Suicide Severity Research Articles

The Mediating Role of Insomnia Severity in the Relationship Between Anxiety Symptoms and Suicidal Ideation: A Real-World Study in a Psychiatric Inpatient Setting.

Insomnia and anxiety symptoms are independent clinical variables involved in suicidal ideation in psychiatric inpatients. In this article, we investigated the relationship among insomnia severity, severity of anxiety symptoms, and suicidal ideation in a sample of psychiatric inpatients with severe mental disorders. We used a mediation model considering insomnia severity as the possible mediator of the relationship between anxiety severity and suicidal ideation. We administered the Columbia Suicide Severity Rating Scale, the Insomnia Severity Index, and the Hamilton Anxiety Rating Scale to 116 consecutive inpatients to the psychiatric unit of Sant'Andrea Hospital in Rome. The effect of anxiety symptoms was mediated by insomnia severity; patients who perceive higher anxiety symptoms were more likely to experience higher levels of insomnia and, thus, higher suicidal ideation intensity. Results showed the importance of assessing and treating both insomnia and anxiety in clinical practice.

Safety Profile of a Cognitively Unimpaired Older Population with Elevated Cerebral Amyloid in a 4.5-Year Clinical Trial

BackgroundPreclinical Alzheimer’s disease is increasingly studied in clinical trials. Although safety signals are routinely monitored in clinical trial populations with Alzheimer’s disease, it can be challenging to identify new safety signals against background rates of age-related medical comorbidities.ObjectivesTo report detailed safety data from a cognitively unimpaired older population with evidence of elevated cerebral amyloid levels on amyloid positron emission tomography in the placebo arm of a Phase 3 clinical trial.DesignPhase 3, 4.5-year, multicenter, placebo-controlled trial.SettingPlacebo data from the Anti-Amyloid Treatment in Asymptomatic Alzheimer’s Disease (A4) study.ParticipantsEnrolled participants were aged 65–85 years with a global Clinical Dementia Rating score of 0, a Mini-Mental State Examination score of 2–-30, a Wechsler Memory Scale Logical Memory IIa (delayed recall) score of 6–18, and elevated brain amyloid levels on 18F-florbetapir positron emission tomography.MeasurementsStudy participants who received placebo were followed up with post-baseline safety measures. Assessments included review of concomitant medication and adverse events, the Columbia Suicide Severity Rating Scale, electrocardiograms, and neuroimaging (brain magnetic resonance imaging).ResultsIn total, 591 study participants (mean age [standard deviation] 71.9 [5.0] years) were assigned to and received placebo in the A4 study, and were followed up to 240 weeks. Participants were primarily White (93.9%) and from the United States (86.8%); 60.4% were women. The most common serious adverse events (incidence rate per 100 person-years) were pneumonia (incidence rate=0.4; 95% confidence interval=0.2–0.7) and atrial fibrillation (incidence rate=0.4; 95% confidence interval=0.2–0.7). The most common treatment-emergent adverse events were upper respiratory tract infection (incidence rate=10.9; 95% confidence interval=9.4–12.5), fall (incidence rate=7.7; 95% confidence interval=6.6–9.0), and nasopharyngitis (incidence rate=5.8; 95% confidence interval=4.8–6.9). The most common ischemia-related findings on magnetic resonance imaging were subcortical infarction (incidence rate=1.4; 95% confidence interval=1.0–2.0) and acute ischemia (incidence rate=0.6; 95% confidence interval=0.3–1.0). Emergent amyloid-related imaging abnormalities with hemosiderin deposition occurred in 32.8% of participants who received placebo; the primary factor associated with these events during the post-baseline period was the number of microhemorrhages at baseline (odds ratio=349.9; 95% confidence interval=247.6–494.4; adjusted p<0.001).ConclusionSafety findings in the placebo-treated group from the A4 study provide a robust characterization of expected safety in a clinical trial population with preclinical Alzheimer’s disease. These results may provide context in planning future studies and safety evaluations during ongoing blinded studies in preclinical Alzheimer’s disease.

