Suicide Research Research Articles

Can a zero-shot learning Large Language Model code complex interview data?

Abstract Background Psychological autopsy is essential to establish theories, explore trends and identify previously unexplored psychosocial risk factors in suicide research. However, qualitative research has been scrutinized for being prone to interpretation bias, problems with accuracy, challenges to reproducibility, and is very time- and cost intensive. The current study aimed to investigate if a Large Language Model can achieve sufficient agreement with a researcher in the deductive coding of interview data obtained in a psychological autopsy study of suicide, to be integrated with qualitative research procedures. Methods Data from 38 interviews was deductively coded by a researcher and a LLAMA 3 based language model. The model performance was evaluated in four increasingly difficult coding tasks, including binary classification and data summarization. Intercoder agreement scores were calculated using Cohen’s Kappa. Results The preliminary results showed that the LLM achieved substantial agreement with the human coders for the binary classification task (.78). The variability in performance was influenced by code definitions. The results of the quality of LLM interpretation and summarization will also be presented. Conclusions State-of-the-art LLM can be easily integrated into the qualitative analyses of psychological autopsy interviews and may improve real time monitoring of suicides. We recommend a human-AI collaborative model, whereby deductive coding by the LLM is complemented by human inductive coding and further interpretation. Key messages • Integrating an LLM with qualitative research procedures is feasible in a collaborative model. • Integrating an LLM with qualitative research procedures allows near real-time monitoring based on qualitative data, which extends to other public health fields.

Smartphone Screen Time Characteristics in People With Suicidal Thoughts: Retrospective Observational Data Analysis Study.

Smartphone-based monitoring in natural settings provides opportunities to monitor mental health behaviors, including suicidal thoughts and behaviors. To date, most suicidal thoughts and behaviors research using smartphones has primarily relied on collecting so-called "active" data, requiring participants to engage by completing surveys. Data collected passively from smartphone sensors and logs may offer an objectively measured representation of an individual's behavior, including smartphone screen time. This study aims to present methods for identifying screen-on bouts and deriving screen time characteristics from passively collected smartphone state logs and to estimate daily smartphone screen time in people with suicidal thinking, providing a more reliable alternative to traditional self-report. Participants (N=126; median age 22, IQR 16-33 years) installed the Beiwe app (Harvard University) on their smartphones, which passively collected phone state logs for up to 6 months after discharge from an inpatient psychiatric unit (adolescents) or emergency department visit (adults). We derived daily screen time measures from these logs, including screen-on time, screen-on bout duration, screen-off bout duration, and screen-on bout count. We estimated the mean of these measures across age subgroups (adults and adolescents), phone operating systems (Android and iOS), and monitoring stages after the discharge (first 4 weeks vs subsequent weeks). We evaluated the sensitivity of daily screen time measures to changes in the parameters of the screen-on bout identification method. Additionally, we estimated the impact of a daylight time change on minute-level screen time using function-on-scalar generalized linear mixed-effects regression. The median monitoring period was 169 (IQR 42-169) days. For adolescents and adults, mean daily screen-on time was 254.6 (95% CI 231.4-277.7) and 271.0 (95% CI 252.2-289.8) minutes, mean daily screen-on bout duration was 4.233 (95% CI 3.565-4.902) and 4.998 (95% CI 4.455-5.541) minutes, mean daily screen-off bout duration was 25.90 (95% CI 20.09-31.71) and 26.90 (95% CI 22.18-31.66) minutes, and mean daily screen-on bout count (natural logarithm transformed) was 4.192 (95% CI 4.041-4.343) and 4.090 (95% CI 3.968-4.213), respectively; there were no significant differences between smartphone operating systems (all P values were >.05). The daily measures were not significantly different for the first 4 weeks compared to the fifth week onward (all P values were >.05), except average screen-on bout in adults (P value = .018). Our sensitivity analysis indicated that in the screen-on bout identification method, the cap on an individual screen-on bout duration has a substantial effect on the resulting daily screen time measures. We observed time windows with a statistically significant effect of daylight time change on screen-on time (based on 95% joint confidence intervals bands), plausibly attributable to sleep time adjustments related to clock changes. Passively collected phone logs offer an alternative to self-report measures for studying smartphone screen time characteristics in people with suicidal thinking. Our work demonstrates the feasibility of this approach, opening doors for further research on the associations between daily screen time, mental health, and other factors.

