Suicidal Individuals Research Articles

When Hope Fades: Considering Self-Esteem, Depression, Social Support, Loneliness in The Context of Suicide Prevention

Individuals engaging in suicidal ideation or making suicide attempts are a substantial demographic group to investigate preventive mental health due to inherent high risks associated with potential outcomes of suicidal behaviors for public health. Factors increasing the likelihood of suicide might include self-esteem, depression, social support, loneliness, or certain demographic profiles, and the purpose of this study is to synthesize these variables to advocate for effective strategies to intervene in cases of suicide. Specifically, this commentary aims to identify suicidal coping mechanisms and psychological resilience factors among suicidal individuals through the enhancement of self-esteem, intervention of depressive symptoms, and promotion of connectedness. Through discussing the determinants that might play a role in the onset of suicidal thoughts and suicide attempts, this paper has important implications for suicide prevention strategies and the identification of psychological resilience factors that can predict suicidal thoughts and suicide attempts in individuals.

Examining suicidality in relation to the menopause: A systematic review

Suicide is one of the leading causes of deaths worldwide, with an estimated 1 in 100 deaths being attributable to suicide. Whilst rates of suicide are higher in men, evidence suggests that suicide attempts are more frequent in women. Suicidality data indicates that deaths by suicide in women are highest in those in midlife, warranting investigation into the relationship between the menopause and suicidality. The current study aimed to review the existing literature examining the relationship between suicidality and the menopause using a systematic review approach. A systematic literature search of MEDLINE, Cochrane Library, Scopus Web of Science, PsycINFO, and Embase databases was conducted in October 2023. Two authors independently screened the titles and abstracts of identified articles against the eligibility criteria. Any inconsistencies were discussed and resolved. This process was subsequently repeated with the articles’ full-text. Risk of bias was assessed using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Relevant data were extracted and summarised in both a tabulated and narrative form. A total of 28 studies met the inclusion criteria, with the findings revealing a complex relationship between the menopause and suicidality. Several studies highlighted that the perimenopause period shows a higher prevalence of suicidal thoughts compared to pre-menopausal and post-menopausal stages. Conversely, some studies indicated increased suicidality during the post-menopausal phase, while others noted elevated suicidality in pre-menopausal individuals and those with primary ovarian insufficiency. Critically, several studies found no link between hormonal status and suicidality. The quality of the studies also varied, with a lack of involvement from individuals with relevant lived experience being a consistent methodological flaw across all the included studies. Overall, the current evidence on menopause and suicidality is mixed. Further research is needed to unravel the relationship between menopause and suicidality.

The Relationship Between Sensory Processing, Substance Abuse and Impulsivity With Suicide in Schizophrenia: A Narrative Review

Background and Objectives: Schizophrenia is a debilitating and complex mental health disorder characterized by symptoms, such as delusions, hallucinations, and cognitive impairments. A high comorbidity rate is observed between substance abuse, schizophrenia and impulsivity. Given the higher rate of suicide among individuals with schizophrenia, this research aims to investigate the correlation between three factors, sensory processing, substance abuse and impulsivity, concerning suicide in individuals diagnosed with schizophrenia. Methods: Research was conducted on PubMed, Google Scholar and Web of Science using the keywords “schizophrenia,” “substance use disorder (SUD),” “sensory processing,” “suicide” and “impulsivity.” Sixteen articles were selected as the most recent and relevant studies for reporting. Results: The reviewed studies demonstrated a high prevalence of suicide in patients with schizophrenia, particularly during the early stages of the illness. Impulsivity plays a contributing role in the elevated rates of suicide and substance abuse, with substance abuse directly influencing the incidence of suicide. Moreover, sensory processing difficulties can lead to self-harm and suicide. Therefore, the presence of these three factors in patients can increase the risk of suicide. Conclusion: Studies have addressed these risk factors to a considerable extent, less attention has been given to sensory processing, impulsivity, and substance abuse, which are significant factors in self-harm and suicide, as well as their predictive value for suicide. Further studies in this area are recommended.

