[SUICIDAL BEHAVIOR IN PRE-ADOLESCENT CHILDREN].

INTRODUCTION: Suicidal behavior among pre-adolescent children is a rare phenomenon so it is rarely studied compared to suicide at older ages. In recent years we have witnessed a disturbing increase in suicide rates among pre-adolescent children, an increase that requires our attention to the phenomenon through clinical observance, prevention and research. Most pre-adolescent children report suicidal thoughts rather than actual suicide attempts. The prevalence of suicide attempts increases after the onset of puberty. Early identification of pre-adolescent children who face suicidal risk will greatly contribute to early intervention and prevention of suicide in later years. In this article, we will review the clinical symptoms of suicidal behavior in pre-adolescent children, the epidemiology of the phenomenon, developmental issues, risk and protective factors, risk assessment, intervention, treatment and prevention.

Identifying suicide attempter in major depressive disorder through machine learning: the importance of pain avoidance, event-related potential features of affective processing.

How to achieve a high-precision suicide attempt classifier based on the three-dimensional psychological pain model is a valuable issue in suicide research. The aim of the present study is to explore the importance of pain avoidance and its related neural features in suicide attempt classification models among patients with major depressive disorder. By recursive feature elimination with cross-validation and support-vector-machine algorithms, scores from the measurements and the task-based EEG signals were chosen to achieve a suicide attempt classification model. In the multimodal suicide attempt classifier with an accuracy of 83.91% and an area under the curve of 0.90, pain avoidance ranked as the top one in the optimal feature set. Theta (reward positive feedback minus neutral positive feedback) was the shared neural representation ranking as the top one of event-related potential features in pain avoidance and suicide attempt classifiers. In conclusion, the suicide attempt classifier based on pain avoidance and its related affective processing neural features has excellent accuracy among patients with major depressive disorder. Pain avoidance is a stable and strong indicator for identifying suicide risks in both traditional analyses and machine-learning approaches. A novel methodology is needed to clarify the relationship between cognitive and affective processing evoked by punishment stimuli and pain avoidance.

Four modeling approaches to study restrictions on everyday life and social activities due to chronic diseases with consequences of suicidal behavior.

The purpose of this study was to discover the association between disability in everyday life and social activities due to chronic diseases and suicidal ideation (SI), suicidal plan (SP), and suicidal attempt (SA) from the Korea National Health and Nutrition Examination Survey (KNHANES), considering the cross-sectional design of this study, 2016-2018 dataset. Variables for finding the associated factors of SI, SP, and SA were confirmed through random forest (RF), decision tree, generalized linear model (GLM), and support vector machine (SVM), and the performance of each model is listed. A total of 17,323 (males: 7,530, females: 9793) responders from the KNHANES from 2016 to 2018 were employed for the study. The relationship between restrictions on daily life, social activities, and three stages of suicidal behaviors due to diseases were analyzed using the R function (R version 4.2.0), randomForest, ctree, glm, and ksvm. The F1-score is a measure used to evaluate the accuracy of the performance of a model, in the binary classification. The score of 1 indicates good performance, whereas a score of 0 signifies poor performance. Due to chronic diseases, disability in everyday life and social activities lead to suicide behaviors. In our study, we examined the impact of limitations in daily living and social activities on suicidal behaviors among participants. Our findings revealed that for those experiencing such limitations, the odds ratios (ORs) for SIs were 6.10 (95% CI: 3.99-9.34) for males and 2.61 (1.79-3.81) for females. SPs were 3.69 (2.36-5.78) for males and 3.94 (2.70-5.75) for females. Similarly, the odds ratios for SAs were 5.04 (2.51-10.13) for males and 2.71 (1.48-4.98) for females, indicating a significant association between these limitations and increased suicidal behaviors, with variances observed between genders. These results underscore the necessity of addressing daily living and social activity restrictions when considering mental health interventions and suicide prevention strategies. In RF, GLM, and SVM, F1-score were 0.8192, 0.6887, and 0.9687 in SA, respectively. Among the patients with chronic disease, those with sequelae, low incomes, and low levels of education had limitations in daily activities and social activities, which increased the likelihood of suicidal thoughts, planning, and attempts.

