[Predictive Value of the Huaxi Emotional Index in Assessing and Identifying High Suicide Risk Among Inpatients With Depression]. / åŽè¥¿å¿ƒæ™´æŒ‡æ•°åœ¨æŠ‘éƒç—‡ä½é™¢æ‚£è€ é«˜è‡ªæ€é£Žé™©è¯„ä¼°ä¸­çš„é¢„æµ‹ä½œç”¨.

Objective: This study aims to investigate the agreement between the Huaxi Emotional Index (HEI) and the Nurses' Global Assessment of Suicide Risk (NGASR) in assessing high suicide risk and to explore the predictive value of HEI in identifying high suicide risk among patients with depression. Methods: Convenience sampling was used and 386 inpatients with depression were included in this cross-sectional study. All patients were admitted to the Mental Health Center, West China Hospital between June and December 2023. The inclusion criteria were as follows, a diagnosis of depression according to the International Classification of Diseases, Tenth Revision (ICD-10), age over 18, and completion of both NGASR and HEI assessments. According to the exclusion criteria, depression patients who had other comorbid mental disorders or those who had severe cognitive impairments and were unable to communicate effectively were excluded. The study was approved by the Biomedical Ethics Review Committee of West China Hospital (Approval No. 647, 2021). Demographic data such as age, sex, ethnicity, marital status, and educational attainment were collected using a self-designed questionnaire. Both the HEI and NGASR were applied to evaluate the patients. We conducted statistical analyses with SPSS 27, employing Spearman's rank correlation for correlation analysis, Kappa tests for consistency between the two instruments, and receiver operating characteristic (ROC) curves for evaluating the predictive performance of HEI scores for high suicide risk, with the optimal HEI cutoff value determined on the basis of the Youden Index. Results: The study included 386 depression inpatients with an average age of 32 years and an average length-of-stay of 14 days. Of these participants, 252 were female (65.3%) and 134 were male (34.7%). Regarding ethnicity, most of the participants were Han Chinese (89.4%), Tibetans accounted for 7.3%, and other minorities, 3.3%. Regarding marital status, 51.3% of the participants were married, 41.2% single, 6.5% divorced, and 1.0% widowed. Regarding educational attainment, 26.2% had an undergraduate or graduate education, 20.7% had junior college education, 24.8% had high school or secondary technical school education, and 28.2% had middle school education or less. The NGASR identified 57.3% of the participants as being at high suicide risk, while the HEI identified 53.6% as having severe emotional distress. There was a moderate agreement between the HEI and the NGASR scores, with a Kappa value of 0.518 ( P<0.001), indicating statistically significant differences. At an HEI score of 17, the Youden Index peaked at 0.52, predicting high suicide risk with a specificity of 76.36%, a sensitivity of 76.02%, and an area under the ROC curve of 0.829 (95% CI: 0.787-0.871), demonstrating statistically significant differences. Conclusion: HEI and NGASR demonstrate moderate agreement in assessing high suicide risk among depression patients. The HEI questionnaire effectively predicts high suicide risk in patients with depression, with 17 being the optimal cutoff value for assessing high suicide risk.

Suicide Risk in Veterinary Professionals in Portugal: Prevalence of Psychological Symptoms, Burnout, and Compassion Fatigue.

Mental health problems and suicide risk among veterinarians and veterinary nurses are well documented in the literature. Data on veterinary assistants have been overlooked, however. In addition, information on Portuguese veterinary professionals is lacking. An online sample of 833 Portuguese veterinary professionals (443 veterinarians, 287 nurses, and 103 assistants) completed self-report questionnaires about suicide risk and mental health between December 2022 and March 2023. Descriptive analysis revealed that 3.5% of respondents attempted suicide during their lifetime; 17.2% experienced extremely severe depression and suicidal ideation; 17.8% and 27.0% experienced extremely severe stress and anxiety, respectively; and 27.4% and 27.7% reported burnout and compassion fatigue, respectively. Multiple linear regression analysis revealed that professionals with a history of mental illness history; with current clinical symptoms of depression, anxiety, and stress; and working more than 40 hours per week experienced greater levels of burnout, compassion fatigue, and suicide ideation. Other variables such as being a woman, being a veterinary assistant, and disagreeing with motives for euthanasia also predicted some mental health problems. Mental health problems in the Portuguese veterinary professionals are a major health concern. These professionals are at higher risk for suicide, and clinical implications and guidelines are discussed.

