiving treatment at the Vilnius City Mental Health Centre at the time of data collection. Data were analysed using phenomenological interpretive analysis to identify recurring experiential patterns. The analysis revealed nine main experiential themes: some life difficulties experienced during the suicide process were not perceived as related to suicidality; repeated traumatic events provided a foundation for the formation of deep feelings of deficiency; a compensatory mechanism emerged to fill these feelings of deficiency; exhaustion developed from the effort to maintain this compensatory mechanism; the main trigger directly challenged the compensatory mechanism; an affective state followed the experience of the primary trigger; during the affective state, dissociation may help isolate psychological pain; suicidal thoughts during the affective state are experienced as arising automatically; and suicide is perceived as a means to end suffering. The findings of the study indicate that individuals’ narratives reveal a pattern of the formation of affective states characteristic of the suicide process. Through reflection, individuals are able to intuitively distinguish significant, distressing life events from those irrelevant to the suicide process and reconsider their experiences. This ability is a valuable resource for both intervention and postvention efforts.

Prevalence and factors associated with depression and suicidal ideation among people with diabetes mellitus and hypertension in Uganda

Background: Depression and suicide ideation are more common among patients with chronic physical illness including diabetes mellitus (DM) and hypertension (HTN). Depression is often undetected, underdiagnosed, and undertreated during routine care and may complicate into suicidal ideation in this population. This study aimed to determine the prevalence of depression and suicidal ideation, and associated factors among people living with DM and /or HTN in Uganda. Methods: We enrolled 512 participants and assessed depression using PHQ-9 , and suicidal ideation using item 9 of PHQ-9. We run logistic regression models to determine the factors associated with depression and suicidal ideation among those with DM only, HTN only or both. Results: The overall prevalence of depression and suicidal ideation was 22.07% and 10%, respectively. Among participants with both DM&HTN the prevalence of depression was 26.3% while 30.4% had comorbid suicidal ideation. Fear of complications (AOR = 7.21; 95% CI =2.68-19.39; p = 0.01) was significantly associated with depression. Adherence on antidiabetic medications (AOR = 0.10; 95% CI = 0.02-0.72; p = 0.02) was protective against depression. Conclusion: The prevalence of depression and suicidal ideation among patients with DM and/or HTN in Uganda is high. Keywords: Depression; suicidal ideation; diabetes mellitus; hypertension; Uganda, sub-Saharan Africa.

Trajectories and predictors of suicidal ideation in clinical characteristics and pharmacological treatments for major depressive disorder: a study based on a national multi-centered prospective cohort

Suicidal ideation (SI) is a significant precursor and risk marker for suicide behaviors in major depressive disorder (MDD). Exploration of SI trajectory from a longitudinal framework are essential for treatment guidelines and clinical management of suicide risk. This study sought to explore SI trajectories and its associated clinical, sociodemographic characteristics, and initial treatment among patients with MDD. We used data from a non-interventional, national multi-centered prospective cohort study. 1 461 patients with MDD were included in the growth mixture modeling using SI at baseline, 2 weeks, 4 weeks, 8 weeks, 12 weeks, and 6 months, 9 months, and 12 months as the indicator. A multinomial regression was employed with SI trajectory as the outcome and anhedonia, depressive symptoms, atypical depressive symptoms, pharmacological treatments, and other covariates as the predictors. Four distinct SI trajectories were identified: a consistently low SI trajectory(50.7%), a persistently mild SI trajectory(20.6%), a fast declined SI trajectory(8.9%), and a slowly declined trajectory(19.8%). Compared to those with a consistently low SI trajectory, a higher score of anhedonia was associated with an increased risk of experiencing persistently mild (RRR = 1.20, 95%CI: 1.05, 1.38) and slowly declined SI (1.54, 95%CI: 1.32, 1.80). Severity of depressive symptom was also positively associated with the risk of experiencing persistently mild (1.15, 95%CI: 1.13, 1.18) and slowly declined SI (1.17, 95%CI: 1.14, 1.21). And the risk of experiencing slowly declined SI was higher for those use SSRI(1.49, 95%CI: 1.02, 2.31), and for those use antidepressant and antipsychotic/mood stabilizer combined therapy (3.78, 95%CI: 1.48, 9.61). The findings of this study are potentially useful for clinical practice as critical indicators of profiles and interventions for prognosis among patients with MDD. Further research is warranted to explore potential modifiable factors and the association between SI trajectories and suicide behavior.

