Self-Harm by Nurses and Midwives - A Study of Hospital Presentations.

Background: Nursing professionals are an occupational group at increased risk of suicide, but little is known about self-harm in this population. Aims: To investigate the characteristics of nurses and midwives who present to hospital following self-harm. Method: We used data from the Oxford Monitoring System for Self-Harm to identify nurses and midwives who presented to the general hospital in Oxford during 2010-2020 following an episode of self-harm and received a psychosocial assessment. Results: During the eleven-year study period, 107 presentations of self-harm involving 81 nurses and midwives were identified. Self-poisoning was the most common self-harm method (71.6%), with antidepressants and paracetamol most frequently involved. Many had consumed alcohol before (43.8%) or during (25.3%) the self-harm act. Some individuals had high or very high suicide intent scores (22/70, 31.4%). Common problems preceding self-harm included problems with a partner (46.9%), psychiatric disorder (29.6%), and problems with employment (27.2%), family (24.7%), and alcohol (23.5%). A range of aftercare options were offered following presentation. Limitations: This study was limited to data from a single hospital. Conclusion: Prevention and management of self-harm within this occupational group requires preventative strategies and availability of interventions addressing the range of factors that may contribute to self-harm, especially relationship problems, psychiatric disorders, employment problems, and alcohol misuse.

Fluidity in capability: Longitudinal assessments of suicide capability using ecological momentary assessments.

INTRODUCTION: Suicide capability is posited to facilitate the movement from ideation-to-action. Emerging evidence suggests capability comprises both trait- and state-like facets. This study examined fluctuations in and associations of acquired, dispositional, practical, and perceived capabilities, and suicidal mental imagery, and suicidal ideation. METHOD: Seventy-five adults (48 females, Mage = 36.53 years) with lived experience of suicidal ideation and/or attempt responded to four prompts per day for 2 weeks that assessed suicide capability and suicidal ideation. Mean-squared successive differences and probability of acute change indices and multilevel models were used for analyses. RESULTS: All facets of suicide capability fluctuated. Acquired and dispositional capabilities were trait-like, with practical and perceived capabilities being state-like. Suicidal mental imagery was the only facet of suicide capability that distinguished participants with a suicide attempt in the past 12 months from participants with a suicide attempt more than 1 year ago and suicide ideators. Suicidal mental imagery was associated with concurrent suicidal ideation and predictive of next assessment suicidal ideation. CONCLUSION: Suicidal mental imagery may be uniquely associated with suicide capability. This study suggests there are trait- and state-like facets of capability that can combine to potentially ready an individual to engage in suicidal behaviors.

Risk of Suicide and Psychiatric Disorders Among Isotretinoin Users: A Meta-Analysis.

Importance: Isotretinoin is hypothesized to contribute to the development of psychiatric disorders, but the epidemiological association and risk factors associated with psychiatric disorders among isotretinoin users remain unclear. Objective: To clarify the absolute and relative risk and risk factors associated with suicide and psychiatric disorders among isotretinoin users. Data Sources: PubMed, Embase, Web of Science, and Scopus were searched from inception until January 24, 2023. Study Selection: Randomized trials and observational studies were selected if they reported the absolute risk, relative risk, and risk factors for suicide and psychiatric disorders among isotretinoin users. Data Extraction and Synthesis: Relevant data were extracted and risk of bias was evaluated at the study level using the Newcastle-Ottawa Scale. Data were pooled using inverse variance-weighted meta-analyses. Heterogeneity was measured using the I2 statistic, and meta-regression analyses were performed. Main Outcomes and Measures: Absolute risk (percentage), relative risks (risk ratios [RR]), and risk factors (RR) of suicide and psychiatric disorders among isotretinoin users. Results: A total of 25 studies including 1 625 891 participants were included in the review and 24 in the meta-analysis. Among the included studies, participants' average age ranged from 16 to 38 years, and distribution by sex ranged from 0% to 100% male. The 1-year pooled absolute risk from between 2 and 8 studies of completed suicide, suicide attempt, suicide ideation, and self-harm were each less than 0.5%, while that of depression was 3.83% (95% CI, 2.45-5.93; I2 = 77%) in 11 studies. Isotretinoin users were less likely than nonusers to attempt suicide at 2 years (RR, 0.92; 95% CI, 0.84-1.00; I2 = 0%), 3 years (RR, 0.86; 95% CI, 0.77-0.95; I2 = 0%), and 4 years (RR, 0.85; 95% CI, 0.72-1.00; I2 = 23%) following treatment. Isotretinoin was not associated with the risk of all psychiatric disorders (RR, 1.08; 95% CI, 0.99-1.19; I2 = 0%). Study-level meta-regression found that studies with participants of older age reported lower 1-year absolute risk of depression, while those with a higher percentage of male participants reported a higher 1-year absolute risk of completed suicide. Conclusions and Relevance: The findings suggest that at a population level, isotretinoin users do not have increased risk of suicide or psychiatric conditions but may instead have a lower risk of suicide attempts at 2 to 4 years following treatment. While these findings are reassuring, clinicians should continue to practice holistic psychodermatologic care and monitor patients for signs of mental distress during isotretinoin treatment.