An exploratory study of the prevalence and adverse associations of in-school traditional bullying and cyberbullying among adolescents in Connecticut.

Bullying, traditional or cyber, among adolescents, is a public health concern. In this study, we explored frequencies and correlates of different forms of bullying among Connecticut high-school students. Youth Risk Behavior Survey data from 2019 from Connecticut adolescents (N = 1814) were used. χ2 tests and survey-weighted logistic regressions examined relationships between bullying subgroups (in-school traditional bullying (ISTB) only, cyberbullying only, and both) and mental concerns, risk behaviors, academic performance, physical health, and receipt of social support, with the logistic regressions adjusted for demographics. The past-12-month frequency of having experienced only cyberbullying was 5.6%, only ISTB was 9.1%, and both forms was 8.7%. Between-group differences were observed by bullying status in terms of sex and race/ethnicity. In adjusted models, bullying status was associated with suicide attempts, suicidal ideation, self-harm, depression/dysphoria, mental health, use of alcohol, marijuana, injection drugs, tobacco, and e-vapor, gambling, driving under influence of alcohol, high-risk sexual behavior, physical fights, weapon-carrying, injuries/threats at school, feeling unsafe at school, dating violence, obesity, poor general health, insecure housing, less perceived family support, and poor academic performance. People experiencing both types of bullying were typically more likely to report adverse measures. High-school students commonly report bullying. The findings that both forms (traditional and cyber) were more robustly linked to negative experiences highlight the need for examining further relationships between types and patterns of bullying and mental health and functioning. Better understanding may help improve preventive anti-bullying interventions.

Interaction between HTR2A rs3125 and negative life events in suicide attempts among patients with major depressive disorder: a cross-sectional study.

BACKGROUND: Both genetic and environmental factors play crucial roles in the development of major depressive disorder (MDD) and suicide attempts (SA). However, the interaction between both items remains unknown. This study aims to explore the interactions between the genetic variants of the serotonin 2 A receptor (HTR2A) and the nitric oxide synthase 1 (NOS1) and environmental factors in patients who experience MDD and SA. METHODS: A total of 334 patients with MDD and a history of SA (MDD-SA) were recruited alongside 518 patients with MDD with no history of SA (MDD-NSA), and 716 healthy controls (HC). The demographic data and clinical characteristics were collected. Sequenom mass spectrometry was used to detect eight tag-single nucleotide polymorphisms (tagSNPs) in HTR2A (rs1328683, rs17068986, and rs3125) and NOS1 (rs1123425, rs2682826, rs3741476, rs527590, and rs7959232). Generalized multifactor dimensionality reduction (GMDR) was used to analyze the gene-environment interactions. RESULTS: Four tagSNPs (rs17068986, rs3125, rs527590, and rs7959232) exhibited significant differences between the three groups. However, these differences were not significant between the MDD-SA and MDD-NSA groups after Bonferroni correction. A logistic regression analysis revealed that negative life events (OR = 1.495, 95%CI: 1.071-2.087, P = 0.018), self-guilt (OR = 2.263, 95%CI: 1.515-3.379, P < 0.001), and negative cognition (OR = 2.252, 95%CI: 1.264-4.013, P = 0.006) were all independently associated with SA in patients with MDD. Furthermore, GMDR analysis indicated a significant interaction between HTR2A rs3125 and negative life events. Negative life events in conjunction with the HTR2A rs3125 CG + GG genotype were associated with a higher SA risk in patients with MDD when compared to the absence of negative life events in conjunction with the CC genotype (OR = 2.547, 95% CI: 1.264-5.131, P = 0.009). CONCLUSION: Several risk factors and a potential interaction between HTR2A rs3125 and negative life events were identified in patients with SA and MDD. The observed interaction likely modulates the risk of MDD and SA, shedding light on the pathogenesis of SA in patients with MDD.