Are Suicide-Specific Interventions Required to Reduce Suicidal Ideation? An Empirical Examination in a Clinical Sample of Eating-Disorder Participants

In this research, we examined whether non-suicide-specific treatments effectively reduced suicidal ideation (SI) among a clinical sample of eating-disorder (ED) patients ( N = 3,447, of whom 50.9% presented with SI). All participants met criteria for a current ED diagnoses based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and were administered a combination of evidence-based treatments in inpatient, residential, partial hospitalization, and intensive outpatient ED treatment facilities. Mediation analyses tested whether SI at discharge decreased specifically through standardized residual change scores in ED symptoms. Both SI and ED symptoms decreased over the course of treatment without clinically meaningful differences by ED diagnosis. ED symptom improvement partially mediated the relationship between SI at admission and discharge, suggesting that treating ED symptoms with evidence-based treatments can be an effective way to reduce SI, at least partially, for many patients. These findings demonstrate the importance of facilitating evidence-based-treatment referrals for specific disorders as a component of broad-based suicide outreach and prevention strategies.

The relationship between existential isolation and suicidal ideation among formerly incarcerated individuals

Background and purpose Formerly incarcerated people die by suicide at a rate 6.75 times higher than the general population. In this study we ask whether existential isolation, the feeling of being alone in one’s subjective experiences, offers new insights into this staggering statistic. We specifically ask whether existential isolation predicts suicidal ideation among formerly incarcerated individuals even after accounting for their levels of interpersonal isolation, emotional support, and instrumental support. Method We examined cross-sectional survey data from American participants (n = 946) recruited over the Amazon Mechanical Turk (MTurk) platform. Results Consistent with prediction, we found that people with an incarceration history reported more existential isolation, but not more interpersonal isolation, than those without an incarceration history. A hierarchical regression analysis revealed that existential isolation explained additional variance in suicidal ideation beyond what was explained by interpersonal isolation, instrumental support, and emotional support. Fisher’s r-to-z transformations demonstrated that the magnitude of the relationship between existential isolation and suicidal ideation was stronger among those with an incarceration history than among those without. Finally, existential isolation mediated the relationship between incarceration and suicidal thoughts, even when holding constant other predictors of suicidal ideation. Conclusion Reentry programs may target existential isolation among formerly incarcerated individuals to improve emotional wellbeing.

Persons with Disabilities Living in Rural Areas of Bangladesh: An Exploration of Their Mental Health and Experiences in Accessing Support During the COVID-19 Pandemic

ABSTRACT The COVID-19 pandemic has presented a major public health challenge across the world, including in Bangladesh. Little scholarly work has explored the mental health experiences of persons with disabilities in rural areas of Bangladesh during the pandemic. A qualitative case study was conducted in the rural areas of Narayanganj, Gazipur, and Narsingdi. A total of 13 in-depth interviews (IDIs) with persons with disabilities and 13 key informant interviews (KIIs) with different stakeholders and caregivers were conducted. Thematic analysis was used to analyse the data. The findings revealed five major themes: lockdown-induced mental health problems, including fear of infection, symptoms of anxiety and depression, sleep disturbance, suicidal ideation, and domestic violence; perceived attitude towards mental health issues, including stigma and discrimination; perceived vulnerability was observed in relation to gender, age, and type of disability; barriers to seeking mental health care including distance, financial burden, and indifference towards mental health care; and finally, availability of mental health care which reaffirms a lack of mental health care in rural areas. The findings highlight the importance of integrating mental health into the primary healthcare system with a focus on persons with disabilities to minimise mental health repercussions during times of emergency.

