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Background: Suicide is a worldwide public health problem. In response to this problem, Australia was one of the first countries to develop national suicide prevention policy. Guided by the National Suicide Prevention Office (NSPO), which was established in 2021, suicide prevention in Australia is in a period of reform. The NSPO is driving a nationally consistent and integrated approach to suicide prevention including leading the development of a new National Suicide Prevention Strategy. This article summarises findings from an environmental scan of government-led suicide prevention in Australia, conducted as an input for the development of the new Strategy. Methods: The scan was conducted from August 2022 to January 2023. We searched relevant government websites and Google to identify policy documents and programs and services. We undertook a desktop review of documents and programs/services using coding templates developed to address the objectives of the scan. Qualitative information was extracted in a systematic manner using these templates. Results: Australia's suicide prevention efforts are significant as demonstrated by activities ranging from policy documents intended to guide and plan activity, the National Mental Health and Suicide Prevention Agreement committing the Federal Government and jurisdictions to work together, and the availability of national, state, local area based, and digital services and programs. Suicide prevention approaches in Australia are mostly selective or indicated. There is less emphasis on universal approaches, wellbeing promotion, strengthening protective factors and mitigating the impact of known drivers of distress. In addition, there is limited evidence to demonstrate a whole-of-government or whole-of-system approach is operating in Australia. Findings should be interpreted in the context that suicide prevention in Australia is currently in a period of transition. Conclusions: Current government emphasis on and investment in suicide prevention activity, together with strong commitment to lived experience and cross sectorial collaboration, are substantial and appropriate. There are also many opportunities to further progress cross-portfolio and cross-jurisdiction suicide prevention and response efforts. This requires urgently adopting a shared understanding of suicide, which includes the diverse drivers of suicidal distress, and improving protective factors and social wellbeing. [ABSTRACT FROM AUTHOR]

Experiencing the suicide of a parent or a sibling is one of the most disruptive and stressful events in the life of a child or adolescent. Yet, little is known about the effectiveness of support offered to children and adolescents bereaved by suicide. This study aimed to evaluate participant and facilitator's perceived helpfulness of the new online Let's Talk Suicide program, piloted in 2021. Thematic Analysis of qualitative interviews with 4 children, 7 parents, and 3 facilitators (N = 14). The analysis identified four themes focused on suicide bereavement specific support, the online environment experiences, expectations and perceived outcomes of the program, and parents' involvement in the program. The young participants, parents, and facilitators were very positive about the program. They felt that it supported the children in their grief after suicide, helped to normalize their experiences, offered social support from peers and professionals, and enhanced their language and skills to express themselves and to deal with their emotions. Though longitudinal research is needed, the new program seems to address an existing gap in postvention services for children and adolescents bereaved by suicide. The children felt supported in their grief as it enhanced their skills and language to express themselves. The program also acknowledged the parents and supported them in their parenting role. Future longitudinal studies may enhance the evidence of effectiveness of the program. [ABSTRACT FROM AUTHOR]

Objective: In the United States, there was an increase in calls to helplines following media reporting of Robin Williams' suicide. We aimed to determine whether this was the case in Australia. Method: The helpline services Lifeline and Beyond Blue provided us with weekly data on calls received for 2013–2015. We conducted interrupted time series regression analyses to determine whether there was an increase in the average weekly number of calls received by each helpline in two periods after the story about Williams' suicide broke (1 week and 4 weeks). Results: We found strong evidence of an increase in calls to Lifeline (incidence rate ratio [IRR] =1.13; 95% confidence interval [CI] =1.02–1.25; p = 0.016) and Beyond Blue (IRR = 1.32; 95% CI = 1.09–1.59; p = 0.004) in the week after Williams' suicide was first reported. We found no evidence of higher than normal call volumes for Lifeline (IRR = 1.04; 95% CI = 0.99–1.10; p = 0.104) or Beyond Blue (IRR = 1.10; 95% CI = 1.00–1.22; p = 0.058) over the four weeks following Williams' death, however, suggesting that calls leveled out over this period. Conclusion: Suicide prevention experts and media professionals must work together to minimize the negative impacts of reports on suicide and maximize their positive ones. In cases where the story is likely to receive extensive international coverage, it may be important for local media to encourage help‐seeking. [ABSTRACT FROM AUTHOR]

Objectives: Depression is a significant public health issue for men, however men are less likely to use mental health services. Alternative interventions, such as physical activity, may be of value for this population. This study sought to determine what levels and intensity of physical activity are associated with lower depression prevalence in Australian men.Methods: Using baseline data from 13,884 participants in the Australian Longitudinal Study on Male Health we compared current depression in men who completed the recommended 150 min of physical activity in the past week with men who did not. Duration of activity was examined using logistic regression with restricted cubic splines. Intensity of physical activity was examined by isotemporal substitution of hours of moderate activity with hours of vigorous activity.Results: Men who completed at least 150 min/week of activity had lower odds of moderate/severe depression symptoms. Duration of activity was inversely associated with moderate/severe depression symptoms. Among physically active men, each additional hour of moderate activity replaced with vigorous activity was associated with lower odds of depression.Limitations: This is a cross-sectional study and so cannot determine causal direction in the relationship between physical activity and depression symptoms observed. Self-report measures of physical activity are widely used but are not as accurate as biometric measurement.Conclusions: In adult men, meeting minimum recommendations is associated with lower current depression. Increased duration and greater intensity of activity were both associated with further reduction in prevalence. Promoting higher levels of physical activity is potentially an intervention for improving men's mental wellbeing. [ABSTRACT FROM AUTHOR]

Objective: This study assessed the extent to which local reporting of Robin Williams' suicide (on 11 August 2014) was associated with suicide in Australia. It followed several studies in the United States which showed that there were significant increases in suicide following media reports of Williams' death and that those media reports were less than optimal in terms of adherence to best-practice guidelines. In a previous study, we demonstrated that Australian media reports of Williams' suicide were largely adherent with our Mindframe guidelines on responsible reporting of suicide, so we speculated that there would be no increase in suicide following the reporting of Williams' suicide in Australia. Method: We extracted data on Australian suicides from the National Coroners Information System for the period 2001 to 2016. We conducted interrupted time series regression analyses to determine whether there were changes in suicides in the 5-month period immediately following Williams' suicide. Results: Our hypothesis that there would be no increase in suicides in Australia following Williams' highly publicised suicide was not supported. There was an 11% increase in suicides in the 5-month period following Williams' death, largely accounted for by men aged 30–64 and by people who died by hanging (the method Williams used). Conclusion: It may be that Australians were exposed to reports that contravened safe reporting recommendations, particularly via overseas media or social media, and/or that some Australian reports may have had unhelpful overarching narratives, despite largely adhering to the Mindframe guidelines. The Mindframe guidelines constitute international best practice but consideration should be given to whether certain recommendations within them should be further reinforced and whether more nuanced information about how stories should be framed could be provided. Future revision and augmentation of the Mindframe guidelines should, as always, involve media professionals. [ABSTRACT FROM AUTHOR]

Background: The Australian Longitudinal Study on Male Health (Ten to Men) was established in 2011 to build the evidence base on male health to inform policy and program development.Methods: Ten to Men is a national longitudinal study with a stratified multi-stage cluster random sample design and oversampling in rural and regional areas. Household recruitment was conducted from October 2013 to July 2014. Males who were aged 10 to 55 years residing in private dwellings were eligible to participate. Data were collected via self-completion paper questionnaires (participants aged 15 to 55) and by computer-assisted personal interview (boys aged 10 to 14). Household and proxy health data for boys were collected from a parent via a self-completion paper-based questionnaire. Questions covered socio-demographics, health status, mental health and wellbeing, health behaviours, social determinants, and health knowledge and service use.Results: A cohort of 15,988 males aged between 10 and 55 years was recruited representing a response fraction of 35 %.Conclusion: Ten to Men is a unique resource for investigating male health and wellbeing. Wave 1 data are available for approved research projects. [ABSTRACT FROM AUTHOR]

