Effect of a Motivational Interviewing-Based Intervention on Initiation of Mental Health Treatment and Mental Health After an Emergency Department Visit Among Suicidal Adolescents: A Randomized Clinical Trial.

Importance: Emergency department (ED) visits present opportunities to identify and refer suicidal youth for outpatient mental health care, although this practice is not routine. Objective: To examine whether a motivational interviewing-based intervention increases linkage of adolescents to outpatient mental health services and reduces depression symptoms and suicidal ideation in adolescents seeking emergency care for non-mental health-related concerns who screen positive for suicide risk. Design, Setting, and Participants: In this randomized clinical trial, adolescents aged 12 to 17 years who screened positive on the Ask Suicide Screening Questions (ASQ) during a nonpsychiatric ED visit at 2 academic pediatric EDs in Ohio were recruited from April 2013 to July 2015. Intention-to-treat analyses were performed from September 2018 to October 2019. Interventions: The Suicidal Teens Accessing Treatment After an Emergency Department Visit (STAT-ED) intervention included motivational interviewing to target family engagement, problem solving, referral assistance, and limited case management. The enhanced usual care (EUC) intervention consisted of brief mental health care consultation and referral. Main Outcomes and Measures: Primary outcomes were mental health treatment initiation and attendance within 2 months of ED discharge and suicidal ideation (assessed by the Suicidal Ideation Questionnaire JR) and depression symptoms (assessed by the Center for Epidemiologic Studies-Depression scale) at 2 and 6 months. Exploratory outcomes included treatment initiation and attendance and suicide attempts at 6 months. Results: A total of 168 participants were randomized and 159 included in the intention-to-treat analyses (mean [SD] age, 15.0 [1.5] years; 126 [79.2%] female; and 80 [50.3%] white). Seventy-nine participants were randomized to receive the STAT-ED intervention and 80 to receive EUC. At 2 months, youth in the STAT-ED group had similar rates of mental health treatment initiation compared with youth in the EUC group as assessed by parent report (29 [50.9%] vs 22 [34.9%]; adjusted odds ratio [OR], 2.08; 95% CI, 0.97-4.45) and administrative data from mental health care agencies (19 [29.7%] vs 11 [19.3%]; adjusted OR, 1.77; 95% CI, 0.76-4.15). At 2 months, youth in the STAT-ED group and the EUC group had similar rates of treatment attendance (1 appointment: 6 [9.7%] vs 2 [3.6%]; adjusted OR, 2.97; 95% CI, 0.56-15.73; ≥2 appointments: 10 [16.1%] vs 7 [12.7%]; adjusted OR, 1.43; 95% CI, 0.50-4.11). There were no significant group × time differences in suicidal ideation (F = 0.28; P = .72) and depression symptoms (F = 0.49; P = .60) during the 6-month follow-up period. In exploratory analyses, at 6 months, STAT-ED participants had significantly higher rates of agency-reported mental health treatment initiation (adjusted OR, 2.48; 95% CI, 1.16-5.28) and more completed appointments (t99.7 = 2.58; P = .01). Conclusions and Relevance: This study's findings indicate that no differences were found on any primary outcome by study condition. However, STAT-ED was more efficacious than EUC at increasing mental health treatment initiation and attendance at 6 months. Trial Registration: ClinicalTrials.gov identifier: NCT01779414.

Entre o debate público e o silêncio: análise da cobertura jornalística online sobre a questão do suicídio de adolescentes e jovens negros no Brasil / Between public debate and silence: analysis of online journalist coverage about the suicide of black teenagers and youth in Brazil / Entre debate público y silencio: análisis de la cobertura periodística online sobre el tema del suicidio de adolescentes y jóvenes en Brasil

Este artigo objetiva analisar o fomento do debate público promovido pela cobertura jornalística on-line sobre a questão do suicídio de adolescentes e jovens negros no Brasil. Para isso, foram selecionadas três reportagens de três veículos de comunicação: G1 ­ Ciência e Saúde (ligado às Organizações Globo), Nexo (jornal digital independente) e o Alma Preta (agência de jornalismo especializada na temática étnica do Brasil). Com o uso de teorias sobre prática jornalística, opinião pública e silêncio, além do emprego da hermenêutica de profundidade, este estudo concluiu que a mídia não promove integralmente o debate público sobre a questão. O G1 ­ Ciência e Saúde reproduziu o discurso da mídia hegemônica, não dando voz para os negros; o Nexo foi o jornal que tratou o tema de forma mais completa, com uso de dados e fontes, sendo negra uma delas; e o Alma Preta foi o que menos abriu espaço para identificação do público negro, com a ausência de fontes e falta de representação.

