Gun Violence Exposure and Suicide Among Black Adults.

Importance: Black individuals are disproportionately exposed to gun violence in the US. Suicide rates among Black US individuals have increased in recent years. Objective: To evaluate whether gun violence exposures (GVEs) are associated with suicidal ideation and behaviors among Black adults. Design, Setting, and Participants: This cross-sectional study used survey data collected from a nationally representative sample of self-identified Black or African American (hereafter, Black) adults in the US from April 12, 2023, through May 4, 2023. Exposures: Ever being shot, being threatened with a gun, knowing someone who has been shot, and witnessing or hearing about a shooting. Main Outcomes and Measures: Outcome variables were derived from the Self-Injurious Thoughts and Behaviors Interview, including suicidal ideation, suicide attempt preparation, and suicide attempt. A subsample of those exhibiting suicidal ideation was used to assess for suicidal behaviors. Results: The study sample included 3015 Black adults (1646 [55%] female; mean [SD] age, 46.34 [0.44] years [range, 18-94 years]). Most respondents were exposed to at least 1 type of gun violence (1693 [56%]), and 300 (12%) were exposed to at least 3 types of gun violence. Being threatened with a gun (odds ratio [OR], 1.44; 95% CI, 1.01-2.05) or knowing someone who has been shot (OR, 1.44; 95% CI, 1.05-1.97) was associated with reporting lifetime suicidal ideation. Being shot was associated with reporting ever planning a suicide (OR, 3.73; 95% CI, 1.10-12.64). Being threatened (OR, 2.41; 95% CI, 2.41-5.09) or knowing someone who has been shot (OR, 2.86; 95% CI, 1.42-5.74) was associated with reporting lifetime suicide attempts. Cumulative GVE was associated with reporting lifetime suicidal ideation (1 type: OR, 1.69 [95% CI, 1.19-2.39]; 2 types: OR, 1.69 [95% CI, 1.17-2.44]; ≥3 types: OR, 2.27 [95% CI, 1.48-3.48]), suicide attempt preparation (≥3 types; OR, 2.37; 95% CI, 2.37-5.63), and attempting suicide (2 types: OR, 4.78 [95% CI, 1.80-12.71]; ≥3 types: OR, 4.01 [95% CI, 1.41-11.44]). Conclusions and Relevance: In this cross-sectional study, GVE among Black adults in the US was significantly associated with lifetime suicidal ideation and behavior. Public health efforts to substantially reduce interpersonal gun violence may yield additional benefits by decreasing suicide among Black individuals in the US.

Transgender Identity and Suicide Attempts and Mortality in Denmark.

Importance: Prior studies have suggested that transgender individuals may be a high-risk group with respect to suicide attempt and mortality, but large-scale, population-based investigations are lacking. Objective: To examine in a national setting whether transgender individuals have higher rates of suicide attempt and mortality than nontransgender individuals. Design, Setting, and Participants: Nationwide, register-based, retrospective cohort study on all 6 657 456 Danish-born individuals aged 15 years or older who lived in Denmark between January 1, 1980, and December 31, 2021. Exposure: Transgender identity was determined through national hospital records and administrative records of legal change of gender. Main Outcomes and Measures: Suicide attempts, suicide deaths, nonsuicidal deaths, and deaths by any cause during 1980 through 2021 were identified in national hospitalization and causes of death registers. Adjusted incidence rate ratios (aIRRs) with 95% CIs controlling for calendar period, sex assigned at birth, and age were calculated. Results: The 6 657 456 study participants (50.0% assigned male sex at birth) were followed up during 171 023 873 person-years. Overall, 3759 individuals (0.06%; 52.5% assigned male sex at birth) were identified as transgender at a median age of 22 years (IQR, 18-31 years) and followed up during 21 404 person-years, during which 92 suicide attempts, 12 suicides, and 245 suicide-unrelated deaths occurred. Standardized suicide attempt rates per 100 000 person-years were 498 for transgender vs 71 for nontransgender individuals (aIRR, 7.7; 95% CI, 5.9-10.2). Standardized suicide mortality rates per 100 000 person-years were 75 for transgender vs 21 for nontransgender individuals (aIRR, 3.5; 95% CI, 2.0-6.3). Standardized suicide-unrelated mortality rates per 100 000 person-years were 2380 for transgender vs 1310 for nontransgender individuals (aIRR, 1.9; 95% CI, 1.6-2.2), and standardized all-cause mortality rates per 100 000 person-years were 2559 for transgender vs 1331 for nontransgender individuals (aIRR, 2.0; 95% CI, 1.7-2.4). Despite declining rates of suicide attempts and mortality during the 42 years covered, aIRRs remained significantly elevated in recent calendar periods up to and including 2021 for suicide attempts (aIRR, 6.6; 95% CI, 4.5-9.5), suicide mortality (aIRR, 2.8; 95% CI, 1.3-5.9), suicide-unrelated mortality (aIRR, 1.7; 95% CI, 1.5-2.1), and all-cause mortality (aIRR, 1.7; 95% CI, 1.4-2.1). Conclusions and Relevance: In this Danish population-based, retrospective cohort study, results suggest that transgender individuals had significantly higher rates of suicide attempt, suicide mortality, suicide-unrelated mortality, and all-cause mortality compared with the nontransgender population.

