The Role of Gender in Patients with Borderline Personality Disorder: Differences Related to Hopelessness, Alexithymia, Coping Strategies, and Sensory Profile.

Background and Objectives: Gender differences are poorly investigated in patients with borderline personality disorder (BPD), although they could be useful in determining the most appropriate pharmacological and non-pharmacological treatment. The aim of the present study was to compare sociodemographic and clinical characteristics and the emotional and behavioral dimensions (such as coping, alexithymia, and sensory profile) between males and females with BPD. Material and Methods: Two hundred seven participants were recruited. Sociodemographic and clinical variables were collected through a self-administered questionnaire. The Adolescent/Adult Sensory Profile (AASP), Beck Hopelessness Scale (BHS), Coping Orientation to Problems Experienced (COPE), and Toronto Alexithymia Scale (TAS-20) were administered. Results: Male patients with BPD showed more involuntary hospitalizations and greater use of alcohol and illicit substances compared to females. Conversely, females with BPD reported more frequent medication abuse than males. Furthermore, females had high levels of alexithymia and hopelessness. Regarding coping strategies, females with BPD reported higher levels of "restraint coping" and "use of instrumental social support" at COPE. Finally, females with BPD had higher scores in the Sensory Sensitivity and Sensation Avoiding categories at the AASP. Conclusions: Our study highlights gender differences in substance use, emotion expression, future vision, sensory perception, and coping strategies in patients with BPD. Further gender studies may clarify these differences and guide the development of specific and differential treatments in males and females with BPD.

Mechanical Restraint in Inpatient Psychiatric Unit: Prevalence and Associated Clinical Variables.

Background and Objectives: mechanical restraint (MR) is a controversial issue in emergency psychiatry and should be better studied to implement other alternative therapeutic interventions. The aim of this study was to estimate the prevalence of MR in an Italian psychiatric unit and identify the sociodemographic and clinical characteristics as well as the pharmacological pattern associated with MR. Materials and Methods: all subjects (N = 799) consecutively admitted to an Italian psychiatric inpatient unit were recruited. Several sociodemographic and clinical characteristics were recorded. Results: The prevalence of MR was 14.1%. Males, a younger age, and a single and migrant status were associated with the MR phenomenon. MR was more prevalent in patients affected by other diagnoses and comorbid illicit substance use, in patients with aggressive behaviors, and those that were involuntary admitted, leading significantly to hospitalization over 21 days. Furthermore, the patients that underwent MR were taking a lower number of psychiatric medications. Conclusions: Unfortunately, MR is still used in emergency psychiatry. Future research should focus on the dynamics of MR development in psychiatry, specifically considering ward- and staff-related factors that could help identify a more precise prevention and alternative intervention strategies.

[Contain psychomotor agitation in somatic units : implementation of a protocol at the HUG]. / Contenir l'agitation psychomotrice dans les unités somatiques : mise en place d'un protocole aux HUG.

Psychomotor agitation in somatic units is a medical and psychiatric emergency requiring rapid intervention by the team in charge of the patient and the liaison psychiatrist. Verbal de-escalation is attempted throughout the treatment. Securing the surroundings is needed to protect both the patient and the team. The etiology of the agitation, somatic and/or psychiatric, should be investigated to allow the administration of an adequate treatment. Antipsychotics and benzodiazepines are often recommended. Physical restraint measures can be applied as a last resort if necessary. The continuation of care is decided jointly between the team in charge and the liaison psychiatrist. An intervention protocol has been drawn up by the HUG liaison psychiatry team.

L'agitation psychomotrice dans les unités somatiques est une urgence médicale et psychiatrique qui nécessite une intervention rapide de l'équipe en charge et du psychiatre de liaison auprès du patient. Une désescalade verbale est tentée tout au long de la prise en charge. La sécurisation de l'environnement pour protéger le patient et l'équipe est primordiale. L'étiologie de l'agitation, somatique et/ou psychiatrique, doit être recherchée, ce qui permet l'administration d'un traitement adéquat. Les antipsychotiques et les benzodiazépines sont souvent préconisés. Des mesures de contention physique peuvent être appliquées en dernière intention si besoin. La poursuite des soins se décide en commun entre l'équipe en charge et le psychiatre de liaison. Un protocole d'intervention a été élaboré par l'équipe de la psychiatrie de liaison des HUG.