Suicide Attempts in Patients With Amyotrophic Lateral Sclerosis: An Analysis of the Korean National Health Insurance Database.

Objective: The knowledge of the common risk factors for suicide attempts may not be simply applicable to patients with amyotrophic lateral sclerosis (ALS). We aimed to identify risk factors associated with suicide attempts in patients with ALS and to determine the annual prevalence and periods of vulnerability associated with attempts.Methods: This nationwide cohort study was performed using the Korean National Health Insurance Database. All patients with ALS concomitantly registered for the Exempted Calculation of Health Insurance for rare, incurable diseases between 2011 and 2017 were identified. We used the Cox proportional hazards regression model and competing risk model to identify the risk factors for suicide attempts. The multivariable models were adjusted for potential risk factors from the univariate analysis.Results: Among 2,955 incident patients, 47 attempted suicide. After adjusting for sex, previous attempts, and previous psychiatric disorders, the hazard ratios for psychiatric hospitalization before ALS diagnosis were 3.17 (95% confidence interval [CI], 1.31-7.70; P = .01) and 3.02 (95% CI, 1.32-6.90; P = .01) in the Cox regression model and the competing risk model, respectively. The annual prevalence of suicide attempts was 0.29%-1.12%. Twenty (42.6%) and 9 (19.1%) attempts occurred within 3 months and 12-18 months after diagnosis, respectively.Conclusions: Psychiatric hospitalization increased the risk of suicide attempts, which clustered at the early stage or on losing autonomy. Those with a history of psychiatric hospitalization should receive an in-depth evaluation and be cautiously monitored.

[Borderline personality disorder and non-suicidal self-injury: the role of mindfulness training in risk reduction].

INTRODUCTION: Due to patients diagnosed with borderline personality disorder (BPD) can engage risky behaviors, it is necessary to develop evidence based interventions in healthcare that can help to reduce the most pressing problems. BPD-specific cognitive therapy-based mindfulness training (MBCT) can be a solution to this challange. LITERATURE REVIEW: Non-suicidal self-injury (NSSI) is a significant predictor of subsequent suicide attempts and occurs in 80% of BPD patients. It is related to impulse- and emotion-dysregulation (cognitive-emotional model), as well as the deficit of mindfulness skills, which are also key difficulties in BPD (emotional cascade model, mindfulness deficit theory). The cognitive-emotional reactivity model of NSSI based on the reactivity model in recurrent depression, the four-function model and theories above. The model differs situational, cognitive, emotional, physiological, and behavioral factors that can trigger or maintain NSSI, and it also helps to determine intervention points. STUDY PROTOCOL: Our hypothesis is that the 8-week MBCT training is more effective in developing mindfulness skills, emotion- and impulse control, and in reducing self-harm also than waiting list or supportive therapy. Participants are BPD patients with NSSI, in a quasi-experimental repeated measure design, planned sample size is N=60 per group. Before the training there is a two-stage interview procedure, patients fill out a questionnaire survey and they have to sign a suicide prevention contract. The planned waiting time between the first interview and the start of the training is 8-12 weeks. The group sessions are based on the MBCT training protocol designed to reduce the risk of suicide, supplemented with BPD-specific elements (specific psychoeducation, loving-kindness meditation). DISCUSSION: Based on the effectiveness of small-sample research, our aim is to test the effectiveness of MBCT training among BPD patients based on the above protocol.

