Suicidal Ideation Research Articles

Research on the intervention effect of Five-Element Music combined with Eight-Section Brocade on depression among medical students in higher vocational colleges.

Depression is the main risk factor leading to suicidal ideation among college students. This study focused on observing and assessing how the combination of Five-Element Music and Eight-Section Brocade affected depression levels among medical students attending higher vocational colleges. From a total of 1,030 medical students studying in higher vocational colleges, we selected 160 students who showed depressive symptoms and met the specific criteria for the study. We used the SDS scale to identify these students and made them the participants of our experiment. Participants were randomly divided into four groups: the music intervention group (listening to traditional Chinese Five-Element Music for 15 min daily), the Eight-Section Brocade intervention group (practicing the Eight-Section Brocade exercises once daily, approximately 15 min), the combined intervention group (first practicing the Eight-Section Brocade exercises once, then listening to music for 15 min), and the control group (no intervention). Each group consisted of 40 participants. The three intervention groups (excluding the control group) underwent continuous intervention for 4 weeks. The SDS, SAS, and PSQI scales were used for evaluation before and after the intervention. Except for the control group, the SDS, SAS, and PSQI scores of the other three groups were lower after the intervention than before the intervention (p < 0.01). After the treatment, the scores on SDS, SAS, and PSQI tests did not vary much between the students who listened to music and those who practiced Eight-Section Brocade (the difference was not statistically significant, p > 0.05). However, the students who did both music and Eight-Section Brocade showed significantly lower scores than those who did only one activity (both p < 0.01). Five-Element Music and Eight-Section Brocade can improve depression, anxiety, and sleep status among medical students in higher vocational colleges. The combined intervention of the two is more effective than a single method, and it is worth promoting and applying in higher vocational colleges. https://www.chictr.org.cn/showproj.html?proj=210705.

Supplemental Material for Suicidal Thoughts Are Associated With Reduced Source Attribution of Emotion

Supplemental Material for Suicidal Thoughts Are Associated With Reduced Source Attribution of Emotion

중년 남성들의 자해 경험에 관한 현상학적 연구

This phenomenological study investigated the self-injury experiences of middle-aged men. Using a phenomenological approach, this study analyzed the self-injury experiences of men who began harming themselves during midlife. The objective was to uncover the practical structure and meaning of these experiences in order to discuss ways to prevent self-injury in middle-aged men and to develop specific interventions in terms of counseling studies. This study involved nine middle-aged men with self-injury experiences. The researchers conducted one-on-one in-depth interviews with the participants and constructed phenomenological texts. The texts were analyzed using the phenomenological data analysis procedure developed by Colaizzi (1978). The results of the data analysis are as follows. This study constructed 52 meanings from the participants, which were categorized according to 18 sub-components. Each of these had six-components : “indirect delivery of message showing the desire to live,” “painkiller for psychological pain,” “relief of tension,” “sudden reenactment of suppressed wounds,” “nullifying of the present and future,” and “fixation of distorted coping strategies.” The study results showed that the participation of middle-aged men was a paradoxical method of suppressing and healing suicidal impulses, and their messages of self-injury expressed the will to communicate with the world. Furthermore, self-injury in middle age is not uniquely a midlife phenomenon but is triggered by negative phenomena accumulated throughout life coinciding with a midlife crisis. In terms of counseling studies, this study discussed and suggested counseling approaches and specific techniques to prevent self-injury and suicide among middle-aged men based on the research findings.

Chronotype, sleep quality, impulsivity and aggression in patients with borderline personality disorder and healthy controls