Polypharmacy as maintenance treatment in bipolar illness: A systematic review.

OBJECTIVES: Polypharmacy is common in maintenance treatment of bipolar illness, but proof of greater efficacy compared to monotherapy is assumed rather than well known. We systematically reviewed the evidence from the literature to provide recommendations for clinical management and future research. METHOD: A systematic review was conducted on the use of polypharmacy in bipolar prophylaxis. Relevant papers published in English through 31 December 2019 were identified searching the electronic databases MEDLINE, Embase, PsycINFO, and the Cochrane Library. RESULTS: Twelve studies matched inclusion criteria, including 10 randomized controlled trials (RCTs). The best drug combination in prevention is represented by lithium + valproic acid which showed a significant effect on time to mood relapses (HR = 0.57) compared to valproic acid monotherapy, especially for manic episodes (HR = 0.51). The effect was significant in terms of time to new drug treatment (HR = 0.51) and time to hospitalization (HR = 0.57). A significant reduction in the frequency of mood relapses was also reported for lithium + valproic acid vs. lithium monotherapy (RR=0.12); however, the trial had a small sample size. Lamotrigine + valproic acid reported significant efficacy in prevention of depressive episodes compared to lamotrigine alone. CONCLUSIONS: The literature to support a generally greater efficacy with polypharmacy in bipolar illness is scant and heterogeneous. Within that limited evidence base, the best drug combination in bipolar prevention is represented by lithium + valproic acid for manic, but not depressive episodes. Clinical practice should focus more on adequate monotherapy before considering polypharmacy.

Antibiomania: a case report of clarithromycin and amoxicillin-clavulanic acid induced manic episodes separately.

BACKGROUND: Antibiomania is a rare but recognized side effect with yet unclear definite pathogenesis although multiple hypotheses have been proposed. The novelty of this case is the suspected pharmacodynamic drug-drug interaction between clarithromycin and amoxicillin-clavulanic acid. CASE PRESENTATION: We present the occurrence of a brief manic episode concerning a 50-year-old man with no psychiatric history, first started on amoxicillin-clavulanic acid therapy and then switched to clarithromycin for left basal pneumonia. Shortly after the antibiotic prescription, he presented psychiatric symptomatology (logorrhea, elevated mood, irritability, increase in physical activity and delusions). The antibiotic was stopped and the patient received lorazepam (2.5 mg p.o.) to treat psychomotor agitation. Approximately 12 h after clarithromycin cessation, amelioration was already observed, supporting the diagnosis of a clarithromycin-induced manic episode. Amoxicillin-clavulanic acid was then reintroduced because of the pneumonia and psychiatric symptoms reemerged. This second antibiotic was also stopped, and 1 week later, the patient was symptom-free. CONCLUSION: The emergence of psychiatric side effects related to antibiotherapy, which is a common treatment, can greatly impact a patient's quality of life. Early recognition and intervention could substantially influence the administered medical care and recovery. Moreover, given the widespread use of antibiotics including in combination, we thought our case report might be clinically useful as a clinical reminder relevant to the use of antibiotic combinations.

Psychiatric emergency admissions during and after COVID-19 lockdown: short-term impact and long-term implications on mental health.

BACKGROUND: The 'lockdown' measures, adopted to restrict population movements in order to help curb the novel coronavirus disease 2019 (COVID-19) pandemic, contributed to a global mental health crisis. Although several studies have extensively examined the impact of lockdown measures on the psychological well-being of the general population, little is known about long-term implications. This study aimed to identify changes in psychiatric emergency department (ED) admissions between two 8-week periods: during and immediately after lifting the lockdown. METHODS: Socio-demographic and clinical information on 1477 psychiatric ED consultations at the University Hospital of Geneva (HUG) were retrospectively analyzed. RESULTS: When grouped according to admission dates, contrary to what we expected, the post-lockdown group presented with more severe clinical conditions (as measured using an urgency degree index) compared to their lockdown counterparts. Notably, after the lockdown had been lifted we observed a statistically significant increase in suicidal behavior and psychomotor agitation and a decrease in behavior disorder diagnoses. Furthermore, more migrants arrived at the HUG ED after the lockdown measures had been lifted. Logistic regression analysis identified diagnoses of suicidal behavior, behavioral disorders, psychomotor agitation, migrant status, involuntary admission, and private resident discharge as predictors of post-lockdown admissions. CONCLUSIONS: Collectively, these findings can have implications concerning the prioritization of mental health care facilities and access for patients at risk of psychopathological decompensation in time of confinement policies, but above all, provide a foundation for future studies focusing on the long-term impact of the pandemic and its associated sanitary measures on mental health. TRIAL REGISTRATION: Research Ethics Committee of Geneva, Registration number 2020-01510, approval date: 29 June 2020.

