Suicide Risk Research Articles

Self-injury and suicidal behaviors in high-risk adolescents: Distal predictors, proximal correlates, and interactive effects of impulsivity and emotion dysregulation.

Suicide rates are rising among U.S. youth, yet our understanding of developmental mechanisms associated with increased suicide risk is limited. One high-risk pathway involves an interaction between heritable trait impulsivity and emotion dysregulation (ED). Together, these confer increased vulnerability to nonsuicidal self-injury (NSSI), suicide ideation (SI), and suicide attempts (SAs). Previous work, however, has been limited to homogeneous samples. We extend the Impulsivity × ED hypothesis to a more diverse sample of adolescents (N = 344, ages 12-15 at Baseline, 107 males and 237 females) who were treated for major depression and assessed four times over two years. In multilevel models, the impulsivity × ED interaction was associated with higher levels and worse trajectories of NSSI, SI, and SAs. As expected, stressful life events were also associated with poorer trajectories for all outcomes, and NSSI was associated with future and concurrent SI and SAs. These findings extend one developmental pathway of risk for self-harming and suicidal behaviors to more diverse adolescents, with potential implications for prevention.

Examining Sex-Based Delays in Utilizing Advocacy Support Services Among Australian Military Veterans: Implications for Health Care Access and Suicide Prevention

This study explores the impact of sex on delays experienced by Australian military veterans in accessing advocacy support services within the veterans’ non-profit sector. A detailed analysis of intake records from 150 injured veterans who entered the Returned and Services League of Australia’s advocacy program in 2021 reveals significant disparities between male and female veterans in seeking assistance. On average, male veterans delay accessing support by 20.4 years post-service, compared to 9.1 years for female veterans. These prolonged delays hinder veterans’ ability to secure financial and medical support from the Department of Veterans’ Affairs, limiting timely access to essential healthcare services. As a result, delays can exacerbate physical and psychological symptoms, impede recovery, and increase the risk of suicide. The findings provide valuable insights for international healthcare professionals on the influence of military culture and traditional masculine norms in shaping veterans’ help-seeking behaviors. By understanding these dynamics, healthcare practitioners can develop targeted, sex-sensitive interventions that address specific barriers faced by male and female veterans. Ensuring timely access to advocacy support is crucial for improving health outcomes and reducing suicide risk in this vulnerable population.

Trauma and imported vulnerability in prison suicides

Suicide rates in prison are much higher than in the community. Significant data supports an approach to understanding this phenomenon that sees suicide as the outcome of incarcerated people bringing their vulnerability with them into prison combined with the pain and deprivation they experience on the inside. This article uses a personality development approach to argue that part of prisoners’ imported vulnerability – which puts them at a higher risk of suicide – results from a life trajectory marked by trauma. To this end, I draw on repeat qualitative interviews with 29 prisoners in Latin America who attempted suicide while incarcerated. Based on a study of their life trajectories, I argue that pre-prison trauma plays a role in suicide in prison by shaping prisoners’ personalities to make them more susceptible to negative emotions and reduced tolerance to distress, adversely impacting their modes of approaching and responding to the world.

Can large language models be sensitive to culture suicide risk assessment?

AbstractSuicide remains a pressing global public health issue. Previous studies have shown the promise of Generative Intelligent (GenAI) Large Language Models (LLMs) in assessing suicide risk in relation to professionals. But the considerations and risk factors that the models use to assess the risk remain as a black box. This study investigates if ChatGPT-3.5 and ChatGPT-4 integrate cultural factors in assessing suicide risks (probability of suicidal ideation, potential for suicide attempt, likelihood of severe suicide attempt, and risk of mortality from a suicidal act) by vignette methodology. The vignettes examined were of individuals from Greece and South Korea, representing countries with low and high suicide rates, respectively. The contribution of this research is to examine risk assessment from an international perspective, as large language models are expected to provide culturally-tailored responses. However, there is a concern regarding cultural biases and racism, making this study crucial. In the evaluation conducted via ChatGPT-4, only the risks associated with a severe suicide attempt and potential mortality from a suicidal act were rated higher for the South Korean characters than for their Greek counterparts. Furthermore, only within the ChatGPT-4 framework was male gender identified as a significant risk factor, leading to a heightened risk evaluation across all variables. ChatGPT models exhibit significant sensitivity to cultural nuances. ChatGPT-4, in particular, offers increased sensitivity and reduced bias, highlighting the importance of gender differences in suicide risk assessment. The findings suggest that, while ChatGPT-4 demonstrates an improved ability to account for cultural and gender-related factors in suicide risk assessment, there remain areas for enhancement, particularly in ensuring comprehensive and unbiased risk evaluations across diverse populations. These results underscore the potential of GenAI models to aid culturally sensitive mental health assessments, yet they also emphasize the need for ongoing refinement to mitigate inherent biases and enhance their clinical utility.

