An examination of the mediating role of maladaptive emotion regulation strategies in the complex relationship between interpersonal needs and suicidal behavior.

Background: Studies have shown that psychological factors, notably interpersonal needs and emotion regulation, play a significant role in suicidal behavior. Interpersonal needs are significant contextual components that affect emotion regulation and contribute to a wide range of dysfunctional behaviors, such as suicidal behavior. It has been postulated that emotion regulation mediates the associations between proximal and distal risk factors of suicidal behavior. Method: The sample consisted of 340 community-dwelling individuals (62.5% women; SD = 0.48) with an age range of 18 through 55 (M = 30.23; SD = 8.54) who completed the interpersonal needs questionnaire, the suicide behaviors questionnaire-revised, and the cognitive emotion regulation questionnaire. The Structural Equation Modeling (SEM) approach was utilized to evaluate a mediation model. Results: The findings indicate that interpersonal needs (i.e., perceived burdensomeness r = .55, p <.01 and thwarted belongingness r = .25, p <.01) and putatively maladaptive cognitive emotion regulation strategies (i.e., self-blame; r = .38, p <.01, catastrophizing; r = .55, p <.01, rumination; r = .40, p <.01, and other blame; r = .44, p <.01) have strong associations with suicidal behavior, and these strategies have a mediating effect on the association between interpersonal needs and suicidal behavior. Conclusions: Our findings show that contextual-interpersonal needs, which underpin suicidal behavior, are significantly influenced by maladaptive emotional processes. Thus, therapeutic outcomes might be enhanced by focusing on the content of the associated cognitions and trying to reduce maladaptive regulatory processes like rumination and catastrophization.

Effectiveness of Peripheral Nerve Block in Terms of Search for a Standardized Treatment Protocol in Diabetic Foot Patients Using Anticoagulants: A Double-Center Study.

BACKGROUND: Lower-extremity amputation for a diabetic foot is mainly performed under general or central neuraxial anesthesia. Ultrasound-guided peripheral nerve block (PNB) can be a good alternative, especially for patients who require continuous anticoagulation treatment and patients with additional comorbidities. We evaluated bleeding due to PNB application in patients with diabetic foot receiving antiplatelet or anticoagulant therapy. Perioperative morbidity and mortality and the need for intensive care hospitalization were analyzed. METHODS: This study included 105 patients with diabetic foot or debridement who underwent distal foot amputation or debridement between February and October 2020. Popliteal nerve block (17 mL of 5% bupivacaine and 3 mL of saline) and saphenous nerve block (5 mL of 2% lidocaine) were applied to the patients. Postoperative pain scores (at 4, 8, 12, and 24 hours) and complications due to PNB were evaluated. Intensive care admission and 1-month mortality were recorded. RESULTS: The most common diseases accompanying diabetes were hypertension and peripheral artery disease. No complications due to PNB were observed. Mean ± SD postoperative first analgesic need was determined to be 14.1 ± 4.1 hours. Except for one patient, this group was followed up without the need for postoperative intensive care. In 16 patients, bleeding occurred as leakage from the surgical area, and it was stopped with repeated pressure dressing. Mean ± SD patient satisfaction score was 8.36 ± 1.59. Perioperative mortality was not observed. CONCLUSIONS: Ultrasound-guided PNB can be an effective and safe anesthetic technique for diabetic patients undergoing distal foot amputation, especially those receiving antiplatelet or anticoagulant therapy and considered high risk.

Inequality on the frontline: A multi-country study on gender differences in mental health among healthcare workers during the COVID-19 pandemic.

Healthcare workers (HCWs) were at increased risk for mental health problems during the COVID-19 pandemic, with prior data suggesting women may be particularly vulnerable. Our global mental health study aimed to examine factors associated with gender differences in psychological distress and depressive symptoms among HCWs during COVID-19. Across 22 countries in South America, Europe, Asia and Africa, 32,410 HCWs participated in the COVID-19 HEalth caRe wOrkErS (HEROES) study between March 2020 and February 2021. They completed the General Health Questionnaire-12, the Patient Health Questionnaire-9 and questions about pandemic-relevant exposures. Consistently across countries, women reported elevated mental health problems compared to men. Women also reported increased COVID-19-relevant stressors, including insufficient personal protective equipment and less support from colleagues, while men reported increased contact with COVID-19 patients. At the country level, HCWs in countries with higher gender inequality reported less mental health problems. Higher COVID-19 mortality rates were associated with increased psychological distress merely among women. Our findings suggest that among HCWs, women may have been disproportionately exposed to COVID-19-relevant stressors at the individual and country level. This highlights the importance of considering gender in emergency response efforts to safeguard women's well-being and ensure healthcare system preparedness during future public health crises.

