Common genetic architecture and environmental risk factors underpin the anxiety-disordered eating relationship: Findings from an adolescent twin cohort.

OBJECTIVE: Despite established comorbidity between anxiety and disordered eating (DE), and a plethora of research using various methodologies to examine this overlap, use of twin modeling to expose whether a shared genetic liability underpins these conditions remains rare. METHOD: Data from a longitudinal sample of female twins were selected: measures of risk for DE from Wave 1 (N = 699, 351 pairs, aged 12-15 years), and the Eating Disorder Examination (EDE) and Children's Anxiety Sensitivity Index (CASI) from Wave 2 (N = 669, 338 pairs, aged 16-19 years). At this time, they also completed Children's Anxiety Sensitivity Index (CASI). Bivariate Cholesky decomposition models adjusting for age and body mass index centile investigated the covariance structure between the CASI and EDE. RESULTS: Modeling both genetic and nonshared environmental influences parsimoniously fit these data. All paths were significant. Additive genetic influences were notable for CASI and EDE phenotypes; 14% of the heritable variance was contributed by CASI to the expression of EDE. There was also a smaller but significant contribution of nonshared environmental influences. A multinomial logistic regression indicated body dissatisfaction (RRR = 1.53; 95% CI = 1.07-2.18) differentiated groups with highest EDE scores from the highest CASI scores. DISCUSSION: Shared genetic and environmental influences appear to underpin the relationship, and potentially the observed comorbidity, between anxiety sensitivity and DE. The age of onset is typically earlier for anxiety than DE, suggesting a significant opportunity for early intervention work to reduce the likelihood of subsequent development of DE.

Does the Partners in Health scale allow meaningful comparisons of chronic condition self-management between men and women? Testing measurement invariance.

AIMS: To determine if the Partners in Health scale, pertinent to assessing patient chronic condition self-management, operates equivalently for men and women. BACKGROUND: There are distinct gender-based differences in self-management behaviours and health perceptions. This may introduce non-invariance in self-report measures. Testing of measurement invariance is a recommended practice in nursing science to ensure robust metrics. DESIGN: A representative cross-sectional population survey in South Australian. METHOD: In 2014, 940 people responded to the South Australian Health Omnibus Survey, a battery of health-related questions. MI and estimation of heterogeneity was tested using Bayesian confirmatory factor analysis. RESULTS: Findings showed self-management constructs were interpreted equivalently between men and women. Observed population heterogeneity associated lower education levels with poorer illness and treatment knowledge, smokers with poorer treatment partnerships and mental health problems with lower coping capacity. CONCLUSION: Approximate measurement invariance was achieved between men and women for Partners in Health scale. IMPACT: There is a lack of well-validated generic instruments, including investigation into gender variability, for measuring chronic condition self-management behaviours. Lower education levels were found to connect with poorer knowledge of health condition and treatment. Mental health problems attenuated ability to cope with the effect of the condition. Findings can facilitate the development of better tailored interventions for self-management of patients' chronic condition/s.

Improving cardiovascular health and quality of life in people with severe mental illness: study protocol for a randomised controlled trial.

BACKGROUND: The estimated 300,000 adults in Australia with severe mental illness (SMI) have markedly reduced life expectancy compared to the general population, mainly due to physical health comorbidities. Cardiovascular disease (CVD) is the commonest cause of early death and people with SMI have high rates of most modifiable risk factors, with associated quality of life (QoL) reduction. High blood pressure, smoking, dyslipidaemia, diabetes and obesity are major modifiable CVD risk factors. Poor delivery of recommended monitoring and risk reduction is a national and international problem. Therefore, effective preventive interventions to safeguard and support physical health are urgently needed in this population. METHODS: This trial used a rigorous process, including extensive piloting, to develop an intervention that delivers recommended physical health care to reduce CVD risk and improve QoL for people with SMI. Components of this intervention are integrated using the Flinders Program of chronic condition management (CCM) which is a comprehensive psychosocial care planning approach that places the patient at the centre of their care, and focuses on building their self-management capacity within a collaborative approach, therefore providing a recovery-oriented framework. The primary project aim is to evaluate the effectiveness and health economics of the CCM intervention. The main outcome measures examine CVD risk and quality of life. The second aim is to identify essential components, enablers and barriers at patient, clinical and organisational levels for national, sustained implementation of recommended physical health care delivery to people with SMI. Participants will be recruited from a community-based public psychiatric service. DISCUSSION: This study constitutes the first large-scale trial, worldwide, using the Flinders Program with this population. By combining a standardised yet flexible motivational process with a targeted set of evidence-based interventions, the chief aim is to reduce CVD risk by 20%. If achieved, this will be a ground-breaking outcome, and the program will be subsequently translated nationwide and abroad. The trial will be of great interest to people with mental illness, family carers, mental health services, governments and primary care providers because the Flinders Program can be delivered in diverse settings by any clinical discipline and supervised peers. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry, ACTRN12617000474358 . Registered on 31 March 2017.

