Suicide In Young People Research Articles

Evaluation of a youth-focused suicide prevention HOPE aftercare service: protocol for a non-randomized hybrid effectiveness-implementation type I design

Abstract Background Suicide is the fourth leading cause of death among young people aged 15–29 worldwide. Young people often present to emergency departments (EDs) with self-harm and suicide-related behaviors. The period following discharge from the ED is recognized as one of elevated risk for both repeated self-harm and suicide. During this critical time, suicide prevention aftercare services are recommended. Despite their increased popularity, evidence demonstrating the effectiveness of these models is very limited. Methods Using a hybrid effectiveness-implementation type I design, this evaluation will assess the effectiveness and implementation of a suicide prevention aftercare (Hospital Outreach Post-suicidal Engagement; HOPE) service designed to reduce risk of self-harm and suicide in young people aged 12–25 who are referred to the service following an ED presentation for self-harm or suicide attempt. Two complementing theoretical frameworks will guide this evaluation, specifically the design, data collection, analysis, and interpretation of results. The RE-AIM evaluation framework will be used to assess Reach, Effectiveness (including cost-effectiveness), Adoption, Implementation and Maintenance of the HOPE aftercare service. The PRISM implementation framework will be used to assess multi-level contextual factors hypothesized to affect the RE-AIM outcomes. Several data sources will be used to assess the changes in primary and secondary outcomes from baseline to post–intervention, and at follow-up, including user and provider self-report surveys, semi-structured interviews, and routinely collected hospital data. An historical control study will also be conducted using data from the Self-Harm Monitoring System for Victoria to examine the impact of the service on rates of self-harm and suicide-related presentations to ED, and compare trends prior to and following commencement of the HOPE aftercare service. In addition, dynamic systems modelling will be used to assess the future scalability of the service. Discussion Findings from this evaluation will determine the effectiveness, including cost-effectiveness, of the HOPE aftercare service and describe the implementation context. They will inform the future development and sustainability of this and other similar services across Australia and internationally. Trial registration This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) on the 19th December 2023 (Registration number ACTRN12623001332617). We do not foresee any amendments to this protocol however, if any unforeseen modifications are required, they will be submitted to ANZCTR. Trial sponsor Orygen, 35 Poplar Road, Parkville, VIC, 3052, Australia.

A Narrative Review on the Impact of Teachers’ Support in the Prevention of Death by Suicide Among Young People

Background: Death by suicide among young people is a growing issue worldwide. Every year, 46000 children (10–19 years old) take their lives. Lack of social support is one of the causes of suicide in young people. This narrative review aims to highlight the impact of teachers’ support in the prevention of death by suicide among young people. Methods: A literature search was conducted in Scopus, PubMed, Embase, and Web of Science to find out the relevant studies using the keywords and synonyms of “social support,” “young,” “suicide,” and “teacher.” The original articles published in indexed and peer-reviewed English language journals in the last 10 years (2014–2023) were included in this review. The included articles were focused on teachers’ support in terms of the prevention of suicide among young people. Results: After screening the title-abstract and full-text articles, the review findings revealed that support from teachers has a positive impact on the prevention of suicide among young people. Young people who have higher teachers’ support show lower suicidal behaviors. Hence, teachers’ support acts as a protective factor against suicide in young people. Conclusion: The review concludes that teachers’ support has shown a positive impact on reducing suicidal behaviors among young people. Teachers are important sources of support in understanding suicidal behaviors in young people. Holistic support from each one of us is the enormous need to reduce the number of suicides. Studies have recommended that teachers’ support should be the focus of intervention, for example, school-based psychoeducation on young people’s suicide.