Ambulatory assessment of suicidal ambivalence: The temporal variability of the wish to live and the wish to die and their relevance in the concurrent and prospective prediction of suicidal desire.

Suicidal ambivalence is increasingly understood as the result of the interplay of two conflicting motivational orientations, the wish to die (WTD) and wish to live (WTL). However, research is scarce regarding the nature of their relationship, their temporal structure, and their relevance in predicting suicidal desire. Fifty psychosomatic/psychiatric inpatients (17 reporting suicide attempts) took part in an intensive longitudinal design with 10 signal-contingent prompts per day over 10 days; assessing WTD, WTL, and suicidal desire. We calculated mean values and variability of WTD, WTL, suicidal ambivalence, and suicidal desire and tested mixed-effects models of suicidal desire. The mean number of answered prompts was 40.98 (SD = 21.68). Repeated-measures correlation of WTD and WTL was r = -0.60. Patients with a history of suicide attempts reported higher WTD, lower WTL, more suicidal ambivalence, stronger suicidal desire, and showed higher variability in all constructs. At the same assessment, WTD was the strongest statistical predictor of suicidal desire. Only WTL and the interaction of WTD and WTL predicted suicidal desire prospectively. Wish to die and WTL are likely two distinct (although correlated) constructs that should not be reduced to a single ambivalence score. A stronger focus on WTL holds potential for suicide research and practice.

Examining missingness at the momentary level in clinical research using ecological momentary assessment: Implications for suicide research.

The use of intensive time sampling methods, such as ecological momentary assessment (EMA), has increased in clinical, and specifically suicide, research during the past decade. While EMA can capture dynamic intraindividual processes, repeated assessments increase participant burden, potentially resulting in low compliance. This study aimed to shed light on study-level and psychological variables, including suicidal ideation (SI), that may predict momentary prompt (i.e., prompt-to-prompt) completion. We combined data from three EMA studies examining mental health difficulties (N = 103; 10,656 prompts; 7144 completed), using multilevel models and machine learning to determine how well we can predict prompt-to-prompt completion and which variables are most important. The two most important variables in prompt-to-prompt completion were hours since the last prompt and time in study. Psychological variables added little predictive validity; similarly, trait-level SI demonstrated a small effect on prompt-to-prompt completion. Our study showed how study-level characteristics can be used to explain prompt-to-prompt compliance rates in EMA research, highlighting the potential for developing adaptive assessment schedules to improve compliance.

Suicidal Behavior and Personality Group Affiliation: Approaches and Research Directions