Background: Suicide is a leading cause of death in Australian males aged 18 to 55. Non-fatal suicidal behaviours and thoughts are indicators of increased risk for future suicide. Suicidal behaviour is complex and multi-determined. Research supports the involvement of stressful life events in suicide and suicidal behaviour, however the evidence regarding suicidal thoughts is less developed. This study investigates stressful life events in relation to suicidal ideation in a large cohort of adult males recruited into Ten to Men, the Australian Longitudinal Study on Male Health.Methods: Baseline data from a national cohort of 13, 884 males aged 18-55 years on suicidal behaviour, psychiatric disorder and life events was used. Multivariable logistic regressions were conducted with current suicidal ideation as the outcome and 12 month life events, 12 month depression, anxiety and harmful/hazardous alcohol use, and socio-demographics as covariates. Further logistic regression models investigated the relative risk of life stress alone, depression/alcohol/anxiety alone and co-occurring life stress and depression/alcohol/anxiety.Results: In multivariable models there was an independent contribution to suicidal ideation for six of 24 life events (ORs 1.27-1.95), 12 month depression (OR 4.49) harmful alcohol use (OR 1.38) and anxiety disorders (OR 1.27). Life events co-occurring with depression (OR 10.3) was higher risk than either alone (depression OR 6.6; life stress OR 2.6). There was a lesser effect for co-occurrence in the anxiety and harmful alcohol use models.Conclusion: Life events appear to be related to suicidal ideation independent of depression, anxiety and harmful alcohol use in adult males, however if life events occur in the context of depression that risk is substantially increased. [ABSTRACT FROM AUTHOR]

The importance of addressing health disparities experienced by boys and men reached tangible prominence in Australia with adoption of the 2010 National Male Health Policy and the establishment of a national longitudinal study on male health—Ten to Men. Ten to Men is based on a holistic model of health with a strong focus on social determinants and health and well-being over the life course. Given the life course focus, we set out to assess if health-related characteristics and the correlates of self-rated health differ across the life course among four sociologically defined generations of Australian males. While some differences in the correlates of good or excellent health were observed across generations, addressing obesity and depression appear to be important for improving the health of Australian males of all ages. [ABSTRACT FROM AUTHOR]

In most countries, men complete suicide at twice the rate of women; masculinity plays an important role in placing men at a greater risk of suicide. This study identifies and describes trends in the topics discussed within the masculinity and suicide literature and explores changes over time. We retrieved publications relating to masculinity and suicide from eight electronic databases and described origins in the field of research by reference to the first decade of publications. We then explored the subsequent evolution of the field by analysis of the content of article titles/abstracts for all years since the topic first emerged, and then separately by three epochs. We included 452 publications (1954–2021); research output has grown substantially in the last five years. Early publications framed suicide in the context of severe mental illness, masculinity as a risk factor, and suicidality as being aggressive and masculine. We observed some differences in themes over time: Epoch 1 focused on sex differences in suicidality, a common theme in epochs 2 was relationship to work and its effect on men's mental health and suicidality, and epoch 3 had a focus on help-seeking in suicidality. The research field of masculinity and suicide is growing strongly, as evidenced by recent increase in publication volume. The structure, content and direction of the masculinity and suicide research are still evolving. Researchers must work with policymakers and practitioners to ensure that emerging findings are translated for use in programs designed to address suicide in boys and men. Masculinity and suicide as a field is not new, with its origins in the literature dating back to 1954. More than half of the total research output in the field (1954–2021) has been published in the last five years. Early work focused on individual-level risk factors to male suicide (e.g., severe mental illness), while contemporary research focused on social and cultural determinants of male suicide (e.g., help-seeking). [ABSTRACT FROM AUTHOR]

Abstract: Background: Tryptophan hydroxylase (TPH) is the rate-limiting enzyme in serotonin synthesis. TPH2 is a recently discovered isoform that is expressed predominantly in serotonin neurons. Associations are reported of TPH2 polymorphisms with MDD, bipolar disorder and suicidal behavior. This study examines a single nucleotide polymorphism in the putative promoter region of the TPH2 gene. Methods: One hundred nine bipolar, 324 major depressive disorder, and 130 healthy volunteers were genotyped for the rs4131347 (−C8347G) promoter SNP. Association was assessed with diagnosis, suicide attempt status, severity of psychopathology and cerebrospinal fluid monoamine metabolite levels of 5-HIAA, HVA, and MHPG. General linear models and logistic regression tested the effect of genotype ⁎ childhood abuse interactions on psychopathology severity and suicide attempt. Results: There was no association between genotype and either mood disorder, suicide attempt status, psychopathology severity or CSF monoamine metabolite levels. Conclusions: No association was detected between the rs4131347 (−C8347G) SNP in the promoter region of the TPH2 gene and mood disorders, suicidal behavior or monoamine function. [Copyright &y& Elsevier]

Predicting suicide is difficult due to the low base rate, even in high-risk groups, and the multi-causal nature of suicidal behavior. Clinical predictors have shown low specificity. Retrospective and cross-sectional studies have identified a number of biologic anomalies associated with suicide and suicide attempt. Prospective studies provide estimates of the predictive utility of biologic measures. Here we review prospective studies of suicidal behavior and serotonergic, noradrenergic, dopaminergic and hypothalamic-pituitary-adrenocortical axis function in mood disorders. The most promising biologic predictors are low CSF 5-HIAA and HPA axis dysfunction as demonstrated by dexamethasone non-suppression that are each associated with about 4.5 fold greater risk of suicide. [ABSTRACT FROM AUTHOR]

Abstract: Background: Mood disorders exhibit familial transmission due to both environmental and genetic risk factors. Mood disorders are more common in women, yet the role of gender in the familial transmission of mood disorders is unclear. This study examines rates of mood disorder transmission to offspring based on the sex of affected parent, sex of offspring and role of clinical factors, such as childhood abuse history, comorbid psychiatric disorders, and traits of aggression and impulsivity. Methods: Risk of transmission of mood disorder to offspring from females and males was compared in a sample of 272 probands with a major mood disorder using generalized estimating equations (GEE). Demographic and clinical characteristics of all male and female probands were compared. Characteristics that differed in probands were entered into the model to obtain an unbiased test of gender differences in transmission rate. Multivariate GEE models, one for male probands and one for female probands, were used to test for risk factors in transmission of mood disorder. Results: Familial transmission rate of mood disorders from female probands was almost double that of males. There was no difference in transmission to male or female offspring. For male probands, offspring mood disorder was independently associated with earlier age of proband mood disorder onset, greater number of proband years ill, and proband history of childhood abuse. For female probands, offspring mood disorder was associated with higher aggression scores in probands. Limitations: We did not directly interview offspring and also had limited data on psychopathology in co-parents. This is a cross-sectional study and cannot account for emergence of illness in offspring in the future. Conclusions: The two-fold higher rate of maternal transmission of mood disorder may reflect differences in regulation of maternal and paternal transmission of mood disorder. Future studies need to determine the relative contribution of genetic and non-genetic factors and identify the factors responsible for higher rates of transmission of mood disorders by females with a mood disorder. [Copyright &y& Elsevier]

Background: Suicide prevention policy in Australia is in a period of reform. The National Suicide Prevention Office is leading the development of a new National Suicide Prevention Strategy (Strategy). Stakeholder input is a critical element in the development of the new Strategy. This article describes key informant views about government-led suicide prevention efforts in Australia obtained as part of an environmental scan conducted as one input to inform the Strategy development process. Methods: We interviewed 24 key informants in November and December 2022. Key informants were purposively recruited to ensure representation from cross-jurisdiction government departments/agencies, peak bodies and leaders in the suicide prevention sector, people with lived experience of suicide, and suicide prevention researchers. We enquired about successes, challenges, and opportunities. NVivo was used to conduct thematic analysis. Results: Key themes identified as successes in Australia's suicide prevention efforts included: leadership and funding for programs, services, and research; valuing the collective lived experience voice; moving towards a whole-of-government/system approach; and high community and political suicide (prevention) awareness. Key themes emerging as challenges in the sector were: defining the suicide prevention sector, limitations in the service system, workforce issues, and building the evidence base. Key themes mentioned as opportunities for improving suicide prevention efforts were: leveraging the current unprecedented awareness and desire for collaboration among multiple stakeholder groups; adopting wellness rather than crisis-driven models of care; including lived experience and co-design in all stages and aspects of policy planning, service development, and evaluation; and investing in data, research, and evaluation. Conclusions: Key informants from across the suicide prevention sector in Australia identified a range of issues for consideration in the development of Australia's new National Suicide Prevention Strategy which are also relevant for suicide prevention policy and program development in other high-income countries. Key issues include the need for concerted efforts to define and build the capacity of the suicide prevention sector, implement and monitor a whole-of-government approach that includes wellness models of care and lived experience, and bolster the evidence base. These efforts require effective leadership and resourcing. [ABSTRACT FROM AUTHOR]

