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

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

Daylight saving time was not associated with a change in suicide rates in Austria, Switzerland and Sweden.

BACKGROUND: Some studies have reported an increase in suicides after the start of daylight saving time (DST), but the evidence is mixed and more research about proposed mechanisms (disrupted sleep, changing light exposure) is needed. METHODS: In our preregistered study, we analyzed change in suicide rates in the 2 weeks before/after DST, based on data between 1980 and 2022 from Austria, Switzerland and Sweden, using Poisson regression models and changepoint analyses. To explore the impact of disrupted sleep, we repeated the analysis for retired people who are likely less bound to DST, and for younger people. To explore the effect of changed daylight exposure, we repeated the analysis for northern and southern regions because twilight and daylight exposure varies by latitude. RESULTS: Suicide rates did not significantly increase after the start of DST (adjusted incidence rate ratio IRR = 0.98, 95% CI 0.91-1.06, P = 0.66, n = 13 362 suicides) or after DST ended (adjusted IRR = 0.99, 95% CI 0.91-1.07, P = 0.76, n = 12 319 suicides). There were no statistically significant findings among younger or older subgroups and also not in Sweden and Austria/Switzerland. No changepoints were detected. CONCLUSIONS: There were no significant changes in suicide rates associated with DST and no clear evidence to support proposed mechanisms (light exposure, disruption of sleep). Our study is one of the largest and was adequately powered. Nonetheless, even larger studies to detect smaller effects could be important to inform the debate about harms and benefits of DST.

Sexual minorities between equality and exclusion.

The situation of people with different sexual orientations and gender identities varies worldwide depending on the legal and social situation despite a formal depathologization in the medical classification systems DSM 1973 and ICD 1991. The spectrum ranges from equality to discrimination and exclusion to social ostracism, sometimes combined with legal persecution, in some countries even with the threat of a death penalty. On the basis of a historical overview of the medical-social discourse, it will be shown which scientific and societal advances make depathologization possible, although even in today's times a consistent and sustainable effect of this depathologization appears to be increasingly difficult in some countries, and in some cases even a societal re-pathologization is taking place. Aspects of persistent medical and societal stigma on the health of LGBT (lesbian, gay, bisexual, transgender) people are highlighted. Scientific models that empirically explain the increased risk of mental illness among LGBT people as a result of various forms of stigma and guidelines for psychotherapeutic treatment are presented. In an outlook, the continuing precarious situation of sexual minorities worldwide is pointed out and the importance of medical, social and political destig matization as a prerequisite for the mental health of LGBT people is emphasized. Non-discriminatory legislation is an important element in addition to medical statements and medical guidelines for treatment.

[Sexual minorities between equality and exclusion].

The situation of people with different sexual orientations and gender identities varies worldwide depending on the legal and social situation despite a formal depathologization in the medical classification systems DSM 1973 and ICD 1991. The spectrum ranges from equality to discrimination and exclusion to social ostracism, sometimes combined with legal persecution, in some countries even with the threat of a death penalty. On the basis of a historical overview of the medical-social discourse, it will be shown which scientific and societal advances make depathologization possible, although even in today's times a consistent and sustainable effect of this depathologization appears to be increasingly difficult in some countries, and in some cases even a societal re-pathologization is taking place. Aspects of persistent medical and societal stigma on the health of LGBT (lesbian, gay, bisexual, transgender) people are highlighted. Scientific models that empirically explain the increased risk of mental illness among LGBT people as a result of various forms of stigma and guidelines for psychotherapeutic treatment are presented. In an outlook, the continuing precarious situation of sexual minorities worldwide is pointed out and the importance of medical, social and political destig matization as a prerequisite for the mental health of LGBT people is emphasized. Non-discriminatory legislation is an important element in addition to medical statements and medical guidelines for treatment.

Did the introduction and increased prescribing of antidepressants lead to changes in long-term trends of suicide rates?