Responding to suicidal behaviour in children and young people with a child maltreatment history: A scoping review

Child maltreatment affects millions of children internationally every year. Development is negatively impacted by maltreatment increasing the likelihood of maladaptive behaviours. Associations between child maltreatment and suicidal behaviour and suicide in young people has been established. However, there is a research gap in understanding effective ways to respond to and intervene with suicidal behaviour in young people who have experienced child maltreatment. A scoping review was conducted in accordance with the Joanna Briggs Institute methodology to investigate interventions that may be effective in preventing and reducing suicidal behaviours in young people who have experienced child maltreatment. Inclusion criteria were studies: (a) of children and young people who engage in suicidal behaviour and have experienced child maltreatment; (b) published in English during the time period 2000–2020; and (c) focused on responses and interventions to prevent or address suicidal behaviour. Across 37 studies, several intervention targets were identified through reflexive thematic analysis including cultivation of self-compassion, gratitude and future orientation, alleviation of depression, anxiety and post-traumatic stress disorder (PTSD) symptoms and psychological distress and addressing cognitive errors and negative views of the self. Screening and clear assessment of suicidal risk by health professionals and child welfare professionals was endorsed across studies. Several evidence-based treatments were proposed to support intervening with this client group, although only Emotional Intelligence Therapy (EIT) was empirically tested with this population. Utilisation of safe systems that the child or young person is in may be beneficial in addressing and reducing suicidal behaviour, such as inclusion of families, peers and the implementation of school-based interventions strategies. Future research is needed to empirically test and assess the effectiveness of interventions.

Developmental Assets and Their Relationship to Suicidal Behavior in Mexican Young Adults.

Suicide in young people is a public health problem. Typically, protective factors for suicide are not studied; research tends to focus on measuring risk factors. However, knowing the risk factors does not mean that we also know the opposing factors that influence a group's health problems. For this reason, we examined the relationship between developmental assets in Mexican youth aged 18 to 25 years who are not at risk for suicide, exhibit self-injurious behavior, and whose last suicide attempt had low or high lethality. A cross-sectional study of 478 young people (73% female and 27% male) from Mexico City was conducted using an online survey and correlations were tested with dummy variables (groups) and multinomial logistic regression. The no-risk group showed associations with all developmental assets, the self-injurious group had an association with the house rules variable, the low lethality group was correlated with twelve assets and the high lethality group with four assets. Four internal developmental strengths were significant in the regression model: avoidance of risk behaviors, school expectations, resistance to pressure, and expression of anger. These results suggest that PYD is a useful framework for examining suicide risk and promotes skill development in young college students.

Saving Lives: Suicide Prevention in LGBTQ Youth.

Suicide in young people is a challenge, but suicide rates in lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ) youth are alarming. The current article explores the influence of several social determinates of health, specifically mental health care access and quality and education, on suicide among LGBTQ youth. Providers must recognize the mental health challenges and disparities in LGBTQ youth and address them to improve mental health and decrease suicide rates. [Journal of Psychosocial Nursing and Mental Health Services, 62(4), 6-8.].

Abrupt Terminations In The Treatment of Suicidal and Self‐Harming Young People: The Negativel in the Therapeutic Relationship

Psychotherapy with suicidal and self‐harming young people is complex, as this population group is difficult to engage in treatment and their internal reactions may remain concealed, leading to impulsive suicide attempts or abandonment of treatment. The resulting countertransference reactions of confusion, guilt and shame are most distressing and often cause psychotherapists to avoid treating this population group. Safety concerns increase when self‐destructive patients abandon therapy, or their condition worsens despite the therapist's best efforts. The vicissitudes of the adolescent developmental process suggest that, in some cases, withholding information, rejection of the therapist's caring interventions, and abrupt termination of treatment arise from the need for separation and independence and are ego syntonic and therefore suicide protecting. In other cases, the risk for suicide may be increased because of the transference experience of hostile abandonment. A negative therapeutic reaction (NTR) is a disturbing development in the course of psychotherapy that has not been adequately explained in the treatment of suicidal young people. This article is a consideration of whether these negative reactions associated with abrupt, unplanned terminations, in the treatment of self‐destructive young people, should appropriately be thought of as an NTR or as a developmental stage in separation.

What Is Helpful and What Is Challenging for the Caregivers of Young People Receiving Interventions to Prevent Suicide? Caregivers' Perspectives-A Rapid Scoping Review.

