The role of Theory of Mind in the transition towards suicidal attempts in youth NSSI: an exploratory pilot study.

Non-suicidal self-injury (NSSI) can both precede and co-occur with suicidal attempts (SA). Underlying mechanisms/factors leading to the transition to SA in NSSI youths have been proposed (including the role of social cognition), despite they should be yet confirmed. Therefore, the study aims at exploring the role of the Theory of Mind in the differentiation of a sample of NSSI youngsters (aged 15-24) according to the presence of SA. We divided the sample into 4 groups using the Deliberate Self Harm Inventory (DSHI) and Columbia Suicide Severity Rating Scale (C-SSRS): control group (notNSSInotSA), NSSI without SA (NSSInotSA), NSSI with SA (NSSIplusSA), and SA without NSSI (SAonly). NSSIplusSA patients displayed higher Reading the Mind in the Eyes Test (RMET) scores (indicative of ToM abilities) than both the NSSInotSA (p=0.0016) and SAonly groups (p=0.0198), while SAonly patients showed lower RMET scores compared to the control group (p=0.0214). Multiple regression models used to differentiate NSSInotSA and NSSIplusSA found a significant association between RMET and LOSCS-CSC (Level Of Self-Criticism Scale-Comparative Self-Criticism) (pC=0.0802, pD=0.0016, pG=0.0053). Our findings supported the hypothesis that a hypertrophic affective ToM may possibly be associated with the occurrence of SA in youth NSSI. Further larger and longitudinal studies should confirm these preliminary findings, by exploring all social cognition dimensions.

Factors associated with intentions to seek formal and informal mental health help among college students with suicidal thoughts and behaviors.

OBJECTIVE: Identify factors associated with formal and informal mental health help-seeking intentions among college students reporting suicidal thoughts and behaviors (STBs). PARTICIPANTS: College students with STBs in the 2018-2020 Healthy Minds Study. METHODS: Cross-sectional secondary analysis using logistic regressions to determine whether demographic (age, sex, race, religion, and finances) and psychosocial factors (mental health, perceptions about mental health help, and barriers) are associated with (in)formal help-seeking intentions. RESULTS: Positive significant factors for all help-seeking intentions included being in a romantic relationship, Christian, symptoms of anxiety, or positive beliefs and knowledge about therapy efficacy. Depressive symptoms, Black/African American, psychological inflexibility, low perceived need, and barriers were negatively associated. Informal help-seeking was negatively associated with Hispanic/Latinx and personal stigma toward mental health. Formal help-seeking was positively associated with Asian/Asian American and negatively associated with financial stress. CONCLUSIONS: Unique factors were associated with formal or informal help-seeking intentions in college students with STBs.

Dimensional measures of psychopathology in children and adolescents using large language models.

BACKGROUND: To enable greater use of NIMH Research Domain Criteria (RDoC) in real-world settings, we applied large language models to estimate dimensional psychopathology from narrative clinical notes. METHODS: We conducted a cohort study using health records from individuals age 18 years or younger evaluated in the psychiatric emergency department of a large academic medical center between November 2008 and March 2015. Outcomes were hospital admission and length of emergency department stay. RDoC domains were estimated using a HIPAA-compliant large language model (gpt-4-1106-preview), and compared to a previously-validated token-based approach. RESULTS: The cohort included 3,059 individuals (median age 16 (25%-75% 13-18); 1580 (52%) female, 1479 (48%) male; 105 (3.4%) identified as Asian, 329 (11%) as Black, 288 (9.4%) Hispanic, 474 (15%) as another race, and 1863 (61%) as white), of whom 1695 (55%) were admitted. Correlation between LLM-extracted RDoC scores and the token-based scores ranged from small to medium by Kendall's Tau (0.14-0.22). In logistic regression models adjusted for sociodemographic and clinical features, admission likelihood was associated with greater scores on all domains, with the exception of sensorimotor, which was inversely associated (p<.001 for all adjusted associations). Tests for bias suggested modest but statistically significant differences in positive valence scores by race (p<.05 for Asian, Hispanic, and Black individuals). CONCLUSION: A large language model extracted estimates of 6 RDoC domains in an explainable manner, which were associated with clinical outcomes. This approach can contribute to a new generation of prediction models or biological investigations based on dimensional psychopathology.

Depression and anxiety in multiple sclerosis. Review of a fatal combination.

