Association of opioid or other substance use disorders with health care use among patients with suicidal symptoms.

INTRODUCTION: Prior literature establishes noteworthy relationships between suicidal symptoms and substance use disorders (SUDs), particularly opioid use disorder (OUD). However, engagement with health care services among this vulnerable population remains underinvestigated. This study sought to examine patterns of health care use, identify risk factors in seeking treatment, and assess associations between outpatient service use and emergency department (ED) visits. METHODS: Using electronic health records (EHRs) derived from five health systems across New York City, the study selected 7881 adults with suicidal symptoms (including suicidal ideation, suicide attempt, or self-harm) and SUDs between 2010 and 2019. To examine the association between SUDs (including OUD) and all-cause service use (outpatient, inpatient, and ED), we performed quasi-Poisson regressions adjusted for age, gender, and chronic disease burden, and we estimated the relative risks (RR) of associated factors. Next, the study evaluated cause-specific utilization within each resource category (SUD-related, suicide-related, and other-psychiatric) and compared them using Mann-Whitney U tests. Finally, we used adjusted quasi-Poisson regression models to analyze the association between outpatient and ED utilization among different risk groups. RESULTS: Among patients with suicidal symptoms and SUD diagnoses, relative to other SUDs, a diagnosis of OUD was associated with higher all-cause outpatient visits (RR: 1.22), ED visits (RR: 1.54), and inpatient hospitalizations (RR: 1.67) (ps < 0.001). Men had a lower risk of having outpatient visits (RR: 0.80) and inpatient hospitalizations (RR: 0.90), and older age protected against ED visits (RR range: 0.59-0.69) (ps < 0.001). OUD was associated with increased SUD-related encounters across all settings, and increased suicide-related ED visits and inpatient hospitalizations (p < 0.001). Individuals with more mental health outpatient visits were less likely to have suicide-related ED visits (RR: 0.86, p < 0.01), however this association was not found among younger and male patients with OUD. Although few OUD patients received medications for OUD (MOUD) treatment (9.9 %), methadone composed the majority of MOUD prescriptions (77.7 %), of which over 70 % were prescribed during an ED encounter. CONCLUSIONS: This study reinforces the importance of tailoring SUD and suicide risk interventions to different age groups and types of SUDs, and highlights missed opportunities for deploying screening and prevention resources among the male and OUD populations. Redressing underutilization of MOUD remains a priority to reduce acute health outcomes among younger patients with OUD.

Group brief cognitive behavioral therapy for suicide prevention compared to dialectal behavior therapy skills group for military service members: a study protocol of a randomized controlled trial.

BACKGROUND: Suicide is a pressing matter for the military. Not only does it pose a health risk, but suicide also compromises operational readiness. Despite provision of suicide prevention clinical best practices, the Department of Defense suffers several challenges (e.g., clinician shortages) limiting the agency's ability to effectively respond to service member suicide. Implementation of evidence-based suicide-specific group therapy is a possible solution to service member well-being needs and system challenges. Service members can also gain coping skills useful beyond managing suicidal thoughts and behaviors. METHODS: This 2-arm non-inferiority randomized controlled trial compares a group therapy format of Brief Cognitive Behavioral Therapy (i.e., G-BCBT) with Dialectical Behavior Therapy (DBT) Skills Group. Both therapies are delivered in-person at a United States Naval Medical Center. Participants (N = 136) are active-duty service members with recent suicidal thoughts or suicidal behavior. Evaluation features electronically delivered questionnaires at baseline, after each treatment session, and at 3- and 6-month follow-up. DISCUSSION: The primary outcome concerns G-BCBT impacts on suicidal ideation. Secondary outcomes of interest are suicide attempt, psychological distress (e.g., symptoms of depression, anxiety), and self-regulatory skills (e.g., emotion regulation). We also examine self-regulatory skills as treatment moderators. Clinical trial strengths and limitations are reviewed. TRIAL REGISTRATION: This study was registered at Clinicaltrials.gov (protocol NCT05401838).

Effectiveness of emergency department-based and initiated youth suicide prevention interventions: A systematic review.