Do Males and Females Conceptualise Work and Social Impairment Differently Following Treatment for Different Mental Health Problems?

The Work and Social Adjustment Scale (WSAS) is used by psychiatric nurses for screening and evaluating patients' treatment outcomes for a variety of mental health problems. This study investigated longitudinal and gender measurement invariance of WSAS using structural equation modeling within a help-seeking problem gambling sample (n=445), and an intervention program for depression and anxiety sample (n=444). The concept of functional impairment was defined by all WSAS items in males and females at pre- and post-treatment assessments. These findings confirm that the WSAS is a robust and efficacious instrument for evaluating treatment outcomes in two differing populations.

Associations between adolescent risk for restrictive disordered eating and long-term outcomes related to somatic symptoms, body mass index, and poor well-being.

OBJECTIVE: To date, no longitudinal, community-based studies have examined the association between disordered eating emerging in adolescence and long-term physical well-being. This study sought to explore the longitudinal associations between risk for restrictive disordered eating (DE-R; those not presenting with binge-purge symptoms) in adolescence and trajectories of functional somatic symptoms (FSS) and body mass index (BMI), and several indicators of poor physical well-being across early- to mid-adulthood, including medication, number of doctor visits, and sick leave. DESIGN: Data were obtained from the Northern Swedish Cohort Study (N = 1,001), a prospective longitudinal study including four time points from age 16 to 42 years. METHODS: A cumulative measure of DE-R risk was computed. Latent class growth analysis was used to identify subpopulation trajectories of FSS and BMI. The three-step method for auxiliary variables and logistic regressions were used to assess associations between DE-R and the trajectory classes as well as indicators of poor physical well-being. RESULTS: Three trajectories were identified for FSS. A gender by BMI interaction led to a classification of four BMI trajectories in men, but three in women. The presence of DE-R risk in adolescence increased odds of unfavourable FSS development, increasing BMI in women, and continually low BMI in men. Indicators of poor physical well-being at ages 21, 30, and 42 years were associated with DE-R risk in adolescence. CONCLUSIONS: Data spanning nearly three decades suggest that physical well-being impairment is related to DE-R risk measured earlier in life, underscoring the urgency for targeted, gender-sensitive preventive interventions for teenagers. Statement of contribution What is already known on this subject? Disordered eating is linked to poor physical and mental well-being and quality of life. No longitudinal studies have examined long-term physical well-being consequences of adolescent disordered eating risk. What does this study add? Non-purging disordered eating symptoms in adolescence predict adverse physical well-being outcomes in middle-aged men and women. Targeted interventions and preventative work during adolescence are needed.

Gender differences in temporal relationships between gambling urge and cognitions in treatment-seeking adults.

Many gambling-specific CBT programs seek to target either gambling-related urge or cognitions or both. However, little is known of the influence of one symptom type on another across time and whether these differ for men and women help-seeking problem gamblers. The aim of this study was threefold: to determine presence of measurement invariance for urge and cognition measures over time; to investigate the effect of baseline urge on end-of-treatment gambling-related cognitions - and the reciprocal relationship; and, identify whether these pathways differ across gender. Self-reported gambling urge (GUS), and gambling-related cognitions (GRCS) data from treatment-seeking problem gamblers prior to and post treatment (N = 223; 62% men) were analyzed with cross-lagged panel models, moderated by gender. Conceptualization of urge and cognitions were found to be temporally stable. There was no significant association between baseline GUS scores and post-treatment GRCS scores, nor the reverse relationship. Putatively, this infers that coexisting urge and gambling-related cognition components of problem gambling operate independently over time. Analyses revealed gambling urge had a significantly stronger tracking correlation across time for men than women when adjusting for cognition paths. This investigation provides early evidence for tailoring CBT in response to sub-population gambling-related characteristics, demonstrated across men and women.

