A pilot study evaluating the preventive effects of platform-end lengthwise fencing on trespassing, person struck by train and traffic delays.

BACKGROUND: Trespassing at train tracks and "person under train" (PUT) incidents are serious health, societal and transportation concerns. There is a need for developing different measures to prevent these events. Here, we hypothesized that platform-end lengthwise fences (PLF) reduce trespassing, the number of PUT incidents (suicides and accidents), and train traffic delays. METHOD: PLFs were installed as the intervention at one station in Stockholm in 2020. The number of trespassers detected using CCTV-cameras was compared before and after at the intervention station over a total period of 29 months (using incidence rate ratio, IRR). The reduction in the number of PUT (over 20 years) and train traffic delays (over 9 years) was also investigated by IRR, and by using three control groups. RESULTS: After installation of PLF there was a significant ∼90% reduction in trespasses (IRR = 0.10, 95%CI 0.04-0.23; one-sided exact p < 0.0001). No PUT incident occurred at the intervention station after the installation, compared to 1.11 per year before installation (IRR = 0.32, 95%CI 0-1.82; one-sided exact p = 0.1216). There was a significant reduction in delay minutes post installation compared to before the installation (Mann Whitney U = 0, upper one-sided exact p = 0.0357). The effect of the PLF was also observable in comparison to the three control groups, suggesting that the preventive effect was not due to wider societal events affecting all stations. CONCLUSION: PLF had a large effect on reducing the number of trespasses and the number of delay minutes due to trespasses and PUT incidents. PLF may also have an effect of reducing PUT incidents. PRACTICAL APPLICATIONS: PLF is deemed to be relatively easy and cheap to install and thus scalable (as compared to full barriers, e.g., platform screen doors) and may be considered at platform-ends having an exit, provided there is enough space to install them.

Menstrual symptoms and subjective well-being among postmenarchal adolescents.

BACKGROUND: Menstrual symptoms are predominantly studied among adults but may occur directly after menarche. Adolescent menstrual healthcare, however, faces specific obstacles and more research into menstrual symptoms as a determinant of adolescent well-being is therefore advocated. OBJECTIVE: This study aimed to investigate menstrual symptoms and their impact on everyday life and well-being among postmenarchal adolescents. STUDY DESIGN: A survey was delivered to a random sample of 1644 schoolgirls, drawn from a population-based project involving 116 lower secondary education schools (7th and 8th grade) in Stockholm, Sweden. Menstrual symptoms (ie, dysmenorrhea, heavy bleeding, irregular periods, mood disturbance, other general symptoms) were investigated through multiple choice questions and defined according to their impact on everyday life as mild (seldom affected), moderate (affected but possible to cope) and severe (affected and difficult to cope). Subjective well-being was measured with the World Health Organization Five Well-Being index. Postmenarchal respondents were eligible for analysis; those with incomplete outcome data or using hormonal contraception were excluded. The frequency and severity of symptoms across different postmenarchal years (1st, 2nd, 3rd, 4th, or 5th+ year after menarche) were studied with Chi-square and Kendall's tau statistics. Analysis of variance was used to study the association between menstrual symptoms and World Health Organization Five Well-Being index scores. A composite menstrual health index variable was obtained through principal component analysis and used to study the overall impact of menstrual symptoms on well-being in regression analyses. RESULTS: Of 1100 postmenarchal girls (mean age, 14.1±0.7 years), 93.2% reported menstrual symptoms, 81.3% had at least 1 moderate symptom and 31.3% had at least 1 severe symptom. The most frequent symptoms were dysmenorrhea (80.4%) and mood disturbance (81.1%), followed by irregular periods (67.9%), heavy bleeding (60.4%), and other general symptoms (60.4%). Throughout postmenarchal years, there was a significant increase in frequency and severity (P<.001) of dysmenorrhea (τ=0.148), heavy bleeding (τ=0.134), mood disturbance (τ=0.117), and other general symptoms (τ=0.110), but not irregular periods (τ=-0.0201; P=.434). Girls with menstrual symptoms had significantly lower World Health Organization Five Well-Being index scores than those without symptoms (mean difference, -17.3; 95% confidence interval, -22.4 to -12.3). Analysis of variance showed significant associations (P<.001) with World Health Organization Five Well-Being index scores for each of the examined menstrual symptoms. In post hoc pairwise comparisons with peers without symptoms, the greatest reductions in World Health Organization Five Well-Being index score were found among girls with severe symptoms (mean difference for: dysmenorrhea, -20.72; heavy bleeding, -15.75; irregular periods, -13.81; mood disturbance, -24.97; other general symptoms, -20.29), but significant differences were observed even for moderate or mild symptoms. The composite menstrual health index was significantly associated with World Health Organization Five Well-Being index scores in regression analysis, independently of age, age at menarche, body mass index, smoking, physical activity, own and parental country of birth, biparental care, and socioeconomic status. CONCLUSION: Despite growing awareness about the relevance of menstruation to women's health, unmet menstrual health needs are a potential threat to the well-being of adolescents. Education, screening, and clinical competence are important tools to reduce the burden of menstrual symptoms during adolescence and to prevent long-term consequences. The development of novel person-centered strategies should be a priority for clinical practice and research in adolescent menstrual health.