This article aims to analyze the public debate at online journalistic coverage on the issue of suicide among black teenagers and young people in Brazil. For this, three news from three media were selected: G1 Ciência e Saúde (linked to Globo Organizations), Nexo (independent digital newspaper) and Alma Preta (journalism agency specializing in ethnic issues in Brazil). Using theories of journalistic practice, public opinion and silence, as well as the use of deep hermeneutics, this study concluded that the media does not fully promote public debate on the issue. G1 ­ Ciência e Saúde reproduced the hegemonic media discourse, giving no voice to blacks; Nexo was the newspaper that dealt with the theme most completely, using data and sources, one of them being black; and Alma Preta was the least open to the identification of the black public, with the absence of sources and lack of representation.

Este artículo tiene como objetivo analizar el debate público a través de la cobertura periodística online sobre el tema del suicidio entre adolescentes y jóvenes negros en Brasil. Para esto se seleccionaron tres medios: G1 ­ Ciência e Saúde (vinculado a Organizaciones Globo), Nexo (periódico digital independiente) y Alma Preta (agencia de periodismo especializada em temas étnicos en Brasil). Utilizando teorías de práctica periodística, opinión pública y silencio, así como el uso de una hermenéutica profunda, este estudio concluyó que los medios no promueven completamente el debate público sobre el tema. G1 ­ Ciência e Saúde reprodujo el discurso de los medios hegemónicos, sin dar voz a los negros; Nexo fue el periódico que trató el tema más completamente, utilizando datos y fuentes; y Alma Preta fue la menos abierta a la identificación del público negro, con la ausencia de fuentes y la falta de representación.

Métodos y sustancias empleados en la conducta suicida en adolescentes / Methods and substances involved in teen suicide

Introducción: Actualmente, el suicidio es un problema de salud que constituye la tercera causa de muerte a nivel mundial en los adolescentes entre 11 y 18 años, y en Cuba es la cuarta causa de muerte en las edades de 10 a 19 años. Los métodos empleados para cometer el intento de suicidio y el suicidio están en dependencia de su disponibilidad, el acceso que la persona tenga a un método particular, el antecedente familiar que tenga del uso de uno u otros métodos, entre otros. Objetivo: Identificar el método utilizado para cometer el intento de suicidio y el suicidio en adolescentes. Métodos: Estudio descriptivo retrospectivo, que forma parte de varias tareas incluidas en el Proyecto de investigación Estrategia de prevención de la conducta suicida en adolescentes de provincias seleccionadas, que duró 10 años. Resultados: Los métodos empleados fueron consumo de psicofármacos y los tóxicos para los intento de suicidio y en los casos de suicidios, fueron, prioritariamente, ahorcamiento e incineración. Las sustancias mayormente empleadas fueron: herbicidas y lociones de uso externo para la piel. Conclusiones: Los métodos empleados que predominaron para los intentos de suicidio fueron los psicofármacos y tóxicos, y el ahorcamiento e incineración para el suicidio, lo que pudiera estar en correspondencia con la disponibilidad de los mismos(AU)

Introduction: Suicide is a current health problem constituting the third leading cause of death worldwide among 11-18-year-old teenagers. In Cuba it is the fourth leading cause of death in the 10-19 years age group. The methods used to commit a suicide attempt or suicide depend on their availability, the person's access to a given method, and family antecedents of the use of one method or another, among others. Objective: Identify the methods used by teenagers to commit attempted or actual suicide. Methods: A retrospective descriptive study was conducted as part of the various tasks included in the research project Strategy to prevent suicidal behavior among teenagers from selected provinces, which was developed for ten years. Results: The methods used in suicide attempts were the intake of psycholeptics and toxic substances, whereas the methods used for actual suicide were mainly hanging and burning. The most common substances were herbicides and topical skin lotions. Conclusions: The methods most frequently used were the intake of psycholeptics and toxic substances for suicide attempts and hanging and burning for suicide. This could be associated to the availability of resources required to commit the act(AU)

Suicidio: contextos y personas / Suicide: contexts and persons

No disponible

Recent advances in understanding and managing self-harm in adolescents.