Are Demoralization and Insight Involved in Suicide Risk? An Observational Study on Psychiatric Inpatients.

INTRODUCTION: Several features contribute to determining suicide risk. This study was designed with the aim of evaluating whether insight into illness and demoralization are involved in suicide risk (active suicidal ideation or behavior). METHODS: For this purpose, in a sample of 100 adult psychiatric inpatients, we used the Columbia Suicide Severity Rating Scale to assess suicide risk, the Demoralization Scale for demoralization symptoms, and the Insight Scale to assess illness insight. We also investigated several demographic and clinical features, including gender, age, duration of untreated illness, previous suicide attempts, and nonsuicidal self-injurious behavior. RESULTS: The results demonstrated that patients with higher scores on the insight-high dimension had 1.35 greater odds of having a higher suicide risk, and those with lifetime suicide attempts had 7.45 greater odds of having a higher suicide risk. Among the various clinical factors, the study indicated that only nonsuicidal self-harm behaviors in the last 3 months was a risk factor for suicide risk. CONCLUSIONS: The results indicated that greater illness insight is involved in suicide risk regardless of demoralization.

Patients with first versus multiple episodes of self-harm: how do their profiles differ?

BACKGROUND: Self-harm (SH) is among the strongest predictors of further episodes of SH, suicide attempt, and death by suicide. People who repeteadly harm themselves are at even higher risk for suicide. Factors influencing the repetition are important to identify when assessing suicidal risk and thereafter to offer specific interventions. Therefore, this study aimed to compare first versus multiple episodes characteristics in a large sample of patients in french-speaking Switzerland. METHOD: We used the database from the French-speaking Swiss program for monitoring SH. Data of the psychiatric assessment of all adults admitted for SH were collected in the emergency department of four Swiss city hospitals between December 2016 and October 2019. RESULTS: 1730 episodes of SH were included. Several variables were significantly associated with multiple episodes, including diagnosis (over representation of personality disorders and under representation of anxiety disorders), professional activity (Invalidity insurance more frequent) and prior psychiatry care. CONCLUSIONS: Patients suffering from a personality disorder and those with invalidity insurance are at risk for multiple episodes of SH and should be targeted with specific interventions.

COVID-19 Related Fears of Patients Admitted to a Psychiatric Emergency Department during and Post-Lockdown in Switzerland: Preliminary Findings to Look Ahead for Tailored Preventive Mental Health Strategies.

Background and Objectives: While the impact on mental health of 2019 coronavirus (COVID-19) has been extensively documented, little is known about its influence on subjective fears. Here, we investigate the COVID-19 impact and its related restrictions on fears of patients admitted to a psychiatric Emergency Department (ED) during and post-lockdown. Materials and Methods: A retrospective study on 1477 consultations at the psychiatric ED of the University Hospital of Geneva (HUG) was performed using a mixed-methods analysis. The first analysis section was qualitative, aiming to explore the type of fears, while the second section statistically compared fears (i) during lockdown (16 March 2020-10 May 2020) and (ii) post-lockdown (11 May 2020-5 July 2020). Fears were also explored among different patient-age sub-groups. Results: 334 patients expressed one/more fears. Both in lockdown and post-lockdown, fears mostly pertained to "containment measures" (isolation, loneliness). When compared lockdown vs. post-lockdown, fears about "work status" (deteriorating, losing work) prevailed in lockdown (p = 0.029) while "hopelessness" (powerless feeling, inability to find solutions) in post-lockdown (p = 0.001). "Self around COVID-19" (dying, getting sick) fear was relatively more frequent in youth (p = 0.039), while "hopelessness" in the elderly (p < 0.001). Conclusions: Collectively, these findings highlight that lockdown/post-lockdown periods generated temporally and demographically distinct COVID-19 related fears patterns, with special regard to youth and elderly, two particularly vulnerable populations when faced with sudden and unexpected dramatic events. For this reason, the particular ED "front-line service" status makes it a privileged observatory that can provide novel insights. From a mental health perspective, these latter can be translated into pragmatic, more personalized prevention strategies to reinforce specific resilience resources and mitigate the current and long-term pandemic's impact.

