Suicidal Ideation Research Articles

Efficacy and Safety of Lithium for Suicide and Suicide-Related Behaviors in Youth: A Review of the Literature

Objectives: This systematic review evaluates the anti-suicidal properties of Lithium in children and adolescents with Bipolar Disorder (BD), addressing gaps in evidence regarding its efficacy and safety in reducing suicidality and self-harming behaviors. Methods: A comprehensive literature search was conducted across PubMed, Web of Science, and Scopus up to February 2024. Eligible studies were those focusing on patients aged 25 years or younger, examining Lithium therapy and its impact on suicidal ideation and behaviors. The review included randomized controlled trials, longitudinal prospective and retrospective studies, and cross-sectional studies, while excluding expert opinions and case reports. Results: Evidence generally supports the efficacy of Lithium in reducing suicidal ideation and self-harming behaviors in youth with BD, though results are mixed. Randomized controlled trials demonstrated its effectiveness in mitigating suicidal thoughts during acute manic episodes, with effects persisting post-treatment. Longitudinal studies suggested that Lithium might offer superior outcomes compared to other mood stabilizers, although its specific impact on suicidality remains inconclusive. Cross-sectional studies and retrospective analyses reveal associations between Lithium use and reduced self-harming behaviors, but causality remains uncertain. While mood-stabilizing effects of Lithium offer potential benefits for reducing suicidality in youth, evidence on its direct impact on emotional dysregulation (ED) and long-term efficacy is limited. Variability in individual responses and adherence issues underscore the need for further research. Future studies should include larger, diverse samples, focus on ED symptoms, and explore Lithium mechanisms in suicidality prevention. Conclusions: Lithium remains a promising treatment for mood stabilization and reduction in suicidality in youth with BD.

Epidemiological Evaluation of Suicidal Deaths due to Hanging: A Retrospective Medicolegal Study in Sylhet

Background: Suicidal hanging is the most common method of suicide in developing countries, especially among young people. During conventional autopsies, it is one of the significant causes of unnatural deaths in Bangladesh. This study was performed to determine the epidemiological evaluation of suicidal deaths due to suicidal hanging at the mortuary of the Forensic Medicine Department of Sylhet MAG Osmani Medical College, Sylhet. Materials and methods: An autopsy record-based retrospective study carried out to ascertain the epidemiological evaluation of 340 cases of suicidal hanging deaths from January 2015 to December 2018 in the Department of Forensic Medicine, Sylhet MAG Osmani Medical College, Sylhet. Results: Hanging was more common in the age ranges of 10-19 years (33.0%) and 20-29 years (29.1%), accounting for nearly two-thirds (62.1%) of all deaths. The incidence was higher in females (59.3%) than males (46.7%). Gowainghat (12.1%) and Kotwali (9.5%) had the highest incidences of victims. The most common autopsy findings were that the subcutaneous tissues underneath the ligature mark were found to be pale, white, hard and glistening in 94.2% of cases, cyanosis was found in 89.8% of cases, dribbling of saliva was seen in 66.3% of cases and subconjunctival petechial haemorrhage was observed in 46.0% of cases. Asphyxia (93.3%) was the most common cause of suicidal hanging deaths identified during autopsy. Conclusion: The majority of victims were female and young individuals were especially vulnerable to suicidal ideation, attempts and suicide by hanging. To reduce suicides, awareness programs, psychological counseling andsuicidal behavioral treatment are recommended. IAHS Medical Journal Vol 7(1), June 2024; 13-16

Risk Factors for Non-Communicable Diseases in Refugees, Asylum Seekers, and Subsidiary Protection Beneficiaries Resettled or Relocated in Portugal Between 2015 and 2020