Associations between sleep habits, quality, chronotype and depression in a large cross-sectional sample of Swedish adolescents.

OBJECTIVE: To investigate behavioral sleep habits, self-perceived quality of sleep, and chronotype, and to examine their association with clinically relevant levels of depression in Swedish adolescents. METHOD: Questionnaire data were obtained from a representative sample of Swedish adolescents (n = 8449; 50.8% girls; aged 12-16). Depression was defined as >13 BDI-II scores. Logistic regression modelling estimated the effects of sleep duration, sleep quality, and chronotype on depression, adjusted for socio-demographic factors. RESULTS: On weekdays, approximately 46% of adolescents slept less than the recommended length of eight hours per night (depressed: 68%, non-depressed: 40%). On weekends, however, only 17% slept shorter than recommended. Short weekday sleep duration was more common among girls than boys (53% vs. 38%) and girls reported worse sleep quality. The regression model showed that depression was predicted by weekday sleep duration (OR = 0.773, p < .0001), sleep quality (OR = 0.327, p < .0001), and late chronotype (OR = 1.126, p = .0017), but not by weekend sleep duration. A 30-minute increase in weekday sleep duration was associated with about 10% lower odds of depression. CONCLUSIONS: A substantial proportion of Swedish adolescents do not seem to meet the sleep recommendations of eight hours per night. Short sleep duration on weekdays, poor sleep quality, and late chronotype were associated with increased risk of depression. Interventions promoting longer weekday sleep duration (e.g., later school start times) seem relevant in this context, but further research is needed to investigate the directionality and underlying mechanisms of these associations.

Predictors of the Use of a Mental Health-Focused eHealth System in Patients With Breast and Prostate Cancer: Bayesian Structural Equation Modeling Analysis of a Prospective Study.

BACKGROUND: eHealth systems have been increasingly used to manage depressive symptoms in patients with somatic illnesses. However, understanding the factors that drive their use, particularly among patients with breast and prostate cancer, remains a critical area of research. OBJECTIVE: This study aimed to determine the factors influencing use of the NEVERMIND eHealth system among patients with breast and prostate cancer over 12 weeks, with a focus on the Technology Acceptance Model. METHODS: Data from the NEVERMIND trial, which included 129 patients with breast and prostate cancer, were retrieved. At baseline, participants completed questionnaires detailing demographic data and measuring depressive and stress symptoms using the Beck Depression Inventory-II and the Depression, Anxiety, and Stress Scale-21, respectively. Over a 12-week period, patients engaged with the NEVERMIND system, with follow-up questionnaires administered at 4 weeks and after 12 weeks assessing the system's perceived ease of use and usefulness. Use log data were collected at the 2- and 12-week marks. The relationships among sex, education, baseline depressive and stress symptoms, perceived ease of use, perceived usefulness (PU), and system use at various stages were examined using Bayesian structural equation modeling in a path analysis, a technique that differs from traditional frequentist methods. RESULTS: The path analysis was conducted among 100 patients with breast and prostate cancer, with 66% (n=66) being female and 81% (n=81) having a college education. Patients reported good mental health scores, with low levels of depression and stress at baseline. System use was approximately 6 days in the initial 2 weeks and 45 days over the 12-week study period. The results revealed that PU was the strongest predictor of system use at 12 weeks (ßuse at 12 weeks is predicted by PU at 12 weeks=.384), whereas system use at 2 weeks moderately predicted system use at 12 weeks (ßuse at 12 weeks is predicted by use at 2 weeks=.239). Notably, there were uncertain associations between baseline variables (education, sex, and mental health symptoms) and system use at 2 weeks, indicating a need for better predictors for early system use. CONCLUSIONS: This study underscores the importance of PU and early engagement in patient engagement with eHealth systems such as NEVERMIND. This suggests that, in general eHealth implementations, caregivers should educate patients about the benefits and functionalities of such systems, thus enhancing their understanding of potential health impacts. Concentrating resources on promoting early engagement is also essential given its influence on sustained use. Further research is necessary to clarify the remaining uncertainties, enabling us to refine our strategies and maximize the benefits of eHealth systems in health care settings.