Depression and anxiety are the most frequent neuropsychiatric symptoms of multiple sclerosis (MS), an autoimmune-mediated demyelinating neurodegenerative disease. Their prevalence is 25-65% and 20-54%, respectively, often associated with chronic fatigue and cognitive impairment, but usually not correlated with motor and other deficits, suggesting different pathophysiological mechanisms. Both disorders often arise before MS diagnosis, lead to faster disability and impair the quality of life. Risk factors are (young) age, genetic and family history burden. While no specific neuropathological data for depression (and anxiety) in MS are available, modern neuroimaging studies showed bilateral fronto-temporal, subcortical and limbic atrophies, microstructural white matter lesions and disruption of frontoparietal, limbic and neuroendocrine networks. The pathogenesis of both depression and anxiety in MS is related to shared mechanisms including oxidative stress, mitochondrial dysfunction, neuroinflammation and neuroendocrine mechanisms inducing complex functional and structural brain lesions, but they are also influenced by social and other factors. Unfortunately, MS patients with anxiety, major depression or suicidal thoughts are often underassessed and undertreated. Current treatment, in addition to antidepressant therapy include transcranial magnetic stimulation, cognitive, relaxation, dietary and other healthcare measures that must be individualized. The present state-of- the-art review is based on systematic analysis of PubMed, Google Scholar and Cochrane Library until May 2024, with focus on the prevalence, clinical manifestation, neuroimaging data, immune mechanisms and treatment options. Depression and anxiety in MS, like in many other neuroimmune disorders, are related, among others, to multi-regional patterns of cerebral disturbances and complex pathogenic mechanisms that deserve further elucidation as a basis for early diagnosis and adequate management to improve the quality of life in this disabling disease.

Romantic relationships buffer minority stress in transgender and non-binary adults: Effects on depressive symptoms and suicidality.

BACKGROUND: Transgender and non-binary (TNB) individuals are at greater risk of mental health concerns relative to their cisgender peers due to experiences of minority stress. Thus, it is critically important to identify factors that may be protective and buffer the effects of minority stress. This study examined whether romantic relationship involvement and quality buffered effects of TNB minority stress on depressive symptoms and suicidal ideation. METHODS: A large international sample (n = 1156) of TNB adults (n = 654 partnered; n = 502 single) reported on minority stress experiences, relationship status and quality, and mental health outcomes (i.e., depressive symptoms and suicidal ideation). RESULTS: The effects of victimization and rejection on depressive symptoms and suicidal ideation were attenuated among partnered individuals. However, once relationship quality was considered, the buffering effects of relationship involvement applied only to those in more satisfying relationships; the stress-buffering effects were not observed among those in distressed relationships. Of particular importance, general interpersonal satisfaction did not act as a minority stress buffer, suggesting there may be unique stress-buffering effects of being in a satisfying romantic relationship on depressive symptoms and suicidal ideation. LIMITATIONS: The cross-sectional nature of the current study precludes definitive conclusions regarding causation. CONCLUSIONS: These findings suggest that romantic involvement may serve a stress-buffering role for TNB adults, but only when these relationships are satisfying. Our results have important theoretical and clinical implications, and further research is needed to investigate the utility of relationship interventions to buffer the effects of TNB minority stress on depressive symptoms and suicidality.

Longitudinal Association between Stressful Life Events and Suicidal Ideation in Adults with Major Depression Disorder: The Mediating Effects of Insomnia Symptoms.

Stressful life events (SLEs) and suicidal ideation (SI) are prevalent in persons with major depression disorder (MDD). Less is known about the underlying role of insomnia symptoms in the association between SLEs and SI. This three-wave prospective cohort study sought to investigate the longitudinal association among SLEs, insomnia symptoms, and SI in persons with MDD. The study population included 511 persons with MDD (mean [SD] age, 28.7 [6.7] years; 67.1% were females). Generalized estimated equations (GEEs) were utilized to explore prospective association among exposure of SLEs, insomnia symptoms, and SI. Additionally, a structural equation model (SEM) was employed to estimate the longitudinal mediating effect of insomnia symptoms in the relationship between SLEs and SI. Our study demonstrated that cumulative SLEs were determined to be longitudinally associated with SI in persons with MDD. We further observed that the association between SLEs and SI was significantly mediated by insomnia symptoms. Clinicians assessing persons with MDD, especially those with the history of SLE, could carefully evaluate and promptly treat insomnia symptoms as part of personalized assessment of their depressive illness, thereby achieving early prevention and intervention for suicidal behaviors in persons with MDD.