Modified thoracoabdominal nerves block through perichondrial approach for laparoscopic cholecystectomy.

OBJECTIVE: A new block, namely, modified thoracoabdominal nerves block through perichondrial approach, is administered below the costal cartilage. We sought to compare the analgesic efficacy of the modified thoracoabdominal nerves block through perichondrial approach block with local anesthetic infiltration at the port sites in an adult population who underwent laparoscopic cholecystectomy. METHODS: Patients who will undergo laparoscopic cholecystectomy were randomized to receive bilateral ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach blocks or local anesthetic infiltration at the port insertion sites. The primary outcome was the total amount of tramadol used in the first 12 h postoperatively. The secondary outcomes were total IV tramadol consumption for the first postoperative 24 h and visual analog scale scores. RESULTS: The modified thoracoabdominal nerves block through perichondrial approach group had significantly less tramadol use in the first 12 h postoperatively (p<0.001). The modified thoracoabdominal nerves block through perichondrial approach group's visual analog scale scores at rest (static) and with movement (dynamic) were significantly lower compared with the port infiltration group (p<0.05). CONCLUSION: Patients who received modified thoracoabdominal nerves block through perichondrial approach block had significantly less analgesic consumption and better pain scores than those who received port-site injections after laparoscopic cholecystectomy.

Comparison of pericapsular nerve group block and femoral nerve block in spinal anesthesia position analgesia for proximal femoral fractures in geriatric patients: a randomized clinical trial.

BACKGROUND: This study aimed to compare the analgesic efficacy of the femoral nerve block (FNB) with that of the pericapsular nerve group (PENG) block in the lateral decubitus position for spinal anesthesia in geriatric hip fracture surgery. METHODS: Patients aged ≥65 years scheduled to undergo hip fracture surgery for proximal femur fractures with an American Society of Anesthesiologists physical status of class I-IV and body mass index of 18-40 kg/m2 were included in the study. The PENG block or FNB was performed 20 min before positioning for spinal anesthesia. Lateral position, hip flexion, and lumbar spine flexion pain were evaluated during spinal anesthesia. RESULTS: Sixty patients completed the study. The median pain scores for lateral positioning were 2 (0-4) and 2.5 in the PENG and FNB groups, respectively (P=0.001). The median pain scores during hip flexion were 1 (0-4) and 2.5 in the PENG and FNB groups, respectively (P<0.001). The median pain score during lumbar flexion was 1 (0-4) and 2.0 in the PENG and FNB groups, respectively (P=0.001). The two groups did not show a significant difference in the quality of the spinal anesthesia position (P>0.05). CONCLUSION: Pre-operative PENG block is more effective in reducing the pain associated with spinal anesthesia position than FNB in geriatric hip fractures. Both blocks had a similar effect on posture quality and the number of spinal interventions.

Religiosity, Identity Confusion, and Psychological Well-Being in Turkish University Students: The Moderating Role of Religious Orientation.

Research conducted in industrialized democracies where Christianity is the prevailing religion has suggested that religiosity may play an important role in identity development and well-being. This study examined the associations between religiosity, religious orientation, identity confusion, and psychological well-being in 488 Turkish university students. The results revealed that extrinsic religious orientation was positively associated with identity confusion. On the other hand, religiosity, extrinsic religious orientation, and identity confusion were negatively associated with psychological well-being, while intrinsic religious orientation was positively associated with psychological well-being. Moderation analysis indicated that extrinsic religious orientation could facilitate psychological well-being in the midst of severe identity confusion.

Problem-solving therapy can reduce psychological distress in patients with Cushing's disease: a randomized controlled trial.