Suicide risk among adolescents in Sarawak, Malaysia: prevalence and determining factors.

OBJECTIVES: Adolescent suicide is a significant global public health concern. Although numerous studies have investigated factors that influence the risk of suicide among adolescents around the world, limited data are available in the Malaysian context, especially among the diverse ethnic communities of Sarawak. This study aimed to determine the factors associated with the risk of suicide among adolescents in Sarawak, Malaysia. METHODS: A community-based cross-sectional study was conducted among 1,344 adolescents in Sarawak using face-to-face interviews. Hierarchical binary logistic regression analysis was performed to identify factors that determine the risk of suicide among adolescents. RESULTS: Two predictive models were constructed. Both models revealed that being female (OR=1.578, 95 % CI: 1.191, 2.092, p=0.001), having Malay ethnicity (OR=1.733, 95 % CI: 1.236, 2.429, p=0.001) and having a disease significantly increased the risk of suicide (OR=1.895, 95 % CI: 1.221, 2.942, p=0.004). In particular, Model 2, which showed a better fit, found that occasional religious practice (OR=1.610, 95 % CI: 1.126, 2.303, p=0.009), poor parental relationships (OR=1.739, 95 % CI: 1.035, 2.922, p=0.037) and higher addiction (OR=1.015, 95 % CI: 1.008, 1.022, p=0.001), depression (OR=1.919, 95 % CI: 1.241, 2.968, p=0.003), and stress (OR=2.707, 95 % CI: 1.689, 4.340, p=0.001) scores were significantly associated with an increased risk of suicide. CONCLUSIONS: This study sheds light on multiple factors that contribute to the risk of suicide among adolescents in Sarawak. These findings underscore the importance of holistic prevention strategies, including psychological and social dimensions, to mitigate the risk of suicide in this population. Further research is warranted to understand the complex interplay of these factors and guide the development of targeted interventions.

Trends in the impact of suicide compared to other external causes of death: from 1995 to 2020.

BACKGROUND: Suicide is one of the world's greatest public health problems. More than 700,000 people lose their lives to suicide every year. While funding for mental health waits to be increased, thousands of suicides occur every day. MATERIAL AND METHODS: This study aims to quantify the global impact of suicide compared to other external causes of death in terms of Years of Potential Life Lost (YPLL), and how this will change between 1995 and 2020. Our source of information is the World Health Organization (WHO) mortality database. We then use YPLL, a standard measure of premature mortality and burden of disease that brings precision to the assessment of the impact of different causes of death. This, combined with the Compound Annual Growth Rate (CAGR) as a way of expressing increase, gives us a better understanding of the real situation and trends of suicide compared to other external causes of death in different countries worldwide. RESULTS: Based on the available sources of information and the selection criteria, we obtained a sample of 69 countries. The CAGR for all causes per capita decreased over the observed period in 65 countries, and it increases in 4 countries. In contrast, the CAGR specifically for suicide decreased in 49 countries, while an increase was observed in 20 countries. CONCLUSIONS: Prevention of most external causes of mortality shows promising data in most countries. However, this is not the case for suicide. Thus, YPLL due to suicide have decreased to a comparatively lesser extent and have even increased in some countries, a very worrying situation that poses many clinical and epidemiological challenges.

Reliability of Suicide Risk Estimates: A Vignette Study.

OBJECTIVE: Suicide risk assessments are obligatory when patients express a death wish in clinical practice. Yet, suicide risk estimates based on unguided risk assessments have been shown to be of low reliability. Since generalizability of previous studies is limited, the current study aimed to assess inter-rater and intra-rater reliability of risk estimates conducted by psychotherapists and psychology students using written case vignettes. METHOD: In total, N = 256 participants (psychology students, psychotherapists) were presented with 24 case vignettes describing patients at either low, moderate, severe or extreme risk of suicide. Participants were asked to assign a level of risk to each single vignette at a baseline assessment and again at a follow-up assessment two weeks later. RESULTS: Risk estimates showed a low inter-rater reliability, both for students (AC1 = .35) and for psychotherapists (AC1 = .44). Intra-rater reliability was moderate for psychotherapists (AC1 = .59) and rather low for psychology students (AC1 = .47). In general, intra- and intra-rater reliability were highest for vignettes displaying "low" and "extreme" risk. CONCLUSIONS: The results highlight that the reliability of unguided suicide risk assessments is questionable. Standardized risk assessment protocols are therefore recommended. Nonetheless, even reliable risk estimation does not imply predictive validity of risk estimates for future suicidal behavior.