Developmental pathways from insomnia to suicidality: A resilience perspective.

BACKGROUND: Insomnia has been identified as a potential risk factor for suicidality. However, to date, few studies using the longitudinal-design have examined the underlying mechanism of this relationship. Based on a resilience perspective, this study aimed to investigate the dynamic longitudinal relationships between insomnia, resilience, and suicidality. METHODS: A total of 5785 freshmen were sampled from a large-scale health-related cohort among Chinese college students. This study spanned six waves, covering the period from 2020 to 2022. Data from T1 to T4 were used because resilience was not measured at baseline (T0) and T5. The cross-lagged panel models and the latent growth curve mediation model were used to examine the longitudinal dynamic relationships between insomnia, resilience, and suicidality. RESULTS: The results showed that insomnia symptoms and suicidality mutually predicted each other, and resilience played a longitudinal mediating role in linking insomnia symptoms and suicidality. CONCLUSIONS: Given that resilience served as a mediator in the relation between insomnia symptoms and suicidality, some resilience-oriented prevention and intervention programs will be helpful in reducing the risk of suicide among university students.

Association between impulsivity and depressive symptoms in recently detoxified patients with alcohol dependence.

Background: Depression and impulsivity are etiologically linked to alcohol dependence (AD) and are known to affect course and outcomes. The relationship between impulsivity and depressive symptoms has been investigated only in a few studies of individuals with AD. Aim: This study aimed to explore the association between impulsivity and depressive symptoms in patients with AD. Materials and Methods: Our study was conducted in the inpatient setup of a tertiary care psychiatry institute. The study design is cross-sectional. The Barratt Impulsiveness Scale (BIS-11) and stop signal task (SST) were used to assess levels of global impulsivity and behavioral impulsivity, respectively, among 60 recently detoxified inpatients with AD. The Hamilton Depression Rating Scale (HAM-D) was used to measure depressive symptoms. The results were analyzed to examine the association of depressive symptoms with impulsivity. Pearson's coefficient of correlation or Spearman's rank correlation and linear regression analysis were performed to explore the association between quantitative variables. Results: Patients with higher HAM-D scores were found to have significantly higher score on all three subscales of the BIS-11. The attention impulsivity subscale had the strongest correlations (r = 0.53, P < 0.001). Depressive symptoms were more strongly correlated with cognitive impulsivity (r = 0.54, P< 0.0001) compared with motor impulsivity and were not significantly associated with behavioral impulsivity. Adjusting for other variables, cognitive impulsivity was found to be the strongest predictor of the severity of depressive symptoms. Conclusions: The study showed a strong association between impulsivity and depressive symptoms in individuals with AD. This relationship may apply more to cognitive impulsivity, reflecting the role of impulsive decisions compared with impulsive actions.

Investigating the Interrelationships Among Mental Health, Substance Use Disorders, and Suicidal Ideation Among Lesbian, Gay, and Bisexual Adults in the United States: Population-Based Statewide Survey Study.

BACKGROUND: Mental health disparities have been documented among lesbian, gay, and bisexual (LGB) adults in the United States. Substance use disorders and suicidal ideation have been identified as important health concerns for this population. However, the interrelationships among these factors are not well understood. OBJECTIVE: This study aims to investigate the interrelationships among mental health, substance use disorders, and suicidal ideation among LGB adults in the United States using a population-based statewide survey. METHODS: Our study was an observational cross-sectional analysis, and the data for this study were collected from a sample of LGB adults who participated in the statewide survey. The survey collected information on mental health, substance use disorders, and suicidal ideation using validated measures. Descriptive statistics and inferential data analysis were conducted to explore the interrelationships among these factors. RESULTS: The results showed that LGB adults who reported higher levels of depression and drug abuse and dependence also reported higher levels of suicidal tendency and mental illness. Inferential data analysis using χ2 tests revealed significant differences in depression score (χ22=458.241; P<.001), drug abuse and dependence score (χ22=226.946; P<.001), suicidal tendency score (χ22=67.795; P<.001), and mental illness score (χ22=363.722; P<.001) among the 3 sexual identity groups. Inferential data analysis showed significant associations between sexual identity and mental health outcomes, with bisexual individuals reporting the highest levels of depression, drug abuse and dependence, suicidal tendency, and mental illness. CONCLUSIONS: This study provides important insights into the interrelationships among mental health, substance use disorders, and suicidal ideation among LGB adults in the United States. The findings underscore the need for targeted interventions and research aimed at addressing the mental health needs of sexual minority populations. Future research should aim to better understand the underlying mechanisms driving these disparities and develop culturally sensitive and tailored interventions that meet the unique needs of LGB individuals. Reducing stigma and discrimination against sexual minority populations is also crucial to improving their mental health outcomes.

