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Prevalence of suicidal behaviour increases rapidly in middle to late adolescence. Predicting suicide attempts across different ages would enhance our understanding of how suicidal behaviour manifests in this period of rapid development. This study aimed to develop separate models to predict suicide attempts within a cohort at middle and late adolescence. It also sought to examine differences between the models derived across both developmental stages. This study used data from the nationally representative Longitudinal Study of Australian Children (N = 2266). We selected over 700 potential suicide attempt predictors measured via self-report questionnaires, and linked healthcare and education administrative datasets. Logistic regression, random forests, and gradient boosting algorithms were developed to predict suicide attempts across two stages (mid-adolescence: 14–15 years; late adolescence: 18–19 years) using predictors sampled two years prior (mid-adolescence: 12–13 years; late adolescence: 16–17 years). The late adolescence models (AUROC = 0.77–0.88, F1-score = 0.22–0.28, Sensitivity = 0.54–0.64) performed better than the mid-adolescence models (AUROC = 0.70–0.76, F1-score = 0.12–0.19, Sensitivity = 0.40–0.64). The most important features for predicting suicide attempts in mid-adolescence were mostly school-related, while the most important features in late adolescence included measures of prior suicidality, psychosocial health, and future plans. To date, this is the first study to use machine learning models to predict suicide attempts at different ages. Our findings suggest that the optimal suicide risk prediction model differs by stage of adolescence. Future research and interventions should consider that risk presentations can change rapidly during adolescence. • Suicide risk profiles differ according to demographic characteristics such as age. • We used machine learning to predict suicide attempts in middle and late adolescence. • The mid and late adolescence models performed differently. • Suicide risk formulations should consider the adolescent's developmental stage. [ABSTRACT FROM AUTHOR]

Strategies to detect the presence of suicidal ideation (SI) or characteristics of ideation that indicate marked suicide risk are critically needed to guide interventions and improve care during care transition periods. Some studies indicate that machine learning can be applied to momentary data to improve classification of SI. This study examined whether the classification accuracy of these models varies as a function of type of training data or characteristics of ideation. A total of 257 psychiatric inpatients completed a 3-week battery of ecological momentary assessment and measures of suicide risk factors. The accuracy of machine learning models in classifying the presence, duration, or intensity of ideation was compared across models trained on baseline and/or momentary suicide risk data. Relative feature importance metrics were examined to identify the risk factors that were most important for outcome classification. Models including both baseline and momentary features outperformed models with only one feature type, providing important information in both correctly classifying and differentiating individual characteristics of SI. Models classifying SI presence, duration, and intensity performed similarly. Results of this study may not generalize beyond a high-risk, psychiatric inpatient sample, and additional work is needed to examine temporal ordering of the relationships identified. Our results support using machine learning approaches for accurate identification of SI characteristics and underscore the importance of understanding the factors that differentiate and drive different characteristics of SI. Expansion of this work can support use of these models to guide intervention strategies. • Strategies to detect suicide ideation are needed for timely intervention. • Machine learning models are relevant for accurately identifying suicide ideation. • Different risk factors are useful for classifying ideation characteristics. • Both baseline and momentary risk factor training data are essential. [ABSTRACT FROM AUTHOR]

Suicide is a leading cause of death among youth in the United States. Pediatric emergency department visits for non-psychiatric concerns present an opportunity to identify youth at risk for suicidality. This quality improvement initiative was undertaken to ensure that those patients identified as low risk for suicide receive resources, bridging the gap between identifying at-risk youth and providing them with appropriate follow up mental health resources. The aim of this project was to increase the proportion of after visit summaries containing mental health resources by 25 % within 6 months for medical patients who are found to have non-acute low suicide risk and are discharged from the emergency department. The primary outcome measure was the proportion of discharged medical patients who screened positive for suicidal ideation and were determined to be at low risk for suicide who received mental health resources on discharge before and after intervention. A multidisciplinary team targeted the following 3 key drivers: 1) multidisciplinary engagement 2) training and education of providers and 3) health information technology. Plan, Do, Study and Act cycles included the following: 1) an educational campaign with regular multidisciplinary meetings, educational updates, and email reminders; 2). an electronic health record change; and 3) An individual report to providers. After the intervention, the percentage of medical patients with low-risk suicidality being discharged with mental health resources increased by more than 70 %. A champion led multidisciplinary team, using PDSA methodology, can implement sustained improvements in mental health resource distribution. • Emergency visits are an opportunity to identify youth at risk for suicidality. • Patients at low risk for suicide may not receive mental health resources. • Education and technology support lead to improvement of resource distribution. [ABSTRACT FROM AUTHOR]

The use of Smart Screening tools to identify mental health problems has scarce empirical data on their effectiveness. This study aims to explore the response rate of patients to this tool and observe their socio-demographic and healthcare characteristics, and the tool's ability to detect potential mental health diagnoses. The study employed an online survey within patient portal from patients of four teaching hospitals in Madrid. The sample included 8749 patients, comprising 66.77 % females and 31.21 % middle-aged adults. 60.56 % responded to the Smart Screening tool. Respondents were found to be predominantly middle-aged women who had been contacted by mental health services multiple times but had not exhibited suicidal behaviour. These patients demonstrated a higher appointment attendance rate and generated low healthcare costs. The tool identified probable low depression and mild anxiety (72.16 %), and individuals aged 50–65 exhibited higher levels of mental health problems, such as psychosis and suicidality, although these results were not all significant regarding previous mental health diagnoses. The Smart Screening tool collects anonymous online data through short questionnaires to apply sophisticated algorithms and determine probable mental health diagnoses. The response rate to the Smart Screening tool was higher than in previous studies. The respondents' profile was middle-aged and older women with moderate mental health problems, although suicidality was also identified. Future research should focus on those who did not respond to the tool and explore the link between previous psychiatric diagnoses and the accuracy of the Smart Screening tool. • The MEmind Smart Screening tool showed a response rate of 60.56 % among patients. • The profile was largely middle-aged women who had moderate mental health problems. • The profile also had high appointment attendance resulting in lower costs. • Patients aged 50–65 had more serious mental illnesses (e.g., psychosis, suicidality) [ABSTRACT FROM AUTHOR]

In South Africa, there is limited mental health infrastructure and resources. Valid screening tools are needed to facilitate identification and linkage to care. We evaluated the performance of Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Primary Care Post Traumatic Stress Disorder Screen for DSM-5 (PC-PTSD-5), and the Columbia Suicide Severity Rating Scale (C-SSRS) among adults in South Africa against a diagnostic gold standard. Adults present at healthcare facilities were screened with the PHQ-9, GAD-7, PC-PTSD-5, and the C-SSRS. Nurses used a structured diagnostic interview to identify depression, anxiety, panic disorder, PTSD and elevated suicide risk. We assessed the internal consistency, criterion validity, and the sensitivity and specificity of these tools. Of the 1885 participants, the prevalence of common mental disorders and suicide risk was 24.4 % and 14.9 %, respectively. The PHQ-9, GAD-7, and PC-PTSD-5 showed good internal consistency (0.80–0.89). All screeners demonstrated good criterion validity. For depression, a cut-off of ≥5 on the PHQ-9 yielded sensitivity of 84.24 %, while ≥10 yielded sensitivity of 48.77 %. For anxiety, the GAD-7 performed similarly. A cut-off of ≥4 on the PC-PTSD yielded sensitivity of 61.96 %. The C-SSRS yielded lower sensitivity than expected. The prevalence data is not generalizable to the larger South African adult population given the use of a targeted, healthcare facility-based sampling and recruitment strategy. The performance of the PHQ-9, GAD-7, and PC-PTSD-5 demonstrated good internal consistency and criterion validity, though sensitivity and specificity trade-offs were enhanced with lower cut-offs. Further research into suicide risk screening is warranted. • The performance of PHQ-9, GAD-7, PC-PTSD-5 was acceptable among adults in South Africa. • Sensitivity and specificity trade-offs were enhanced using lower cut-offs. • The C-SSRS yielded lower sensitivity than expected. [ABSTRACT FROM AUTHOR]