Non-communicable diseases, previously thought of as a problem of high-income countries, now coexist in low- and middle-income countries, including the countries of origin for many refugees traveling to Europe. We aimed to describe the prevalence of risk factors for non-communicable diseases among refugees, asylum seekers, and subsidiary protection beneficiaries resettled or relocated in Portugal between 2015 and 2020 and compare these to the prevalence of risk factors in the 12 months before they left their country of origin. A cross-sectional study was conducted between 2019 and 2020 of all refugees, asylum seekers, and subsidiary protection beneficiaries attending a Lisbon, Portugal refugee center. Behavioral and biological risk factors were assessed using the WHO STEPwise modified questionnaire. A descriptive statistical analysis was conducted, which included 80 respondents, mainly men, with an average age of of 30.3 ± 9.8 years. The prevalence of several behavioral risk factors for non-communicable diseases among refugees, asylum seekers, and subsidiary protection beneficiaries was higher at the time of the study than in the 12 months before leaving the country of origin. Differences between men and women were noted in tobacco (49.1% vs. 25.9%) and alcohol use (43.4% vs. 18.5%) in the receiving country. Overweight and obesity also showed differences by gender (7.5% vs. 11.1% and 39.6% vs. 48.1%). The prevalence of suicidal ideation and suicidalplanning was high, and varied from 6.3% and 20% in the country of origin to 16.3% and 38.5% respectively in the receiving country, however the prevalence of suicide attempts was lower in the receiving country (66.7%) compared to the country of origin (100.0%). Information on health and social determinants is critical to identify priorities and increase access to access to gender-specific health and community level interventions, including mental health, to reduce risk factors associated with refugee relocation and resettlement.

Developing Culturally Sensitive Suicide Prevention Programs for Medical Professionals in Indonesia

Introduction: Medical professionals in Indonesia experience high levels of stress, increasing their risk for mental health problems and suicidal behavior. Culturally appropriate suicide prevention programs are critical to address this issue. This study aimed to develop and evaluate the feasibility and acceptability of a culturally adapted suicide prevention program for Indonesian medical professionals. Methods: This mixed-methods study had two phases. Phase 1 involved program development, adapting an existing evidence-based suicide prevention program using a Delphi method with Indonesian mental health experts (n=10) and cultural consultants (n=5). Phase 2 comprised a pilot implementation of the program with 30 medical professionals. Quantitative data on program feasibility (attendance, completion rates) and acceptability (satisfaction surveys, qualitative feedback) were collected and analyzed. Results: The Delphi method resulted in a culturally adapted program incorporating Indonesian values related to collectivism, family support, religious beliefs, and stigma associated with mental health. Pilot implementation showed high attendance (87%) and program completion rates (93%). Participants expressed high satisfaction with the program's content, cultural relevance, and delivery format. Qualitative feedback emphasized the importance of peer support, spiritual integration, and addressing workplace stressors. Conclusion: This study provides preliminary evidence for the feasibility and acceptability of a culturally sensitive suicide prevention program for Indonesian medical professionals. Further research is needed to evaluate the program's effectiveness in reducing suicidal ideation and behavior.

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.