The association between ketamine and esketamine and suicidality: reports to the Food And Drug Administration Adverse Event Reporting System (FAERS).

INTRODUCTION: Replicated evidence indicates that ketamine and esketamine reduce measures of suicidality in persons with treatment-resistant depression (TRD). It remains uncertain whether individuals experience worsening of preexisting suicidality with either agent. RESEARCH DESIGN AND METHODS: The Food and Drug Administration Adverse Event Reporting System (FAERS) database was searched from 1970 and 2019 to 30 September 2023 for reports of suicidal ideation, depression suicidal, suicidal behavior, suicidal attempt, and completed suicide in association with ketamine and esketamine exposure, respectively. We present reporting odds ratios (ROR) significance was determined when the lower limit of the 95% confidence interval (CI) exceeded 1.0. Lithium was used as the control agent. RESULTS: Observed a higher ROR for suicidal ideation (ROR 7.58, 95% CI 6.34-9.07) and depression suicidal (ROR 14.19, 95% CI 1.80-112.07) with esketamine. Significantly lower RORs were observed for suicide attempt with ketamine (ROR 0.15, 95% CI 0.11-0.21) and esketamine (ROR 0.57, 95% CI 0.48-0.67). CONCLUSIONS: Mixed RORs across aspects of suicidality were observed with ketamine and esketamine. Limitations of the FAERS database prevent any determination of causal effects new onset suicidality to either agent. The lower RORs for suicide attempt with ketamine and esketamine is noted but cannot be interpreted as a direct therapeutic effect.

Anxiety disorders as predictors of suicidality in people with type 2 diabetes mellitus: Findings of a study in six European countries. / Zaburzenia lekowe jako predyktory samobójczosci u osób z cukrzyca typu 2: Wyniki badania przeprowadzonego w szesciu europejskich krajach.

OBJECTIVES: Anxiety disorders are significant predictors of suicidality and are proposed to be independent risk factors for suicide attempts. They are common in people with type 2 diabetes (T2DM) and are associated with longer duration of diabetes and poorer treatment outcomes. The aim was to examine associations between anxiety disorders and suicidal thoughts and behaviour in people with T2DM, to establish the prevalence of suicidality among people with T2DM in the selected European countries and to examine whether anxiety disorders were predictive of current outcomes of suicidality in this population using data from the International Prevalence and Treatment of Diabetes and Depression study. METHODS: The study sample comprised 1063 adults with T2DM from 6 European countries. The presence of anxiety disorders and suicidality was assessed with the MINI International Neuropsychiatric Interview. The group of participants with current suicidal risk was compared with the group of participants with no suicidal risk. RESULTS: The participants from Germany were more likely to report suicidality than those from other countries, whereas people from Serbia and Ukraine were less likely to report it. Depression and anxiety disorders significantly contributed to the increased presence of suicidality among people with T2DM. Agoraphobia was a significant predictor of suicidality when controlling for depression. The participants with T2DM and comorbid agoraphobia had 4.86 times higher odds to report suicidality than those without agoraphobia. CONCLUSIONS: Agoraphobia was a significant predictor of suicidality in people with T2DM.

The effect of social support and resource support on emotional exhaustion, insomnia, and suicidal ideation among allied health trainees and post-graduate year doctors in Taiwan.