Suicide risk estimates have been shown to be of low reliabilitySuicide risk estimates by psychotherapists and students also showed low inter-rater and intra-rater reliability in the current studyReliable risk estimation does not imply predictive validity of risk estimates for future suicidal behavior.

Risk factors and methods in suicides of elderly patients connected to mental health services from 1999-2024.

Introduction: Suicide prevention is an important aspect of psychiatric care, with older men being a population identified at especially high suicide risk and a recent increase in suicides among older women. Methods: Using data collected by the region's quality assurance team, we examined all suicide deaths occurring between March 1999 and February 2024 in patients aged 60 years or older who were connected to the region's Addiction and Mental Health Program at the time of death. Data were analyzed to describe which factors were most commonly identified in suicides in older adults receiving mental healthcare. We also compared male and female cases to determine whether certain factors were more commonly observed in one gender. Results: We identified 48 cases of suicide occurring in patients aged 60 or over. 60% of suicides occurred in males. Overdose and hanging were the most common suicide methods used, and all suicides occurring on inpatient units occurred via hanging. Depression was the most common diagnosis, and was diagnosed more frequently in suicides of female older adults. A greater proportion of suicides in older women were associated with previous history of suicide attempts. Discussion: Our findings support many current best practices for suicide prevention in psychiatric care, including minimizing ligatures and anchor points on inpatient settings, assessing for and limiting access to means in individuals at-risk, and assessing suicide risk in hospitalized patients prior to passes and discharge. Recognition and treatment of depression remain important aspects in the treatment of older adults to prevent suicide.

Assessment of Suicide Risk and Cultural Considerations in Forcibly Displaced Migrant Youth.

Migrant youth who face forced displacement from their home countries have an emergent mental health burden, placing them at increased suicide risk. As such, it is crucial for pediatric providers to include suicide screening and assessment in their care for this population. Migrant families seek safety but, in many cases, encounter adverse events and psychosocial inequities in the migration journey and in the host community. Factors such as trauma, acculturative stress, and intersectionality influence suicide risk in migrants. Summative traumatic events contribute to the mental health load and worsen suicidal outcomes in migrant youth. Acculturative stress can lead to social marginalization in the host country, further adding to the existing mental health burden. Finally, intersectionality encompasses complex sociocultural influences, which shape the development of cultural identity in migrant youth and influence suicide risk. By examining these factors, the author advances cultural considerations in screening and assessment for suicide risk in migrant youth through evidence-based tools in pediatric clinical practice. Barriers to access to mental health services, stigma, and distrust of the health care system within the host community are also addressed. The author establishes recommendations for early suicide screening and prevention within this population through trauma-informed care, active advocacy, and cultural sensitivity.

Suicide Following a Near-Death Experience.

Background: Sometimes during real or presumed life-threatening and/or near-death circumstances, an individual undergoes an altered state of consciousness referred to as a near-death experience (NDE). The prevalent position in the field of NDE research for the last several decades has been that such experiences result in positive antisuicidal attitudes and that it is highly unlikely that experients will try to kill themselves afterward. In addition, the important consideration of passive suicidal ideation is neglected in NDE research. Aims: To question the premature assumption that people are highly unlikely to die by suicide after an NDE. Method: Four case studies of suicide after an NDE are provided and examined. Results: Although important quantitative data are still needed, it can no longer be argued that people do not die by suicide after an NDE. Limitations: Only four cases were available for examination, and the degree of impact that the NDE had on their suicide is uncertain. Conclusion: Much more research is needed on suicide risk post NDE. In the meantime, the NDE should not be ignored in suicide assessments, but therapists and other relevant professionals need to be attentive to any possible indications of either active or passive suicidal ideation post NDE.

Relationship between serum inflammatory cytokines and suicide risk in patients with major depressive disorder.