Evaluation of the Risk Identification for Suicide and Enhanced Care Model in a Native American Community.

Importance: There are many prognostic models of suicide risk, but few have been prospectively evaluated, and none has been developed specifically for Native American populations. Objective: To prospectively validate a statistical risk model implemented in a community setting and evaluate whether use of this model was associated with improved reach of evidence-based care and reduced subsequent suicide-related behavior among high-risk individuals. Design, Setting, and Participants: This prognostic study, done in partnership with the White Mountain Apache Tribe, used data collected by the Apache Celebrating Life program for adults aged 25 years or older identified as at risk for suicide and/or self-harm from January 1, 2017, through August 31, 2022. Data were divided into 2 cohorts: (1) individuals and suicide-related events from the period prior to suicide risk alerts being active (February 29, 2020) and (2) individuals and events from the time after alerts were activated. Main Outcomes and Measures: Aim 1 focused on a prospective validation of the risk model in cohort 1. Aim 2 compared the odds of repeated suicide-related events and the reach of brief contact interventions among high-risk cases between cohort 2 and cohort 1. Results: Across both cohorts, a total of 400 individuals identified as at risk for suicide and/or self-harm (mean [SD] age, 36.5 [10.3] years; 210 females [52.5%]) had 781 suicide-related events. Cohort 1 included 256 individuals with index events prior to active notifications. Most index events (134 [52.5%]) were for binge substance use, followed by 101 (39.6%) for suicidal ideation, 28 (11.0%) for a suicide attempt, and 10 (3.9%) for self-injury. Among these individuals, 102 (39.5%) had subsequent suicidal behaviors. In cohort 1, the majority (220 [86.3%]) were classified as low risk, and 35 individuals (13.3%) were classified as high risk for suicidal attempt or death in the 12 months after their index event. Cohort 2 included 144 individuals with index events after notifications were activated. For aim 1, those classified as high risk had a greater odds of subsequent suicide-related events compared with those classified as low risk (odds ratio [OR], 3.47; 95% CI, 1.53-7.86; P = .003; area under the receiver operating characteristic curve, 0.65). For aim 2, which included 57 individuals classified as high risk across both cohorts, during the time when alerts were inactive, high-risk individuals were more likely to have subsequent suicidal behaviors compared with when alerts were active (OR, 9.14; 95% CI, 1.85-45.29; P = .007). Before the active alerts, only 1 of 35 (2.9%) individuals classified as high risk received a wellness check; after the alerts were activated, 11 of 22 (50.0%) individuals classified as high risk received 1 or more wellness checks. Conclusions and Relevance: This study showed that a statistical model and associated care system developed in partnership with the White Mountain Apache Tribe enhanced identification of individuals at high risk for suicide and was associated with a reduced risk for subsequent suicidal behaviors and increased reach of care.

Multifaceted risk for non-suicidal self-injury only versus suicide attempt in a population-based cohort of adults.

BACKGROUND: Non-suicidal self-injury and suicide attempt represent significant public health concerns. While these outcomes are related, there is prior evidence that their etiology does not entirely overlap. Efforts to directly differentiate risk across outcomes are uncommon, particularly among older, population-based cohorts. METHODS: This research has been conducted using the UK Biobank. Data on individuals' self-reported history of non-suicidal self-injury only versus suicide attempt (maximum N = 6643) were analyzed. Applying LASSO and standard logistic regression, participants reporting one of these outcomes were assessed for differences across a range of sociodemographic, behavioral, and environmental features. RESULTS: Sociodemographic features most strongly differentiated between the outcomes of non-suicidal self-injury only versus suicide attempt. Specifically, Black individuals were more likely to report a suicide attempt, as were those of mixed race, those endorsing higher levels of depressive symptoms or trauma history, and those who had experienced financial problems (odds ratios 1.02-3.92). Those more likely to engage in non-suicidal self-injury only were younger, female, had higher levels of education, those who resided with a partner, and those who had a recently injured relative. LIMITATIONS: Differences in timing across correlates and outcomes preclude the ability to establish causal pathways. CONCLUSIONS: The factors identified in the current study as differentially associated with non-suicidal self-injury only versus suicide attempt provide further evidence of at least partially distinct correlates, and warrant follow-up in independent samples to investigate causality.

Interpretable Estimation of Suicide Risk and Severity from Complete Blood Count Parameters with Explainable Artificial Intelligence Methods.