Acceptance and willingness-to-pay for oocyte cryopreservation in medical versus age-related fertility preservation scenarios among Swedish female university students.

Oocytes can be effectively cryopreserved and stored for future use in in-vitro fertilisation. Oocyte cryopreservation (OC) can therefore mitigate different threats to female fertility, but attitudes and policies often seem more favourable in medical rather than age-related fertility preservation scenarios. The value of OC for potential candidates may be perceived differently depending on the indications, although relevant empirical data are lacking. An adequately powered sample of Swedish female university students (n = 270; median age 25; range 19-35) were randomly delivered a medical (n = 130) or age-related (n = 140) fertility preservation scenario within an online survey. Sociodemographic factors, reproductive experiences, and awareness about OC were not significantly different between the groups. Differences in four outcomes were studied: proportions of respondents (1) positive to the use of OC, (2) positive to public funding for OC, or (3) open to considering OC; and (4) willingness-to-pay (WTP) for OC, measured in thousand Swedish krona (K SEK) through contingent valuation. There were no significant differences in the proportions of respondents positive to the use of OC (medical: 96%; age-related: 93%) or open to consider it (medical: 90%; age-related: 88%) in each scenario. However, public funding had significantly greater support in the medical scenario (85%) than in the age-related one (64%). The median WTP (45 K SEK ≈ 4.15 K EUR) approximated the current Swedish market price for a single elective cycle and was not significantly different between the scenarios (Cliff's delta - 0.009; 95%CI - 0.146, 0.128). These findings suggest that it may be inappropriate to justify counselling and priority policies only on the assumption that fertility preservation with OC for medical indications is more beneficial to women than when the same technique is used for age-related reasons. However, it would be interesting to investigate further why public funding appears more debatable than the treatment itself.

Longitudinal Effects of Screen Time on Depressive Symptoms among Swedish Adolescents: The Moderating and Mediating Role of Coping Engagement Behavior.

Studies suggest that hourly digital screen time increases adolescents' depressive symptoms and emotional regulation difficulties. However, causal mechanisms behind such associations remain unclear. We hypothesized that problem-focused and/or emotion-focused engagement coping moderates and possibly mediates this association over time. Questionnaire data were collected in three waves from a representative sample of Swedish adolescents (0, 3 and 12 months; n = 4793; 51% boys; 99% aged 13-15). Generalized Estimating Equations estimated the main effects and moderation effects, and structural regression estimated the mediation pathways. The results showed that problem-focused coping had a main effect on future depression (b = 0.030; p < 0.001) and moderated the effect of screen time (b = 0.009; p < 0.01). The effect size of this moderation was maximum 3.4 BDI-II scores. The mediation results corroborated the finding that future depression was only indirectly correlated with baseline screen time, conditional upon intermittent problem-coping interference (C'-path: Std. beta = 0.001; p = 0.018). The data did not support direct effects, emotion-focused coping effects, or reversed causality. We conclude that hourly screen time can increase depressive symptoms in adolescent populations through interferences with problem-focused coping and other emotional regulation behaviors. Preventive programs could target coping interferences to improve public health. We discuss psychological models of why screen time may interfere with coping, including displacement effects and echo chamber phenomena.

Increased suicide risk among younger women in winter during full moon in northern Europe. An artifact or a novel finding?

Available evidence suggests that there is no effect of moon phases on suicidal behavior. However, a Finnish study recently reported elevated suicide rates during full-moon, but only among premenopausal women and only in winter. This could not be replicated in an Austrian study and stirred a discussion about whether the Finnish finding was false-positive or if there are unaccounted moderator variables differing between Finland and Austria. The goal of the present study was to provide another replication with data from Sweden, which is geographically more comparable to Finland than Austria. We also investigated the discussed moderator variables latitude and nightly artificial brightness. There were 48,537 suicides available for analysis. The fraction of suicides during the full-moon quarter in winter did not differ significantly from the expected 25% among premenopausal women (23.3%) and in the full sample (24.7%). The incidence risk ratios for full moon quarter in Poisson regression models were 0.96 (95% CI: 0.90-1.02) for premenopausal women and 1.01 (95% CI: 0.99-1.04) for the full sample. According to Bayes-factor analysis, the evidence supports the null-hypothesis (no association) over the alternative hypothesis (some association). We found similar results when we split the data by latitude and artificial nightly brightness, respectively. In line with the Austrian study, there was no increase of suicides in Sweden among premenopausal women in winter during full-moon. The results from the Finnish study are likely false positive, perhaps resulting from problematic but common research and publication practices, which we discuss.

