Evaluating potential effects of distress symptoms' interventions on suicidality: Analyses of in silico scenarios.

BACKGROUND: Complexity science perspectives like the network approach to psychopathology have emerged as a prominent methodological toolkit to generate novel hypotheses on complex etiologies surrounding various mental health problems and inform intervention targets. Such approach may be pivotal in advancing early intervention of suicidality among the younger generation (10-35 year-olds), the increasing burden of which needs to be reversed within a limited window of opportunity to avoid massive long-term repercussions. However, the network approach currently lends limited insight into the potential extent of proposed intervention targets' effectiveness, particularly for target outcomes in comorbid conditions. METHODS: This paper proposes an in silico (i.e., computer-simulated) intervention approach that maps symptoms' complex interactions onto dynamic processes and analyzes their evolution. The proposed methodology is applied to investigate potential effects of changes in 1968 community-dwelling individuals' distress symptoms on their suicidal ideation. Analyses on specific subgroups were conducted. Results were also compared with centrality indices employed in typical network analyses. RESULTS: Findings concur with symptom networks' centrality indices in suggesting that timely deactivating hopelessness among distressed individuals may be instrumental in preventing distress to develop into suicidal ideation. Additionally, however, they depict nuances beyond those provided by centrality indices, e.g., among young adults, reducing nervousness and tension may have similar effectiveness as deactivating hopeless in reducing suicidal ideation. LIMITATIONS: Caution is warranted when generalizing findings here to the general population. CONCLUSION: The proposed methodology may help facilitate timely agenda-setting in population mental health measures, and may also be augmented for future co-creation projects.

A network approach to understand co-occurrence and relative importance of different reasons for suicide: a territory-wide study using 2002-2019 Hong Kong Coroner's Court reports.

Background: Suicide is a complex and multifaceted issue, and suicidal behaviors are often driven by multiple, interacting factors. It has been challenging to identify reasons for suicide using existing scientific methodologies. This study aims to identify critical reasons for suicide and suicidal behaviors through the application of novel network science methods. Methods: Based on cases investigated by the Hong Kong Coroner's Court from 2002 to 2019, we modelled identified reasons for 13,001 suicide cases as a co-occurrence network, and calculated each reason's eigencentrality to determine their respective relative importance. We then analyzed the temporal and demographic changes in the structure and eigencentrality of the network. We further conducted simulation studies based on the United Nations population projection to assess potential burden of different reasons for suicide on the population in the coming years. Findings: School-related issues had the highest eigencentrality (eigencentrality = 0.49) for individuals younger than 20 years of age. Financial issues were crucial for adults aged 20-59 years, but their importance differed between males (eigencentrality = 0.51) and females (eigencentrality = 0.14). Physical illness (eigencentrality = 0.80) was the core concern for adults over 60 years. Across the Hong Kong population, the reasons for suicide appear to have shifted from financial issues in the early 2000s (eigencentrality = 0.46) to issues related to physical illnesses since 2011 (eigencentrality = 0.58). Simulation findings indicate that, by 2050, most suicides in Hong Kong will be due to physical illness-related issues (eigencentrality = 0.69) due to the rapidly aging population. Interpretation: There have been important sex and age differences over time, in reasons for suicide. Given the projected increasing age of the Hong Kong population over the next decades, older adults with physical illnesses appear to be the highest contributors to suicide cases in the overall population. This novel network analysis approach provides important data-driven information upon which to base effective proactive public health suicide prevention strategies and interventions. Funding: Hong Kong Jockey Club Charities Trust, Collaborative Research Fund (C7151-20G), and General Research Fund (17606521).

Preventing comorbidity between distress and suicidality: a network analysis.

Suicidality among individuals between 10 and 35 years of age may be poised to exert massive burdens on society through decreased economic productivity and increased incidence of chronic physical conditions in the individuals' later years, thereby necessitating early prevention of suicide. While research suggests that the pathway to suicidality may begin from episodes of psychological distress, such pathway may involve complex interplays between intermediary psychiatric symptoms and external stimuli that are not easily delineated through conventional means. This study applies the network approach to psychopathology to elucidate this complexity. Comorbidity between psychological distress and suicidality in 1968 community-dwelling individuals is analyzed with regularized partial correlation networks to identify their bridge symptoms and links. Temporal relationships between symptoms are analyzed through temporal symptom network formed from 453 individuals who completed subsequent follow-up surveys. Network analysis shows that feelings of hopelessness and the presence of suicidal ideation are the strongest bridge symptoms in the comorbidity symptom network, and form the only prominent link that bridges psychological distress and suicidality. Effects of sleep troubles, anxiety, and poor social relationships on suicidal ideation appear to be mediated by hopelessness. The same observations hold among individuals with and without diagnoses of psychiatric disorders, as well as young people (10-24 year-olds) and young adults (25-35 year-olds). The edge between hopelessness and suicidal ideation remains the strongest bridge link after controlling for effects of symptoms from the previous time point. Findings here provide an evidence base for both professional training in caregiving professions as well as gatekeeper training in community members to emphasize more on how to effectively recognize hopelessness, and instill hope, in young people and young adults for various types of distress.