Background: Studies have shown that increased inflammatory cytokines are associated with suicide risk, but the relationship between suicide risk and inflammatory cytokines is not clear. This study aimed to investigate the relationship between specific inflammatory markers and suicide risk in patients with MDD. Methods: This is a cross-sectional study. Firstly, we measured and compared psychological characteristics and 10 peripheral inflammatory cytokines in 130 MDD patients and 130 healthy controls(HC). Secondly, MDD patients were divided into 4 groups according to the severity of suicide risk for comparison between groups. Finally, multiple linear regression analysis was used to explore the predictors of suicide risk. Results: We found that the group with higher suicide risk had higher levels of IL-6, CRP, TNF-α, CXCL-2, and IFN-γ, and lower levels of IL-2 and IL-8 (all p<0.01). However, we found no difference in CRP between MIS and LS groups (p=0.337). Regression models were well-fitted. IL-2,IL-8 negatively predicted suicide risk (all p<0.05),IL-6,CRP,TNF-α,CXCL-2, and IFN-γ can positively predict the risk of suicide (all p<0.05). Limitations: This study employed a self-assessment scale. Conclusions: The higher the levels of IL-6, CRP, TNF-α, CXCL-2, and IFN-γ and the lower the levels of IL-2 and IL-8 of MDD patients, the higher the risk of suicide.

Psychological dimensions in alcohol use disorder: comparing active drinkers and abstinent patients.

Background: Alcohol use disorder (AUD) is a major public health concern due to its various physical, psychological, and social consequences. Despite regulatory differences, abstinence remains the primary treatment objective. Addressing the multifaceted nature of alcohol use disorder requires a comprehensive approach. Methods: 150 AUD patients (66%male) with a mean age of 54.10 ± 11.3 years were recruited for the study. Depression, impulsivity, alexithymia, and hopelessness were assessed to determine if there were significant differences in these dimensions between abstinent (N=72) and active drinkers (N=78). Results: The study found significant differences in the psychological dimensions scores, active drinkers exhibited higher levels of depression, impulsivity, alexithymia, and hopelessness compared to abstinent patients. Conclusion: Treatment outcomes for patients with AUD vary between regulatory agencies, but abstinence remains the safest and most preferred objective in managing AUD. Prioritizing abstinence-oriented interventions is crucial for achieving long term recovery and minimizing relapse risk. These results emphasize the intricate relationship between AUD and mental health issues, highlighting the need for comprehensive interventions addressing both alcohol consumption and associated psychological distress. Promoting abstinence (or at least reducing alcohol consumption) not only preserves mental health but also prevents life-threatening consequences such as suicide.

Suicides, Other External Causes of Death, and Psychiatric Status in Suicide Attempters: A National Registry-Based Analysis in Israel, 2006-2020.

OBJECTIVE: To assess risk factors and rates of suicide and other external cause deaths, among suicide attempters compared to the total population, stratified by psychiatric hospitalization discharge and mental diagnosis. METHODS: A national registry-based analysis of suicide and external cause mortality was performed among suicide attempters between 2006 and 2020 in Israel in the National Hospital ED database. Data was stratified by psychiatric hospitalization status by linking to the national psychiatric case registry. Age adjusted mortality rates were calculated.A multivariate cox regression model assessed the relative risk of demographic factors and psychiatric diagnosis and hospitalization on outcomes. RESULTS: Among 57,579 first suicide attempters, of whom 16,874 had a psychiatric hospitalization, there were 853 suicides (1.5%) and 473 deaths from other external causes (0.8%), 485 suicides (2.9%) and 199 external cause deaths (1.2%) in the psychiatric group. Suicide risk was highest in the year after the attempt, but continued throughout the study, particularly in the psychiatric hospitalized group. Suicide rates within one year of first suicide attempt were 137 (95% CI 122-152) times higher than the total population, 190 (155-233) times in females and 128 (112-145) times in males, 178 (153-207), 243 (181-325) and 158 (132-190) times higher, respectively, in those with a psychiatric hospitalization. CONCLUSIONS: We found a greatly increased risk for suicide and significant increase for other external causes of death amongst a cohort of suicide attempters, compared to the total population, particularly those with a history of psychiatric hospitalization.

Past suicide attempters might have much higher risk for suicide than already known.Their risk for death by other external causes is also significantly higher.Having past suicide attempts and psychiatric admissions leads to highest risk.