Suicidal thoughts and behaviors (STBs) in children are an escalating public health concern. This study focused on 1 understudied candidate risk factor, namely, preschool-onset major depressive disorder (PO-MDD), as a predictor of persistent and emerging STBs from early childhood into preadolescence. Participants were 137 children 8 to 12 years of age who met criteria for PO-MDD when they were 3 to 6 years of age, and a nondepressed sample of 53 age-, income-, and sex-matched peers. STBs were reported by caregivers (preschool, preadolescence) and children (preadolescence) using age-appropriate diagnostic interviews. By preadolescence, children who had PO-MDD were 7.38 times more likely than their peers to have endorsed STBs after early childhood (p <.001; 67.9% vs 22.6%), including 6.71 times more likely to have engaged in suicide behaviors/attempts (p =.012; 21.9% vs 3.8%); they were also 8.98 times more likely to have endorsed STBs over the prior month (p =.005; 26.3% vs 3.8%). Similar findings emerged when limiting the PO-MDD group to children without preschool STBs, and when controlling for externalizing comorbidities, implicating PO-MDD as a unique diagnostic predictive risk factor. However, children who had PO-MDD with STBs were 3.46 times more likely than children who had PO-MDD without STBs to endorse later STBs (p =.018; 83.1% vs 54.2%), indicating substantial continuity of preschool STBs alongside strikingly high rates of emerging STBs into preadolescence. This longitudinal study explores preschool onset major depressive disorder (PO-MDD) as a predictor of having suicidal thoughts or attempting suicide by age 12. 137 children aged 8 to 12 years who met criteria for PO-MDD when they were 3 to 6 years of age and 53 non-depressed peers were included in the study. The study found that preadolescents who had experienced preschool-onset depression were 6.14 times more likely to experience active suicidal thoughts and 8.03 times more likely to have made a suicide attempt by age 12 when compared to preadolescents who did not experience preschool depression. Results suggest that children with preschool-onset depression would likely benefit from increased suicide screening, proactive safety planning and early interventions. PO-MDD is a strong risk factor for the emergence and persistence of STBs into preadolescence. Children with PO-MDD would likely benefit from increased suicide screening, proactive safety planning, and early interventions. [ABSTRACT FROM AUTHOR]

Clinician collaboration can help high-risk individuals to manage their suicidal crises. However, limited research has directly examined how higher patient-clinician collaboration during assessment and intervention can effectively reduce suicidal ideation. This novel randomized clinical trial compared a high vs. low level of patient-clinician collaboration by pairing commonly used assessment (Structured Interview vs. Narrative Assessment) and intervention approaches (Safety Planning Intervention vs. Crisis Response Planning). We hypothesized that the interventions involving higher (than lower) patient-clinician collaboration during assessment (Narrative Assessment) or intervention (Crisis Response Planning) would lead to larger reductions in suicidal ideation. Eighty-two participants with a history of suicide ideation and/or attempts were randomly assigned to one of the four interventions varying in patient-clinician collaboration. After attrition, sixty-six participants completed the study. Suicidal ideation via ecological momentary assessment was measured 14 days before and 14 days after treatment. Although the severity of suicidal ideation decreased in all groups, the two groups that included highly collaborative assessment had larger pre-post reductions in suicidal ideation (Narrative Assessment+Safety Plan; d within = 0.26, and Narrative Assessment+Crisis Response Plan; d within = 0.19) than the groups that included a checklist-based assessment (Structured Interview). Longer follow-up periods with a larger sample would have provided an understanding of the durability of intervention effects. Results suggest that the inclusion of higher patient-clinician collaboration techniques during suicide risk assessment can effectively reduce suicidal thoughts. Thus, clinician-led collaborative risk assessment approaches can enhance the effects of safety planning-type interventions among patients with elevated risk for suicide versus checklist-based assessment approaches. • Higher clinician-led collaboration via Narrative assessment reduces suicide risk. • Narrative assessment paired with Safety Plan Intervention reduces suicidal thoughts. • Narrative assessment paired with a Crisis Response Plan reduces suicidal thoughts. • Collaborative risk assessments can enhance safety planning-type interventions. [ABSTRACT FROM AUTHOR]

The dexamethasone suppression test (DST), which measures HPA-axis functioning, is a potential biomarker for suicidal behavior. The current study aimed (a) to synthesize available knowledge on the association between DST non-suppression and suicidal behavior, and (b) to study potential moderators. A total of 4236 studies were screened, 43 were included. Suicide attempts and suicide completion were studied separately. The meta-analysis included 37 effect sizes for suicide attempts (n = 3733) and 11 effect sizes for suicide completion (n = 1626). DST non-suppression was associated with completed suicide (odds ratio (OR) = 2.10, (95 % CI [1.37, 3.23]). For suicide attempts, we found no evidence that DST status was associated in the overall meta-analysis including all patient samples. However, moderator analysis indicated that the DST status was associated with suicide attempts in patient samples that included psychopathology other than just mood disorders, such as psychotic, substance use and personality disorders (OR = 2.34, 95 % CI [1.39–3.93], k = 11). The potential influence of publication bias and exclusion of some relevant published studies (since effect sizes could not be calculated, authors could not supply data or authors could not be reached) are limitations. Furthermore, missing moderator data decreased our ability to explain heterogeneity between studies. The results of this meta-analysis support the hypothesis that DST non-suppression is predictive of suicidal behavior. More research is needed to investigate optimal cut-off values, confounding factors and the potential usefulness of the DST in clinical practice in terms of personalized medicine. • The dexamethasone suppression test (DST) may be a biomarker for suicidal behavior. • DST status predicted completed suicide. • DST status was associated with suicide attempts only in certain patient samples. • The DST should be studied as part of a more comprehensive suicide risk assessment. [ABSTRACT FROM AUTHOR]

Suicide is more prevalent among older adults compared to younger individuals. Late-life depression (LLD) poses the highest risk for suicide. However, early recognition of suicidal ideation is challenging. Dysfunction in odor identification (OI), a characteristic of LLD, may hold potential for early identification of suicidal ideation. This study aims to compare OI between LLD patients with suicidal ideation (LLD-S) and LLD patients without suicidal ideation (LLD-NS), and examine its relationship with cognitive function. A total of 262 LLD-NS patients, 63 LLD-S patients, and 316 healthy normal older adults (HOAs) underwent OI testing, standardized clinical interviews, and comprehensive neuropsychological assessments. (1) LLD-S patients exhibited lower OI scores and poorer cognitive performance (including global cognition, information processing speed, memory, language, executive function, and visuospatial ability) compared to LLD-NS patients and HOAs. (2) There were interactive effects between suicidal ideation and OI dysfunction, leading to lower scores in information processing speed and visuospatial ability. (3) OI dysfunction mediated the differences in cognition between the LLD-NS and LLD-S groups. The present study was a cross-sectional design. LLD-S patients had worse odor identification than LLD-NS patients and HOAs, suggesting that OI testing could be a valuable approach for identifying suicidal ideation in LLD and screening for suicide risk. The presence of both OI impairment and suicidal ideation was associated with poorer cognitive performance in LLD. • LLD-S exhibited lower OI scores compared to LLD-NS and HOAs. • Interaction between SI and OI dysfunction contributed to lower information processing speed and visuospatial ability. • OI dysfunction mediated the differences in cognition between LLD-NS and LLD-S groups. • OI examination could be a valuable approach for identifying SI in LLD and screening for suicide risk. [ABSTRACT FROM AUTHOR]