Objectives: The National Suicide Prevention Trial was announced by the Australian Government in 2016 and aimed to prevent suicidal behaviour in 12 trial sites (representing a population of ~8 million). This study investigated the early population-level impact of the National Suicide Prevention Trial activity on rates of suicide and hospital admissions for self-harm in comparison to control areas. Methods: Relative and absolute differences in monthly rates of suicide and hospital admissions for self-harm were compared in the period after the National Suicide Prevention Trial implementation (July 2017–November 2020) to the period prior to implementation (January 2010–June 2017) in (1) 'National Suicide Prevention Trial areas' and (2) 'Control areas', using a difference-in-difference method in a series of negative binomial models. Analyses also investigated whether associations for suicide and self-harm rates differed by key socio-demographic factors, namely sex, age group, area socio-economic status and urban–rural residence. Results: There were no substantial differences between 'National Suicide Prevention Trial areas' and 'Control areas' in rates of suicide (2% relative decrease, relative risk = 0.98, 95% confidence interval = [0.91, 1.06]) or self-harm (1% relative decrease, relative risk = 0.99, 95% confidence interval = [0.96, 1.02]), adjusting for sex, age group and socio-economic status. Stronger relative decreases in self-harm only were evident for those aged 50–64 years, high socio-economic status areas, metropolitan and remote geographic areas. Conclusion: There was limited evidence that the National Suicide Prevention Trial resulted in reductions in suicide or hospital admissions for self-harm during the first 4 years of implementation. Continued monitoring of trends with timely data is imperative over the next 2–3 years to ascertain whether there are any subsequent impacts of National Suicide Prevention Trial activities. [ABSTRACT FROM AUTHOR]

Background: Suicide rates among those employed in male-dominated professions such as construction are elevated compared to other occupational groups. Thus far, past research has been mainly quantitative and has been unable to identify the complex range of risk and protective factors that surround these suicides.Methods: We used a national coronial database to qualitatively study work and non-work related influences on male suicide occurring in construction workers in Australia. We randomly selected 34 cases according to specific sampling framework. Thematic analysis was used to develop a coding structure on the basis of pre-existing theories in job stress research.Results: The following themes were established on the basis of mutual consensus: mental health issues prior to death, transient working experiences (i.e., the inability to obtain steady employment), workplace injury and chronic illness, work colleagues as a source of social support, financial and legal problems, relationship breakdown and child custody issues, and substance abuse.Conclusion: Work and non-work factors were often interrelated pressures prior to death. Suicide prevention for construction workers needs to take a systematic approach, addressing work-level factors as well as helping those at-risk of suicide. [ABSTRACT FROM AUTHOR]

Background: The Australian Longitudinal Study on Male Health (Ten to Men) used a complex sampling scheme to identify potential participants for the baseline survey. This raises important questions about when and how to adjust for the sampling design when analyzing data from the baseline survey.Methods: We describe the sampling scheme used in Ten to Men focusing on four important elements: stratification, multi-stage sampling, clustering and sample weights. We discuss how these elements fit together when using baseline data to estimate a population parameter (e.g., population mean or prevalence) or to estimate the association between an exposure and an outcome (e.g., an odds ratio). We illustrate this with examples using a continuous outcome (weight in kilograms) and a binary outcome (smoking status).Results: Estimates of a population mean or disease prevalence using Ten to Men baseline data are influenced by the extent to which the sampling design is addressed in an analysis. Estimates of mean weight and smoking prevalence are larger in unweighted analyses than weighted analyses (e.g., mean = 83.9 kg vs. 81.4 kg; prevalence = 18.0 % vs. 16.7 %, for unweighted and weighted analyses respectively) and the standard error of the mean is 1.03 times larger in an analysis that acknowledges the hierarchical (clustered) structure of the data compared with one that does not. For smoking prevalence, the corresponding standard error is 1.07 times larger. Measures of association (mean group differences, odds ratios) are generally similar in unweighted or weighted analyses and whether or not adjustment is made for clustering.Conclusions: The extent to which the Ten to Men sampling design is accounted for in any analysis of the baseline data will depend on the research question. When the goals of the analysis are to estimate the prevalence of a disease or risk factor in the population or the magnitude of a population-level exposure-outcome association, our advice is to adopt an analysis that respects the sampling design. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnoea is a common disorder with under-rated clinical impact, which is increasingly being recognised as having a major bearing on global disease burden. Men are especially vulnerable and become a priority group for preventative interventions. However, there is limited information on prevalence of the condition in Australia, its co-morbidities, and potential risk factors.Methods: We used data from 13,423 adult men included in the baseline wave of Ten to Men, an Australian national study of the health of males, assembled using stratified cluster sampling with oversampling from rural and regional areas. Those aged 18-55 years self-completed a paper-based questionnaire that included a question regarding health professional-diagnosed sleep apnoea, physical and mental health status, and health-related behaviours. Sampling weights were used to account for the sampling design when reporting the prevalence estimates. Odds ratios were used to describe the association between health professional-diagnosed sleep apnoea and potential correlates while adjusting for age, country of birth, and body-mass index (BMI).Results: Prevalence of self-reported health professional-diagnosed sleep apnoea increased from 2.2 % in age 18-25 years to 7.8 % in the age 45-55 years. Compared with those without sleep apnoea, those with sleep apnoea had significantly poorer physical, mental, and self-rated health as well as lower subjective wellbeing and poorer concentration/remembering (p < 0.001 for all). Sleep apnoea was significantly associated with older age (p < 0.001), unemployment (p < 0.001), asthma (p = 0.011), chronic obstructive pulmonary disease/chronic bronchitis (p = 0.002), diabetes (p < 0.001), hypercholesterolemia (p < 0.001), hypertension (p < 0.001), heart attack (p < 0.001), heart failure (p < 0.001), angina (p < 0.001), depression (p < 0.001), post-traumatic stress disorder (p < 0.001), other anxiety disorders (p < 0.001), schizophrenia (p = 0.002), overweight/obesity (p < 0.001), insufficient physical activity (p = 0.006), smoking (p = 0.005), and high alcohol consumption (p < 0.001).Conclusion: Health professional-diagnosed sleep apnoea is relatively common, particularly in older males. Associations between sleep apnoea and cardiovascular, metabolic, respiratory, and psychiatric disorders have important clinical and public health implications. As men are especially vulnerable to sleep apnoea as well as some of its chronic co-morbidities, they are potentially a priority group for health interventions. Modifiable lifestyle related factors such as smoking, alcohol consumption, level of physical activity and BMI are possible key foci for interventions. [ABSTRACT FROM AUTHOR]

Self-rated depression and hopelessness severity are predictors of suicide attempt in major depression. This study evaluated whether: (1) greater self-rated distress relative to severity of clinician-rated depression is a trait; (2) that trait is familial; and (3) that trait is linked to familial transmission of suicidal behavior. A total of 285 mood disorder probands and 457 offspring were assessed twice, at least 1 year apart. Family and subject intra-class correlations for self-report depression and hopelessness, controlling for clinician-rated depression severity, were computed. Mixed general linear models determined offspring-proband correlations. Within-individual intra-class correlation (ICC) for depression-hopelessness was 37.8% (bootstrap 95% CI: 31.0–46.3%). Parent-offspring ICC was 10.7% (bootstrap 95% CI: 3.5–17.8%). Suicide attempt concordant parent-offspring correlation for subjective depression was positive, but negative for attempter parent and nonattempter offspring (p = .0213 for slope interaction). Pessimism was greater in proband or offspring attempters than proband or offspring nonattempters (p < .05). Self-reported hopelessness is partly trait-dependent, and there is modest familial transmission of self-reported depression linked to suicidal behavior that may partly explain familial transmission of suicidal behavior. [ABSTRACT FROM PUBLISHER]