Mild cognitive impairment and suicidal ideation among adults aged 65 years or older from low- and middle-income countries.

OBJECTIVES: Mild cognitive Impairment (MCI) is a unique indicator of underlying distress that may be strongly associated with suicide risk. Despite this, to date, no study has examined the association between MCI and suicidal ideation. Therefore, the present study aimed to examine the association between MCI and suicidal ideation among adults aged ≥65 years from six low- and middle-income countries (LMICs) (China, Ghana, India, Mexico, Russia, South Africa). METHOD: Cross-sectional, nationally representative data from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. MCI was defined using the National Institute on Aging-Alzheimer's Association criteria. Self-reported information on past 12-month suicidal ideation was collected. Multivariable logistic regression and meta-analysis were conducted to assess associations. RESULTS: Data on 13,623 individuals aged ≥65 years were analyzed. The prevalence of suicidal ideation ranged from 0.5% in China to 6.0% in India, while the range of the prevalence of MCI was 9.7% (Ghana) to 26.4% (China). After adjustment for potential confounders, MCI was significantly associated with 1.66 (95%CI=1.12-2.46) times higher odds for suicidal ideation. DISCUSSION: MCI was significantly associated with higher odds for suicidal ideation among older adults in LMICs. Future longitudinal studies from LMICs are necessary to assess whether MCI is a risk factor for suicidal ideation.

Is shyness related to depression and suicide risk?

INTRODUCTION: Suicidal behavior is an important health issue, representing a leading cause of mortality, particularly among young adults. Depression was found to be predictive of suicide risk and predicted by shyness. Consequently, we tested a model wherein shyness leads to depression, which in turn leads to suicide risk. Moreover, we expected gender to moderate the effect of shyness on depression and suicide risk. METHODS: A convenience sample of 478 first-year college students (51% women, Age: M = 25.42, SD = 3.61) completed online self-report questionnaires assessing suicide risk, depression, shyness, and demographic variables. RESULTS: As expected, shyness was significantly correlated with depression (r = 0.40) and suicide risk (r = 0.24), and depression and suicide risk were also correlated with each other (r = 0.57). Depression statistically mediated the relationship between shyness and suicide risk (indirect effect for women = 0.92, SE = 0.16; for men = 0.72, SE = 0.17). Gender did not moderate the mediation effect. However, a direct link between shyness and suicide risk was found only among men (direct effect = 0.52, SE = 0.21). CONCLUSIONS: The results suggest that shyness may be a significant factor in the development of depression and suicide risk, potentially serving as a valuable marker for identifying at-risk individuals. Moreover, clinicians should be aware of these associations, particularly among men, in order to maintain and support mental health as well as reduce suicidality.

Trajectories of suicidal risk among individuals with first-episode psychosis: Relationship to recovery and symptoms.

This study examined trajectories of suicide-risk and their relationship to symptoms, recovery, and quality of life over time. Data was obtained from the Recovery after an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) study. 404 individuals with first-episode psychosis (FEP) completed measures of suicide-risk, depression, positive symptoms, recovery, and quality of life at baseline, 6mo, 12mo, 18mo, and 24mo. Latent class analysis was used to identify temporal trajectories of suicide-risk. General linear mixed models for repeated measures were used to examine the relationship between the latent trajectories of suicide-risk and clinical variables. Results identified three latent trajectories of suicide-risk (low-risk, worsening, and improving). The low-risk and improving classes experienced improvements in depression, positive symptoms, quality of life, and recovery over time. The worsening class experienced improvements in positive symptoms and quality of life, but no change in depression or recovery. These results suggest that some individuals with FEP are at risk for persistent depression and worsening suicide-risk during treatment despite experiencing improvements in positive symptoms and quality of life. These findings have important clinical implications, as persistent depression and worsening suicide-risk might be masked by the primary focus on positive symptoms and quality of life in most FEP clinics.

The impact of history of depression and access to weapons on suicide risk assessment: a comparison of ChatGPT-3.5 and ChatGPT-4.