How does routinely delivered cognitive-behavioural therapy for gambling disorder compare to "gold standard" clinical trial?

Currently, it is unknown whether treatment outcomes derived from randomized controlled trials (RCTs) of cognitive-behavioural therapy (CBT) for problem gamblers still hold when applied to patients seen in routine practice. Thus, data from an RCT of cognitive therapy versus exposure therapy for problem gambling versus patients of a gambling help service were compared. Assessments of problem gambling severity, psychosocial impairment, and alcohol use were undertaken at baseline and post-treatment and evaluated within a counterfactual framework. Findings showed that the contrast between routine CBT for pokies and horse betting had a significant effect, indicative of a 62% lower gambling urge score if routine CBT recipients had all been horse/track betters opposed to gambling with "pokies." However, the majority of contrasts indicated therapeutic outcomes achieved in routine CBT treatments were of equivalent robustness relative to RCT conditions. The present findings infer routine practice treatment outcomes are as efficacious as those generated in RCT contexts.

The Anorexia Nervosa Genetics Initiative: Study description and sample characteristics of the Australian and New Zealand arm.

OBJECTIVES: Anorexia nervosa is a severe psychiatric disorder with high mortality rates. While its aetiology is poorly understood, there is evidence of a significant genetic component. The Anorexia Nervosa Genetics Initiative is an international collaboration which aims to understand the genetic basis of the disorder. This paper describes the recruitment and characteristics of the Australasian Anorexia Nervosa Genetics Initiative sample, the largest sample of individuals with anorexia nervosa ever assembled across Australia and New Zealand. METHODS: Participants completed an online questionnaire based on the Structured Clinical Interview Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) eating disorders section. Participants who met specified case criteria for lifetime anorexia nervosa were requested to provide a DNA sample for genetic analysis. RESULTS: Overall, the study recruited 3414 Australians and 543 New Zealanders meeting the lifetime anorexia nervosa case criteria by using a variety of conventional and social media recruitment methods. At the time of questionnaire completion, 28% had a body mass index ⩽ 18.5 kg/m2. Fasting and exercise were the most commonly employed methods of weight control, and were associated with the youngest reported ages of onset. At the time of the study, 32% of participants meeting lifetime anorexia nervosa case criteria were under the care of a medical practitioner; those with current body mass index < 18.5 kg/m2 were more likely to be currently receiving medical care (56%) than those with current body mass index ⩾ 18.5 kg/m2 (23%). Professional treatment for eating disorders was most likely to have been received from general practitioners (45% of study participants), dietitians (42%) and outpatient programmes (42%). CONCLUSIONS: This study was effective in assembling the largest community sample of people with lifetime anorexia nervosa in Australia and New Zealand to date. The proportion of people with anorexia nervosa currently receiving medical care, and the most common sources of treatment accessed, indicates the importance of training for general practitioners and dietitians in treating anorexia nervosa.

Weight-related peer-teasing moderates genetic and environmental risk and disordered eating: twin study.

BackgroundWeight-related peer-teasing is considered a potent prospective risk factor for development of disordered eating and clinical eating disorders. Currently, the interplay between genetic and environmental influences has yet to be elucidated.AimsTo determine whether peer-teasing moderates latent genetic and/or environmental risk for disordered eating among female adolescent twins.MethodFull quantitative gene-environment interplay modelling of longitudinal trajectory of disordered eating in 685 female twins from the Australian Twin Registry.ResultsA model permitting moderation of disordered eating by peer-teasing involving genetic and non-shared environment effects fit these data best. As levels of peer-teasing increased, both genetic and environmental influences on disordered eating strengthened; however, genetic sources increased proportionally more than environmental sources.ConclusionsWeight-related peer-teasing represents a particularly powerful trigger for disordered eating. Nevertheless, it is amenable to intervention/prevention activities spanning individual to universal levels of endeavour.

Psychological Resilience Provides No Independent Protection From Suicidal Risk.