Early adolescent self-identifying Black youth present with high rates of suicidality. This study assesses associations among 7 explanatory variables (sex, weapon carrying, weight perceptions, grades, grade level, bullying at school, and cyberbullying) and suicide ideation, planning, and attempts, and identifies associations with suicidality as a composite measure among a sample of Black middle school adolescents (BMSA) in the United States. Data were extracted from the 2019 Middle School Youth Risk Behavior Survey. Descriptive statistics were calculated, and associations between suicide ideation, planning, and attempts were explored. A network graphical representation of polychoric and tetrachoric correlations across suicidality outcomes and explanatory variables was performed. A multivariable, multinomial logistic regression model estimated associations among explanatory variables and suicide ideation (with and without planning) and planning (with and without ideation). Both suicide attempt and a composite suicidality metric were explored using independent logistic models with multiple imputation. The sample included 7,643 self-identifying BMSA. Our findings indicate that approximately 28% reported suicidality. Prevalence rates were found of about 1 in 4 BMSA for suicidal ideation, 1 in 6 for suicidal planning, and 1 in 10 for attempting suicide. Female BMSA, victims of cyberbullying, and BMSA carrying a weapon experienced significantly higher odds of all suicidality outcome measures. Practical implications for identifying and screening suicidality among BMSA to guide suicide prevention efforts are necessary. Findings validate the need for informed cultural approaches to suicide screening and prevention efforts to reduce suicide risk outcomes, especially when identifiable environmental factors are strongly associated with those outcomes. Suicide rates have alarmingly increased for early adolescent Black youth, and exploring factors that inform suicide risk behavior outcomes is necessary for this population. Using responses of 7,643 Black middle school adolescents who participated in the 2019 Youth Risk Behavior Survey, the authors found that approximately 28% of Black middle school adolescents reported some form of suicidality with higher odds experienced among female participants. Other factors associated with suicidality included carrying a weapon, being bullied, being cyberbullied, and reporting lower grades in school. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. [ABSTRACT FROM AUTHOR]

Suicide is a serious global issue, with major depressive disorder (MDD) being a significant risk factor for suicidal thoughts and behaviors. There is an urgent need to determine whether event-related potential components (ERPs) could be used as an indicator to assess suicidal risk. From 2020 to 2023, 258 participants in total were recruited into the study. All participants were divided into four groups: MDD patients at high (n = 66), moderate (n = 66), and low risk (n = 56) of suicide, and healthy controls (HCs)(n = 70). Each participant provided socio-demographic information and underwent evaluations using clinical psychological scales such as 7-item Generalized Anxiety Disorder (GAD-7), Health Questionnaire-9 items (PHQ-9), and Nurses' Global Assessment of Suicide Risk (NGASR). The auditory brainstem response test and ERP examination were performed for all subjects. Our study found that the amplitude of P2–P3 and N2–P3 was significantly reduced in MDD patients at moderate and high risk of suicide, and these were negatively correlated with NGASR total score (all P < 0.05). Point B latency was positively correlated with NGASR total score (P < 0.05). Patients with MDD patients at low risk for suicide had a lower A-B amplitude compared to HCs (P < 0.05). No differences were found in MMN or P50 components between the four groups (all P > 0.05). MDD patients at higher risk of suicide exhibited severe impairment of cognitive function. ERP indices, such as the amplitude of P2–P3 and N2–P3, could be associated with the risk of suicide in MDD patients. • Compared to HCs, MDD patients at moderate and high risk for suicide had a lower P2–P3b amplitude and NGASR total score. • Compared to HCs, MDD patients at moderate and high risk for suicide had a lower N2–P3 amplitude and NGASR total score. • Compared to HCs, MDD patients at low risk for suicide had a lower A-B amplitude. • Point B latency was positively correlated with NGASR total score. [ABSTRACT FROM AUTHOR]

Suicide is one of the leading causes of death worldwide (WHO, 2021). Depression is a common precursor to suicide and suicidality; however, individuals' experience of depression and the meaning of suicide differs depending on one's cultural background (Colucci, 2013 ; Goodmann et al., 2021; Kleinman, 2004). The current study explores the relationship between suicide and depression among six broad cultural groups in a large sample (N = 17,015) of adults representing six broad cultural groups (Latin America, South Asia, former Soviet Bloc, Western English-speakers, Chinese, and Arab World). Participants were recruited to a multilingual depression and suicide screening study via Google Ads (Leykin et al., 2012; Gross et al., 2014). As expected, the presence of depression was associated with suicide attempts. However, cultural group moderated this association, with Chinese participants being most likely to report suicide attempts while screening negative for depression. Although depression remains an important predictor of suicidality, it appears that certain cultural groups may be at higher risk even when depression is not present. Clinicians should consider using culturally adapted assessments for depression and suicidality. • 17,015 individuals completed an online screener of depression and suicidality. • Participants represented six broad cultural groups. • Chinese group was far more likely to attempt suicide with negative depression screen. • Cultural differences remained when controlling for common predictors of suicidality. [ABSTRACT FROM AUTHOR]

Inconsistent self-reports of lifetime suicide attempts (LSAs) are a major obstacle for accurate assessment of suicidal behavior. This study is the first to posit that adolescents at higher risk report LSAs more consistently than those at lower risk, revealing a link between suicide attempt risk and consistent reporting. A machine learning model was trained with 70 % of the baseline assessment data of a longitudinal sample of Norwegian adolescents (n = 10,739). The model was used to estimate the LSA risk score for the remaining 30 % of the testing dataset. The relationship between these baseline risk scores and the consistency of reporting LSAs was assessed using a 2-year follow-up reassessment of the testing dataset. Internalizing problems, optimism about the future, conduct problems, substance use, and disordered eating were important factors associated with suicide attempt risk. Of the participants, 63.41 % had inconsistent self-reports at the two-year follow-up. Adolescents who consistently reported LSAs had significantly higher scores of suicide attempt risk at baseline. Two logistic regression analyses confirmed an association between suicide attempt risk and inconsistent self-reported LSAs and showed that sex (being male), and lower levels of depression and conduct problems significantly predicted such inconsistencies. Those who inconsistently reported LSAs were more likely than the others to be classified by the model as false negatives at the baseline risk assessment due to their lower estimated risk scores. Suicide attempts were measured with a single item in this study. These risk factors support the theory of adolescent suicidality (TAS) and could improve suicide attempt risk assessment. Inconsistent self-reported LSAs signal lower suicide attempt risk. • Adolescents at low risk of suicide are more likely to inconsistently report lifetime suicide attempts (LSA) • Internalizing problems, optimism about the future, conduct problems, substance use, and disordered eating were LSA risk factors • The examined risk factors support a recent Theory of Adolescent Suicidality (TAS) [ABSTRACT FROM AUTHOR]

Sleep disturbance may exacerbate the risk of suicide among youth with depression, but whether this association is independent of psychopathology requires further study. This cross-sectional study included 576 youths (13–25 years old) recruited from January 2022 to May 2023. The patients were first divided into two groups by the presence of suicidal ideation according to the Columbia-Suicide Severity Scale (C-SSRS). Sleep quality was assessed by the Athens Insomnia Scale (AIS) and mental health with the Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA). Logistic regression was conducted to analyze the association between sleep disturbance and suicidal ideation, adjusted for depressive symptoms severity. The suicidal ideation group exhibited more severe sleep disturbances, anxiety symptoms, and depressive symptoms than the non-suicidal ideation group. Pearson correlation showed that sleep disturbance (AIS) was significantly correlated with the severity of anxiety symptoms, depressive symptoms, and suicidal ideation. Logistic regression analysis revealed that the AIS factor "daytime dysfunction" (β = 0.145; OR = 1.156, 95 % CI: 1.02, 1.309; p = 0.023) was significantly associated with suicidal ideation after adjusting for demographic characteristics and depressive symptoms severity. Due to the cross-sectional nature of the data, no causal inference can be made regarding the observed associations between sleep disturbance and suicidal ideation. Sleep disturbance, particularly in the realm of daytime dysfunction, is associated with increased suicidal ideation among depressed youth. Clinicians need to assess and manage sleep disturbance in the context of suicidal ideation for young depression patients. • Sleep disturbances are common in youth with depression • Youth with suicidal ideation have more severe depressive and anxiety symptoms • Individuals who experience suicidal ideation may have an increased burden of sleep disturbance and related issues • Sleep disturbance may be an important element of suicide risk assessment [ABSTRACT FROM AUTHOR]