A pilot study evaluating the effectiveness of preventing railway suicides by mid-track fencing, which restrict easy access to high-speed train tracks.

BACKGROUND: Suicides in the railway system is a serious health, societal, and transportation concern. Restriction of the access to suicide methods in the form of different physical barriers is a promising approach for suicide prevention. METHOD: Mid-track fencing, which is fencing placed in-between the high-speed and commuter train tracks, was installed at one out of seven stations along a train line outside of Stockholm in the years 2013/2014. The number of suicides at the intervention station was compared to six other stations used as controls, over a total period of 20 years (2002-2021). RESULTS: Suicides at high-speed tracks occurring at stations was the major cause of death on the investigated railway line. Prior to the year 2014, the intervention and control stations displayed similar time trends in the number of suicides. After installation of the mid-track fencing in 2014, there was a 62.5% reduction in the rate of suicides occurring at the intervention station. Compared to the six other control stations, the intervention station displayed a significant reduction in the number of suicides during the years 2014-2021 (OR = 0.14, 95%CI 0.013-0.95). Suicides at the railway lines in-between stations were not increased post-intervention. However, nearby control stations showed a 162% increase in suicides after the intervention, suggesting the induction of transfer effects. CONCLUSION: Mid-track fences restricting access to high-speed train tracks may have a large effect on reducing the number of railway suicides at intervention stations, but may also induce an increase in suicides at nearby stations without mid-track fences. PRACTICAL APPLICATIONS: Partial physical barriers such as mid-track fencing is deemed to be relatively easy and cheap to install (as compared to full barriers; e.g., full height platform screen doors) and should be considered at all stations on railway lines that have high-speed trains passing by.

Sociodemographic Characteristics Associated With an eHealth System Designed to Reduce Depressive Symptoms Among Patients With Breast or Prostate Cancer: Prospective Study.

BACKGROUND: eHealth interventions have become a topic of interest in the field of mental health owing to their increased coordination and integration of different elements of care, in treating and preventing mental ill health in patients with somatic illnesses. However, poor usability, learnability, and user engagement might affect the effectiveness of an eHealth intervention. Identifying different sociodemographic characteristics that might be associated with higher perceived usability can help improve the usability of eHealth interventions. OBJECTIVE: This study aimed to identify the sociodemographic characteristics that might be associated with the perceived usability of the NEVERMIND (Neurobehavioural Predictive and Personalised Modelling of Depressive Symptoms During Primary Somatic Diseases) eHealth system, comprising a mobile app and a sensorized shirt, in reducing comorbid depressive symptoms in patients with breast or prostate cancer. METHODS: The study included a total of 129 patients diagnosed with breast (n=80, 62%) or prostate (n=49, 38%) cancer, who received a fully automated mobile app and sensorized shirt (NEVERMIND system). Sociodemographic data on age, sex, marital status, education level, and employment status were collected at baseline. Usability outcomes included the System Usability Scale (SUS), a subjective measure that covers different aspects of system usability; the user version of the Mobile App Rating Scale (uMARS), a user experience questionnaire; and a usage index, an indicator calculated from the number of days patients used the NEVERMIND system during the study period. RESULTS: The analysis was based on 108 patients (n=68, 63%, patients with breast cancer and n=40, 37%, patients with prostate cancer) who used the NEVERMIND system for an average of 12 weeks and completed the study. The overall mean SUS score at 12 weeks was 73.4 (SD 12.5), which indicates that the NEVERMIND system has good usability, with no statistical differences among different sociodemographic characteristics. The global uMARS score was 3.8 (SD 0.3), and women rated the app higher than men (ß=.16; P=.03, 95% CI 0.02-0.3), after adjusting for other covariates. No other sociodemographic characteristics were associated with higher uMARS scores. There was a statistical difference in the use of the NEVERMIND system between women and men. Women had significantly lower use (ß=-0.13; P=.04, 95% CI -0.25 to -0.01), after adjusting for other covariates. CONCLUSIONS: The findings suggest that the NEVERMIND system has good usability according to the SUS and uMARS scores. There was a higher favorability of mobile apps among women than among men. However, men had significantly higher use of the NEVERMIND system. Despite the small sample size and low variability, there is an indication that the NEVERMIND system does not suffer from the digital divide, where certain sociodemographic characteristics are more associated with higher usability. TRIAL REGISTRATION: German Clinical Trials Register RKS00013391; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013391.