BACKGROUND: COVID-19-related stigmatization refers to COVID-19-related judgements by others that devalue the individual. Such stigmatization towards healthcare workers may cause psychological burden and negative consequences. Such stigmatization may have particularly overwhelmed allied health trainees (AHTs) and post-graduate year doctors (PGYDs) because they just started their medical career. Social support and resource support have been reported to benefit psychological health and reduce stigmatization. Therefore, the present study used a cross-sectional study design to investigate the association between perceived stigma, self-stigma, psychological distress, and negative outcomes (including emotional exhaustion, insomnia and suicidal ideation) among AHTs and PGYDs in Taiwan. METHODS: An online survey distributed between July and December, 2022 received 522 responses. Variables were assessed using the 21-item Depression, Anxiety and Stress Scale, Insomnia Severity Index and a series of self-designed questions to assess social support, resource support, perceived stigma, self-stigma, emotional exhaustion, and suicidal ideation. RESULTS: Structural equation modeling showed that perceived stigma was associated with self-stigma (standardized coefficient [ß] = 0.428, p < 0.001), and self-stigma was associated with psychological distress (ß = 0.197, p < 0.001), as well as being associated with emotional exhaustion, insomnia, and suicidal ideation (ß = 0.349, 0.556 and 0.212, all p-values < 0.001). While social support and resource support were negatively associated with perceived stigma (ß= - 0.175 and - 0.152, p < 0.01), additional associations were found between social support and emotional exhaustion (ß= - 0.093, p < 0.001), as well as between resource support and insomnia (ß= - 0.120, p < 0.001). CONCLUSIONS: The results showed that COVID-19 related stigmatization was correlated to the detrimental consequences of emotional exhaustion, insomnia and suicidal ideation. Clear paths regarding the associations of social support and resource support with the three negative associations were found as the possible solutions. Strategies to reduce the stigmatization and these negative outcomes, or improve the psychological health will benefit AHTs and PGYDs in maintaining a healthy mental status.

Lifetime victimization experiences, depressiveness, suicidality, and feelings of loneliness in youth in care.

BACKGROUND: Research has demonstrated the damaging effects of poly-victimization on the mental health of children and adolescents. However, few studies have been conducted in high-risk youth in care (Y-IC) samples. OBJECTIVE: The study examines the frequency of lifetime victimization and the association of poly-victimization and victimization types on depressiveness, suicidality, and feelings of loneliness among Y-IC. PARTICIPANTS AND SETTING: 164 participants aged 14 and 21 years (M = 17.39, SD = 1.95), who live in family-based care or residential care. METHODS: The Juvenile Victimization Questionnaire (JVQ) was used to assess lifetime victimization. The Patient Health Questionnaire (PHQ-9), and the Loneliness Scale-SOEP (LS-S) to measure depressiveness, suicidality, and loneliness. Hierarchical regression models were calculated. RESULTS: Participants reported on average 12.66 (SD = 6.58) victimization experiences. The female and diverse gender groups reported higher rates of victimization, loneliness, depressiveness, and suicidality than the males. Participants in residential care reported more victimizations and stronger feelings of loneliness than those in family-based care. Poly-victimization was not associated with any of these internalizing symptoms but peer victimization was significantly associated with depressiveness (ß = 0.23, p = .002) and loneliness (ß = 0.22, p = .006), sexual victimization with depressiveness (ß = 0.22, p = .004). CONCLUSION: Y-IC show high levels of victimization and internalizing symptoms, with higher burden on girls and youth living in residential care. Findings underscore the relevance of social exclusion experiences among peers within Y-IC. Interventions should address multiple forms of victimization, with a special focus on sexual and peer victimization.

Adverse Childhood Experiences Moderate the Relationship Between Pain and Later Suicidality Severity Among Youth: A Longitudinal High-Risk Cohort Study.

Pain in adolescence can lead to the development of serious mental health issues, including suicidality. This risk may be strengthened among youth exposed to more adverse childhood experiences (ACEs; abuse, neglect, household challenges). This longitudinal study examined the role of ACEs in the relationship between pain and later suicidality onset and severity among a cohort of adolescents at risk for developing mental health problems. Participants were 139 healthy youth (Mage = 13.74 years, standard deviation = 1.56, 64% female) between the ages of 11 to 17 years, recruited based on parental history of depression or anxiety. Youth completed validated measures of internalizing symptoms, ACEs, and pain characteristics at baseline and follow-up diagnostic interviews 9 and/or 18 months later to assess for onset and severity of suicidality. After controlling for demographics, baseline internalizing symptoms, and ACEs, worse pain interference and increased ACEs at baseline predicted increased suicidality severity at follow-up. Moderation analyses revealed that there was a significant interaction between ACEs and pain interference and pain intensity. Increased pain interference (b = 7.65, P < .0001) or intensity (b = 6.96, P = .0003) was only associated with increased suicidality severity at follow-up in youth with high levels of ACEs. This study demonstrates that ACEs strengthen the relationship between pain and later suicidality severity among youth at risk of developing mental health problems. Findings underscore the critical need to adopt a trauma-informed lens to pediatric pain prevention and treatment (eg, screening for ACEs) and for the pain to be on the child's mental health agenda. PERSPECTIVE: This article provides evidence that, while pain is a risk factor for future increased suicidality severity, it is a particularly strong risk factor in youth who experienced increased childhood adversity. These results may help identify youth at greatest risk for suicidality.