OBJECTIVE: This systematic review examined the effectiveness of Emergency Department-based and initiated youth suicide prevention interventions for suicide attempts, suicidal ideation, hospitalization, family system functioning, and other mental health symptoms. METHODS: We searched five databases for randomized controlled trial (RCT) studies that examined Emergency Department-based and initiated suicide prevention interventions among youth aged 10 to 18 years old between May 2020 to June 2022. Using Cohen's d and 95% confidence interval as our standardised metrics, we followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) and Synthesis Without Meta-Analysis in Systematic Reviews (SWiM) guidelines when synthesizing, interpreting, and reporting the findings of this review. RESULTS: Five studies were included in this review. Findings were first synthesized according to the targeted population of the study intervention and this review's outcomes. Two interventions were effective for decreasing depressive symptoms, hospitalization recidivism, and/or increasing family empowerment. There were no interventions that reduced subsequent suicide attempts. A meta-analysis was not conducted due to the heterogeneity of the data. CONCLUSION: A need exists to develop and evaluate Emergency Department-based and initiated youth suicide prevention interventions that can be successfully and sustainably implemented in practice. Future research should focus on evaluating the components of interventions that effectively mitigate suicide risk among high-risk youth.

Understanding suicidal transitions in Australian adults: protocol for the LifeTrack prospective longitudinal cohort study.

BACKGROUND: The factors that influence transition from suicidal ideation to a suicide attempt or remission of suicidal thoughts are poorly understood. Despite an abundance of research on risk factors for suicidal ideation, no large-scale longitudinal population-based studies have specifically recruited people with suicidal ideation to examine the mechanisms underlying critical transitions to either suicide attempt or recovery from suicidal ideation. Without longitudinal data on the psychological, behavioural, and social determinants of suicide attempt and the remission of suicidal ideation, we are unlikely to see major gains in the prevention of suicide. AIM: The LifeTrack Project is a population-based longitudinal cohort study that aims to identify key modifiable risk and protective factors that predict the transition from suicidal ideation to suicide attempt or remission of suicidal ideation. We will assess theory-informed risk and protective factors using validated and efficient measures to identify distinct trajectories reflecting changes in severity of suicidal ideation and transition to suicide attempt over three years. METHODS: A three-year prospective population-based longitudinal cohort study will be conducted with adults from the general Australian population who initially report suicidal ideation (n = 842). Eligibility criteria include recent suicidal ideation (past 30 days), aged 18 years or older, living in Australia and fluent in English. Those with a suicide attempt in past 30 days or who are unable to participate in a long-term study will be excluded. Participants will be asked to complete online assessments related to psychopathology, cognition, psychological factors, social factors, mental health treatment use, and environmental exposures at baseline and every six months during this three-year period. One week of daily measurement bursts (ecological momentary assessments) at yearly intervals will also capture short-term fluctuations in suicidal ideation, perceived burdensomeness, thwarted belongingness, capability for suicide, and distress. CONCLUSION: This study is intended to identify potential targets for novel and tailored therapies for people experiencing suicidal ideation and improve targeting of suicide prevention programs. Even modest improvements in current treatments may lead to important reductions in suicide attempts and deaths. STUDY REGISTRATION: Australian New Zealand Clinical Trials Registry identifier: ACTRN12623000433606.

[Clinical evaluation and suicide prevention in a psychic suffering teenager]. / Évaluation clinique et prévention du passage à l'acte suicidaire chez un(e) adolescent(e) en souffrance psychique.

The number of young people presenting themselves to the emergencies for suicide attempts or suicidal ideation has been increasing in recent years, and there are not enough child psychiatrists to take care of all these suffering teenagers. It is therefore of major importance that front-line responders are able and comfortable in evaluating these patients in order to prevent suicidal behavior. This article aims to lay the foundations of the pediatric psychiatric clinical evaluation of the teenagers and to estimate the suicidal potential of young people in order to assess the degree of urgency of each situation and the most relevant therapeutic orientation.

Le nombre de jeunes se présentant aux urgences pour tentative de suicide ou idées suicidaires ne cesse d'augmenter ces dernières années et les pédopsychiatres ne sont pas suffisamment nombreux pour prendre en charge tous ces adolescents en souffrance psychique. Il est donc d'une importance capitale que les intervenants de première ligne se sentent à l'aise et soient capables d'évaluer ces patients afin de prévenir un passage à l'acte suicidaire. Cet article a pour but de poser les bases de l'évaluation clinique pédopsychiatrique de l'adolescent et de permettre d'estimer le potentiel suicidaire des jeunes. Cette approche devrait permettre de juger le degré d'urgence de chaque situation et d'orienter le patient vers la thérapeutique la plus pertinente.