Introduction. As it follows from a number of scientific works, not only suicide rates, but also their motives and ways of committing suicide vary widely in different countries, strata of society and strata of the population. In recent decades, research on this issue has become interdisciplinary and cross-cultural. Suicidal behavior is increasingly considered in the context of the suicidal person’s belonging to a certain social group or cultural community. Objective. To analyze the impact of an individual’s membership in a large social group or cultural community on suicidal behavior. The main directions of suicidal behavior research. In the vast array of theoretical and research works the following directions of suicidal behavior study can be distinguished: existential, clinical, socio-demographic, socio-cultural and socio-psychological. Starting from E. Durkheim’s sociological etude “Suicide”, the group affiliation of an individual is considered as a leading factor of suicidal behavior. However, the sociological approach appears limited because its proponents place excessive emphasis on demographic variables rather than on the psychological significance of suicide and the values of the individual prone to suicidal behavior. A. Adler’s socio-psychological conceptualization of suicide is partly responsible for overcoming these limitations. Adler’s socio-psychological concept of suicide, which takes into account not only demographic indicators, but also how suicides perceive, evaluate and experience their own group affiliation and the values of their social group. According to A. Adler, the predictors of suicide are a sense of community (belonging) and social interests of the individual. Sense of community and group belonging as a factor of suicidal behavior. Comparison of studies conducted in three countries (Russia / USSR, Japan and the USA) allows us to identify two socio-psychological factors of suicidal behavior: 1) negative attitude to one’s own group or cultural identity; 2) hypertrophy of the sense of community and belonging, leading to a decrease in the value of one’s own personality and individual life. Discussion. As modern cross-cultural studies show, suicidal behavior can be observed both at the deficit of the sense of community and group belonging and at the high level of development of this sense. This is conditioned, on the one hand, by the attitude of a suicide victim to his/her social group and cultural identity, and, on the other hand, by the historically formed attitude of society to suicide.

Exploring possibilities for a feminist ethic of collective care in suicide research

Suicide is a major public health concern responsible for around 700,000 deaths globally every year. In response, researchers worldwide seek to understand suicide and suicide prevention, primarily using quantitative methods. As such, the development of qualitative methods tailored for the complexities of working with participants, for whom the primary ethical concern occupying researchers and ethics committees alike is whether taking part in the research will increase suicidal distress and contribute to a greater risk of dying by suicide, is in its infancy. Seeking to address this gap, in this article, I draw on feminist research methods to explore the unique design considerations and challenges faced when doing interview-based, qualitative suicide research. I argue that qualitative suicide research must resist risk focussed approaches to ethics, and instead reframe our ethical decision-making to centre a feminist ethic of care, drawing on Brannelly and Barnes’ concept of “care-full” research practices. Central to this reframing is recognition of the ways in which reciprocal relationships between researchers, research participants, and research institutions are inherent to qualitative research, meaning that no single research actor can be thought of in isolation from the other, necessitating a relational approach to our feminist research ethic.

Artificial intelligence-based suicide prevention and prediction: A systematic review (2019–2023)

Suicide is a major global public health concern, and the application of artificial intelligence (AI) methods, such as natural language processing (NLP), machine learning (ML), and deep learning (DL), has shown promise in advancing suicide prediction and prevention efforts. Recent advancements in AI – particularly NLP and DL have opened up new avenues of research in suicide prediction and prevention. While several papers have reviewed specific detection techniques like NLP or DL, there has been no recent study that acts as a one-stop-shop, providing a comprehensive overview of all AI-based studies in this field. In this work, we conduct a systematic literature review to identify relevant studies published between 2019 and 2023, resulting in the inclusion of 156 studies. We provide a comprehensive overview of the current state of research conducted on AI-driven suicide prevention and prediction, focusing on different data types and AI techniques employed. We discuss the benefits and challenges of these approaches and propose future research directions to improve the practical application of AI in suicide research. AI is highly capable of improving the accuracy and efficiency of risk assessment, enabling personalized interventions, and enhancing our understanding of risk and protective factors. Multidisciplinary approaches combining diverse data sources and AI methods can help identify individuals at risk by analyzing social media content, patient histories, and data from mobile devices, enabling timely intervention. However, challenges related to data privacy, algorithmic bias, model interpretability, and real-world implementation must be addressed to realize the full potential of these technologies. Future research should focus on integrating prediction and prevention strategies, harnessing multimodal data, and expanding the scope to include diverse populations. Collaboration across disciplines and stakeholders is essential to ensure that AI-driven suicide prevention and prediction efforts are ethical, culturally sensitive, and person-centered.

Global Suicide Mortality Rates (2000-2019): Clustering, Themes, and Causes Analyzed through Machine Learning and Bibliographic Data.