The effect of bright light therapy on irritability in bipolar depression: a single-blind randomised control trial.

OBJECTIVE: The symptom-complex irritability, widely used in descriptions of bipolar patients' manic and mixed states, also represents a common feature in depressive phases. Irritability negatively affects the clinical course of depression, leading to a higher risk of treatment non-adherence, violence, and suicide attempts. Nevertheless, proportional attention from the scientific literature seems to be scarce. We conducted the first randomised controlled trial with the aim of evaluating BLT as a possible therapeutic strategy for irritability in bipolar depression. METHODS: 180 inpatients were randomly assigned to: Group A exposed to bright light therapy (BLT) daily, or Group B treated with pharmacotherapy only. A qualitative assessment of irritability was performed after a 4-week program. RESULTS: Group A showed about one-third fewer cases of irritability compared to Group B, this reduction was not related to the overall remission of depressive symptoms. CONCLUSIONS: The present study supports the usefulness of BLT in irritability in bipolar depression.

Irritability is an underestimated feature of bipolar depression.Irritability is related to higher suicide risk and lower quality of life.Bright light therapy is an effective strategy to reduce irritability in bipolar depression.

Mental imagery of suicide and non-suicidal self-injury: A meta-analysis and systematic review.

BACKGROUND: The vast majority of research on, and clinical assessment of, cognitions related to suicide and non-suicidal self-injury (NSSI) has focused on verbal thoughts. And yet, mental imagery is more realistic and emotionally arousing than verbal thoughts. METHODS: We conducted a systematic review and meta-analysis documenting the prevalence of suicidal and NSSI mental imagery and describing the content and characteristics of suicidal and NSSI mental imagery, links between suicidal and NSSI mental imagery and suicidal and NSSI behavior, and how to intervene on suicidal and NSSI mental imagery. Studies published through December 17, 2022 were identified through a systematic search of MEDLINE and PsycINFO. RESULTS: Twenty-three articles were included. Prevalence rates of suicidal (73.56%) and NSSI (84.33%) mental imagery were high among clinical samples. Self-harm mental imagery commonly depicts engagement in self-harm behavior and is experienced as vivid, realistic, and preoccupying. When experimentally induced, self-harm mental imagery reduces physiological and affective arousal. Preliminary evidence suggests that suicidal mental imagery is associated with suicidal behavior. CONCLUSIONS: Suicidal and NSSI mental imagery are highly prevalent and may be associated with heightened risk for self-harm behavior. Assessments and interventions for self-harm should consider incorporating and addressing suicidal and NSSI mental imagery to mitigate risk.

Content and Process of Adolescent Suicide Ideation: Implications for Risk Assessment.

This study examined differences in the content and process of suicide ideation between adolescents presenting with recent suicide ideation or a suicide attempt in clinical settings. Across two combined study samples, adolescents (N = 229; 79% female; 73% Hispanic/Latine), ages 12-19, presenting with a recent suicide attempt, recent suicide ideation with a past suicide attempt history, or recent suicide ideation with no past suicide attempt history were interviewed in detail about the process and content of their suicide ideation. The group with suicide ideation and a past suicide attempt more often reported that their recent ideation lasted greater than 4 h compared to those with suicide ideation but no past suicide attempt history. The suicide attempt group more often considered ingestion as their first method of attempt, compared to the other two suicide ideation groups, and less often considered "other" methods (e.g., jumping from a height or onto train/traffic, hanging). Wish to die was lower in the ideation-only group, compared to both other groups. Separate analyses from Study 2 suggested that the majority of adolescents' suicide ideation contained imagery; however, a higher proportion of adolescents with suicide ideation and a past suicide attempt reported imagery in their ideation than those with ideation but no past attempt. Understanding what adolescents think about when they consider suicide and how they think about it may be informative about risk of a suicide attempt.

Vitamin D in Depression: A Potential Bioactive Agent to Reduce Suicide and Suicide Attempt Risk.