Insomnia, Social Disconnectedness, and Suicidal Ideation Severity in Underserved Veterans

Insomnia, Social Disconnectedness, and Suicidal Ideation Severity in Underserved Veterans

Association between suicidal ideation, negative symptoms and theory of mind in first episode psychosis.

Suicidal thoughts are common among patients with first episode psychosis (FEP). The impact of symptoms' severity and social cognition on suicidal risk should be a focus of attention. This study aimed at assessment of the severity of suicidal ideation in patients with FEP and its potential association with the theory of mind (ToM) impairment and symptoms' severity. Ninety-six participants were recruited consecutively and subdivided into three equal groups: FEP, schizophrenia, and healthy controls (HC). The symptoms' severity was assessed using Positive and Negative Syndrome Scale (PANSS) and Beck Depression Inventory (BDI). Suicidal ideation was evaluated using Beck Scale for Suicidal Ideation (BSSI). Reading the Mind in the Eyes revised version (RMET) was used to assess ToM. Suicidal ideation was significantly higher only in FEP compared to HC (p = 0.001). Both FEP and schizophrenia had substantially lower performance than HC on RMET (p < 0.001). Higher depression (β = 0.452, p = 0.007) and negative symptoms (β = 0.433, p = 0.027) appeared to be significantly associated with increased suicidal ideation severity in FEP while RMET did not. Patients with FEP and chronic schizophrenia have comparable deficits in theory of mind dimension of social cognition. The severity of negative and depressive symptoms potentially contributes to the increased risk of suicide in FEP.

Dynamic Deconstructive Psychotherapy for Suicidal Adolescents: Effectiveness of Routine Care in an Outpatient Clinic.

Suicidal behavior and demand for services have been increasing in adolescents. Many of the current treatments are focused on symptom mitigation, crisis management, and safety planning; however, few are aimed at remediating underlying vulnerabilities that may be contributing to suicide risk. Dynamic Deconstructive Psychotherapy (DDP) has been found to be effective for suicidal adults but has never been studied for adolescents. The present study examined real-world outcomes of 65 suicidal adolescents, aged 13-17 years, receiving weekly DDP in an outpatient clinic. The primary outcome was change in suicide ideation from baseline to 6 months of treatment as assessed by the Suicide Ideation Subscale of the Columbia Suicide Severity Rating Scale. In intent-to-treat analyses, suicide ideation significantly decreased over the 6 months with a large treatment effect (d = 1.19). Secondary measures, such as suicide attempts, self-harm, depression, anxiety, disability, self-compassion, and inpatient utilization, also improved significantly. Among the 42 adolescents (65%) who completed at least 6 months of treatment, suicide attempts decreased by 84%. DDP may be effective in reducing suicide ideation and other risk factors in suicidal adolescents and may be cost-effective given reduced inpatient utilization. These initial promising findings warrant further research and development.

Understanding Internalized Stigma's Role in Sex-Specific Suicidal Ideation among Individuals with Bipolar Disorder.

Background: The experience of stigma can exert a profound impact on the mental health and well-being of individuals with bipolar disorder (BD). Our study explores which factors of internalized stigma are associated with suicidal ideation and how they differ between the two sexes in a clinical sample of BD patients. Methods: The study follows a cross-sectional study design, employing the Clinical Global Impression for Bipolar Patients (CGI-BP) to evaluate the overall severity of illness and the alteration in patients affected by bipolar disorder, the Internalized Stigma of Mental Illness (ISMI) assessing self-stigma among individuals experiencing mental disorders, and the Columbia Suicide Severity Rating Scale (C-SSRS) identifying and assessing individuals vulnerable to suicide. Descriptive analyses, analysis of variance (ANOVA), and logistic regression analysis were conducted, and 344 BD subjects were recruited. Results: Our ANOVA results revealed a significant association between sex and suicide across ISMI sub-items (p = 0.000). Logistic regression analysis comprised three phases: Discrimination was consistently significant across all phases (p < 0.001), while Alienation and Stereotype emerged as additional predictors of suicide in later phases of the analysis (p < 0.001). Conclusions: Our study contributes to the growing body of literature on internalized stigma, sex, and suicidality among individuals with bipolar disorder. Early intervention programs and prevention strategies are needed.