BACKGROUND: The peripheral inflammatory markers are important in the pathophysiology of suicidal behavior. However, methods for practical uses haven't been developed enough yet. This study developed predictive models based on explainable artificial intelligence (xAI) that use the relationship between complete blood count (CBC) values and suicide risk and severity of suicide attempt. SUBJECTS AND METHODS: 544 patients who attempted an incomplete suicide between 2010-2020 and 458 healthy individuals were selected. The data were obtained from the electronic registration systems. To develop prediction models using CBC values, the data were grouped in two different ways as suicidal/healthy and attempted/non-attempted violent suicide. The data sets were balanced for the reliability of the results of the machine learning (ML) models. Then, the data was divided into two; 80% of as the training set and 20% as the test set. For suicide prediction, models were created with Random Forest, Logistic Regression, Support vector machines and XGBoost algorithms. SHAP, was used to explain the optimal model. RESULTS: Of the four ML methods applied to CBC data, the best-performing model for predicting both suicide risk and suicide severity was the XGBoost model. This model predicted suicidal behavior with an accuracy of 0.83 (0.78-0.88) and the severity of suicide attempt with an accuracy of 0.943 (0.91-0.976). Lower levels of NEU, WBC, MO, NLR, MLR and, age higher levels of HCT, PLR, PLT, HGB, RBC, EO, MPV and, BA contributed positively to the predictive created model for suicide risk, while lower PLT, BA, PLR and RBC levels and higher MO, EO, HCT, LY, MLR, NEU, NLR, WBC, HGB and, age levels have a positive contribution to the predictive created model for violent suicide attempt. CONCLUSION: Our study suggests that the xAI model developed using CBC values may be useful in detecting the risk and severity of suicide in the clinic.

Effects of social deprivation on risk factors for suicidal ideation and suicide attempts in commercially insured US youth and adults.

We used US nationwide commercial insurance claims data (2011-2015) to study the effect of social deprivation on clinical and demographic risk factors for suicidal ideation (SI) and suicide attempts (SA) among US youth and adults < 65 years, after having a mental health or substance use disorder-related outpatient encounter. Neighborhood social deprivation level was summarized by the quintile of social deprivation index (SDI) at individuals' zip code level. Cox proportional hazard models were used to evaluate the effect of social deprivation on demographic and clinical risk factors for SI and SA. The study cohort consisted of 317,383 individuals < 65 years, with 124,424 aged < 25 (youth) and 192,959 aged between 25 and 64 (adults). Neighborhood social deprivation impacted risk factors for SI and SA differently for youth and adults. Among youth, SDI interacted with multiple risk factors for both SI and SA. The effects of the risk factors were larger on youth from middle socioeconomic neighborhoods. Among adults, risk of SI was the strongest in the most deprived neighborhoods, but risk of SA did not vary by neighborhood deprivation level. Our findings suggest community-based suicide prevention initiatives should be tailored according to neighborhood deprivation level and the targeted individual's age to maximize the impact.

The Association Between Resiliency Factors and Suicide Indicators Among American Indian/Alaska Native Middle School Students in New Mexico: A Strength-Based Analysis.

OBJECTIVE: Suicide is a leading cause of death among American Indian/Alaska Native (AI/AN) young people aged 10-19 years in the United States, but data collection and reporting in this population are lacking. We examined results of an oversample project in New Mexico to determine the association between resiliency factors and suicide-related behaviors among AI/AN middle school students. METHODS: We conducted analyses using data from the 2019 New Mexico Youth Risk and Resiliency Survey for students in grades 6 through 8. An oversampling method was used to increase the sample size of AI/AN students. We used logistic regression to determine the association between resiliency factors and suicide indicators among AI/AN students, stratified by sex. RESULTS: Among female AI/AN students, community support had the strongest protective effect against having seriously thought about suicide (adjusted odds ratio [aOR] = 0.23; 95% CI, 0.14-0.38), while family support was significantly associated with the lowest odds of having made a suicide plan (aOR = 0.15; 95% CI, 0.08-0.28) and having attempted suicide (aOR = 0.21; 95% CI, 0.13-0.34) (P < .001 for all). Among male AI/AN students, school support had the strongest protective effect against all 3 outcomes: seriously thought about suicide (aOR = 0.34; 95% CI, 0.19-0.62; P < .001), having made a suicide plan (aOR = 0.19; 95% CI, 0.09-0.39; P < .001), and having attempted suicide (aOR = 0.27; 95% CI, 0.12-0.65; P = .003). CONCLUSIONS: Oversampling AI/AN young people can help accurately quantify and understand health risk behaviors and strengths of this population, leading to improved health and wellness. Family, community, and school-based support should be considered in interventions geared toward suicide prevention among AI/AN young people.

Digital self-harm and suicidality among adolescents.

BACKGROUND: Research on digital self-harm - the anonymous online posting, sending, or otherwise sharing of hurtful content about oneself - is still in its infancy. Yet unexplored is whether digital self-harm is related to suicidal ideation or suicide attempts. METHODS: In the current study, survey data were collected in 2019 from a national sample of 4972 American middle and high school students (Mage = 14.5; 50% female). Logistic regression analysis was used to assess whether lifetime engagement in two different indicators of digital self-harm was associated with suicidal thoughts and attempts within the past year. RESULTS: Logistic regression analysis showed that engagement in digital self-harm was associated with a five- to sevenfold increase in the likelihood of reporting suicidal thoughts and a nine- to 15-fold increase in the likelihood of a suicide attempt. CONCLUSIONS: Results suggest a connection between digital self-harm and suicidality. As such, health professionals must screen for digital self-harm to address underlying mental health problems among youth that may occur prior to or alongside suicidality, and parents/caregivers must convey to children that they are available to dialog, support, and assist with the root issues that may eventually manifest as digital self-harm.