(1) Background: Suicide is a leading cause of death among young people. Preventing suicide in young people is a priority. Caregivers play a vital role in ensuring interventions for young people experiencing suicide ideation and/or attempts are implemented, and that they are maintained over time. Despite this, little is known about what caregivers find helpful and challenging in relation to suicide prevention interventions. This rapid scoping review is the first to address this gap. (2) Methods: Searches were completed on six electronic databases using keywords relating to 'suicide prevention, 'young people', and 'caregivers'. Ten studies-using both qualitative and quantitative methods, and involving >1400 carers from the United States and Europe-were selected for inclusion. (3) Results: The review shows that caregivers value interventions that are delivered by non-judgmental clinicians, that are suitable to the particular needs of their child, that are available when needed, and that support their confidence and communication. Caregivers experience difficulties with interventions that require their attendance at specific times, and that fail to recognize and/or address their own mental health needs. (4) Conclusions: The findings can be used to inform and improve the intervention design, with the aim of improving outcomes for caregivers and young people.

Experience of online, text-based, anonymous mental health support during COVID-19 for young women previously at risk of suicide

ABSTRACT Suicide in young people (YP) is of increasing concern. Online mental health (MH) support platforms are becoming increasingly prevalent and may offer a way to support YP’s MH. However, there are challenges to safeguarding YP on these platforms, such as the inability to see or respond to behaviours that pose risk. The present study aims to explore the experience of online, anonymous, text-based services provided by Kooth, an online MH platform, to YP previously at risk of suicide during the COVID-19 pandemic. Five female YP previously at risk of suicide were interviewed through online chat-based semi-structured interviews, and data were analysed with Interpretative Phenomenological Analysis. Results discuss three superordinate themes: a safe space to share; control; and need for connection. Thematic results highlight the desire for anonymity and control of therapeutic conversations due to concerns regarding confidentiality, and the perceived consequences of seeking help. Participants were successfully able to build connections through chats with online MH support staff. However, miscommunication was an issue throughout their experience, and could exacerbate negative feelings. Themes suggest that anonymous, online services can overcome access barriers and enable YP to share and process their experiences. Implications for clinical practice are discussed.

Evaluating the acceptability of ATMAN intervention for self-harm in youth in India: A pilot study

Background There is a dearth of psychological interventions for self-harm that have been tested and found acceptable by youth in low- and middle income countries. ĀTMAN (Sanskrit word meaning “self” or “self-existent essence”) is one such contextually adapted psychological intervention developed in India. It has three key elements; problem-solving, emotion regulation, and social network strengthening skills. Objective We delivered ATMAN in a series of young people who self-harm to optimize the content, structure and delivery mechanisms, and to assess their experiences of therapy and engagement. Methods ATMAN was delivered sequentially by a psychiatrist and non-specialist counselor in 16 participants between 14 to 24 years who presented to a tertiary level public hospital in Mumbai with self-harm. Quantitative measurement tools included Beck’s Scale for Suicidal Ideation (BSI), the Patient Health Questionnaire −9 (PHQ-9), Functional Assessment of Self-Mutilation, and session feedback form. Qualitative tools included PSYCHLOPS and exit interviews. Results Eight female and four male participants completed therapy with a mean of five sessions and an average duration of 50 min. There were no differences in module wise feedback ratings of the psychiatrist and counselor. There were significant differences in the pre- and post-therapy scores on BSI (mean difference (confidence interval)) (−16.8 (−20.2, −13.3)) and PHQ-9 (−10.8 (−14.5, −7.04)). Various content modifications were undertaken during this phase. Conclusion ATMAN was acceptable to youth in India who self-harm. Modifications introduced during pilot trial phase make ATMAN better suited to the needs of the youth. ATMAN has the potential to be delivered by non- specialist counselors and to be integrated at all levels of health care settings including primary health care to reduce the burden of suicide in young people. However, an extended randomized controlled trial of ATMAN treatment with multiple counselors will help in identifying key competencies that should be developed during training and supervision, and various quality assurance measures that can be undertaken for effective implementation of ATMAN.

Self-harm and suicidal ideation among young people is more often recorded by child protection than health services in an Australian population cohort.