Validation of the Spanish Childhood Trauma Questionnaire-Short Form in adolescents with suicide attempts.

Child maltreatment is associated with a higher probability of mental disorders and suicidal behavior in adolescence. Therefore, accurate psychometric instruments are essential to assess this. To validate the Spanish version of the Childhood Trauma Questionnaire-Short Form (CTQ-SF) in adolescents with suicide attempts. Multisite cohort study of 208 adolescents with suicide attempts using data from the following scales: Mini International Neuropsychiatric Interview (MINI), Columbia Suicide Severity Rating Scale (C-SSRS), Patient Health Questionnaire (PHQ-9), and CTQ-SF. Statistical analysis: CTQ-SF scores analyzed by descriptive statistics. Internal consistency: McDonald's omega and Cronbach's alpha. Concurrent validity with PHQ-9 and C-SSRS scores: Spearman correlation coefficient. Structural validity: Confirmatory factor analysis. Floor and ceiling effects: Physical abuse and neglect as well as sexual abuse demonstrated high floor effects (50.0, 35.1, and 61.1% of adolescents, respectively). No ceiling effects were found. The CTQ-SF had excellent internal consistency (McDonald's omega = 0.94), as did the majority of its subscales (Cronbach's alpha 0.925-0.831) except for physical neglect (0.624). Its concurrent validity was modest, and the emotional neglect subscale had the lowest Spearman correlation coefficients (0.067-0.244). Confirmatory factor analysis: Compared with alternative factor structures, the original CTQ-SF model (correlated 5-factor) exhibited a better fit [S-B χ 2 = 676.653, p < 0; RMSEA (90% CI = 0.076-0.097) = 0.087; SRMR = 0.078; CFI = 0.980; TLI = 0.978]. The Spanish CTQ-SF is a reliable, valid instrument for assessing traumatic experiences in adolescents at high risk of suicide. It appears appropriate for use in routine clinical practice to monitor maltreatment in this group.

Baseline circulating biomarkers, their changes, and subsequent suicidal ideation and depression severity at 6 months: A prospective analysis in patients with mood disorders

BackgroundIdentifying circulating biomarkers associated with prospective suicidal ideation (SI) and depression could help better understand the dynamics of these phenomena and identify people in need of intense care. In this study, we investigated the associations between baseline peripheral biomarkers implicated in neuroplasticity, vascular homeostasis and inflammation, and prospective SI and depression severity during 6 months of follow-up in patients with mood disorders. Methods149 patients underwent a psychiatric evaluation and gave blood to measure 32 plasma soluble proteins. At follow-up, SI incidence over six months was measured with the Columbia Suicide Severity Rating Scale, and depressive symptoms were assessed with the Inventory for Depressive Symptomatology. Ninety-six patients provided repeated blood samples. Statistical analyses included Spearman partial correlation and Elastic Net regression, followed by the covariate-adjusted regression models. Results51.4 % (N = 71) of patients reported SI during follow-up. After adjustment for covariates, higher baseline levels of interferon-γ were associated with SI occurrence during follow-up. Higher baseline interferon-γ and lower orexin-A were associated with increased depression severity, and atypical and anxious, but not melancholic, symptoms. There was also a tendency for associations of elevated baseline levels of interferon-γ, interleukin-1β, and lower plasma serotonin levels with SI at the six-month follow-up time point. Meanwhile, reduction in transforming growth factor- β1 (TGF-β1) plasma concentration correlated with atypical symptoms reduction. ConclusionWe identified interferon-γ and orexin-A as potential predictive biomarkers of SI and depression, whereas TGF-β1 was identified as a possible target of atypical symptoms.