Machine learning (ML) has been widely used to predict suicidal ideation (SI) in adolescents and adults. Nevertheless, studies of accurate and efficient models of SI prediction with preadolescent children are still needed because SI is surprisingly prevalent during the transition into adolescence. This study aimed to explore the potential of ML models to predict SI among preadolescent children. A total of 4691 Chinese children (54.89 % boys, M age = 10.92 at baseline) and their parents completed relevant measures at baseline and the children provided 6-month follow-up data for SI. The current study compared four ML models: Random Forest (RF), Decision Tree (DT), Support Vector Machine (SVM), and Multilayer Perceptron (MLP), to predict SI and to identify variables with predictive value based on the best-performing model among Chinese preadolescent children. The RF model achieved the highest discriminant performance with an AUC of 0.92, accuracy of 0.93 (balanced accuracy = 0.88). The factors of internalizing problems, externalizing problems, neuroticism, childhood maltreatment, and subjective well-being in school demonstrated the highest values in predicting SI. The findings of this study suggested that ML models based on the observation and assessment of children's general characteristics and experiences in everyday life can serve as convenient screening and evaluation tools for suicide risk assessment among Chinese preadolescent children. The findings also provide insights for early intervention. • This study employed machine learning models for prediction of suicidal ideation among preadolescent children. • The random forest model achieved the highest discriminant performance with an AUC of 0.92, accuracy of 0.93. • Key predictors: internalizing/externalizing problems, neuroticism, childhood maltreatment, and subjective well-being in school. [ABSTRACT FROM AUTHOR]

Loneliness is a critical issue affecting the general population. Current evidence from national surveys of loneliness is scarce. The study aimed to examine the impact of COVID-19 pandemic on the prevalence of loneliness and its associating suicide risks in Taiwan. Four annual telephone interview surveys were performed by the Taiwan Suicide Prevention Center in 2015–2017 and 2020 during COVID outbreak. Each year the sample was randomly selected by stratifying the general public in different geographical areas and fulfilled a questionnaire collecting information including loneliness, psychological distress, and suicide risk assessment. All the data were analyzed using SPSS25 analysis. A total of 8460 participants were recruited. The average prevalence of loneliness was 12.6 %. Feelings of loneliness was significantly correlated with psychological distress and most risk factors relating to suicide. The odds of loneliness for lifetime suicidal ideation, lifetime suicide attempt, and future suicide intent were 4.9, 5.1, and 9.2, respectively. During the COVID-19 period, loneliness and suicidality demonstrated a noteworthy decline trend, whereas "no one trustworthy to talk to" was the only item that showed significant increase under the pandemic and also impacted on loneliness. Nearly one in ten Taiwanese people felt lonely before and during COVID-19. Loneliness was closely linked with various suicide risk factors such as lifetime suicide ideation and attempt or future intention. Although psychological distress and suicide risk were not increased during COVID-19, maintaining trustful relationships to seek support appeared to be critical to prevent the risks of loneliness or suicide. [ABSTRACT FROM AUTHOR]

This study sought to identify independent risk factors associated with suicide following a diagnosis of bladder cancer and to develop a predictive model with the potential to contribute to suicide rate reduction. Harnessing data from the Surveillance, Epidemiology, and End Results (SEER) database, we identified bladder cancer patients diagnosed between 2004 and 2015, randomly assigning them to training and validation cohorts. The Cox proportional hazard model was employed to identify relevant predictors, leading to the construction of prediction nomogram models. Validation of prognostic nomograms involved assessing the consistency index (C-index), receiver operating characteristic (ROC) curve, and calibration curve. A total of 109,961 eligible bladder cancer patients were enrolled, randomly divided into training and validation sets. Multivariate Cox regression analysis revealed that sex, marital status, tumor local status (T Stage), and lymph node metastatic conditions (N Stage) were independent predictors for suicide in bladder cancer patients. Evaluation of the nomogram's accuracy through the C-index and ROC curve demonstrated acceptable performance in both training and validation sets. Moreover, the calibration plot indicated moderate accuracy of the nomogram in both datasets. Overall, this study successfully identified risk factors for suicide among bladder cancer patients and developed a nomogram, offering individualized diagnosis, intervention, and risk assessment to mitigate the risk of suicide in this patient population. • By utilizing easily accessible and understandable predictors, we developed a simple yet reliable prediction model. • This model could assist oncologists or urologists in rapidly identifying individuals at risk of suicide, enabling them to implement appropriate precautions promptly. • The application of such prediction models has the potential to prevent unnecessary deaths and significantly reduce the burden of bladder cancer. [ABSTRACT FROM AUTHOR]

The revised Suicide Crisis Inventory (SCI)-2 is a self-report measure to assess the suicide crisis syndrome (SCS). We aimed to assess the factor structure, reliability, and validity of SCI-2 among adults with major depression. Using a cross-sectional design, between November 2021 and August 2022, the Hindi SCI-2, along with other self-report measures, was administered to Indian adult respondents clinically diagnosed with major depression across 24 centers in India. Confirmatory factor analysis was carried out to test the factor structure of SCI-2. Additionally, convergent, discriminant, and criterion validity were tested using bivariate or biserial correlations, as appropriate. We obtained responses from 654 participants (Mean age = 36.9 ± 11.9 years, 50.2 % female). The SCI-2 fit both a one-factor (χ2[1769] = 14,150.74, p <.001, CFI = 0.98, RMSEA = 0.10), and five-factor solution (χ2[1759] = 13,130.83, p <.001,CFI = 0.98, RMSEA = 0.10) with the five-factor solution providing a significantly better fit. Internal consistencies of the SCI-2 total and subscale scores ranged from good to excellent. Most subscales significantly converged with each other and with other relevant measures although these associations were weak for thwarted belongingness and goal reengagement subscales. Small to moderate associations were noted in support of discriminant and criterion validity. We could not assess the predictive validity of SCI-2 for suicidal behaviors. Consistent with prior data, the Hindi SCI-2 fit a five-factor solution and showed good psychometric properties. These findings support the use of SCI-2 to assess SCS among Indian adults with major depression. • In the general population, the SCI-2 has demonstrated a five-factor solution. • We performed confirmatory factor analysis of Hindi SCI-2 in major depression. • The five-factor model of SCI-2 showed a superior fit versus the one-factor model. • Excellent internal consistency and good convergent validity were noted. • These findings support the use of SCI-2 in major depression in Asian settings. [ABSTRACT FROM AUTHOR]

Food insecurity has become a growing burden within a global context where climate change, catastrophes, wars, and insurgencies are increasingly prevalent. Several studies have reported an association between suicidal behaviors (i.e., suicide ideation, plans, and attempts) and food insecurity. This meta-analytic review synthesized the available literature to determine the pooled prevalence of suicidal behaviors among individuals experiencing food insecurity, and examined the strength of their association. Databases (Ovid , PubMed , Web of Science , and CINAHL) were searched from inception to July 2022 using appropriate search terms. Eligible studies reporting the number/prevalence of suicidal behaviors among individuals experiencing food insecurity or the association between food insecurity and suicidal behaviors were included. The pooled prevalence of suicidal behaviors was determined using the random-effects model. The review was registered with PROSPERO (CRD42022352858). A total of 47 studies comprising 75,346 individuals having experienced food insecurity were included. The pooled prevalence was 22.3 % for suicide ideation (95 % CI: 14.7–29.9; I 2 = 99.6 %, p < 0.001, k = 18), 18.1 % for suicide plans (95 % CI: 7.0–29.1; I 2 = 99.6 %, p < 0.001, k = 4), 17.2 % for suicide attempts (95 % CI: 9.6–24.8; I 2 = 99.9 %, p < 0.001, k = 12), and 4.6 % for unspecified suicidal behavior (95 % CI: 2.8–6.4; I 2 = 85.5 %, p < 0.001, k = 5). There was a positive relationship between experiencing food insecurity and (i) suicide ideation (aOR = 1.049 [95 % CI: 1.046–1.052; I 2 = 99.6 %, p < 0.001, k = 31]), (ii) suicide plans (aOR = 1.480 [95 % CI: 1.465–1.496; I 2 = 99.1 %, p < 0.001, k = 5]), and (iii) unspecified suicide behaviors (aOR = 1.133 [95 % CI: 1.052–1.219; I 2 = 53.0 %, p = 0.047, k = 6]). However, a negative relationship was observed between experiencing food insecurity and suicide attempts (aOR = 0.622 [95 % CI: 0.617–0.627; I 2 = 98.8 %, p < 0.001, k = 15]). The continent and the countries income status where the study was conducted were the common causes of heterogeneity of the differences in the odds of the relationships between experiencing food insecurity and suicidal behaviors - with North America and high-income countries (HICs) having higher odds. For suicide attempts, all non HICs had a negative relationship with food insecurity. There was significant heterogeneity among the included studies. There is a high prevalence of suicidal behaviors among individuals experiencing food insecurity. Initiatives to reduce food insecurity would likely be beneficial for mental wellbeing and to mitigate the risk of suicidal behaviors among population experiencing food insecurity. The paradoxical finding of suicide attempts having a negative relationship with food insecurity warrants further research. • The prevalence of suicidal behaviors is high among individuals experiencing food insecurity. • The prevalence of suicidal behaviors was higher in high-income countries compared to other countries, and the rates in North America were particularly higher compared to other continents. • With the exception of suicide attempts, all other types of suicidal behaviors had a positive significant relationship with food insecurity. • Initiatives to reduce food insecurity could be beneficial for mental wellbeing and to mitigate the risk of suicidal behaviors among populations experiencing food insecurity. • In addition, there is a need to screen for suicide among individuals experiencing food insecurity for early management, support, and intervention. [ABSTRACT FROM AUTHOR]