[About the use of ketamine in emergency psychiatric settings]. / À propos de l'utilisation du traitement de la kétamine aux urgences psychiatriques.

Ketamine and its S-enantiomer, esketamine, have shown to be promising molecules for use in psychiatry. Widely investigated for the treatment of drug-resistant depression, they could be used in emergency conditions, due to their rapid onset of action, in two main conditions : 1) psychomotor agitation, and 2) acute suicidal ideation and behavior (suicidal crisis). In particular, intranasal administration offers a non-invasive, safe and very easy to administer option. An effect begins a few hours to a day after intake and lasts for about a week. These molecules present an innovative option for the future and their specific use in psychiatric emergencies.

La kétamine et son énantiomère S, l'eskétamine, se sont révélés être des molécules prometteuses pour leur utilisation en psychiatrie. Largement étudiées pour le traitement de la dépression pharmacorésistante, elles pourraient être utilisées dans des conditions d'urgence et, grâce à leur rapidité d'action, dans deux situations : 1) l'agitation psychomotrice, et 2) l'idéation et le comportement suicidaire aigus (crise suicidaire). En particulier, l'administration par voie intranasale offre une option non invasive, sûre et facile à utiliser. On observe un effet quelques heures à un jour après la prise, qui perdure pendant environ une semaine. Ces molécules représentent une option innovatrice pour le futur et pour une utilisation spécifique aux urgences psychiatriques.

Suicidality in Patients with Brain Tumors: A Brief Literature Review with Clinical Exemplar.

Background: Suicidality and brain tumors are two life-threatening conditions and, somewhat unexpectedly, the associations between them have scarcely been reported. Objective: In this study, we aimed to provide a brief literature review of epidemiological studies on suicidal ideation (SI) and suicidal behavior (SB) in patients with brain tumors. To illustrate various aspects of brain tumors that potentially underlie the emergence of suicidality, the review is supplemented with a clinical exemplar of a long-term survivor of brain tumor (glioblastoma) who experienced persistent SI. Furthermore, we discuss putative both neurobiological (including anatomical and immunological) and psychosocial mechanisms that might be accountable for the development of SI and SB in patients with brain tumors. Conclusions: While the etiology of this phenomenon appears to be multifactorial and still remains a subject of much debate, it is of critical importance to identify patients for which a psychiatric evaluation could recognize, in a timely manner, a possible suicide risk and alleviate the deep related suffering, by appropriate psychopharmacological and supportive and psychotherapeutic interventions.

Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry.

BACKGROUND AND OBJECTIVES: Psychiatric disorders constitute frequent causes of emergency department (ED) admissions and these rates are increasing. However, referring to ED a whole range of conditions that could or should be dealt with elsewhere is imposing itself as a problematic situation. We aimed: (1) to provide a descriptive picture of the socio-demographic and diagnostic characteristics of the visits among adults at the psychiatric ED; (2) to estimate the clinical pertinence of these visits. MATERIALS AND METHODS: Retrospective analysis of diagnostic/socio-demographic characteristics and clinical trajectories of patients admitted for a psychiatric condition at the adult psychiatric ED of the University Hospital of Geneva (HUG), Switzerland, during a 6-week timespan. RESULTS: In our sample (n = 763 total admissions for psychiatric conditions; n = 702 for inclusion of patients having received a medical evaluation), depression/anxiety, suicidal behavior (SB), psychotic episode, and substance use disorder (SUD), in descending order, were the most common diagnoses for referral. Patients belonged to younger age groups (≤65 years), had a familial status other than married/in couple, and did not present an unfavorable socio-demographic profile. Concerning the pertinence for a psychiatric ED, primary diagnosis of depression/anxiety is the only variable significantly associated with different grade of degree. By the examination of the patients' trajectory from admission to discharge, the clinical pertinence for a psychiatric ED admission existed for cases assigned to the Echelle Suisse du Tri (EST®) scale degree 1 (corresponding to most urgent and severe conditions), particularly for diagnoses of depression/anxiety associated with SB, SB as primary or comorbid diagnosis, and psychotic and manic/hypomanic episode. However, diagnoses of depression/anxiety without urgent and severe features (degrees 2, 3, 4) constituted the most frequent mode of presentation. CONCLUSIONS: Ambulatory and community-integrated settings could be more appropriate for the majority of patients admitted to adult psychiatric EDs. Moreover, the implementation of telepsychiatry strategies represents a very promising opportunity to offer these patients care continuity, reduce costs and filter the demand for psychiatric ED.