Change in suicidal ideation, depression, and anxiety following collaborative care in the community

BackgroundThe Collaborative Care Model (CoCM) increases access to mental health treatment and improves outcomes among patients with mild to moderate psychopathology; however, it is unclear how effective CoCM is for patients with elevated suicide risk.MethodsWe examined data from the Penn Integrated Care program, a CoCM program including an intake and referral management center plus traditional CoCM services implemented in primary care clinics within a large, diverse academic medical system. In this community setting, we examined: (1) characteristics of patients with and without suicidal ideation who initiated CoCM, (2) changes in suicidal ideation (Patient Health Questionnaire-9 [PHQ-9] item 9), depression (PHQ-9 total scores), and anxiety (Generalized Anxiety Disorder Scale-7 scores) from the first to last CoCM visit overall and across demographic subgroups, and (3) the relationship between amount of CoCM services provided and degree of symptom reduction.ResultsFrom 2018 to 2022, 3,487 patients were referred to CoCM, initiated treatment for at least 15 days, and had completed symptom measures at the first and last visit. Patients were 74% female, 45% Black/African American, and 45% White. The percentage of patients reporting suicidal ideation declined 11%-7% from the first to last visit. Suicidal ideation severity typically improved, and very rarely worsened, during CoCM. Depression and anxiety declined significantly among patients with and without suicidal ideation and across demographic subgroups; however, the magnitude of these declines differed across race, ethnicity, and age. Patients with suicidal ideation at the start of CoCM had higher depression scores than patients without suicidal ideation at the start and end of treatment. Longer CoCM episodes were associated with greater reductions in depression severity.ConclusionsSuicidal ideation, depression, and anxiety declined following CoCM among individuals with suicidal ideation in a community setting. Findings are consistent with emerging evidence from clinical trials suggesting CoCM’s potential for increasing access to mental healthcare and improving outcomes among patients at risk for suicide.

Prevalence and Predictors of Suicidal Ideation among Adolescents

Suicides among young people continue to be a serious problem. Suicide is the second leading cause of death for children, adolescents, and young adults. The objectives of the present study were to assess the prevalence and predictors of suicidal ideation among adolescents; associate suicidal ideation among adolescents with selected socio-demographic variables and predictors. Quantitative research approach and descriptive research design was adopted for the study. The study was conducted among 250 adolescents selected through purposive sampling technique from selected Colleges, Thrissur. The tool consisted of a semi structured questionnaire to assess the socio-demographic data, Columbia Suicidal Severity Rating Scale (C-SSRS) screen version to assess the prevalence of suicidal ideation and a structured questionnaire to assess the predictors of suicidal ideation among adolescents. Reliability and validity of the tools were established. Data were collected, tabulated and analyzed using descriptive and inferential statistics. The findings of the study revealed that the prevalence rate of suicidal ideation among adolescents is 28%. The predictors such as lack of teachers support (91.4%), social media abuse (74.3%), loneliness and hopeless (72.9%) are found in most of the adolescents. A statistically significant association was found between education of father (p=0.04) and education of mother (p=0.04) with suicidal ideation among adolescents at p&lt;0.05. The predictors such as family history of suicide (p=0.00), helplessness (p=0.04) and lack of parental support (p=0.01) have a statistically significant association with suicidal ideation among adolescents. The study concluded that the prevalence rate of suicidal ideation among adolescents is significant. The early identification of the predictors can prevent the actual occurrence of suicide among adolescents.

Psychometric Properties of a Persian Version of the Columbia Suicide Severity Rating Scale (C-SSRS) in Iranian Soldiers.