Temporal interaction of suicidal ideations and behaviors with loneliness in persistent depressive disorder - a feasibility study using ecological momentary assessment.

Individuals with persistent depressive disorder (PDD) are at increased risk for suicidality. Suicidality may be precipitated by loneliness. However, their temporal interplay in PDD has not been studied. We conducted a feasibility study using ecological momentary assessment (EMA) to measure short-term courses of suicidality and loneliness in 20 inpatients with PDD and current suicidality. EMA adherence of 13 completers was 81.3%. Suicidal ideations and loneliness varied with one standard deviation over three to six hours. This pilot study confirmed the feasibility of EMA in PDD and provided new insights in dynamics of suicidality and loneliness informing future study designs.

Identifying momentary suicidal ideation using machine learning in patients at high-risk for suicide.

Strategies to detect the presence of suicidal ideation (SI) or characteristics of ideation that indicate marked suicide risk are critically needed to guide interventions and improve care during care transition periods. Some studies indicate that machine learning can be applied to momentary data to improve classification of SI. This study examined whether the classification accuracy of these models varies as a function of type of training data or characteristics of ideation. A total of 257 psychiatric inpatients completed a 3-week battery of ecological momentary assessment and measures of suicide risk factors. The accuracy of machine learning models in classifying the presence, duration, or intensity of ideation was compared across models trained on baseline and/or momentary suicide risk data. Relative feature importance metrics were examined to identify the risk factors that were most important for outcome classification. Models including both baseline and momentary features outperformed models with only one feature type, providing important information in both correctly classifying and differentiating individual characteristics of SI. Models classifying SI presence, duration, and intensity performed similarly. Results of this study may not generalize beyond a high-risk, psychiatric inpatient sample, and additional work is needed to examine temporal ordering of the relationships identified. Our results support using machine learning approaches for accurate identification of SI characteristics and underscore the importance of understanding the factors that differentiate and drive different characteristics of SI. Expansion of this work can support use of these models to guide intervention strategies.

Suicide Risk Screening in Children and Adolescents with Autism Spectrum Disorder Presenting to the Emergency Department: Screening for Suicide Risk in Youth with Autism

Suicide Risk Screening in Children and Adolescents with Autism Spectrum Disorder Presenting to the Emergency Department: Screening for Suicide Risk in Youth with Autism

How, Why and When: Nursing Staff's Experiences of Working With Suicide Risk Assessment Instruments.

To describe psychiatric nursing staff´s experiences of working with suicide risk assessment instruments. Around the world, approximately 720,000 people die by suicide each year, of which almost 20% have an ongoing contact with specialist psychiatry during their last month alive. To identify which patients have an increased risk of suicide is a highly important task for nursing staff. Suicidal behaviour is complex and unpredictable. Nursing staff work closely with patients in everyday psychiatric care and often possess unique patient knowledge. These professionals must therefore be able to know when a patient's eventual suicidality requires further attention and efforts. A descriptive qualitative study. Convenience sampling including nursing staff with more than 2 years of experience in specialist psychiatry. The data collection took place through semi-structured interviews and was then analysed according to conventional content analysis. The nursing staff felt that a natural conversation is superior suicide risk assessment instruments and that experience and patient knowledge are the primary factors for facilitating a suicide risk assessment. This meant that some nursing staff rarely used suicide risk assessment instruments, although they sometimes could be a useful support in the conversation and provided a sense of personal security when documenting results. Suicide risk assessment instrument can be significant and helpful in certain cases, but the essential components of a suicide risk assessment consist of a conversation to understand the meaning of suicide from the patient's perspective. Psychiatric nursing staff contributed to this study by sharing their experiences through interviews.