Cognitive behavioral therapy for suicide prevention among Veterans receiving substance use disorder treatment: Results from a randomized trial.

Veterans receiving substance use disorder (SUD) treatment are at a clear elevated risk for engaging in suicidal behaviors. Intervening to reduce suicide risk during an episode of SUD treatment could meaningfully target a key high-risk group of Veterans. Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP) was developed to reduce the frequency and duration of suicidal ideation, as well as decrease suicidal behaviors. The form of CBT-SP in this study progressed from building an understanding of the cognitive model to practicing new skills, and highlighted the links between substance use, craving, self-efficacy and suicidal ideation and attempts. CBT-SP was compared to an attention matched 8-session control condition (termed Supportive Psychoeducational Control [SPC]) during a multi-site randomized controlled trial for 299 Veterans receiving outpatient SUD treatment services within the Veterans Health Administration. The frequency of suicidal ideation remained relatively constant over 24-months of follow-up, however the duration of suicidal ideation decreased, and suicide attempts decreased relative to baseline in both conditions. Forty-two participants (14%) reported at least one suicide attempt during the 2-year follow-up period. No statistically significant differences were found between CBT-SP and SPC on any of these outcomes. Analyses of secondary outcomes indicate that preparatory behaviors for suicide were less common among those in the CBT-SP condition than SPC across the 24-month follow-up (OR, 95%CI = 0.44 (0.25, 0.79); p = 0.02). Veterans in SUD treatment are a high-risk group and delivery of suicide-specific interventions is feasible during SUD care. However, results did not indicate that CBT-SP was superior to SPC on any primary outcomes, underscoring the importance of identifying and testing alternative approaches that support suicide reduction in this group.

The role of problem-solving skills in the prevention of suicidal behaviors: A systematic review and meta-analysis.

BACKGROUND: This meta-analysis was conducted to assess the association between problem-solving skills and suicidal behaviors and elucidate the potential role of problem-solving skills in influencing the occurrence of suicidal behaviors. METHODS: PubMed, Web of Science, and Scopus were searched until August 16, 2023. Studies addressing the associations between problem-solving skills and suicidal behaviors were included. The I2 statistics were used to examine between-study heterogeneity. The Begg and Egger tests were used to determine the possibility of publication bias. Using a random-effects model, the overall effect size was presented as an odds ratio (OR) or standard mean difference (SMD) with 95% confidence intervals (CIs). RESULTS: Of 8040 identified studies, 29 (including 974,542 participants) were eligible. Based on observational studies, problem-solving skills were found to be inversely related to suicidal ideation (OR = 0.64; 95% CI: 0.50, 0.82); suicide attempts (OR = 0.75; 95% CI: 0.63, 0.89), and suicide death (OR = 0.02; 95% CI: 0.01, 0.03). The overall score of problem-solving skills was higher in those who did not attempt suicide than those who did (SMD = 0.84; 95% CI: 54, 1.13). Based on randomized clinical trials, problem-solving therapy was found to reduce the risk of suicide (OR = 0.51; 95% CI: 0.29, 0.87). Furthermore, the overall risk of suicide was lower among those who received problem-solving therapy than those who did not (SMD = -0.02; 95% CI: -0.29, 0.25). CONCLUSIONS: This meta-analysis revealed an inverse association between problem-solving skills and suicidal behaviors. However, further research is needed to better understand the complex relationship between problem-solving skills and suicidal behaviors.

Differences in the characteristics of people who purchase pesticides from shops for self-harm versus those who use pesticides available in the domestic environment in Sri Lanka.