Suicide attempt survivors’ recovery-related agency in the relational context of services: a qualitative analysis

BackgroundSuicidal persons’ contacts with services present a key opportunity for suicide prevention. However, interventions by services are not always effective. A deeper understanding of suicidal service users’ agency and its implications may facilitate the provision of meaningful responses to help-seeking during suicidal crises. This abductive study explores the recovery-related agency of suicide attempt survivors and the perceived role of interactions with services in facilitating or hindering it.MethodsFourteen Finnish suicide attempt survivors were interviewed in-depth on their experiences of interacting with services during a recent suicidal episode. An operationalization of recovery-related agency as the expressed ability to take (mental or physical) action in a direction perceived as aiding recovery from suicidality (i.e., the coupling of recovery-related intentionality and power) was used to explore transcribed interviews through directed content analysis. Data were further categorized based on whether the service context was perceived as helpful or unhelpful to recovery efforts.ResultsAll participants expressed both agency and non-agency in relation to their recovery process. The relational context provided by services was presented as highly relevant for the achievement and sustainability of recovery-related agency as well as for participants’ experience of safety in instances when agency was lacking. The results are presented as a typology of recovery-related agency in its perceived relational context, with the categories of sustained agency, strained agency, contained non-agency and uncontained non-agency.ConclusionsThe concept of agency helped capture important aspects of suicidal individuals’ recovery-related efforts and the role of services in facilitating or hindering them. The findings illuminate the value of viewing suicidal service users as agents of their own recovery process as well as the potential costs of ignoring this perspective in service delivery and design.

Adolescent, caregivers, and therapists’ experiences of youth and family suicide intervention: A qualitative study

Objective This study explores the experience of an individual and family therapy youth suicide intervention from the perspectives of seven psychotherapy triads (young people aged 12–18, their parents/caregivers and therapists). Method Data were collected through semi-structured individual interviews and analyzed using consensual qualitative research methods. Results Four domains were identified: Focusing on the youth-parent relationship, individual therapy for young people and their parents, conjoint therapy, and public service structures and systemic practice that facilitated tailored treatment. All participant groups valued intervention that improved the youth-parent relationship; however, they held different views about its influence on suicidality and recovery. Separate youth and parent therapy was crucial for facilitating the tailoring of treatment and enhancing the reparative potential of conjoint therapy. Barriers to productive intervention included inaccessible, fragmented, and siloed treatment that excluded parents, stigmatizing clinician responses, and acute care that was not attuned to need or developmental context. Helpful intervention was systemically and attachment-informed, multi-disciplinary, individually tailored, and integrated freely available specialist therapy with crisis and inpatient care. Conclusion A relational, nuanced, and flexible approach is needed to tailor youth suicide treatment in the context of the complexity of youth-parent relationships.

Research on cyberbullying and suicide: a bibliometric analysis

AbstractSuicide is a global mental health problem. In recent years, suicidal ideation, suicide attempts and suicides have increased in children and adolescents. In this population, cyberbullying is a public health problem that has grown along the increase in use of devices with internet access. Cybervictimization is related to negative health effects, even including suicidal ideation or suicide in cyberbullied individuals. This study is the first bibliometric analysis on scientific literature related to cyberbullying and suicide based on the traditional laws of bibliometrics. The aim was to generate a global overview of the research related to this object of study. We analysed 242 documents published in journals indexed in the Web of Science, examining the trend followed by annual publications, identifying the prolific (most productive) and prominent (prolific co‐authors with one or more papers between most cited papers) co‐authors, leading countries and journals, the most cited documents and the most used author keywords. Annual publications followed an exponential growth trend (R2 = 89.2%), meaning that there is a great interest in the scientific community for this study object. International Journal of Environmental Research and Public Health and Psychiatry Research were the journals with most document published. Baiden, P. (prolific), Kowalski, R. (most cited), Hinjuja, S. and Patchin, J. (prominents) were the most highlighted co‐authors, reference authors on the subject. Most scientific output originated in the USA. Five thematic lines were identified among the author keywords. The results of this research show the growing interest of the scientific community in this topic, along with useful information for researchers and publishers, identifying relevant co‐authors, journals interested in the topic and emerging lines of research, highlighting self‐harm, cyber‐victimisation, suicide risks and suicidal behaviours as the most recent thematic lines.