Purpose: This study aimed to explore the relationship between the masculine norm of self-reliance and suicidal thoughts among Australian men, hypothesising that lack of help-seeking might mediate the relationship between high self-reliance and the emergence of suicidal thoughts.This study used data from on the Australian Longitudinal Study on Male Health ‘Ten to Men’, a prospective longitudinal cohort study that began in 2013/2014 with boys and men aged 10–55 years (N = 16,021) at wave 1. The focus was on men who participated in waves 1 and 2 (2013/2014, 2015/2016) and had linked administrative data. A causal mediation analysis was conducted to quantify the total effect of self-reliance at wave 1 on suicidal thoughts at wave 2, and to investigate the extent of mediation by help-seeking between waves 1 and 2.High self-reliance was associated with an increased odds of suicidal thoughts (OR = 1.46, 95% CI 1.24–1.72). However, there was no significant mediating effect of a lack of help-seeking on the relationship between self-reliance and suicidal thoughts (OR = 1.00, 95% CI 0.99–1.01).Findings suggest that highly self-reliant men are at an increased risk of experiencing suicidal thoughts; however, this relationship is not explained by lack of help-seeking. Future studies could explore other potential mechanisms to better understand why highly self-reliant men are more likely to experience suicidal thoughts.Methods: This study aimed to explore the relationship between the masculine norm of self-reliance and suicidal thoughts among Australian men, hypothesising that lack of help-seeking might mediate the relationship between high self-reliance and the emergence of suicidal thoughts.This study used data from on the Australian Longitudinal Study on Male Health ‘Ten to Men’, a prospective longitudinal cohort study that began in 2013/2014 with boys and men aged 10–55 years (N = 16,021) at wave 1. The focus was on men who participated in waves 1 and 2 (2013/2014, 2015/2016) and had linked administrative data. A causal mediation analysis was conducted to quantify the total effect of self-reliance at wave 1 on suicidal thoughts at wave 2, and to investigate the extent of mediation by help-seeking between waves 1 and 2.High self-reliance was associated with an increased odds of suicidal thoughts (OR = 1.46, 95% CI 1.24–1.72). However, there was no significant mediating effect of a lack of help-seeking on the relationship between self-reliance and suicidal thoughts (OR = 1.00, 95% CI 0.99–1.01).Findings suggest that highly self-reliant men are at an increased risk of experiencing suicidal thoughts; however, this relationship is not explained by lack of help-seeking. Future studies could explore other potential mechanisms to better understand why highly self-reliant men are more likely to experience suicidal thoughts.Results: This study aimed to explore the relationship between the masculine norm of self-reliance and suicidal thoughts among Australian men, hypothesising that lack of help-seeking might mediate the relationship between high self-reliance and the emergence of suicidal thoughts.This study used data from on the Australian Longitudinal Study on Male Health ‘Ten to Men’, a prospective longitudinal cohort study that began in 2013/2014 with boys and men aged 10–55 years (N = 16,021) at wave 1. The focus was on men who participated in waves 1 and 2 (2013/2014, 2015/2016) and had linked administrative data. A causal mediation analysis was conducted to quantify the total effect of self-reliance at wave 1 on suicidal thoughts at wave 2, and to investigate the extent of mediation by help-seeking between waves 1 and 2.High self-reliance was associated with an increased odds of suicidal thoughts (OR = 1.46, 95% CI 1.24–1.72). However, there was no significant mediating effect of a lack of help-seeking on the relationship between self-reliance and suicidal thoughts (OR = 1.00, 95% CI 0.99–1.01).Findings suggest that highly self-reliant men are at an increased risk of experiencing suicidal thoughts; however, this relationship is not explained by lack of help-seeking. Future studies could explore other potential mechanisms to better understand why highly self-reliant men are more likely to experience suicidal thoughts.Conclusion: This study aimed to explore the relationship between the masculine norm of self-reliance and suicidal thoughts among Australian men, hypothesising that lack of help-seeking might mediate the relationship between high self-reliance and the emergence of suicidal thoughts.This study used data from on the Australian Longitudinal Study on Male Health ‘Ten to Men’, a prospective longitudinal cohort study that began in 2013/2014 with boys and men aged 10–55 years (N = 16,021) at wave 1. The focus was on men who participated in waves 1 and 2 (2013/2014, 2015/2016) and had linked administrative data. A causal mediation analysis was conducted to quantify the total effect of self-reliance at wave 1 on suicidal thoughts at wave 2, and to investigate the extent of mediation by help-seeking between waves 1 and 2.High self-reliance was associated with an increased odds of suicidal thoughts (OR = 1.46, 95% CI 1.24–1.72). However, there was no significant mediating effect of a lack of help-seeking on the relationship between self-reliance and suicidal thoughts (OR = 1.00, 95% CI 0.99–1.01).Findings suggest that highly self-reliant men are at an increased risk of experiencing suicidal thoughts; however, this relationship is not explained by lack of help-seeking. Future studies could explore other potential mechanisms to better understand why highly self-reliant men are more likely to experience suicidal thoughts. [ABSTRACT FROM AUTHOR]

Objective: Bipolar disorder is associated with high risk for suicidal acts. Observational studies suggest a protective effect of lithium against suicidal behavior. However, testing this effect in randomized clinical trials is logistically and ethically challenging. The authors tested the hypothesis that lithium offers bipolar patients with a history of suicide attempt greater protection against suicidal behavior compared to valproate. Method: Patients with bipolar disorder and past suicide attempts (N=98) were randomly assigned to treatment with lithium or valproate, plus adjunctive medications as indicated, in a double-blind 2.5-year trial. An intent-to-treat analysis was performed using the log-rank test for survival data. Two models were fitted: time to suicide attempt and time to suicide event (attempt or hospitalization or change in medication in response to suicide plans). Results: There were 45 suicide events in 35 participants, including 18 suicide attempts made by 14 participants, six from the lithium group and eight from the valproate group. There were no suicides. Intent-to-treat analysis using the log-rank test showed no differences between treatment groups in time to suicide attempt or to suicide event. Post hoc power calculations revealed that the modest sample size, reflective of challenges in recruitment, only permits detection of a relative risk of 5 or greater. Conclusions: Despite the high frequency of suicide events during the study, this randomized controlled trial detected no difference between lithium and valproate in time to suicide attempt or suicide event in a sample of suicide attempters with bipolar disorder. However, smaller clinically significant differences between the two drugs were not ruled out. [ABSTRACT FROM AUTHOR]

Background. National systems-based suicide prevention approaches are increasingly being implemented. Community participation is fundamental to the successful implementation of these approaches, but can be challenging to undertake. We present findings from the evaluation of Australia's National Suicide Prevention Trial (the Trial). Methods. We completed consultations with 127 community members and 46 Primary Health Network (PHN) staff. Thematic analysis was undertaken to understand the process of community participation in the planning and implementation of the Trial. Results. Themes were identified regarding: a collaborative PHN; an engaged and passionate community; maintaining engagement; getting the right people involved; and getting stakeholders to work together. Continuous negotiation about Trial ownership, acceptability of the Trial model, and choice of activities was required. Community participation was somewhat challenging for PHNs, taking much longer than anticipated for a range of reasons. Conclusions. Future system-based approaches could benefit from the provision of community participation skills training and support to enable a more coordinated, and perhaps more easily achieved, approach to the involvement of community. Despite a long process of relationship building between stakeholders, this led to improved community cohesion and integration in local suicide prevention, ready for future collaborative work. [ABSTRACT FROM AUTHOR]

Background: The need to understand and respond to the unique characteristics and drivers of suicidal behaviour in rural areas has been enabled through the Australian Government's 2015 mental health reforms facilitating a move to an evidence-based, regional approach to suicide prevention. However, a key challenge has been the complex decision-making environment and lack of appropriate tools to facilitate the use of evidence, data and expert knowledge in a way that can inform contextually appropriate strategies that will deliver the greatest impact. This paper reports the co-development of an advanced decision support tool that enables regional decision makers to explore the likely impacts of their decisions before implementing them in the real world. Methods: A system dynamics model for the rural and remote population catchment of Western New South Wales was developed. The model was based on defined pathways to mental health care and suicidal behaviour and reproduced historic trends in the incidence of attempted suicide (self-harm hospitalisations) and suicide deaths in the region. A series of intervention scenarios were investigated to forecast their impact on suicidal behaviour over a 10-year period. Results: Post-suicide attempt assertive aftercare was forecast to deliver the greatest impact, reducing the numbers of self-harm hospitalisations and suicide deaths by 5.65% (95% interval, 4.87−6.42%) and 5.45% (4.68−6.22%), respectively. Reductions were also projected for community support programs (self-harm hospitalisations: 2.83%, 95% interval 2.23−3.46%; suicide deaths: 4.38%, 95% interval 3.78−5.00%). Some scenarios produced unintuitive impacts or effect sizes that were significantly lower than what has been anticipated under the traditional evidence-based approach to suicide prevention and provide an opportunity for learning. Conclusion: Systems modelling and simulation offers significant potential for regional decision makers to better understand and respond to the unique characteristics and drivers of suicidal behaviour in their catchments and more effectively allocate limited health resources. [ABSTRACT FROM AUTHOR]