Self-Hatred: The Unaddressed Symptom of Borderline Personality Disorder.

Individuals with borderline personality disorder (BPD) often report chronic, severe self-hatred. It is frequently experienced as immutable, seen as a barrier to recovery, and is associated with risk for self-injury and suicide attempts. Yet self-hatred remains a poorly understood, underdiagnosed, and undertreated presentation of BPD. In this concept article and review, we describe the nature of self-hatred in BPD and related disorders, propose a theory as to the development of self-hatred in BPD, review the assessments of and interventions for self-hatred, and consider next steps in the research, assessment, and treatment of self-hatred in BPD. Through increased awareness, understanding, and measures of self-hatred in BPD, new treatment paradigms can be developed to ensure more comprehensive recovery.

An epigenetic candidate-gene association study of parental styles in suicide attempters with substance use disorders.

Suicide attempts (SA) are prevalent in substance use disorders (SUD). Epigenetic mechanisms may play a pivotal role in the molecular mechanisms of environmental effects eliciting suicidal behaviour in this population. Hypothalamic-pituitary-adrenal axis (HPA), oxytocin and neurotrophin pathways have been consistently involved in SA, yet , their interplay with childhood adversity remains unclear, particularly in SUD. In 24 outpatients with SUDs, we examined the relation between three parental dysfunctional styles and history of SA with methylation of 32 genes from these pathways, eventually analysing 823 methylation sites. Extensive phenotypic characterization was obtained using a semi-structured interview. Parental style was patient-reported using the Measure of Parental Style (MOPS) questionnaire, analysed with and without imputation of missing items. Linear regressions were performed to adjust for possible confounders, followed by multiple testing correction. We describe both differentially methylated probes (DMPs) and regions (DMRs) for each set of analyses (with and without imputation of MOPS items). Without imputation, five DMRs in OXTR, CRH and NTF3 significantly interacted with MOPS father abuse to increase the risk for lifetime SA, thus covering the three pathways. After imputation of missing MOPS items, two other DMPs from FKBP5 and SOCS3 significantly interacted with each of the three father styles to increase the risk for SA. Although our findings must be interpreted with caution due to small sample size, they suggest implications of stress reactivity genes in the suicidal risk of SUD patients and highlight the significance of father dysfunction as a potential marker of childhood adversity in SUD patients.

Women's experiences of attempted suicide in the perinatal period (ASPEN-study) - a qualitative study.

BACKGROUND: Suicide is a leading cause of maternal death during pregnancy and the year after birth (the perinatal period). While maternal suicide is a relatively rare event with a prevalence of 3.84 per 100,000 live births in the UK [1], the impact of maternal suicide is profound and long-lasting. Many more women will attempt suicide during the perinatal period, with a worldwide estimated prevalence of 680 per 100,000 in pregnancy and 210 per 100,000 in the year after birth [2]. Qualitative research into perinatal suicide attempts is crucial to understand the experiences, motives and the circumstances surrounding these events, but this has largely been unexplored. AIM: Our study aimed to explore the experiences of women and birthing people who had a perinatal suicide attempt and to understand the context and contributing factors surrounding their perinatal suicide attempt. METHODS: Through iterative feedback from a group of women with lived experience of perinatal mental illness and relevant stakeholders, a qualitative study design was developed. We recruited women and birthing people (N = 11) in the UK who self-reported as having undertaken a suicide attempt. Interviews were conducted virtually, recorded and transcribed. Using NVivo software, a critical realist approach to Thematic Analysis was followed, and themes were developed. RESULTS: Three key themes were identified that contributed to the perinatal suicide attempt. The first theme 'Trauma and Adversities' captures the traumatic events and life adversities with which participants started their pregnancy journeys. The second theme, 'Disillusionment with Motherhood' brings together a range of sub-themes highlighting various challenges related to pregnancy, birth and motherhood resulting in a decline in women's mental health. The third theme, 'Entrapment and Despair', presents a range of factors that leads to a significant deterioration of women's mental health, marked by feelings of failure, hopelessness and losing control. CONCLUSIONS: Feelings of entrapment and despair in women who are struggling with motherhood, alongside a background of traumatic events and life adversities may indicate warning signs of a perinatal suicide. Meaningful enquiry around these factors could lead to timely detection, thus improving care and potentially prevent future maternal suicides.