Objective: Suicide is an important health issue nearly all over the world. The Columbia Suicide Severity Rating Scale (C-SSRS) is a well-known instrument for suicide risk assessment. Our purpose in this study is to provide a Persian version of the C-SSRS and evaluate its psychometric properties in the Iranian military population, particularly suicide risk leveling characteristic of the C-SSRS. Method : For linguistic adaptation, we gathered opinions of an expert panel consisting of 23 professionals in mental health sciences. Furthermore, this version was administered to two groups of soldiers, one representing a sample of normal population (N = 338), while the other group comprised a sample of clinical population from a referral psychiatric hospital (N = 348) in Tehran, capital of Iran, from July 2021 until one year later. Besides the C-SSRS, the Beck Scale for Suicidal Ideation (BSSI), Beck Hopelessness Scale (BSS), and General Health Questionnaire 28 (GHQ28) were obtained from the participants. Correlation coefficients, internal consistency, and factor analysis were evaluated using the Statistical Package for the Social Sciences (version 23) software. Results: All items of the Persian version of the C-SSRS had acceptable content validity and face validity. This tool demonstrated high correlation coefficients with the BSSI (r = 0.73, P < 0.001) and BHS (r = 0.64, P < 0.001), but a low correlation coefficient with the GHQ28 (r = 0.22, P < 0.001). Specifically, the suicide risk level based on the C-SSRS had a high correlation with both the BSSI and BHS. Also, its internal consistency was satisfactory (Cronbach's alpha = 0.89). Furthermore, factor analysis revealed two factors that is consistent with suicidal ideation and suicidal behavior factors. Conclusion: Our results indicated acceptable validity and reliability for the Persian version of the C-SSRS, demonstrating its capability to classify suicide risk. It can be concluded that the ordinal suicide risk level (as red, orange, yellow and green) is a valid index for the application of the C-SSRS.

Personality disorders among a sample of Egyptian patients with major depressive disorder and their association with suicide

BackgroundDepression is a prevalent psychiatric disorder that can arise at any age and is often present as a co-occurring illness in different illnesses. There is a high comorbidity rate between major depressive disorder and personality disorders (PDs). The current study aimed to investigate the significant impact of personality disorders on depression severity, functional impairment, and suicidal tendencies in individuals with depression.MethodsThe researchers conducted a cross-sectional observational study involving 120 patients, with an age range from 18 to 56 years of both genders, recruited from Okasha’s Institute of Psychiatry in Cairo, Egypt. Their major depressive disorder diagnosis was verified through the use of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Participants underwent evaluations using the SCID-II to evaluate personality disorders, the Hamilton Depression-Rating Scale (HAM-D) to assess the severity of depression, the Columbia Suicide Severity Rating Scale (C-SSRS) to investigate suicidal ideation, and the Global Assessment of Functioning Scale (GAF) to determine functional level.ResultsBorderline personality disorder and narcissistic personality disorder were the predominant personality disorders in the sample, with prevalence rates of 55.8% and 40.8%, respectively. Sixty-six percent of the participants reported experiencing suicidal thoughts at some point in their lifetime, whereas only 17.5% had actually attempted suicide. Borderline personality disorder showed a strong correlation with more severe depression (P value 0.043), a decline in functioning (P value 0.001), the existence of suicidal thoughts (P value 0.001), and a past of suicide attempts (P value 0.038).ConclusionsPersonality disorders are highly prevalent in patients with depression, borderline PD, and narcissistic PD were the most common PDs. Borderline PD showed a significant effect on depression severity. PDs, mainly borderline, avoidant, depressive, and narcissistic PDs contribute to more impairment of functioning of the MDD patients. There is a significant effect of the presence of co-morbid personality disorder on suicidal thoughts and suicidal attempts, mainly depressive and borderline PDs.

Validation of screening instruments for common mental disorders and suicide risk in south African primary care settings