Telehealth Brief Cognitive Behavioral Therapy for Suicide Prevention

ImportanceSuicide rates continue to increase in the US. Evidence-based treatments for suicide risk exist, but their effectiveness when delivered via telehealth remains unknown.ObjectiveTo test the efficacy of brief cognitive behavioral therapy (BCBT) for reducing suicide attempts and suicidal ideation among high-risk adults when delivered via telehealth.Design, Setting, and ParticipantsThis 2-group parallel randomized clinical trial comparing BCBT with present-centered therapy (PCT) was conducted from April 2021 to September 2023 with 1-year follow-up at an outpatient psychiatry and behavioral health clinic located in the midwestern US. Participants reporting suicidal ideation during the past week and/or suicidal behavior during the past month were recruited from clinic waiting lists, inpatient service, intermediate care, research match, and direct referrals from clinicians. A total of 768 participants were invited to participate, 112 were assessed for eligibility, and 98 were eligible and randomly assigned to a treatment condition. Data analysis was from April to September 2024.InterventionsParticipants received either BCBT, an evidence-based suicide-focused treatment that teaches emotion regulation and reappraisal skills, or PCT, a goal-oriented treatment that helps participants identify adaptive responses to stressors. Participants were randomized using a computerized stratified randomization algorithm with 2 strata (sex and history of suicide attempts).Main Outcomes and MeasuresThe primary outcome was suicide attempts as measured by the Self-Injurious Thoughts and Behaviors Interview-Revised. The secondary outcome was severity of suicidal ideation as measured by the Scale for Suicide Ideation.ResultsParticipants included 96 adults (mean [SD] age, 31.8 [12.6] years; 64 female [66.7%] and 32 male [33.3%]), with 51 receiving BCBT and 45 receiving PCT. Of all participants, 85 (88.5%) completed at least 1 session. From baseline to 12 months, 12 participants receiving PCT (estimated percentage, 35.6%) made 56 suicide attempts and 11 participants receiving BCBT (estimated percentage, 30.0%) made 36 suicide attempts. Participants randomized to BCBT made significantly fewer suicide attempts than participants randomized to PCT (mean [range], 0.70 [0.00-8.00] attempts per participant vs 1.40 [0.00-10.00] per participant) and had a 41% reduced risk for suicide attempts (hazard ratio, 0.59; 95% CI, 0.36-0.96; P = .03). Severity of suicidal ideation significantly decreased in both treatments (F4,330 = 50.1; P < .001) but did not differ between groups (F4,330 = 0.2; P = .91).Conclusions and RelevanceThe findings of this randomized clinical trial suggest that BCBT delivered via video telehealth is effective for reducing suicide attempts among adults with recent suicidal thoughts and/or behaviors.Trial RegistrationClinicalTrials.gov Identifier: NCT04844294

Abstract 4120830: A Curious Case of Clozapine Carditis with Cardiac Convalescence

Case Presentation: Clozapine is an antipsychotic used in treatment-resistant schizophrenia. Its use has been limited by adverse events, rarely including myocarditis. Here, we describe a rare case of clozapine-induced myocarditis and the improvement of cardiac function with avoidance of clozapine for one week and initiation of guideline-directed medical therapy (GDMT). A 29-year-old man with schizophrenia on risperidone and paroxetine was admitted with schizophrenia decompensation and suicidal ideations. He was transitioned to clozapine with improvement in his psychiatric symptoms. Thirteen days after starting clozapine, he developed nausea, vomiting, tachycardia, and low-grade fever. He had leukocytosis but it was thought to be, in part, secondary to methylprednisolone before rituximab infusions for his multiple sclerosis. An electrocardiogram revealed sinus tachycardia, and troponin, which was taken in the setting of clozapine therapy, was 6. Four days later, his fever and tachycardia with chills and dyspnea persisted; troponin was in the forties and increased to 235 within a few hours. Over the next 36 hours, troponin peaked at 3,600. C-reactive protein and erythrocyte sedimentation rates were elevated at 20.5 and 51, compared to 1.8 and 3 respectively upon initiation of symptoms a few days earlier. A respiratory viral panel, blood and urine cultures, human immunodeficiency virus, and an autoimmune workup were unrevealing. Clozapine was held. A transthoracic echocardiogram revealed a reduced systolic function with a left ventricular ejection fraction (LVEF) of 40%. A cardiac magnetic resonance imaging revealed acute myocarditis with LVEF 24%. He was started on GDMT and a repeat echocardiogram six days later revealed normalization of systolic function with LVEF 56% with clinical improvement. His last dose of clozapine was seven days earlier. He was discharged on GDMT and clozapine was added to his allergy list. Discussion: Myocarditis is a serious and rare adverse event to clozapine therapy. Symptoms are non-specific and delays in diagnosis may lead to myocardial damage and fatal arrhythmias. In light of the patient’s presentation, unrevealing workup, and improvement with avoidance of clozapine, we believe that the individual had clozapine-induced myocarditis. It is important to highlight the occurrence of this rare outcome to consider this toxicity and initiate treatment in time.