Adolescent suicide is a serious public health problem, and non-suicidal self-injury (NSSI) is both highly comorbid with suicidality among adolescents and a significant predictor of suicide attempts (SAs) in adolescents. We will clarify extant definitions related to suicidality and NSSI and the important similarities and differences between these constructs. We will also review several significant risk factors for suicidality, evidence-based and evidence-informed safety management strategies, and evidence-based treatment for adolescent self-harming behaviors. Currently, dialectical behavior therapy (DBT) for adolescents is the first and only treatment meeting the threshold of a well-established treatment for self-harming adolescents at high risk for suicide. Areas in need of future study include processes underlying the association between NSSI and SAs, clarification of warning signs and risk factors that are both sensitive and specific enough to accurately predict who is at imminent risk for suicide, and further efforts to sustain the effects of DBT post-treatment. DBT is a time- and labor-intensive treatment that requires extensive training for therapists and a significant time commitment for families (generally 6 months). It will therefore be helpful to assess whether other less-intensive treatment options can be established as evidence-based treatment for suicidal adolescents.

A regional systems intervention for suicide prevention in the Netherlands (SUPREMOCOL): study protocol with a stepped wedge trial design.

BACKGROUND: In the Netherlands, suicide rates showed a sharp incline and this pertains particularly to the province of Noord-Brabant, one of the southern provinces in the Netherlands. This calls for a regional suicide prevention effort. METHODS/DESIGN: Study protocol. A regional suicide prevention systems intervention is implemented and evaluated by a stepped wedge trial design in five specialist mental health institutions and their adherent chain partners. Our system intervention is called SUPREMOCOL, which stands for Suicide Prevention by Monitoring and Collaborative Care, and focuses on four pillars: 1) recognition of people at risk for suicide by the development and implementation of a monitoring system with decision aid, 2) swift access to specialist care of people at risk, 3) positioning nurse care managers for collaborative care case management, and 4) 12 months telephone follow up. Eligible patients are persons attempting suicide or expressing suicidal ideation. Primary outcome is number of completed suicides, as reported by Statistics Netherlands and regional Public Health Institutes. Secondary outcome is number of attempted suicides, as reported by the regional ambulance transport and police. Suicidal ideation of persons registered in the monitoring system will, be assessed by the PHQ-9 and SIDAS questionnaires at baseline and 3, 6, 9 and 12 months after registration, and used as exploratory process measure. The impact of the intervention will be evaluated by means of the RE-AIM dimensions reach, efficacy, adoption, implementation, and maintenance. Intervention integrity will be assessed and taken into account in the analysis. DISCUSSION: The present manuscript presents the design and development of the SUPREMOCOL study. The ultimate goal is to lower the completed suicides rate by 20%, compared to the control period and compared to other provinces in the Netherlands. Moreover, our goal is to provide specialist mental health institutions and chain partners with a sustainable and adoptable intervention for suicide prevention. TRIAL REGISTRATION: Netherlands Trial Register under registration number NL6935 (5 April 2018). This is the first version of the study protocol (September 2019).

Prevention of suicidal behaviour: Results of a controlled community-based intervention study in four European countries.

The 'European Alliance Against Depression' community-based intervention approach simultaneously targets depression and suicidal behaviour by a multifaceted community based intervention and has been implemented in more than 115 regions worldwide. The two main aims of the European Union funded project "Optimizing Suicide Prevention Programmes and Their Implementation in Europe" were to optimise this approach and to evaluate its implementation and impact. This paper reports on the primary outcome of the intervention (the number of completed and attempted suicides combined as 'suicidal acts') and on results concerning process evaluation analysis. Interventions were implemented in four European cities in Germany, Hungary, Portugal and Ireland, with matched control sites. The intervention comprised activities with predefined minimal intensity at four levels: training of primary care providers, a public awareness campaign, training of community facilitators, support for patients and their relatives. Changes in frequency of suicidal acts with respect to a one-year baseline in the four intervention regions were compared to those in the four control regions (chi-square tests). The decrease in suicidal acts compared to baseline in the intervention regions (-58 cases, -3.26%) did not differ significantly (χ2 = 0.13; p = 0.72) from the decrease in the control regions (-18 cases, -1.40%). However, intervention effects differed between countries (χ2 = 8.59; p = 0.04), with significant effects on suicidal acts in Portugal (χ2 = 4.82; p = 0.03). The interviews and observations explored local circumstances in each site throughout the study. Hypothesised mechanisms of action for successful implementation were observed and drivers for 'added-value' were identified: local partnership working and 'in-kind' contributions; an approach which valued existing partnership strengths; and synergies operating across intervention levels. It can be assumed that significant events during the implementation phase had a certain impact on the observed outcomes. However, this impact was, of course, not proven.