BACKGROUND: Little is known about the role of resilience in the likelihood of suicidal ideation (SI) over time. AIMS: We examined the association between resilience and SI in a young-adult cohort over 4 years. Our objectives were to determine whether resilience was associated with SI at follow-up or, conversely, whether SI was associated with lowered resilience at follow-up. METHOD: Participants were selected from the Personality and Total Health (PATH) Through Life Project from Canberra and Queanbeyan, Australia, aged 28-32 years at the first time point and 32-36 at the second. Multinomial, linear, and binary regression analyses explored the association between resilience and SI over two time points. Models were adjusted for suicidality risk factors. RESULTS: While unadjusted analyses identified associations between resilience and SI, these effects were fully explained by the inclusion of other suicidality risk factors. CONCLUSION: Despite strong cross-sectional associations, resilience and SI appear to be unrelated in a longitudinal context, once risk/resilience factors are controlled for. As independent indicators of psychological well-being, suicidality and resilience are essential if current status is to be captured. However, the addition of other factors (e.g., support, mastery) makes this association tenuous. Consequently, resilience per se may not be protective of SI.

Characterizing and predicting trajectories of disordered eating over adolescence.

This study sought to identify distinct trajectory classes of growth of disordered eating (DE), and their respective correlates and risk factors. Females ages 12-19 years (Australian Twin Registry) were interviewed by telephone with the Eating Disorder Examination on 3 occasions (Wave 1: N = 699; Wave 2: N = 669; Wave 3: N = 499). Each participant also completed self-report measures across all waves, and their parents at Waves 1 and 2. Growth mixture modeling determined the optimal classes representing DE growth trajectories over 3 data-points. The best fit was a 3-class solution constituting: (a) no growth in DE over time (90%; low-static) where 10% reported a lifetime eating disorder (ED); (b) a high intercept but decreasing over time (7%; 53% had a lifetime ED; attenuating); (c) an increasing level of DE (3%; 80% experiencing a lifetime ED; escalating). The majority (64%) of EDs in the attenuating group were diagnosed at Wave 1, whereas 84% of EDs in the escalating group were diagnosed at subsequent waves. The low-static group had fewest significant correlates/risk factors for DE. A multivariable GEE identified that over adolescence, internalization of the thin ideal was 2.5 times more likely characterize an escalating rather than low-static DE symptom trajectory. These findings underscore the fundamental importance of concentrating efforts on reducing the potency of the thin ideal message, and strategies directed toward resolving life stressors by effective management of emotion and problem resolution, in order to prevent the development of DE.

Piloting a perfectionism intervention for pre-adolescent children.

OBJECTIVE: The aim of this pilot study was to evaluate a school-based intervention program focussing on reducing perfectionism in pre-adolescent children. METHOD: A 2-lesson intervention or the control condition was implemented across three schools (N = 125; M age = 11.60 years; 47.2% girls). Students completed assessments at baseline, post-intervention and 4-week follow-up. RESULTS: Significant between group differences for self-oriented perfectionism-striving were identified post-intervention and were maintained at 4-week follow-up (d = 0.47 and 0.40 respectively). Significant interactions between group and time favouring the intervention group were identified for the hyperactivity and emotional problems. DISCUSSION: Findings from this study provide preliminary support for the effectiveness of a perfectionism intervention at an earlier age than has been targeted to date. While these findings appear promising, the justification of such approaches with this age group will require follow-up investigations with expanded intervention content, longer follow-up assessments, larger samples, and evidence of impact on other variables such as well-being. TRIAL REGISTRATION: ACTRN12614001262695.

Does shared genetic risk contribute to the co-occurrence of eating disorders and suicidality?

OBJECTIVE: There is a high level of co-occurrence of suicidality with eating disorders (EDs) but the reason for this is unknown. To test the hypothesis that suicidality and EDs share genetic risk contributing to the expression of both phenotypes. METHOD: Female twins (N = 1,002) from the Australian Twin Registry, aged 28-40 years, were interviewed with diagnostic interviews. Lifetime diagnostic information relating to eating disorders [anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder, and purging disorder (PD)], suicidality (ranging transitory thoughts to suicide attempts), and major depression. RESULTS: Any suicidal thoughts were reported by 24% of the sample, but prevalence of lifetime suicidality among female twins with EDs was much higher (43%), presence of an ED diagnosis more than doubling likelihood of suicidality (OR = 2.32, 95% CI: 1.63-3.31). AN and BN conveyed greatest risk of suicidality (OR = 2.03, 95% CI: 1.06-3.87; OR = 3.97, 95% CI: 2.01-7.85, respectively). Twin phenotype correlations showed monozygotic twins had uniformly higher estimates than dizygotic counterparts. A trivariate Cholesky model indicated a common genetic influence on suicidality and ED phenotypes (but not depression), and no nonshared environmental source. DISCUSSION: Both cross twin phenotypic correlations and genetic modeling infer a common genetic pathway for suicidality and EDs, but further investigation is needed to elucidate whether this may constitute emotional dysregulation or other temperament-linked factors. Study findings also indicate that ED clients must be routinely assessed for presence of suicidality, independent of depression status.