Assessing suicidality in adult ADHD patients: prevalence and related factors

BackgroundThe association between Attention-deficit hyperactivity disorder (ADHD) and suicidality has been subject of growing interest for research in the latest years. Suicidality was generally assessed categorically and without the use of validated instruments, leading to heterogeneous or even conflicting evidence. The prevalence of both suicidal ideation and attempts varies considerably, and the associated risk factors remain unclear. Our study investigated suicidality in ADHD using a dimensional approach and a validated and internationally recognized instrument. Our primary aim was to evaluate the prevalence of suicidal ideation (SI), severe suicidal ideation (SSI), suicidal behavior (SB) and non suicidal self-injury behavior (NSSIB) in a sample of adult patients with ADHD. The second objective was to identify sociodemographic and clinical features associated with increased risk of suicidality in these patients.MethodsThe sample included 74 adult patients with clinical diagnosis of ADHD. Suicidality was assessed by administering the Columbia-Suicide Severity Rating Scale. Logistic regressions were used to examine predictors of SI, SSI, SB and NSSIB.ResultsThe lifetime prevalence of SI and SSI were 59.5% and 16.2%, respectively. The 9.5% of patients showed lifetime SB, while NSSIB was found in 10.8% of the subjects. Lifetime SI was associated with severity of inattentive symptoms during adulthood, low self-esteem and impairment in social functioning. Lifetime SSI appeared related to severity of inattentive symptoms during childhood, attentional impulsiveness and number of hospitalizations, while physical activity appeared to be protective. The prevalence of lifetime SB and NSSIB did not appear significantly related to any socio-demographic or clinical feature.ConclusionsAdults with ADHD should be considered at risk of suicide and it is important to determine which patients are at higher risk, in order to guide preventive interventions. The association between ADHD and suicidal ideation did not appear to be influenced by psychiatric comorbidities, but rather by inattention itself, which represents the core symptom of ADHD.

Variables Associated with Abandonment, Permanence, or Clinical Discharge from a Suicide Risk Attention Program

Variables Associated with Abandonment, Permanence, or Clinical Discharge from a Suicide Risk Attention Program

Social Connection and Suicidal Thoughts and Behaviors in the Million Veteran Program Cohort

People with lower levels of social connection are at increased risk for suicidal thoughts and behaviors. This extends to populations at greater risk of death by suicide, including U.S. military veterans. Despite this well-established association, it is unclear which measures of social connection are most useful in identifying veterans who could benefit from intervention to prevent suicide. To this end, we used data from the Million Veteran Program (MVP) to investigate the measures of social connection most strongly associated with suicidal thoughts and behaviors. Our sample included 264,626 veterans who reported on three measures of social connection—marital status, household size, and perceived social support—and were assessed for suicidal thoughts and behaviors using electronic health records. Veterans who were partnered (OR = 0.78, 95% CI [0.76-0.80], p < .001), living with others (OR = 0.71, 95% CI [0.70-0.73], p < .001), or reported higher levels of social support (OR = 0.67, 95% CI [0.65-0.69], p < .001), were less likely to have suicidal thoughts and behaviors. These associations varied by veterans’ age, sex, and era of military service. When combined into a single risk score, lower levels of social connection were associated with greater likelihood of suicidal thoughts and behaviors (β = 1.42, 95% CI [1.40-1.43], p < .001). Social support, particularly positive social interactions, showed the strongest associations with suicidal thoughts and behaviors in elastic net regression models. Common measures of social connection, particularly social support, could be useful in assessing suicide risk and treatment needs for veterans.

The Interrelationship of Benefit Finding, Stigma, and Suicide Risk Among Patients with Schizophrenia and Their Caregivers: A Six-Month Follow-Up Study.