Is internet gaming disorder associated with suicidal behaviors among the younger generation? Multiple logistic regressions on a large-scale purposive sampling survey.

The ubiquity of Internet gaming as part of the younger generation's (11-35 year-olds) lifestyle to-day warrants a deeper understanding of its impact on their mental health. In particular, there has been scant research investigating the link between Internet Gaming Disorder (IGD) and suicidal behaviors in this demographic group, even though several mental health symptoms of the former are known risk factors for the latter. This paper aims to establish the presence or absence of association between IGD and each of suicidal ideation, self-harm, and suicide attempt among the younger generation. A large-scale online survey on Internet gamers in Hong Kong was conducted in February 2019. 3430 respondents were recruited through purposive sampling. Study samples were stratified into distinct age groups and multiple logistic regression was conducted for each measured suicidal behavior in each age group. After controlling for sociodemographics, Internet usage, self-reported bullying perpetration and bullying victimization, social withdrawal, and self-reported psychiatric diagnoses such as depression and psychosis, analyses revealed that adolescent (11-17 year-old) gamers with IGD were more likely than their peers who had no IGD to have had suicidal ideation, self-harm, and suicide attempt in their lifetime. These associations did not hold for 18-35 year-old gamers. Findings suggest that it may be prudent to recognize IGD as a growing public mental health priority for the young populace, particularly adolescents. Existing suicide prevention efforts can be complemented through screening adolescents for IGD, and could be expanded to online gaming platforms to reach more hidden at-risk individuals.

Shifts in patterns of help-seeking during the COVID-19 pandemic: The case of Hong Kong's younger generation.

RATIONALE: Help-seeking can convert an individual's bonding social capital into social support, which has been shown to buffer the impact of psychological distress. The younger generation (individuals aged 15-35 years) have been the least likely to actively seek help despite facing a rising burden of mental health problems. COVID-19 pandemic restrictions may have altered their help-seeking behaviors, but the extent of such shift remains little understood, particularly in Asian contexts. OBJECTIVE: To understand how the younger generation's patterns of help-seeking (activation of different combinations of support sources) have shifted in pandemic times, who have experienced the shift, and what explanatory factors are involved. METHODS: Data were obtained from two waves (2019, 2020) of online survey responses by 438 community-dwelling younger generation people in Hong Kong, recruited through the authors' affiliated institutions and territory-wide community outreach organizations. Latent class analysis was conducted on participants' self-reported help-seeking behaviors in each survey wave. Constituents' characteristics in each latent class were examined, and between-wave changes in individuals' class membership were identified. Logistic regressions identified explanatory factors that significantly explained the changes. RESULTS: Three consistent patterns of help-seeking were identified in both survey waves. A major shift was observed for individuals with poorer mental health histories who faced moderate distress. They relied on their family, friends, and partner pre-pandemic, but no longer activated these supports during the pandemic. Posting status updates on social media, along with various communication habits and sociodemographic factors that differed by age group, were associated with this shift. CONCLUSIONS: Shifts in the younger generation's patterns of help-seeking may be an early warning signal to invest additional resources in facilitating help-seeking among the younger generation. Findings also serve as a reminder that public health restrictions may have inadvertent mental health implications that should be considered in future scenarios.

Temporal and spatial trends in suicide-related visits before and during the COVID-19 pandemic in the US, 2018-2021.

BACKGROUND: COVID-19 disproportionately impacted mental health in disadvantaged populations and areas. However, disparities in long-term changes in suicide-related visits across the US are unclear. This retrospective study aims to characterize temporal and spatial changes in suicide-related visits in healthcare settings from 2018 to 2021 in the U.S. METHODS: We use electronic health records for 21,860,370 patients from Healthjump through the COVID-19 Research Database Consortium. Healthjump harmonizes EHR data from over 55 national databases across the US. Suicide ideation and suicide attempts between January 1, 2018 and December 12, 2021 were identified by the diagnosis codes in 6 periods in 2021 compared with the same periods in 2018-2020. RESULTS: There was 30,019 suicidal ideation, and 7392 suicide attempt visits from January 2018 to November 2021. 15-20-year-olds were the most represented age group at 6302 suicide ideation visits (21.0 % of suicide ideation visits) and 1326 suicide attempt visits (17.9 % of suicide attempt visits), followed by suicide-related visits among 60+ years old. Compared with pre-pandemic periods, youth aged 15-20, females, White, non-Hispanic, and English speakers had increased suicide-related visits, especially suicidal ideation (P < 0.05). Suicide attempts with non-medical substances increased to 28.0 % in the first 6 months of the pandemic in 2020, compared with the prior year (21.5 %). COVID-19 patients had increased suicidal ideation in 2020. LIMITATIONS: The EHR data is not nationally representative. CONCLUSIONS: This study found significant and disproportionate increases in suicide related visits over the COVID-19 stages. To prevent the next storms of suicides, future interventions shall accommodate needs among vulnerable groups during and after periods of crisis.