IntroductionIn South Africa, there is limited mental health infrastructure and resources. Valid screening tools are needed to facilitate identification and linkage to care. We evaluated the performance of Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Primary Care Post Traumatic Stress Disorder Screen for DSM-5 (PC-PTSD-5), and the Columbia Suicide Severity Rating Scale (C-SSRS) among adults in South Africa against a diagnostic gold standard. MethodsAdults present at healthcare facilities were screened with the PHQ-9, GAD-7, PC-PTSD-5, and the C-SSRS. Nurses used a structured diagnostic interview to identify depression, anxiety, panic disorder, PTSD and elevated suicide risk. We assessed the internal consistency, criterion validity, and the sensitivity and specificity of these tools. ResultsOf the 1885 participants, the prevalence of common mental disorders and suicide risk was 24.4 % and 14.9 %, respectively. The PHQ-9, GAD-7, and PC-PTSD-5 showed good internal consistency (0.80–0.89). All screeners demonstrated good criterion validity. For depression, a cut-off of ≥5 on the PHQ-9 yielded sensitivity of 84.24 %, while ≥10 yielded sensitivity of 48.77 %. For anxiety, the GAD-7 performed similarly. A cut-off of ≥4 on the PC-PTSD yielded sensitivity of 61.96 %. The C-SSRS yielded lower sensitivity than expected. LimitationsThe prevalence data is not generalizable to the larger South African adult population given the use of a targeted, healthcare facility-based sampling and recruitment strategy. ConclusionsThe performance of the PHQ-9, GAD-7, and PC-PTSD-5 demonstrated good internal consistency and criterion validity, though sensitivity and specificity trade-offs were enhanced with lower cut-offs. Further research into suicide risk screening is warranted.

History of suicidal behavior and clozapine prescribing among people with schizophrenia in China: a cohort study

BackgroundClozapine is an off-label drug used in most countries to prevent suicide in individuals with schizophrenia. However, few studies have reported real-world prescription practices. This study aimed to explore the association between a history of suicidal behavior and clozapine prescribing during eight weeks of hospitalization for individuals with early-stage schizophrenia.MethodsThis observational cohort study used routine health data collected from a mental health hospital in Beijing, China. The study included 1057 inpatients who had schizophrenia onset within 3 years. History of suicidal behavior was coded from reviewing medical notes according to the Columbia Suicide Severity Rating Scale. Information on antipsychotic use during hospitalization was extracted from the prescription records. Time to clozapine use was analyzed using Cox regression models adjusted for sociodemographic and clinical covariates.ResultsThe prevalence rates of self-harm, suicidal behavior, and suicide attempt were 12.3%, 7.5%, and 5.4%, respectively. A history of self-harm history was positively associated with clozapine uses upon admission (4.1% vs. 0.8%, exact p = 0.009). Among those who had not used clozapine and had no clozapine contraindication, A history of suicidal behavior increased the possibility of switch to clozapine within 56 days after admission (Hazard Ratio[95% CI], 6.09[2.08–17.83]) or during hospitalization (4.18[1.62–10.78]).ConclusionThe use of clozapine for early-stage schizophrenia was more frequent among those with suicidal behavior than among those without suicidal behavior in China, although the drug instructions do not label its use for suicide risk.

Investigating Psychiatric Disorders in Patients with Suicide Attempt

Background Attempting suicide is considered one of the important indicators of the mental health of individuals in society. One of the important issues in suicide is psychiatric disorders and related factors. Given that no comprehensive study was conducted in Yazd province, this study aimed to assess psychiatric disorders in patients with suicide attempts. Methods This analytical cross-sectional study was conducted on 344 patients with suicide attempts at Shahid Beheshti Hospital from March 2021 to March 2022. The type of psychiatric illness was diagnosed based on the clinical interview and DSM-5 diagnostic criteria. All information was extracted from medical records entered into SPSS version 22 and analyzed. P &lt; 0.05 was assumed significant. Results The average age of the patients was 27.09 ± 11.78 years. Among them, 145 were men (42.2%) and 199 were women (57.8%). The most common psychiatric disorder was Major depressive disorder (MDD) (46.5%). Moreover, the lowest frequency of psychiatric disorders was schizophrenia (1.2%). There was a significant relation between psychiatric disorders and variables, including age, number of suicides, gender, and suicide method (P &lt; 0.05). A significant relation was seen between the severity of diseases and gender (P &lt; 0.05). Conclusion Among the various types of psychiatric disorders, MDD was more prevalent in individuals who commit suicide. Hence, it was essential to focus more attention on this particular group of patients. Additionally, the use of medication was the most common method of suicide. It should also be noted that the severity of suicide was higher in men.

Examining putamen resting-state connectivity markers of suicide attempt history in depressed adolescents.