Suicide research is directed at understanding social, economic, and biological causes of suicide thoughts and behaviors. (1) Background: Worldwide, certain countries have high suicide mortality rates (SMRs) compared to others. Age-standardized suicide mortality rates (SMRs) published by the World Health Organization (WHO) plus numerous bibliographic records of the Web of Science (WoS) database provide resources to understand these disparities between countries and regions. (2) Methods: Hierarchical clustering was applied to age-standardized suicide mortality rates per 100,000 population from 2000-2019. Keywords of country-specific suicide-related publications collected from WoS were analyzed by network and association rule mining. Keyword embedding was carried out using a recurrent neural network. (3) Results: Countries with similar SMR trends formed naturally distinct groups of high, medium, and low suicide mortality rates. Major themes in suicide research worldwide are depression, mental disorders, youth suicide, euthanasia, hopelessness, loneliness, unemployment, and drugs. Prominent themes differentiating countries and regions include: alcohol in post-Soviet countries; HIV/AIDS in Sub-Saharan Africa, war veterans and PTSD in the Middle East, students in East Asia, and many others. (4) Conclusion: Countries naturally group into high, medium, and low SMR categories characterized by different keyword-informed themes. The compiled dataset and presented methodology enable enrichment of analytical results by bibliographic data where observed results are difficult to interpret.

A Qualitative Assessment of Reasons for Living and Dying in the Context of Feeling Trapped Among Adults in the United Kingdom

Objective Contemporary approaches to suicide assessment and treatment incorporate reasons for living (RFL) and reasons for dying (RFD). This study qualitatively explored individuals’ self-described RFL and RFD in the context of suicidal thinking and behaviors. Method Within a community United Kingdom (UK) sample, adults (N = 331, aged 16+) responded to eight open-ended questions probing their experiences of suicide, defeat, and entrapment. Utilizing these data, which were collected from a larger online survey examining risk and protective factors for suicidal behaviors, this study explored RFL and RFD within these narratives. After the research team established an initial code book, RFL and RFD codes were subsequently analyzed through inductive and deductive thematic analyses. Results The present study identified five complimentary RFD-RFL themes: (1) Hopelessness-Hopefulness, (2) Stress of Responsibilities-Duty to Responsibilities, (3) Social Disconnection-Social Connection, (4) Death as Sin-Desire for an Afterlife, and (5) Temporary Escapes as Coping-Entrapment (i.e., a lack of escape). Three subthemes within the RFD theme Entrapment were General/Unspecified, By Feelings, and Within Self. Conclusions Identified themes reflect the existing quantitative RFL and RFD literature. The identified RFL and RFD themes are discussed with reference to their clinical applications in advancing suicide-specific assessments and interventions. We propose a dimensional framework for RFD and RFL which informs future suicidal behaviors research and practice.

Substance use patterns and mental health comorbidities in youth with a history of depression or suicidality: Findings from TX-YDSRN

BackgroundThere is a robust relationship between depression and substance use in youth, with higher levels of substance use associated with greater depressive symptomatology. However, previous research has examined individual substances, without consideration of psychiatric comorbidities. Here, we investigate patterns of substance use among depressed and/or suicidal youth within the context of psychiatric comorbidities. Methods945 youth with depression and/or suicidality from the Texas Youth Depression and Suicide Research Network (TX-YDSRN) were assessed for current use of alcohol, nicotine, cannabis, and other drugs and comorbid psychiatric diagnoses. We used latent class analysis to identify patterns of past-year substance use, then examined if demographics or psychiatric disorders predicted class membership. ResultsWe identified three patterns of substance use: non-use (63.4 %), moderate likelihood of using alcohol, nicotine and cannabis (23.8 %), and high likelihood of using all substances (12.7 %). Compared to non-users, individuals in the moderate and high likelihood classes were more likely to be older. Individuals in the high likelihood class were more likely to have a substance use disorder, ADHD, and higher suicidality scores. LimitationsWe cannot ascertain the causal or temporal ordering of substance use and psychiatric diagnoses due to the cross-sectional nature of the study. ConclusionsUsing a brief, self-report measure of substance use, we identified three classes of substance users differing in probability of past-year use, which were predicted by older age and some psychiatric comorbidities. While research on universal screening of substance use in youth remains limited, we discuss who may benefit from such screening among depressed youth.