This study aimed to assess the dyadic dynamics of benefit finding, stigma, and suicide risk on the depression severity of individuals with schizophrenia and their caregivers. We prospectively recruited a total of 72 individuals with schizophrenia and 72 caregivers of individuals with schizophrenia from a medical center in Taiwan between August 2022 and July 2023. Patients with schizophrenia and their caregivers were assessed using the Taiwanese Depression Questionnaire, Benefit Finding Scale, Explanatory Model Interview Catalogue, Suicide Assessment Scale, and Mini International Neuropsychiatric Interview. The most prevalent psychiatric diagnoses in the caregivers were depressive disorders (29.2%). Using structural equation modeling, we found that patients' suicidal risk (β = 0.45, p < 0.001) may contribute to the severity of depression in individuals with schizophrenia. We also found that caregivers' BF degree (β = -0.25, p < 0.01) and suicidal risk (β = 0.64, p < 0.001) may contribute to the severity of depression in the caregivers of individuals with schizophrenia. Furthermore, we found that caregivers' suicidal risk (β = 0.28, p < 0.05) and caregivers' stigma (β = -0.31, p < 0.01) level may contribute to the severity of depression in individuals with schizophrenia. Clinicians should actively manage caregivers' stigma and provide positive reinforcement for caregivers' BF, as this may help reduce depression in both caregivers and individuals with schizophrenia. Additionally, assessing suicide risk in both groups is essential for preventing suicides among individuals with schizophrenia and caregivers alike.

Automated Real-Time Tool for Promoting Crisis Resource Use for Suicide Risk (ResourceBot): Development and Usability Study.

Real-time monitoring captures information about suicidal thoughts and behaviors (STBs) as they occur and offers great promise to learn about STBs. However, this approach also introduces questions about how to monitor and respond to real-time information about STBs. Given the increasing use of real-time monitoring, there is a need for novel, effective, and scalable tools for responding to suicide risk in real time. The goal of this study was to develop and test an automated tool (ResourceBot) that promotes the use of crisis services (eg, 988) in real time through a rule-based (ie, if-then) brief barrier reduction intervention. ResourceBot was tested in a 2-week real-time monitoring study of 74 adults with recent suicidal thoughts. ResourceBot was deployed 221 times to 36 participants. There was high engagement with ResourceBot (ie, 87% of the time ResourceBot was deployed, a participant opened the tool and submitted a response to it), but zero participants reported using crisis services after engaging with ResourceBot. The most reported reasons for not using crisis services were beliefs that the resources would not help, wanting to handle things on one's own, and the resources requiring too much time or effort. At the end of the study, participants rated ResourceBot with good usability (mean of 75.6 out of 100) and satisfaction (mean of 20.8 out of 32). This study highlights both the possibilities and challenges of developing effective real-time interventions for suicide risk and areas for refinement in future work.

Cariprazine in Bipolar Disorder and Substance Use: A Dual Approach to Treatment?

Bipolar disorder (BD) is characterized by recurrent episodes of mania, hypomania, and depression and is often complicated by comorbid substance use disorders (SUDs). Up to 60% of individuals with BD experience SUDs, which exacerbate mood instability and increase the risk of rapid cycling, suicide, and poor clinical outcomes. Current treatment strategies, including lithium and valproate, show limited efficacy in treating both BD and SUD. Psychotherapeutic approaches such as cognitive behavioral therapy (CBT) offer benefits but lack a specific focus on substances such as cannabis and cocaine. Since there is still debate on how to treat this comorbidity, there is a need to find new therapeutic options; this mini-review examines the pharmacological properties of cariprazine and its emerging role in the treatment of comorbid BD and SUD. Cariprazine, an atypical antipsychotic with partial agonism at dopamine D2 and D3 receptors, has shown promise in treating both mood symptoms and cognitive dysfunction in BD. Its unique affinity for D3 receptors, which are involved in motivation and reward processing, may offer advantages in reducing drug craving. Clinical trials indicate that cariprazine effectively treats manic, depressive, and mixed episodes in BD with a favorable side effect profile, particularly at lower doses. Preliminary results suggest its potential to reduce craving and substance use in individuals with co-occurring BD and SUD. Therefore, cariprazine, with its unique pharmacodynamic mechanism, could be further studied for the treatment of BD in comorbidity with SUD. However, evidence on the role of cariprazine in the treatment of SUDs remains limited, based primarily on case reports and animal studies. Further research, including large-scale clinical trials, is needed to determine its full efficacy in this dual diagnosis.