Suicide is one of the leading causes of death worldwide. According to the World Health Organization (WHO), every year, more than 700 thousand people die from this cause. Therefore, suicide is a public health issue. The complex interaction between different factors causes suicide; however, depression is one of the most frequent factors in people who have attempted suicide. Several studies have reported that vitamin D deficiency may be a relevant risk factor for depression, and vitamin D supplementation has shown promising effects in the adjunctive treatment of this mood disorder. Among the beneficial mechanisms of vitamin D, it has been proposed that it may enhance serotonin synthesis and modulate proinflammatory cytokines since low serotonin levels and systemic inflammation have been associated with depression and suicide. The present narrative review shows the potential pathogenic role of vitamin D deficiency in depression and suicide and the potential benefits of vitamin D supplementation to reduce their risk.

Suicide in Chinese myths and legends-Some familiar themes.

AIM: To expand our understanding of suicide by examining reports of this behavior from the Chinese mythical era (commencing circa 1200 BCE) and drawing comparisons with subsequent eras. METHOD: Four hundred recently published accounts of Chinese myths and folk tales were examined, along with supplementary material. Lists were created including one focused on attempted suicide and another on completed suicide. Comparisons were drawn with the suicide of a later era China and the current west. RESULTS: No evidence was located of suicide resulting from mental disorder. Six accounts of attempted suicide and 13 of completed suicide were located. Triggers included the death of a loved one, the loss of a valued possession, complicated relationships, and the avoidance of guilt and disgrace. These accord with current western behavior. CONCLUSION: There is at least fair agreement in the triggers of suicide in past eras in China and the current western era. This supports the view that suicide may be, in some instances, a customary response to circumstances.

The association between vitamin D serum levels, supplementation, and suicide attempts and intentional self-harm.

OBJECTIVES: The purpose of this study is to determine the associations between Vitamin D supplementation, 25(OH) blood serum levels, suicide attempts, and intentional self-harm in a population of veterans in the Department of Veterans Affairs (VA). METHODS: A retrospective cohort study of US Veterans supplemented with Vitamin D. Veterans with any Vitamin D3 (cholecalciferol) or Vitamin D2 (ergocalciferol) fill between 2010 and 2018 were matched 1:1 to untreated control veterans having similar demographics and medical histories. Cox proportional hazards regression was used to estimate the time from the first Vitamin D3 (cholecalciferol) or Vitamin D2 (ergocalciferol) prescription fill to the first suicide attempt or intentional self-harm. Analyses were repeated in stratified samples to measure associations by race (Black or White), gender (male or female), blood levels (0-19 ng/ml, 20-39 ng/ml, and 40+ ng/ml), and average daily dosage. RESULTS: Vitamin D3 and D2 supplementation were associated with a 45% and 48% lower risk of suicide attempt and self-harm ((D2 Hazard Ratio (HR) = 0.512, [95% CI, 0.457, 0.574]; D3 HR = 0.552, [95% CI, 0.511, 0.597])). Supplemented black veterans and veterans with 0-19 ng/ml vitamin D serum levels were at ~64% lower risk relative to controls (Black Veteran HR: 0.362 [95% CI: 0.298,0.440]; 0-19 ng/ml HR: 0.359 [95% CI: 0.215,0.598]). Supplementation with higher vitamin D dosages was associated with greater risk reductions than lower dosages (Log Average Dosage HR: 0.837 [95% CI: 0.779,0.900]). CONCLUSIONS: Vitamin D supplementation was associated with a reduced risk of suicide attempt and self-harm in Veterans, especially in veterans with low blood serum levels and Black veterans.

Peer Intervention following Suicide-Related Emergency Department Presentation: Evaluation of the PAUSE Pilot Program.

The risk for future suicidal behaviours is elevated following suicide attempts, particularly for those with complex needs or those who are disconnected from healthcare systems. The PAUSE program was designed to address this gap using peer workers to provide continuity and coordination of care following suicide-related emergency presentations. This study aimed to evaluate the pilot program's effect on suicidal ideation and hope, and to explore the acceptability and participants' experiences. A mixed-methods design was employed with pre- and post-evaluation questionnaires, including the GHQ-28-SS (general health questionnaire suicide scale), AHS (adult hope scale), and K10 (Kessler psychological distress scale). Participant engagement rates and semi-structured interviews were used to explore program acceptability. In total, 142 people were engaged with the PAUSE pilot between 24 August 2017 and 11 January 2020. There were no significant gender differences in engagement. The suicidal ideation scores decreased, and the hope scores increased after participation in PAUSE. A thematic analysis revealed that participants identified that the key program mechanisms were holistic and responsive support, ongoing social connectedness, and having peer workers who understood their experiences and treated them like people rather than clients. The small number of participants and lack of a control group limited the result generalizability. The findings suggest that PAUSE was an effective and acceptable model for supporting people following suicide-related hospitalisations in this pilot sample.