Participation in a daily diary study about suicide ideation yields no iatrogenic effects: A mixed method analysis.

Despite evidence that participation in suicide research is not associated with worsening ideation, behaviors, or intent, the rise of intensive longitudinal methods to assess ideation and behaviors necessitates further investigation for potential iatrogenic effects. The present study assessed rates of change in suicide ideation (SI) in a 10-day daily diary study. Seventy-two adult participants with ongoing SI participated in 10 daily diary surveys and three follow-up assessments. One open-ended item was included to address participant experiences in the study. A multilevel piecewise growth model revealed steady declines in SI for participants over the 10 days. However, rates of SI increased during the follow-up assessments, indicating that participation in the daily surveys was associated with general reductions in SI. Further, qualitative analyses of experiences in the study revealed the following themes: Useful (n = 34), Heightened Awareness (n = 21), Functional (n = 6), Not Useful (n = 6), and Beneficence (n = 4). This study demonstrated that participation in suicide research, including intensive longitudinal methods such as daily diary studies, did not have iatrogenic effects on participants with SI. Qualitative results demonstrated the numerous benefits participants derived while taking part in this study.

Examining community-level protection from Alaska Native suicide: An Indigenous knowledge-informed extension of the legacy of Michael Chandler and Christopher Lalonde.

Chandler and Lalonde broadened the scope of inquiry in suicide research by providing theoretical grounding and empirical support for the role of community, culture, and history in understanding Indigenous youth suicide and reimagining its prevention. Their work pushed the field to consider the intersectional process of individual and collective meaning-making in prevention of Indigenous suicide, together with the central role culture plays in bringing coherence to this process over time. Their innovation shifted the research focus to include the shared histories, contexts, and structures of meaning that shape individual lives and behaviors. We describe here a new generation of research extending their pathbreaking line of inquiry. Recent work aims to identify complex associations between community-level structures and suicidal behavior by collaborating with Alaska Native people from rural communities to describe how community protective factors function as preventative resources in their daily lives. Community engagement and knowledge co-production created a measure of community protection from suicide. Structured interviews with rural Alaska Native community members allowed use of this measure to produce relevant, accessible, and actionable knowledge. Ongoing investigations next seek to describe their mechanisms in shaping young people's lives through a multilevel, mixed-methods community-based study linking community-level protection to protection and well-being of individual youth. These efforts to understand the multiple culture-specific and culturally mediated pathways by which communities build on their strengths, resources, and practices to support Indigenous young people's development and reduce suicide risk are inspired by and expand on Chandler and Lalonde's remarkable legacy.

Why Should Developmental Scientists Engage in Research on Adolescent Suicide? The Case for Developmentally Informed Suicidology

Adolescent suicide is a critical and prevalent issue yet is rarely studied by developmental psychologists. We assert that developmentalists’ lack of engagement has stymied progress on adolescent suicide research and practice, and we demonstrate how developmental perspectives can contribute to the next decade of research and practice in suicidology. Specifically, we (a) review theories in suicidology (that are largely a-developmental); (b) discuss how developmental phenomena may explain findings regarding the epidemiology of adolescent suicide; (c) review the evidence on the etiology of adolescent suicide, where efforts to identify risk factors have not led to strong predictions, highlighting underutilized approaches from the developmental risk and resilience literature; and (d) review strategies and developmental gaps across the suicide prevention continuum from primary prevention to postvention, recommending an adolescent developmental perspective on the development and study of school- and community-based suicide prevention and postvention. In doing so, we propose a new subfield of Developmentally Informed Suicidology.