Age Differences in the Associations Between Outness and Suicidality Among LGBTQ+ Youth.

OBJECTIVE: Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) youth are at increased risk for suicidality compared to their heterosexual and cisgender peers, and outness (the extent to which an individual is open about their LGBTQ+ identity to others) is an important correlate of suicidality. However, previous research has led to mixed findings regarding whether outness functions as a risk or protective factor for suicidality, and the available evidence suggests that age may play an important role. As such, the goal of the current study was to examine whether the associations between outness and suicidality differed between LGBTQ+ adolescents (ages 12-17) and emerging adults (ages 18-24). METHOD: The analytic sample included 475 LGBTQ+ youth who completed an online survey after contacting a national, LGBTQ+ crisis service provider. RESULTS: Results indicated that age significantly moderated the association between outness and suicidal ideation, such that greater outness was significantly associated with greater suicidal ideation for adolescents, but not for emerging adults. In contrast, age did not significantly moderate the associations between outness and likelihood of a past suicide attempt or perceived likelihood of a future suicide attempt. However, the main effect of outness was significant in both models, such that greater outness was significantly associated with a greater likelihood of a past suicide attempt and a greater perceived likelihood of a future suicide attempt. CONCLUSIONS: These findings suggest that the associations between outness and suicidality among LGBTQ+ youth may depend on age as well as the dimension of suicidality (ideation versus attempt). HighlightsBeing more open about one's LGBTQ+ identity may confer risk for suicidality.The influence of outness on suicidal ideation may be strongest during adolescence.There is a need for LGBTQ+ affirming policies and laws to reduce suicidality.

Parental suicide attempts and offspring's risk of attempting or dying by suicide: does the timing of a parental suicide attempt matter?

BACKGROUND: Studies on the transmission of suicide risk have focused on parental history of suicide attempts (SAs), overlooking when the attempt happened. This study examined how the offspring's risk of attempting or dying by suicide varied by the timing of a first parental SA and the sex of the parent who attempted suicide. METHODS: Participants were 59 469 members of the 1987 Finnish Birth Cohort. The Finnish Hospital Discharge and Cause of Death Registers were the sources for parental and offspring SAs and offspring suicide. Timing of parental SA was coded as before (pre-pregnancy and pregnancy) and after the child's birth [infant/toddler years (0-2 years), childhood (3-11 years), adolescence (12-17 years), and young adulthood (18-26 years)]. RESULTS: In the multivariate models, having a parent who attempted suicide increased the offspring's risk of attempting suicide (odds ratio (OR) = 1.77, 95% confidence interval (CI) 1.39-2.25), but not of dying by suicide. Compared to unexposed offspring, those exposed after child's birth were at higher risk of attempting suicide (OR = 1.90, 95% CI 1.46-2.47), specifically when the parent attempted during offspring's childhood, adolescence, and young adulthood. A first maternal SA increased offspring's risk of attempting suicide regardless of the timing. CONCLUSIONS: The impact of a parental SA on offspring's risk of attempting suicide differed depending on the timing and sex of the parent who attempted suicide, suggesting that the transmission of suicide risk may occur through genetic as well as environmental factors. Our findings call for an intergenerational approach in suicide risk assessment.

Suicide attempts and mental health diagnoses in combat-injured service members: A retrospective cohort study.

INTRODUCTION: Examinations of risk factors for suicide attempt in United States service members at high risk of mental health diagnoses, such as those with combat injuries, are essential to guiding prevention and intervention efforts. METHODS: Retrospective cohort study of 8727 combat-injured patients matched to deployed, non-injured patients utilizing Department of Defense and Veterans Affairs administrative records. RESULTS: Combat injury was positively associated with suicide attempt in the univariate model (HR = 1.75, 95% CI 1.5-2.1), but lost significance after adjustment for mental health diagnoses. Utilizing Latent Transition Analysis in the combat-injured group, we identified five mental/behavioral health profiles: (1) Few mental health diagnoses, (2) PTSD and depressive disorders, (3) Adjustment disorder, (4) Multiple mental health comorbidities, and (5) Multiple mental health comorbidities with alcohol use disorder (AUD). Multiple mental health comorbidities with AUD had the highest suicide attempt rate throughout the study and more than four times that of Multiple mental health comorbidities in the first study year (23.4 vs. 5.1 per 1000 person years, respectively). CONCLUSION: Findings indicate that (1) combat injury's impact on suicide attempt is attenuated by mental health and (2) AUD with multiple mental health comorbidities confers heightened suicide attempt risk in combat-injured service members.