ABSTRACT Impulsivity, aggression, and suicide are the major clinical symptoms of borderline personality disorder (BPD). Although previous studies indicated poor sleep quality and its relationship with clinical symptoms in patients with BPD, chronotype, an important sleep parameter, was not investigated in these patients. This study aimed to analyze chronotype and its relationship with clinical symptoms in patients with BPD. Participants in this study consisted of 68 BPD patients and 65 healthy controls. Subjective sleep characteristics, impulsivity, aggression, suicide probability, and chronotype were assessed using the Pittsburgh Sleep Quality Index (PSQI), Barratt Impulsivity Scale, Buss-Perry Aggression Scale (BPAQ), Suicide Probability Scale, and Morningness – Eveningness Questionnaire, respectively. PSQI total and subscale scores subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, and daytime drowsiness were significantly higher in the BPD group (p < 0.001). There was a positive correlation between the PSQI total score and the BPAQ total score (r = 0.268, p = 0.027). The rate of evening type was significantly higher in the control group (p = 0.004). Suicide attempts and the subscale of suicide probability hopelessness, suicidal ideation, and negative self-evaluation scores were significantly higher in evening type BPD patients. (p = 0.017, p = 0.009, p = 0.001, p = 0.047). Sleep quality is associated with aggression, and the eveningness chronotype is associated with suicide. It may be useful to focus on sleep problems in treating BPD patients.

Post-pandemic persistence of adverse health behaviors in patients with psychotic disorders: A follow-up study

ObjectiveThe ramifications of the COVID-19 pandemic on patients with psychotic disorders have been previously documented by the authors of this study. The aim of study is to investigate whether the effects of the pandemic continued among the same cohort of patients with psychotic disorders who participated in the initial study. Methods232 of the 255 participants in the initial study participated in this follow-up study. The assessment covered sociodemographic data, changes in physical and mental health since the pandemic, new diagnoses of physical illnesses, smoking, medication adherence, suicidal behavior. ResultsThe body weight of the patients before, during, and after the pandemic was 77.6 ± 13.1,81.3 ± 14.1,and 83.1 ± 14.3, respectively and there was increase in BW in the post-pandemic compared to before the pandemc and the during the pandemic (Z: - 8.658, p < 0.001, r: -0.57; Z: −6.852, p < 0.001, r: ‐0.45 respectively). The mean number of cigarettes smoked daily by the patient's before the pandemic, during the pandemic, and after the pandemic was 11.1 ± 14.2,14.9 ± 16.2,and 12.9 ± 14.9, respectively. There was a decrease in the number of cigarettes smoked daily in the post-pandemic compared to the during the pandemic (Z: −4753, p < 0.001, r: −0.45). Both suicidal ideations and attempts were significantly higher during the pandemic compared to after the pandemic (p < 0.001,p < 0.001). Medication adherence in the post-pandemic period was not different compared to the pandemic levels (Z: −0.621, p:0.535). ConclusionThe study confirmed the continuation of adverse outcomes noted previously, such as increased body weight, increased daily cigarette consumption, and diminished medication adherence.

Evaluation of Suicidality in Psychiatric Outpatients: Experience of Ar-razi Hospital in Salé

Suicidality, encompassing suicidal ideation, plans, and suicide attempts, is a complex phenomenon particularly prevalent among psychiatric patients. This study focuses on identifying the risk factors associated with suicidality in outpatients at a psychiatric hospital in Morocco. A total of 278 patients were evaluated using a questionnaire covering sociodemographic data, psychiatric history, and suicidal behaviors. The results show that gender, religious practices, mood disorders, substance use, particularly alcohol and benzodiazepines, and a history of suicide attempts are significant predictors of suicidality. These findings highlight the importance of a multidimensional approach to suicide assessment and prevention in this population.

Deep learning for identifying personal and family history of suicidal thoughts and behaviors from EHRs

Personal and family history of suicidal thoughts and behaviors (PSH and FSH, respectively) are significant risk factors associated with suicides. Research is limited in automatic identification of such data from clinical notes in Electronic Health Records. This study developed deep learning (DL) tools utilizing transformer models (Bio_ClinicalBERT and GatorTron) to detect PSH and FSH in clinical notes derived from three academic medical centers, and compared their performance with a rule-based natural language processing tool. For detecting PSH, the rule-based approach obtained an F1-score of 0.75 ± 0.07, while the Bio_ClinicalBERT and GatorTron DL tools scored 0.83 ± 0.09 and 0.84 ± 0.07, respectively. For detecting FSH, the rule-based approach achieved an F1-score of 0.69 ± 0.11, compared to 0.89 ± 0.10 for Bio_ClinicalBERT and 0.92 ± 0.07 for GatorTron. Across sites, the DL tools identified more than 80% of patients at elevated risk for suicide who remain undiagnosed and untreated.