Life-Satisfaction, Engagement, Mindfulness, Flourishing, and Social Support: Do they Predict Depression, Suicide Ideation, and History of Suicide Attempt in Late Life?

OBJECTIVE: Suicide is an outcome arising from a combination of risk and protective factors. Examining psychological resilience traits associated with successful aging may help to better understand late-life suicide and depression. We examined self-reported protective factors including mindfulness, life satisfaction and engagement, flourishing, and subjective and objective social support in a high suicide-risk sample of depressed older adults. METHODS: Participants were 297 individuals aged 55+ (mean age: 64.2): 92 depressed suicide attempters, 138 depressed individuals who never attempted suicide, and 67 non-psychiatric comparisons. Using linear and binomial logistic regression, we examined the effects of a combined Protective Factor value on presence and severity of depression and suicidal ideation, and history of suicide attempt. RESULTS: Relative to the non-psychiatric comparison group, all depressed participants had significantly lower Protective Factor values. Higher Protective Factor value was associated with lower likelihood of depression, depression severity, and likelihood of ideation, but was not associated with ideation severity or history of suicide attempt. Participants with one standard deviation higher Protective Factor had lower odds of ideation incidence by a factor of OR=0.68 (95%CI=0.48-0.96). CONCLUSION: Resiliency characteristics relevant to psychological wellbeing and successful aging may mitigate the emergence of depression and suicidal ideation, as well as the severity of depression in late-life. The Resilience Factor used in this study can help clinicians nuance their appraisal of depression and suicide risk.

Research and Diagnostic Algorithmic Rules (RADAR) for mood disorders, recurrence of illness, suicidal behaviours, and the patient's lifetime trajectory.

The top-down Diagnostic and Statistical Manual/International Statistical Classification of Diseases categories of mood disorders are inaccurate, and their dogmatic nature precludes both deductive (as indisputable) and inductive (as top-down) remodelling of case definitions. In trials, psychiatric rating scale scores employed as outcome variables are invalid and rely on folk psychology-like narratives. Using machine learning techniques, we developed a new precision nomothetic model of mood disorders with a recurrence of illness (ROI) index, a new endophenotype class, namely Major Dysmood Disorder (MDMD), characterised by increased ROI, a more severe phenome, and more disabilities. Nonetheless, our previous studies did not compute Research and Diagnostic Algorithmic Rules (RADAR) to diagnose MDMD and score ROI, lifetime (LT), and current suicidal behaviours, as well as the phenome of mood disorders. Here, we provide rules to compute bottom-up RADAR scores for MDMD, ROI, LT and current suicidal ideation and attempts, the phenome of mood disorders, and the lifetime trajectory of mood disorder patients from a family history of mood disorders and substance abuse to adverse childhood experiences, ROI, and the phenome. We also demonstrate how to plot the 12 major scores in a single RADAR graph, which displays all features in a two-dimensional plot. These graphs allow the characteristics of a patient to be displayed as an idiomatic fingerprint, allowing one to estimate the key traits and severity of the illness at a glance. Consequently, biomarker research into mood disorders should use our RADAR scores to examine pan-omics data, which should be used to enlarge our precision models and RADAR graph.

Presença de risco de transtorno do estresse pós-traumático em policiais militares feridos por arma de fogo / Presence of risk of posttraumatic stress disorder in military police officers wounded by firearms / Presencia de riesgo de trastorno de estrés postraumático en policías militares heridos por armamiento de fuego