The NEVERMIND e-health system in the treatment of depressive symptoms among patients with severe somatic conditions: A multicentre, pragmatic randomised controlled trial.

Background: This study assessed the effectiveness of the NEVERMIND e-health system, consisting of a smart shirt and a mobile application with lifestyle behavioural advice, mindfulness-based therapy, and cognitive behavioural therapy, in reducing depressive symptoms among patients diagnosed with severe somatic conditions. Our hypothesis was that the system would significantly decrease the level of depressive symptoms in the intervention group compared to the control group. Methods: This pragmatic, randomised controlled trial included 425 patients diagnosed with myocardial infarction, breast cancer, prostate cancer, kidney failure, or lower limb amputation. Participants were recruited from hospitals in Turin and Pisa (Italy), and Lisbon (Portugal), and were randomly assigned to either the NEVERMIND intervention or to the control group. Clinical interviews and structured questionnaires were administered at baseline, 12 weeks, and 24 weeks. The primary outcome was depressive symptoms at 12 weeks measured by the Beck Depression Inventory II (BDI-II). Intention-to-treat analyses included 425 participants, while the per-protocol analyses included 333 participants. This trial is registered in the German Clinical Trials Register, DRKS00013391. Findings: Patients were recruited between Dec 4, 2017, and Dec 31, 2019, with 213 assigned to the intervention and 212 to the control group. The sample had a mean age of 59·41 years (SD=10·70), with 44·24% women. Those who used the NEVERMIND system had statistically significant lower depressive symptoms at the 12-week follow-up (mean difference=-3·03, p<0·001; 95% CI -4·45 to -1·62) compared with controls, with a clinically relevant effect size (Cohen's d=0·39). Interpretation: The results of this study show that the NEVERMIND system is superior to standard care in reducing and preventing depressive symptoms among patients with the studied somatic conditions. Funding: The NEVERMIND project received funding from the European Union's Horizon 2020 Research and Innovation Programme under grant agreement No. 689691.

Relation between occupation, gender dominance in the occupation and workplace and suicide in Sweden: a longitudinal study.

OBJECTIVES: To describe the association between occupations and suicide, and to explore the effect of gender dominance in the occupation and in the workplace on the risk of suicide. DESIGN: Register-based cohort study. PARTICIPANTS: 3 318 050 workers in Sweden in 2005 and followed up until 2010. Exclusion criteria for the study were: missing information in the occupational codes, yearly income of <100 Swedish krona, missing information of the employer, death or migration, and registered occupational code reported from more than 5 years ago. OUTCOME: Suicides occurring during 2006-2010 identified in the cause of death register by the International Classification of Diagnoses-10 codes X60-84 and Y10-34. RESULTS: Occupations with increased suicide were life science and health professionals (OR: 2.8, 95% CI: 1.50 to 5.26) among women. In men, these were metal, machinery and related workers (OR: 1.5, 95% CI: 1.09 to 2.05) and personal and protective service workers (OR: 1.59, 95% CI: 1.14 to 2.22). In terms of gender dominance in the occupation, borderline associations with increased suicide risk were found for men in both male-dominated (OR: 1.32, 95% CI: 0.98 to 1.79) and female-dominated (OR: 1.37, 95% CI: 0.99 to 1.91) occupations. For women, borderline increased risk of suicide was found in female-dominated occupations (OR: 1.51, 95% CI: 0.95 to 2.40). Finally, men showed a borderline increased risk of suicide in female-dominated workplaces (OR: 1.31, 95% CI: 0.94 to 1.81). CONCLUSIONS: This study found that women in the 'life science and health professionals' group and men in the 'metal, machinery and related workers' as well as 'personal and protective service workers' groups have increased incidence of suicide also when adjusting for sociodemographic characteristics, precariousness of the employment relationship, spells of unemployment, previous mental disorders and suicide attempts. Moreover, gender dominance at workplace and occupation seems to be associated with the risk of suicide among men. The results of our study are novel and are worth exploring in future qualitative studies.

Suicides during the Swedish midsummer holiday: analysis of cause of death data 1980-2018.