Group Guidance with Problem-Solving Techniques to Prevent Suicidal Ideation

Aim: determine the differences in the level of suicidal ideation before and after the implementation of group guidance on students at Muhammadiyah Middle School, Palangkaraya, (2) determine the effectiveness of group guidance in preventing suicidal ideation in students at Muhammadiyah Middle School, Palangkaraya. Method: The population in this study were all students of class VIII of SMP Muhammadiyah Palangka Raya, Central Kalimantan, totaling 71 students. The sample of this study consisted of 9 students out of 21 students of class VIII-C. Sampling was determined by the purposive sampling technique. Result and Discussions: The results of the study showed that: (1) before being given group guidance services, most of the students in class VIII-C, namely 9 students, experienced suicidal ideation with a moderate category. After being given group guidance services with the Problem Solving technique, most of the students, namely 5 students with a low category, and 4 students with a moderate category. The total Pre-test score was 587 and the Post-test score was 437, the total score difference was 150. This means that many changes occurred after the provision of group guidance services by the researcher; (2) the results of the hypothesis test calculation using SPSS 25 software on the paired sample T-Test method showed that the significance value obtained was 0.001. This shows that the Sig value &lt;0.05, which means that there is an influence of Problem-Solving to prevent suicidal ideation in class VIII.C students of SMP Muhammadiyah Palangka Raya.

Brief psychological intervention for suicide prevention based on problem-solving applied in different formats to people over 50 years old: protocol for a randomized controlled trial

BackgroundSuicide is a major public health problem, especially among individuals over 50 years old. Despite the suitability of this life stage for prevention, research on the efficacy of psychological interventions is scarce and methodologically limited, affecting their clinical utility and efficacy. Brief, flexible interventions that can be applied both in-person and remotely are needed. This study aims to evaluate the efficacy of a brief problem-solving-based suicide prevention program applied through various modalities to individuals over 50 years old.MethodsA randomized controlled trial will be conducted. A sample of 212 adults aged 50 or older with suicidal ideation will be randomly assigned to a problem-solving-based psychological intervention administered face-to-face (PSPI-P; n = 53), by telephone multiconference (PSPI-M; n = 53), via a smartphone app (PSPI-A; n = 53), or to a usual care control group (UCCG; n = 53). The intervention will be delivered in 7 sessions or modules of 90 min each. Blind trained evaluators will conduct assessments at pre-intervention, post-intervention, and follow-ups at 3, 6, and 12 months. The primary outcome will be suicidal ideation evaluated using the Suicidal Ideation Scale (SSI) and the Columbia Suicide Severity Rating Scale (C-SSRS). Secondary outcomes will include hopelessness, anxiety and depression symptoms, reasons for living, impulsivity, problem-solving skills, social support, anger syndrome, gratitude, personality, dropouts, treatment adherence, and satisfaction with the intervention.DiscussionThis study will provide evidence of the efficacy of a brief problem-solving-based intervention for suicide prevention in individuals over 50 years old, administered face-to-face, by telephone multiconference, and via a smartphone app. If results are favorable, it will indicate that an effective, accessible, clinically and socially useful suicide prevention intervention has been developed for affected individuals, families, and communities.Trial registrationClinicalTrials.gov NCT06338904. Registered April 1, 2024.

The transnational mental health burden of Haiti's alleged collapse: preliminary findings from The Haitian Well-Being Study.