Suicidal ideation (SI) is prevalent among individuals at clinical high-risk for psychosis (CHR). Natural language processing (NLP) provides an efficient method to identify linguistic markers of suicidality. Prior work has demonstrated that an increased use of "I", as well as words with semantic similarity to "anger", "sadness", "stress" and "lonely", are correlated with SI in other cohorts. The current project analyzes data collected in an SI supplement to an NIH R01 study of thought disorder and social cognition in CHR. This study is the first to use NLP analyses of spoken language to identify linguistic correlates of recent suicidal ideation among CHR individuals. The sample included 43 CHR individuals, 10 with recent suicidal ideation and 33 without, as measured by the Columbia-Suicide Severity Rating Scale, as well as 14 healthy volunteers without SI. NLP methods include part-of-speech (POS) tagging, a GoEmotions-trained BERT Model, and Zero-Shot Learning. As hypothesized, individuals at CHR for psychosis who endorsed recent SI utilized more words with semantic similarity to "anger" compared to those who did not. Words with semantic similarity to "stress", "loneliness", and "sadness" were not significantly different between the two CHR groups. Contrary to our hypotheses, CHR individuals with recent SI did not use the word "I" more than those without recent SI. As anger is not characteristic of CHR, findings have implications for the consideration of subthreshold anger-related sentiment in suicidal risk assessment. As NLP is scalable, findings suggest that language markers may improve suicide screening and prediction in this population. [ABSTRACT FROM AUTHOR]

Although chronotype has been associated with suicidal behavior, current research suggest that this relationship may be mediated by other factors. The aim of this study was to assess whether chronotype, specifically morningness, may predict suicidal behavior and whether this relationship may be mediated by general mental health, depressive and anxiety symptoms, and/or social functioning among young adults. The study group comprised 306 students: 204 (65.8%) women, 101 (32.6%) men and one who chose not to identify with either option (0.3%). The participants completed The Composite Scale of Morningness, The General Health Questionnaire, 30-item version, Suicide Acceptance Questionnaire and The Suicidal Behaviors Questionnaire-Revised. Correlations between the continuous variables of interest revealed a weak, but significant, negative association between morning affect (CSM) and suicidal behavior (SBQ-R); a moderate positive association was found between suicidal behavior (SBQ-R) and depression/anxiety, and a weak one between suicidal behavior (SBQ-R) and interpersonal relations (GHQ-30). The models predicting suicidal behavior, and chronotype-related variables as predictors of suicidal behavior, were then tested. Although the morning affect predicted suicidal behavior, this effect became irrelevant when combined with mental health characteristics: psychopathological symptoms of depression and anxiety and the quality of interpersonal relations. Our findings imply that the role of chronotype is secondary to general mental health: mental disorder symptoms should be considered as the core risk factors for suicide and serve as the focus for suicide risk assessments. [ABSTRACT FROM AUTHOR]

Suicide is a leading cause of death of 10- to 19-year-olds in the United States.1 Firearms were used in 48% of suicides of 15- to 19-year-olds and in 38% of suicides of 10- to 14-year-olds in 2020.1 During the COVID-19 pandemic, gun sales surged, leading to increases in household firearm ownership,2 a known risk factor for suicide.3 There are many ways in which adolescents access firearms. Most commonly, adolescents encounter firearms owned by an adult in the home. One study showed that one-third of adolescents reported they could access a loaded household gun in less than 5 minutes, even in households where parents did not believe that their child could access a household firearm.4 Another study found that 39% of parents who reported that their children did not know the location of household guns, and 22% of parents who reported that their children had never handled a household gun, were contradicted by their children's reports.5Adolescents can legally own rifles or shotguns if gifted to them by a parent. Federal law (18 U.S.C. 922) prohibits possession of handguns by minors less than 18 years of age; however, there are no federal minimum age requirements for possession of long guns (shotguns, rifles).Social media contributes to adolescent gun culture. TikTok users have created and viewed popular videos about guns,6 including videos with instructions on building guns from hardware store materials or via 3D printing. Adolescents can purchase kits online to assemble fully functional handguns. No federal restrictions or background check requirements exist on who can purchase "ghost gun" kits.7Child and adolescent mental health providers often assess suicide risk with a screening tool such as the Columbia−Suicide Severity Rating Scale, with a clinical assessment, or with a combination of both. Either way, the assessment should include asking about access to lethal means, including firearms. Many adolescent suicide attempts are impulsive; completed suicides may be prevented if access to firearms is limited during periods of crisis.8 However, many clinicians do not talk about firearms with patients even when clinically relevant.9 This may be due to assumptions that adolescents do not have access to firearms, or to lack of comfort with this topic. One study surveying medical residents reported the most common barriers to providing firearm counseling were not knowing how to ask about firearm access and not knowing how to respond to patients' answers about firearm access.9Once identifying an adolescent at risk for suicide, clinicians can intervene by providing evidenced-based interventions tailored to each situation. In this article, we present steps adapted from the BulletPoints Project for clinicians to intervene with adolescents at risk for firearm suicide. [ABSTRACT FROM AUTHOR]

Suicide hotlines are widely used, with potential for identification of callers at especially high risk. This prospective study was conducted at the largest psychological support hotline in China. From 2015 to 2017, all distressed callers were consecutively included and assessed, using a standardized scale consisting of 12 elements, yielding scores of high risk (8–16), moderate risk (4–7), and low risk (0–3) for suicidal act. All high-risk and half of moderate- and low-risk callers were scheduled for a 12-month follow-up. Main outcomes were suicidal acts (nonlethal attempt, death) over follow-up. Of 21,346 fully assessed callers, 5822, 11,791, and 3733 were classified as high-, moderate-, or low-risk for suicidal acts, with 8869 callers (4076 high-, 3258 moderate-, and 1535 low-risk) followed up over 12 months. Over follow-up, 802 (9.0 %) callers attempted suicide or died by suicide. The high-risk callers (15.1 %) had 3-fold higher risk for subsequent suicidal acts than moderate- (5.1 %) and 12-fold higher risk than low-risk callers (1.3 %). The weighted sensitivity, specificity, and positive predictive value of high risk scores were 56.4 %, 74.9 %, and 14.4 %. Assessed callers with different risk levels were followed disproportionally. Suicidal risk assessment during a hotline call is both feasible and predictive of risk, guiding resource allocation to higher risk callers. • A comprehensive suicidal risk assessment scale for suicide prevention hotline has been developed. • Of 21,346 fully assessed hotline callers, 8869 callers were followed up over 12-month. • Findings of this prospective study indicate that predictive validities of the scale are acceptable. • Suicidal risk assessment is viable for determination of intervention plan in hotline in resources-limited countries. [ABSTRACT FROM AUTHOR]

The current study developed a predictive model for suicide ideation among South Korean (Korean) adolescents using a comprehensive set of factors across demographic, physical and mental health, academic, social, and behavioral domains. The aim of this study was to address the pressing public health concerns of adolescent suicide in Korea and the methodological limitations of suicidal research. This study used machine learning methods (decision tree, logistic regression, naive Bayes classifier) to improve the accuracy of predicting suicidal ideation and related factors among a nationally representative sample of Korean middle school students (N = 6666). Factors within all domains, including demographic characteristics, physical and mental health, and academic, social, and behavioral, were important in predicting suicidal thoughts among Korean adolescents, with mental health being the most important factor. The predictive model of the current research does not infer causality, and there may have been some loss of information due to measurement issues. Study results provide insights for taking a multidimensional approach when identifying adolescents at risk of suicide, which may be used to further address their needs through intervention programs within the school setting. Considering the cultural stigma attached to disclosing suicidal ideation and behavior, the current study proposes the need for a preventive screening process based on the observation and assessment of adolescents' general characteristics and experiences in everyday life. • Limitations in the prediction of suicide risk among South Korean adolescents has long been a key issue in suicide research. • This study employed machine learning to consider multifaceted domains of adolescent lives including demographic, physical health, mental health, academic, social, and behavioral characteristics for accurate prediction of suicide risk. • This study contributes to designing suicide screening methods that target the general population of South Korean adolescents. [ABSTRACT FROM AUTHOR]