There is a noted paucity of quantitative research examining the interrelationship between masculinity and disability. We analyzed a sample of 12,418 men aged 18 to 55 years from the Australian Longitudinal Study on Male Health (the Ten to Men Study) to investigate associations between disability and conformity to norms of masculinity viewed as traditional in Western societies. To assess masculinity, we used the Conformity to Masculine Norms Inventory–22, both as an overall scale and across 11 different subscales. We found little difference between men with and without a disability on the overall masculinity scale; however, differences were observed on subscales. Men with a disability reported greater conformity to Self-Reliance norms and lower conformity to Pursuit of Status, Heterosexual Presentation, and Primacy of Work. These results suggest that men with disabilities reformulate masculinity to assemble a masculine identity that draws on norms such as self-reliance but places less importance on other elements of masculinity seen as traditional in Western societies. Public Significance Statement: Evidence regarding the relationship between masculinity and disability is lacking. This analysis uses population data to compare similarities and differences between how men with and without a disability conform to norms of masculinity. The results demonstrate that men with a disability differ from those without a disability on some key masculinity subscales. Men with a disability report greater conformity to Self-Reliance norms and lower conformity to norms related to the breadwinner role (Pursuit of Status and Primacy of Work), and Heterosexual Presentation. Further research is needed to understand how these differences in conformity to masculine norms might impact health and well-being. [ABSTRACT FROM AUTHOR]

Background: Adolescent boys and young men are at particular risk of suicide. Suicidal ideation is an important risk factor for suicide, but is poorly understood among adolescent males. Some masculine behaviors have been associated with deleterious effects on health, yet there has been little quantitative examination of associations between masculinity and suicide or suicidal ideation, particularly among boys/young men. This study aimed to examine associations between conformity to masculine norms and suicidal ideation in a sample of adolescents. Methods: A prospective cohort design, this study drew on a sample of 829 Australian boys/young men from the Australian Longitudinal Study on Male Health. Boys were 15–18 years at baseline, and 17–20 years at follow-up. Masculine norms (Wave 1), were measured using the Conformity to Masculine Norms Inventory (CMNI-22). Suicidal ideation (Wave 2) was a single-item from the Youth Risk Behavior Survey. Logistic regression analysis was conducted, adjusting for available confounders including parental education, Indigenous Australian identity and area disadvantage. Results: In adjusted models, greater conformity to violent norms (OR = 1.23, 95% Confidence Interval [CI]: 1.03–1.47) and self-reliance norms (OR = 1.40, 95% CI: 1.15–1.70) was associated with higher odds of reporting suicidal ideation. Greater conformity to norms regarding heterosexuality was associated with reduced odds of reporting suicidal ideation (OR = 0.80, 95% CI: 0.68–0.91). Conclusions: These results suggest that conforming to some masculine norms may be deleterious to the mental health of young males, placing them at greater risk of suicidal ideation. The results highlight the importance of presenting young males with alternative and multiple ways of being a male. Facilitating a relaxation of norms regarding self-reliance, and encouraging help-seeking, is vital. Furthermore, dismantling norms that rigidly enforce masculine norms, particularly in relation to heteronormativity, is likely to benefit the broad population of males, not only those who do not conform to heterosexual and other masculine norms. [ABSTRACT FROM AUTHOR]

Investigators in large-scale population health studies face increasing difficulties in recruiting representative samples of participants. Nonparticipation, item nonresponse, and attrition, when follow-up is involved, often result in highly selected samples even in well-designed studies. We aimed to assess the potential value of multilevel regression and poststratification, a method previously used to successfully forecast US presidential election results, for addressing biases due to nonparticipation in the estimation of population descriptive quantities in large cohort studies. The investigation was performed as an extensive case study using baseline data (2013–2014) from a large national health survey of Australian males (Ten to Men: The Australian Longitudinal Study on Male Health). Analyses were performed in the open-source Bayesian computational package RStan. Results showed greater consistency and precision across population subsets of varying sizes when compared with estimates obtained using conventional survey sampling weights. Estimates for smaller population subsets exhibited a greater degree of shrinkage towards the national estimate. Multilevel regression and poststratification provides a promising analytical approach to addressing potential participation bias in the estimation of population descriptive quantities from large-scale health surveys and cohort studies. [ABSTRACT FROM AUTHOR]

Aims Past research suggests that adverse experiences at work (such as job stressors and precarious employment) are associated with thoughts about suicide, especially among males. A limitation of this research is that it is largely cross-sectional. Thus, it is unknown whether job stressors are a prior cause of thoughts about suicide. This study examined the baseline association between adverse experiences at work and thoughts about suicide at follow-up in a large nationally representative cohort of employed men. Methods We used data from the Australian Longitudinal Study on Male Health (Ten to Men). The outcome was thoughts about suicide in the prior 12 months (reported in wave 2) and the key exposure variables were: high job demands, low job control, job insecurity, perceived unfairness of pay, occupational skill level, and employment arrangement (all reported in wave 1). We adjusted for possible confounders, including mental health and suicidal thoughts (wave 1). Results In a sample of 8379 and after adjustment, job insecurity (OR 1.35, 95% CI 1.13–1.61, P = 0.001), low job control (OR 1.19, 95% CI 1.06–1.33, P = 0.004), and employment on a casual or on a fixed term basis (OR 1.30, 95% 1.01–1.67, P = 0.041) were associated with a greater odds of thoughts about suicide at follow up. Results for all by job control were maintained after removing those who reported thoughts of suicide at baseline. Conclusion This study suggests that experiences at work may be risk factors for thoughts about suicide among employed men. More research is needed to unpack the complex associations between, employment, and experiences of suicide. [ABSTRACT FROM AUTHOR]

Aims: Past research suggests that adverse experiences at work (such as job stressors and precarious employment) are associated with thoughts about suicide, especially among males. A limitation of this research is that it is largely cross-sectional. Thus, it is unknown whether job stressors are a prior cause of thoughts about suicide. This study examined the baseline association between adverse experiences at work and thoughts about suicide at follow-up in a large nationally representative cohort of employed men. Methods: We used data from the Australian Longitudinal Study on Male Health (Ten to Men). The outcome was thoughts about suicide in the prior 12 months (reported in wave 2) and the key exposure variables were: high job demands, low job control, job insecurity, perceived unfairness of pay, occupational skill level, and employment arrangement (all reported in wave 1). We adjusted for possible confounders, including mental health and suicidal thoughts (wave 1). Results: In a sample of 8379 and after adjustment, job insecurity (OR 1.35, 95% CI 1.13-1.61, P = 0.001), low job control (OR 1.19, 95% CI 1.06-1.33, P = 0.004), and employment on a casual or on a fixed term basis (OR 1.30, 95% 1.01-1.67, P = 0.041) were associated with a greater odds of thoughts about suicide at follow up. Results for all by job control were maintained after removing those who reported thoughts of suicide at baseline. Conclusion: This study suggests that experiences at work may be risk factors for thoughts about suicide among employed men. More research is needed to unpack the complex associations between, employment, and experiences of suicide. [ABSTRACT FROM AUTHOR]

Objectives: We compare the prevalence of suicidal thoughts and attempts between Indigenous and non-Indigenous males in urban and regional Australia, and examine the extent to which any disparity between Indigenous and non-Indigenous males varies across age groups. Methods: We used data from the baseline wave of The Australian Longitudinal Study on Male Health (Ten to Men), a large-scale cohort study of Australian males aged 10–55 years residing in urban and regional areas. Indigenous identification was determined through participants self-reporting as Aboriginal, Torres Strait Islander or both. The survey collected data on suicidal thoughts in the preceding 2 weeks and lifetime suicide attempts. Results: A total of 432 participants (2.7%) identified as Indigenous and 15,425 as non-Indigenous (97.3%). Indigenous males were twice as likely as non-Indigenous males to report recent suicidal thoughts (17.6% vs 9.4%; odds ratio = 2.1, p < 0.001) and more than three times as likely to report a suicide attempt in their lifetime (17.0% vs 5.1%; odds ratio = 3.6; p < 0.001). The prevalence of recent suicidal thoughts did not differ between Indigenous and non-Indigenous males in younger age groups, but a significant gap emerged among men aged 30–39 years and was largest among men aged 40–55 years. Similarly, the prevalence of lifetime suicide attempts did not differ between Indigenous and non-Indigenous males in the 14- to 17-years age group, but a disparity emerged in the 18- to 24-years age group and was even larger among males aged 25 years and older. Conclusion: Our paper presents unique data on suicidal thoughts and attempts among a broad age range of Indigenous and non-Indigenous males. The disparity in the prevalence of suicidal thoughts increased across age groups, which is in contrast to the large disparity between the Indigenous and non-Indigenous suicide rates in younger age groups. [ABSTRACT FROM AUTHOR]