Suicide is a current leading cause of death in adolescents and young adults. The neurobiological underpinnings of suicide risk in youth, however, remain unclear and a brain-based model is lacking. In adult samples, current models highlight deficient serotonin release as a potential suicide biomarker, and in particular, involvement of serotonergic dysfunction in relation to the putamen and suicidal behavior. Less is known about associations among striatal regions and relative suicidal risk across development. The current study examined putamen connectivity in depressed adolescents with (AT) and without history of a suicide attempt (NAT), specifically using resting-state functional magnetic resonance imaging (fMRI) to evaluate patterns in resting-state functional connectivity (RSFC). We hypothesized the AT group would exhibit lower striatal RSFC compared to the NAT group, and lower striatal RSFC would associate with greater suicidal ideation severity and/or lethality of attempt. We examined whole-brain RSFC of six putamen regions in 17 adolescents with depression and NAT (MAge [SD] = 16.4[0.3], 41% male) and 13 with AT (MAge [SD] = 16.2[0.3], 31% male). Only the dorsal rostral striatum showed a statistically significant bilateral between-group difference in RSFC with the superior frontal gyrus and supplementary motor area, with higher RSFC in the group without a suicide attempt compared to those with attempt history (voxel-wise p<.001, cluster-wise p<.01). No significant associations were found between any putamen RSFC patterns and suicidal ideation severity or lethality of attempts among those who had attempted. The results align with recent adult literature and have interesting theoretical and clinical implications. A possible interpretation of the results is a mismatch of the serotonin transport to putamen and to the supplementary motor area and the resulting reduced functional connectivity between the two areas in adolescents with attempt history. The obtained results can be used to enhance the diathesis-stress model and the Emotional paiN and social Disconnect (END) model of adolescent suicidality by adding the putamen. We also speculate that connectivity between putamen and the supplementary motor area may in the future be used as a valuable biomarker of treatment efficacy and possibly prediction of treatment outcome.

Anxiety and Depression Symptoms Improve in Partial Hospitalization Treatment for Adolescents with and without Suicidal Thoughts and Behaviors: Leveraging Measurement-Based Care and Electronic Health Record Data

ABSTRACT Partial hospitalization programs (PHPs) offer an alternative to inpatient care for youth with acute psychiatric needs. PHP treatment is effective for adults, but fewer studies have examined adolescent programs. In the current study, we describe a large sample of adolescents enrolled in a PHP and evaluate symptom change over treatment. Demographic information, insurance, treatment length, readmission status (i.e. repeat admissions), the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Columbia Suicide Severity Rating Scale (C-SSRS) were extracted from electronic health records. The sample (N = 1237, ages 12–18) was predominantly female assigned at birth (70%), White (84%), and non-Hispanic/Latine (92%). Approximately 25% of the adolescents reported suicidal thoughts and behaviors (STBs) and 8% were readmissions. Anxiety and depression symptoms decreased significantly over the course of treatment (p < .001). Female patients reported more severe symptoms than males (p’s < 0.001), and patients who identified as racial and/or ethnic minorities reported higher anxiety and depression (p’s < 0.05) over treatment. Past month STBs was associated with higher anxiety (p = .003) and depression (p < .001) symptoms at admission, though these youth experienced similar symptom reduction. Readmission status did not predict symptoms at admission or change over treatment. This naturalistic study suggests that PHP treatment reduces anxiety and depression symptoms for adolescents with STBs and those with repeat admissions. Demographic factors impacted symptom severity and suggested that patients identified as racial and/or ethnic minorities may experience barriers to accessing treatment. Treatment needs and considerations for adolescents in PHPs are discussed.