Suicidality spans from having suicidal ideation to planning and making an attempt. However, not all individuals with suicidal thoughts will proceed to plan or attempt suicide. Our study investigated (i) the prevalence of suicide planning and attempt among those with suicidal ideation and (ii) their associations with sociodemographic characteristics, mental disorders, adverse childhood events and prior suicidal behaviour. This cross-sectional analysis utilised data from Singapore Mental Health Study 2016. Only respondents with suicidal ideation were included. A total of 411 and 365 individuals were examined to establish the prevalence of suicide planning and attempt respectively. Multivariable logistic regressions were performed to determine associations. The prevalence of suicide planning and attempt were 17.7 % and 10.6 % respectively, with >80.0 % occurring within a year of suicidal ideation. Suicide planning was more likely among those who had mood disorders. Suicide attempt was more likely for those were currently married, had lower educational qualifications, history of anxiety disorders, history of emotional neglect and parental separation. Recall bias may be present because the age of onset for various mental disorders and suicidal behaviours were self-reported. As suicide was criminalised when the study was conducted, the prevalence of suicidal behaviours may have been underestimated. Individuals at risk of suicide planning and attempt should be identified early since most of them progressed within a year. Findings suggest the importance of including prior suicide behaviour and history of dysfunctional family and emotional abuse in suicide risk assessment and intervention. • 17.7 % of those with suicidal ideation planned suicide and 10.6 % attempted suicide. • Suicide planning was more likely for those who had history of mood disorders. • Suicide attempts were correlated with emotional neglect and parental separation. • Identifying individuals at risk early can prevent suicide behaviour later in life. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic's mental health impact is well-established. While early evidence suggested suicide deaths remained stable or declined, suicidal ideation (SI) became more prevalent than before the pandemic. Our study: (1) examined the prevalence and distribution of SI among Canadian adults, (2) compared SI among those with and without pre-existing mental illnesses, and (3) evaluated associations between pandemic-related stressors (i.e., unemployment, insecure employment, loss of income, medical vulnerability, COVID-19 exposure) with SI, and whether such associations were mediated by depression, thwarted belongingness, perceived burdensomeness, or perceived discrimination. The sample was comprised of data gathered at three timepoints (Wave 1 08/18/2020–10/01/2020, n = 6629; Wave 2 12/21/2020–03/31/2021, n = 5920; Wave 3 09/07/2021–12/07/2021, n = 7354). Quota-based responses from survey research panels which matched the geographic, age, and sex distribution of the Canadian population were supplemented with convenience-sampled responses. The prevalence of SI was 4.1 % (Wave 1), 5.3 % (Wave 2), and 5.8 % (Wave 3). Odds of SI were higher for respondents under the age of 35 years and with pre-existing mental illnesses. SI was associated with quarantining due to suspected or confirmed COVID-19 exposure, potential COVID-19 exposure at work, medical vulnerability toward COVID-19, insecure employment or unemployment, and income loss. These associations were mediated by psychological experiences, particularly depression and thwarted belongingness. This cross-sectional, observational study cannot establish temporality or causality. Results highlight groups who may benefit from enhanced screening for depression and suicide risk. Reducing depression and increasing sense of belonging should be prioritized. • 4.1 % to 5.8 % of Canadian adults endorsed suicidal thoughts in 3 surveys in 2020–21. • Rates of SI were higher in those aged 18–35 and with pre-existing mental illnesses. • SI was related to employment, income loss and potential/confirmed COVID-19 exposure. • Men and racialized minorities reported more SI without pre-existing mental illness. • Depression and belongingness mediated pandemic stressors' associations with SI. [ABSTRACT FROM AUTHOR]

Rates of suicide are significantly higher for individuals with schizophrenia spectrum disorders (SSDs) than those in the general population. With limited understandings of factors contributing to engaging in a suicide attempt among the psychosis population in the literature, the current study sought to preliminarily explore depression, suicide intent, and suicide plan among adults with and without psychosis symptom experiences who presented to an emergency department (ED) after making a suicide attempt. Electronic health record data were collected from the ED of an academic healthcare system in the Midwestern United States between 2011 and 2022. Patients included 1178 adults who arrived after making a suicide attempt. Trained research assistants conducted chart reviews and data were explored in SPSS28. A significantly smaller proportion of patients with psychosis had depressive symptoms and endorsed having suicide intent prior to their attempt in comparison to patients without psychosis. A smaller trending (p <.10) proportion of patients with psychosis endorsed having a suicide plan prior to their attempt than those with psychosis. Exploratory findings highlight the importance of EDs assessing for suicide risk beyond traditional approaches among patients with psychosis symptom experiences, including considerations for the potential of individuals not experiencing depression, suicide intent, or a suicide plan. Future research is particularly needed to examine psychosis symptomatology and the experience of distress as potential contributing factors to suicide behavior and death among patients with psychosis symptoms to better inform suicide risk assessment and intervention efforts. [ABSTRACT FROM AUTHOR]

Background: The aim of this multicenter study was to investigate the suicide risk in medically ill patients admitted to six Italian hospitals for whom a consultation-liaison intervention was requested.Methods: Participants completed socio-demographic and clinical report forms and the Brief Illness Perception Questionnaire. Suicidality was assessed using the P4 screener that investigates the presence of Past suicide attempts, Plans to commit a suicide, Probability of completing suicide, and Preventive factors. Participants were categorized as being at no, low or high suicide risk. Univariate and multivariable associations of categorical and continuous variables with suicide risk were investigated using multinomial logistic regression.Results: Of the 641 inpatients, with mean age 60 years (SD = 16.9) and 49.2 % male, 13.2 % were at high suicidal risk (HR), 7.6 % low risk (LR) and 79.2 % no risk. Contacts with psychiatrists in the previous six months were associated with LR and HR (OR = 2.159 and 2.634, respectively), ongoing benzodiazepine use was associated with a threefold likelihood of LR (OR = 3.005), and the experienced intensity of illness symptoms was associated with LR and HR (OR = 1.257 and OR = 1.248, respectively). CL psychiatrists prescribed appropriate psychotropic drugs and activated liaison interventions and psychological support for the level of suicidal risk.Limitations: The use of self-report measures bears the risk of recall bias.Conclusions: Our findings based on psychiatric consultations in the general hospital underscore the need to include suicide risk in the routine assessment of inpatients referred to CL psychiatric services and to plan an appropriate management of suicidal risk after discharge. [ABSTRACT FROM AUTHOR]

The Suicide Crisis Syndrome (SCS) is a new proposed suicide-specific diagnosis. In the present large replication study, we examine SCS diagnostic criteria to determine which configuration of symptoms demonstrates the strongest convergent and predictive validity for near-term suicidal behaviour. We conducted confirmatory factor analysis (CFA) to examine the factor structure of the proxy-SCS variables derived from an extensive self-report test battery and administered to 903 psychiatric patients (age (M = 36.70, SD = 13.91); gender (64.0% female)) at intake and 4-8-week follow-up assessments. Convergent and predictive validity of five configurations of the proposed SCS diagnostic criteria for suicidal ideation (SI) and attempts (SA) were examined using regression analyses. The new clinician-rated SCS-Checklist was piloted with 68 participants. Both the one-factor and the five-factor models of proxy-SCS variables exhibited strong model fit, supporting the uni-dimensionality as well as the five-criteria structure of the SCS. All four configurations were uniquely related to the presence of a suicide attempt at follow-up when controlling for intake SI, lifetime SA, age, and gender, but none were significantly associated with intake SA when controlling for intake SI, age, and gender. All bivariate correlations between proxy-assessed and checklist-assessed SCS symptom configurations were significant and positive. The proposed five-symptom structure of the SCS diagnostic criteria was supported and appears to describe a clinically meaningful syndrome specifically related to near-term suicidal behaviour. SCS assessment may significantly improve clinical evaluation of imminent suicide risk. Future studies are needed to assess the utility of the syndrome in clinical settings. • The uni-dimensionality and five-criteria structure of the proxy-SCS was supported by strong one- and five-factor model fits. • The five-symptom proxy-SCS configuration is clinically necessary for reliably predicting near-term suicide attempts. • The five-symptom SCS-Checklist may be a reliable clinician-friendly suicide risk assessment tool, pending further research. [ABSTRACT FROM AUTHOR]