Este estudo teve como objetivo identificar o risco de desenvolvimento de transtorno de estresse pós-traumático (TEPT), bem como sua associação com pensamentos ou tentativas suicidas e a saúde mental de policiais militares feridos por arma de fogo, na Região Metropolitana de Belém (RMB), nos anos de 2017 a 2019. A pesquisa contou com a participação de 30 entrevistados, que responderam o Inventário Demográfico e a Lista de verificação de TEPT para o DSM-5 (PCL-5). Para análise dos dados, utilizou-se a técnica estatística Análise Exploratória de Dados e a técnica multivariada Análise de Correspondência. Os resultados revelaram a existência de risco de desenvolvimento do transtorno de forma parcial ou total em uma expressiva parcela da população entrevistada, tendo homens como maioria dos sintomáticos, com média de 38 anos, exercendo atividades operacionais e vitimados em via pública quando estavam de folga do serviço. O ferimento deixou a maioria com sequelas, com destaque para dores crônicas, limitações de locomoção e/ou mobilidade e perda parcial de um membro. E, ainda, policiais sintomáticos apresentaram comportamentos suicidas, relatando já terem pensado ou tentado tirar a própria vida. Desta forma, conclui-se que policiais militares são expostos constantemente a traumas inerentes a sua profissão. Quando há ameaça de vida, como nos casos de ferimentos por arma de fogo, são suscetíveis a sequelas físicas decorrente do ferimento, somadas a sequelas mentais tardias, como o surgimento de sintomatologias de TEPT e ideação suicida.(AU)

This study aimed to identify the risk of developing post-traumatic stress disorder (PTSD) and its associations around suicidal thoughts or attempts and mental health in military police officers injured by firearms, in the Metropolitan Region of Belem (RMB), from 2017 to 2019. The research had the participation of 30 respondents who answered the Demographic Inventory and the PTSD checklist for DSM-5 (PCL-5). For data analysis, we used the statistical technique Exploratory Data Analysis and the multivariate technique Correspondence Analysis. The results revealed the existence of risk of developing partial or total disorder in a significant portion of the interviewed population, with men as most of the symptomatic individuals, with mean age of 38 years, developing operational activities and victimized on public roads when they were off duty. The injuries left most of them with sequelae, especially chronic pain, limited locomotion and/or mobility, and partial loss of a limb. In addition, symptomatic officers showed suicidal behavior, such as reporting they had thought about or tried to take their own lives. Thus, we conclude that military policemen are constantly exposed to traumas inherent to their profession. When their lives are threatened, as in the case of firearm wounds, they are susceptible to physical sequelae resulting from the injury, in addition to late mental sequelae, such as the appearance of PTSD symptoms and suicidal ideation.(AU)

Este estudio tuvo como objetivo identificar el riesgo de desarrollo de trastorno de estrés postraumático (TEPT) y sus asociaciones con pensamientos o tentativas suicidas y la salud mental en policías militares heridos por armamiento de fuego, en la Región Metropolitana de Belém (Brasil), en el período entre 2017 y 2019. En el estudio participaron 30 entrevistados que respondieron el Inventario Demográfico y la Lista de verificación de TEPT para el DSM-5 (PCL-5). Para el análisis de datos se utilizaron la técnica estadística Análisis Exploratoria de Datos y la técnica multivariada Análisis de Correspondencia. Los resultados revelaron que existen riesgos de desarrollo de trastorno de estrés postraumático de forma parcial o total en una expresiva parcela de la población de policías entrevistados, cuya mayoría de sintomáticos eran hombres, de 38 años en media, que ejercen actividades operacionales y fueron victimados en vía pública cuándo estaban de día libre del servicio. La lesión dejó la mayoría con secuelas, especialmente con dolores crónicos, limitaciones de locomoción y/o movilidad y la pierda parcial de un miembro. Aún los policías sintomáticos presentaran comportamiento suicida, tales como relataran qué ya pensaron o tentaron quitar la propia vida. Se concluye que los policías militaran se exponen constantemente a los traumas inherentes a su profesión. Cuando existe amenaza de vida, como en los casos de heridas por armamiento de fuego, son expuestos a secuelas físicas transcurridas de la herida, sumado a secuelas mentales tardías, como el surgimiento de sintomatologías de TEPT y la ideación suicida.(AU)

Prevenção do suicídio: esquecimento do ser e era da técnica / Suicide prevention: forgetfulness of being and technical era / Prevención del suicidio: olvido del ser y la era de la técnica