INTRODUCTION: Previous studies have demonstrated increased suicide rates on holidays such as New Year, nationally and internationally. Comparable to New Year's Eve, Swedish Midsummer is a major holiday, linked to high levels of alcohol consumption in the population. We, therefore, hypothesized that suicides and deaths with undetermined intent would increase during the Midsummer celebration. METHODS: We used a retrospective death registry design to investigate all suicides that occurred on Midsummer's Eve (ME), Midsummer's Day (MD) and 28 adjacent days (AD) during 1980-2018. Data were stratified by diagnosis type, sex and age, and was analyzed with paired t-tests, Poisson regression, and time-series charts with 95% confidence intervals. RESULTS: During the 30-day investigation period, the observed average was 4.3 deaths per day (23.3% cases with undetermined intent). ME, but not MD, was associated with significantly fewer suicides compared to AD (-1.08 deaths, p < .01). ME, but not MD, was simultaneously associated with more deaths with undetermined intent (+0.58 deaths, p = .007). No moderating sex or age effects were found. Descriptive statistics showed that poisonings, drownings and traffic-related injuries were common among the undetermined ME cases. DISCUSSION: The study found that suicide decreases and deaths with undetermined intent increases on ME. The findings are interpreted considering that substance use may affect both suicidal intentions and diagnosis classifications. Social and cultural support and holiday anticipations might also account for suicidal behaviors on ME.

Measuring Attitudes toward Suicide Prevention among Occupational Staff Frequently Exposed to Suicidal Individuals: Psychometric Evaluation and Validation.

As the attitudes of healthcare staff are thought to influence the quality and effectiveness of interventions targeting patients' suicide risk, attitudes are often used as an outcome in the evaluation of suicide-preventive training. Due to various problems related to the validity and reliability of commonly used scales, there is a lack of overall agreement on how to measure these attitudes. Confirmatory factor analysis (CFA) was used to cross-validate previously used models and to investigate new models to measure professionals' attitudes toward work with suicidal individuals and to test the longitudinal stability of the models by analyzing new sets of data. The population in the first study consisted of a heterogenous group of 1350 professionals who managed suicidal individuals relatively frequently. The second study included 640 professionals. The results of the cross-validation of previous models were described and a new questionnaire measuring attitudes toward suicide prevention, suicidal individuals, and organizational-facilitated self-efficacy (OSAQ-12) was presented. The three presented models retained a good fit and were stable over time. Valid and reliable measurement models that measure aspects of attitudes toward suicide are a prerequisite for conducting both cross-sectional and intervention studies.

A Naturalistic, European Multi-Center Clinical Study of Electrodermal Reactivity and Suicide Risk Among Patients With Depression.

Background: Electrodermal hyporeactivity has been proposed as a marker of suicidal risk. The EUDOR-A study investigated the prevalence of electrodermal hyporeactivity among patients with depression and its association with attempted and completed suicide. Methods: Between August 2014 and March 2016, 1,573 in- and outpatients with a primary diagnosis of depression (active or remission phase) were recruited at 15 European psychiatric centers. Each patient was followed-up for 1 year. Electrodermal activity was assessed at baseline with the ElectroDermal Orienting Reactivity Test. Data on the sociodemographic characteristics, clinical diagnoses, and treatment of the subjects were also collected. The severity of the depressive symptoms was assessed through the Montgomery-Asberg Depression Rating Scale. Information regarding number, time, and method of suicide attempts was gathered at baseline and at the end of the 1-year follow-up. The same data were collected in case of completed suicide. Results: Hyporeactive patients were shown to be significantly more at risk of suicide attempt compared to reactive patients, both at baseline and follow-up. A sensitivity of 29.86% and a positive predictive value (PPV) of 46.77% were found for attempted suicide at baseline, while a sensitivity of 35.36% and a PPV of 8.92% were found for attempted suicide at follow-up. The sensitivity and PPV for completed suicide were 25.00 and 0.61%, respectively. However, when controlled for suicide attempt at baseline, the association between hyporeactivity and follow-up suicide attempt was no longer significant. The low number of completed suicides did not allow any analysis.

Serious and persistent suicidality among European sexual minority youth.