Associations between fearlessness about death and suicidal ideation in individuals with psychosis.

BACKGROUND: Despite high rates of suicide among people with psychosis, relatively little is known about the mechanisms underlying the transition from suicidal ideation to behavior in this population. The Interpersonal Psychological Theory of Suicide (IPTS) proposes that fearlessness about death (FAD) may play a role in this relationship. The present study tested whether constructs of the IPTS [thwarted belongingness (TB), perceived burdensomeness (PB), and FAD] were associated with the severity of suicidal ideation in a sample of adults with histories of psychosis. METHOD: 261 adults with histories of psychosis completed measures of IPTS constructs, current severity of suicidal ideation, and history of suicidal attempts. We examined differences between those with past suicide attempts and those without and conducted regression analyses to evaluate the associations among TB, PB, FAD and severity of current suicidal ideation. RESULTS: Contrary to expectations, a history of suicidal behavior was not uniquely associated with FAD. Regression analyses revealed TB × PB and FAD × PB interactions emerged as significant correlates of the severity of suicidal ideation, with the relationship between PB and suicidal ideation more pronounced at higher levels of FAD and TB. Interestingly, positive symptoms of psychosis were positively associated with PB. IMPLICATIONS: This study provides support for broadening the investigation of FAD as a contributor to suicidal ideation in individuals with psychotic symptoms. Future research investigating the role of other contributors that may influence capability for suicide (e.g., impulsivity) may add additional understanding of suicide in this population.

Alterations in plasma endocannabinoid concentrations among individuals with major depression treated with electroconvulsive therapy.

The role of the endocannabinoid system (ECS) in depression and suicidality has recently emerged. The purpose of the study was to identify changes in plasma endocannabinoid concentrations of several endocannabinoids and correlate them with depressive symptoms and suicidality in patients with severe major depression undergoing electroconvulsive therapy (ECT). The study included 17 patients that were evaluated in four visits at different stages of therapy. At each visit depression, anxiety and suicidality symptoms were assessed and blood samples collected. Several endocannabinoid concentrations increased following six sessions of ECT, as 2-AG (p < 0.05) and LEA (p < 0.01), and following twelve sessions of ECT, as 2-AG (p < 0.05), AEA (p < 0.05), LEA (p < 0.05) and DH-Gly (p < 0.05). Endocannabinoids also correlated with symptoms of depression, anxiety and suicidality at baseline and at the sixth ECT session. Finally, we found one endocannabinoid, l-Gly, that differentiated between remitted and not-remitted patients at the seventh and thirteenth ECT sessions (p < 0.05). Our findings suggest that depression is markedly related to imbalance of the endocannabinoid system, and further regulated by ECT. Plasma endocannabinoids could be promising biomarkers for detection of depression response and remission.

The Clinical Sequelae of the COVID-19 Pandemic: Loneliness, Depression, Excessive Alcohol Use, Social Media Addiction, and Risk for Suicide Ideation.

BACKGROUND: Depression, loneliness, and alcohol use disorder are associated with suicide ideation. The ongoing COVID-19 pandemic has challenged our social structures with social distancing and isolation policies implemented worldwide, severely restricting social interactions. Studies regarding the effects of the pandemic are starting to shed light on the harmful psychological effects of these policies. AIMS: This study aims to identify whether the increase in suicidal ideation among college students (mostly young adults) during the pandemic was due to the known risk factors of loneliness, depression, alcohol use disorder, social media addiction, and other background variables. METHOD: Nine hundred and eleven college students completed self-report questionnaires assessing suicidal risk, depressive symptoms, loneliness, excessive alcohol use, and social media use. RESULTS: During the pandemic suicidal ideation was associated with loneliness (χ2 = 54.65, p < 0.001), depressive symptoms (χ2 = 110.82, p < 0.001), alcohol use disorder (χ2 = 10.02, P < 0.01) and social media addiction (χ2 = 13.73, P < 0.001). Being single [OR = 2.55; p < 0.01], and self-identifying as a non-heterosexual [OR = 2.55; p < 0.01] were found to constitute additional risk factors. LIMITATIONS: The structural nature of quantitative self-report scales does not offer the flexibility of gaining a deeper understanding of causes, specific to particular circumstances that may lead participants to ideate on suicide, even briefly. CONCLUSIONS: Social distancing and isolation policies during the COVID-19 pandemic constitute an additional factor in the risk for suicide ideation.