A pilot study examining hemomania behaviors in psychiatry outpatients engaged with nonsuicidal self-injury.

BACKGROUND: This study aims to conduct the first-ever evaluation of our previously proposed behaviors of "hemomania" in individuals engaged with nonsuicidal self-injury (NSSI). METHODS: The study encompassed 130 outpatients engaged with NSSI who applied at the psychiatry outpatient clinic. NSSI behaviors were assessed using the Inventory of Statements About Self-Injury, while psychiatric diagnoses were evaluated using the Structured Clinical Interview for DSM-5 Disorders-Clinician Version. Subsequently, participants completed the Depression Anxiety Stress Scale-21 and Short Form of Barratt Impulsiveness Scale. RESULTS: The prevalence of at least one hemomania behavior including seeing blood, tasting blood, bloodletting, and blood-drinking was observed to be 43.1% in individuals with NSSI. When participants were divided into two groups, individuals with hemomania exhibited: (1) a higher incidence of psychiatric comorbidities, increased suicide attempts, and more severe symptoms of depression, anxiety, stress, and impulsivity, (2) higher comorbidity rates of borderline personality disorder, body-focused repetitive behaviors, and dissociative disorders, and (3) elevated frequencies of certain NSSI behaviors, including cutting, biting, needle-ticking, and carving, compared to those without. CONCLUSION: Hemomania could be considered a specific impulse control disorder, characterized by heightened impulsivity and a persistent urge to obtain one's own blood. However, further studies are needed to validate this hypothesis.

Sleep and circadian rhythms in adolescents with attempted suicide.

Sleep and circadian rhythm disorders are very common in adolescents and have been linked to suicidal ideation. However, little is known about adolescent sleep before a suicide attempt (SA). The objectives of this study were to compare the sleep of adolescents aged 13 to 18 over a period of 4 weeks before a SA compared to a non-SA group, then to analyze the association between sleep, support social and well-being based on information from validated questionnaires. In 2015, 250 adolescents were included, 55 were recruited the day after a SA in French hospitals (before SA evaluations were retrospective). Logistic regression analyzes showed that during school days, bedtime was equivalent in both groups, but sleep onset latency was significantly longer in SA (86 min vs. 52 min, p = 0.016), and wake-up time was earlier (6 h 22 vs. 6 h 47, p = 0.002), resulting in a shorter total sleep time of 44 min (OR = 0.76, CI 95% [0.61-0.93]) the month preceding SA. Adolescents with longer sleep time performed better on perceived psychological well-being (p = 0.005), relationship with parents (p = 0.011) and school environment (p < 0.001). Results indicate a significant change in the quantity and quality of adolescents' subjective sleep in the 4 weeks preceding SA requiring objective measures to study the predictive properties of sleep in SA.

Developing a risk prediction model for death at first suicide attempt-Identifying risk factors from Thailand's national suicide surveillance system data.