BACKGROUND: Suicide is a leading cause of death among adolescents and more knowledge from high risk groups is needed in order to develop effective preventive strategies. The aim of this study was to evaluate the association between sexual minority status and suicidality in a multinational sample of European school pupils. METHODS: A self-report questionnaire was delivered to 2046 adolescents (mean age 15.34±1.01; 56.3% females) recruited from 27 randomly selected schools in 6 European countries. Suicidal ideation, measured with the Paykel Suicide Scale (PSS), and lifetime suicide attempts were compared between heterosexual and sexual minority (i.e. those with a non-heterosexual orientation) youth. Poisson regression analyses studied the longitudinal association between sexual minority status and the rate of serious suicidal ideation, measured at three time-points during a 4-month period. Several variables, including alcohol and illegal drugs use, bullying, family interaction, school-related stress, economic status, and religiosity, were included in multivariable analysis. Sex-stratified analyses evaluated the association respectively among females and males. RESULTS: Of 1958 pupils included in analysis (mean age 15.35±1.00; females 56.8%), 214 (10.9%) were categorized as sexual minority youth (SMY). When compared to heterosexual youth (HSY), SMY were significantly more exposed to substance abuse, bullying, school-related stress, and lower economic status. SMY pupils had significantly higher suicidal ideation scores (p<0.001; r 0.145) as well as higher prevalence of serious suicidal ideation (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.83-3.79) and previous suicide attempts (OR 2.72, 95%CI 1.77-4.18), compared to their HSY peers. The rate of serious suicidal ideation reports during the study was significantly higher among SMY compared to HSY (rate ratio [RR] 2.55, 95%CI 1.90-3.43). A significant difference was found even when controlling for the pupils' country as well as after adjustment for alcohol and illegal drugs use, bullying, family interaction, school-related stress, economic status, and religiosity (adjusted RR 1.73, 95%CI 1.23-2.48). Stratified analyses showed significant associations between SMY status and persistent serious suicidal ideation for both sexes, with a notably strong association among male pupils (females aRR 1.51, 95%CI 1.01-2.24; males aRR 3.84, 95%CI 1.94-7.59). CONCLUSIONS: European sexual minority youth are a high-risk group for suicidality, independently from objective factors such as victimization or substance abuse. There is a need to develop primary and secondary preventive measures for sexual minority youth, including the management of context vulnerabilities and related distal stressors, before the establishment of proximal stressors. Context-targeting interventions may effectively focus on social and economic factors, as well as on the potentially different risk profile of female and male sexual minority youth.

Suicidal Thoughts and Behaviors Among Swedish Suicide-Bereaved Women: Increased Risk Associated With the Loss of a Child, Feelings of Guilt and Shame, and Perceived Avoidance From Family Members.

Previous studies have shown that suicide-bereaved individuals may suffer increased risk of suicidal thoughts and behaviors (STBs) due to traumatic grief. In this paper, we present the self-reported rate of STB among Swedish suicide-bereaved women (N = 293). Data was collected in a cross-sectional anonymous survey on the homepages of Sweden's leading suicide survivor organization, SPES. We used logistic regression to evaluate risks (of any STB event) related to losing a child compared to other relatives and the experience of social avoidance from family members, as well as feelings of shame and guilt. The self-reported rate of suicidal thoughts, plans, and attempts was 60, 24, and 5 percent, respectively, considerably higher than in the general population. Results showed that all of the investigated variables were independent risk factors for STB (ORs ranged between 1.29 and 2.69). Women who had both lost a child and experienced family avoidance reported the highest STB rate (87.5%), and we found an interaction effect between these two risk factors (OR = 3.45; 95% CI = 1.05-11.32) that was related to self-reported shame. It is concluded that perceived responsibility for someone else's suicide, and the social avoidance associated with it, may play an important role for suicide survivors and should be targeted by postvention activities.

A protocol for a multicentre, parallel-group, pragmatic randomised controlled trial to evaluate the NEVERMIND system in preventing and treating depression in patients with severe somatic conditions.

BACKGROUND: Depressive symptoms are common in individuals suffering from severe somatic conditions. There is a lack of interventions and evidence-based interventions aiming to reduce depressive symptoms in patients with severe somatic conditions. The aim of the NEVERMIND project is to address these issues and provide evidence by testing the NEVERMIND system, designed to reduce and prevent depressive symptoms in comparison to treatment as usual. METHODS: The NEVERMIND study is a parallel-groups, pragmatic randomised controlled trial to assess the effectiveness of the NEVERMIND system in reducing depressive symptoms among individuals with severe somatic conditions. The NEVERMIND system comprises a smart shirt and a user interface, in the form of a mobile application. The system is a real-time decision support system, aiming to predict the severity and onset of depressive symptoms by modelling the well-being condition of patients based on physiological data, body movement, and the recurrence of social interactions. The study includes 330 patients who have a diagnosis of myocardial infarction, breast cancer, prostate cancer, kidney failure, or lower limb amputation. Participants are randomised in blocks of ten to either the NEVERMIND intervention or treatment as usual as the control group. Clinical interviews and structured questionnaires are administered at baseline, at 12 weeks, and 24 weeks to assess whether the NEVERMIND system is superior to treatment as usual. The endpoint of primary interest is Beck Depression Inventory II (BDI-II) at 12 weeks defined as (i) the severity of depressive symptoms as measured by the BDI-II. Secondary outcomes include prevention of the onset of depressive symptoms, changes in quality of life, perceived stigma, and self-efficacy. DISCUSSION: There is a lack of evidence-based interventions aiming to reduce and prevent depressive symptoms in patients with severe somatic conditions. If the NEVERMIND system is effective, it will provide healthcare systems with a novel and innovative method to attend to depressive symptoms in patients with severe somatic conditions. TRIAL REGISTRATION: DRKS00013391. Registered 23 November 2017.