Postgraduate psychological stress detection from social media using BERT-Fused model.

Postgraduate students face various academic, personal, and social stressors that increase their risk of anxiety, depression, and suicide. Identifying cost-effective methods of detecting and intervening before stress turns into severe problems is crucial. However, existing stress detection methods typically rely on psychological scales or devices, which can be complex and expensive. Therefore, we propose a BERT-fused model for rapidly and automatically detecting postgraduate students' psychological stress via social media. First, we construct an improved BERT-LDA feature extraction algorithm to extract group stress features from large-scale and complex social media data. Then, we integrate the BiLSTM-CRF named entity recognition model to construct a multi-dimensional psychological stress profile and analyze the fine-grained feature representation under the fusion of multi-dimensional features. Experimental results demonstrate that the proposed model outperforms traditional models such as BiLSTM, achieving an accuracy of 92.55%, a recall of 93.47%, and an F1-score of 92.18%, with F1-scores exceeding 89% for all three types of entities. This research provides both theoretical and practical foundations for universities or institutions to conduct fine-grained perception and intervention for postgraduate students' psychological stress.

Global Overview of Suicidal Behavior and Risk Factors among General Population during the COVID-19 Pandemic: A Systematic Review and a Meta-Regression.

The COVID-19 pandemic has significantly impacted mental health worldwide, leading to increased rates of suicidal behavior. This systematic review and meta-regression aim to investigate the global prevalence and risk factors associated with suicidal behaviors in the general population during the pandemic. The study included 202 articles from January 1, 2019, to October 31, 2023, sourced from databases such as Embase, MEDLINE, CINAHL, Web of Science, and Cochrane Library. The meta-analysis revealed a prevalence of 13.5% for suicidal ideation, 10.4% for suicide attempts, and a death rate of 0.5%, translating to 4.52 per 100,000 person-years. Significant risk factors identified include being transgender, young adults (18-44years), unmarried status, low education, retirement, living alone, low social support, a history of suicide attempts, substance use, depression, anxiety, PTSD, sleep problems, poor perceived physical health, loneliness, quarantine, and residing in the Americas or multiple regions. The findings underscore the urgent need for targeted mental health interventions during pandemics, focusing on high-risk groups such as young adults, transgender individuals, those with low social support, and people with mental health issues. This comprehensive analysis provides valuable insights for policymakers and healthcare providers to develop effective strategies to mitigate the heightened risk of suicide during global health crises.

Acute Self-Harm Ideation as Presenting Adverse Event Associated with Adalimumab Treatment of Severe Scalp Psoriasis

We present a case of a 34-year-old woman with severe scalp psoriasis who developed acute self-harm ideations and major depressive symptoms shortly after initiating adalimumab treatment. The patient had a history of major depressive disorder, post-traumatic stress disorder, and anxiety, all well-controlled with multiple medications. Following the administration of adalimumab, she experienced intrusive thoughts of self-harm and exacerbation of depressive symptoms, prompting immediate discontinuation of the drug. The patient's symptoms resolved completely three weeks after discontinuation. This case highlights the potential psychiatric risks associated with adalimumab therapy for psoriasis, especially in patients with preexisting mental health conditions. Dermatologists should carefully evaluate patients for psychiatric disorders and suicide risk factors before initiating treatment and be vigilant in monitoring for adverse psychiatric events during therapy. Proper counseling and prompt identification of adverse events are crucial to prevent serious outcomes.

Single Question for Screening Suicide Risk in Patients With Cancer in Nursing Routine Work: A Retrospective Cross-Sectional Study.