BACKGROUND: Ecological studies have explored associations between suicide rates and antidepressant prescriptions in the population, but most of them are limited as they analyzed short-term correlations that may be spurious. The aim of this long-term study was to examine whether trends in suicide rates changed in three European countries when the first antidepressants were introduced in 1960 and when prescription rates increased steeply after 1990 with the introduction of the serotonin reuptake inhibitors (SSRIs). METHODS: Data were extracted from the WHO Mortality Database. Suicide rates were calculated for people aged 10-89 years from 1951-2015 for Italy, 1955-2016 for Austria and 1951-2013 for Switzerland. Trends in suicide rates stratified by gender were analyzed using joinpoint regression models. RESULTS: There was a general pattern of long-term trends that was broadly consistent across all three countries. Suicide rates were stable or decreasing during the 1950s and 1960s, they rose during the 1970s, peaked in the early 1980s and thereafter they declined. There were a few notable exceptions to these general trends. In Italian men, suicide rates increased until 1997, then fell sharply until 2006 and increased again from 2006 to 2015. In women from all three countries, there was an extended period during the 2000s when suicide rates were stable. No trend changes occurred around 1960 or 1990. CONCLUSIONS: The introduction of antidepressants around 1960 and the sharp increase in prescriptions after 1990 with the introduction of the SSRIs did not coincide with trend changes in suicide rates in Italy, Austria or Switzerland.

Suicide risk over the course of the day, week, and life.

BACKGROUND: Suicide rates vary with important cycles in life, according to scientific findings and sometimes only according to lay beliefs. This paper reviews empirical studies on the association between suicides and a selection of cycles in life (the course of day, week, year, and life, menstrual cycle, and the moon phases). METHODS: Non-systematic review with a selection of key-papers and recent reviews, and analyses of Austrian daily suicide data from 1970-2017. RESULTS: For the time of day, suicides occur slightly more frequently from morning to mid-day. However, among people awake, suicides peak during nighttime. For the course of the week, suicide rates increase on Mondays and decrease on weekends. Similarly, there are more suicides after major holidays. For the course of the year, suicide rates increase in spring/summer, decrease in December, are lowest on Christmas, peak on New Year's Day, and go back to about the yearly average thereafter. With respect to the life cycle, suicide rates are lowest in children and highest in elderly people, especially in men. Suicide rates increase during menstruation but not in the pre-menstruation phase. Suicide rates do not vary with moon-phases. CONCLUSIONS: There is robust evidence that suicide rates vary with some cycles in human life, such as day of the week, seasons and holidays, and there is some evidence that suicides vary with time of day and the menstrual cycle. Some of the associations seem counter-intuitive but can be explained with theories of suicides and related psychosocial mechanisms (e.g., the Broken Promise Effect). Since the effects are mostly small, findings cannot easily be translated into clinical practice but they enhance our understanding of suicides nonetheless.

Perceptions of LGBQ+ youth and experts of suicide prevention video messages targeting LGBQ+ youth: qualitative study.

BACKGROUND: Young lesbian, gay, bisexual, transgender, queer as well as other sexual/gender minorities (LGBTQ+) persons have higher rates of suicidal ideation and behavior compared to their non-LGBTQ+ peers, particularly during their coming out. The "It Gets Better" project is a multi-national media campaign that aims to reduce suicide among LGBTQ+ adolescents by providing personal narratives of hope delivered by mainly adult LGBTQ+ persons. There is only little knowledge so far on how young LGBTQ+ people as well as experts in suicide prevention and counseling perceive these videos, and how to potentially improve the videos based on their perceptions. METHODS: A total of n = 19 LGBQ+ adolescents and young adults and n = 9 experts participated in focus groups to discuss perceptions of a selection of "It Gets Better" videos. Eight focus groups were conducted to assess perceptions on the process of watching the videos, possible effects on young LGBQ+ viewers in general, and suicidal LGBQ+ youth in particular, as well as factors that were relevant to their perceptions. RESULTS: Messages were found to be helpful in terms of promoting hope. LGBQ+ youth identified several key strategies to increase identification with messages, which they considered crucial for their effectiveness. Criticism emerged from a perceived lack of diversity in terms of portrayed sexual identities, and some shallowness in the portrayal of suicidal ideation and how things can get better. The experts' perceptions of the videos were largely consistent with LGBQ+ youth, highlighting a positive potential of videos to support coming out and identity building processes. CONCLUSIONS: Young people and experts view the videos as helpful and relevant, but identified several strategies to better tailor them to the needs of LGBTQ+ adolescents, including suicidal peers. The insights gained are useful to the increasing number of suicide prevention projects using personal narratives of coping delivered via media to help prevent suicide.