Suicide in young and middle-aged individuals: lessons from a psychosocial autopsy study

Abstract Background Sociodemographic characteristics of suicides are available from Statistics Netherlands. To improve suicide prevention, it is not only necessary to know who dies but also why people die. A psychosocial autopsy was conducted in the Netherlands to investigate differences in psychosocial characteristics and precipitating factors of suicides of young (<30) and middle-aged (40-70) suicide decedents. Methods Data were collected from bereaved individuals. A questionnaire detailed sociodemographic and psychosocial characteristics of the decedents. We reconstructed the suicidal process in the months preceding the suicide in an interview. Findings from the questionnaire and interview were integrated. An independent expert committee formulated recommendations for suicide prevention. Results 162 suicides were investigated. Young decedents showed high levels of substance use and academic pressure. Young adults with developmental disorders were vulnerable in the transition to adulthood. Young males reached out less to support and care. By contrast, suicides of young females were distinguished by comorbidity of psychiatric disorders, frequent suicidal behaviours, high levels of care use, wait lists and a loss of (treatment) perspective, harmful social media use and bullying. Work and financial problems were common in middle-aged decedents. Physical disability and pain were frequently mentioned for middle-aged females. Suicide in middle-aged males was characterized by financial distress, interpersonal conflicts such as divorce, high levels of binge drinking and addiction. Conclusions Our data provide a topology of the needs of individuals at risk for suicide. Suicide prevention strategies can be improved by better transition support and explicit suicide monitoring in young adults with a developmental disorder, active waitlist policies in mental healthcare, and improved collaboration between debt counsellors and mental care professionals based on shared accountability. Key messages • Bereaved individuals elucidated a wide range of psychosocial problems in suicide decedents. • Suicide prevention should adhere to a needs-based approach.

Suicidal thinking and behavior in young people at Clinical High Risk for Psychosis: Psychopathological considerations and treatment response across a 2-year follow-up study.

Suicidal ideation has high rates among individuals at Clinical High Risk for Psychosis (CHR-P). CHR-P mental states are currently defined as attenuated psychotic symptoms, brief intermittent psychotic symptoms, or genetic risk and functioning deterioration syndrome. However, the relationship between psychotic experiences and suicidality in CHR-P subjects is still not fully understood. Research emphasizes the need to address suicidality in CHR-P individuals due to its incidence and severe socio-economic impact. This study aimed to assess the baseline prevalence and 2-year incidence rates of suicidal thinking and behaviors in an Italian CHR-P sample, investigate the stability of suicidal ideation over 2 years, and examine its associations with treatment outcomes, sociodemographic characteristics, and clinical factors. CHR-P participants were treated in an "Early Intervention in Psychosis" program and completed the PANSS and the GAF scale at baseline and every 12 months. 180 CHR-P individuals were enrolled (92 with suicidal ideation [SI+]). SI+ subjects had a higher baseline prevalence of past suicide attempts. Over 2 years, a decrease in suicidal ideation severity was observed in the total group. Longitudinal improvement in disorganized symptoms was a key predictor of the decrease in suicidal ideation. Participants with a history of suicide attempts were more likely to attempt again. Addressing disorganization is crucial for suicide prevention in the CHR-P population. Continuous risk monitoring and preventive actions are needed for those with past suicide attempts.

An Examination of Episodic Future Thinking and Episodic Memory Among Suicidal and Nonsuicidal Adolescents

ABSTRACT Objective Suicidal individuals experience ambivalent states where they simultaneously consider death and the continuation of their lives. But we have little understanding of how suicidal individuals, particularly youth, mentally construct their future lives. To address this knowledge gap, we aimed to examine episodic future thinking and the related cognitive process of episodic memory among suicidal and nonsuicidal adolescents. Method We administered a performance-based measure of episodic future thinking to community-based adolescents (N = 176, 15–19 years; 69.3% female at birth, 57.1% identifying with a racial minoritized group) and examined the concurrent and predictive validity of details generated within an imagined future event in relation to suicidal ideation (SI; ranging from passive desire of wanting to be dead to active desire to kill oneself). Results Greater difficulty imagining discrete actions within an imagined positive future event was associated with past and subsequent SI, although these associations were largely accounted for by depressive symptoms. In contrast, greater difficulty imagining action-related details tied to either positive or negative future events predicted SI 6 months later controlling for symptoms of both anxiety and depression, SI history, and narrative style. Conclusions Findings from this study offer an initial glimpse into how suicidal adolescents imagine their future and may inform the design of interventions intended to promote a stronger desire for life than death.