More than 60% of suicides globally are estimated to take place in low- and middle-income nations. Prior research on suicide has indicated that over 50% of those who die by suicide do so on their first attempt. Nevertheless, there is a dearth of knowledge on the attributes of individuals who die on their first attempt and the factors that can predict mortality on the first attempt in these regions. The objective of this study was to create an individual-level risk-prediction model for mortality on the first suicide attempt. We analyzed records of individuals' first suicide attempts that occurred between May 1, 2017, and April 30, 2018, from the national suicide surveillance system, which includes all of the provinces of Thailand. Subsequently, a risk-prediction model for mortality on the first suicide attempt was constructed utilizing multivariable logistic regression and presented through a web-based application. The model's performance was assessed by calculating the area under the receiver operating curve (AUC), as well as measuring its sensitivity, specificity, and accuracy. Out of the 3,324 individuals who made their first suicide attempt, 50.5% of them died as a result of that effort. Nine out of the 21 potential predictors demonstrated the greatest predictive capability. These included male sex, age over 50 years old, unemployment, having a depressive disorder, having a psychotic illness, experiencing interpersonal problems such as being aggressively criticized or desiring plentiful attention, having suicidal intent, and displaying suicidal warning signals. The model demonstrated a good predictive capability, with an AUC of 0.902, a sensitivity of 84.65%, a specificity of 82.66%, and an accuracy of 83.63%. The implementation of this predictive model can assist physicians in conducting comprehensive evaluations of suicide risk in clinical settings and devising treatment plans for preventive intervention.

Sociodemographic and clinical risk factors for suicidal ideation and suicide attempt in functional/dissociative seizures and epilepsy: a large cohort study.

BACKGROUND: People with functional/dissociative seizures (FDS) are at elevated suicidality risk. OBJECTIVE: To identify risk factors for suicidality in FDS or epilepsy. METHODS: Retrospective cohort study from the UK's largest tertiary mental healthcare provider, with linked national admission data from the Hospital Episode Statistics. Participants were 2383 people with a primary or secondary diagnosis of FDS or epilepsy attending between 01 January 2007 and 18 June 2021. Outcomes were a first report of suicidal ideation and a first hospital admission for suicide attempt (International Classification of Diseases, version 10: X60-X84). Demographic and clinical risk factors were assessed using multivariable bias-reduced binomial-response generalised linear models. FINDINGS: In both groups, ethnic minorities had significantly reduced odds of hospitalisation following suicide attempt (OR: 0.45-0.49). Disorder-specific risk factors were gender, age and comorbidity profile. In FDS, both genders had similar suicidality risk; younger age was a risk factor for both outcomes (OR: 0.16-1.91). A diagnosis of depression or personality disorders was associated with higher odds of suicidal ideation (OR: 1.91-3.01). In epilepsy, females had higher odds of suicide attempt-related hospitalisation (OR: 1.64). Age had a quadratic association with both outcomes (OR: 0.88-1.06). A substance abuse disorder was associated with higher suicidal ideation (OR: 2.67). Developmental disorders lowered the risk (OR: 0.16-0.24). CONCLUSIONS: This is the first study systematically reporting risk factors for suicidality in people with FDS. Results for the large epilepsy cohort complement previous studies and will be useful in future meta-analyses. CLINICAL IMPLICATIONS: Risk factors identified will help identify higher-risk groups in clinical settings.

Ideación suicida entre reclusos: análisis con perspectiva de género, durante cinco años de seguimiento (2017-2022) / Suicidal ideation among prisoners: analysis with a gender perspective in a five-year follow-up (2017-2022)

Introducción: En el entorno penitenciario, hay una elevada incidencia de conductas autolesivas, con una tasa de suicidio superior a la existente en la población general. Estudios previos describen la asociación de factores sociodemográficos, clínicos y criminológicos, con el riesgo de suicidio en la población penitenciaria masculina, pero hay pocas investigaciones centradas en el análisis de la conducta suicida entre mujeres. El objetivo del trabajo es analizar las características de las internas que ingresan en una unidad psiquiátrica por presentar ideas de suicidio o haber realizado tentativas.Material y método: Análisis descriptivo y comparativo de 97 internos (68 hombres, 29 mujeres) ingresados en la Unidad de Hospitalización Psiquiátrica de la Penitenciaria de Cataluña (UHPP-C), por ideas de suicidio, entre el 1 de enero de 2017 y el 31 de diciembre de 2022. Resultados: Se encuentran diferencias respecto al lugar de nacimiento, con mayor presencia de nacionalidades africanas en varones no nacionales, mientras que las internas extranjeras suelen ser originarias de países latinoamericanos. Los hombres tienen menor edad media, con ingresos más prolongados y una mayor tasa de reingreso. También padecen más trastornos psicóticos y adictivos. Las mujeres presentan mayor prevalencia de trastornos de personalidad y cuadros afectivos. Conclusiones: Hay diferencias sociodemográficas y clínicas entre hombres y mujeres internos en prisión que requieren ingreso por ideación suicida. Incluir la perspectiva de género en los estudios sobre el riesgo suicida en la población penitenciaria puede proporcionar una base sólida para futuros estudios, permitiendo así una comprensión más completa de la ideación suicida y las necesidades de intervención en la población penitenciaria.(AU)