Suicidal ideation (SI), a risk factor for suicide, is prevalent in internalizing psychopathologies, including depression and anxiety. Rumination and worry are well-studied repetitive negative thinking (RNT) constructs implicated in internalizing psychopathologies. These constructs have shared and distinct characteristics. However, the relationship between rumination and worry and their associations with SI are not fully understood in clinical samples. The present study used correlational and regression analysis to evaluate these relationships as a secondary data analysis in treatment-seeking participants with internalizing psychopathologies in two independent samples (Study 1: n = 143; Study 2: n = 133). Results showed about half of the participants endorsed SI (Study 1: n = 79; Study 2: n = 71). Correlations revealed a significant, positive relationship between rumination and worry. Regression results with SI as the dependent variable showed rumination significantly positively corresponded with SI in both studies. Post-hoc partial correlations controlling for symptom severity (depression, anxiety), worry, and age showed the rumination-SI relationship was maintained in both studies. Findings for worry and SI were inconsistent between studies. Findings indicate rumination, but not worry, could be a stable, unique contributor to SI in internalizing psychopathologies. It may be useful to incorporate RNT into suicide risk assessment for individuals with internalizing conditions. • Suicidal ideation is prevalent in internalizing conditions. • Repetitive negative thinking may contribute to suicidal ideation. • Rumination and worry are common forms of repetitive negative thinking. • Rumination, not worry, consistently corresponded with suicidal ideation. • Rumination may be a risk factor for suicidality in internalizing conditions. [ABSTRACT FROM AUTHOR]

• It is feasible and acceptable to use EMA to assess suicidality among young people with mood disorder in the Chinese cultural and social context. • Despite decreased adherence over time, participants reported an overall positive experience with the EMA study (e.g., helpful, friendly, and acceptable). However, a small proportion of participants had negative experiences (e.g., annoyance and missing prompts). • Future EMA studies should consider the frequency of surveys, the burden perceived by individuals, and individual differences when designing the EMA protocol. Suicidal thoughts and behaviors (STBs) are increasing among young people (aged 12–24 years) in China. Although Ecological Momentary Assessment (EMA) has been increasingly used to study STBs worldwide, no study has been conducted on young people with mood disorders (MD) in China. This mixed-method study aimed to evaluate the feasibility and acceptability of suicide risk monitoring in 75 young people with MD. Participants completed five to eight daily EMA surveys and wore smart bands for the EMA study. Semi-structured interviews were used to collect feedback. High adherence to EMA surveys (73.0 %) and smart bands (87.4 %) indicated feasibility. Participants reported an overall positive experience with the EMA study (helpful, friendly, and acceptable). Additionally, the reasons they were willing to comply with the EMA study were: (1) seeing the possibility of returning to "normal," and (2) experiencing the process of returning. However, a small proportion of participants had negative experiences (e.g., annoyance and missing prompts). The results of this mixed-methods study provide preliminary support for the feasibility and acceptability of using EMA (combined smartphones and wearable sensor devices) to assess suicidality among young people with MD in the Chinese cultural and social context. [ABSTRACT FROM AUTHOR]

Research has posited that machine learning could improve suicide risk prediction models, which have traditionally performed poorly. This systematic review and meta-analysis evaluated the performance of machine learning models in predicting longitudinal outcomes of suicide-related outcomes of ideation, attempt, and death and examines outcome, data, and model types as potential covariates of model performance. Studies were extracted from PubMed, Web of Science, Embase, and PsycINFO. A bivariate mixed effects meta-analysis and meta-regression analyses were performed for studies using machine learning to predict future events of suicidal ideation, attempts, and/or deaths. Risk of bias was assessed for each study using an adaptation of the Prediction model Risk Of Bias Assessment Tool. Narrative review included 56 studies, and analyses examined 54 models from 35 studies. The models achieved a very good pooled AUC of 0.86, sensitivity of 0.66 (95% CI [0.60, 0.72)], and specificity of 0.87 (95% CI [0.84, 0.90]). Pooled AUCs for ideation, attempt, and death were similar at 0.88, 0.87, and 0.84 respectively. Model performance was highly varied; however, meta-regressions did not provide evidence that performance varied by outcome, data, or model types. Findings suggest that machine learning has the potential to improve suicide risk detection, with pooled estimates of machine learning performance comparing favourably to performance of traditional suicide prediction models. However, more studies with lower risk of bias are necessary to improve the application of machine learning in suicidology. [ABSTRACT FROM AUTHOR]

The widespread problem of suicide and its severe burden in bipolar disorder (BD) necessitate the development of objective risk markers, aiming to enhance individual suicide risk prediction in BD. This study recruited 123 BD patients (61 patients with prior suicide attempted history (PSAs), 62 without (NSAs)) and 68 healthy controls (HEs). The Latent Dirichlet Allocation (LDA) model was used to decompose the resting state functional connectivity (RSFC) into multiple hyper/hypo-RSFC patterns. Thereafter, according to the quantitative results of individual heterogeneity over latent factor dimensions, the correlations were analyzed to test prediction ability. Model constructed without introducing suicide-related labels yielded three latent factors with dissociable hyper/hypo-RSFC patterns. In the subsequent analysis, significant differences in the factor distributions of PSAs and NSAs showed biases on the default-mode network (DMN) hyper-RSFC factor (factor 3) and the salience network (SN) and central executive network (CEN) hyper-RSFC factor (factor 1), indicating predictive value. Correlation analysis of the individuals' expressions with their Nurses' Global Assessment of Suicide Risk (NGASR) revealed factor 3 positively correlated (r = 0.4180, p < 0.0001) and factor 1 negatively correlated (r = − 0.2492, p = 0.0055) with suicide risk. Therefore, it could be speculated that patterns more associated with suicide reflected hyper-connectivity in DMN and hypo-connectivity in SN, CEN. This study provided individual suicide-associated risk factors that could reflect the abnormal RSFC patterns, and explored the suicide related brain mechanisms, which is expected to provide supports for clinical decision-making and timely screening and intervention for individuals at high risks of suicide. • Latent Dirichlet Allocation model reveals suicide risk factors in bipolar disorder. • Significant default-mode network hyper-connectivity linked to high suicide risks. • Hyper-connectivity in central executive and salience network may resist suicide. • Predictive model closely correlates with individual clinical suicide risk scores. [ABSTRACT FROM AUTHOR]

• Suicide is a major public health concern in the United states. • Death/suicide implicit associations shown to be objective marker for suicide risk. • Age effect associated with key measures on death/suicide implicit association test. • Death/suicide implicit associations differentiated suicide risk only in younger ages. The Death/Suicide Implicit Association Test (d/s-IAT) has differentiated individuals with prior and prospective suicide attempts in previous studies, however, age effects on test results remains to be explored. A three-site study compared performance on the d/s-IAT among participants aged 16–80 years with depression and prior suicide attempt (n = 82), with depression and no attempts (n = 80), and healthy controls (n = 86). Outcome measures included the standard difference (D) score, median reaction times, and error rates. Higher D scores represent a stronger association between death/suicide and self, while lower scores represent a stronger association between life and self. The D scores differed significantly among groups overall. Participants with depression exhibited higher scores compared to healthy controls, but there was no difference between participants with and without prior suicide attempts(F [2,242]=8.76, p <.001). Response times for participants with prior attempts differed significantly from other groups, with no significant differences in error rates. The D score was significantly affected by age (β =-0.007, t = 3.65, p <.001), with slowing of response times in older ages. Results suggest reaction time d/s-IAT D scores may not distinguish implicit thinking about suicide as response times slow with age, but slowed response times may be sensitive to suicide risk potentially indicating basic information processing deficits. [ABSTRACT FROM AUTHOR]