12452 Unraveling An Intriguing Clinical Sequence: Thyrotoxicosis Antecedent To Stiff Person Syndrome

Abstract Disclosure: A. Jain: None. M.N. Rayan: None. Title: Unraveling an Intriguing Clinical Sequence: Thyrotoxicosis Antecedent to Stiff Person Syndrome Background: Stiff Person Syndrome (SPS) is an autoimmune phenomenon resulting in the progressive rigidity of limbs and trunk muscles. It is associated with GAD-positive antibodies in the CSF and serum and is linked to Type 1 Diabetes, Celiac disease, and other autoimmune diseases. Clinical Case: A 34-year-old female with no past medical history was brought into the ED by family for paranoia, suicidal ideations, and visual and auditory hallucinations. She was found to be tachycardic and altered in the ED. Endocrinology was initially consulted for concerns of hyperthyroid pathology due to lab work showing a TSH of <0.008 uIU/mL and free T4 of 4 pg/mL. Thyroid ultrasound revealed heterogeneous, hypervascular thyroid tissue. Further investigation revealed TRAB 4.05 IU/L (n 0-0.9 IU/L) and TSI 3 IU/L (n < 0.577 IU/L). A diagnosis of Graves’ disease was made, and she was started on methimazole 20mg daily and metoprolol 25mg daily. Due to a lack of response to methimazole, other organic causes were investigated including psychiatric and neurological etiology. The patient's symptoms continued to worsen, with new tremors of the upper and lower extremities. Thyroid labs showed improvement, and hence thyrotoxicosis was not thought to be the underlying etiology of her encephalopathy. Neurology was consulted, and EEG and MRI Brain were performed which were unrevealing. Lumbar puncture revealed elevated oligoclonal bands and GAD-65 antibodies, suggesting autoinflammatory encephalitis. High-dose steroids were started, with no improvement. Due to the failure of steroids to treat her symptoms, she was given 5 days of plasmapheresis and a dose of rituximab. Slowly, the patient began to improve and could follow commands and communicate with staff. A formal diagnosis of SPS was made at this time. Upon seeing her in follow-up 1 month after discharge, her TRAB and TSI antibodies were negative, and she was able to be titrated off of methimazole. Conclusion: SPS is strongly associated with autoimmune diseases, with up to 30-40% having T1DM. The association between hyperthyroidism and SPS, however, is exceedingly rare and the etiology remains unclear. Presentation: 6/1/2024