Rural suicide in Newfoundland and Labrador: A qualitative exploration of health care providers' perspectives.

Residents of rural regions may have higher and unique suicide risks. Newfoundland and Labrador (NL) is a Canadian province replete with rural regions. Despite an abundance of rural suicide research, heterogeneity in rural regions may preclude amalgamating findings to inform prevention efforts. Thus, exploring the unique needs of NL is needed. Importantly, health care providers (HCP) may afford unique perspectives on the suicide-related needs or concerns of rural life. We asked HCPs of residents of rural NL their perceived suicide risk factors, concerns, and needs for rural NL. Twelve HCPs of rural residents of NL completed virtual semi-structured interviews. Interviews were analysed using reflexive thematic analysis [13,14]. HCPs noted individual, psychological, social, and practical factors linked to rural-suicide risk and subsequent needs. Findings highlight the unique challenges of residing and providing health care in rural NL and inform prevention and intervention efforts.

Defining Suicidal Thought and Behavior Phenotypes for Genetic Studies.

Standardized definitions of suicidality phenotypes, including suicidal ideation (SI), attempt (SA), and death (SD) are a critical step towards improving understanding and comparison of results in suicide research. The complexity of suicidality contributes to heterogeneity in phenotype definitions, impeding evaluation of clinical and genetic risk factors across studies and efforts to combine samples within consortia. Here, we present expert and data-supported recommendations for defining suicidality and control phenotypes to facilitate merging current/legacy samples with definition variability and aid future sample creation. A subgroup of clinician researchers and experts from the Suicide Workgroup of the Psychiatric Genomics Consortium (PGC) reviewed existing PGC definitions for SI, SA, SD, and control groups and generated preliminary consensus guidelines for instrument-derived and international classification of disease (ICD) data. ICD lists were validated in two independent datasets (N = 9,151 and 12,394). Recommendations are provided for evaluated instruments for SA and SI, emphasizing selection of lifetime measures phenotype-specific wording. Recommendations are also provided for defining SI and SD from ICD data. As the SA ICD definition is complex, SA code list recommendations were validated against instrument results with sensitivity (range = 15.4% to 80.6%), specificity (range = 67.6% to 97.4%), and positive predictive values (range = 0.59-0.93) reported. Best-practice guidelines are presented for the use of existing information to define SI/SA/SD in consortia research. These proposed definitions are expected to facilitate more homogeneous data aggregation for genetic and multisite studies. Future research should involve refinement, improved generalizability, and validation in diverse populations.

Examining heterogeneity in the affect-regulating function of suicidal ideation: Person-specific analyses in male inpatients with depression.

Men have an increased risk to die by suicide compared to women but are underrepresented in suicide research. To improve individual risk prediction for suicide-related thoughts and behaviors (STBs), risk factors are increasingly being studied at an individual level. The possible affect-regulatory function of suicidal ideation has hardly been investigated ideographically and has not yet been tested in a male sample. We investigated the bidirectional associations between suicidal ideation and negative and positive affect in a sample of n = 21 male inpatients with unipolar depression and a history of suicidal ideation both at the group level and at the individual level. Participants underwent an intensive ecological momentary assessment for 6 days with 10 data points per day. We found no evidence for an affect-regulatory function of suicidal ideation at the group level, neither for effects of affect on subsequent suicidal ideation (antecedent affect-regulatory hypothesis) nor for effects of suicidal ideation on subsequent affect (consequence affect-regulatory hypothesis). Person-specific analyses revealed substantial variability in strength and direction of the considered associations, especially for the associations representing the antecedent hypothesis. The demonstrated between-person heterogeneity points to the necessity to individualize the investigation of risk factors to enhance prediction and prevention of STBs.