The magnitude of suicidal ideation, attempts and associated factors of HIV positive youth attending ART follow ups at St. Paul's hospital Millennium Medical College and St. Peter's specialized hospital, Addis Ababa, Ethiopia, 2018.

BACKGROUND: Suicide which is considered a psychiatric emergency, is a serious cause of mortality worldwide. Youth living with HIV/AIDS (YLWHA) have higher rates of suicidal behavior than the general public. This study aimed to assess the magnitude and associated factors of suicide ideation and attempt among the Human Immune deficiency Virus (HIV) positive youth attending anti-retroviral therapy (ART) follow up at St. Paul`s hospital Millennium Medical College and St. Peter`s specialized hospital, Addis Ababa, Ethiopia. METHODS: In this cross-sectional study, 413 HIV positive youth were recruited for interviews, using the systematic random sampling technique. The Composite International Diagnostic Interview (CIDI) was used to assess suicide. PHQ-9, the Oslo social support and HIV perceived stigma scale instruments were used to assess the factors. We computed bivariate and multivariable binary logistic regressions to assess factors associated with suicidal ideation and attempt. Statistical significance was declared at P-value <0.05. RESULT: The magnitude of suicidal ideation and attempts were found to be 27.1% and 16.9%, respectively. In the multivariate analysis, female sex (adjusted odd ratio(AOR) = 3.1, 95% CI, 1.6-6.0), family death (AOR = 2.1, 95%CI 1.15-3.85), WHO clinical stage III of HIV (AOR = 3.1 95% CI 1.3-7.35), WHO clinical stage IV of HIV (AOR = 4.76, 95%CI, 1.3-7.35), co-morbid depression (AOR = 7.14, 95%CI, 3.9-12.9), and perceived HIV stigma (AOR = 4.2, 95%CI, 2.27-8.2) were significantly associated with suicidal ideation, whereas female sex (AOR = 4.12, 95%CI, 1.82-9.78), opportunistic infections (AOR = 3.1, 95%CI, 1.6-6.04), WHO clinical stage III of HIV (AOR = 3.1 95%CI 1.24-7.81), co-morbid depression (AOR = 5.6 95% CI, 2.8-11.1), and poor social support (AOR = 3.4, 95%CI, 1.2-9.4) were statistically significant with suicidal attempt. The result suggests that the magnitude of suicidal ideation and attempts among HIV positive youth were high. We recommend that clinicians consider youth with comorbid depression, perceived HIV stigma and poor social support.

A Pilot Study of an Intervention to Prevent Suicide After Psychiatric Hospitalization.

A prior meta-analysis found that the World Health Organization Brief Intervention and Contact Program (WHO BIC) significantly reduces suicide risk. WHO BIC has not been studied in high-income countries. We piloted an adapted version of WHO BIC on an inpatient mental health unit in the United States. We assessed the feasibility and acceptability. We also evaluated changes in suicidal ideation, hopelessness, and connectedness using a repeated measures analysis of variance. Of 13 eligible patients, 9 patients enrolled. Patients experienced significant improvements in suicidal ideation, hopelessness, and connectedness at 1 and 3 months (Beck Scale for Suicidal Ideation, F(2,16) = 14.96, p < 0.01; Beck Hopelessness Scale, F(2,16) = 5.88, p < 0.05; perceived burdensomeness subscale, F(2,16) = 10.97, p < 0.013; and thwarted belongingness subscale, F(2,16) = 4.77, p < 0.03). Patients were highly satisfied. An adapted version of WHO BIC may be feasible to implement in a high-resource setting, but trials need to confirm efficacy.