8679 Case: The Sexual, Physical and Psychological Effects of Post-Finasteride Syndrome

Abstract Disclosure: E.M. Lonergan: None. S.M. Maher: None. I. Yaseen: None. D.B. O'Shea: None. Post-finasteride syndrome (PFS) is an increasingly recognised disorder with a myriad of physical and neuropsychiatric symptoms persisting for greater than three months in a small proportion of patients treated with Finasteride. We present the case of a 45-year-old male who was taking oral Finasteride for hair loss. He first presented to endocrinology services having stopped Finasteride after twenty years reporting new onset reduced libido, penile shrinkage, fatigue, new food intolerances and agitated depression which was the predominant symptom in this case. He described the emergence of gynaecomastia, which was evident on examination, as well as muscle atrophy. Biochemistry was unremarkable including testosterone 24.6 nmol/L (8.6-29.0), oestradiol 100 pmol/L (50 – 159), LH 7.1 IU/L (1.7-8.6), FSH 16.8 IU/L (1.5-12.4), urinary free cortisol 177 nmol/24h (12-486) and urinary steroid profile. The patient was offered a trial of IM testosterone for 3 months followed by a course of hCG which he declined after discussing with patients online via a PFS patient forum citing anecdotal pseudo immune downregulation in this cohort. GLP-1 receptor agonist therapy was considered as a second-line treatment option. The patient expressed a preference for hydrocortisone treatment after conducting online research which has not been commenced due to a lack of evidence. The inhibition of 5-alpha-reductase in Finasteride-treated patients has been documented to cause reversible sexual dysfunction. However, with increasing case reports of PFS, it was included in the list of Rare and Genetic Diseases of the NIH in 2015. The syndrome encompasses symptoms and signs seen in our case, as well as erectile dysfunction, decreased ejaculatory volume, infertility, Peyronie’s disease, testicular pain, dry skin, memory problems and insomnia. Suicidal ideation was included in the product label as per FDA mandate in 2022. The literature is largely inconclusive regarding the underlying aetiology, duration, and severity of the disorder. A large retrospective study revealed 0.8% of patients developed sexual dysfunction with persistence in 33% of these cases after drug suspension, the main independent risk factor being drug treatment for longer than 7 months. Neuropsychiatric symptoms are likely related to the presence of 5-alpha-reductase isoforms in the brain with resulting alterations in CSF and plasma neuroactive steroid levels and metabolites. Evidence-based treatment options for PFS are limited. PFS is a rare but debilitating syndrome to which a subset of patients appears to be predisposed, but of which the pathophysiology is poorly understood. Further studies in this regard, as well as an exploration of effective treatment options are required. Presentation: 6/1/2024

8768 Initiation of Exogenous Sex Hormones in a Pediatric Gender Clinic

Abstract Disclosure: C.M. Roberts: None. M.M. Knoll: None. G. Robertson: None. A. Egan: None. C. Moser: None. Introduction: The demographics of patients seeking care for gender dysphoria have changed significantly since care was started in 1987. The criteria for prescribing sex hormones have also evolved to allow a greater range of patients to receive gender-affirming hormones. We examined factors associated with prescription of gender-affirming hormones to patients presenting for gender-affirming care our clinic. Methods: Secondary analysis of sex hormone initiation as a minor among 14-17-year-old adolescents diagnosed with gender dysphoria, seen in the pediatric gender clinic between 2/19/2018 and 7/20/2022. We extracted demographic variables, appointment dates, and sex hormone prescription data from our electronic medical record. We collected patient reports of gender identity and suicidal behavior, and parent and adolescent reports of general adolescent well-being, months of gender dysphoria and social transition, and parental support for the adolescent’s gender identity from electronic clinic surveys. Results: We identified 273 adolescent-parent dyads with complete data. Most of our sample were assigned female at birth (74.4%), transgender male (59.3%), and white (83.5%) adolescents who lived in urban (86.4%) and lower-middle-income (64.5%) areas. The average age was 15.9+/-1.1 years. A minority of adolescents reported recent suicidal ideation 60/273 (22%), and prior suicide attempts 20/273 (7%). Parents reported a shorter duration of gender dysphoria (-16.7 months (95%CI: -22.0, -11.5)) and social transition (-4.7: -6.5, -3.0), and higher levels of parental support than adolescents. Approximately half, 146/273 (53.5%), of adolescents started sex hormones. The average age at initiation was 16.5 years +/- 0.9. Age at presentation, length of gender dysphoria or social transition, and the presence of suicidal ideation or attempts were not associated with initiation of sex hormones. Assigned males (OR:1.82:95%CI 1.04, 3.19), adolescents with higher parent-reported parental support for the adolescent’s identity (1.03:1.01, 1.04), and adolescents with private insurance rather than Medicaid (Blue Cross- 5.39:2.73, 10.64) were more likely to start sex hormones as a minor. Conclusion: Published criteria for the initiation of sex hormones among adolescents with gender dysphoria, including age, persistence of dysphoria, and the presence of suicidality, did not predict the prescription of sex hormones to minors in our clinic. Parent-reported support for the adolescent’s gender identity played a small role in predicting the prescription of hormones, but male sex assigned at birth and having private health insurance played larger roles. Further exploration of these findings is needed to ensure equity in the treatment of gender dysphoria. Presentation: 6/3/2024