OBJECTIVE: To evaluate the effects of online group problem-solving therapy (PST) for reducing negative problem orientation (NPO), psychological distress, and increasing quality of life in patients with Cushing's disease (CD). METHODS: In this randomized trial, we allocated 55 eligible patients to either PST (n = 28) or treatment as usual (TAU) (n = 27) groups. The analyses primarily relied on intent-to-treat (ITT) principle and were repeated with intervention completers (per-protocol analyses). Social problem-solving inventory-revised short form, Beck Depression Inventory (BDI), General Health Questionnaire-12 (GHQ-12), Perceived Stress Scale (PSS), The Satisfaction with Life Scale, and Cushing's Quality of Life scale were used. Pre-test, post-test, and follow-up measures were obtained. Linear mixed models were used to compare PST and treatment as usual (TAU) groups across time. RESULTS: Of the total 55 patients with CD, the mean age was 46 ± 12 years, 49 patients (89%) were female, and 41 patients (74.5%) were in remission. The patients within the PST and TAU groups were similar in terms of age, sex, and disease activity. ITT analyses showed a greater reduction of NPO scores in patients who received PST as compared to patients who received usual care (df = 45.9, p = 0.029, Cohen's d = 0.47). The decrease in NPO was sustained at follow-up (mean difference: - 2.2, p = 0.007). Results of the ITT analyses revealed no superior benefits of the intervention for psychological distress. However, per-protocol analyses demonstrated that PST provided a greater decrease in BDI, PSS, and GHQ-12 scores. CONCLUSION: PST may decrease NPO and improve the psychological well-being of patients with CD.

Linguistic validation of a widely used recovery score: quality of recovery-15 (QoR-15).

BACKGROUND: The quality of recovery-15 (QoR-15) is a patient reported outcome questionnaire that measures the quality of recovery after surgery and anesthesia. The QoR-15 has been validated in many languages; Turkish version of the QoR-15 has not yet been established. The aims of this study were to translate the QoR-15 questionnaire into Turkish and to perform a full psychometric evaluation of the Turkish version. METHODS: After translating the original English version of the QoR-15 scale into Turkish, the QoR-15T scale was psychometrically validated. This process included validity, reliability, responsiveness, feasibility. The QoR-15T was evaluated before the surgery and 24 h after surgery. RESULTS: A total of 210 patients completed the pre- and postoperative questionnaires, providing a completion rate of 93.75%. The correlation coefficient between QoR-15T score and VAS score was 0.644 on postoperative day 1 (p < 0.001). Inter item Cronbach's alpha was 0.863. Global test-retest concordance coefficient was 0.98 (95% CI: 0.94-1.00). DISCUSSION: The QoR-15T scale is a reliable and valid instrument for evaluating postoperative quality of recovery in Turkish speaking patients. The psychometric characteristics used to assess postoperative quality of recovery were similar to those in the English version.

Do neoliberal values provide a fertile soil for suicidal ideation?

BACKGROUND: Values associated with neoliberal ideologies are blamed for damaging the social fabric. They may also have deleterious effects on suicidal ideation. OBJECTIVE: We investigated whether neoliberal values were associated with the risk for suicidal ideation through a set of mediating factors (suicide stigma, help-seeking attitudes, perceived stress, and suicide acceptability). METHODS: A total of 508 (249 female) adults from the U.S. responded to a self-administered questionnaire that contained measures of suicidal ideation, neoliberal values, suicide stigma, help-seeking attitudes, perceived stress, and suicide acceptability. We tested a path model that linked neoliberal values to suicidal ideation through multiple mediators. We tested total versus partial mediation models. RESULTS: We found empirical evidence for a full mediation of the association of neoliberal values with perceived stress. Neoliberal values were associated with suicide stigma; suicide stigma was associated with negative attitudes towards help-seeking, which, in turn, were associated with high levels of perceived stress. The association of neoliberal values with suicide acceptability was partially mediated. Perceived stress was positively associated with suicide risk directly and indirectly through suicide acceptability. CONCLUSION: Our findings suggest that values related to neoliberal ideologies prepare a context that fosters the risk for suicide. For a contextualized understanding of suicidal behavior, more research is needed that explores the role of social, cultural, political, and economic ideologies in the suicidal process.

Are Nonfatal Suicide Attempts Instrumental in Achieving Personal and Interpersonal Goals?

This study focused on the well-being of the survivors of suicide attempts and the well-being of their interpersonal relationships after the attempt. The data came from a sample of 392 college students from 10 Muslim majority countries who reported having attempted suicide in the last 4 years. Suicide was conceptualized as a goal-directed behavior embedded in a sociocultural context and motivated by personal or interpersonal goals. We tested a process that linked culturally shaped self-construal to the postsuicidal personal and interpersonal well-being. We posited that this process would operate through the attitudes towards suicide, motives for suicide, the strength of the intention to die. Our model indicated that the acceptability of suicide was positively associated with escape motives, and this association was even stronger for the individuals with interdependent self-construals. Escape motives were negatively associated with postsuicidal personal and interpersonal well-being, but communication motives were not associated with these outcomes. We also found evidence that having an interdependent self-construal might be beneficial for postsuicidal personal and interpersonal well-being. Our results further suggested that the postsuicidal personal and interpersonal well-being of highly interdependent individuals may depend on the interpretation of their act of suicide by their close others.