Relevance of the interpersonal theory of suicide in an adolescent psychiatric inpatient population.

The interpersonal theory of suicide (IPTS) has been widely studied in adults, but not adolescent populations at acute risk for suicide. Accordingly, this study aimed to evaluate IPTS clinical utility in a high-risk sample of suicidal adolescent inpatients. We assessed whether constructs of the IPTS (1) are associated with suicidal thoughts and behaviors (STBs) on admission to a psychiatric hospitalization, and (2) prospectively predict suicide attempt (SA) or psychiatric rehospitalization 90 days after discharge. On admission, adolescent patients self-reported recent STBs, perceived burdensomeness (PB), thwarted belongingness (TB), and depression. Parents reported their child's rehospitalization and suicide attempts 90 days after discharge. Generalized linear regression modelling was used to determine how key constructs of the IPTS are associated with STBs prior to admission and whether they prospectively predict SA or rehospitalization 90 days after discharge. IPTS constructs did not predict rehospitalization or SA within 90 days of discharge. Although PB and TB interacted to associate with prehospitalization SI frequency, and PB, TB and NSSI interacted to associate with prehospitalization SA, the nature of these interactions were not as the IPTS predicts. IPTS constructs are relevant proximal predictors of prehospitalization STB in adolescents, but may operate differently than in adults.

Daily patterns in nonsuicidal self-injury and coping among recently hospitalized youth at risk for suicide.

Among adolescents at high suicide risk, using a daily diary design, this study examined: (1) the co-occurrence between nonsuicidal self-injury (NSSI) and suicidal ideation, (2) the link between NSSI and coping, and (3) endorsement of using NSSI to cope with suicidal ideation (anti-suicide function). Thirty-four adolescents hospitalized due to suicide risk (76% female; ages 13-17) responded to daily surveys for four weeks after discharge (n = 650 observations). NSSI was positively associated with suicidal ideation at the between- (i.e. relative to others) and within-person (relative to adolescents' own average) levels of analysis. When NSSI and suicidal thoughts co-occurred, adolescents used NSSI to cope with thoughts of suicide on nearly all occasions. While adolescents did not use less adaptive coping when they engaged in NSSI (i.e. within-person), youth who utilized more coping strategies in general (i.e. between-person) had lower probability of NSSI. The probability of NSSI also decreased when adolescents perceived coping to be helpful and for youth who generally tended to perceive coping as helpful. Findings offer fine-grained insights about the intersection of NSSI, suicidal thoughts, and coping among high-risk adolescents, adding to the body of research highlighting the benefit of broadening adolescents' coping strategies as well as assessing their perceived utility.

Assessment of Selective and Universal Screening for Suicide Risk in a Pediatric Emergency Department.

Importance: According to National Patient Safety Goal 15.01.01, all individuals being treated or evaluated for behavioral health conditions as their primary reason for care in hospitals and behavioral health care organizations accredited by The Joint Commission should be screened for suicide risk using a validated tool. Existing suicide risk screens have minimal or no high-quality evidence of association with future suicide-related outcomes. Objective: To test the association between results of the Ask Suicide-Screening Questions (ASQ) instrument in a pediatric emergency department (ED), implemented through selective and universal screening approaches, and subsequent suicide-related outcomes. Design, Setting, and Participants: In this retrospective cohort study at an urban pediatric ED in the United States, the ASQ was administered to youths aged 8 to 18 years with behavioral and psychiatric presenting problems from March 18, 2013, to December 31, 2016 (selective condition), and then to youths aged 10 to 18 years with medical presenting problems (in addition to those aged 8-18 years with behavioral and psychiatric presenting problems) from January 1, 2017, to December 31, 2018 (universal condition). Exposure: Positive ASQ screen at baseline ED visit. Main Outcomes and Measures: The main outcomes were subsequent ED visits with suicide-related presenting problems (ie, ideation or attempts) based on electronic health records and death by suicide identified through state medical examiner records. Association with suicide-related outcomes was calculated over the entire study period using survival analyses and at 3-month follow-up for both conditions using relative risk. Results: The complete sample was 15 003 youths (7044 [47.0%] male; 10 209 [68.0%] black; mean [SD] age, 14.5 [3.1] years at baseline). The follow-up for the selective condition was a mean (SD) of 1133.7 (433.3) days; for the universal condition, it was 366.2 (209.2) days. In the selective condition, there were 275 suicide-related ED visits and 3 deaths by suicide. In the universal condition, there were 118 suicide-related ED visits and no deaths during the follow-up period. Adjusting for demographic characteristics and baseline presenting problem, positive ASQ screens were associated with greater risk of suicide-related outcomes among both the universal sample (hazard ratio, 6.8 [95% CI, 4.2-11.1]) and the selective sample (hazard ratio, 4.8 [95% CI, 3.5-6.5]). Conclusions and Relevance: Positive results of both selective and universal screening for suicide risk in pediatric EDs appear to be associated with subsequent suicidal behavior. Screening may be a particularly effective way to detect suicide risk among those who did not present with ideation or attempt. Future studies should examine the impact of screening in combination with other policies and procedures aimed at reducing suicide risk.