We investigated patterns of service contact for self-harm and suicidal ideation recorded by a range of human service agencies - including health, police and child protection - with specific focus on overlap and sequences of contacts, age of first contact and demographic and intergenerational characteristics associated with different service responses to self-harm. Participants were 91,597 adolescents for whom multi-agency linked data were available in a longitudinal study of a population cohort in New South Wales, Australia. Self-harm and suicide-related incidents from birth to 18 years of age were derived from emergency department, inpatient hospital admission, mental health ambulatory, child protection and police administrative records. Descriptive statistics and binomial logistic regression were used to examine patterns of service contacts. Child protection services recorded the largest proportion of youth with reported self-harm and suicidal ideation, in which the age of first contact for self-harm was younger relative to other incidents of self-harm recorded by other agencies. Nearly 40% of youth with a health service contact for self-harm also had contact with child protection and/or police services for self-harm. Girls were more likely to access health services for self-harm than boys, but not child protection or police services. Suicide prevention is not solely the responsibility of health services; police and child protection services also respond to a significant proportion of self-harm and suicide-related incidents. High rates of overlap among different services responding to self-harm suggest the need for cross-agency strategies to prevent suicide in young people.

Managing self-harm in young people presenting to the emergency department and challenges in navigating the national guidelines.

Suicide is the most common cause of death for young people in the UK and around 50% of completed suicides in young people have previous self-harm as a theme. Hence, robust management of young people presenting with self-harm to the emergency department is crucial. Guidelines published by the National Institute for Health and Care Excellence (NICE) and the Royal College of Psychiatrists advise an overnight admission for under-16s with self-harm, which is a challenge during winter pressures or bed shortages. In this editorial we discuss the difficulties faced when navigating NICE 2004 guidance documents with the realities of the coalface and consider the prospects for current practice and the future with the NICE 2022 guidance.

Co-occurrence of Aggression and Suicide Attempt Among Young People and Related Factors: Findings from Iranian Youth Cohort Study in Ravansar.

Aggression and suicide attempt are behaviors that affect public health. To better understand the nature of these behaviors, the present study was conducted to investigate the concurrence of suicide attempt and aggression in young people. This study sought to identify those factors which contribute to the co-occurrence of suicide attempt and aggression in young people. The present study was part of the recruitment phase of Ravansar youth cohort study (a branch of the PERSIAN Cohort) with a sample of 2991 people from Ravansar in western Iran. Registration and data collection were done between October 2014 and January 2017. Data were collected using structured interviews and standard questionnaires, and analyzed using multi-nominal logistic regression analysis. The results showed that the variables of age and education were significant correlates of concurrence of suicide attempt and aggression. Also, among the mental disorders, only major depressive disorder (MDD) (OR=8.34, P=0.001) predicted the concurrence of suicide attempt and aggression in the past 12 month. In contrast, the variables of generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), dysthymia, and substance use disorder were not significant in predicting the concurrence of attempted suicide and aggression. The occurrence of aggression and suicide in young people is a complex phenomenon, and more research should be done to better understand this phenomenon.

Exploring psychological and psychosocial correlates of non-suicidal self-injury and suicide in college students using network analysis

BackgroundNon-suicidal self-injury (NSSI) and suicide are a serious health concern in young people. Remarkable progress has been made in understanding the correlates and risk factors for suicidality. However, it remains unclear the complex interplay between different factors and which factors are most saliently associated with NSSI and suicide risk and should be targeted for interventions. MethodsThis study utilized network analysis to examine the interrelationship between NSSI, suicide and a variety of psychological (e.g., depression, psychotic-like experiences) and psychosocial (e.g., childhood maltreatment, family dysfunction, being bullied and social support) correlates in a sample of Chinese first year college students (n = 2328). ResultsThe severity of depressive symptoms was the only factor connected to both NSSI and suicide. Other psychiatric factors like psychotic experiences could only act in an indirect way via the bridging effect of depression. Emotional abuse, compared with other forms of childhood adversities, was found to be the most influential maltreatment form associated with suicidal ideation and attempts. Finally, social support showed the potential to lower the risk of self-injury and suicide in young people. LimitationsOnly a subset of risk and resilience factors of NSSI and suicide were included. Causal inference was impossible due to the cross-sectional design. ConclusionsOur findings highlighted the importance of identifying risk groups with mental illnesses or negative childhood events, and providing additional support during the key time of transitioning into higher education.