The Fear of Losing-Nonsuicidal Self-Injury as a Protective Mechanism in Eating Disorders.

Background: This study examined the moderating role of loss aversion (LA) on the relationship between impulsivity, nonsuicidal self-injury (NSSI), suicidal attempts, and ideations among Eating Disorder (ED) patients. Methods: Data was collected on 81 ED patients and 37 healthy controls. ED patients were divided into 2 groups: 25 AN-Rs, 56 AN-BPs and BNs. Measurements of trait impulsivity, LA, NSSI, suicide attempts, and suicide ideations were collected. Results: The rate of attempting suicide was highest in the AN-BP/BN (34.8%), lower in the AN-Rs (8%), and the lowest in the controls (2.7%). Suicide ideation was also higher in AN-BP/BN compared to both AN-R and controls. NSSI was higher in the AN-BP/BN group compared to both AN-R and control groups. LA scores were lower among participants with EDs compared to controls. BMI and depression were positively associated with suicide ideation and NSSI. Impulsivity was associated to suicide attempt and suicide ideation. Contrary to our hypothesis, LA scores were positively correlated with NSSI and SI. A stepwise regression revealed that contradictory to our hypothesis, higher LA predicted NSSI prevalence severity of NSSI and suicide ideation. Limitations: (1) Cross-sectional design; (2) Relatively small sample size of clinical subjects and only female participants; (3) Heterogeneity of treatment status. Conclusions: EDs are associated with lower levels of LA compared to general population. Although high LA is considered a protective factor against "high damage" decisions, it may serve as a facilitator of lower risk decisions which help the individual soothe and communicate his or her own suffering such as NSSI.

A longitudinal examination of the interpersonal theory of suicide and effects of school-based suicide prevention interventions in a multinational study of adolescents.

BACKGROUND: Predictions of two different models for suicide attempts (SA) over 12 months, as differentially impacted by specific school-based suicide prevention interventions, were compared. These were as follows: (a) interpersonal theory (IPTS) and (b) a two-pathway model, one path associated with externalizing symptoms and continuum of self-harm behaviors, and the other with internalizing symptoms. METHODS: Self-report questionnaires were completed by 11,110 high school students from ten EU countries enrolled in the Saving and Empowering Young Lives in Europe (SEYLE) study. Baseline measures included perceived burdensomeness, thwarted belongingness from parents and peers, health risk behaviors, self-injury, suicide ideation (SI), and attempts (SA). SI and SA were reassessed at 12-month follow-up. Each model's predictions of SI and SA groups over time (i.e., repeated SA, remitted SA, SA onset, and no SA) were estimated in the no intervention/control group. The superior model was estimated across intervention groups. RESULTS: Interpersonal theory showed better fit compared to the two-pathway model. In partial agreement with IPTS predictions, parental low belongingness but not peer belongingness or burdensomeness predicted greater likelihood of SI. The likelihood of repeated SA versus no SA was higher among adolescents who reported SI, self-injury, risk behaviors, and particularly both SI and self-injury. All three interventions attenuated the combined effect of SI and self-injury. Youth Aware of Mental Health Program (YAM) additionally decreased the effect of risk behaviors on the likelihood of repeated SA. CONCLUSIONS: Interpersonal theory assumptions were partially supported. Perceived interpersonal difficulties with parents were primarily related with SI, and risk behaviors and self-injury were important predictors of SA. Suicide prevention interventions may be effective by mitigating the hazardous effect of varying self-harm behaviors and may be further advanced by increasing parental involvement.

Risk Assessment Tools and Data-Driven Approaches for Predicting and Preventing Suicidal Behavior.

Risk assessment of suicidal behavior is a time-consuming but notoriously inaccurate activity for mental health services globally. In the last 50 years a large number of tools have been designed for suicide risk assessment, and tested in a wide variety of populations, but studies show that these tools suffer from low positive predictive values. More recently, advances in research fields such as machine learning and natural language processing applied on large datasets have shown promising results for health care, and may enable an important shift in advancing precision medicine. In this conceptual review, we discuss established risk assessment tools and examples of novel data-driven approaches that have been used for identification of suicidal behavior and risk. We provide a perspective on the strengths and weaknesses of these applications to mental health-related data, and suggest research directions to enable improvement in clinical practice.