Role of primary care in supporting older adults who self-harm: a qualitative study in England.

BACKGROUND: Self-harm and suicide are major public health concerns. Self-harm is the strongest risk factor for suicide, with the highest suicide rates reported in older populations. Little is known about how older adults access care following self-harm, but they are in frequent contact with primary care. AIM: To identify and explore barriers and facilitators to accessing care within primary care for older adults who self-harm. DESIGN AND SETTING: An exploratory qualitative methods study using semi-structured interviews with older adults and third-sector workers in England. Older adults were invited to participate in one follow-up interview. METHOD: Interviews occurred between September 2017 and September 2018. These were audio-recorded, transcribed verbatim, and data analysed thematically. A patient and public involvement and engagement group contributed to the study design, data analysis, and interpretation. RESULTS: A total of 24 interviews with nine older adults and seven support workers, including eight follow-up interviews with older adults, were conducted. Three themes emerged: help-seeking decision factors; sources of support; and barriers and facilitators to accessing primary care. CONCLUSION: Despite older adults' frequent contact with GPs, barriers to primary care existed, which included stigma, previous negative experiences, and practical barriers such as mobility restrictions. Older adults' help-seeking behaviour was facilitated by previous positive experiences. Primary care is a potential avenue for delivering effective self-harm support, management, and suicide prevention in older adults. Given the complex nature of self-harm, there is a need for primary care to work with other sectors to provide comprehensive support to older adults who self-harm.

Violence In Older Adults: Scope, Impact, Challenges, And Strategies For Prevention.

Although often perceived to be a problem of the young, violence commonly affects older adults, a rapidly growing segment of the population. Violence can be directed toward older adults (elder abuse and intimate partner violence), self-directed (suicide), or perpetrated by older adults against others (intimate partner violence and violence in dementia). Across forms of violence, firearm access increases lethality, and veterans may be a particularly high-risk population. The forms of violence in older adults have some common risk factors (such as medical or psychiatric illness) and common challenges for prevention (such as balancing autonomy and well-being in vulnerable adults). The integration of prevention strategies across the life span, disciplines, and forms of violence offers promise for promoting older adult health and well-being. Looking forward, key areas for attention will include raising awareness about these topics and prioritizing funding for the implementation and evaluation of violence prevention interventions in health care settings and the community.

Violence And The US Health Care Sector: Burden And Response.

Violence has significant impacts on the US health care sector, which include the need to care for injured victims and prevent violence to its physicians and employees, as well as the surrounding community. In 2017 violence resulted in about 2.3 million emergency department visits and 376,500 hospitalizations, with an estimated total medical cost of about $8.7 billion. Victims also often need short- and long-term physical and psychological rehabilitation. Health care workers experience the highest rates of violent injuries in the workplace in the US: 7.8 per 1,000 workers per year, compared to rates under 2.0 per 1,000 for other private industry. Treating and preventing injuries to workers in 2016 added an estimated $429 million in direct and indirect costs to US health systems. Health systems and clinicians have embraced screening and interventions in primary care, mental health care, emergency departments, and other clinical settings to prevent violence among high-risk patients, including potential victims of intimate partner violence, victims of youth violence, and suicidal patients. Some interventions include addressing patients' access to firearms, the most lethal method for assaults and suicides. Community health needs assessments help health systems identify violence as a key community health priority and lead to improvements in the delivery of violence prevention programs.