Background: Online and mobile telephone applications ('apps') have the potential to improve the scalability of effective interventions for suicidal ideation and self-harm. The aim of this review was therefore to investigate the effectiveness of digital interventions for the self-management of suicidal ideation or self-harm. Methods: Seven databases (Applied Science & Technology; CENTRAL; CRESP; Embase; Global Health; PsycARTICLES; PsycINFO; Medline) were searched to 31 March, 2017. Studies that examined the effectiveness of digital interventions for suicidal ideation and/or self-harm, or which reported outcome data for suicidal ideation and/or self-harm, within a randomised controlled trial (RCT), pseudo-RCT, or observational pre-test/post-test design were included in the review. Results: Fourteen non-overlapping studies were included, reporting data from a total of 3,356 participants. Overall, digital interventions were associated with reductions for suicidal ideation scores at post-intervention. There was no evidence of a treatment effect for self-harm or attempted suicide. Conclusions: Most studies were biased in relation to at least one aspect of study design, and particularly the domains of participant, clinical personnel, and outcome assessor blinding. Performance and detection bias therefore cannot be ruled out. Digital interventions for suicidal ideation and self-harm may be more effective than waitlist control. It is unclear whether these reductions would be clinically meaningful at present. Further evidence, particularly with regards to the potential mechanisms of action of these interventions, as well as safety, is required before these interventions could recommended. [ABSTRACT FROM AUTHOR]

Purpose: Males feature prominently in suicide statistics, but relatively little work has been done to date to explore whether endorsement of dominant masculinity norms heightens the risk of or is protective against suicidal thinking. This paper aimed to further knowledge in this area.Methods: We used baseline data from 13,884 men (aged 18-55) in the Australian Longitudinal Study on Male Health (Ten to Men) cohort. These men filled in self-complete questionnaires in 2013/14 which covered a range of topics, including conformity to dominant masculinity norms and suicidal thinking. We conducted logistic regression analyses to estimate the strength of association between these two variables.Results: After controlling for other key predictors of suicidal thinking, one characteristic of dominant masculinity-self-reliance-stood out as a risk factor for suicidal thinking (AOR 1.33; 95% CI 1.25-1.42).Conclusions: It suggests that one particular element of dominant masculinity-being self-reliant-may place men at increased risk of suicidal thinking. This finding resonates with current theories of how suicidal thinking develops and leads to action. It also has implications for the full gamut of suicide prevention approaches that target males in clinical settings and in the general population, and for our broader society. Further work is needed, however, to confirm the direction of the relationship between self-reliance and suicidality, and to unpack the means through which self-reliance may exert an influence. [ABSTRACT FROM AUTHOR]

Background: The aim of this review was to assess whether suicide prevention provided in the primary health care setting and delivered by GPs results in fewer suicide deaths, episodes of self-harm, attempts and lower frequency of thoughts about suicide.Methods: We conducted a systematic review and meta-analysis using PRIMSA guidelines. Eligible studies: 1) evaluated an intervention provided by GPs; 2) assessed suicide, self-harm, attempted suicide or suicide ideation as outcomes, and; 3) used a quasi-experimental observational or trial design. Study specific effect sizes were combined using the random effects meta-analysis, with effects transformed into relative risk (RR).Results: We extracted data from 14 studies for quantitative meta-analysis. The RR for suicide death in quasi-experimental observational studies comparing an intervention region against another region acting as a "control" was 1.26 (95% CI 0.58, 2.74). When suicide in the intervention region was compared before and after the GP program, the RR was 0.78 (95% CI 0.62, 0.97). There was no evidence of a treatment effect for GP training on rates of suicide death in one cRCT (RR 1.07, 95% CI 0.79, 1.45). There was no evidence of effect for the most other outcomes studied.Limitations: All of the studies included in this review are likely to have a high level of bias. It is also possible that we excluded or missed relevant studies in our review process CONCLUSIONS: Interventions have produced equivocal results, which varied by study design and outcome. Given these results, we cannot recommend the roll out of GP suicide prevention initiatives. [ABSTRACT FROM AUTHOR]

In the original publication there was an error in the calculation of scores for a number of the CMNI subscales and consequently the overall scale score. Recalculating the scores did not alter the substantive finding, and largely resulted in only small adjustments to estimates. Tables 1 and 2 are revised to show the corrected values, and revisions to the text reflecting these changes are noted. [ABSTRACT FROM AUTHOR]

Background Low gamma-aminobutyric acid (GABA) is implicated in both anxiety and depression pathophysiology. They are often comorbid, but most clinical studies have not examined these relationships separately. We investigated the relationship of cerebrospinal fluid (CSF) free GABA to the anxiety and depression components of a major depressive episode (MDE) and to monoamine systems. Methods and Materials Patients with a DSM-IV major depressive episode ( N = 167: 130 major depressive disorder; 37 bipolar disorder) and healthy volunteers ( N = 38) had CSF free GABA measured by gas chromatography mass spectroscopy. Monoamine metabolites were assayed by high performance liquid chromatography. Symptomatology was assessed by Hamilton depression rating scale. Results Psychic anxiety severity increased with age and correlated with lower CSF free GABA, controlling for age. CSF free GABA declined with age but was not related to depression severity. Other monoamine metabolites correlated positively with CSF GABA but not with psychic anxiety or depression severity. CSF free GABA was lower in MDD compared with bipolar disorder and healthy volunteers. GABA levels did not differ based on a suicide attempt history in mood disorders. Recent exposure to benzodiazepines, but not alcohol or past alcoholism, was associated with a statistical trend for more severe anxiety and lower CSF GABA. Conclusions Lower CSF GABA may explain increasing severity of psychic anxiety in major depression with increasing age. This relationship is not seen with monoamine metabolites, suggesting treatments targeting the GABAergic system should be evaluated in treatment-resistant anxious major depression and in older patients. [ABSTRACT FROM AUTHOR]

Assessment of personality disorders during the acute phase of major depression may be invalidated by the potential distortion of personality traits in depressed mood states. However, few studies have tested this assumption. We examined the stability of personality disorder diagnoses during and then after a major depressive episode (MDE). Subjects with major depression (N = 82) completed the 17-item Hamilton Depression Scale (HAM-17) and the Structured Clinical Interview for Axis II both at baseline during an MDE and at 3-month follow-up. We compared subjects who continued to meet DSM-IV criteria for the same Axis II diagnoses with patients whose diagnosis changed and patients with no DSM-IV personality disorder to determine the relationship to major depression and its severity. Sixty-six percent of subjects met DSM-IV criteria for at least one Axis II diagnosis at baseline and 80% had the same personality disorder diagnoses at follow-up. Thirty-four percent had a full remission of MDE at 3-month follow-up. Instability of Axis II diagnosis was associated with number of Axis II diagnoses at baseline (p = .036) and Hispanic ethnicity (p = .013). HAM-17 score change was unrelated to differences in the number of symptoms of personality disorders from baseline to follow-up, nor was remission from MDE on follow-up. Axis II diagnoses in acutely depressed patients reassessed after 3 months are often stable and not associated with remission of or improvement in major depression. [ABSTRACT FROM AUTHOR]

Objective: Bipolar disorder is associated with high risk for suicidal acts. Observational studies suggest a protective effect of lithium against suicidal behavior. However, testing this effect in randomized clinical trials is logistically and ethically challenging. The authors tested the hypothesis that lithium offers bipolar patients with a history of suicide attempt greater protection against suicidal behavior compared to valproate.Method: Patients with bipolar disorder and past suicide attempts (N=98) were randomly assigned to treatment with lithium or valproate, plus adjunctive medications as indicated, in a double-blind 2.5-year trial. An intent-to-treat analysis was performed using the log-rank test for survival data. Two models were fitted: time to suicide attempt and time to suicide event (attempt or hospitalization or change in medication in response to suicide plans).Results: There were 45 suicide events in 35 participants, including 18 suicide attempts made by 14 participants, six from the lithium group and eight from the valproate group. There were no suicides. Intent-to-treat analysis using the log-rank test showed no differences between treatment groups in time to suicide attempt or to suicide event. Post hoc power calculations revealed that the modest sample size, reflective of challenges in recruitment, only permits detection of a relative risk of 5 or greater.Conclusions: Despite the high frequency of suicide events during the study, this randomized controlled trial detected no difference between lithium and valproate in time to suicide attempt or suicide event in a sample of suicide attempters with bipolar disorder. However, smaller clinically significant differences between the two drugs were not ruled out. [ABSTRACT FROM AUTHOR]

