From Social Stress and Isolation to Autonomic Nervous System Dysregulation in Suicidal Behavior.

PURPOSE OF REVIEW: In this narrative review we wanted to describe the relationship of autonomic nervous system activity with social environment and suicidal spectrum behaviors. RECENT FINDINGS: Patients with suicidal ideation/suicide attempt have higher sympathetic nervous system (SNS) and lower parasympathetic nervous system (PNS) activity in resting conditions and during acute stress tasks compared with patients without suicidal ideation/suicide attempt. Death by suicide and violent suicide attempt also are related to SNS hyperactivation. Similarly, a SNS/PNS imbalance has been observed in people with childhood trauma, stressful life events or feelings of loneliness and isolation. Social support seems to increase PNS control and resilience. Due to the importance of the social context and stressful life events in suicidal behavior, SNS/PNS imbalance could act as a mediator in this relationship and be a source of relevant biomarkers. Childhood trauma and stressful life events may impair the autonomic nervous system response in suicidal patients. Loneliness, isolation and social support may act as moderators in acute stress situations.

Writing to Keep on Living: A Systematic Review and Meta-Analysis on Creative Writing Therapy for the Management of Depression and Suicidal Ideation.

PURPOSE OF REVIEW: The purpose of this review and meta-analysis was to explore the effectiveness of creative writing therapies for the management of depression and suicidal ideation. RECENT FINDINGS: Twenty one of the 31 reviewed studies showed that creative writing significantly improved depressive symptoms, while five studies suggested improvement in other symptoms. The results of meta-analyses showed that narrative writing significantly reduced depression compared to those in neutral writing or treatment as usual condition in both post intervention and follow-up. However, the number of studies exploring the effects of creative writing in suicidal ideation was too low to perform a meta-analysis. A structured and well-targeted intervention using creative writing could have beneficial results for the management of depressive symptoms. More studies are needed to explore the potential benefits of creative writing for reducing suicidal ideation.

Randomised trial of three treatments for amblyopia: Vision therapy and patching, perceptual learning and patching alone.

BACKGROUND: Active vision therapy for amblyopia shows good results, but there is no standard vision therapy protocol. This study compared the results of three treatments, two combining patching with active therapy and one with patching alone, in a sample of children with amblyopia. METHODS: Two protocols have been developed: (a) perceptual learning with a computer game designed to favour the medium-to-high spatial frequency-tuned achromatic mechanisms of parvocellular origin and (b) vision therapy with a specific protocol and 2-h patching. The third treatment group used patching only. Fifty-two amblyopic children (aged 4-12 years), were randomly assigned to three monocular treatment groups: 2-h patching (n = 18), monocular perceptual learning (n = 17) and 2-h patching plus vision therapy (n = 17). Visual outcomes were analysed after 3 months and compared with a control group (n = 36) of subjects with normal vision. RESULTS: Visual acuity (VA) and stereoacuity (STA) improved significantly after treatment for the three groups with the best results for patching plus vision therapy, followed by monocular perceptual learning, with patching only least effective. Change in the interocular difference in VA was significant for monocular perceptual learning, followed by patching. Differences in STA between groups were not significant. For VA and interocular differences, the final outcomes were influenced by the baseline VA and interocular difference, respectively, with greater improvements in subjects with poorer initial values. CONCLUSIONS: Visual acuity and STA improved with the two most active treatments, that is, vision therapy followed by perceptual learning. Patching alone showed the worst outcome. These results suggest that vision therapy should include monocular accommodative exercises, ocular motility and central fixation exercises where the fovea is more active.

Characteristics of Single vs. Multiple Suicide Attempters Among Adult Population: A Systematic Review and Meta-Analysis.

PURPOSE OF REVIEW: We aimed to examine the factors that differentiate single and multiple suicide attempters in adult population. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to conduct this review and meta-analysis. The review protocol was registered in PROSPERO. We carried out a systematic literature search in three databases to identify original studies that explored the differences between single and multiple suicide attempters among adult population. RECENT FINDINGS: There might be meaningful differences between those individuals that attempt suicide once in their lifespan and those who make multiple attempts in terms of sociodemographic and clinical characteristics. There are no previous meta-analysis addressing this topic in the adult population. A total of 75 studies were included in the review and 69 were included in the meta-analysis. Multiple attempters were more likely to present certain disorders such as mood and psychotic disorders, as well as personality or substance use disorders. Higher suicide ideation and suicide intent scores also characterized this group. Childhood trauma experiences, stressful life events, and higher rates of hopelessness were statistically significant in multiple attempters. Identifying the factors predicting multiple suicide attempts helps to delineate a high-risk suicidal profile that should be taken into account in the clinical and suicide prevention scenario.