Depression and anxiety in expectant and new fathers: longitudinal findings in Australian men.

BACKGROUND: Despite growing interest in men's perinatal mental health, we still know little about whether becoming a new father is associated with increases in psychological distress. AIMS: To use prospective longitudinal data to investigate whether becoming a first-time expectant (partner pregnant) and/or new father (child <1 year) is associated with increases in depression and anxiety. METHOD: Men were aged 20-24 years at baseline (n = 1162). Levels of depression and anxiety were measured at four time points over 12 years. Over this time, 88 men were expectant fathers, 108 men were new fathers and 626 men remained non-fathers. RESULTS: Longitudinal mixed models showed no significant increase in depression or anxiety as a function of expectant or new fatherhood, as compared with pre-fatherhood levels. CONCLUSIONS: Our findings suggest that, generally, expectant and new fathers are not at greater risk of depression or anxiety. Future epidemiological research should continue to identify men who are most (and least) at risk to focus resources and assistance most effectively.

A longitudinal study of midage women with indicators of disordered eating.

This longitudinal study of midage women has two main aims: to examine the effect of disordered eating (DE) on quality of life (QoL) among women, including a comparison with a younger cohort and to investigate the mediating roles of both depressive symptoms and social support on the longitudinal relationship between DE and QoL as potential mechanisms of action. We used self-report data from six waves of the Australian Longitudinal Study on Women's Health over 14 years. A total of 12,338 women participating in the midage cohort (aging from 45-50 to 59-64) provided self-report indications of DE at Surveys 1 and 2, and QoL (SF-36 component scales-mental [MCS] and physical [PCS]) at Surveys 2-6. DE was reported by 10.98% of the women; this group also reported significantly poorer mental and physical QoL than those without DE, and this effect was sustained over time. Comparison with a parallel analysis of a younger cohort of women showed that the effect on midage women's physical QoL is greater than that of the younger women. The relationships between baseline DE and changes in QoL (both physical and mental) over time were mediated by levels of depressive symptoms and of social support over time. This study underscores the significant effect of DE on QoL in midage, an effect which is partially or fully mediated by depressive symptoms or social support. Well-being of midage women with indicators of DE needs to be supported by tailoring prevention and interventions activities specifically for this group.

A systematic review and evaluation of measures for suicidal ideation and behaviors in population-based research.

The use of measures of suicidal ideation and behavior with sound measurement properties is critical in identifying people most at risk of suicide. In particular, brief self-report measures of suicidal ideation and behaviors are needed for use in large-scale population-based research and in the development and evaluation of suicide prevention programs in the community. This review aimed to identify and recommend psychometrically sound self-report measures of suicidal ideation and behaviors that could be used in population-based research of adults. To identify existing self-report measures for adult use, a systematic search was conducted using MEDLINE (Medical Literature Analysis and Retrieval System Online) and PsycINFO (Psychological Information Database) databases. Abstracts, reference lists, and previous review papers were screened. Once measures were identified, we used a hierarchical criterion-based approach to assess their utility, psychometric properties, and appropriateness for population-based research. Nineteen measures were evaluated against 6 criteria. Three brief measures that met all criteria of the evaluation and demonstrated adequate psychometric properties were the Depressive Symptom Index Suicidality Subscale (DSI-SS), Suicidal Behaviors Questionnaire-Revised (SBQ-R), and Suicidal Ideation Attributes Scale (SIDAS). None of the comprehensive measures met all criteria for use in population-based studies, due to financial costs imposed on use, although the Beck Scale for Suicide Ideation (BSSI) and the Adult Suicidal Ideation Questionnaire (ASIQ) had considerable evidence of psychometric robustness. Suicide researchers are encouraged to further establish the validity of scores on these measures across diverse adult populations.