Seguimiento por WhatsApp durante un año a pacientes con intento suicida atendidos en el Servicio de Urgencias de un hospital universitario privado / One-year follow- up to suicide attempted patients in the Emergency Department of a private hospital using WhatsApp

El suicidio como problema de salud pública mundial muestra tasas fluctuantes con tendencia a elevarse. Las estrategias en salud pública encaminadas a la reducción del intento y del reintento suicida son la principal alternativa. Objetivo: establecer la incidencia de reintento suicida, oportunidad de atención y adherencia al seguimiento de pacientes atendidos por intento suicida en el servicio de urgencias de un hospital universitario privado. Métodos y participantes: estudio de tipo cohorte prospectiva descriptiva en pacientes ≥18 años con intento suicida de riesgo bajo asignados a tratamiento psiquiátrico ambulatorio y seguido mediante la aplicación WhatsApp durante un año después del egreso. Resultados: la prevalencia de intento suicida de los pacientes que consultaron al servicio de urgencias fue de 0,38%. De 164 pacientes con intento suicida 33 ingresaron al estudio. Tenían una mediana de edad de 23 RI (25-75): 19-33 años, el 87,8% (n: 29) fueron mujeres, 42,4% (n: 22) tenía escolaridad secundaria y 63,6% (n: 21) eran del estrato socioeconómico medio. La incidencia acumulada de reintento suicida fue del 36,3% (n: 12), más frecuente al primer mes. La atención por psiquiatría más temprana fue a las dos semanas del egreso. La adherencia al seguimiento fue del 45,4%. Conclusiones: la incidencia acumulada del reintento suicida fue elevada. La oportunidad de atención y la adherencia al seguimiento fueron bajas. A pesar de los diferentes métodos hasta ahora utilizados, el seguimiento de la conducta suicida sigue siendo difícil. Se necesitan investigaciones que exploren alternativas de intervención de tipo social y comunitario.

Suicide as a global public health issue shows fluctuating rates with a tendency to increase. Public health strategies aimed to reduce suicide attempt and retry are the main alternative. Objective: establish the incidence of suicidal retry, opportunity for care and adherence to treatment in the follow-up of patients treated for suicide attempt in the emergency room of a private University hospital. Methods and participants: a descriptive prospective cohort study in patients ≥18 years of age with a low-risk suicide attempt assigned to outpatient psychiatric treatment and followed up through WhatsApp application for one year after discharge. Results: the prevalence of suicide attempt in patients who consulted the emergency room was 0.38%. Of 164 patients with a suicide attempt, 33 were low risk. With a median age of 23 IR (25-75): 19-33 years, 87.8% (n: 29) were women, 42.4% (n: 22) with secondary school level and 63.6% (n: 21) with middle socioeconomic stratum. 24.2% (n: 8). The accumulate incidence of retry was 36,3% (n: 12), more frequently in the first month. The earlier attention by psychiatry was after two weeks of discharge. The follow-up adherence was of 45,4%. Conclusions: the accumulated incidence for retry was high. The opportunity for outpatient psychiatric care and adherence to follow up were low. Despite the different methods used until now, monitoring suicidal behavior remains difficult. It is necessary research that explore alternatives for community and social intervention.

Atendimento pré-hospitalar às tentativas de suicídio: um estudo transversal / Prehospital care for suicide attempts: a cross-sectional study

OBJETIVO: Caracterizar o atendimento pré-hospitalar às vítimas de tentativa de suicídio. MÉTODOS: Estudo transversal com dados de atendimento pré-hospitalar realizado pelo Serviço de Atendimento Móvel de Urgência (SAMU), em Teresina, Piauí, no período de julho/2015 a dezembro/2018. Foram realizadas análise descritiva com o teste Qui-quadrado de Pearson ou teste exato de Fisher e análise da densidade das tentativas de suicídio pela estimativa de Kernel. RESULTADOS: Os atendimentos às tentativas de suicídio predominaram em mulheres (60,9%), adultos de 20 a 29 anos (28,4%), residentes na Região Centro/Norte (35,9%), aos domingos (16,5%) e nos turnos da tarde (32,9%) e noite (34,9%). Foram relatados reincidências de tentativas (9,2%), histórico de atendimento psiquiátrico (14,1%), uso abusivo de álcool (17,5%) e outras drogas (4,6%). O atendimento em ambulâncias de suporte avançado e maior mortalidade antes do socorro foram mais frequentes em vítimas do sexo masculino (40,8% e 5,8%, respectivamente). A Zona Centro/Norte da cidade concentrou as ocorrências para ambos os sexos. CONCLUSÃO: Os atendimentos pré-hospitalares às tentativas de suicídio em Teresina demonstraram grande demanda por vítimas do sexo feminino e jovens e maior densidade de ocorrência na Zona Centro/Norte da cidade. O uso de bebida alcoólica, os meios de autolesão mais letais e a mortalidade foram associados ao sexo masculino. Faz-se necessário divulgar essas informações, capacitar os profissionais sobre a prevenção e abordagem às tentativas de suicídio, além de promover políticas públicas capazes de reduzir as tentativas de suicídio.