Effects of Multiple Forms of Information Bias on Estimated Prevalence of Suicide Attempts According to Sexual Orientation: An Application of a Bayesian Misclassification Correction Method to Data From a Systematic Review.

Multiple epidemiologic studies demonstrate a disparity in suicide risk between sexual minority (lesbian, gay, bisexual) and heterosexual populations; however, both "exposure" (sexual minority status) and outcome (suicide attempts) may be affected by information bias related to errors in self-reporting. We therefore applied a Bayesian misclassification correction method to account for possible information biases. A systematic literature search identified studies of lifetime suicide attempts in sexual minority and heterosexual adults, and frequentist meta-analysis was used to generate unadjusted estimates of relative risk. A Bayesian model accounting for prior information about sensitivity and specificity of exposure and outcome measures was used to adjust for misclassification biases. In unadjusted frequentist analysis, the relative risk of lifetime suicide attempt comparing sexual minority with heterosexual groups was 3.38 (95% confidence interval: 2.65, 4.32). In Bayesian reanalysis, the estimated prevalence was slightly reduced in heterosexual adults and increased in sexual minority adults, yielding a relative risk of 4.67 (95% credible interval: 3.94, 5.73). The disparity in lifetime suicide attempts between sexual minority and heterosexual adults is greater than previously estimated, when accounting for multiple forms of information bias. Additional research on the impact of information bias in studies of sexual minority health should be pursued.

Guidelines for the pharmacological acute treatment of major depression: conflicts with current evidence as demonstrated with the German S3-guidelines.

Several international guidelines for the acute treatment of moderate to severe unipolar depression recommend a first-line treatment with antidepressants (AD). This is based on the assumption that AD obviously outperform placebo, at least in the case of severe depression. The efficacy of AD for severe depression can only be definitely clarified with individual patient data, but corresponding studies have only been available recently. In this paper, we point out discrepancies between the content of guidelines and the scientific evidence by taking a closer look at the German S3-guidelines for the treatment of depression. Based on recent studies and a systematic review of studies using individual patient data, it turns out that AD are marginally superior to placebo in both moderate and severe depression. The clinical significance of this small drug-placebo-difference is questionable, even in the most severe forms of depression. In addition, the modest efficacy is likely an overestimation of the true efficacy due to systematic method biases. There is no related discussion in the S3-guidelines, despite substantial empirical evidence confirming these biases. In light of recent data and with their underlying biases, the recommendations in the S3-guidelines are in contradiction with the current evidence. The risk-benefit ratio of AD for severe depression may be similar to the one estimated for mild depression and thus could be unfavorable. Downgrading of the related grade of recommendation would be a logical consequence.

[Effects and side effects of the disease concept "Homosexuality"]. / Wirkungen und Nebenwirkungen des Krankheitskonzepts "Homosexualität".