Adverse events (AEs) and serious adverse events (SAEs) are important outcomes of any intervention study yet are under-researched. Vague and variable definitions and substantial underreporting make comparisons of risk between studies difficult and evaluation of the safety of a particular intervention almost impossible. These realities may deter researchers from studying at-risk populations. Suicidal behavior is an adverse event in any study, and potentially a very serious one. Thus the issues of reporting and definition are particularly salient for researchers who work with populations at risk for suicidal behavior, especially when the suicidal behavior is the outcome of interest. We conducted a qualitative study with experienced suicide researchers and intervention experts to delineate the issues related to reporting serious adverse events faced by investigators conducting trials in suicide prevention. Participants from multiple sites were interviewed by phone, interviews transcribed and coded for definition and reporting issues and suggested solutions. A narrative synthesis was prepared and validated by all participants. Participants highlighted the difficulties in defining AEs and SAEs and stressed the importance and complexity of ensuring the AE was related to the study and reported properly, and were in agreement about the consequences of AEs to both institutions and individuals. Participants identified the need for the development of clear and consistent AE definitions and reporting requirements. Clear and consistently applied definitions of adverse and serious adverse events and reporting requirements would enhance the comparability of intervention studies in suicidal populations. [ABSTRACT FROM AUTHOR]

Abstract: Advanced parental age has been shown to increase offspring risk for a number of neuropsychiatric disorders including schizophrenia and Down''s syndrome. Other psychiatric disorders have been less studied with respect to the effect of parental age on offspring risk. In this study we examine if advanced parental age increased risk for ICD-10 diagnoses. We hypothesized that advanced parental age would increase risk for offspring psychotic disorders and mental retardation but not other ICD-10 diagnoses. We examined follow-up data for 30,965 subjects treated in outpatient psychiatric facilities between 1980 and 2007. Subjects were younger than 18years of age at their first outpatient visit. A comparison group was obtained from data on registered births in Spain from 1975. We compared parental age (maternal, paternal, combined) across diagnostic categories using ANOVA and logistic regression was used to estimate the risk of psychopathology in the offspring with advanced parental age (maternal, paternal, combined). Maternal and paternal ages were higher for subjects diagnosed with mental retardation. Risk for psychotic disorders showed a significant linear increase only with advancing maternal age, and not paternal age as is more often reported. [Copyright &y& Elsevier]

Objective: Exposure to suicidal behavior in peers and relatives is thought to increase risk for suicidal behavior in vulnerable individuals, possibly as a result of imitation or modeling. This study examines exposure to suicidal behavior and likelihood of suicide attempt in a high-risk cohort of offspring of a depressed parent.Method: A total of 449 offspring of 255 probands with a mood disorder were enrolled in a family study. Probands and offspring were assessed for psychopathology and suicide attempt history, and offspring for suicide exposure. Generalized estimating equations (GEE) and generalized least squares models were used to compare suicide attempt history in exposed and nonexposed offspring as well as characteristics of exposure in exposed offspring suicide attempters and exposed nonattempters. GEE was used to compare exposure occurring before first attempt in attempter offspring and exposure occurring before the same age in matched nonattempter offspring.Results: Offspring reporting exposure to suicidal behavior were four times more likely to report a lifetime suicide attempt compared with unexposed offspring, controlling for age. Suicide attempt status was not associated with age at first exposure, total number or degree (attempt or threat) of exposures, or relationship. Analysis of exposure occurring before age at first suicide attempt found no association between exposure and suicide attempt.Conclusions: Offspring exposed to suicidal behavior are more likely to report a lifetime suicide attempt than nonexposed offspring. However, when examining the temporal sequence of exposure and attempt, the association is no longer significant, suggesting that imitation is not sufficient explanation. [ABSTRACT FROM AUTHOR]

The article presents a study on the impact of exposure to suicidal behavior on suicide attempt of children of depressed parents. The study is conducted to 499 offspring of probands having mood disorders. Results showed that offspring with records of exposure to suicidal behavior are four times expected to record a lifetime suicide attempt compared to those who are non-exposed.

Because Bipolar Disorder (BD) individuals making highly lethal suicide attempts have greater injury burden and risk for suicide, early identification is critical. BD patients were classified as high- or low-lethality attempters. High-lethality attempts required inpatient medical treatment. Mixed effects logistic regression models and permutation analyses examined correlations between lethality, number, and order of attempts. High-lethality attempters reported greater suicidal intent and more previous attempts. Multiple attempters showed no pattern of incremental lethality increase with subsequent attempts, but individuals with early high-lethality attempts more often made high-lethality attempts later. A subset of high-lethality attempters make only high-lethality attempts. However, presence of previous low-lethality attempts does not indicate that risk for more lethal, possibly successful, attempts is reduced. [ABSTRACT FROM AUTHOR]

Abstract: Background: The tryptophan hydroxylase 1 (TPH1) gene is reported to be associated with suicidal behavior. This has not been confirmed by prospective studies of suicide and clinical or biological mediators of this genetic risk have not been identified. Methods: 343 subjects (Caucasian, African-American, Hispanic) presenting with a Major Depressive Episode were genotyped for polymorphisms A218C in intron 7 and A-6526G in the promoter region of TPH1, and monitored for suicide attempts for up to one year. Clinical correlates of suicidal behavior and CSF-HIAA, HVA and MHPG levels were explored as possible mediators of genetic risk. Analyses were adjusted for ethnicity. Results: The AA genotype on intron 7 and the AA genotype on the promoter (both more prevalent in Caucasians) predicted suicide attempts during the 1 year follow-up, and were associated with past attempts of high medical lethality, regardless of ethnicity. The intron 7 genotype was associated with fewer reported reasons for living, and lower impulsivity. Haplotype analysis indicated significant increase in risk of suicide attempts for subjects with four risk alleles. TPH1 genotype was not associated with CSF metabolite levels. Limitations: The TPH1 gene is likely one of several genes associated with suicidal behavior. Power to detect differential genotype effects by ethnicity is low. Conclusions: Polymorphisms of TPH1 may assist in identifying a subgroup of mood disorder patients that is at higher risk for suicidal behavior. [Copyright &y& Elsevier]

Twin, adoption, and family studies have established the heritability of suicide attempts and suicide. Identifying specific suicide diathesis-related genes has proven more difficult. As with psychiatric disorders in general, methodological difficulties include complexity of the phenotype for suicidal behavior and distinguishing suicide diathesis-related genes from genes associated with mood disorders and other suicide-associated psychiatric illness. Adopting an endophenotype approach involving identification of genes associated with heritable intermediate phenotypes, including biological and/or behavioral markers more proximal to genes, is an approach being used for other psychiatric disorders. Therefore, a workshop convened by the American Foundation for Suicide Prevention, the Department of Psychiatry at Columbia University, and the National Institute of Mental Health sought to identify potential target endophenotypes for genetic studies of suicidal behavior. The most promising endophenotypes were trait aggression/impulsivity, early-onset major depression, neurocognitive function, and cortisol social stress response. Other candidate endophenotypes requiring further investigation include serotonergic neurotransmission, second messenger systems, and borderline personality disorder traits. [Copyright &y& Elsevier]

The Met allele of the Catechol-O-Methyltransferase (COMT) gene functional polymorphism (COMT-V158M) is associated with lower enzymatic activity than the Val allele and is reported to be associated with aggression, depression, and suicidal behavior. Since depression and impulsive-aggressive behavior may mediate risk for suicidal behavior, we assessed the association of this polymorphism with suicidal behavior. Clinical (impulsive aggression) and biological (CSF monoamine metabolites) endophenotypes were tested as potential mediators of the effect of genotype on suicide risk. Subjects with mood disorders (N = 486) and healthy volunteers (N = 119), all European Caucasian, were genotyped for COMT-V158M and assessed for DSM IV diagnoses, lifetime suicidal behavior, lifetime impulsivity, hostility, and aggression. CSF monoamine metabolites were assayed in a sub-sample of mood disorder patients (N = 111). We found no association between genotype and mood disorder diagnosis or with reported history of suicide attempt in mood disorder subjects. There was no association between genotype and lethality or method of suicide attempt, or with aggressive/impulsive traits. Further, there was no difference in monoamine metabolites by genotype. The COMT-V158M polymorphism was not associated with suicidal behavior in a Caucasian sample of mood disorder subjects, or with possible clinical or biological endophenotypes. [ABSTRACT FROM AUTHOR]