OBJECTIVE: To characterize pre-hospital care for victims of attempted suicide. METHODS: Cross-sectional study with pre-hospital care data conducted by the Mobile Emergency Care Service (SAMU), in Teresina, Piauí, from July/2015 to December/2018. Descriptive analysis was performed using Pearson's chi-square test or Fisher's exact test and analysis of the density of suicide attempts using the Kernel estimate. RESULTS: Attendance to suicide attempts predominated in women (60,9%), adults aged 30 to 59 years (46,8%), residing in the Center/North Region (35,9%), on Sundays (16,5%), in the afternoon (32,9%) and night (34,9%) shifts. Recurrence of attempts (9,2%), history of psychiatric care (14,1%), alcohol abuse (17,5%) and other drugs (4,6%) were reported. The attendance in ambulances of advanced support and higher mortality before the rescue were more frequent in male victims (40,8% and 5,8%, respectively). The Center/North zone of the city concentrated the occurrences for both sexes. CONCLUSION: Pre-hospital care for suicide attempts in Teresina showed great demand for female victims, young people and a higher density of occurrence in the Center/North zone of the city. Alcohol use, more lethal means of self-harm and mortality were associated with males. It is necessary to disseminate this information and train professionals on the prevention and approach to suicide attempts, in addition to promoting public policies capable of reducing suicide attempts.

Avaliação do comportamento suicida em estudantes de Medicina / Assessment of suicidal behavior in medical students

OBJETIVO: O objetivo deste estudo foi avaliar a prevalência de comportamento suicida (ideação, plano e tentativa) nos últimos 12 meses e ao longo da vida e fatores associados entre alunos de Medicina da Universidade Federal do Rio de Janeiro (UFRJ). MÉTODOS: Um estudo seccional foi desenvolvido em uma amostra representativa e aleatória (n = 324) de 1.217 estudantes de Medicina da UFRJ entre abril e novembro de 2019. Os dados foram coletados por cinco pesquisadores em uma entrevista presencial com 296 alunos (taxa de participação de 91,4%), usando um questionário do Estudo Multicêntrico de Intervenção no Comportamento Suicida para avaliar o comportamento suicida, o PHQ-9 (Questionário de Saúde do Paciente-9) para avaliar o episódio depressivo maior e o ASSIST (Teste de Triagem do Envolvimento com Substâncias) para aferir o uso e abuso de substâncias. Para a avaliação das associações, utilizou-se o modelo de regressão logística. RESULTADOS: As prevalências nos últimos 12 meses foram de 18,9% (IC de 95%: 14,9-23,8) para ideação, 6,1% (IC de 95%: 3,9-9,4) para plano e 1,7% (IC de 95%: 0,7- 4,1) para tentativa de suicídio. As prevalências ao longo da vida foram de 27,7% (IC de 95%: 22,9-33,0) para ideação, 12,5% (IC de 95%: 9,2-16,7) para plano e 5,7% (IC de 95%: 3,6-9,0) para tentativa de suicídio. Os resultados encontrados foram maiores que os achados dos estudos nacionais. O episódio depressivo maior e o tratamento psicológico atual foram associados ao comportamento suicida na análise final. CONCLUSÕES: A associação com tratamento em saúde mental e episódio depressivo maior sugere que as universidades deveriam implementar programas para a prevenção do comportamento suicida.

OBJECTIVE: The aim of this paper is to analyze the lifetime and past 12-month prevalence rates of suicidal behavior (suicidal ideation, suicide plans and suicidal attempt) and associated factors among medical students at the Federal University of Rio de Janeiro. METHODS: Sectional study was applied to a representative and random set (n = 324) of 1,217 medical students between April and November of 2019. The data were collected by five researchers through in-person interviews with 296 of 324 volunteers (participation rate of 91.4%), using the Multisite Intervention Study on Suicidal Behavior interview to assess suicidal behavior, the PHQ-9 (Patient Health Questionnaire-9) to assess major depressive episode, and ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) to assess substance use and abuse. A logistic regression model was used to calculate associations. RESULTS: The rates of past-12 month were found to be 18.9% (CI 95%: 14.9-23.8) for ideation, 6.1% (CI 95%: 3.9-9.4) for suicide plans and 1.7% (CI 95%: 0.7-4.1) for suicidal attempts. The lifetime prevalence rates were 27.7% (CI 95%: 22,9-33,0) for suicidal ideation, 12.5% (CI 95%: 9.2-16.7) for plans and 5.7% (CI 95%: 3.6-9.0) for suicidal attempts. These rates are higher than the measured results among medical students in Brazil. The factors associated in the final analysis were the major depressive episode and current psychological treatment. CONCLUSIONS: The association between mental health treatment and major depressive episode suggest that the universities should implement suicidal behavior prevention programs.