The diagnosis of homosexuality was removed from the DSM in 1973 and from the ICD in 1991. Despite this formal depathologization, negative effects of the concept of "homosexuality" as a disease, which stems from the 19th century, are still evident to this day and will be highlighted in this article. Furthermore, we also demonstrate the related interactions between social and medical processes. First, we give a global overview of the legal and social situation of sexual minorities, ranging from gender equality to marginalization and persecution. This is followed by a historical outline of the medical-social discourses in order to understand the connection between social stigmatization and pathologizing theories on homosexuality. Thereby, it can be demonstrated how scientific and social progress made the depathologization of homosexuality necessary, but also how difficult a consistent and sustainable effect of this depathologization appears to be. Additionally, we focus on the effects of persistent medical and social stigma on the health of LGB (lesbian, gay, bisexual) people. For this purpose, scientific models will be utilised in order to explain the increased risk of mental illness in LGB people arising as a direct result of various forms of stigmatization. In an outlook, we point out the ongoing precarious situation of sexual minorities in many parts of the world and emphasize the importance of destigmatizing polices and guidelines as carried out by the World Medical Association in 2013.

Minority stress model components and affective well-being in a sample of sexual orientation minority adults living with HIV/AIDS.

To date very little literature exists examining theoretically-based models applied to day-to-day positive and negative affective well-being among lesbian, gay, and bisexual (LGB) persons living with HIV/AIDS (PLWHA). Grounded in the perspective of Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674-697. Minority Stress Model, the present study examined HIV- and sexual orientation-related factors influencing affective well-being (i.e., positive affect, negative affect, life satisfaction, and stress). Participants were 154 HIV-positive LGB adults from an urban area in the southwestern United States. Data were drawn from an archival database (i.e., Project Legacy). The study methodology featured a cross-sectional self-report survey of minority stress, victimization, coping, and emotional well-being, among other subjects. Primary regression results were: (1) males reported less general stress than females; (2) higher internalized HIV-related stigma was associated with elevated negative affect; (3) higher internalized homophobia was associated with elevations in negative affect and general stress; (4) higher coping self-efficacy was associated with lesser negative affect, lesser general stress, greater positive affect, and greater satisfaction with life; (5) a significant interaction between HIV-related victimization and coping self-efficacy showed that coping self-efficacy was positively associated with positive affect only (only for non-victims). Contrary to expectations, coping self-efficacy demonstrated the largest main effects on affective well-being. Results are discussed with regard to potential need for theoretical refinement of Minority Stress Model applied to PLWHA and affective well-being outcomes. Recommendations are offered for future research.

Sexual orientation differences in treatment expectation, alliance, and outcome among patients at risk for suicide in a public psychiatric hospital.

BACKGROUND: Sexual minority (SM) individuals (gay, lesbian, bisexual, or otherwise nonheterosexual) are at increased risk for mental disorders and suicide and adequate mental healthcare may be life-saving. However, SM patients experience barriers in mental healthcare that have been attributed to the lack of SM-specific competencies and heterosexist attitudes and behaviors on the part of mental health professionals. Such barriers could have a negative impact on common treatment factors such as treatment expectancy or therapeutic alliance, culminating in poorer treatment outcomes for SM versus heterosexual patients. Actual empirical data from general psychiatric settings is lacking, however. Thus, comparing the treatment outcome of heterosexual and SM patients at risk for suicide was the primary aim of this study. The secondary aim was to compare treatment expectation and working alliance as two common factors. METHODS: We report on 633 patients from a suicide prevention inpatient department within a public psychiatric hospital. Most patients were at risk for suicide due to a recent suicide attempt or warning signs for suicide, usually in the context of a severe psychiatric disorder. At least one indicator of SM status was reported by 21% of patients. We assessed the treatment outcome by calculating the quantitative change in suicide ideation, hopelessness, and depression. We also ran related treatment responder analyses. Treatment expectation and working alliance were the assessed common factors. RESULTS: Contrary to the primary hypothesis, SM and heterosexual patients were comparable in their improvement in suicide ideation, hopelessness, or depression, both quantitatively and in treatment responder analysis. Contrary to the secondary hypothesis, there were no significant sexual orientation differences in treatment expectation and working alliance. When adjusting for sociodemographics, diagnosis, and length of stay, some sexual orientation differences became significant, indicating that SM patients have better outcomes. CONCLUSIONS: These unexpected but positive findings may be due to common factors of therapy compensating for SM-specific competencies. It may also be due to actual presence of SM competencies - though unmeasured - in the department. Replication in other treatment settings and assessment of SM-specific competencies are needed, especially in the field of suicide prevention, before these findings can be generalized.