OBJECTIVE: Data from South Asia indicate that for 15%-20% of suicide attempts, pesticides are purchased from shops; otherwise, pesticides are obtained from an individual's house or nearby environment. We aimed to investigate the difference between individuals who directly purchase pesticides from shops for suicide attempts and suicide deaths versus those related to accessing the pesticides from an individual's house or nearby environment. METHODS: We conducted two comparative studies in rural Sri Lanka: (1) non-fatal shop cases (n = 50) were survivors of self-poisoning with pesticides who ingested the pesticides after purchasing them from a shop; non-fatal domestic cases (n = 192) were survivors who accessed pesticides from their house or nearby environment. (2) fatal shop cases (n = 50) were individuals who died after ingesting pesticides they purchased for the act; fatal domestic cases (n = 102) were patients who died after ingesting pesticides they accessed at house or nearby environment. Logistic regression analysis was used to assess the characteristics which distinguished between the shop and domestic cases. RESULTS: Data indicate that 20.7% and 32.9% of individuals who used pesticides for suicide attempts and suicide deaths had purchased them from shops, respectively. Being a non-farmer was the main distinguishing characteristic of shop cases: adjusted odds ratios (AOR) 8.9, 95% confidence intervals (CI) 3.2-24.4 for non-fatal shop cases, and AOR 4.0, 95% CI 1.5-10.6 for fatal shop cases. Non-fatal shop cases also had higher suicide intent (AOR 3.0, CI 1.0-8.9), and ingesting an insecticide (AOR 4.8, CI 1.8-1.0-8.9) than non-fatal domestic cases. CONCLUSION: A high suicide intent of individuals who purchase pesticides for the event explains the high proportion of such fatal cases. Such high suicide intent makes the prevention implications difficult to spell out for those individuals who purchase pesticides for self-poisoning. However, our findings are valuable for clinicians to assess pesticide poisoning cases in hospitals.

The Cost of Universal Suicide Risk Screening for Adolescents in Emergency Departments.

Suicide is the second leading cause of death among adolescents. As nearly 20% of adolescents visit emergency departments (EDs) each year, EDs have an opportunity to identify previously unrecognized suicide risk. A novel Computerized Adaptive Screen for Suicidal Youth (CASSY) was shown in a multisite study to be predictive for suicide attempts within 3 months. This study uses site-specific data to estimate the cost of CASSY implementation with adolescents in general EDs. When used universally with all adolescents who are present and able to participate in the screening, the average cost was USD 5.77 per adolescent. For adolescents presenting with non-behavioral complaints, the average cost was USD 2.60 per adolescent. Costs were driven primarily by time and personnel required for the further evaluation of suicide risk for those screening positive. Thus, universal screening using the CASSY, at very low costs relative to the cost of an ED visit, can facilitate services needed for at-risk adolescents.

Estratégias de cuidado a pessoas que tentaram suicídio segundo a literatura / Care strategies for individuals who have attempted suicide according to literature / Estrategias de atención a personas que intentan suicidio según la literatura

O suicídio representa um problema de saúde pública e o cuidado desenvolvido com pessoas que tentam suicídio pode ser determinante para evitar a ocor-rência de novas tentativas. Este trabalho teve como objetivo identificar as estra-tégias de cuidado às pessoas que tentam suicídio e mais especificamente seus alcances e limites. Foi realizada uma revisão da literatura a partir de buscas nas bases Google Scholar, Scielo e Pepsic com a palavra-chave "tentativa de suicídio". Foram selecionados e lidos na íntegra oito artigos publicados entre 2006 e 2017. Destaca-se a importância do acolhimento, ações com a família, trabalho em equipe multiprofissional e encaminhamento para outros serviços da rede. Observam-se dificuldades do trabalho em rede, ausência de diálogo entre as equipes, dificuldades no cuidado de pessoas que tentam suicídio, falta de capacitação e problemas de infraestrutura. Ressalta-se a necessidade da educação permanente em saúde e o oferecimento de suporte psicossocial para os profissionais. (AU)

Suicide represents a public health issue, and the care provided to individuals who attempt suicide can play a crucial role in preventing further attempts. This study aimed to identify the care strategies for individuals who attempt suicide, specifically examining their effectiveness and limitations. A litera-ture review was conducted using searches in the Google Scholar, Scielo, and Pepsic databases with the keyword "suicide attempt." Eight articles published between 2006 and 2017 were selected for in-depth review. The importance of providing support, involving families, fostering multidisciplinary teamwork, and referring individuals to other network services is emphasized. Challenges in establishing effective networks, fostering communication among teams, addressing the complexities of caring for suicide attempt survivors, addressing training gaps, and overcoming infrastructure issues are observed. The need for ongoing health education and the provision of psychosocial support for healthcare professionals is underscored. (AU)