Tentativa de suicídio: prevalência e fatores associados entre usuários da Atenção Primária à Saúde / Suicide attempt: prevalence and associated factors among users of Primary Health Care

OBJETIVO: Estimar a prevalência de tentativa de suicídio entre usuários da Atenção Primária à Saúde (APS) e verificar fatores associados. MÉTODOS: Estudo transversal realizado com indivíduos de 18 anos ou mais, atendidos na rede urbana da APS de Passo Fundo, Rio Grande do Sul. Foi calculada a prevalência do desfecho, com intervalo de confiança de 95% (IC95), além das Razões de Prevalência (RPs) brutas e ajustadas para verificação dos fatores associados. RESULTADOS: Amostra de 1.443 indivíduos, prevalência da tentativa de suicídio de 9% (IC95 8%-11%), com maior probabilidade em mulheres (RP = 3,01; IC95 1,54-5,86), 18-59 anos (RP = 2,15; IC95 1,38-3,34), sem cônjuge (RP = 1,82; IC95 1,09-3,03), com duas ou mais doenças crônicas não transmissíveis (RP = 1,54; IC95 1,08-2,18), diagnóstico de HIV/AIDS (RP = 3,02; IC95 1,30-7,02), de depressão (RP = 2,69; IC95 1,83-3,96), história familiar de tentativa de suicídio (RP = 1,99; IC95 1,50-2,63) e insônia (RP = 1,46; IC95 1,05-2,02). Observou-se tendência linear inversamente proporcional em relação à escolaridade, com redução de 42% na probabilidade do desfecho entre os participantes com ensino superior (RP = 0,58; IC95 0,39-0,86). CONCLUSÕES: Constataram-se alta prevalência de tentativa de suicídio, em comparação à média nacional, e associação com idade adulta, sexo feminino, menor escolaridade, ausência de cônjuge, diagnóstico de doenças crônicas, insônia e história familiar de suicídio.

OBJECTIVE: To estimate the prevalence of attempted suicide among Primary Health Care (PHC) users and to verify the associated factors. METHODS: Cross-sectional study, performed with individuals aged ≥ 18 years, assisted in the urban PHC services in Passo Fundo, Rio Grande do Sul, Brazil. The prevalence of the outcome was calculated, with a confidence interval of 95% (95% CI), in addition to the crude and adjusted Prevalence Ratios (PR) to verify the associated factors. RESULTS: Sample of 1,443 individuals, 9% prevalence of attempted suicide (95% CI 8%-11%), most likely in women (PR = 3.01; 95% CI 1.54-5.86), 18-59 years (PR = 2.15; 95% CI 1.38-3.34), individuals without a spouse (PR = 1.82; 95% CI 1.09-3.03), with two or more chronic non-communicable diseases (PR = 1.54; 95% CI 1.08-2.18), diagnosis of HIV/AIDS (PR = 3.02; 95% CI 1.30-7.02) and of depression (PR = 2.69; 95% CI 1.83-3.96), family history of attempted suicide (PR = 1.99; 95% CI 1.50-2.63) and insomnia (PR = 1.46; 95% CI 1.05-2.02). An inversely proportional linear trend was observed in relation to education, with a 42% reduction in the probability of the outcome among participants with higher education (PR = 0.58; 95% CI 0.39-0.86). CONCLUSIONS: There was a high prevalence of attempted suicide compared to the national average and association with adult age, female gender, lower education level, absence of a partner, diagnosis of chronic diseases, insomnia and family history of suicide.

Cannabis use and suicidal ideation among youth: Can we democratize school policies using digital citizen science?

BACKGROUND: School policies and programs are important in preventing Cannabis use among youth. This study uses an innovative digital citizen science approach to determine the association between Cannabis use and suicidal ideation among youth while investigating how school health policies mediate this association. METHODS: The study engaged 818 youth (aged 13-18 years) and 27 educators as citizen scientists via their own smartphones. Youths responded to time-triggered validated surveys and ecological momentary assessments to report on a complex set of health behaviours and outcomes. Similarly, educators' reported on substance misuse and mental health school policies and programs. Multivariable logistic regression modeling and mediation analyses were employed. RESULTS: 412 youth provided data on substance misuse and suicidal ideation. Cannabis use and other factors such as bullying, other illicit drug use, and youth who identified as females or other gender were associated with increased suicidal ideation. However, school policies and programs for substance misuse prevention did not mediate the association between Cannabis use and suicidal ideation. CONCLUSIONS: In the digital age, it is critical to reimagine the role of schools in health policy interventions. Digital citizen science not only provides an opportunity to democratize school policymaking and implementation processes, but also provides a voice to vulnerable youth.

Prediction of Suicide Attempts Using Clinician Assessment, Patient Self-report, and Electronic Health Records.