Risk of common psychiatric disorders, suicidal behaviours, and premature mortality following violent victimisation: A matched cohort and sibling-comparison study of 127,628 people who experienced violence in Finland and Sweden.

Associations between violent victimisation and psychiatric disorders are hypothesised to be bidirectional, but the role of violent victimisation in the aetiologies of psychiatric disorders and other adverse outcomes remains unclear. We aimed to estimate associations between violent victimisation and subsequent common psychiatric disorders, suicidal behaviours, and premature mortality while accounting for unmeasured familial confounders. Using nationwide registers, we identified a total of 127,628 individuals born in Finland (1987 to 2004) and Sweden (1973 to 2004) who had experienced violent victimisation, defined as either hospital admissions or secondary care outpatient visits for assault-related injuries. These were age- and sex-matched with up to 10 individuals in the general population (n = 1,276,215). Additionally, we matched those who had experienced violent victimisation with their unaffected siblings (n = 132,408). Outcomes included depression, anxiety, personality disorders, alcohol use disorders, drug use disorders, suicidal behaviours, and premature mortality. Participants were followed from the victimisation date until the date of the outcome, emigration, death, or December 31, 2020, whichever occurred first. Country-specific associations were estimated using stratified Cox regression models, which also accounted for unmeasured familial confounders via sibling comparisons. The country-specific associations were then pooled using meta-analytic models. Among 127,628 patients (69.0% male) who had experienced violent victimisation, the median age at first violent victimisation was 21 (interquartile range: 18 to 26) years. Incidence of all outcomes was larger in those who were exposed to violent victimisation compared to population controls, ranging from 2.3 (95% confidence interval (CI) [2.2; 2.4]) per 1,000 person-years for premature mortality (compared with 0.6, 95% CI [0.6; 0.6], in controls) to 22.5 (95% CI [22.3; 22.8]) per 1,000 person-years for anxiety (compared with 7.3, 95% CI [7.3; 7.4], in controls). In adjusted models, people who had experienced violent victimisation were between 2 to 3 times as likely as their siblings to develop any of the outcomes, ranging from adjusted hazard ratio [aHR] 1.7 (95% CI [1.7; 1.8]) for depression to 3.0 (95% CI [2.9; 3.1]) for drug use disorders. Risks remained elevated 2 years post-victimisation, ranging from aHR 1.4 (95% CI [1.3; 1.5]) for depression to 2.3 (95% CI [2.2; 2.4]) for drug use disorders. Our reliance on secondary care data likely excluded individuals with milder assault-related injuries and less severe psychiatric symptoms, thus suggesting that our estimates may be conservative. Another limitation is the possibility of residual genetic confounding, as full siblings share on average about half of their co-segregating genes. However, the associations remained robust even after adjusting for both measured and unmeasured familial confounders. In this longitudinal cross-national cohort study, we observed that those who had experienced violent victimisation were at least twice as likely as their unaffected siblings to develop common psychiatric disorders (i.e., depression, anxiety, personality disorder, and alcohol and drug use disorders), engage in suicidal behaviours, and to die prematurely. Importantly, these risk elevations remained 2 years after the first victimisation event. Improving clinical assessment, management, and aftercare psychosocial support could therefore potentially reduce rates of common psychiatric disorders, suicidality, and premature mortality in individuals experiencing violent victimisation.

Neme priče: mikrozgodovinski pogled na samomor v sodnih spisih prve polovice 20. stoletja