El suicidio es un problema de salud pública y la atención a las personas que intentan suicidarse puede ser determinante para prevenir nuevos intentos. Este trabajo tuvo como objetivo identificar las estrategias de atención a las personas que intentan suicidarse, su alcance y límites. Se realizó una revisión de la literatura a partir de búsquedas en las bases de datos Google Scholar, Scielo y Pepsic con la palabra clave "intento de suicidio". Se seleccionaron ocho artículos publicados entre 2006 y 2017. Se destaca la importancia de la acogida, las acciones con la familia, el trabajo en equipo multiprofesional y la derivación a otros servicios de la red. Existen dificultades en el trabajo en red, ausencia de diálogo entre equipos, dificultades en la atención, falta de formación y problemas de infraestructura. Se enfatiza la necesidad de educación permanente para la salud y la provisión de apoyo psicosocial a los profesionales. (AU)

Prevention of Re-attempt Suicide Through Brief Contact Interventions: A Systematic Review, Meta-analysis, and Meta-regression of Randomized Controlled Trials.

Brief contact intervention (BCI) is a low-cost intervention to prevent re-attempt suicide. This meta-analysis and meta-regression study aimed to evaluate the effect of BCI on re-attempt prevention following suicide attempts (SAs). We systematically searched using defined keywords in MEDLINE, Embase, and Scopus up to April, 2023. All randomized controlled trials (RCTs) were eligible for inclusion after quality assessment. Random-effects model and subgroup analysis were used to estimate pooled risk difference (RD) and risk ratio (RR) between BCI and re-attempt prevention with 95% confidence intervals (CIs). Meta-regression analysis was carried out to explore the potential sources of heterogeneity. The pooled estimates were (RD = 4%; 95% CI 2-6%); and (RR = 0.62; 95% CI 0.48-0.77). Subgroup analysis demonstrated that more than 12 months intervention (RR = 0.46; 95% CI 0.10-0.82) versus 12 months or less (RR = 0.67; 95% CI 0.54-0.80) increased the effectiveness of BCI on re-attempt suicide reduction. Meta-regression analysis explored that BCI time (more than 12 months), BCI type, age, and female sex were the potential sources of the heterogeneity. The meta-analysis indicated that BCI could be a valuable strategy to prevent suicide re-attempts. BCI could be utilized within suicide prevention strategies as a surveillance component of mental health since BCI requires low-cost and low-educated healthcare providers.

Uncontrollability of suicidal ideation adds incremental explanatory power in prediction of later suicidal ideation.

OBJECTIVE: Suicidal ideation and suicidal behaviors are major public health concerns in the United States and are difficult to treat and predict. Risk factors that are incrementally informative are needed to improve prediction and inform prevention of suicidal thoughts and behaviors. Uncontrollability of suicidal ideation, one parameter of suicidal ideation, is one such candidate. METHOD: In the current study, we assessed the predictive power of uncontrollability of suicidal ideation, over and above overall suicidal ideation, for future suicidal ideation in a large sample of active-duty service members. A total of 1044 suicidal military service members completed baseline assessments, of whom 664 (63.6%) completed 3-month follow-up assessments. RESULTS: While baseline overall suicidal ideation itself was the strongest predictor of future suicidal ideation, uncontrollability of suicidal ideation added some incremental explanatory power. CONCLUSION: Further study of uncontrollability of suicidal thought is needed to elucidate its impact on suicidal outcomes.

Suicide and All-Cause Mortality Within 1 Year After a Suicide Attempt in the VigilanS Cohort.

Objective: Obtaining better knowledge on the outcomes of patients who attempt suicide is crucial for suicide prevention. The aim of our study was to determine the causes of death 1 year after a suicide attempt (SA) in the VigilanS program, mortality rates, and risk factors associated with any cause of death and suicide.Methods: A prospective cohort of 7,406 people who had attempted suicide between January 1, 2017, and December 31, 2018, was included in the study. The vital status of each participant was sought, and the cause of death was established through a phone call to their general practitioner or psychiatrist. Second, the relationship between sociodemographic and clinical factors and death by suicide within 1 year of an SA was assessed using a multivariable Cox model.Results: At 1 year, 125 (1.7%) participants had died, 77 of whom died by suicide. Half of the deaths occurred within the first 4 months after an SA. Hanging (20.3%; 24/125) and self-poisoning (19.5%; 23/125) were the methods the most often used for suicide. We demonstrated that male sex (HR = 1.79 [1.13-2.82], P = .01) and being 45 years of age or older (between 45 and 64 years old, HR = 2.08 [1.21-3.56], P < .01; 65 years or older, HR = 5.36 [2.72-10.54], P < .01) were associated with a higher risk of death by suicide 1 year after an SA and that being younger than 25 years was associated with a lower risk (HR = 0.22 [0.07-0.76], P = .02).Conclusions: One out of 100 people who attempted suicide died by suicide within 1 year after an SA. Greater vigilance is required in the first months following an SA, especially for males older than 45 years.Trial Registration: ClinicalTrials.gov identifier: NCT03134885.