7945 Modelling the Factors Associated With Sexual and Mood Symptoms Within the First Year of Anabolic-Androgenic Steroid Cessation in Men

Abstract Disclosure: B. Grant: None. J. Kean: None. N.L. de Silva: None. O. Quinton: None. P. Bassett: None. J. McVeigh: None. A. Lingford-Hughes: None. S. Minhas: None. S. Bhasin: None. W.S. Dhillo: None. C.N. Jayasena: None. Context: Anabolic-androgenic steroids (AAS) are misused by millions of men worldwide to boost muscle size and physical performance. Recent studies have quantified the recovery of cardiovascular markers and testicular function following AAS cessation. Qualitative studies demonstrate that low mood, anxiety, suicidal ideation, and sexual dysfunction are also common following AAS cessation. However, no previous study has focused on quantifying symptoms within the first year of AAS cessation, nor investigated independently associated factors for these symptoms. Methods: Cross-sectional, observational study of 165 men in 3 groups; non-AAS (n=43); current-AAS (n=76); past-AAS ≤1 year (n=46). All participants completed questions on substance misuse, Beck Depression Inventory-II (BDI-II), International Index Erectile Function-15 (IIEF-15), General Anxiety Disorder (GAD-7), Quality-of-life (SF-36), and underwent fasting, morning blood sampling with urine toxicology. Results: As expected, current-AAS had lower gonadotropins and elevated serum total testosterone compared with past-AAS and non-AAS. Sexual function measured using IIEF-15 was impaired in men stopping AAS <1year (past-AAS) compared with current AAS users: (1) total: 69.0 [95% CI 64.0, 71.0], current-AAS; 61.0 [95% CI 56.0, 66.0], past-AAS; p=0.077; (2) erectile function: 30.0 [95% CI 29.0, 30.0], current-AAS; 28 [95% CI 21.0, 29.0], past-AAS; p=0.015; (3) sexual desire: 9.0 [95% CI 8.0, 10.0], current-AAS; 6.0 [95% CI 5.0, 8.0], past-AAS; p<0.0001; (4) overall satisfaction: 10.0 [95% CI 8.0, 10.0], current-AAS; 7.0 [95% CI 7.0, 8.0], past-AAS; p=0.002. Multivariable analysis suggested that psychiatric comorbidity (coefficient -6.5 [95% CI -13.0, -1.3] p=0.03) and AAS cessation (coefficient -10.8 [95% CI -5.6, -17.2]; p<0.001) were associated with lower total IIEF-15 scores.Depression scoring was worse in the past-AAS group compared with non-AAS: BDI-II 4.0 [95% CI 2.0, 7.0], non-AAS; 7.0 [95% CI 4.0, 16.0], past-AAS; p=0.0448. Multivariable analysis suggested that psychiatric comorbidity (OR 2.39 [95% CI 1.60, 3.57]; p<0.001) and lower serum total testosterone (OR 0.85 [95% CI 0.88, 0.94]; p=0.002) were associated with higher BDI-II scores.Energy and fatigue measured using SF-36 was lower in the past-AAS group compared with non-AAS: 70 [95% CI 65, 75], non-AAS; 60 [95% CI 50, 65], past-AAS; p=0.0498. No significant differences in anxiety scoring were detected. Discussion: We report the first, detailed quantification and modelling of symptoms in men currently misusing and stopped AAS within the previous year. These data reveal potentially treatable factors to improve symptoms of AAS cessation if proven within interventional studies. Presentation: 6/2/2024

7945 Modelling the Factors Associated With Sexual and Mood Symptoms Within the First Year of Anabolic-Androgenic Steroid Cessation in Men