The aim of this study was to evaluate the effectiveness of ChatGPT-3.5 and ChatGPT-4 in incorporating critical risk factors, namely history of depression and access to weapons, into suicide risk assessments. Both models assessed suicide risk using scenarios that featured individuals with and without a history of depression and access to weapons. The models estimated the likelihood of suicidal thoughts, suicide attempts, serious suicide attempts, and suicide-related mortality on a Likert scale. A multivariate three-way ANOVA analysis with Bonferroni post hoc tests was conducted to examine the impact of the forementioned independent factors (history of depression and access to weapons) on these outcome variables. Both models identified history of depression as a significant suicide risk factor. ChatGPT-4 demonstrated a more nuanced understanding of the relationship between depression, access to weapons, and suicide risk. In contrast, ChatGPT-3.5 displayed limited insight into this complex relationship. ChatGPT-4 consistently assigned higher severity ratings to suicide-related variables than did ChatGPT-3.5. The study highlights the potential of these two models, particularly ChatGPT-4, to enhance suicide risk assessment by considering complex risk factors.

Military sexual trauma and lower relationship satisfaction are associated with suicide risk among male service members and veterans.

Male service members/veterans die by suicide at increased rates relative to civilians and females in the military, with risk increasing following military sexual trauma (MST) exposure. Suicide theories emphasize the role of feeling connected to others, and in the context of romantic relationships, it is possible that higher relationship satisfaction buffers the effects of MST. That said, MST exposure is associated with higher relationship distress, so the potential buffering effects are unclear. The current brief report assessed the interaction of relationship satisfaction and MST exposure as correlates of suicide risk among a convenience sample of 290 partnered male service members/veterans. This secondary analysis utilized a survey to assess MST exposure, relationship satisfaction, suicide risk, and demographics. Using linear regression, suicide risk was regressed on MST exposure, relationship satisfaction, and their interaction, as well as demographic covariates. The average score for relationship satisfaction suggested distressed relationships (M=13.41, SD= 4.55) and 16.21% (n=47) reported MST. Suicide risk was elevated (M=5.95, SD=3.23). The linear regression revealed that MST exposure (B=1.21, p=.02) and lower relationship satisfaction (B=-0.97, p<.001) were individually associated with higher suicide risk; however, their interaction was non-significant (p>.05). MST exposure and satisfaction in one's romantic relationship have unique and separate associations with suicide risk. Relationship satisfaction did not buffer the effects of MST on suicide, and this may be due to overall poor satisfaction scores. Notwithstanding, findings highlight the need to address both MST exposure and relationship satisfaction to reduce risk of suicide.

The association between problematic short video use and suicidal ideation and self-injurious behaviors: the mediating roles of sleep disturbance and depression.

BACKGROUND: Prior work suggests that problematic short video use was associated with adverse psychological, physiological, and educational outcomes. With the prevailing of short video platforms, the potential relationships between this problematic behavior and suicidal ideation and self-injurious behaviors have yet to be thoroughly examined. Besides, considering the potential dual nature of problematic short video use, particularly its positive aspects, a potential mechanism may exist linking such problematic behavior to SI and SIBs, ultimately driving individuals towards extreme outcomes. Nevertheless, such mediation paths have not been rigorously examined. Thus, the current study aimed to investigate their relationships and delve into the underlying mechanism, specifically identifying potential mediators between sleep disturbance and depression. METHODS: A quantitative cross-sectional study design was employed to model data derived from a large sample of first- and second-year university students residing in mainland China (N = 1,099; Mage = 19.80 years; 51.7% male). RESULTS: Results showed that problematic short video use has a dual impact on SI and SIBs. On the one hand, problematic short video use was directly related to the decreased risk of suicidal ideation, attempts, and NSSI. On the other hand, such problematic behavior was indirectly associated with the increased risk of NSSI through sleep disturbance, and it indirectly related to the elevated risk of suicidal ideation, attempts, and NSSI through depression. Besides, on the whole, problematic short video use was positively associated with NSSI but not suicidal ideation and attempts. CONCLUSIONS: These findings indicated that problematic short video use had a dual impact on SI and SIBs. Consequently, it is paramount to comprehend the genuine magnitude of the influence that such problematic behavior holds over these intricate psychological conditions.

Risk factors for subsequent suicidal acts among 12-25-year-old high-risk callers to a suicide prevention hotline in China: a longitudinal study.