Characteristics of single vs. multiple suicide attempters among adolescents: a systematic review and meta-analysis.

There might be differential characteristics between those who have attempted suicide once in their lifetime (single attempters) and those who have attempted suicide two or more times (multiple attempters). We aimed to identify the factors that differentiate single and multiple attempters in child and adolescents. This study was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, and the review protocol was registered in PROSPERO. We conducted a systematic literature search in three databases to identify original studies exploring the characteristics of single attempters vs. multiple attempters among adolescents. We considered a wide range for the definition of adolescent, following most recent recommendations: 10-24 years. We carried out a meta-analysis. Fourteen studies were included in the systematic review and 13 in the meta-analysis with a total sample of with a total of 4286 participants. The factors statistically significantly associated with being a multiple attempter in the meta-analysis were: anxiety disorders, depression severity, alcohol abuse, substance abuse, aggressiveness, and hopelessness. Multiple attempters have a more severe clinical profile, with greater severity of symptoms. Knowledge of the risk factors associated with being a multiple attempter could help us to predict which patients are more likely to reattempt suicide and need further monitoring and a tailored treatment. Prevention programs tailored for the adolescent population, along with identification of early risk factors, could help to prevent suicidal behavior among this vulnerable population.

Optimism as a protective factor against the psychological impact of COVID-19 pandemic through its effects on perceived stress and infection stress anticipation.

The 2019 coronavirus disease (COVID-19) and the recommended social isolation presented a challenge to people's mental health status. Optimism is a psychological factor that plays a key role in the evaluation of stressful situations. The purpose of this study was to investigate the mediating role of perceived stress and Covid-19-related stress anticipation in the relationship between optimism and post-traumatic stress symptoms. Our sample included 1015 participants ranging in age from 18 to 79 years, 80% of whom were Spaniards. At the beginning of the worldwide pandemic, participants were confined to their homes for at least seven days and completed an online survey measuring various sociodemographic and psychological variables. We found an indirect effect of optimism on intrusion and hyperarousal through perceived stress and stress anticipation. In addition, we observed an indirect effect of optimism on avoidance through perceived stress. Finally, the results showed a significant indirect effect of optimism on the total post-traumatic stress symptoms score through perceived stress and stress anticipation. Our results indicate that positive beliefs inherent to optimism are related to less psychological impact of the COVID-19 outbreak.

Good decision-making is associated with an adaptive cardiovascular response to social competitive stress.

Competition elicits different psychological and cardiovascular responses depending on a person's skills. Decision-making has been considered a distal factor that influences competition, but there are no studies analyzing this relationship. Our objective was to analyze whether decision-making affects the response to competition. Specifically, we aimed to test whether good performers on a decision-making test, the Iowa Gambling Task (IGT), showed an adaptive cardiovascular response to competition. In all, 116 participants (44 women) performed the IGT and were classified into Good or Poor decision-makers. Subsequently, they were exposed to a stress task in two different conditions: a face-to-face competition (winners/losers) or a control condition, while an electrocardiogram was recorded. In the competition group, good decision-makers increased their high-frequency respect to the total heart rate variability (HF/HRV) levels during the task, compared to Poor decision-makers. Again, competition group good decision-makers, showed lower LF and higher HF/HRV reactivity than the control group, which represents lower HRV stress pattern. Moreover, in the group of losers, good decision-makers had a decline in low frequency (LF) during the task and faster recovery than poor decision-makers. In conclusion, good decision-makers have a more adaptive stress response and higher levels of mental effort, based on total HRV interpretation. Decision-making skills could be a factor in a more adaptive cardiovascular response to competition.

Are visual analogue scales valid instruments to measure psychological pain in psychiatric patients?