EEG changes in intensive care patients diagnosed with COVID-19: a prospective clinical study.

INTRODUCTION: Coronavirus disease (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was declared a pandemic on March 11th, 2020, by the World Health Organization (WHO). There has been a substantial increase in the epileptic seizures and status epilepticus reported in the pandemic period. In this context, it is aimed with this study to identify the electroencephalography (EEG) features of patients admitted to the intensive care unit with the diagnosis of COVID-19 and to look for any specific patterns in these features. MATERIAL AND METHOD: The material of this study primarily comprised the neurological evaluations and continuous EEG recordings of 87 intensive care patients who were diagnosed with COVID-19. In addition, demographic and clinical features and comorbid conditions of these patients were also analyzed, and any correlation thereof was investigated. RESULTS: The EEG data of 87 patients who were diagnosed with COVID-19 and were followed up in the intensive care unit were recorded and then analyzed. Abnormal EEG findings were detected in 93.1% (n = 81) of the patients, which were found to increase significantly with age (p < 0.001). The mean age of patients with specific epileptiform abnormalities on EEG was found to be significantly higher than those with non-specific abnormalities. Epileptiform discharges were seen in 37.9% (n = 33) of the patients. Nonconvulsive status epilepticus (NCSE) was detected in 5.7% of the patients, and antiepileptic drugs were started in 25 (28.7%) of the patients. DISCUSSION: Statistically significant EEG changes were observed in the continuous EEGs of the patients followed up in the intensive care unit due to COVID-19 infection. However, further studies are needed to associate the EEG changes observed in the COVID-19 patients with the epileptogenesis of COVID-19 infection.

The impact of the COVID-19 pandemic on the mental health of healthcare workers: study protocol for the COVID-19 HEalth caRe wOrkErS (HEROES) study.

BACKGROUND: Preliminary country-specific reports suggest that the COVID-19 pandemic has a negative impact on the mental health of the healthcare workforce. In this paper, we summarize the protocol of the COVID-19 HEalth caRe wOrkErS (HEROES) study, an ongoing, global initiative, aimed to describe and track longitudinal trajectories of mental health symptoms and disorders among health care workers at different phases of the pandemic across a wide range of countries in Latin America, Europe, Africa, Middle-East, and Asia. METHODS: Participants from various settings, including primary care clinics, hospitals, nursing homes, and mental health facilities, are being enrolled. In 26 countries, we are using a similar study design with harmonized measures to capture data on COVID-19 related exposures and variables of interest during two years of follow-up. Exposures include potential stressors related to working in healthcare during the COVID-19 pandemic, as well as sociodemographic and clinical factors. Primary outcomes of interest include mental health variables such as psychological distress, depressive symptoms, and posttraumatic stress disorders. Other domains of interest include potentially mediating or moderating influences such as workplace conditions, trust in the government, and the country's income level. RESULTS: As of August 2021, ~ 34,000 health workers have been recruited. A general characterization of the recruited samples by sociodemographic and workplace variables is presented. Most participating countries have identified several health facilities where they can identify denominators and attain acceptable response rates. Of the 26 countries, 22 are collecting data and 2 plan to start shortly. CONCLUSIONS: This is one of the most extensive global studies on the mental health of healthcare workers during the COVID-19 pandemic, including a variety of countries with diverse economic realities and different levels of severity of pandemic and management. Moreover, unlike most previous studies, we included workers (clinical and non-clinical staff) in a wide range of settings.

Airway management in general anesthesia for endovascular treatment of cerebral arteriovenous malformation: a retrospective observational study.