Abstract Disclosure: B. Grant: None. J. Kean: None. N.L. de Silva: None. O. Quinton: None. P. Bassett: None. J. McVeigh: None. A. Lingford-Hughes: None. S. Minhas: None. S. Bhasin: None. W.S. Dhillo: None. C.N. Jayasena: None. Context: Anabolic-androgenic steroids (AAS) are misused by millions of men worldwide to boost muscle size and physical performance. Recent studies have quantified the recovery of cardiovascular markers and testicular function following AAS cessation. Qualitative studies demonstrate that low mood, anxiety, suicidal ideation, and sexual dysfunction are also common following AAS cessation. However, no previous study has focused on quantifying symptoms within the first year of AAS cessation, nor investigated independently associated factors for these symptoms. Methods: Cross-sectional, observational study of 165 men in 3 groups; non-AAS (n=43); current-AAS (n=76); past-AAS ≤1 year (n=46). All participants completed questions on substance misuse, Beck Depression Inventory-II (BDI-II), International Index Erectile Function-15 (IIEF-15), General Anxiety Disorder (GAD-7), Quality-of-life (SF-36), and underwent fasting, morning blood sampling with urine toxicology. Results: As expected, current-AAS had lower gonadotropins and elevated serum total testosterone compared with past-AAS and non-AAS. Sexual function measured using IIEF-15 was impaired in men stopping AAS <1year (past-AAS) compared with current AAS users: (1) total: 69.0 [95% CI 64.0, 71.0], current-AAS; 61.0 [95% CI 56.0, 66.0], past-AAS; p=0.077; (2) erectile function: 30.0 [95% CI 29.0, 30.0], current-AAS; 28 [95% CI 21.0, 29.0], past-AAS; p=0.015; (3) sexual desire: 9.0 [95% CI 8.0, 10.0], current-AAS; 6.0 [95% CI 5.0, 8.0], past-AAS; p<0.0001; (4) overall satisfaction: 10.0 [95% CI 8.0, 10.0], current-AAS; 7.0 [95% CI 7.0, 8.0], past-AAS; p=0.002. Multivariable analysis suggested that psychiatric comorbidity (coefficient -6.5 [95% CI -13.0, -1.3] p=0.03) and AAS cessation (coefficient -10.8 [95% CI -5.6, -17.2]; p<0.001) were associated with lower total IIEF-15 scores.Depression scoring was worse in the past-AAS group compared with non-AAS: BDI-II 4.0 [95% CI 2.0, 7.0], non-AAS; 7.0 [95% CI 4.0, 16.0], past-AAS; p=0.0448. Multivariable analysis suggested that psychiatric comorbidity (OR 2.39 [95% CI 1.60, 3.57]; p<0.001) and lower serum total testosterone (OR 0.85 [95% CI 0.88, 0.94]; p=0.002) were associated with higher BDI-II scores. Energy and fatigue measured using SF-36 was lower in the past-AAS group compared with non-AAS: 70 [95% CI 65, 75], non-AAS; 60 [95% CI 50, 65], past-AAS; p=0.0498. No significant differences in anxiety scoring were detected. Discussion: We report the first, detailed quantification and modelling of symptoms in men currently misusing and stopped AAS within the previous year. These data reveal potentially treatable factors to improve symptoms of AAS cessation if proven within interventional studies. Presentation: 6/2/2024