BIPOLAR DISORDER EPISODES IN THE PROTAGONIST OF JENNIFER NIVEN’S ALL THE BRIGHT PLACES

This study investigates the depiction of bipolar disorder in Jennifer Niven’s All the Bright Places, focusing on its impact on the protagonist, Theodore Finch. Using a psychological framework, the research draws on Lesmana’s theory of bipolar disorder to analyze the manic and depressive episodes Finch experiences throughout the novel. The narrative vividly portrays Finch’s drastic mood swings, alternating between periods of elevated euphoria and profound depression. This analysis examines how these emotional extremes shape Finch's interactions with others, influence his relationships, and contribute to his suicidal thoughts. Through a deep dive into Finch’s character, the study emphasizes the challenges of living with bipolar disorder, illustrating how the disorder affects both personal identity and social dynamics. The findings reveal that Finch's experiences align with the characteristic patterns of manic and depressive episodes, as outlined in Lesmana’s theory. Ultimately, the research highlights the importance of addressing mental health issues in literature, enriching the conversation on psychological themes and fostering greater empathy for those affected by such conditions.

Prevalence of major depression, suicidal ideation, and mental health treatment among cancer survivors

Abstract Objectives Cancer diagnosis and treatment can result in a significant psychological burden. This study sought to investigate the prevalence of major depression, associated treatments, and suicidal ideation in cancer survivors compared to a non-cancer cohort. Methods This is a retrospective, population-based study using survey responses from the National Survey on Drug Use and Health collected from January 2015 to December 2019. Survey data sets were queried for all respondents who provided a cancer history. Respondents with a reported history of cancer (“cancer survivors”) were further stratified by whether they reported a “recent” cancer diagnosis within the past 12 months. Survey responses were evaluated for recent diagnoses of and treatments for major depressive disorder and suicidal ideation. Results Among the 212,411 survey respondents identified, 7,635 (3.6%) reported a cancer history, with 1,486 (0.7%) reporting a recent cancer history. There were no differences in prevalence of major depression between cancer survivors and participants without cancer (9.3% vs 9.2%, p = 0.762), though the prevalence was slightly higher among recent cancer survivors (10.0% vs 9.2%, p = 0.259). Among respondents diagnosed with major depression, cancer survivors were significantly more likely to receive treatment for depression (78.6% vs 60.3%, p < 0.001). Suicidal ideation was significantly lower among cancer survivors (5.1% vs 6.2%, p < 0.001) including recent survivors (5.0% vs 6.2%, p < 0.001). Significance of results There was no overall difference in the prevalence of major depression between cancer survivors and respondents without cancer. Survivors with major depression were more likely to receive treatments. Prevalence of major depression was higher in recent cancer survivors.

Evaluation of pitolisant, sodium oxybate, solriamfetol, and modafinil for the management of narcolepsy: a retrospective analysis of the FAERS database

ObjectiveNarcolepsy, a rare neurological disorder believed to have an autoimmune etiology, necessitates lifelong management. This study aimed to provide evidence supporting the safety of pharmacological treatment for narcolepsy.MethodsFive-year data on pitolisant, sodium oxybate, solriamfetol, and modafinil were extracted from the FDA Adverse Event Reporting System (FAERS) self-reporting database for the period spanning from 2019 to 2023. Various statistical methods, including the reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian confidence propagation neural network analysis (BCPNN), and multi-item gamma Poisson shrinker (MGPS), were employed to quantify the signals. Finally, a comparative analysis was conducted between demographic data, outcomes, and inherent associations among the medications and the signals.ResultsAfter data analysis, we obtained 50 signals (a cumulative count of 762 cases) for pitolisant, 640 signals (corresponding to 46,962 cases) for sodium oxybate, 40 signals (equivalent to 1,228 cases) for solriamfetol, and finally, 72 signals (representing 632 cases) for modafinil. The majority of these patients were female. Psychiatric and nervous system disorders were identified as the predominant adverse drug events (ADEs). For sodium oxybate, it is crucial to consider psychiatric disorders (such as suicidal ideation), respiratory disorders (including sleep apnea syndrome and respiratory depression), and signs of pregnancy and congenital familial diseases. For solriamfetol, noteworthy new ADEs include drug inefficacy, suicidal ideation, restless legs syndrome, and somnambulism. Furthermore, a relationship has been observed between modafinil use and restricted fetal growth, spontaneous abortion, cognitive disorders, and drug inefficacy and abuse.ConclusionThe majority of observed adverse reactions in this study were consistent with those listed in the product instructions. However, potential novel or notable ADE signals were identified through real-world pharmacovigilance analysis. It is anticipated that this paper will offer additional information regarding safe and rational medication for narcolepsy.