Transnational drug trafficking, political unrest, gang violence, and paramilitarism, which are pervasive in Haiti, have resulted in a mental health crisis for the broader Haitian community. This study explores the mental well-being of Haitians in Haiti and the United States by identifying barriers and facilitators to mental health through the lived experiences of men and women. Four Focus group discussions conducted in April and November 2023 engaged 28 participants (20 women and eight men) aged between 23 and 60 years from locations in Haiti (Port-au-Prince, Cite Soleil, Cayes, Cap-Haitien, Saint-Marc) and the United States. Discussions revolved around the definition of mental health, stressors, coping mechanisms, risk and protective factors, and barriers to mental health care. Six principal themes emerged: 1- Chronic Traumatic Stress: continued violence, political instability, unemployment, lack of social support, adverse childhood experiences, family separation, and forced displacement were significant sources of stress. 2- Increased Health Burden: Participants reported experiencing chronic physical and psychological symptoms [i.e., hypertension, anxiety, depression, sleep issues, substance abuse, suicidal ideations, characteristics of post-traumatic stress disorder (PTSD)], which were attributed to Haiti's social, political, and infrastructure collapse. 3- Risk Factors: limited access to mental health services, pervasive hopelessness, scarcity of opportunities, and stigma were identified as significant risks. 4- Future Uncertainty: widespread concerns regarding the future predominated. 5- Multigenerational Concerns: Significant anxiety concerning the mental health and development of children, as well as the functionality of mental health practitioners, was noted. 6- Coping and Protective Factors: Effective coping strategies include mental stimulation, peer support, managing digital consumption, engaging in leisurely activities, such as listening to music, and faith/spirituality. The study's findings underscore the sociopolitical and economic crisis in Haiti, which has resulted in violence and a dismantle of political, educational, financial, and health infrastructures. These factors were identified as the primary source of chronic distress, contributing to widespread mental health issues, adverse physical symptoms, and disruption in daily life. The implications for practice, healing, research & policy are discussed.

Project SUCCESS: Youth Substance use and Mental Health.

This study aims to assess whether students at schools implementing Project SUCCESS (PS) have different substance use and mental health outcomes than those at schools not implementing PS. Surveys were administered to 18,151 middle and high school students from 29 school districts and 50 schools. Multivariable logistic and linear regressions controlling for individual- and school-level characteristics were used. Students at schools with PS had lower odds of past month cigarette use, vaping, alcohol use, marijuana use, past year suicide ideation, and had fewer depressive symptoms relative to students at schools without PS. Findings suggest students at schools with PS may be less likely to engage in substance use and less likely to experience mental health challenges than students at schools without PS.

The Association Between Hidradenitis Suppurativa and Suicidal Ideation, Attempts, and Completion: A Systematic Review

The Association Between Hidradenitis Suppurativa and Suicidal Ideation, Attempts, and Completion: A Systematic Review

Familias con Orgullo: Pilot Study of a Family Intervention for Latinx Sexual Minority Youth to Prevent Drug Use, Sexual Risk Behavior, and Depressive Symptoms.

Families are key in the healthy development of Latinx sexual minority youth (Latinx SMY), a group that experiences behavioral, mental, and sexual health disparities. Despite this, there are no family-based interventions for Latinx SMY and their families to prevent drug use, sexual risk behaviors, and depressive symptoms. The purpose of this pilot study was to evaluate the preliminary impact (i.e., estimated effect sizes) of Familias con Orgullo (FcO) and examine its feasibility and acceptability among 30 Latinx SMY and their parents. Parents and adolescents were randomized to FcO or a control condition and assessed pre/post-intervention. Feasibility was measured based on session completion and effect sizes. Focus groups were conducted to evaluate intervention acceptability. Findings showed promising effects favoring FcO on parent-adolescent communication (d = 0.46) and parental involvement (d = 0.34). There were also promising effects favoring FcO on suicidal thoughts (OR = 0.75) and depression symptoms (OR = 0.69). Finally, 100% of the adolescents in FcO either continued to remain drug-free or transitioned from current use to no use (from baseline to post-intervention) compared to 74% in the control. Effect sizes for condomless sex, parental monitoring, and positive parenting were small. Session completion (above 80%) and focus group findings indicated strong feasibility and acceptability. FcO holds promise for reducing drug use and depressive symptoms and improving family functioning among Latinx SMY.

Reactive Astrocytosis-A Potential Contributor to Increased Suicide in Long COVID-19 Patients?