Introduction: There is a high incidence of self-harming behavior in the prison setting, with a suicide rate that is higher than that of the general population. Previous studies describe the association of sociodemographic, clinical, and criminological factors with the risk of suicide in the male prison population, but there is little research that specifically analyses suicidal behavior among women. The objective of this study is to analyze the characteristics of inmates who are admitted to a psychiatric unit for suicidal thoughts or attempted suicide. Material and method: Descriptive and comparative analysis of 97 inmates (68 men, 29 women) admitted to the Unidad de Hospitalización Psiquiátrica Penitenciaria de Cataluña (UHPP-C), for suicidal ideation, between January 1, 2017, and December 31, 2022. Results: There are differences in terms of place of birth, with a more significant presence of African nationalities in non-national males, while foreign inmates tend to come from Latin American countries. Men have a lower mean age, longer admissions, and a higher readmission rate. They also suffer from more psychotic and addictive disorders. Women have a higher prevalence of personality disorders and affective symptoms. Conclusions: There are sociodemographic and clinical differences between male and female prison inmates who require admission for suicidal ideation. Including a gender perspective in studies on suicide risk in the prison population can provide a solid foundation for future studies, thus allowing a more complete understanding of suicidal ideation and intervention needs in theprison population.(AU)

Visual Impairment and Suicide Risk: A Systematic Review and Meta-Analysis.

Importance: Suicide is a substantial public health concern that involves various recognized contributing factors. Sensory impairments, specifically visual impairment, are deemed potential risk factors. Nonetheless, comprehensive information about associated risk levels and underlying determinants remains limited. Objective: To investigate the association between visual impairment and different aspects of suicide, including the assessment of risk levels and exploration of potential contributing factors. Data Sources: An electronic search was performed in the PubMed, EMBASE, Scopus, and Cochrane Library databases from their inception to February 8, 2024. Study Selection: All published studies were considered without restrictions on study design, publication date, or language. Data Extraction and Synthesis: Two independent reviewers extracted the published data using a standardized procedure in accordance with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Random-effects meta-analyses were used to estimate pooled effect sizes. Multiple meta-regression analyses were conducted to identify potential factors contributing to the association between visual impairment and the risk of suicide. Main Outcomes and Measures: The primary outcome measure was the odds ratio (OR) of suicidal behavior (including suicide attempt and suicide death) for individuals with visual impairment compared with those without. The secondary outcome measures were the pooled ORs of suicidal ideation and suicide death, respectively. Results: A total of 31 population-based studies with 5 692 769 unique individuals (mean [SD] age, 48.4 [8.5] years; 2 965 933 females [52%]) were included. For 17 studies (5 602 285 individuals) that evaluated suicidal behavior, the pooled OR was 2.49 (95% CI, 1.71-3.63). For 21 studies (611 899 individuals) that assessed suicidal ideation, the pooled OR was 2.01 (95% CI, 1.62-2.50). For 8 studies (5 067 113 individuals) investigating the association between visual impairment and suicide death, the pooled OR was 1.89 (95% CI, 1.32-2.71). The multiple meta-regression model identified age group as a predictive factor associated with suicidal behavior, with the studies included suggesting that adolescents were at the highest risk. While this analysis showed moderate heterogeneity for suicide death, high heterogeneity was observed for suicidal behavior and suicidal ideation. Conclusions and Relevance: The findings of this systematic review and meta-analysis support the association between visual impairment and increased risk of suicidal tendencies. The risk differed by age group, with a pronounced risk observed among adolescents.