Long Term Outcomes in Patients With Differences in Sex Development in Lucknow, India

ABSTRACTContextThe long term outcomes for individuals with a difference in sex development (DSD) are influenced by ethnic, socio‐cultural and economic factors, besides the medical issues. Data from India on these aspects are sparse.Design and MeasurementsWe report on gender identity, patients' opinion regarding timing of genitalia surgery, suicidal thoughts, romantic inclination, and quality of life (QOL, SF36 scale), in 31 young adults with a DSD.ResultsMedian (IQR) age was 23 (19–27) years; 16 raised male, 15 female. Age at first surgery was 6.0 (2.0–16.25) years. Gender identity in 30 patients remained identical with sex of rearing. Majority (27) thought the timing of genital surgery should be in childhood. Six of 31 patients had attempted suicide at least once. Four patients reported sexual abuse in the past. Twelve patients reported romantic relationships, rates similar to reports from India, with seven reporting sexual intercourse. Eleven of 31 patients reported aversion to and fear of sexual activity, due to fear of rejection. Heterosexual orientation was reported by 25 of 29 patients. QOL scores were not different between patients and 46 healthy controls or 43 people with type 1 diabetes. Mental QOL scores were lower for those with history of teasing (37.10 ± 16.01 vs. 47.76 ± 9.4 in those without, p = 0.04) and with suicidal thoughts (33.9 ± 14.51 vs. 45.65 ± 13.2 for those without, p = 0.04).ConclusionsThe absence of prominent gender dysphoria in our young adults was noteworthy, as was their preference for early genital surgery. Lack of adequate mental health support is a high alert for our teams involved in the care of DSD and as well as for policy‐makers.

Correlations between problematic internet use and suicidal behavior among Chinese adolescents: a systematic review and meta-analysis

BackgroundProblematic Internet Use (PIU) has been increasingly linked to suicidal behavior among adolescents, raising significant public health concerns, particularly in Chinese youth. This study aimed to systematically review and meta-analyze the correlation between PIU and suicidal behavior in Chinese adolescents to provide a clearer understanding of this association.MethodsA comprehensive search was conducted across seven databases up to July 1, 2024. Studies investigating the relationship between PIU and suicidal behavior among Chinese adolescents were included. A random-effects meta-analysis was employed to assess pooled effect sizes, with subgroup analyses conducted to explore potential moderators, such as geographic region, age, gender, assessment tools for PIU and suicidal ideation, and the presence of depression. Data analysis was performed using STATA software (version 16).ResultsThis meta-analysis, comprising 23 studies with 353,904 participants, identified significant associations between PIU and suicidal behavior among Chinese adolescents. PIU was associated with increased risks of suicidal ideation (OR = 1.72, 95% CI: 1.45, 2.03), suicidal plans (OR = 1.50, 95% CI: 1.02, 2.20), and suicidal attempts (OR = 1.48, 95% CI: 1.16, 1.89). Subgroup analyses indicated higher risks in specific groups: adolescents from Central China (OR = 1.84, 95% CI: 1.46, 2.32), college students (OR = 2.09, 95% CI: 1.66, 2.62). The risk of suicidal ideation was particularly elevated when depression was not controlled (OR = 1.86, 95% CI: 1.53, 2.25). These findings underscore the need for targeted interventions in vulnerable populations.ConclusionThis meta-analysis demonstrated significant associations between PIU and suicidal behaviors among Chinese adolescents. The findings emphasize the need for targeted interventions, particularly for adolescents from Central and Western China, college students, and those with untreated depression. Focused strategies are required to mitigate the risks associated with PIU and to effectively address suicidal behaviors in these high-risk populations.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024577593, identifier CRD42024577593.

Does help-seeking mediate the relationship between the masculine norm of self-reliance and suicidal thoughts among men?

Does help-seeking mediate the relationship between the masculine norm of self-reliance and suicidal thoughts among men?