Epidemiological Characteristics, Spectrum of Upper Gastrointestinal Tract Injuries and Burden of Corrosive Intake Patients in A Tertiary Care Hospital in Islamabad

Objective: To investigate the epidemiology and spectrum of upper gastrointestinal (UGI) tract injuries, as well as to assess the burden of Corrosive intake patients who presented to an Islamabad tertiary care hospital.Study Design: Descriptive cross-sectional.Place and Duration of Study: The study was carried out at the Department of Gastroenterology of Pakistan Institute of Medical Sciences, Islamabad, Pakistan from January 2021 to December 2021.Materials and Methods: A retrospective descriptive study was carried out at the department of Gastroenterology using patient records. After taking a thorough history, patients were admitted in the hospital, which was followed by a physical examination, necessary investigations, and an initial emergency management. The study did not include any follow-up cases. Corrosive ingestion induced tissue damage was assessed via endoscopy using Zargar’s classification. The data was analyzed using SPSS version 26.Results: The total number of patients who were brought to emergency department with corrosive ingestion during one year were 74. There were 45 females (60.81%) and 29 male patients (39.19%). Age ranged from 13 to 60 years (mean 27.01 ± 18.91) with highest incidence in the age group of 21-30 years which was 44.59 % followed by 11-20 age Group (28.28 %). 41 patients were unmarried (55.41%), whereas 33 were married (44.59 %). Corrosive ingestion was most common in illiterate patients (44.59 %). 46 patients (62.16%) confessed that they ingested corrosive substance intentionally while 28 (37.84 %) claimed it happened due to accidental ingestion. Washroom cleaner was found to be the most commonly used corrosive Agent (90.54%). The most common sites that sustained corrosive injuries were the oropharynx and oesophagus, while the duodenum was found to be the least affected with normal endoscopic examination in the majority of the patients (51.35 %).Conclusion: In developing countries, corrosive ingestion is a major public health concern, with a high proportion of suicidal ingestions. It is particularly common in suicidal young people with easy access to washroom cleaners. The seriousness of this problem emphasises the importance of pursuing multidisciplinary solutions. In addition, strict action and stringent legislation by governing bodies are required in developing countries to limit adults' unrestricted access to hazardous corrosive elements.

Saving and Empowering young lives in PAKistan (SEPAK): An Exploratory Cluster Randomized Controlled Trial (cRCT)

IntroductionSuicide is a leading cause of death among young people and most deaths by suicide occur in low and middle-income countries. School is the best place where we can identify and respond to youth suicide risk. School-based interventions for suicide prevention in young people have been successful across US, Europe and Australia, but require adaptations to be acceptable and feasible in Pakistan.ObjectivesTo develop and test culturally adapted preventative interventions for suicidal behaviours among pupils in secondary schools in Pakistan. The qualitative component aimed at exploring the views of students, parents, teachers and general practitioners on cultural adaptation, experience of participation, areas of improvement and suggestions for scale-up of the school-based suicide prevention program (SEPAK).MethodsA clustered randomised controlled trial. The four culturally modified interventions 1) Linking Education and Awareness of Depression and Suicide Awareness (LEADS) Training for pupils (students=260) 2) the Question, Persuade, and Refer (QPR) for teachers (students=203) 3) QPR for parents (students=445); 4) Screening by Professionals (Profscreen) (students=260) were compared against control intervention (educational posters) (students=227). Structured questionnaires were administered at baseline and 1-month post-intervention to assess suicidal behaviours, psychological well-being and quality of life. A total of 8 focus groups (FGs) were conducted at pre and post intervention stage with each stakeholders.ResultsPatient and public involvement and Engagement (PPIE) was strongly embedded in the project to ensure meaningful benefits for participants. A total of 40 schools were recruited from 8 cities across Pakistan. A total of 243 students attended LEADS intervention, 92 teachers and 304 parents completed QPR training, and 9 general practitioners were trained in ProfScreen. The retention rate at follow-up was 99% that shows feasibility of delivering intervention package in Pakistan. All participants marked SEPAK as effective in identifying risk of and preventing self-harm and suicide in young people and in improving pathways to treatment. Interventions were perceived as helpful in improving knowledge about mental health, impact of mental health difficulties on functioning, reducing stigma, equipping stakeholders to identify and signpost at-risk people. Improvement in clinical and teaching practice as well as understanding others behaviors were also reported.ConclusionsThis study suggest feasibility of integrating a suicide prevention program in existing educational system and highlights positive role of creating awareness about suicide in youth, introduction of school-based mental health programs, parental counseling and strengthening of the health system by training general practitioners in early identification of suicide risk and promoting suicide prevention strategiesDisclosure of InterestNone Declared