BACKGROUND AND OBJECTIVE: This retrospective and observational study aimed to retrospectively evaluate the use of the endotracheal tube (ETT) and the Laryngeal Mask Airway (LMA) for the airway management with respect to airway safety, hemodynamic stability, adverse respiratory events, and recovery characteristics in patients who underwent endovascular treatment (EVT) for cerebrovascular arteriovenous malformation under general anesthesia between 2011 and 2018. METHODS: The study included data from the patient's electronic medical records and anesthesia files. The primary outcome measure was the incidence of hemodynamic disturbances and respiratory adverse events during airway management. The secondary outcome measure was the comparison of recovery characteristics. RESULTS: The airway was secured using ETT in 41 patients and LMA in 39 patients. Airway safety was established in all patients without a complication throughout the procedure. Mean arterial blood pressure and heart rate were increased to > 20% of baseline levels at intubation and extubation periods in more patients in the ETT group than the LMA group (27 vs. 3; p = 0.07, and 11 vs. 2; p = 0.021). Respiratory adverse events including straining and coughing were observed in ten patients in the ETT group but only in one patient in the LMA group (p = 0.013). Time to extubation, to neurological assessment, and to discharge from the angiography unit were similar (p > 0.05). CONCLUSION: It was concluded that LMA provided sufficient airway safety as with ETT and may be used as an alternative to ETT for EVTs under general anesthesia.

Cultural and interpersonal risk factors for suicide ideation and suicide attempts among Muslim college students from 11 nations.

BACKGROUND: Research on suicidality in low to middle-income countries is scarce. We addressed this issue by investigating suicidality in a cross-national college student samples from 11 predominantly low to middle-income majority Muslim countries. METHODS: The sample consisted of 7427 college students (56% female) who reported to be affiliated with Islam. Data on self-construal, social support, negative life-events, acceptability of suicide, suicidal ideation, and suicide attempts were collected with self-administered questionnaires. RESULTS: Acceptability of suicide and the experience of negative life-events were positively, and perceived social support was negatively associated with suicidal ideation. Interdependent self-construal was negatively related to the acceptability of suicide and positively associated with perceived social support, implying a negative indirect effect on suicidal ideation although its direct effect was positive. The number of negative life-events was the strongest positive predictor of ever attempting suicide. The interdependent self-construal moderated the association of negative life-events with suicide attempts. LIMITATIONS: Cross-sectional and self-report nature of the study were its major limitations. Participants may have suppressed their responses about suicide because of religious and legal reasons. CONCLUSION: Remarkable similarities across 11 country samples emerged in the linkages between cultural and interpersonal factors with suicidality. Our findings highlight the value of a nuanced approach to suicidality, that can recognize the differences in the processes associated with suicidal ideation and suicide attempts, as well as the need to consider the interplay of a broad range of personal, interpersonal, and cultural influences.

Comparison of three sitting positions for combined spinal - epidural anesthesia: a multicenter randomized controlled trial.

BACKGROUND AND OBJECTIVES: The aim of this prospective, multi-centered and multi-arm parallel randomized trial was to test the hypothesis that modified sitting positions including hamstring stretch position (HSP) and squatting position (SP) would reduce needle - bone contact events and increase the success rate of combined spinal - epidural anesthesia (CSEA) compared to traditional sitting position (TSP) in patients undergoing total knee or hip arthroplasty. PATIENTS AND METHODS: Three hundred and sixty American Society of Anesthesiologists (ASA) I-III patients, aged between 45-85 years were randomly allocated to one of three groups using computer-generated simple randomization: group TSP (n = 120), group HSP (n = 120), and group SP (n = 120). Primary outcome measures were the number of needle-bone contact and success rates. Secondary outcome measure was the ease of interspinous space identification. RESULTS: Seven patients in group SP and four of HSP could not tolerate their position and were excluded. Number of needle-bone contact, success rates, and grade of interspinous space identification were similar between groups (p = 1.000). Independent of positioning, the success rates were higher in patients whose interspinous space was graded as easy compared to difficult or impossible (p < 0.001). Success rates reduced, interspinous space identification became more challenging, and number of needle - bone contact increased as patient's body mass index (BMI) increased (p < 0.001). CONCLUSION: SP and HSP may be used as alternatives to the TSP. BMI and ease of interspinous space identification may be considered important determinants for CSEA success.

Brain edema after ultrasound-guided supraclavicular block.