Prediction of electroconvulsive therapy outcome: A network analysis approach

AbstractObjectiveWhile electroconvulsive therapy (ECT) for the treatment of major depressive disorder is effective, individual response is variable and difficult to predict. These difficulties may in part result from heterogeneity at the symptom level. We aim to predict remission using baseline depression symptoms, taking the associations among symptoms into account, by using a network analysis approach.MethodWe combined individual patient data from two randomized controlled trials (total N = 161) and estimated a Mixed Graphical Model to estimate which baseline depression symptoms (corresponding to HRSD‐17 items) uniquely predicted remission (defined as either HRSD≤7 or MADRS<10). We included study as moderator to evaluate study heterogeneity. For symptoms directly predictive of remission we computed odds ratios.ResultsThree baseline symptoms were uniquely predictive of remission: suicidality negatively predicted remission (OR = 0.75; bootstrapped confidence interval (bCI) = 0.44–1.00) whereas retardation (OR = 1.21; bCI = 1.00–2.02) and hypochondriasis (OR = 1.31; bCI = 1.00–2.25) positively predicted remission. The estimated effects did not differ across trials as no moderation effects were found.ConclusionBy using a network analysis approach this study identified that the presence of suicidal ideation predicts an overall worse treatment outcome. Psychomotor retardation and hypochondriasis, on the other hand, seem to be associated with a better outcome.

Suicidal risk among Chinese parents of autistic children and its association with perceived discrimination, affiliate stigma and social alienation

BackgroundCaring for autistic children becomes challenging and may lead to negative psychological outcomes, even increasing the suicide risk (SR). Researchers have studied the SR among parents of autistic children in Western nations, but little is known about it in China and how it relates to perceived discrimination (PD), affiliate stigma (AS), and social alienation (SA). The current study aimed to reveal the SR prevalence rate among Chinese parents of autistic children, and clarify whether AS and SA may play mediating roles in the association between SR and PD.MethodsA total of 645 Chinese parents of autistic children were recruited to complete a series of scales to evaluate SR, SA, AS, and PD using the Suicidal Behaviors Questionnaire-Revised (SBQ-R), Perceived Discrimination Scale for Parents of Children with Autism Spectrum Disorders (PDS-FP), Affiliate Stigma Scale (ASS), and General Social Alienation Scale (GSAS), respectively. Then, the SR prevalence rate among Chinese parents of autistic children was evaluated; and the multiple mediation analysis and structural equation modeling with the bootstrap method were conducted to test the mediating effects of AS and SA in the association between SR and PD.Results34.6% Chinese parents of autistic children had high SR. In particular, the incidence rate of suicide ideation, suicide plans, suicide attempts, and suicide likelihood during the previous year were 49.8%, 11.9%, 2.5%, and 13.8%, respectively. Additionally, PD was positively associated with SR (r = .40, p < .01); and AS and SA showed significant mediating effects on the association between PD and SR (p < .01).ConclusionsThe current study evaluated the SR prevalence rate among Chinese parents of autistic children, and clarified the mediating effects of AS and SA in the association between SR and PD. Findings might bring new insights and guidance for intervention of suicidality among Chinese parents of autistic children.

Applying the Concept of Epistemic Injustice as a Philosophical Window to Examine Discrimination Experiences of LGBTQIA+ Migrants With Nurses