Quelle est la part du tabagisme dans l’augmentation du risque suicidaire chez les jeunes fumeurs ? Revue systématique

The correlation between smoking and suicide is well documented in the general population: there is an increased risk of suicide among tobacco smokers. However, the association between smoking and suicidal behaviors (ideations, plans, attempts) in youth is poorly elucidated. This is a systematic review of the literature examined data on the relationship between active and passive smoking and suicidal ideation (SI), suicide planning (SP), and suicide attempts (SA) among youth in the general population. Medline searches were performed for the period 1980-2020. Cross-sectional, case-control, prospective population-based studies of young people (age less than 18years) were included in this review; studies of specific populations (patients with an identified pathology of any kind) were excluded. This review included 43studies: 23studies on the association between active smoking and SI, SI and/or PS, TS; three studies on the association between passive smoking and suicidal behavior, three studies on the association between smoking and suicidal behavior in young people in psychiatric hospital settings, and five studies comparing the suicidal behavior of girls and boys. Analysis of the data collected lead to the conclusion that active or passive smoking is associated with suicidal behavior in young people. Smoking appears to contribute to psychopathological disorders, including depression, the use of other psychoactive substances, or psychosocial suffering which are often associated with an increased risk of suicide in young people. The correlations between smoking and the presence of mental disorders have been highlighted; tobacco use may contribute to the development of depression, anxiety and stress. Further studies are needed to verify the existence of a causal link between smoking and suicide. Smoking is associated with the risk of suicidal behavior in young people; it should be included among the criteria for assessing suicidal risk in youth. Smoking cessation, which improves psychological well-being, should be further integrated into the prevention of suicidal behavior.

Online harms? Suicide-related online experience: a UK-wide case series study of young people who die by suicide.

Few studies have examined online experience by young people who die by suicide. A 3-year UK-wide consecutive case series of all young people aged 10-19 who died by suicide, based on national mortality data. We extracted information on the antecedents of suicide of 544 of these 595 deaths (91%) from official investigations, mainly inquests. Suicide-related online experience was reported in 24% (n = 128/544) of suicide deaths in young people between 2014 and 2016, equivalent to 43 deaths per year, and was more common in girls than boys (OR 1.87, 95% CI 1.23-2.85, p = 0.003) and those identifying as LGBT (OR 2.35, 95% CI 1.10-5.05, p = 0.028). Searching for information about method was most common (n = 68, 13%), followed by posting suicidal ideas online (n = 57, 10%). Self-harm, bereavement (especially by suicide), social isolation, and mental and physical ill-health were more likely in those known to have suicide-related online experience compared to those who did not. 29 (5%) were bullied online, more often girls (OR 2.84, 1.34-6.04, p = 0.007). Online bullying often accompanied face-to-face bullying (n = 16/29, 67%). Suicide-related online experience is a common, but likely underestimated, antecedent to suicide in young people. Although its causal role is unclear, it may influence suicidality in this population. Mental health professionals should be aware that suicide-related online experience - not limited to social media - is a potential risk for young patients, and may be linked to experiences offline. For public health, wider action is required on internet regulation and support for children and their families.