Long COVID-19 is an emerging chronic illness of significant public health concern due to a myriad of neuropsychiatric sequelae, including increased suicidal ideation (SI) and behavior (SB). This review provides a concise synthesis of clinical evidence that points toward the dysfunction of astrocytes, the most abundant glial cell type in the central nervous system, as a potential shared pathology between SI/SB and COVID-19. Depression, a suicide risk factor, and SI/SB were both associated with reduced frequencies of various astrocyte subsets and complex proteomic/transcriptional changes of astrocyte-related markers in a brain-region-specific manner. Astrocyte-related circulating markers were increased in depressed subjects and, to a less consistent extent, in COVID-19 patients. Furthermore, reactive astrocytosis was observed in subjects with SI/SB and those with COVID-19. Astrocyte dysfunctions occurred in depression, SI/SB, and COVID-19. Reactive-astrocyte-mediated loss of the blood-brain barrier (BBB) integrity and subsequent neuroinflammation-a factor previously linked to SI/SB development-might contribute to increased suicide in individuals with long COVID-19. As such, the formulation of new therapeutic strategies to restore astrocyte homeostasis, enhance BBB integrity, and mitigate neuroinflammation may reduce SI/SB-associated neuropsychiatric manifestations among long COVID-19 patients.

Suicidal Ideation, Clinical Worsening and Outcomes among Child Participants in Trauma-Focused Treatment.

Research on clinical trajectories of children with suicidal ideation (SI) and clinical worsening (CW) during cognitive behavioral therapy (CBT) for childhood trauma is limited. The current study utilized secondary data from a randomized clinical trial comparing Trauma-Focused CBT versus Stepped care CBT to examine (1) clinical profile and outcomes of children with SI, recurrent thoughts of death/dying, and past attempts; and (2) clinical worsening during treatment and difference in outcomes. Children (ages 4-12) and their parents (N = 183) participated and 132 completed treatment. Interviews assessing SI, thoughts of death/dying, past attempts, and number/type of trauma were conducted with children (ages 7-12) and parents. Outcome measures (baseline and post-treatment) completed by parents included child posttraumatic stress symptoms, impairment, and internalizing and externalizing problems and an independent evaluator rated overall severity. Children (ages 7-12), parents and therapists completed ratings during treatment that indicated CW. Results did not differ by treatment group; thus, the pooled sample was used. Children with SI at baseline had higher severity than children without. For completers, no children (n = 14) with SI at baseline had SI at post-treatment. Child (n = 3) and therapist (n = 5) ratings of CW were low. Eighteen children (13.64%) were rated as CW by parents. Most ratings occurred at the beginning of treatment. Children with therapist ratings of CW had higher internalizing problems. Findings suggest that children with SI and CW can improve from trauma-focused CBT. More research is needed on the clinical trajectory of children with SI and trauma, and on clinical tools to monitor CW. Clinical trial registration information: https://clinicaltrials.gov : NCT02537678.

The association between microaggressions and mental health among UK trans people: a cross-sectional study.

Epidemiological studies investigating the mental health impacts of microaggressions in the trans population have tended to have methodological limitations, including a lack of validated measures, raising concerns about the validity of their findings. To address this evidence gap, we investigated the associations between microaggressions and poor mental health (depression; anxiety; non-suicidal self-harm [NSSH]; suicidal thoughts; suicide attempt) amongst trans people. We conducted a cross-sectional survey of 787 trans adults in the UK, measuring mental health and exposure to microaggressions using the Gender Identity Microaggressions Scale (GIMS). Using univariable and multivariable linear and logistic regression models we tested for an association of microaggressions with depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), lifetime NSSH, lifetime suicidal thoughts, and lifetime suicide attempt. Of the 787 participants, 574 (73%) provided complete data. Microaggressions were a common experience, affecting 97.6% of participants over their lifetime. In adjusted analyses, using sociodemographic and clinical variables, increased microaggression scores were associated with increased depressive symptoms (adjusted coefficient: 1.86 (95%CI = 1.35 to 2.36)), anxiety symptoms (adjusted coefficient: 1.57 (95%CI = 1.09 -2.05)) and with increased odds of NSSH (Odds Ratio [OR]adj 1.83 (95%CI = 1.45 -2.30)), suicidal thoughts (ORadj 2.18, (95%CI = 1.52 -3.13)), and suicide attempt (ORadj, 1.59, (95%CI = 1.32 -1.92)). In exploratory analyses different GIMS subscales were associated with these various outcomes. There was evidence of associations between microaggressions and adverse mental health outcomes, as well as to support specific microaggressions being associated with specific outcomes, emphasizing the importance of public health interventions that target microaggressions directed at trans adults. Longitudinal studies are needed to investigate the temporality of the associations between microaggressions and mental health outcomes.