Electroencephalogram Resting State Frequency Power Characteristics of Suicidal Behavior in Female Patients With Major Depressive Disorder.

BACKGROUND: Difficulties in predicting suicidal behavior hamper effective suicide prevention. Therefore, there is a great need for reliable biomarkers, and neuroimaging may help to identify such markers. METHODS: Electroencephalography (EEG) was used to investigate resting state spatial-frequency power characteristics of female patients with major depressive disorder (MDD); 19 were recent suicide attempters (within the previous 30 days), 36 were suicide ideators, and 23 were nonsuicidal. Patients were enrolled at neuroCare Clinic Nijmegen (Nijmegen, the Netherlands) between May 2007 and November 2016, and the primary diagnosis of nonpsychotic MDD was confirmed using the Mini-International Neuropsychiatric Interview, DSM-IV criteria, and a score of ≥ 14 on the 21-item Beck Depression Inventory. Nonparametric, cluster-based permutation tests were applied to detect robust power differences between the study groups on the EEG broadband signal (2-100 Hz). Furthermore, a nonadaptive distributed source imaging method (eLORETA) was utilized to examine if these suicide-based frequency characteristics are localized in brain areas previously reported in the neuroimaging literature. RESULTS: When compared to nonsuicidal depressed patients, attempters and ideators displayed both decreased beta and low gamma activity in the frontal regions. Moreover, ideators had increased alpha activity over the posterior regions and increased high beta, low gamma activity over the left occipital region when compared to psychiatric controls. Attempters had reduced beta and low gamma activity over the right temporal region when compared to ideators. In addition, eLORETA localized attempter and ideator reduced frontal activity within the orbito-, medial-, middle-, superior-, and inferior-frontal areas and the anterior cingulate cortex. In attempters, reduced right temporal activity was localized within the right inferior-, middle-, and superior-temporal cortices and the fusiform gyrus. CONCLUSIONS: Frequency power characteristics of attempters and ideators are consistent with findings from the neuroimaging literature concerning suicide, implying EEG resting state assessment could become a potential biomarker to predict suicide risk.

Extended suicide, or homicide followed by suicide.

BACKGROUND: Suicide with accompanying homicide is frightening and ill understood. AIMS: To raise professional awareness of its complexities and difficulties and identify areas for developing research. METHOD: A Crime in Mind seminar was held in London in December 2018, with four expert presentations and discussion. This paper draws on that seminar and supplementary literature. FINDINGS: Homicide/suicide is very difficult to predict and thus prevent. Victims and perpetrators may have a dependency relationship. Better training, especially of general practitioners, may increase the likelihood of detecting signs of despair and delusional ideas. Psychiatrists should be more alert to fixed delusions and homicidal thoughts. Individual assessment and management alone is unlikely to be sufficient. Public health strategies are likely to be important too. Weapons control is vital. Employers of people with great personal responsibility and special access to potentially lethal tools, such as airline pilots, and perhaps clinicians, should have regular, compulsory, mental health checks. CONCLUSIONS: Six points of clinical importance emerged, including lowering the threshold for diagnosing delusional disorder and the establishment of anti-violence clinics.

Physician Aid-in-Dying and Suicide Prevention in Psychiatry: A Moral Crisis?

Involuntary psychiatric commitment for suicide prevention and physician aid-in-dying (PAD) in terminal illness combine to create a moral dilemma. If PAD in terminal illness is permissible, it should also be permissible for some who suffer from nonterminal psychiatric illness: suffering provides much of the justification for PAD, and the suffering in mental illness can be as severe as in physical illness. But involuntary psychiatric commitment to prevent suicide suggests that the suffering of persons with mental illness does not justify ending their own lives, ruling out PAD. Since both practices have compelling underlying justifications, the most reasonable accommodation might seem to be to allow PAD for persons with mental illness whose suffering is severe enough to justify self-killing, but prohibit PAD for persons whose suffering is less severe. This compromise, however, would require the articulation of standards by which persons' mental as well as physical suffering could be evaluated. Doing so would present a serious philosophical challenge.