Based on the archival materials from the Celje and Maribor District Courts (Kreisgerichte) and the specific cases from the Trbovlje County Court (Bezirksgericht), referring to the areas with the highest suicide rates in the Drava Banate, this article examines suicide in the first half of the 20th century. Based on individual cases from judicial practice, as well as newspaper reports, the article sheds light on the social, economic and regional conditions in the considered areas in the first half of the 20th century, as well as the position of women in society and the prevalence of family and sexual violence. At the time when the increasing suicide rates were attributed to the aftermath of World War I, the effects of the economic crisis, and alcoholism, the article analyses the presence and gradual dominance of psychological and psychiatric discourse in determining the causes of individual suicides. By analysing the individual cases, the author presents the attitude towards suicide in rural areas – the shame and stigma still felt by the family members when a relative of theirs commits suicide. The author analyses cases where either the suicide could not be identified or when the corps of the deceased was not found, as well as cases of suicide due to fear and/or shame due to crimes committed. Furthermore, the article focuses on the phenomenon of female suicide and, in this context, on the examples of murder-suicide and the role of women in them, analyses the contemporaneous media discourse, and describes the course of the investigations in the cases where it was not clear whether the death had resulted from suicide or murder.

The Association between Suicidal Ideation and Subtypes of Comorbid Insomnia Disorder in Apneic Individuals.

Background/Objectives: Given the existence of higher suicidality in apneic individuals, this study aimed to determine the potential role played by subtypes of the comorbid insomnia disorder (CID) in the occurrence of suicidal ideation for this specific subpopulation. Methods: To perform our analyses, 1488 apneic individuals were retrospectively extracted from the Sleep Laboratory hospitalization register. Only apneic individuals with suicidal ideation highlighted during the psychiatric interview and/or with a score ≥1 on item G of the Beck Depression Inventory confirmed during the clinical interview were included in the group with suicidal ideation. The likelihood of suicidal ideation associated with CID subtypes was investigated using logistic regression analyses. Results: The prevalence of suicidal ideation was 9.3% in our sample of apneic individuals. After hierarchically introducing the significant confounders for adjustment, multivariate logistic regression analyses demonstrated that unlike short sleep duration alone and CID without short sleep duration, the likelihood of suicidal ideation was only higher for CID with short sleep duration in apneic individuals. Conclusions: Thus, we highlighted in this study that CID with short sleep duration could play a major role in higher suicidality for apneic individuals, which seems to require systematic screening and appropriate treatment of this comorbid sleep disorder to enable better management of suicidal risk in this specific subpopulation.

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.

“No miracle cure” interface evaluation of a UK suicide prevention app in a Norwegian context

Background 600 Norwegians die by suicide annually. Self-help apps may potentially reach and support suicidal individuals, next of kin, bereaved and professionals with educational information, access to suicide emergency help, hotlines, and coping tools. Knowledge regarding feasible app interface for suicide prevention self-help apps in a Norwegian context is however lacking. Aim Evaluate user-friendliness and user interface of the Norwegian version of the British Stay Alive suicide prevention app and assess whether the app could be useful in suicide prevention. Materials and Methods Eight Norwegian Fountain house members and twelve university students evaluated the app interface, and their experiences were discussed through individual- or focus-group interviews. Results Participants perceived app tools as relevant and useful for suicide prevention, however they raised concerns on privacy, evidence base, interface complexity, unintended symbolic value of app colours and content, and suitability in suicidal states. Conclusion The current Norwegian Stay Alive version has the potential to be user friendly, however improvements of interface are suggested. Significance Stay Alive interface must be adjusted and subjected to reiterative evaluations and feasibility assessments in collaboration with additional stakeholder populations to remedy interface concerns, and identify optimal Norwegian interface design, prior to implementation.

Mood disorders and suicide: pilot study on postmortem toxicologic evidence and adherence to psychiatric therapy by determining blood levels of medications.

Suicide is one of the leading causes of death today, and among all mental illness, mood disorders account for one of the main risk factors. It is well known and proven that suicides are very common among people undergoing treatment and prescribed psychiatric medication. So far, however, there have only been a few studies dealing with this particular phenomenon. For this reason, autopsy patients who died by suicide, suffered from a mood disorder, and were known to be taking psychiatric medication at the time of death were selected for this study. The blood and urine samples taken during the autopsy underwent toxicological analysis and the results were compared with the prescribed therapy. A total of 22 people were included in the study: 12 presenting with depression and 10 with bipolar disorder. The toxicological analysis revealed that only 6 cases (27%) showed a qualitative match with the prescribed medication. In 5 cases (22.7%) the medication was only partially complied with and in 11 cases (50%) it was not complied with at all. Furthermore, even when medication was present, the value was often below the therapeutic range. Overall, more than 70% of the test subjects adhered to their medication only partially or not at all. Since treatment adherence is considered as a key factor in reducing the risk of suicide, this inevitably raises relevant clinical and forensic questions. Against this background, prospective monitoring of post-mortem medication levels in suicidal individuals and synergistic collaboration between clinicians and forensic pathologists could help to evaluate the effectiveness of specific medical interventions, highlight existing critical problems and develop new approaches to suicide prevention.