OBJECTIVE: The Psychological-Physical-Pain Visual Analogue Scale (PPP-VAS) was thought to probably help in identifying patients at risk of suicide. However, no data on its validity to measure psychological pain was available. Our main aim was to investigate the convergent validity of the PPP-VAS using two well-validated scales of psychological pain, the Orbach and Mikulincer Mental Pain scale (OMMP) and the Holden et al. Psychache Scale. METHODS: This multicentre study recruited a total of 1618 adult psychiatric inpatients and outpatients in Italy. Psychological pain was evaluated using the OMMP, Holden et al., and PPP-VAS scales. Psychiatric status, suicidal status, physical pain, depression, and hopelessness were also assessed. RESULTS: A structural equation model (SEM) using the items of psychological pain from the PPP-VAS showed that items loaded significantly on the psychological pain factor and showed good fit. Similarly, a second SEM model using the three scales of psychological pain showed acceptable fit and converged into a psychological pain construct. Correlations between the PPP-VAS and depression, hopelessness, and physical pain showed moderate correlations (r = 0.43 to r = 0.67). Finally, psychological pain evaluated with the PPP-VAS was significantly related with recent suicidal ideation in all patients (OR [95 % CI] = 1.07 [1.05, 1.09]) and recent suicide attempts in moderately to severely depressed patients, OR [95 % CI] = 1.01 [1.02, 1.03]. CONCLUSION: The PPP-VAS showed good psychometric properties in evaluating psychological pain. The characteristics of the PPP-VAS makes this scale a great option for its use in clinical practice to detect patients at risk of suicide.

Do Decision-Making Styles Predict Vagal Control? The Role of Resting Heart Rate Variability.

Decision-making styles are a habit-based propensity that drive behavior and affect daily life. Rational and intuitive decision-making styles have been associated with good mental health. However, the underlying mechanisms are not clear. In the last decade, high basal levels of heart rate variability (HRV) have been proposed as an index of health and emotional control, and this could be one of the variables involved in the effects of decision making on health. Therefore, the aim of this study is to analyze the capability of decision-making styles to predict resting HRV. A cross-sectional study was conducted in a sample of 199 (119 women) young university students, and a resting ECG was recorded to extract frequency domain HRV variables. Subsequently, participants completed sociodemographic data and the General Decision-Making Style questionnaire (GDMS). Results showed that the intuitive style predicted high-frequency HRV, while the avoidant style predicted less low-frequency HRV. This study presents new data on the relationship between decision-making style and HRV, suggesting that the intuitive style has a cardioprotective effect, while the avoidant style is related to lower HRV, which has been associated with health vulnerability. In conclusion, this study contributes to the understanding of HRV and its potential as a biomarker for cognitive styles that may improve health.

Time perception and suicidal ideation during COVID-19 pandemic: A longitudinal study.

BACKGROUND: There are several reports of disruptions in time perception during lockdown periods throughout the COVID-19 pandemic. Our aim was to study the role of subjective flow of time (SFT) in the triggering of suicidal ideation in patients with a history of suicide attempt (SA), as compared with affective controls without such history (AC). METHODS: This study involved 296 psychiatric patients that were assessed five times between 2020 and 2021. We analyzed the SFT using a mixed logistic model and characterized SFT during significant periods of governmental restrictions. Multivariate logistic regressions were used to identify independent SFT characteristics. We evaluated the association between SFT and suicidal ideation, considering interactions with depression, insomnia, loneliness, and social support. RESULTS: The findings revealed a significant alteration in SFT, closely linked to the implementation and easing of governmental restrictions. During the initial lockdown, SA exhibited lower SFT levels compared to AC. Furthermore, the relationship between SFT and suicidal ideation was influenced by depression. In the interim period between lockdowns, SFT's impact on suicidal ideation was mediated by insomnia. DISCUSSION: Disturbances in SFT could be related to adaptability to lockdown conditions or may be a coping mechanism with depression, insomnia, suicidal ideation and overall psychological distress. Understanding the interplay of SFT with these factors provides crucial insights into the complex psychological mechanisms involved.

Pain tolerance and threshold in suicide attempters: A systematic review and meta-analysis.

It has been hypothesized that individuals less sensitive to pain could be at higher risk of suicide. However, data on pain sensitivity in suicide attempters (SA) obtained using experimental procedures are heterogeneous. The aim of this systematic review and meta-analysis was to investigate and compare pain tolerance and threshold in SA (patients with lifetime history of suicide attempt), non-attempters (psychiatric controls, PC), and healthy controls (HC). A random effects meta-analysis was used to estimate the standardized mean differences using data from 16 studies that compared physical pain tolerance and threshold in SA and PC or HC. Pain tolerance and threshold were not significantly different in SA and PC. However, pain tolerance, but not threshold, was higher in SA than HC. Our findings do not support the hypothesis of an altered pain perception related as a trait for suicidal vulnerability, but rather suggest altered pain perception related to psychiatric vulnerability.

Impulsivity in fatal suicide behaviour: A systematic review and meta-analysis of psychological autopsy studies.