Do Suicide Attempters Have a Right Not to Be Stabilized in an Emergency?

The standard of care in the United States favors stabilizing any adult who arrives in an emergency department after a failed suicide attempt, even if he appears decisionally capacitated and refuses life-sustaining treatment. I challenge this ubiquitous practice. Emergency clinicians generally have a moral obligation to err on the side of stabilizing even suicide attempters who refuse such interventions. This obligation reflects the fact that it is typically infeasible to determine these patients' level of decisional capacitation-among other relevant information-in this unique setting. Nevertheless, I argue, stabilizing suicide attempters over their objection sometimes violates a basic yet insufficiently appreciated right of theirs-the right against bodily invasion. In such cases, it is at least prima facie wrong to stabilize a patient who wants to die even if they lack a contrary advance directive or medical order and suffer from no terminal physical illness.

Rapid Response Unit for Children and Adolescents at Risk of Suicide: Promoting Therapeutic Linkage and Reducing the Risk of Relapse.

INTRODUCTION: The increase in suicidal behavior among adolescents under 17 years of age in Catalonia between 2019 and 2022 has gone from 473 to 1425 cases, which entails a new healthcare challenge. The objective of the article is to explain the procedure and intervention of the Rapid Response Unit (RRU) for children and adolescents at risk of suicide. The RRU is a multidisciplinary unit designed to prevent relapse and increase link-up to treatment. The cases attended in its 14 months of operation are described. METHODOLOGY: 24 patients, 18 females and 6 males aged between 12 and 17 years, attended for the first time at the Child and Adolescent Health Centre of Cornellà for activation of the Suicide Risk Code (CRS) in hospital emergency departments during the period studied. RESULTS: After the intervention, high suicidal risk decreased from 29.17% to 0%, medium risk decreased from 37.5% to 20.83% and low risk increased from 33.33% to 79.17%. In addition, there was only one new CRS activation in the 3 months following the first activation. In the RRU, care was intensive: 52.7% of cases with visits once a week and more than once a week in 24.9%. During the intervention months 100% of cases were linked and no interruptions occurred. CONCLUSIONS: Rapid Response Unit (RRU) decreases the risk of recurrence of suicidal behavior and ensures therapeutic linkage.

Risk factors of reattempt among suicide attempters in South Korea: A nationwide retrospective cohort study.

This study aimed to identify underlying demographic and clinical characteristics among individuals who had previously attempted suicide, utilizing the comprehensive Health Insurance Review and Assessment Service (HIRA) database. Data of patients aged 18 and above who had attempted suicide between January 1 and December 31, 2014, recorded in HIRA, were extracted. The index date was identified when a suicide attempt was made within the year 2014. The medical history of the three years before the index date and seven years of follow-up data after the index date were analyzed. Kaplan-Meier estimate was used to infer reattempt of the suicide attempters, and Cox-proportional hazard analysis was used to investigate risk factors associated with suicide reattempts. A total of 17,026 suicide attempters were identified, of which 1,853 (10.9%) reattempted suicide; 4,925 (28.9%) patients had been diagnosed with depressive disorder. Of the reattempters, 391 (21.1%) demonstrated a history of suicide attempts in the three years before the index date, and the mean number of prior attempts was higher compared to that of the non-reattempters (1.7 vs.1.3, p-value < 0.01). Prior psychiatric medication, polypharmacy, and an increase in the number of psychotropics were associated with suicide reattempt in overall suicide attempters. (Hazard ratio (HR) = 3.20, 95% confidence interval [CI] = 2.56-4.00; HR = 2.42, 95% CI = 1.87-3.14; HR = 19.66, 95% CI = 15.22-25.39 respectively). The risk of reattempt decreased in individuals receiving antidepressant prescriptions compared to those unmedicated, showing a reduction of 78% when prescribed by non-psychiatrists and 89% when prescribed by psychiatrists. Similar risk factors for suicide reattempts were observed in the depressive disorder subgroup, but the median time to reattempt was shorter (556.5 days) for this group compared to that for the overall attempters (578 days). Various risk factors including demographics, clinical characteristics, and medications should be considered to prevent suicide reattempts among suicide attempters, and patients with depressive disorder should be monitored more closely.