[Psychopathological differences between female adolescent patients with and without suicide attempt]. / Diferencias psicopatológicas entre pacientes adolescentes del sexo femenino con y sin intento de suicidio.

Background: Traditionally, psychopathology has been related to suicide risk, furthermore if we bear in mind that the recent meta-analysis on the relationship between some mental disorders and the risk of suicide attempt are inconclusive, and have been performed with non-clinical samples. Objective: To establish the psychopathological differences between female adolescent patients with and without suicide attempt. Material and methods: Comparative, prospective, correlational and cross-sectional study. A sample of 50 female participants was used, divided into 2 groups: one of cases, (n = 25), made up of female patients between 15 and 19 years of age with suicide attempt, and a control group of pairs (n = 25) with no history of suicide attempt. The following instruments were applied: the Plutchik Impulsivity Scale, the Beck Hopelessness Scale, the K-Sads-PL, the Beck Suicidal Ideation Scale, and the Hamilton Depression Scale. Results: A greater presence of the disorders evaluated was found: major depressive disorder, dysthymic disorder, generalized anxiety disorder and panic disorder in the group with suicide attempt. Furthermore, the case group obtained higher mean scores on the Beck Hopelessness Scale, the Beck Suicidal Ideation Scale, the Hamilton Depression Scale and the Plutchik Impulsivity Scale. Conclusions: The results agree with most of previous studies. It is suggested to carry out preventive interventions in cases where a considerably increased risk is detected.

Introducción: tradicionalmente se ha relacionado la psicopatología con el riesgo suicida, más si se toma en consideración que los recientes metaanálisis sobre la relación entre algunos trastornos mentales y el riesgo de tentativa suicida no son concluyentes, y se han realizado con muestras no clínicas. Objetivo: establecer las diferencias psicopatológicas entre pacientes adolescentes del sexo femenino con y sin intento suicida. Material y métodos: estudio comparativo, prospectivo, correlacional y transversal. Se utilizó una muestra de 50 participantes de sexo femenino, distribuidas en dos grupos: el de casos, (n = 25), compuesto por pacientes entre 15 y 19 años con intento suicida y un grupo control (n = 25) de pares sin historia de tentativa. Se aplicaron los siguientes instrumentos: la Escala de Impulsividad de Plutchik, la Escala de Desesperanza de Beck, el K-Sads-PL, la Escala de Ideación Suicida de Beck y la Hamilton de Depresión. Resultados: se encontró mayor presencia de los trastornos evaluados: trastorno depresivo mayor, trastorno distímico, trastorno de ansiedad generalizada y trastorno de pánico en el grupo con intento suicida. Además, el grupo caso obtuvo mayor puntución media en las escalas de Desesperanza de Beck, de Ideación Suicida de Beck, la Hamilton de Depresión y la de Impulsividad de Plutchik. Conclusiones: los resultados coinciden con la mayoría de estudios previos. Se sugiere hacer intervenciones preventivas en casos donde se detecte un riesgo considerablemente aumentado.

Prediction of suicidal ideation in children and adolescents using machine learning and deep learning algorithm: A case study in South Korea where suicide is the leading cause of death.