6941 Congenital Generalized Lipodystrophy - An Undiagnosed Case in an Underserved Border Community

Abstract Disclosure: D. Evans: None. A. Gutierrez: None. S. Echetebu: None. M. Zerah: None. Introduction: Congenital Generalized Lipodystrophy (Berardinelli-Seip Syndrome) is estimated to occur 1-10/10 million people1. Patients may present with specific clinical features and/or hormonal imbalances such as hyperinsulinemia and hypertriglyceridemia. Complications of CGL result in a decreased average life expectancy of 51.2 years2. Here we present a case of a female from a medically underserved city in Mexico who was not diagnosed until the age of 16, three years after immigration to the United States. Case Presentation: The patient lived in Mexico and had little medical care. After she immigrated, she was referred to Pediatric Endocrinology due to an elevated hemoglobin A1c, hypertriglyceridemia, and elevated liver enzymes. At birth and in adolescence, the patient did not resemble any of her five fully biological siblings, had little adipose tissue, and had well-defined musculature. Physical exam findings included generalized absence of adipose tissue and prominent musculature, large hands and feet, acromegaloid features, acanthosis nigricans, hirsutism, and phlebomegaly. Breast development was Tanner Stage IV, and genitalia was Tanner Stage V, without clitoromegaly. Patient is currently being treated by psychiatry for Major Depressive Disorder and suicidal ideation. Results: She was diagnosed with diabetes mellitus due to elevated glucose on OGGT and hypertriglyceridemia. She was then started on a low carbohydrate diet, Metformin, and Atorvastatin. After treatment a significant improvement in labs were observed. Triglyceride levels decreased from 1112 mg/dL to 392 mg/dL(35-150 mg/dL), A1c from 8.5% to 5.8%(<5.8%), AST from 36 U/L to 16 U/L(12-32U/L), and ALT from 51 U/L to 20 U/L(5-32U/L). OGGT levels measured after treatment began were as follows: fasting: 95 mg/dL (70-100mg/dL), 1 hour: 242 mg/dL (130-140 mg/dL), and 2 hours: 229 mg/dL(<155 mg/dL). A liver ultrasound was normal. Genetic testing, Echocardiogram, EKG, and Leptin levels are all pending. Discussion/Conclusion: This case of an adolescent with CGL, who was not diagnosed until 16 years of age, demonstrates not only the health disparities and challenges faced by patients in border communities, but it also demonstrates the lack of knowledge of CGL in healthcare. By presenting this case, we hope to increase awareness of CGL within the medical community at large, and to improve the quality of life of our patients.

Campaign against living miserably: A look from social learning theory (SLT)

ABSTRACT The Campaign Against Living Miserably (CALM) aims at advocating against suicide and changing the way mental health is addressed in everyday conversation. Social learning theory (SLT) explains how people imitate others’ behaviors—for example, through a process called learning by imitation. Observation and imitation are vital aspects of how people develop behaviors and habits. One of these behaviors is highly negative and controversial: suicide and the unhealthy mental health relationships that come with it. People can emulate the death of another by copying their behavior, sometimes without even entirely meaning to do so. This paper applies the tenets of SLT—i.e. attention, retention, reproduction, and motivation—to aspects of CALM and to the negative impacts of phenomena such as social media influencers (SMIs) and celebrity suicides. What makes this approach interesting is that the CALM campaign can benefit from the use of one of the longest-established theories in the fields of psychology and communication. More precisely, regarding mental health and the media, most studies have focused on how social media is causing depression or anxiety. This is why this manuscript adds fresh insights by using key SLT precepts to raise awareness as to how these suicidal thoughts and symptoms form.

6426 Pregnancy-induced ACTH-independent Cushing Syndrome: A Rare Phenomenon Secondary To Aberrant Receptors On Adrenal Glands