Suicide risk profile and the social convoy: Population-level patterns of the young generation's help-seeking behavior and implications for suicide prevention.

BACKGROUND: Social support network offers a large potential in augmenting suicide prevention efforts tailored for the young generation (YG), but has so far been largely overlooked in population health studies. Key issues that remain scarcely understood include the composition of the YG's activated support network when they faced psychological distress, along with the prevalence and suicide risk profile associated with these patterns. METHODS: Using data from three consecutive population-representative surveys (2018-2020) on help-seeking behaviors of the YG living in Hong Kong, we first conducted latent class analysis to derive the YG's help-seeking patterns. Next, we conducted multinomial logistic regression to identify unique factors associated with each pattern and multiple logistic regressions for suicide risk indicators to examine risk levels associated with each pattern. RESULTS: Analyses revealed 4 underlying patterns of help-seeking behaviors among the study population. Each pattern was consistently associated with a distinct suicide risk profile based on constituents' level of distress and history of suicide risk behaviors. Severity of suicide risk increased as individuals increased the activation radius of their social convoy, and this increase was more pronounced when individuals extended the radius beyond their inner circle. Individuals whose activated inner circle consisted of family members in addition to just friends & partner had lower suicide risks. CONCLUSIONS: Social support networks hold much potential in augmenting suicide prevention efforts tailored for the general young population. Such efforts may be directed at empowering the inner circle of their convoy, given its predominance for the YG to seek help from.

The lethality of suicide methods: A systematic review and meta-analysis.

BACKGROUND: The use of suicide methods largely determines the outcome of suicide acts. However, no existing meta-analysis has assessed the case fatality rates (CFRs) by different suicide methods. The current study aimed to fill this gap. METHODS: We searched Scopus, Web of Science, PubMed, ProQuest and Embase for studies reporting method-specific CFRs in suicide, published from inception to 31 December 2020. A random-effect model meta-analysis was applied to compute pooled estimates. RESULTS: Of 10,708 studies screened, 34 studies were included in the meta-analysis. Based on the suicide acts that resulted in death or hospitalization, firearms were found to be the most lethal method (CFR:89.7%), followed by hanging/suffocation (84.5%), drowning (80.4%), gas poisoning (56.6%), jumping (46.7%), drug/liquid poisoning (8.0%) and cutting (4.0%). The rank of the lethality for different methods remained relatively stable across study setting, sex and age group. Method-specific CFRs for males and females were similar for most suicide methods, while method-CFRs were specifically higher in older adults. CONCLUSIONS: This study is the first meta-analysis that provides significant evidence for the wide variation of the lethality of suicide methods. Restricting highly lethal methods based on local context is vital in suicide prevention.

The effects of border control and quarantine measures on the spread of COVID-19.

The rapid expansion of coronavirus disease 2019 (COVID-19) has been observed in many parts of the world. Many newly reported cases of COVID-19 during early outbreak phases have been associated with travel history from an epidemic region (identified as imported cases). For those cases without travel history, the risk of wider spreads through community contact is even higher. However, most population models assume a homogeneous infected population without considering that the imported and secondary cases contracted by the imported cases can pose different risks to community spread. We have developed an "easy-to-use" mathematical framework extending from a meta-population model embedding city-to-city connections to stratify the dynamics of transmission waves caused by imported, secondary, and others from an outbreak source region when control measures are considered. Using the cumulative number of the secondary cases, we are able to determine the probability of community spread. Using the top 10 visiting cities from Wuhan in China as an example, we first demonstrated that the arrival time and the dynamics of the outbreaks at these cities can be successfully predicted under the reproduction number R0 = 2.92 and incubation period τ = 5.2 days. Next, we showed that although control measures can gain extra 32.5 and 44.0 days in arrival time through an intensive border control measure and a shorter time to quarantine under a low R0 (1.4), if the R0 is higher (2.92), only 10 extra days can be gained for each of the same measures. This suggests the importance of lowering the incidence at source regions together with infectious disease control measures in susceptible regions. The study allows us to assess the effects of border control and quarantine measures on the emergence and global spread of COVID-19 in a fully connected world using the dynamics of the secondary cases.