Suicidality and Intellectual Disability: A Systematic Review

ABSTRACT Background Suicidality in individuals with intellectual disability is a critical but under-researched area. This systematic review aims to synthesize existing literature on the prevalence, risk factors, and interventions for suicidality among individuals with intellectual disability. Methods Adhering to the PRISMA guidelines, a comprehensive review of databases was conducted for empirical studies on suicidality in intellectual disability. Data were extracted on sample characteristics, methodologies, and key findings. Results Nineteen studies met the inclusion criteria. Consistent risk factors, notably comorbid psychiatric disorders, emerged. Passive suicide methods predominated with a positive correlation between higher intellectual functioning and increased suicidal behaviors. Conclusions The increased vulnerability to suicide in this population highlights the need for targeted interventions and comprehensive risk assessments. Much future research is required in the face of paucity of data with the priority on developing specific suicide prevention tools while addressing cultural stigmas to enhance support for this population.

Suicidal Crisis Negotiations: An Investigation of Situational Characteristics, Hooks and Triggers

Crisis negotiation teams have previously been described as “gatekeepers” to suicidal individuals, with research showing that these are amongst the most common calls negotiators attend to. Despite this, the situational features of these calls and the communicative dynamics that may lead to the safe resolution of suicidal crises, remain poorly understood. Using a mixed method approach, situational characteristics across four suicidal incident types were examined, and “hooks” and “triggers” that were common in each incident type were identified. The results revealed some consistencies across incident types regarding incident location, and the mental health and substance use histories of subjects. Inconsistencies were observed for communication method used, weapons involved, and resolution details. Numerous hooks and triggers were identified for each incident type. The findings increase our understanding of suicidal crises and have implications for negotiator training (e.g., the features of actual suicidal incidents can inform the content of scenario-based training).

Individual suicide risk factors with resting-state brain functional connectivity patterns in bipolar disorder patients based on latent Dirichlet allocation model

BackgroundThe widespread problem of suicide and its severe burden in bipolar disorder (BD) necessitate the development of objective risk markers, aiming to enhance individual suicide risk prediction in BD. MethodsThis study recruited 123 BD patients (61 patients with prior suicide attempted history (PSAs), 62 without (NSAs)) and 68 healthy controls (HEs). The Latent Dirichlet Allocation (LDA) model was used to decompose the resting state functional connectivity (RSFC) into multiple hyper/hypo-RSFC patterns. Thereafter, according to the quantitative results of individual heterogeneity over latent factor dimensions, the correlations were analyzed to test prediction ability. ResultsModel constructed without introducing suicide-related labels yielded three latent factors with dissociable hyper/hypo-RSFC patterns. In the subsequent analysis, significant differences in the factor distributions of PSAs and NSAs showed biases on the default-mode network (DMN) hyper-RSFC factor (factor 3) and the salience network (SN) and central executive network (CEN) hyper-RSFC factor (factor 1), indicating predictive value. Correlation analysis of the individuals' expressions with their Nurses' Global Assessment of Suicide Risk (NGASR) revealed factor 3 positively correlated (r = 0.4180, p < 0.0001) and factor 1 negatively correlated (r = − 0.2492, p = 0.0055) with suicide risk. Therefore, it could be speculated that patterns more associated with suicide reflected hyper-connectivity in DMN and hypo-connectivity in SN, CEN. ConclusionsThis study provided individual suicide-associated risk factors that could reflect the abnormal RSFC patterns, and explored the suicide related brain mechanisms, which is expected to provide supports for clinical decision-making and timely screening and intervention for individuals at high risks of suicide.