Abstract Disclosure: K. Manglani: None. S.T. Sharma: None. Pregnancy-induced hypercortisolism is a rare phenomenon with very few cases reported in the literature. The pathogenesis is thought to be secondary to the expression of aberrant LH/hCG receptors on the adrenal gland that stimulate cortisol production in pregnancy. We present a case of a 31-year-old female with no past comorbidities until her first pregnancy in 2017 when she gained around 50lbs, developed violaceous striae, acne, hirsutism, depression with suicidal ideation for which she was hospitalized twice, and underwent emergent C-section at 34 weeks’ gestation due to pre-eclampsia. She was referred to the Endocrinology clinic post-delivery, and screening for Cushing syndrome was negative at that time: 24-hour urinary free cortisol (UFC), late-night salivary cortisol (LNSC) and 1-mg dexamethasone (dex) suppression test (DST) were normal. She presented again in 2020 during her second pregnancy at 14 weeks gestation, with 20lb weight gain in the first trimester, acne, hirsutism, and easy bruising. Labs showed cortisol of 22.4 mcg/dL (6.2-19.4), ACTH <1.5 pg/mL, total testosterone 168 ng/dL (8-48), androstenedione 751 ng/dL (41-262), DHEAS 91.2 mcg/dL (84.8-378), 24-hour UFC 277 mcg/day (6-42), LNSC 0.671 mcg/dL, 1mg DST with post-dex cortisol 24 mcg/dL (dex level 58 ng/dL), and 8-mg DST with post-dex cortisol level of 28.2 mcg/dL (dex level 457 ng/dL). Testing was consistent with ACTH-independent Cushing syndrome. Ultrasound and MRI of the abdomen/pelvis showed normal adrenal glands with no hyperplasia or mass. Given worsening hypercortisolism and her course during a prior pregnancy, medical treatment with metyrapone was initiated. We started at a dose of 500 mg daily and gradually increased to 1500 mg with close monitoring of her blood pressure and cortisol levels. She underwent vaginal delivery at 38 weeks’ gestation, and the baby required a brief stay in the NICU for respiratory distress but was otherwise doing well. The patient developed secondary adrenal insufficiency post-delivery requiring hydrocortisone, with recovery of her HPA axis in around 10 weeks. Since then, she has been off hydrocortisone with normal UFC, ACTH, and cortisol levels. This case enables discussion regarding the underlying etiology, diagnostic difficulties, and management of this rare condition. Although the exact etiology is unknown, the postulated mechanism is aberrant LH/hCG receptor expression given the patient’s presentation during each pregnancy, normal cortisol levels between both pregnancies, and a brief period of adrenal insufficiency post-delivery. Management of hypercortisolism during pregnancy remains challenging. Metyrapone, a steroidogenesis inhibitor, can be considered for control of hypercortisolemia during pregnancy (off-label) in select cases to prevent maternal and fetal complications. Presentation: 6/1/2024

Project Yarn Circle: development and pilot evaluation of a cultural connection suicide prevention program for Aboriginal and Torres Strait Islander young people

ABSTRACT Background Aboriginal and Torres Strait Islander young people experience markedly higher suicide mortality than non-Indigenous youth in Australia, yet there is little evidence of effective preventative strategies. Many are misaligned to the needs of First Nations young people due to a lack of consideration of protective factors such as community and cultural connection. Objective To date no research has examined whether increasing cultural connectedness may reduce Aboriginal and Torres Strait Islander youth suicidality. The current study outlines the development, implementation, and pilot evaluation of Project Yarn Circle, a school-based suicide prevention initiative utilising cultural education and connection. Method Project Yarn Circle was piloted by an Indigenous owned and managed youth mental health organisation, delivering 5 weekly sessions to 276 young people at 9 schools in Southeast Queensland, Australia, between 2019 and 2023. Sessions connected students to cultural knowledge and practices (stories, painting, dance, Indigenous languages) with Elders and local cultural knowledge facilitators. Results Pre- and post-program evaluation questionnaires completed 6–8 weeks apart found that participants had significantly lower suicidal ideation (GHQ-18-SS), pre 7.16, post 6.61, p = .043 higher positive ideation/reasons for living (PANSI-PI) pre 22.44, post 23.60, p = .009, and higher self-esteem (RSES) pre 16.55, post 23.60, p = .005. Analyses of cultural connectedness items co-designed for this evaluation study and validated using Exploratory Factor Analysis found that students demonstrated greater cultural identity clarity, peer cultural competence, strength from culture, salience of cultural continuity and sense of belonging. Conclusions These findings provide new evidence towards utilising cultural connectedness as an intervention mechanism in Indigenous youth suicide prevention.