Understanding Suicide Attempts Among Gay Men From Their Self-perceived Causes.

Gay men are at higher risk of suicidality. This paper describes the causes of suicide attempts as perceived by the men themselves and analyzes their impact on severity and recidivism. Mental health surveys conducted among gay men in Geneva, Switzerland, from two probability-based time-space samples in 2007 and 2011, were merged to yield a combined sample N = 762. Suicide ideation, plans, and attempts were assessed, and respondents who had ever attempted suicide answered open questions about perceived causes which were coded and categorized for analysis within the framework of cultural epidemiology. In all, 16.7% of the respondents reported a suicide attempt in their lifetime (59.5% of them with multiple attempts). At their latest attempt, over two thirds asserted intent to die, and half required medical assistance. There was a wide variety of perceived causes, with most individuals reporting multiple causes and many of the most common causes cited at both the first and most recent subsequent attempts. Social/inter-personal problems constitute the most prominent category. Problems with love/relationship and accepting one's homosexuality figure consistently among the top three causes. Whereas the former tend to be associated with weaker intent to die, the latter are associated with the strongest intent to die and reported at multiple attempts. Problems with family are among the most common perceived causes at first attempt but not at the most recent subsequent attempt. Nevertheless, they tend to be related to the strongest intent to die and the greatest medical severity of all the perceived causes. Ten percent of men attempting suicide cited depression as a cause. Although it tended to be associated with weaker intent to die, depression was most likely to be reported at multiple attempts. Respondent-driven assessment yielded both common and idiosyncratic causes of suicide and their distinct effects. Some of these perceived causes are not prominent in the current literature, yet they have important implications for understanding risk and preventing suicide among gay men.

Mental health of sexual minorities. A systematic review.

Many studies, reviews, and meta-analyses have reported elevated mental health problems for sexual minority (SM) individuals. This systematic review provides an update by including numerous recent studies, and explores whether SM individuals are at increased risk across selected mental health problems as per dimensions of sexual orientation (SO), genders, life-stages, geographic regions, and in higher quality studies. A systematic search in PubMed produced 199 studies appropriate for review. A clear majority of studies reported elevated risks for depression, anxiety, suicide attempts or suicides, and substance-related problems for SM men and women, as adolescents or adults from many geographic regions, and with varied SO dimensions (behaviour, attraction, identity), especially in more recent and higher quality studies. One notable exception is alcohol-related problems, where many studies reported zero or reversed effects, especially for SM men. All SM subgroups were at increased risk, but bisexual individuals were at highest risk in the majority of studies. Other subgroup and gender differences are more complex and are discussed. The review supports the long-standing mental health risk proposition for SM individuals, overall and as subgroups.

Nothing like Christmas--suicides during Christmas and other holidays in Austria.

BACKGROUND: Contrary to the myth that suicides increase around Christmas, multiple studies reveal that suicide rates decrease towards Christmas and return back to normal or even peak in the beginning of the new year. We aimed to replicate this effect for Austria. METHODS: The analyses were based on the official suicide statistics 2000-13 using Poission regression and Bayesian changepoint analysis. We also investigated changes of suicide rates during other major holidays and weekends. Seasonal effects were controlled for by using restricted control periods. RESULTS: Suicide rates declined before Christmas and were minimal on December 24th, remained low until the end of the year, peaked on New Year's day, but remained at average level in New Year's week. In contrast, suicide rates increased in the week after Easter and on Mondays/Tuesdays after weekends. No significant effects were found in the week after Whitsun and summer holidays. CONCLUSION: Compared with other holidays, Christmas time is clearly associated with fewer suicides in Austria, too, and may even counteract the 'broken promise' effect. This finding may help clarifying common myths in suicide prevention and may enhance the proper timing of preventive efforts.