[Suicidal crisis and suicide prevention†: psychopharmacological aspects]. / Crise suicidaire et prévention du suicide†: aspects psychopharmacologiques.

Suicide is a common cause of death in Switzerland. It often occurs during a period of crisis marked by a disruption of the subject's intrapsychic, interpersonal or social balance. The management of this crisis is crucial and essentially psychotherapeutic. Drug therapy may be necessary for the management of acute symptoms or for the prevention of long-term suicidal risk. Benzodiazepines and atypical antipsychotics are often used for acute symptoms such as anxiety or sleep disorders while other molecules are recognized in reducing long-term suicidal risk. Some disorders, such as borderline personality disorder, account for more frequent suicidal behaviors. The pharmacological management of these specific situations is discussed.

Le suicide est une cause de mortalité fréquente en Suisse. Il survient souvent durant une période de crise marquée par une perturbation de l'équilibre intrapsychique, interpersonnel ou social du sujet. La prise en charge de cette crise est cruciale et essentiellement psychothérapeutique. Un traitement médicamenteux peut s'avérer nécessaire pour la gestion des symptômes aigus ou la prévention du risque suicidaire à long terme. Les benzodiazépines et les antipsychotiques atypiques sont souvent utilisés pour les symptômes aigus comme l'anxiété ou les troubles du sommeil. D'autres molécules sont reconnues dans la diminution du risque suicidaire à long terme. Certains troubles, comme le trouble borderline, rendent compte de comportements suicidaires plus fréquents. La prise en charge pharmacologique de ces situations spécifiques est discutée.

The Meaning in Life in Suicidal Patients: The Presence and the Search for Constructs. A Systematic Review.

Background and Objectives: Research on suicidal behavior (SB) has frequently focused more on risk factors than protective factors. Since the historic works of Viktor E. Frankl, who inquired how some Nazi concentration camps prisoners maintained their will to live though confronted with pervasive absurdity, Meaning in Life (MiL) has been interpreted as a potent resiliency factor. MiL then declined along a multitude of theoretical perspectives and was associated with various functioning domains of the individual. Surprising, few studies investigated the role of MiL on SB. We aimed to review and synthetize current literature on possible associations between MiL and SB, which included suicidal ideation (SI), suicidal attempts (SA), and completed suicide, focusing on two MiL constructs (the presence of MiL and search for MiL) from Michael F. Steger's recent conceptualization. Material and Methods: A systematic strategy following PRISMA guidelines was used to search for relevant articles in Pubmed/MEDLINE, Scopus, PsycINFO, and ScienceDirect (January 1980-February 2019) and yielded 172 articles, 37 of which met our inclusion criteria. Results: MiL emerged as a protective factor against SI, SA, and completed suicides, directly or through mediation/moderation models with other SB-related variables. When distinguishing the presence of MiL and the search for MiL, a consensual protective impact was described for the former. Data for the latter were less consistent but rather oriented towards a non-protective impact Conclusions: These findings could have clinical repercussions for SB prevention, in both suicide risk assessment refinement and psychotherapeutic interventions. Further research is needed to examine dynamic interplay of the two constructs.

[Demoralization and meaning in life in suicidal ideation†: a role for patients suffering from chronic pain?] / Démoralisation et sens dans la vie dans l'idéation suicidaire†: un role chez les patients douloureux chroniques†?