Workplace Injury Compensation and Mental Health and Self-Harm Outcomes: A Systematic Review.

Workers' compensation systems aim to financially support injured workers. However, seeking compensation often leads to poorer physical and mental health outcomes. This review examines previous studies to investigate the relationship between workers' compensation and mental health and self-harm outcomes. A three-tiered search strategy across five databases identified studies that examined workers' compensation claims as an exposure or risk factor, with outcomes related to mental health, self-harm and suicidality. Nine full-text studies were included; however, heterogeneity limited generalizability. Most studies supported an association between pursuing compensation and poorer mental health and self-harm outcomes. Some studies attributed this to specific aspects of the system such as justice perception and navigation of the claims system. Findings suggest an association between workers' compensation and mental health or self-harm outcomes. Inconclusive findings highlight the need for further research. Understanding the psychiatric impacts of pursuing compensation is crucial to help formulate a more accessible compensation system.

Suicidal thoughts and behaviours in body dysmorphic disorder: Prevalence and correlates in a sample of mental health service users in the UK.

BACKGROUND: Previous research indicates an association of body dysmorphic disorder (BDD) with suicidal thoughts and behaviours, but has largely relied on small cohorts drawn from specialist clinics. METHODS: Anonymised health-records from the South London and Maudsley NHS Foundation Trust between 2007 and 2019 were systematically searched using the Clinical Record Interactive Search data system. RESULTS: 298 patients diagnosed with BDD between age 12 and 65 years were identified. 206 (69 %) had experienced lifetime suicidal ideation. 149 (50 %) had recorded lifetime acts of self-harm or suicide attempts, most commonly involving cutting and self-poisoning. Rates of self-harm/suicide attempts were similar in those diagnosed before or after 18 years. Comorbid depression was associated with suicidal ideation (OR: 4.26 95% CI 2.07-9.72). Additionally, comorbid depression, OCD and anxiety were all associated with self-harm/suicide attempts (OR: 1.94 95% CI 1.15-3.31, OR: 1.99 95% CI 1.09-3.73, and OR: 1.93 95% CI 1.09-3.45, respectively). The presence of two or more psychiatric comorbidities was associated with a significantly elevated likelihood of suicidal ideation (OR: 7.06 95% CI 2.80-21.7) and self-harm/suicide attempts (OR: 4.62 95% CI 2.32-9.62). LIMITATIONS: It is likely that BDD was under-diagnosed in the cohort, and those identified may not be representative. Additionally, the frequency and detail with which suicidal thoughts and behaviours were assessed varied and may also represent underestimates. CONCLUSIONS: Suicidal ideation and self-harm/suicide attempts are common among individuals with BDD accessing mental health services. Psychiatric comorbidity and suicidal ideation should be assessed in all BDD patients.

A Narrative Review of Depression and Suicide in Adolescent Females to Guide Assessment and Treatment Recommendations.

STUDY OBJECTIVE: Suicide is a leading cause of death for adolescents. Medical professionals are increasingly being asked to screen for depressive symptoms and suicidal ideation with little training. The purpose of this paper is to review factors related to suicidal thoughts and actions, assessment of symptoms, and initial suggestions for treatment for medical providers. METHODS: A literature review of risk and resilience factors, assessment measures, and treatment options for depression and suicidal ideation and behavior in adolescent females was conducted. RESULTS: Given the higher risk of suicidal thoughts and depressive symptoms in adolescent females, accurate and thorough assessment of symptoms is recommended. CONCLUSION: Medical providers should be aware of symptoms related to depression and suicidal ideation in order to provide more effective assessments. Recommendations for brief assessment measures that can be used in the clinic and possible first line treatments are provided.