Our aim is to review and perform a meta-analysis on the role of impulsivity in fatal suicide behaviour. We included papers who used psychological autopsy methodology, assessed adult death by suicide, and included assessment of impulsivity. We excluded papers about assisted suicide, terrorist suicide, or other cause of death other than suicide or postmortem diagnosis made only from medical records or database. 97 articles were identified. 33 were included in the systematic review and nine in the meta-analysis. We found that people who die by suicide with high impulsivity are associated with younger age, substance abuse, and low intention to die, whereas those with low impulsivity were associated with older age, depression, schizophrenia, high intention to die and low social support. In the meta-analysis, suicide cases had higher impulsivity scores than living controls (Hedges' g = 0.59, 95 % CI [0.28, 0.89], p=.002). However, studies showed heterogeneity (Q = 90.86, p<.001, I2=89.0 %). Impulsivity-aggressiveness interaction was assessed through meta-regression (ß=0.447, p=.045). Individuals with high impulsivity would be exposed to a higher risk of fatal suicide behaviour, aggressiveness would play a mediating role. People who die by suicide with high and low impulsivity display distinct characteristics, which may reflect different endophenotypes leading to suicide by different pathways.

Symptomatology of posttraumatic stress and burnout associated with aggressions suffered by primary care health professionals. A transversal study.

Objective: To know the incidence of aggressions in Primary Care, and to determine the psychological symptoms that may accompany these experiences. A transversal study was carried out in North-Eastern Spain, in 2022. Methods: 207 participants (60.9% women, mean age 48.8 years), primary care professionals (nurses and doctors), responded to Questionnaire of Sociodemographic and Occupational variables, List of Aggressions, General Health Questionnaire, Posttraumatic Stress Disorder Checklist, and Maslach Burnout Inventory. Results: 57.49% had suffered aggressions in the last year (44.4% threats, 55.1% insults and 18.4% physical aggressions). They showed more psychological symptoms than those who had not been assaulted: re-experiencing, avoidance, distancing, emotional or cognitive disturbances and hypervigilance, as well as to emotional exhaustion, depersonalization and low personal realization. Although no statistically significant differences were found in terms of the number of victims with respect to gender, men showed more symptoms of trauma. Conclusion: The data show the increase of violent episodes in Primary Care. Although the attacks perpetrated in this sector do not usually present the magnitude required for the diagnosis of post-traumatic stress, many of its symptoms were manifested in those who had suffered violence. Likewise, a relationship was found between aggression and burnout. The need to have post-incident protocols is evident, raising awareness among professionals about the importance of reporting episodes, as well as designing and implementing prevention plans. The damage generated by these behaviors does not only affect nurses and doctors, but, indirectly, all users of the health system.

Digital Platform for the Prevention of Suicidal Behaviour and Non-Suicidal Self-Injuries in Adolescents: The SmartCrisis-Teen Study Protocol.

Suicidal behavior and Non-Suicidal Self-Injuries (NSSIs) are a major health problem in the adolescent population. New technologies can contribute to the development of innovative interventions in suicide prevention. Here, we present the SmartCrisis-Teen study protocol. The study consists of a randomized clinical trial which aims to evaluate the effectiveness of a digital safety plan to prevent suicidal behavior and NSSIs in adolescents. This is a multicentric study which will be conducted among the adolescent population, both in clinical and student settings, with a target sample of 1080 participants. The intervention group will receive an Ecological Momentary Intervention (EMI) consisting of a digital safety plan on their mobile phone. All participants will receive their Treatment As Usual (TAU). Participants will be followed for six months, with weekly and monthly telephone visits and face-to-face visits at three and six months. Participants will be assessed using traditional questionnaires as well as Ecological Momentary Assessment (EMA) and Implicit Association Tests (IATs). With this intervention, we expect a reduction in NSSIs through the acquisition of coping strategies and a decrease in suicidal behavior over the course of follow-up. This study provides a novel, scalable digital intervention for preventing suicidal behavior and NSSIs in adolescents, which could contribute to improving adolescent mental health outcomes globally.

Reliability and validity of proxy reports of impulsivity and aggression: An evidence-based assessment approach to psychological autopsy methods.