Martin Heidegger, em sua ontologia, destaca uma característica específica da atualidade que atravessa o comportamento humano, na filosofia, na ciência ou no senso comum: o esquecimento do ser. O filósofo diferencia a época atual das demais épocas históricas. O horizonte histórico contemporâneo se desvela por meio do desafio e da exploração, da tentativa de controle e domínio dos acontecimentos, ao modo da disponibilidade e em função da produtividade. O filósofo esclarece que todo esse desenraizamento do homem atual está atrelado ao esquecimento daquilo que é o mais essencial, qual seja, a existência. A questão que norteia este estudo é apurar, por meio das referências de Heidegger e dos estudos sobre suicídio, o quanto a interpretação da morte voluntária nos dias atuais está atravessada por tal esquecimento. Pretendemos investigar o quanto as ações de prevenção desenvolvidas pela suicidologia se encontram atravessadas por tal esquecimento do ser do homem e, dessa forma, acabam por estabelecer relações entre ser e ente em uma consequente redução ao ente como invariante e atemporal. O caminho para investigar a questão iniciará por abordar, em maiores detalhes, a analítica existencial, a questão da técnica e o movimento de esquecimento do ser apontados por Heidegger a fim de problematizar as perspectivas científicas atuais sobre o suicídio em sua prevenção para, então, estabelecer uma compreensão fenomenológica e existencial sobre o referido fenômeno.(AU)

Martin Heidegger, in his ontology, highlights a specific characteristic of the present moment that crosses human behavior, in philosophy, science, or common sense: the forgetfulness of being. The philosopher differentiates the current age from other historical ages. The contemporary historical horizon is unveiled by the challenge and the exploration, from the attempt to control and dominate events, to the mode of standing reserve and in terms of productivity. The philosopher clarifies that all this uprooting of the current man is linked to the forgetfulness of what is the most essential, namely, the existence itself. The question that guides this study is to investigate, via Heidegger's references and studies on suicide, to what extent the interpretation of voluntary death today is crossed by such forgetfulness. We intend to investigate to what extent the prevention actions developed by suicidology are crossed by such forgetfulness of the human's being and, in this way, they end up establishing relationships between being and entity in a consequent reduction to entity as an invariant and timeless. The path to investigate the issue will start by addressing, in greater detail, the existential analytics, the question concerning technique and the movement of forgetting the being pointed out by Heidegger to problematize the current scientific perspectives on suicide and its prevention to, then, propose a phenomenological and existential understanding about the referred phenomenon.(AU)

Martin Heidegger en su ontología destaca una característica específica del presente que atraviesa el comportamiento humano, ya sea en la filosofía, la ciencia o el sentido común: el olvido del ser. El filósofo diferencia la época actual de otras épocas históricas. El horizonte histórico contemporáneo se devela el desafío y la exploración, el intento de controlar y dominar los eventos, en la modalidad de disponibilidad y en términos de productividad. Y así aclara que todo este desarraigo del hombre actual está involucrado en el olvido de lo más esencial, que es la existencia misma. A partir de las referencias a Heidegger y de los estudios sobre el suicidio, este estudio busca saber hasta qué punto la interpretación de la muerte voluntaria hoy está atravesada por este olvido. Pretendemos investigar en qué medida las acciones de prevención desarrolladas por la suicidología se encuentran atravesadas por el olvido del ser del hombre y, de esta manera, terminan por establecer relaciones entre el ser y el ente, en una consecuente reducción al ente como invariante y atemporal. Para investigar el tema se abordará inicialmente, con mayor detalle, la analítica existencial, la cuestión de la técnica y el movimiento del olvido del ser señalado por Heidegger para problematizar las perspectivas científicas actuales sobre el suicidio y su prevención y, luego, proponer una comprensión fenomenológica y existencial sobre el referido fenómeno.(AU)

Association Between Folic Acid Prescription Fills and Suicide Attempts and Intentional Self-harm Among Privately Insured US Adults.