ABSTRACTBoth stigma and discrimination, defined as a lack of knowledge of and a sense of discomfort in providing care to lesbian, gay, bisexual, transgender, queer, intersex, and + (LGBTQIA+) migrants, was found to manifest in a sample of LGBTQIA+ migrants who received nursing care in a recent study. The study concluded that nurses continue to have a limited understanding of the experiences of LGBTQIA+ migrants in the Canadian context, and that LGBTQIA+ migrants continue to have troubling 'care' experiences with nurses. Miranda Fricker has developed the concept of epistemic injustice drawing on feminist philosophy and social epistemology. Epistemic injustice refers to unfair treatment of a person by judging them as 'not a knower' in a communicative situation. For example, in a few circumstances when LGBTQIA+ migrants were admitted to psychiatric units due to suicide ideations as a direct result of identifying as a LGBTQIA+ migrants, the medical and nursing team responded with 'They are in Canada now. It is safe here!' and 'So, you are [LGBTQIA + ]! What's the big deal?' These unjust statements reflect an epistemic situation in which the hearer is negating what was heard, that is, that the speaker's intersecting identities of LGBTQIA+ and new immigrant has directly led to suicide ideation. The concept of epistemic injustice helps to frame this situation as one where the care provider is not doing justice to the needs of LGBTQIA+ migrants. This article draws on the narrative of an LGBTQIA+ migrant who is not recognised as a credible source of knowledge about their own lives and needs in the context of Canadian nursing care. Epistemic injustice helps to understand how stigma and discrimination is produced in this community by the very nursing profession who ostensibly want to help them.

Mental health and lifestyle-related behaviors in medical students in a Jordanian University, and variations by clerkship status

BackgroundThe rigors of medical education often take a toll on students' mental well-being, resulting in heightened stress, anxiety, depression, somatization, and thoughts of self-harm. This study aimed to determine the prevalence of mental health problems among Jordanian medical students (Yarmouk University), explore the links between mental state and demographic and lifestyle factors, and compare mental health profiles between pre-clinical/pre-clerkship (years 1–3) and clinical/clerkship (years 4–6) students.MethodsAn online survey was distributed to undergraduate medical students at Yarmouk University. Mental health was measured using validated tools (depression: Patient Health Questionnaire, PHQ-9; eating disorders: SCOFF; Generalized Anxiety Disorder Scale, GAD-7; Somatic Symptoms: Patient Health Questionnaire, PHQ-15; overall stress (single-item measure); ability to handle stress; stressors and coping mechanisms. Data on sociodemographic factors, academic performance, and lifestyle choices, also were collected. Bivariate and multivariable analyses evaluated the associations between academic level and mental health, accounting for sociodemographic and lifestyle factors.ResultsOf the 618 medical students who responded, 48.4% screened positive for depression, 36.7% for anxiety, and 63.6% for high level of stress. Slightly over half experienced somatic symptoms, and 28.6% exhibited signs of eating disorders. Roughly, 26% had suicidal thoughts, as measured by item 9 of the PHQ-9 scale. Low reported rates of healthy behaviors were observed (e.g. balanced diets, 5.7%; vigorous physical activity, 17.0%). Smoking prevalence was 24.6%, notably higher among clinical students. At the multivariable level, stress, insomnia, eating disorders and cigarette smoking were significantly associated with depression, anxiety and somatization. Higher physical activity scores were associated with lower depression risk. Females were significantly more likely than males to fall in more severe somatization categories.ConclusionThis study highlights the need to address the alarming rates of mental health problems among Jordanian medical students. While few significant differences were observed between pre-clinical and clinical students, the high rates of depression, anxiety, stress, and negative health practices in both groups suggest the need for interventions that begin at enrollment as well as during transitions to clinical settings. Prioritizing mental health support and promoting healthier lifestyles among medical students are vital steps toward nurturing resilient, well-rounded future medical professionals.

The Role of Thwarted Belongingness and Perceived Burdensomeness on Suicidal Ideation in College Students

College is a critical period that is vulnerable to suicide with a prevalence of suicidal ideation of around 12%. Data reports had suicidal ideation during their lifetime. Suicidal ideation is a desire, wish, or thought to commit suicide, which is the first step to suicide. Interpersonal Theory of Suicide (ITS) by Joiner said that suicidal ideation arises when two interpersonal needs are not met, like thwarted belongingness and perceived burdensomeness. This study was a quantitative research method that examine the role of TB and PB as two factors causing the emergence of suicidal ideation based on the ITS. The results showed a positive relationship between TB and PB with suicidal ideation in college students. This finding indicates that college students who feel socially disconnected and feel a burden to others tend to have higher suicidal ideation. Keywords: suicide ideation, interpersonal theory of suicide, thwarted belongingness, perceived burdensomeness

Teletherapy and Medication Management of Attention-Deficit/Hyperactivity Disorder with Co-occurring Internalizing Symptoms and Suicidality During the Pandemic.