Predictive Model of Suicide Risk in Young People: The Mediating Role of Alcohol Consumption

Suicidal behavior is one of the public health problems that cause most deaths in young people and has been associated with emotional and affective problems, so predictive models are required to account for the relationship between depression, anxiety, hopelessness, and alcohol consumption to propose actions for its prevention. The Plutchik Suicide Risk Scale, the CAGE Questionnaire, the Hopelessness Scale, the Depression Inventory and the Beck Anxiety Scale were applied. A total of 1.379 young people (M = 20.45; SD = 3.23) from the cities of Manizales (n = 739; 53.6%) and Medellín (n = 640; 46.5%) in Colombia were evaluated. The variables of anxiety, hopelessness and depression explained 51% (R 2 = 0.509; 95% CI = 0.467–0.552; p = 0.001) of the variation in suicidal risk. Likewise, alcohol consumption is a mediating variable between depression and anxiety in the prediction of suicidal risk, whose total, direct and indirect effects are statistically significant. The findings support the role of alcohol consumption as a mediating variable between anxiety, depression, hopelessness and suicidal risk in young people, given the difficulties it causes in information processing, regulation of emotions and therefore in having an adequate coping with the demands of the environment. This justifies the importance of directing suicide prevention actions through strategies for the reduction of alcohol consumption and the management of emotions in young people. HIGHLIGHTS Alcohol modulates the effect of depression and anxiety on suicide risk This is a study on the risk of suicide in young people in Colombia The findings have implications for timely clinical interventions.

Web-based support services to help prevent suicide in young people and students: A mixed-methods, user-informed review of characteristics and effective elements.

The online world may provide an alternative means to engage young people and students with suicidal feelings, who are typically reluctant to seek help. We aimed to map, characterise and obtain user evaluation of current online suicide support for this group in order to assess the usefulness of current provision and how it may be improved. We conducted a mixed-methods study, comprised of an internet search, content analysis of site features and qualitative interviews with site users: 9 young people and 4 general practitioners. Data collection took place in 2019 and 2020 in the UK. Young people participants were recruited through the well-being networks of a large University in South-West England and via a national young person's mental health app. General practitioners were recruited locally through professional networks. We identified a wide range of easily accessible online support, including examples of interactive services, such as live chat and text messaging, but a lack of support that is both suicide-specific and young adult-specific, and an absence of online suicide or mental health crisis support services tailored specifically for students. Qualitative data showed that clarity, brevity and immediacy are the most important facets of engaging crisis help for young people, and that young people may prefer to use text-based rather than verbal forms of communication when seeking help. Few services provided access to active peer support, outside of lived-experience stories, which were evaluated as both valuable and potentially harmful. There is a need to further develop tailored suicide specific online crisis support for young people and students, which is able to 'speak to' their age-specific needs and preferences. While lived experience may provide a valuable means of supporting young audiences, caution is required since this may have unintended negative consequences and further research is needed to understand the safe framing of such material.

Diminished frontal pole size and functional connectivity in young adults with high suicidality

BackgroundSuicide rates among young people have been increasing in recent years, yet no validated methods are available for identifying those who are at greatest risk for suicide. Abnormalities in the medial prefrontal cortex have been previously observed in suicidal individuals, but confounding factors such as treatment and chronic illness may have contributed to these findings. Thus, in this study we tested whether the size of the medial prefrontal cortex is altered in suicidal young adults who have received no treatment with psychotropic medications. MethodsSuicidality was evaluated using the Suicide Behaviors Questionnaire-Revised (SBQ-R) and surface areas of four regions-of-interest (ROIs) within the medial prefrontal cortex were measured using magnetic resonance imaging (MRI) in a cohort of college students (n = 102). In addition, a secondary seed-based functional connectivity analysis was conducted using resting-state functional MRI data. Areas and functional connectivity of the medial prefrontal cortex of young adults with high suicidality (HS; SBQ-R score > 7; n = 20) were compared to those with low suicidality (LS; SBQ-R score = 3, n = 37). ResultsCompared to the LS group, the HS group had a significantly lower surface area of the right frontal pole (p < 0.05, Bonferroni-corrected) and significantly lower functional connectivity of the right frontal pole with the bilateral inferior frontal cortex (p < 0.001, Monte-Carlo corrected). LimitationThese findings require replication in a larger sample and extension in younger (adolescent) populations. ConclusionDiminished frontal pole surface area and functional connectivity may be linked to elevated levels of suicidality in young people.