Multi-modal risk factors differentiate suicide attempters from ideators in military veterans with major depressive disorder

BackgroundThe suicide rate for United States military veterans is 1.5× higher than that of non-veterans. To meaningfully advance suicide prevention efforts, research is needed to delineate factors that differentiate veterans with suicide attempt/s, particularly in high-risk groups, e.g., major depressive disorder (MDD), from those with suicidal ideation (no history of attempt/s). The current study aimed to identify clinical, neurocognitive, and neuroimaging variables that differentiate suicide-severity groups in veterans with MDD. MethodsSixty-eight veterans with a DSM-5 diagnosis of MDD, including those with no ideation or suicide attempt (N = 21; MDD-SI/SA), ideation-only (N = 17; MDD + SI), and one-or-more suicide attempts (N = 30; MDD + SA; aborted, interrupted, actual attempts), participated in this study. Participants underwent a structured diagnostic interview, neurocognitive assessment, and 3 T-structural/diffusion tensor magnetic-resonance-imaging (MRI). Multinomial logistic regression models were conducted to identify variables that differentiated groups with respect to the severity of suicidal behavior. ResultsRelative to veterans with MDD-SI/SA, those with MDD + SA had significantly higher left cingulum fractional anisotropy, decreased attentional control on emotional-Stroop, and faster response time with intact accuracy on Go/No-Go. Relative to MDD + SI, MDD + SA had higher left cingulum fractional anisotropy and faster response time with intact accuracy on Go/No-Go. LimitationsFindings are based on retrospective, cross-sectional data and cannot identify causal relationships. Also, a healthy control group was not included given the study's focus on differentiating suicide profiles in MDD. ConclusionsThis study suggests that MRI and neurocognition differentiate veterans with MDD along the suicide-risk spectrum and could inform suicide-risk stratification and prevention efforts in veterans and other vulnerable populations.

Transitions in Suicide Risk from Early Adolescence to Early Adulthood

Objective Understanding patterns of suicide risk over the course of development can aid our ability to prevent suicide. Our community-based study examined changes in suicide risk status and predictors of changes in risk status in a sample of 521 adolescents over six assessments between the start of middle school and young adulthood (ages 12–22). Methods Suicidal thoughts and behaviors (STB) were measured with the Diagnostic Interview Schedule for Children and the Moods and Feelings Questionnaire. Latent transition analysis (LTA) was utilized to evaluate transitions in suicide risk status over the course of development. Nine risk factors’ initial values and change over time were modeled as predictors in the LTA. Results Latent class analysis identified a four-class model of developmental suicide risk patterns: Class 1: Infrequent STB (73–87% of participants), Class 2: Diminishing STB (1–17% of participants), Class 3: Escalating STB (6–16% of participants), and Class 4: Consistently High STB (1–5% of participants). LTA demonstrated that infrequent STB members and escalating STB members were likely to maintain their risk class across time points. Conclusions Classification of STB trajectories demonstrated self-worth and family involvement were salient variables affecting transitions in risk over time and suggest prevention targets early in adolescence that could have impact on suicide risk in adulthood.