Sam (he/him) is an 11-year-old cisgender white male with previous diagnoses of attention-deficit/hyperactivity disorder, anxiety, and major depressive disorder who was referred to an outpatient psychiatry clinic after hospitalization for suicidal ideation and agitation. Family history is significant for bipolar disorder, depression, anxiety, substance use/abuse, and suicidality. Sam started a trial of atomoxetine 10 mg po QAM in December 2019 due to increasing inattention in the backdrop of worsening anxiety. Sam received school-based counseling through his IEP, which Sam declined due to embarrassment from being pulled out of the classroom, and services were quickly discontinued. In January 2020, obsessive-compulsive symptoms emerged, specifically obsessions about cleanliness with related compulsions. He started biweekly cognitive behavioral therapy with an outpatient provider to target obsessive-compulsive disorder symptoms. Concomitantly, a developmental-behavioral pediatrician who diagnosed obsessive-compulsive disorder started Sam on fluoxetine 10 mg po QAM. Atomoxetine was also increased to 25 mg po QAM for 4 weeks and built up to 40 mg po QAM in February 2020.Depressive symptoms emerged in Spring 2020, around the time of the COVID-19 pandemic, despite ongoing treatment with fluoxetine. There was a significant increase in aggression, agitation, and compulsive cleaning, which did not respond to the addition of lorazepam 0.5 mg po daily. Owing to concerns that medication was exacerbating his presentation, his prescriber began to wean him off both atomoxetine and fluoxetine.Sam presented to the Emergency Department in the summer of 2020 due to worsening symptoms, including suicidal ideation and aggression, in the context of medication adjustment, social isolation, and academic difficulty with virtual schooling. He completed a 3-week inpatient hospitalization followed by a 2-week virtual partial hospitalization program, during which Sam struggled with attention and engagement. As part of his discharge plan, he was referred to the outpatient psychiatry department to continue outpatient therapy and medication management.During the virtual transfer appointment to outpatient therapy, his parents reported persistent concerns for ongoing attention-deficit/hyperactivity disorder, depression, anxiety, and obsessive-compulsive symptoms, along with a fear of a resurgence of suicidal thinking. Sam reported exhaustion from virtual partial hospitalization program sessions he attended earlier in the day and was eager to leave the appointment. He minimized concerns, denied suicidal ideation or intent, and reported a strong disinterest in doing "another virtual therapy." In-person sessions would be ideal for Sam, given his history of attention difficulties, clinical complexity, and acuity and his self-identified dislike for virtual settings. However, services needed to be done virtually due to the quarantine shutdown. How would you proceed with treating Sam?

Outcomes of Universal Suicide Risk Screening in Medical Inpatients

Objectives Universal screening for suicide risk has not been shown to reduce suicide rates or reliably predict suicide, but there have been few studies assessing other potential benefits of this practice. We aimed to investigate the feasibility of implementing a universal inpatient suicide risk screening protocol and determine if a positive suicide screen was predictive of the need for psychiatric admission, and if it reduced the length of stay prior to psychiatric admission. Methods We conducted a retrospective chart review of non-psychiatric admissions over 1 year at a tertiary care academic hospital. We calculated the proportion of patients screening positive for suicidal ideation (SI), and among those screening positive, the proportion receiving a psychiatric consult and being admitted to psychiatry. Length of stay among groups was determined. We performed chi square analysis and adjusted multivariate logistic regression comparing different demographics. Results 97.2% of patients were screened, with 2.6% screening positive. Of these patients, 44.6% received a psychiatric consultation and 9.2% were admitted to psychiatry. Psychiatric admissions who screened positive for SI averaged 5.7 days until transfer to psychiatry, compared to 17.9 days for those who screened negative. Suicide risk screening had a sensitivity of 62.0%, specificity of 97.6%, positive predictive value of 9.2%, and a negative predictive value of 99.8% for psychiatric admission. Conclusions Universal suicide risk screening is feasible and may help identify patients requiring psychiatric care sooner, reducing length of stay of those requiring psychiatric admission.