Objective: Comorbid anxiety disorder is reported to increase suicidality in bipolar disorder. However, studies of the impact of anxiety disorders on suicidal behavior in mood disorders have shown mixed results. The presence of personality disorders, often comorbid with anxiety and bipolar disorders, may explain these inconsistencies. This study examined the impact of comorbid Cluster B personality disorder and anxiety disorder on suicidality in bipolar disorder. Methods: A total of 116 depressed bipolar patients with and without lifetime anxiety disorder were compared. Multiple regression analysis tested the association of comorbid anxiety disorder with past suicide attempts and severity of suicidal ideation, adjusting for the effect of Cluster B personality disorder. The specific effect of panic disorder was also explored. Results: Bipolar patients with and without anxiety disorders did not differ in the rate of past suicide attempt. Suicidal ideation was less severe in those with anxiety disorders. In multiple regression analysis, anxiety disorder was not associated with past suicide attempts or with the severity of suicidal ideation, whereas Cluster B personality disorder was associated with both. The results were comparable when comorbid panic disorder was examined. Conclusions: Comorbid Cluster B personality disorder appears to exert a stronger influence on suicidality than comorbid anxiety disorder in persons with bipolar disorder. Assessment of suicide risk in patients with bipolar disorder should include evaluation and treatment of Cluster B psychopathology. [ABSTRACT FROM AUTHOR]

Los familiares de primer grado de individuos con trastornos del estado de ánimo que realizaron tentativas de suicidio tienen un riesgo mayor de presentar trastornos del estado de ánimo, de realizar tentativas de suicidio y de consumarlo. Este estudio examinó los factores comunes y propios relacionados con los trastornos del estado de ánimo y la conducta suicida familiar. Método: Se registraron los antecedentes de trastornos del estado de ánimo y de conducta suicida, definidos según el DSM-IV, de los familiares de primer grado de 457 probandos con trastornos de estado de ánimo. El 81 % permanecía hospitalizado y el 62 % era de sexo femenino Se evaluó el alcance de la agresividad y de la impulsividad a lo largo de la vida y se registró el testimonio de los probandos sobre los malos tratos físicos o abusos sexuales padecidos durante la infancia, las tentativas de suicidio y la edad de inicio de los trastornos del estado de ánimo. Se realizaron análisis unifactoriales y multifactoriales para identificar los factores predictivos de los actos suicidasen los familiares de primer grado. Resultados: EI 23. 2 % de los probandos con trastornos del estado de ánimo que habían efectuado una tentativa de suicidio tenían un familiar de primer grado con antecedentes de conducta suicida, frente al 13,2 % de los probandos con trastornos del estado de ánimo que no habían efectuado una tentativa de suicidio (razón de probabilidad = 1,99, intervalo de confianza [IC] 95 %- 1,21-3,26). El 30,8 % de los familiares de primer grado diagnosticados de trastorno del estado de ánimo también mostró una conducta suicida, frente al 6,6% de los familiares de primer grado no diagnosticados de un trastorno del estado de ánimo (razón de probabilidad = 6,25, IC 95 % = 3,44-11,35). Los probandos con antecedentes de tentativas de suicidio y sin ellos no difirieron en cuanto a la incidencia de trastornos del estado de ánimo en los familiares de primer grado (50,6 % frente al 48,1 %). Los índices de malos tratos durante la infancia y el alcance de la agresividad mostrada a lo largo de la vida fueron superiores en los probandos con antecedentes familiares de conducta suicida. La edad de inicio más temprana de los trastornos del estado del ánimo en los probandos se relacionó con un mayor alcance de la agresividad experimentada a lo largo de la vida y la comunicación de índices más altos de malos tratos durante la infancia, trastornos del estado de ánimo o conducta suicida en los familiares de primer grado. Conclusiones: El riesgo de conductas suicidas en las familias de probandos con trastornos del estado de ánimo se relaciona, en los probandos, con un inicio precoz de los trastornos del estado de ánimo, la presencia de rasgos de agresividad, impulsividad y el testimonio de haber sufrido malos tratos durante la infancia. Estas características clínicas se están investigando actualmente en los familiares en situación de riesgo, con el objetivo de determinar la transmisión familiar de estas características clínicas. [ABSTRACT FROM PUBLISHER]

Context In 2002, an estimated 877 000 lives were lost worldwide through suicide. Some developed nations have implemented national suicide prevention plans. Although these plans generally propose multiple interventions, their effectiveness is rarely evaluated. Objectives To examine evidence for the effectiveness of specific suicide-preventive interventions and to make recommendations for future prevention programs and research. Data Sources and Study Selection Relevant publications were identified via electronic searches of MEDLINE, the Cochrane Library, and PsychINFO databases using multiple search terms related to suicide prevention. Studies, published between 1966 and June 2005, included those that evaluated preventative interventions in major domains; education and awareness for the general public and for professionals; screening tools for at-risk individuals; treatment of psychiatric disorders; restricting access to lethal means; and responsible media reporting of suicide. Data Extraction Data were extracted on primary outcomes of interest: suicidal behavior (completion, attempt, ideation), intermediary or secondary outcomes (treatment seeking, identification of at-risk individuals, antidepressant prescription/use rates, referrals), or both. Experts from 15 countries reviewed all studies. Included articles were those that reported on completed and attempted suicide and suicidal ideation; or, where applicable, intermediate outcomes, including help-seeking behavior, identification of at-risk individuals, entry into treatment, and antidepressant prescription rates. We included 3 major types of studies for which the research question was clearly defined: systematic reviews and meta-analyses (n = 10); quantitative studies, either randomized controlled trials (n = 18) or cohort studies (n = 24); and ecological, or population- based studies (n = 41). Heterogeneity of study populations and methodology did not permit formal meta-analysis; thus, a narrative synthesis is presented. Data Synthesis Education of physicians and restricting access to lethal means were found to prevent suicide. Other methods including public education, screening programs, and media education need more testing. Conclusions Physician education in depression recognition and treatment and restricting access to lethal methods reduce suicide rates. Other interventions need more evidence of efficacy. Ascertaining which components of suicide prevention programs are effective in reducing rates of suicide and suicide attempt is essential in order to optimize use of limited resources. [ABSTRACT FROM AUTHOR]

Objective: First-degree relatives of persons with mood disorder who attempt suicide are at greater risk for mood disorders and attempted or completed suicide. This study examined the shared and distinctive factors associated with familial mood disorders and familial suicidal behavior. Method: First-degree relatives' history of DSM-IV-defined mood disorder and suicidal behavior was recorded for 457 mood disorder probands, of whom 81% were in-patients and 62% were female. Probands' lifetime severity of aggression and impulsivity were rated, and probands' reports of childhood physical or sexual abuse, suicide attempts, and age at onset of mood disorder were recorded. Univariate and multivariate analyses were carried out to identify predictors of suicidal acts in first-degree relatives. Results: A total of 23.2% of the probands with mood disorder who had attempted suicide had a first-degree relative with a history of suicidal behavior, compared with 13.2% of the probands with mood disorder who had not attempted suicide (odds ratio=1.99, 95% Cl=1.21-3.26), Thirty percent (30.8%) of the first-degree relatives with a diagnosis of mood disorder also manifested suicidal behavior, compared with 6.6% of the first-degree relatives with no mood disorder diagnosis (odds ratio=6.25, 95% Cl=3.44-11.35). Probands with and without a history of suicide attempts did not differ in the incidence of mood disorder in first-degree relatives (50.6% versus 48.1%). Rates of reported childhood abuse and severity of lifetime aggression were higher in probands with a family history of suicidal behavior, Earlier age at onset of mood disorder in probands was associated with greater lifetime severity of aggression and higher rates of reported childhood abuse, mood disorder in first-degree relatives, and suicidal behavior in first-degree relatives. Conclusions: Risk for suicidal behavior in families of probands with mood disorders appears related to early onset of mood disorders, aggressive/impulsive traits, and reported childhood abuse in probands. Studies of such clinical features in at-risk relatives are under way to determine the relative transmission of these clinical features. [ABSTRACT FROM AUTHOR]