Changes in functional connectivity and suicidality after electroconvulsive therapy in depressed patients

ObjectiveSuicidality is a common and serious symptom of depression and patients with depression and suicidality often respond to electroconvulsive therapy (ECT), but the mechanism of its effect is poorly understood. We used resting-state functional magnetic resonance imaging (rs-fMRI) to explore changes in brain connectivity before and after ECT in depressed patients with suicidality.MethodsTwenty-three depressed patients with suicidality underwent rs-fMRI at baseline and after 8–12 ECT sessions. Thirty-two age-, sex-, and education-matched healthy controls (HCs) underwent rs-fMRI once. We used functional connectivity (FC) analysis to identify brain regions with altered connectivity in patients compared to HCs and assess changes in FC before and after ECT. We also assessed the clinical symptoms using the Hamilton Depression Scale, 17-item (HAMD-17), and Beck Scale for Suicide Ideation (BSSI).ResultsCompared to HCs, at baseline, patients had reduced FC between the left orbitofrontal cortex (OFC_ Ant_L) and left angular gyrus (Angular_L) (t = 3.849, P < 0.05) with OFC_Ant_L as ROI. With left superior frontal gyrus (Frontal_sup_L) as ROI, patients also had reduced FC between Frontal_sup_L and left superior medial frontal gyrus, medial orbital (Frontal_Med_Orb_L) and left precuneus (Precuneus_L) (t = 3.650, P < 0.05), and increased FC between Frontal_sup_L and right middle frontal gyrus (Frontal_Mid_R) (t = -4.220, P < 0.05). After ECT, with Frontal_sup_L as ROI, patients showed increased FC between Frontal_sup_L and Angular_L after ECT (t = -3.982, P < 0.05) and decreased FC between Frontal_sup_L and right superior and inferior parietal gyrus (Parietal_Sup&Inf_R). In ECT responders, the change in FC between Frontal_sup_L and Angular_L was negatively correlated with the change of the score of BSSI (r = -0.645, P = 0.042), and the change in FC between Frontal_sup_L and Parietal_Sup&Inf_R was positively correlated with the change of the score of BSSI (r = 0.714, P = 0.023). There was no correlation between changes in FC with changes in HAMD-17 score (all P > 0.05).ConclusionOur findings suggest that FC between Frontal_sup_L and Angular_L, and FC between Frontal_sup_L and Parietal_Sup&Inf_R may be involved in the mechanisms by which ECT exerts its effects on suicidality in patients with depression. Our findings provide insights into the neural underpinnings of ECT and may inform the development of more targeted novel therapeutic strategies for suicidality.Trial registrationChinese Clinical Trial Registry, ChiCTR2100048182, Registered 04 July 2021, www.chictr.org.cn

Suicidal Ideation and Suicide Attempts After Direct or Indirect Psychotherapy

Suicidal ideation and suicide attempts are debilitating mental health problems that are often treated with indirect psychotherapy (ie, psychotherapy that focuses on other mental health problems, such as depression or personality disorders). The effects of direct and indirect psychotherapy on suicidal ideation have not yet been examined in a meta-analysis, and several trials have been published since a previous meta-analysis examined the effect size of direct and indirect psychotherapy on suicide attempts. To investigate the effect sizes of direct and indirect psychotherapy on suicidal ideation and the incidence of suicide attempts. PubMed, Embase, PsycInfo, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials were searched for articles published up until April 1, 2023. Randomized clinical trials of psychotherapy for any mental health problem, delivered in any setting, compared with any control group, and reporting suicidal ideation or suicide attempts were included. Studies measuring suicidal ideation with 1 item were excluded. PRISMA guidelines were followed. Summary data were extracted by 2 independent researchers and pooled using 3-level meta-analyses. Hedges g was pooled for suicidal ideation and relative risk (RR) was pooled for suicide attempts. Of 15 006 studies identified, 147 comprising 193 comparisons and 11 001 participants were included. Direct and indirect psychotherapy conditions were associated with reduced suicidal ideation (direct: g, -0.39; 95% CI, -0.53 to -0.24; I2, 83.2; indirect: g, -0.30; 95% CI, -0.42 to -0.18; I2, 52.2). Direct and indirect psychotherapy conditions were also associated with reduced suicide attempts (direct: RR, 0.72; 95% CI, 0.62 to 0.84; I2, 40.5; indirect: RR, 0.68; 95% CI, 0.48 to 0.95; I2, 0). Sensitivity analyses largely confirmed these results. Direct and indirect interventions had similar effect sizes for reducing suicidal ideation and suicide attempts. Suicide prevention strategies could make greater use of indirect treatments to provide effective interventions for people who would not likely seek treatment for suicidal ideation or self-harm.