Supraclavicular nerve block is the most popular regional anesthesia approach for upper limb surgery. It also predispose some complications because of the adjacent neurovascular structures such as pleura, recurrent laryngeal and phrenic nerve, supraclavicular vessels, and spinal cord structures. The widespread use of ultrasound for peripheral nerve blocks has reduced the incidence of these complications. We aimed to present a case of brain edema developed after ultrasound-guided supraclavicular block which was not reported in the literature before. A 25 years old, American Society of Anesthesia (ASA) score I, male patient was admitted to our clinic to perform the replacement of external fixator with an internal fixator. The ultrasound guidance supraclavicular nerve block was performed. After the block, we observed disorientation, blurring in consciousness, paleness, tachycardia, hypertension and tachypnea. Upon this, we performed induction for general anesthesia and intubation. After the onset of myoclonic epileptic seizure, he was re-intubated in the recovery room. Bilateral cerebral parenchyma was edematous, the sulci were faint and venous structures were prominent on the brain computerized tomography. Because of magnetic resonance imaging (MRI) finding that restricted diffusion which was compatible with cortical-subcortical acute ischemia, mannitol, dexamethasone and furosamid were started as anti-edema treatment. On the third day in intensive care unit, the patient was extubated because of improvement in consciousness and marked decrease in brain swelling on the control radiologic imaging. It should be kept in mind that brain edema secondary to local anesthetic systemic toxicity (LAST) may develop as a complication after brachial plexus blocks. KEY WORDS: Brain Edema, Epileptic Seizure, Supraclavicular Nerve Block, Ultrasound.

Associations of religiosity, attitudes towards suicide and religious coping with suicidal ideation and suicide attempts in 11 muslim countries.

OBJECTIVE: The study investigated the associations of religiosity, religious coping and suicide acceptance to suicide ideation and attempts in 7427 young adults affiliating with Islam from 11 Muslim countries. METHOD: A self-administered questionnaire was used to collect the data. We used F and χ2 tests and correlation analyses to report descriptive statistics. Multi-group path models with (i) a zero-inflated Poisson distribution and, (ii) a Binomial distribution were used to model the number of occurrences of suicidal ideation, and occurrence of a suicide attempt, respectively. RESULTS: Religiosity was negatively associated with acceptability of suicide, but it was positively related to punishment after death across the 11 countries. Religiosity was negatively associated with ever experiencing suicidal ideation, both directly and indirectly through its association with attitudes towards suicide, especially the belief in acceptability of suicide. Neither positive nor negative religious coping were related to suicidal ideation. However, religiosity was negatively related to suicide attempts among those who experienced suicidal ideation at least once. This association was mediated through the belief in acceptability of suicide and religious coping. Negative religious coping was positively associated with suicide attempts probably because it weakened the protective effects of religiosity. CONCLUSIONS: Findings from this study suggest that the effects of religiosity in the suicidal process operate through attitudes towards suicide. We therefore conclude that clinical assessment as well as research in suicidology may benefit from paying due attention to attitudes towards suicide.

Suicidal Behavior in the Mediterranean Countries.

INTRODUCTION: Suicidal behavior is a serious public health problem worldwide and shows large intersocietal variation. This study aimed at comparatively investigating the aspects of suicidal behavior in 22 countries surrounding the Mediterranean Sea. METHODS: The study was conducted with official data retrieved from several sources. The suicidal mortality data were collected from World Health Organization's data repository. Descriptive statistics, group comparison, correlational and regression statistical analyses were used to summarize the data. RESULTS: The average age standardized suicide rates in the Mediterranean countries are lower than the world average. Except in Morocco, more men kill themselves than women. Suicide rates are lower in Mediterranean Muslim than in Mediterranean Christian countries. Slovenia, France and Croatia have the highest suicide mortality rates. Greatest percentages of suicidal ideation are seen in Croatia, Turkey and Slovenia and the greatest percentages of suicidal attempts are seen in Palestine, Cyprus, Greece and Slovenia. According to the results of the multiple regression analyses, the coefficient of human inequality index was associated with lower both-sex and male suicide rates. Greater percentages of people saying religion is unimportant in daily life in a country were found to be related to higher female suicide rates. CONCLUSION: The findings from the study have shown that the prevalence of suicidal deaths, thoughts and attempts vary between the Mediterranean countries. Lower suicide rates are observed in the Muslim Mediterranean nations than in the Judeo-Christian ones. However, the rates of suicide mortality in non-Arab Muslim nations being comparable to the rates in non-Muslim countries confirm the concerns over mis/underreporting of suicidal behavior in Arab Muslim countries due to religio-cultural stigma attached to suicide. The average suicidal mortality rates are lower in Mediterranean countries than the world average. Generally, more men than women kill themselves. Results from the multivariate analysis revealed that as the level of human inequality increases the rates for both-sex and male suicidal mortality decreases. Religion seem to be protective against female suicides. The study has also shown that more research is needed about suicidal behavior in the Mediterranean countries.