Analysing Crime Scene Data, Medical Records and Forensic Information to Determine the Causes of Suicides.

OBJECTIVE:  To analyse crime scene data, medical records, and forensic information to unveil insights into the causes and traits of suicides. STUDY DESIGN:  Descriptive study. Place and Duration of the Study: Department of Family Medicine, Kayseri City Hospital, Kayseri, Turkiye, between January 2020 to December 2021. METHODOLOGY:  A suicide investigation team (doctor, social worker, psychologist) was created to study cases and conduct on-site psychological autopsies. Triggered by emergency calls, the team interviewed suicide victims' relatives using semi-structured questionnaires, gathering data on personal details, time, method, and potential motives. Medical records revealed psychiatric history and medication use, while national judicial systems were reviewed for legal records. RESULTS:  A total of 158 fatal suicides were studied. Males accounted for 73.4%, females 26.6%. The leading cause was psychiatric illness (43%), chiefly depression (39%). Suicide peaked in the fall, especially in September, mainly at 23:00-23:59. Home was the common site (58.9%), and hanging was the primary method (44.3%). Prior hospitalisation for suicide attempts was 7.5%. Criminal records were held by 16.4% (26 individuals). CONCLUSION:  The results support the idea that suicides have seasonal patterns and that there are temporal windows of increased risk for suicide. KEY WORDS:  Suicide reasons, Suicide time, Psychological autopsy, Seasonal and temporal patterns.

Evaluating the clinical utility of an easily applicable prediction model of suicide attempts, newly developed and validated with a general community sample of adults.

BACKGROUND: A suicide attempt (SA) is a clinically serious action. Researchers have argued that reducing long-term SA risk may be possible, provided that at-risk individuals are identified and receive adequate treatment. Algorithms may accurately identify at-risk individuals. However, the clinical utility of algorithmically estimated long-term SA risk has never been the predominant focus of any study. METHODS: The data of this report stem from CoLaus|PsyCoLaus, a prospective longitudinal study of general community adults from Lausanne, Switzerland. Participants (N = 4,097; Mage = 54 years, range: 36-86; 54% female) were assessed up to four times, starting in 2003, approximately every 4-5 years. Long-term individual SA risk was prospectively predicted, using logistic regression. This algorithm's clinical utility was assessed by net benefit (NB). Clinical utility expresses a tool's benefit after having taken this tool's potential harm into account. Net benefit is obtained, first, by weighing the false positives, e.g., 400 individuals, at the risk threshold, e.g., 1%, using its odds (odds of 1% yields 1/(100-1) = 1/99), then by subtracting the result (400*1/99 = 4.04) from the true positives, e.g., 5 individuals (5-4.04), and by dividing the result (0.96) by the sample size, e.g., 800 (0.96/800). All results are based on 100 internal cross-validations. The predictors used in this study were: lifetime SA, any lifetime mental disorder, sex, and age. RESULTS: SA at any of the three follow-up study assessments was reported by 1.2%. For a range of seven a priori selected threshold probabilities, ranging between 0.5% and 2%, logistic regression showed highest overall NB in 97.4% of all 700 internal cross-validations (100 for each selected threshold probability). CONCLUSION: Despite the strong class imbalance of the outcome (98.8% no, 1.2% yes) and only four predictors, clinical utility was observed. That is, using the logistic regression model for clinical decision making provided the most true positives, without an increase of false positives, compared to all competing decision strategies. Clinical utility is one among several important prerequisites of implementing an algorithm in routine practice, and may possibly guide a clinicians' treatment decision making to reduce long-term individual SA risk. The novel metric NB may become a standard performance measure, because the a priori invested clinical considerations enable clinicians to interpret the results directly.