Chronic pain is strongly related to the emotional state of the individual and may be associated with suicidal ideation. The concepts of demoralization and meaning in life may have a role in suicidal ideation as a factor of crisis and resilience, respectively. Demoralization, and especially one of its elements, hopelessness, predisposes to suicidal behavior and is often associated with chronic pain conditions. In addition, the meaning that a patient with chronic pain attributes to his or her existence may also influence suicidal behavior. Follow-ups focused on demoralization and meaning in life may be a promising psychotherapeutic approach for patients suffering from chronic pain.

La douleur chronique est fortement liée à l'état émotionnel de l'individu et peut être associée à l'idéation suicidaire. Les concepts de démoralisation et de sens dans la vie peuvent avoir un rôle sur l'idéation suicidaire respectivement en tant que facteur de crise et de résilience. La démoralisation, et surtout l'un de ses éléments, le désespoir, prédispose au comportement suicidaire et est souvent associée à des états douloureux chroniques. En outre, le sens qu'un patient souffrant de douleurs chroniques peut attribuer à son existence peut également influencer le comportement suicidaire. Une prise en charge centrée sur la démoralisation et le sens dans la vie pourrait constituer une approche psychothérapeutique prometteuse pour les patients souffrant de douleurs chroniques.

[Prevention of suicide at Emergency Room: from the « Interpersonal Theory of Suicide ¼ to the connectedness]. / Prévenir le suicide aux urgences : de la « Théorie Interpersonnelle du Suicide ¼ à la connectedness.

Suicidal behavior (SB) has a dramatic epidemiological and clinical relevance in Switzerland. Both official reports and literature highlight SB prevention as a priority and recommend adopting new approaches, inspired by psychological models and ensuing in pragmatic interventions. Moreover, Emergency Room's (ER) role as a critical link in SB prevention chain is encouraged. Based on « Interpersonal Theory of Suicide ¼, « impossible situation ¼, and connectedness constructs, such interventions could be realized at ER through m-Health applications, with the main aim of reinforcing the patient's feeling of connectedness to his context. However, these applications have to be used with a critical view, because in no case they can be assimilated to clinical evaluation or human presence and interaction in the therapeutic relation.

Les conduites suicidaires ont une signification épidémiologique et clinique dramatique en Suisse. Les rapports officiels et la littérature font de leur prévention une priorité et recommandent de nouvelles approches, inspirées des modèles psychologiques et entraînant des interventions pragmatiques. En outre, le rôle des urgences, lien crucial dans la chaîne de prévention, est encouragé. Sur la base des postulats de la « Théorie Interpersonnelle du Suicide ¼, de la « situation impossible ¼ et de la connectedness, ces interventions pourraient s'opérer aux urgences à travers des applications m-Health. Cependant, il convient d'adopter une vision critique et attentive, car ces applications ne doivent en aucun cas se substituer à l'évaluation clinique ni à la présence et à l'interaction humaines dans la relation thérapeutique.

Neurobiology of suicide: do biomarkers exist?

Clinical risk factors have a low predictive value on suicide. This may explain the increasing interest in potential neurobiological correlates and specific heritable markers of suicide vulnerability. This review aims to present the current neurobiological findings that have been shown to be implicated in suicide completers and to discuss how postmortem studies may be useful in characterizing these individuals. Data on the role of the main neurobiological systems in suicidality, such as the neurotransmitter families, hypothalamic-pituitary-adrenal axis, neurotrophic factors, and polyamines, are exposed at the different biochemical, genetic, and epigenetic levels. Some neuroanatomic and neuropathological aspects as well as their in vivo morphological and functional neuroimaging correlates are also described. Except for the serotoninergic system, particularly with respect to the polymorphism of the gene coding for the serotonin transporter (5-HTTLPR) and brain-derived neurotrophic factor, data did not converge to produce a univocal consensus. The possible limitations of currently published studies are discussed, as well as the scope for long-term prospective studies.

Effectiveness of physical barriers to prevent suicide by jumping from high-risk bridges: From an integrative review to a northern Italian province's paradigm.