Importance: Half of the people who die by suicide make a health care visit within 1 month of their death. However, clinicians lack the tools to identify these patients. Objective: To predict suicide attempts within 1 and 6 months of presentation at an emergency department (ED) for psychiatric problems. Design, Setting, and Participants: This prognostic study assessed the 1-month and 6-month risk of suicide attempts among 1818 patients presenting to an ED between February 4, 2015, and March 13, 2017, with psychiatric problems. Data analysis was performed from May 1, 2020, to November 19, 2021. Main Outcomes and Measures: Suicide attempts 1 and 6 months after presentation to the ED were defined by combining data from electronic health records (EHRs) with patient 1-month (n = 1102) and 6-month (n = 1220) follow-up surveys. Ensemble machine learning was used to develop predictive models and a risk score for suicide. Results: A total of 1818 patients participated in this study (1016 men [55.9%]; median age, 33 years [IQR, 24-46 years]; 266 Hispanic patients [14.6%]; 1221 non-Hispanic White patients [67.2%], 142 non-Hispanic Black patients [7.8%], 64 non-Hispanic Asian patients [3.5%], and 125 non-Hispanic patients of other race and ethnicity [6.9%]). A total of 137 of 1102 patients (12.9%; weighted prevalence) attempted suicide within 1 month, and a total of 268 of 1220 patients (22.0%; weighted prevalence) attempted suicide within 6 months. Clinicians' assessment alone was little better than chance at predicting suicide attempts, with externally validated area under the receiver operating characteristic curve (AUC) of 0.67 for the 1-month model and 0.60 for the 6-month model. Prediction accuracy was slightly higher for models based on EHR data (1-month model: AUC, 0.71; 6 month model: AUC, 0.65) and was best using patient self-reports (1-month model: AUC, 0.76; 6-month model: AUC, 0.77), especially when patient self-reports were combined with EHR and/or clinician data (1-month model: AUC, 0.77; and 6 month model: AUC, 0.79). A model that used only 20 patient self-report questions and an EHR-based risk score performed similarly well (1-month model: AUC, 0.77; 6 month model: AUC, 0.78). In the best 1-month model, 30.7% (positive predicted value) of the patients classified as having highest risk (top 25% of the sample) made a suicide attempt within 1 month of their ED visit, accounting for 64.8% (sensitivity) of all 1-month attempts. In the best 6-month model, 46.0% (positive predicted value) of the patients classified at highest risk made a suicide attempt within 6 months of their ED visit, accounting for 50.2% (sensitivity) of all 6-month attempts. Conclusions and Relevance: This prognostic study suggests that the ability to identify patients at high risk of suicide attempt after an ED visit for psychiatric problems improved using a combination of patient self-reports and EHR data.

Perceptions towards charcoal-burning suicide and the surge of this lethal method in Taiwan.

OBJECTIVE: Whether sociocultural perceptions of charcoal-burning suicide have influenced its rapid increase in prevalence is unclear. We aimed to explore perceptions of Taiwan's general population regarding charcoal-burning suicide, their personal belief in life after death, and related feelings of thoughts associated with those who attempt charcoal-burning suicide. METHODS: An online web-based survey, focussing on sociocultural attitudes towards death, as well as perceptions towards charcoal-burning suicide, and those who attempt charcoal-burning suicide, was conducted from 14 January to 14 June 2016. RESULTS: In total, 1343 adults completed the online survey (mean age of 33.46; 66.6% women). Notably, 90.3% of participants considered charcoal burning to be an easily accessible suicide method. Multivariable analyses revealed that among the examined factors, the perceived 'painlessness' of charcoal-burning suicide was associated with an over seven-fold increased risk of choosing charcoal-burning suicide (OR = 7.394; p < 0.001; 95% CI: 2.614-20.912). CONCLUSION: As reflected in this study, charcoal-burning suicide is perceived as easily accessible and painless. The perceived 'painlessness' may be the factor that distinguishes the choice of charcoal-burning suicide from that of other suicide methods. Future efforts to target these perceptions regarding charcoal-burning suicide may be warranted in both media reporting and suicide prevention programmes.

Potential drug-drug interactions in acute poisonings managed in the intensive care unit: Occurrence, risk factors and relationship to patient severity on admission.

Beyond the direct toxicity resulting from each drug in the poisoned patient, additional toxicities may result from drug-drug interactions (DDIs). We aimed to determine the frequency of potential DDIs in the poisoned patient and investigate whether DDIs are associated with severity. We conducted a 1-year cohort study in a toxicological ICU. DDIs were identified using an electronic interaction-checker tool. Among our 354 ICU poisoned patients, 134 (38%) presented at least one potential DDI between acute poisoning drugs and 180 (51%) at least one potential DDI between acute poisoning and long-term treatment drugs. Using multivariate analyses, previous suicide attempt was associated with the presence of potential DDIs between acute poisoning drugs in suicide attempt patients (P = 0.014). Chronic alcoholism (P = 0.005) and tobacco smoking (P = 0.022) were associated with the presence of potential DDIs between acute poisoning and long-term treatment drugs in recreational drug users. Presence of potential DDIs between acute poisoning and long-term treatment drugs was associated with catecholamine infusion (P = 0.022) in suicidal self-exposure patients. Presence of potential pharmacodynamic DDIs between acute poisoning and long-term treatment drugs was associated with aspiration pneumonia onset in recreational drug users (P = 0.03). ICU poisoned patients present a high rate of potential DDIs that may influence the outcome.