Empirical clustering to identify individuals for whom insomnia is more closely related to suicidal ideation

BackgroundAlthough the effect sizes are modest, insomnia is consistently associated with suicidal thoughts and behaviors. Subgroup analyses can efficiently identify for whom insomnia is most relevant to suicidal ideation. To improve clinical case identification, the present study sought to identify subclusters of lifetime suicidal ideators for whom insomnia was most closely related to current suicidal ideation. MethodsData on N = 4750 lifetime suicidal ideators were extracted from the Military Suicide Research Consortium's Common Data Elements. Data on sociodemographic characteristics, severity and history of suicidal thoughts and behaviors, and related clinical characteristics were clustered by unsupervised machine learning algorithms. Robust Poisson regression estimated cluster by insomnia associations with current suicidal ideation. ResultsThree clusters were identified: a modest symptom severity cluster (N = 1757, 37.0 %), an elevated severity cluster (N = 1444 30.4 %), and a high severity cluster (N = 1549 32.6 %). In Cluster 1, insomnia was associated with current suicidal ideation (PRR 1.29 [1.13–1.46]) and remained significant after adjusting for sociodemographic and clinical covariates. In Cluster 2, insomnia was associated with current suicidal ideation (PRR 1.14 [1.01–1.30]), but not after adjusting for sociodemographic and clinical covariates. In Cluster 3, insomnia was associated with current suicidal ideation (PRR 1.12 [1.03–1.21]) and remained significant after adjusting for sociodemographic covariates, but not clinical covariates. LimitationsCross-sectional design, lack of diagnostic data, non-representative sample. ConclusionInsomnia appears more closely related to current suicidal ideation among modest severity individuals than other subgroups. Future work should use prospective designs and more comprehensive risk factor measures to confirm these findings.

Ethical Concerns of Research Ethics Committees in Suicide Research: A Qualitative Study From Pakistan

Ethical Concerns of Research Ethics Committees in Suicide Research: A Qualitative Study From Pakistan

Addressing the gender paradox: Effective suicide prevention strategies for women

The gender paradox in suicide research refers to the phenomenon that while males report higher suicide mortality, females suffer more from suicidal thoughts, leading to higher suicidal risks. This paradox may lead to the misconception that female suicides do not require as much attention. Therefore, there is an urgent need for researchers to shift their perspectives from the current male-centric approach to more inclusive knowledge for female suicidality. Following this, the current commentary emphasizes the importance of identifying and addressing the crucial but overlooked psychosocial factors underlying female suicidality. In addition, the ecological framework is employed as a guiding tool for exploring the intricate interplay of biological, psychological, societal, and cultural factors that are associated with female suicidality, thereby allowing researchers and stakeholders to develop more effective prevention and intervention strategies tailored to women's needs. Overall, this commentary calls for more refined and equitable approaches to suicide prevention that address the needs of individuals for all gender identities.

State of the Art on Suicide Studies in Morocco: Trends, Risk Factors and Implications for Prevention

Suicide remains a pressing public health concern in Morocco, yet the research landscape surrounding this issue is relatively sparse. To address this gap, we conducted a comprehensive review of 96 articles about suicide in Morocco, sourced from the Scopus database. Focusing on the period from 2014 to 2023, 68 articles were selected for detailed analysis, revealing critical insights into the multifaceted nature of suicidal behavior in the country. Through a thematic categorization of the literature, encompassing domains such as Suicidal Behavior and Mental Health, Epidemiology and Risk Factors, Psychological Disorders, Suicide Prevention, Medical Emergencies, and Methodology and Technology, our review synthesized vital findings and trends in Moroccan suicide research. Notably, the analysis illuminated concerning patterns of suicidal behavior and identified significant risk factors, including mental health disorders, psychosocial stressors, and socio-economic challenges. In light of these findings, urgent attention is warranted to develop and implement targeted prevention strategies tailored to the unique needs of the Moroccan population to mitigate the impact of suicide on individuals, families, and communities alike.