BACKGROUND: Korea has the highest suicide rate among Organisation for Economic Co-operation and Development (OECD) countries. Consequently, central and local governments and private organizations in Korea cooperate in promoting various suicide prevention projects to actively respond to suicide problems. Machine learning has been used to predict suicidal ideation in the fields of health and medicine but not from a social science perspective. OBJECTIVE: Since suicidal ideation is a major predictor of suicide attempts, being able to anticipate and mitigate it helps prevent suicide. Therefore, this study presents a data-based analysis method for predicting suicidal thoughts quickly and effectively and suggests countermeasures against the causes of suicidal thoughts. PARTICIPANTS AND METHODS: To predict early signs of suicidal ideation in children and adolescents, big data collected for approximately 4 years (from 2017 to 2020) from the Korea Youth Policy Institute (NYPI) were used. To accurately predict suicidal ideation, supervised ma- chine learning classification algorithms such as logistic regression, random forest, XGBoost, multilayer perceptron (MLP), and convolutional neural network (CNN) were used. RESULTS: Using CNN, suicidal ideation was predicted with an accuracy of approximately 90 %. The logistic regression results showed that sadness and depression increased suicidal thoughts by more than 25 times, and anxiety, loneliness, and experience of abusive language increased suicidal thoughts by more than three times. CONCLUSIONS: Machine learning and deep learning approaches have the potential to predict and respond to suicidal thoughts in children, adolescents, and the general population, as well as help respond to the suicide crisis by preemptively identifying the cause.

Sociodemographic Characteristics and Clinical Profile of Suicide Attempters Attending the Emergency Department at a Tertiary Care Hospital in Oman: A Retrospective Study.

OBJECTIVE: This study examined the sociodemographic and clinical characteristics of individuals who attended the emergency department of a tertiary care center in Muscat, Oman following a suicide attempt. METHODS: A retrospective study (N=154) was conducted between January 2015 and June 2018. Information that was collected included sociodemographic variables (age, nationality, sex, marital status, and occupation), risk (medical comorbidities, psychiatric history, substance misuse, alcohol misuse, and previous history of suicide attempts), and precipitating factors, as well as the chosen methods for the suicide attempts. RESULTS: In all, 83.1% of the sample were Omanis, and women constituted 69.5%. The mean age of the sample was 27 years; 30% were students, 42% were unemployed, and 40.9% had a history of psychiatric disorders. Family conflict, suffering from chronic illness, and having social problems were the most common precipitating factors for the suicide attempt. The most common method used in the suicide attempt was drug overdose (48.1%), mainly involving paracetamol (acetaminophen) (40%). Significant gender differences emerged in precipitating factors, history of substance misuse, and methods of suicide. CONCLUSIONS: The data from this study are consistent with international trends that suggest that women and younger age groups are the most vulnerable to suicide attempts. Although in its infancy, the type of research presented here could lay the groundwork for preventive interventions and programs.

[Suicidal behavior in emergency care: 10 tips for an active, empathetic and preventative approach]. / Suïcidaal gedrag op de SEH.

Patients with suicidal behaviour are frequently seen in A&E departments. Providing care for this patient group can be challenging and medical staff have often not received specialized training to improve their knowledge and skills. An empathetic approach combined with brief interventions such as safety planning, collaborating with carers and partnership with local organizations can help A&E professionals to optimize care for these patients and contribute to the prevention of future suicide attempts.

Brief Psychotherapeutic Intervention Compared with Treatment as Usual for Adolescents with Nonsuicidal Self-Injury: Outcomes over a 2-4-Year Follow-Up.

INTRODUCTION: The "Cutting Down Programme" (CDP), a brief psychotherapeutic intervention for treating nonsuicidal self-injury (NSSI) in adolescents, was comparable to high-quality treatment as usual (TAU) in a previous randomized controlled trial (RCT). OBJECTIVE: The aim of the study was to evaluate the long-term outcomes of the CDP over up to 4 years. METHODS: Assessments of NSSI, suicide attempts, borderline personality disorder (BPD), depression, and quality of life took place 2 to 4 years (T3) after enrollment in a RCT. The evolution of NSSI, suicide attempts, depression, and quality of life was analyzed using (generalized) linear mixed-effects models. Ordered logistic regression was used for analyzing BPD diagnoses. Data from T0, T2, and T3 are reported. RESULTS: Out of 74 patients, 70 (95%) were included in the T3 assessment. The frequency of NSSI events alongside with suicide attempts and depression further decreased between T2 and T3 and BPD between T0 and T3 in both groups. Quality of life remained stable in both groups between T2 and T3. Both groups received substantial but comparable additional treatment between T2 and T3. More treatment sessions during the follow-up period were linked to larger improvements of NSSI. CONCLUSIONS: The CDP was found to be as effective as TAU in promoting recovery from NSSI and comorbid symptoms in the long term. Results suggest that treatment effects from a brief psychotherapeutic intervention may endure and even further improve after completion of the program. However, additional treatment seems to improve chances for recovery independent from CDP versus TAU.