INTRODUCTION: Psychological autopsy methods often include measures of impulsivity and aggression. The aim is to assess their reliability and validity in a Spanish sample. METHODS: Cross-sectional web-based survey was fulfilled by 184 proband and proxy pairs. Data was collected on sociodemographic characteristics, impulsivity through Barratt Impulsiveness Scale (BIS-11), aggression through Buss-Perry Aggression Questionnaire (BPAQ), and history of suicide ideation. Proxies filled out BIS-11, BPAQ and suicide ideation with the responses they would expect from the probands. Reliability was assessed using intraclass correlation coefficients (ICC) between proband and proxies. Logistic regression analysis was performed to assess the predictive validity of proxy reports in predicting probands' suicide ideation. RESULTS: Bivariate analysis showed differences in BPAQ (Median 68 vs. 62; p=0.001), but not in BIS-11 (p>.050). BIS-11 showed good concordance (ICC=0.754; CI 95% 0.671-0.816) and BPAQ acceptable (ICC=0.592; CI 95% 0.442-0.699). In the probands regression model BPAQ predicted suicide ideation (OR 1.038; CI 95% 1.016-1.061) but not BIS-11 (OR 0.991; CI 95% 0.958-1.025). In the proxy-report model BPAQ also predicted probands' suicide ideation (OR 1.036; CI 95% 1.014-1.058) but not BIS-11 (OR 0.973; CI 95% 0.942-1.004). CONCLUSION: Used as proxy-reported assessment tools, BIS-11 showed better reliability than the BPAQ. However, both showed validity in Spanish population and could be included in psychological autopsy protocols.

Looking for the Key to Winning: Psychophysiological Predicting Factors in Healthy University Students.

Performance in competitive situations has been linked to various psychobiological factors such as personality traits (e.g., competitiveness), situational appraisal (e.g., motivation), and cardiovascular response (e.g., heart rate). However, it remains unclear whether these factors can predict competitive success. This paper aims to assess, through discriminant analysis, the predictive capacity of these psychobiological variables regarding the likelihood of winning, ultimately delineating a psychophysiological profile associated with success. Across three distinct studies, a total of 154 participants (66 men) engaged in a face-to-face laboratory competition. Prior to the competition, assessments of competitiveness traits, anxiety, self-efficacy, and motivation were conducted, and heart rate reactivity during the competition was measured. These variables collectively formed the basis for constructing the predictive model. The results of the initial study demonstrated that our model accurately classified 68.8% of the cases. Specifically, high levels of competitiveness, self-efficacy, motivation, and heart rate reactivity, coupled with low anxiety, were predictive of winning. These findings were subsequently replicated in two independent validation samples involving both men and women (studies 2 and 3), thereby reinforcing the robustness of the earlier results. In conclusion, our findings suggest that the psychological state preceding competition, along with cardiovascular reactivity, may serve as predictors for the probability of winning.

Pandemics and Suicide Rates in Spain: From the Spanish Flu to COVID-19.

Objective: The aim of this study was to examine suicide rates in Spain during the COVID-19 pandemic and the influenza pandemic of 1918-1920.Methods: Data on deaths by cause for the periods 1910-1925 and 2016-2020 were obtained from the National Statistics Institute of Spain.Results: During the Spanish influenza pandemic, a peak of deaths in 1918 due to influenza, acute bronchitis, pneumonia, and other respiratory diseases coincided with an increase in suicides (from 5.9 in 1917 to 6.6 per 100,000 population in 1918). The pattern was repeated in the COVID-19 pandemic during 2020, with an increase in suicides from 7.8 in 2019 to 8.3 per 100,000 population in 2020. In both cases, the male:female suicide ratio was reduced in similar proportion, with a higher net increase in the number of suicides among males but a higher percentage increase among females.Conclusions: Albeit limited, there is evidence that the pandemics may have affected suicide rates. However, the effect was most likely due to precipitation of different diathesis-stressor factors in each setting, given the different historical contexts.

Impulsivity as a mediator between childhood maltreatment and suicidal behavior: A systematic review and meta-analysis.

Childhood maltreatment is a known risk factor for the development of suicidal behavior. Possible mediators of the association between childhood maltreatment and suicide have been analyzed. Some studies have considered impulsivity as one of these mediators, but there are no previous reviews on this topic. We, therefore, present a systematic review and mediation meta-analysis of the literature summarizing the evidence on impulsivity as a mediator of the relationship between childhood maltreatment and lifetime suicidal behavior. This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The review was registered in the PROSPERO database. We searched PubMed, PsycINFO, WebOfScience, and EMBASE databases up to February 2021 to identify studies exploring the association between childhood maltreatment and suicide through impulsivity. Fourteen articles met the selection criteria and were included in the review. Seven articles could be included in the mediation meta-analysis. Impulsivity was a significant mediator of the relationship between childhood maltreatment and suicidal behavior in ten of the fourteen included studies. This result was confirmed using mediation meta-analysis (ß = .06, 95% CI 0.03-0.10). Studies suggest that exposure to traumatic situations in childhood affects the proper neurobiological, cognitive, and affective development of individuals. This may increase impulsivity, which in turn would be related to an increased risk of suicide. The effects of childhood maltreatment and impulsivity may be both therapeutic targets of interest to reduce suicide rates.