Evaluation of Risk Factors Associated with Severe Suicide Attempts among Individuals Presenting at the Emergency Department

Severe suicide attempts represent critical incidents characterized by high lethality or medical acuity, posing significant risks of morbidity and mortality. Objective: To assess the risk factors linked to severe suicide attempts among those presenting in the Emergency Department. Methods: The cross-sectional study took place at the Department of Forensic Medicine, Makran Medical College, Turbat, Pakistan covering the period from 21 December 2023 to 21 March 2024. The study included 90 patients aged 18 years or older who were admitted to the ED with a documented suicide attempt. Variables related to demographic characteristics, clinical presentations, substance use history, and details of the suicide attempt. Collected data were processed and analyzed using IBM SPSS, version 27.0. Results: The majority of participants were female (56.7%), with a mean age of 31.01 ± 12.42 years. Major depressive disorder was the most prevalent (33.3%), followed by anxiety disorder (18.9%). Other conditions included abuse of narcotics (6.7%), schizophrenia (4.4%), and a history of previous suicide attempts (1.1%). The most frequently cited reasons were psychiatric illnesses (n=28, 31.1%) and family problems (n=26, 28.9%), followed by financial problems (13.3%) and romantic relationship issues (6.7%). In the study cases, suicide attempts mostly occurred between 6 am to 12 pm (38.9%) and 12 pm to 6 pm (34.4%). The majority of patients were hospitalized (61.1%). Conclusions: It was concluded that the urgent need for targeted suicide prevention initiatives, with major depressive disorder identified in 33.3% and drug poisoning as prevalent in 40.0% of suicide attempts.

Do measures of social support and social distress share general factors associated with suicidal ideation and attempts?

Aspects of social relationships have variably been associated with suicidal ideation (SI) and suicide attempts (SAs). This study assessed whether social support and social distress measures have general factors versus measure-specific factors that are associated with suicide risk. Adults (N = 455, 60.0% female), admitted to psychiatric inpatient units following a recent suicide attempt or active SI, completed assessments of social support (emotional support, instrumental support, friendship, perceived support from significant others, friends, family) and social distress (loneliness, perceived rejection, perceived burdensomeness, thwarted belongingness). Bifactor modeling examined general and specific factors of social support and distress in relation to SI (week prior to hospitalization, via the Beck Scale for SI) and SAs (past 30 days, via the Columbia Suicide Severity Rating Scale). SI was significantly associated with the general social support (B = -1.51), the general social distress (B = 1.67), and the specific perceived burdensomeness (B = 1.57) factors. SAs were significantly associated with the specific Perceived Rejection (OR = 1.05) and Thwarted Belongingness (OR = 0.91) factors. General social support and social distress were associated with SI but not recent SAs. Specific social distress factors were also related to SI and SAs controlling for general social distress, suggesting areas for future interventions.

Gender differences in risk and resilience for suicidal thoughts and behaviors: A national longitudinal survey study of United States veterans with a recent suicide attempt

BackgroundThis study reports on gender differences in psychosocial symptoms and suicidal thoughts and behaviors from the first longitudinal, national survey of veterans with a recent nonfatal suicide attempt to inform women-tailored suicide prevention. MethodsWe recruited all female veterans with a documented nonfatal suicide attempt between October 2018 and September 2019 and a stratified matched sample of males. Surveys were administered at baseline, month 6, and month 12; 968 veterans completed the baseline survey with valid gender data. Surveys assessed psychosocial constructs, suicidal ideation severity, and suicidal behavior. Administrative datasets provided healthcare and suicide attempt data during the one year follow up. ResultsWomen retained higher social rejection and institutional betrayal, and lower self-compassion and autonomy than men over follow up. Higher overall self-compassion was associated with lower baseline suicide ideation for both women and men; however, this association was stronger for women (Δ = −0.19; 95 % CI = -0.31, −0.07; d = −0.15). Individuals with higher overall psychological distress had greater odds of a subsequent suicide attempt (AOR = 2.20, 95 % CI = 1.56, 3.11). Social rejection had the strongest association with worsening psychological distress, both within individuals (b = 0.18; 95 % CI = 0.14, 0.23; d = 0.23) and between individuals (b = 0.07; 95 % CI = 0.04, 0.10; d = 0.09). LimitationsResults may not generalize beyond a VHA-utilizing veteran population. ConclusionsFindings from this study inform potential therapeutic targets and topics for future research on tailoring suicide prevention for women veterans. While all veterans may need support reducing distress, women may need additional support in multiple other areas.