BACKGROUND: A few previous cross-sectional studies investigated correlated factors of suicidal ideation or suicide attempts among suicide prevention hotline callers; however, scarcely any evidence was from a longitudinal study. In addition, it is still unclear whether improvements in some suicide risk factors could reduce the occurrence of subsequent suicidal acts. This longitudinal study focusing on the risk factors for subsequent suicidal acts among adolescent and young adult callers with high suicide risk aims to fill this gap. METHODS: This study recruited 12-25-year-old high-risk callers to a China nationwide suicide prevention hotline. Potential risk factors, including hopefulness, psychological distress, depression, history of suicide attempts, alcohol or substance misuse, and acute life events, were examined during the index calls, and improvements in hopefulness, psychological distress, and suicide intent were assessed before ending the index calls. The recruited callers were followed up 12 months after their index calls. The primary outcome was the occurrence of suicidal acts (suicide attempts or suicide death) during follow-up. Kaplan-Meier survival curves, log-rank tests, and Cox proportional hazards model were used. RESULTS: During the follow-up period, 271 of 1656 high-risk adolescent and young adult callers attempted suicide, and seven callers died by suicide. After adjusting for demographic variables, low hopefulness (Hazard Ratio [HR] = 2.03, 95% Confidence Interval [CI]=[1.47, 2.80]) at the beginning of the index call was associated with a higher risk for subsequent suicidal acts, whereas improvements in psychological distress (HR = 0.61, 95%CI [0.41, 0.89]) and suicidal intent (HR = 0.56, 95%CI [0.38, 0.84]) during the index call reduced the risk of subsequent suicidal acts. In addition, alcohol or substance misuse (Model 2, HR = 1.65, 95%CI [1.11, 2.46]) and suicide attempt history(Model 1: one episode, HR = 1.96, 95%CI=[1.05, 3.66]; two or more episodes, HR = 2.81, 95%CI [1.59, 4.96]. Model 2: one episode, HR = 2.26, 95%CI [1.06, 4.82]; two or more episodes: HR = 3.28, 95%CI [1.63, 6.60]) were risk factors for subsequent suicidal acts. CONCLUSIONS: While suicide prevention hotline operators deliver brief psychological interventions to high-risk adolescent and young adult callers, priority should be given to callers with low hopefulness and to the alleviation of callers' high psychological distress and suicide intent.

Empowerment of Italian general practitioners in depression and suicide prevention: the iFightDepression tool, a game changer of the EAAD-Best project.

General Practitioners (GPs) play a key role in the early detection and management of depression and in preventing suicide risk. They are often the first healthcare professionals that people in crisis contact. However, their effectiveness can be limited by several barriers, including the lack of specific training and appropriate tools.The EAAD-Best project aims to fill these gaps through its iFightDepression tool, an online tool designed to support patients, psychologists, psychiatrists, and GPs in managing depression and preventing suicide. This article examines the implementation of the iFightDepression platform in Italy, assessing its impact on the empowerment of GPs in the fight against depression. Through a qualitative and quantitative analysis of the data collected by the project, the 'unmet need' of GPs' in Italy regarding their specific training in mental health is highlighted.The response of 2,068 Italian GPs in just 7 months after the start of the iFD project is an expression of GPs' engagement to work against depression and for suicide risk prevention.

Rethinking the role of trazodone in the different depressive dimensions.

INTRODUCTION: The efficacy of trazodone for several psychopathologic dimensions of depression has been shown in the literature. Trazodone has been widely used in some clinical contexts (e.g. for insomnia and depression in the elderly). However, the role of trazodone in several aspects of depression is not well known. AREA COVERED: Eight experts from academic and medical centers across Italy met to identify the difficulties and barriers faced in daily clinical practice in the assessment and management of major depressive disorder and how the use of trazodone could address some unmet needs. The objective of the expert meetings and the present document was to increase knowledge of particular areas of treatment with trazodone. EXPERT OPINION: Evidence of the role of trazodone in patients affected by major depressive disorder with anxiety symptoms, insomnia, agitation, cognitive deficits, alcohol use disorders, physical comorbidities, and suicide risk has been identified, showing the effectiveness of trazodone in different presentations of major depressive disorder. The main characteristics of patients with depression for whom trazodone seems to be most effective have been identified, providing clinicians with information on possible uses of this drug in such population of patients.