The validity of military screening for mental health problems: diagnostic accuracy of the PCL, K10 and AUDIT scales in an entire military population.

Depression, alcohol use disorders and post-traumatic stress disorder (PTSD) are serious issues among military personnel due to their impact on operational capability and individual well-being. Several military forces screen for these disorders using scales including the Kessler Psychological Distress Scale (K10), Alcohol Use Disorders Identification Test (AUDIT), and Post-traumatic Stress Disorder Checklist (PCL). However, it is unknown whether established cutoffs apply to military populations. This study is the first to test the diagnostic accuracy of these three scales in a population-based military cohort. A large sample of currently-serving Australian Defence Force (ADF) Navy, Army and Air Force personnel (n = 24,481) completed the K10, AUDIT and PCL-C (civilian version). Then, a stratified sub-sample (n = 1798) completed a structured diagnostic interview detecting 30-day disorder. Data were weighted to represent the ADF population (n = 50,049). Receiver operating characteristic (ROC) analyses suggested all three scales had acceptable sensitivity and specificity, with areas under the curve from 0.75 to 0.93. AUDIT and K10 screening cutoffs closely paralleled established cutoffs, whereas the PCL-C screening cutoff resembled that recommended for US military personnel. These self-report scales represent a cost-effective and clinically-useful means of screening personnel for disorder. Military populations may need lower cutoffs than civilians to screen for PTSD.

The Australian Defence Force Mental Health Prevalence and Wellbeing Study: design and methods.

BACKGROUND: The Australian Defence Force (ADF) Mental Health Prevalence and Wellbeing Study (MHPWS) is the first study of mental disorder prevalence in an entire military population. OBJECTIVE: The MHPWS aims to establish mental disorder prevalence, refine current ADF mental health screening methods, and identify specific occupational factors that influence mental health. This paper describes the design, sampling strategies, and methodology used in this study. METHOD: At Phase 1, approximately half of all regular Navy, Army, and Air Force personnel (n=24,481) completed self-report questionnaires. At Phase 2, a stratified sub-sample (n=1,798) completed a structured diagnostic interview to detect mental disorder. Based on data from non-responders, data were weighted to represent the entire ADF population (n=50,049). RESULTS: One in five ADF members met criteria for a 12-month mental disorder (22%). The most common disorder category was anxiety disorders (14.8%), followed by affective (9.5%) and alcohol disorders (5.2%). At risk ADF sub-groups were Army personnel, and those in the lower ranks. Deployment status did not have an impact on mental disorder rates. CONCLUSION: This study has important implications for mental health service delivery for Australian and international military personnel as well as contemporary veterans.

Does resilience predict suicidality? A lifespan analysis.

In this article, we examine the association between resilience and suicidality across the lifespan. Participants (n = 7485) from the Personality and Total Health (PATH) Through Life Project, a population sample from Canberra and Queanbeyan, Australia, were stratified into three age cohorts (20-24, 40-44, 60-64 years of age). Binary Logistic regression explored the association between resilience and suicidality. Across age cohorts, low resilience was associated with an increased risk for suicidality. However, this effect was subsequently made redundant in models that fully adjusted for other risk factors for suicidality among young and old adults. Resilience is associated with suicidality across the lifespan, but only those in midlife continued to report increased likelihood of suicidality in fully-adjusted models.

Temporal effects of separation on suicidal thoughts and behaviours.

Divorce has been identified as a risk factor for suicide. However, little research has been conducted on the time trajectory of the influence of relationship separation on suicidal outcomes. This study aimed to assess the effects over time of relationship breakdown and separation on suicidality. Data were drawn from 6616 Australian adults participating in the PATH through Life Project, a population-based longitudinal study. Suicidal ideation was reported by 406 participants (6.1%), and 99 (1.5%) reported a suicide plan or attempt in the past year. The effects of separation on suicidality were strongest soon after separation, with a nearly three-fold increase in ideation (adjusted OR = 2.73, p < 0.001) and an eight-fold increase in plans/attempts (adjusted OR = 7.75, p < 0.001) in the two years following separation, gradually diminishing subsequently. The period up to four years before a separation was also found to be a time of increased risk for suicidal thoughts and behaviours, while marriage was protective. Separation is a strong risk factor for suicidality and mental health services should target recently separated individuals.