To examine the efficacy of the Single Suicide Question, a tactful single-item tool, in assessing suicide risk among cancer patients. Suicide risk screening in cancer patients faces challenges such as cultural, the degree of attention given and the complexity and diversity of assessment methods. An efficient and simple suicide screening tool is needed within the nursing and treatment process. A retrospective cross-sectional study. All data utilised in this study were obtained from assessments conducted by researchers at our institution between March 2018 and August 2023. Retrospectively analysed Single Suicide Question scores from 9703 patients (March 2018-August 2023), with 229 undergoing additional using other established tools (the Patient Health Questionnaire-9, Generalised Anxiety Disorder-7, Distress Thermometer) alongside the Mini International Neuropsychiatric Interview Suicidal Subscale (MINI Suicidal Subscale). These 229 patients were divided into the cut-off determination dataset (174/229) and the validation dataset (55/229) to analyse, validate and compare the screening efficacy, consistency and optimal cut-off points of the tools relative to the MINI Suicidal subscale (golden standard). K-fold cross-validation was employed to assess the stability of the Single Suicide Question and to revalidate its screening efficacy. In cut-off determination dataset, the Single Suicide Question exhibited good screening efficacy and substantial agreement relative to the MINI Suicidal subscale, as validated in the validation dataset, outperforming other tools. The optimal cut-off points of Single Suicide Question for screening moderate or higher and high suicide risk as 2 and 3 respectively. Its stability in K-fold cross-validation further supported its screening efficacy. The Single Suicide Question shows potential as a preliminary screening tool for suicide risk. Furthermore, it has also demonstrated the potential of a simple, tactful, culturally fitting question in assessing suicide risk, providing insight for the development of relevant tools in different cultural and linguistic backgrounds. Our study demonstrates the potential of the Single Suicide Question as a screening tool for identifying suicide risk among cancer patients, which may facilitate efficient suicide screening. Furthermore, it reveals that tactful, culturally fitting, yet simple tools can achieve good screening efficacy, providing insights for the development of similar tools in different cultural and linguistic contexts. This study investigated the effectiveness of using a culturally contextualised, specific single question to screen for suicide risk in Chinese cancer patients, demonstrating high screening efficacy and stability. With further research, this method may provide a tactful, culturally informed and efficient suicide screening approach to address the critical issue of suicide risk in cancer care, and it also serves as a reference for developing similar tools in diverse cultural and linguistic contexts. The study followed the STROBE checklist guidelines for cross-sectional studies. The data provided by patients were the foundation of this study. Nurses played a central role in conducting the majority of assessments and contributing to the research design in this study.

Honor ideology and private firearm ownership in US active-duty soldiers.

This study investigated whether honor ideology, or a belief that one's reputation must be defended at all costs, is related to firearms ownership in soldiers. N=301 active-duty soldiers completed online self-report measures in this cross-sectional study. Honor ideology was higher in soldiers who privately own a firearm compared with those who do not currently own and do not plan to after military separation. Higher honor ideology was correlated with a disbelief that private firearms ownership is related to soldier suicide risk. Levels of honor ideology were equal in soldiers who own a private firearm for protection versus other reasons (eg, hunting, maintaining a collection). Honor ideology may be related to suicide risk through increased likelihood of owning a private firearm and disbelief in private firearm ownership being related to one's own suicide risk in soldiers. Honor ideology could be relevant to consider when means safety initiatives are developed for active-duty military personnel.

Integrating Diverse Data Streams for Enhanced Emotional Intelligence in Mental Health Care

This research presents a comprehensive system for real-time emotion recognition and analysis using multimodal data, including image, video, audio, and text. The system employs deep learning models to extract features and classify emotions from each modality. By integrating these predictions, we aim to provide a holistic understanding of a user's emotional state and assess potential risks. The system further analyzes the collected emotion data to identify trends, patterns, and indicators of emotional well-being and suicide risk. Visualizations such as time-series plots, distribution charts, and stacked area charts are employed to represent the emotional dynamics over time.Based on the analysis; the system generates personalized recommendations and alerts for users exhibiting signs of distress or emotional instability, including potential suicide risk factors. The goal is to promote proactive well-being management and early intervention. It is crucial to emphasize that this system is a tool for early detection and should be used in conjunction with professional mental health care.