Importance: Suicide is a leading cause of death in the United States, having increased more than 30% from 2000 to 2018. An inexpensive, safe, widely available treatment for preventing suicidal behavior could reverse this trend. Objective: To confirm a previous signal for decreased risk of suicide attempt following prescription fills for folic acid in a national pharmacoepidemiologic study of patients treated with folic acid. Design, Setting, and Participants: A within-person exposure-only cohort design was used to study the dynamic association between folic acid (vitamin B9) prescription fills over a 24-month period and suicide attempts and intentional self-harm. Data were collected from a pharmacoepidemiologic database of US medical claims (MarketScan) for patients with private health insurance who filled a folic acid prescription between 2012 and 2017. The same analysis was repeated with a control supplement (cyanocobalamin, vitamin B12). Data were analyzed from August 2021 to June 2022. Exposure: Folic acid prescription fills. Main Outcome and Measure: Suicide attempt or intentional self-harm resulting in an outpatient visit or inpatient admission as identified by codes from the International Statistical Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification. Results: Data on 866 586 patients were collected; 704 514 (81.30%) were female, and 90 296 (10.42%) were 60 years and older. Overall, there were 261 suicidal events during months covered by a folic acid prescription (5 521 597 person-months) for a rate of 4.73 per 100 000 person-months, compared with 895 suicidal events during months without folic acid (8 432 340) for a rate of 10.61 per 100 000 person-months. Adjusting for age and sex, diagnoses related to suicidal behavior, diagnoses related to folic acid deficiency, folate-reducing medications, history of folate-reducing medications, and history of suicidal events, the hazard ratio (HR) for folic acid for suicide events was 0.56 (95% CI, 0.48-0.65), with similar results for the modal dosage of 1 mg of folic acid per day (HR, 0.57; 95% CI, 0.48-0.69) and women of childbearing age (HR, 0.60; 95% CI, 0.50-0.73). A duration-response analysis (1-mg dosage) revealed a 5% decrease in suicidal events per month of additional treatment (HR, 0.95; 95% CI, 0.93-0.97). The same analysis for the negative control, cyanocobalamin, found no association with suicide attempt (HR, 1.01; 95% CI, 0.80-1.27). Conclusions and Relevance: This large-scale pharmacoepidemiologic study of folic acid found a beneficial association in terms of lower rates of suicide attempts. The results warrant the conduct of a randomized clinical trial with suicidal ideation and behavior as outcomes of interest. If confirmed, folic acid may be a safe, inexpensive, and widely available treatment for suicidal ideation and behavior.

A novel source of carbon monoxide for suicide attempt.

Carbon monoxide (CO) inhalation is a common method of suicide. The combination of formic acid with sulfuric acid creates carbon monoxide. This novel method is described in readily accessible internet-based resources. We present the case of a 35-year-old woman who developed CO toxicity by using this method. It is important for hyperbaric medicine physicians to be aware of this source of CO toxicity.

Emotion dysregulation and mindfulness in non-suicidal self-injury.

This study examined the association between mindfulness and engagement in non-suicidal self-injury (ENSSI) and whether emotion dysregulation explains this association. A secondary objective was to explore the difference between participants who engaged in a suicide attempt and those who only engaged in non-suicidal self-injury. A sample of 201 psychiatric patients (62.7% female; age range: 18-71 years old) participated in the study. The path analysis indicated that trait mindfulness was negatively associated with all emotion dysregulation dimensions and that one of these dimensions, impulse control difficulty, was associated with higher ENSSI. Moreover, impulse control difficulty was associated with increased odds of having attempted suicide. These findings suggest that mindfulness is a relevant construct to ENSSI with and without a suicide attempt. Future studies should investigate mindfulness-based interventions for ENSSI and the role played by the capacity to control impulses when experiencing negative emotions.

Association between suicide attempt and previous healthcare utilization among homeless youth.

INTRODUCTION: The purpose of this study was to examine the association between prior emergency department (ED) visit or hospitalization and subsequent suicide attempt among homeless youth aged 10-17 years old. METHODS: With New York statewide databases, a case-control design was conducted. Cases and controls were homeless patients with an ED visit or hospitalization due to suicide attempt (cases) or appendicitis (controls) between April and December. We examined ED and inpatient records for 90 days prior to the visit for suicide attempt or appendicitis. The primary exposure variable was prior healthcare utilization for any reason other than the following four reasons: mental health disorder, substance use, self-harm, and other injuries. Multivariable logistic regression models, with year fixed effect and hospital random effect, were used. RESULTS: A total of 335 cases and 742 controls were identified. Cases had lower odds of prior healthcare utilization for any reason other than the four reasons listed above. (adjusted Odds Ratio [aOR]: 0.53, p-value = 0.03). CONCLUSIONS: The association between prior healthcare utilization and decreased risk of suicide attempt among homeless youth may be due to comprehensive care provided during healthcare utilization. It may also reflect the presence of a social network that provided a protective effect.