Background: Although uncommon, suicide by jumping is almost always lethal and can be significantly elevated locally due to the availability of tall structures including bridges and other high-risk locations. Empirical evidence suggests that restricting access to certain suicide methods is highly effective at preventing suicide, prompting the construction of physical barriers in many high-risk jumping locations. However, some have argued that these measures are too costly and only lead to method or location substitution. Objectives: To examine whether physical barriers are effective at preventing suicide by jumping or whether method or location substitution occur. Methods: An integrative review of the most representative literature. Results: Results clearly show that physical barriers are highly effective at preventing suicide by jumping with little to no method or location substitution occurring. Furthermore, their cost is far outweighed by the monetary benefits of averted suicides. Conclusions: Using the Italian pre-alpine/alpine areas as a paradigm, we argue that local topography and socioeconomic particularities led to significantly elevated rates of suicide in general, and of suicide by jumping from bridges in particular, especially among young adults who are more vulnerable to economic crises and show elevated susceptibility to impulsive acts, a known characteristic associated with suicide by jumping, which makes the issue even more topical and clinically relevant. As these finding are easily generalized to other territories with similar topographical and/or economic characteristics, we end with a call to action, urging local authorities to heed the scientific evidence and take the necessary steps to improve suicide prevention.

The Role of Emotion Dysregulation in Understanding Suicide Risk: A Systematic Review of the Literature.

Suicide prevention represents a global imperative, and efforts to identify potential risk factors are intensifying. Among these, emotional regulation abilities represent a transdiagnostic component that may have an impactful influence on suicidal ideation and behavior. Therefore, the present systematic review aimed to investigate the association between emotion dysregulation and suicidal ideation and/or behavior in adult participants. The review followed PRISMA guidelines, and the research was performed through four major electronic databases (PubMed/MEDLINE, Scopus, PsycInfo, and Web of Science) for relevant titles/abstracts published from January 2013 to September 2023. The review included original studies published in peer-reviewed journals and in English that assessed the relationship between emotional regulation, as measured by the Difficulties in Emotional Regulation Scale (DERS), and suicidal ideation and/or behavior. In total, 44 studies were considered eligible, and the results mostly revealed significant positive associations between emotion dysregulation and suicidal ideation, while the findings on suicide attempts were more inconsistent. Furthermore, the findings also confirmed the role of emotion dysregulation as a mediator between suicide and other variables. Given these results, it is important to continue investigating these constructs and conduct accurate assessments to implement effective person-centered interventions.

Global trends in youth suicide from 1990 to 2020: an analysis of data from the WHO mortality database.

Background: Suicide is a serious but preventable public health concern at the global level, showing relevant geographical differences. This study aims to monitor global temporal and geographical patterns in suicide mortality in pre-adolescents, adolescents, and young adults (i.e., aged 10-24 years), from 1990 to 2020 or the most recent available year. Methods: Using the World Health Organisation mortality database, we conducted an analysis on a subset of 52 countries with valid and high-quality data. We computed age-standardised suicide rates (ASR) by sex, country, and calendar year, and performed a joinpoint regression analysis to identify significant changes in the temporal suicide trends over the studied period. Findings: High variability in suicide rates and trends was observed, with a male-to-female ratio of two to five. Between 1990 and 2020, most European countries reported declining suicide trends, with some exceptions. In particular, alarming trends emerged in the United Kingdom, with annual rises of 2.5% (95% CI: 1.6-3.5) since 2005 among males and 8.5% (95% CI: 4.7-12.6) since 2012 among females. The most favorable trends and lowest suicide rates were in Southern Europe, with 3.1/100,000 persons in Italy (2020) and 3.5/100,000 persons in Spain (2021) among males, and 0.9/100,000 persons in Italy (2020) and 1.1/100,000 persons in Romania (2019) among females. Conversely, the highest rates were in Central-Eastern Europe, with 10.2/100,000 males in the Russian Federation (2019) and 10.0/100,000 males in Poland (2002). Higher suicide rates and significant increases were reported in not European areas. The highest ASR was 15.5/100,000 males in the United States of America, with an annual increase of 3.8% (95% CI: 3.1-4.5) among males in 2009-2020 and 6.7% (95% CI: 5.6-7.8) among females in 2007-2017, followed by a levelling off. Interpretation: Temporal and geographical comparisons of suicide mortality should be interpreted with caution due to potential misclassification or under-reporting of suicide deaths in some countries. Funding: None.