Suicide in individuals with eating disorders who had sought mental health treatment in England: a national retrospective cohort study

Although studies have suggested a high risk of suicide in people with eating disorders, most studies have focused on suicidal ideation and attempts. There is little research on the characteristics of people with eating disorders who died by suicide, nor investigation of trends over time. We aimed to compare the characteristics of patients with eating disorders who died by suicide versus patients with other mental health diagnoses who died by suicide in England and to examine the trends in rates. In this national retrospective cohort study, data on all people (aged ≥10 years) who died by suicide in England, UK, between Jan 1, 1997, and Dec 31, 2021, while under the care (within the previous 12 months) of mental health services were obtained from the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), in which clinical information is collected via a questionnaire completed by the mental health professional responsible for the patient's care. Incidence of suicide in, and demographic, clinical, and treatment characteristics of, patients with a diagnosis of eating disorder (as recorded by the treating clinician) who died by suicide were compared with patients with other mental health diagnoses who died by suicide within the same timeframe using univariable logistic regression analysis. People with related lived experience were involved in the study design, implementation, interpretation, and writing of the manuscript. Of 119 446 people for whom NCISH were notified of dying by suicide in England, 30 795 were under the recent care of mental health services, of whom 30 246 had known diagnoses and were included in analyses. Of these individuals, 10 373 (34%) were female and 19 873 (66%) were male; 2236 (8%) were of minority ethnicity; 382 (1%) had a diagnosis of eating disorder and 29 864 (99%) had another mental health diagnosis. Compared with patients with other mental health diagnoses who died by suicide, patients with eating disorders were younger (median age 33 years [range 15-90] vs 45 years [10-100]), more often female (343 [90%] female and 39 [10%] male in the eating disorders group; 10 030 [34%] female and 19 834 [66%] male in the other diagnoses group), and less likely to have evidence of conventional risk factors for suicide such as living alone (odds ratio [OR] 0·68, 95% CI 0·55-0·84). 22 (6%) of 382 were from a minority ethnic group. Patients with an eating disorder were characterised by a greater clinical complexity (eg, self-harm [OR 2·31, 95% CI 1·78-3·00], comorbidity [9·79, 6·81-14·1], and longer duration of illness [1·95, 1·56-2·43]), and were more likely to have died following overdoses (2·00, 1·62-2·45) than patients with other diagnoses. Childhood abuse (52 [37%] of 140) and domestic violence (18 [20%] of 91) were common in patients with eating disorders. Similar to patients with other diagnoses, most (244 [75%] of 326) of those with eating disorders who died by suicide were rated as low risk by clinicians at last contact. The number of suicide deaths in patients with eating disorders rose between 1997 and 2021 (incidence rate ratio [IRR] 1·03, 95% CI 1·02-1·05; p<0·0001), but rates fell when accounting for the greater number of patients entering mental health services (IRR 0·97, 0·95-1·00; p=0·033). This study was focused on people who sought help from mental health services. It did not consider subtypes of eating disorders or include a control group, but it does highlight possible areas for intervention. The comprehensive provision of evidence-based treatment for eating disorders and underlying conditions to address the clinical complexity in these patients might help to reduce suicide. Recognising limitations in clinical risk assessment, addressing early life experiences and current adversities, and appropriate prescribing might also be of benefit. Suicide prevention must remain a priority for eating disorder services and mental health care more widely. The Healthcare Quality Improvement Partnership.

Substitution of Methods in Suicide Deaths - Firearm Injury and Hanging.

Background: Prevention strategies for suicide emphasize restrictions on firearm access. These restrictions may lose efficacy if individuals substitute other lethal suicide methods. Aims: The objective of this study is to determine the extent to which individuals who die by suicide in the United States substitute hanging for firearm injury. Methods: This study is a repeated cross-sectional analysis of suicide deaths in the United States from 2003 to 2021. Multiple regression was used to estimate the effect of firearm access proxies on individual suicide methods (hanging vs. firearm injury). Results: The probability of death by hanging was significantly and negatively associated with proxies of firearm access. Limitations: This study does not compare crude rates of suicide by state, which rise on average with rates of firearm ownership. The National Violent Death Reporting System expanded over the sample period, so early years have incomplete ascertainment. Rates of gun ownership and gun safety law scales are measured as proxies. Conclusions: Although means restriction around firearm access is a critical tool for suicide prevention, complementary strategies for prevention around hanging merit further study.