• The Link between Primary Care Clinics and Public Health Resources Intervention (LinkPC-PH), a primary care suicide prevention program supported by community public health resources, was effective in reducing suicide rates. • The suicide rate in the intervention area decreased by 25% following the intervention. Implementation of the LinkPC-PH intervention was associated with reduction in suicide rates. • These results empirically substantiate suicide prevention programs in primary care clinics by community public health resources for reduced suicide rates to support effective community-based suicide prevention interventions. The importance of appropriate and intensive follow-up management for individuals identified with suicide risk through screening is highlighted. The Link between Primary Care Clinic and Public Health Resources Intervention(LinkPC-PH), a suicide prevention program in primary care clinics supported by community public health resources, was implemented at the district level in 2017. The purpose of the present study is to evaluate the effectiveness of the LinkPC-PH intervention by comparing suicide rates before(2014-2016) and after(2017-2019) implementation of the intervention using a difference-in-differences design. The LinkPC-PH comprises several dimensions of intervention including screening, risk assessment of suicidality, and referral in primary care clinics and crisis contact within 24 hours, case management, and safety planning led by public health professionals. After adjustment for district-level confounders, an intervention-implemented district had 2.87 fewer suicide deaths per 100,000 people in a population sample at post-intervention than would have been expected from the same trend in suicide rates as non-implemented intervention districts. In other words, the suicide rate in the intervention area decreased by 25% following the intervention. These results empirically substantiate suicide prevention programs in primary care clinics by community public health resources for reduced suicide rates to support effective community-based suicide prevention interventions. [ABSTRACT FROM AUTHOR]

Background: How suicide risk should be assessed is under discussion with arguments for both actuarial and clinical approaches. The aim of the present study was to compare the predictive accuracy of a clinical suicide risk assessment to that of the Suicide Intent Scale (SIS) in predicting suicide within one year of an episode of self-harm with or without suicidal intent.Methods: Prospective clinical study of 479 persons assessed in a psychiatric emergency department after an episode of self-harm. The clinical risk assessment and the SIS rating were made independently of each other. Suicides within one year were identified in the National Cause of Death Register. Receiver operating characteristic (ROC) curves were constructed, optimal cut-offs were identified and accuracy statistics were calculated.Results: Of 479 participants, 329 (68.7%) were women. The age range was 18-95 years. During one-year follow up, 14 participants died by suicide. The area under the curve (AUC) for the clinical risk assessment and the SIS score were very similar, as were the accuracy statistic measures at the optimal cut-offs of the respective methods. The positive predictive value (PPV) of each assessment method was 6%.Limitations: The clinical suicide risk assessment is not standardized. The number of suicides is small, not allowing for stratification by e.g. gender or diagnosis.Conclusion: Predictive accuracy was similar for a clinical risk assessment and the SIS, and insufficient to guide treatment allocation. [ABSTRACT FROM AUTHOR]

Dialectical behavior therapy (DBT) in its initial iteration was developed for the treatment of suicidal and self-injuring adults. As a result, the assessment and management of suicidal and nonsuicidal self-injurious (NSSI) behavior was and is central to the conduct of standard DBT. In this paper the authors describe the DBT approach to suicide risk assessment including discussion of both comprehensive and targeted suicide risk assessment and the associated documentation. In addition, it describes when and when not to conduct such assessment. Finally, this article describes management of both imminent and distant suicide risk and the application of DBT treatment strategies that can be applied in session. • How to conduct suicide risk assessment in DBT • When to conduct suicide risk assessment in DBT • Management of suicide risk in DBT using DBT strategies [ABSTRACT FROM AUTHOR]

The suicide risk in bipolar disorder (BD) is the highest among psychiatric disorders, and the neurobiological mechanism of suicide in BD remains unclear. The study aimed to investigate the underlying relevance between the implicated abnormalities of dynamic functional connectivity (FC) and suicide attempt (SA) in BD. We used the sliding window method to analyze the dynamic FC patterns from resting-state functional MRI data in 81 healthy controls (HC) and 114 BD patients (50 with SA and 64 with none SA). Then, the temporal properties of dynamic FC and the relationship between altered measures and clinical variables were explored. We found that one of the five captured brain functional states was more associated with SA. The SA patients showed significantly increased fractional window and dwell time in the suicide-related state, along with increased number of state transitions compared with none SA (NSA). In addition, the connections within subcortical network-subcortical network (SubC-SubC), default mode network-subcortical network (DMN-SubC), and attention network-subcortical network (AN-SubC) were significantly changed in SA patients relative to NSA and HC in the suicide-related state. Crucially, the above-altered measures were significantly correlated with suicide risk. Our findings suggested that the impaired dynamic FC within SubC-SubC, DMN-SubC, and AN-SubC were the important underlying mechanism in understanding SA for BD patients. It highlights the temporal properties of whole-brain dynamic FC could serve as the valuable biomarker for suicide risk assessment in BD. • The temporal properties of whole-brain dynamic functional connectivity (FC) could be the critical potential predictors of suicidal behaviors for BD patients. • The dynamic FC within subcortical network-subcortical network, default mode network-subcortical network, and attention network-subcortical network were important targets in exploring the physiological mechanism of suicide attempt in BD patients. • The altered regular time allocation of the function interactions between subcortical network and other three large-scale networks could increase the susceptibility of suicide in BD patients. [ABSTRACT FROM AUTHOR]

Bipolar disorders (BD) in youths are strongly associated with suicidal ideation. Childhood trauma is a prominent environmental stressor associated with both BD diagnosis and suicide. Primary emotional systems are altered in adult BD and may contribute to suicide risk in youths. The aim of this study was to investigate primary emotional systems distribution patterns and childhood trauma in youths' BD with and without suicidal ideation (BD-IS, BD-NIS). We assessed 289 participants, 103 youths with DSM-5 BD and 186 healthy controls (HCs). Primary emotional systems were obtained with Panksepp's Affective Neuroscience Personality Scale (ANPS), and history of childhood trauma using the Childhood Trauma Questionnaire (CTQ). Suicidal ideation was assessed through the Columbia Suicide Scale for the Rating of Suicide Severity (C-SSRS). The associations with suicidal ideation were tested using two different multivariate models. Over 48 % of participants reported lifetime suicidal ideation and differed on clinical variables from BD-NIS. According to the first model (Wilk's Lambda = 0.72, p < 0.0001), BD-IS scored higher on Panksepp's ANGER and lower on PLAY and CARE than BD-NIS. Both BD-SI and BD-NSI scored higher on ANGER and SEEK and lower on PLAY and CARE than HCs. BD-IS reported more emotional abuse than BD-NIS. They also reported more emotional, sexual, and physical abuse, and emotional neglect than HCs. Only ANGER (OR = 1.13, 95 % CI = 1.01–1.26, Wald = 5.72) and CTQ-Emotional abuse (OR = 1.26, 95 % C.I. = 1.04–1.52, Wald = 5.72) independently predicted suicidal ideation. Findings support the importance of assessing primary emotional systems and childhood trauma, in particular emotional abuse, in youths with BD at risk for suicide. [ABSTRACT FROM AUTHOR]

Une revue exploratoire (Scoping Review) inspirée du modèle d'Arskey et O'Malley (2005) a été réalisé afin de connaître les différentes dimensions du phénomène du risque suicidaire chez les enfants de moins de 12 ans. Les moteurs de recherche PubMed, Web of Science, CINAHL, EMBASE et Google Scholar ont été utilisés pour constituer l'échantillon de 13 articles et un rapport. Ces articles ont été publiés entre 2005 et 2017 et écrits en français ou en anglais. En général, les enfants de moins de 12 ans présentent plus de propos ou d'idées suicidaires que de tentatives. Les moyens utilisés pour les tentatives sont : l'intoxication médicamenteuse, la pendaison et l'étranglement. Il demeure difficile de reconnaître l'intentionnalité derrière le geste. Souvent, le geste semble impulsif chez ces enfants. Des biais méthodologiques existent dans les différentes études, rendant plus difficile la mesure précise de l'ampleur du phénomène. De plus, bien que le développement du concept de mort s'effectue progressivement, il n'est pas nécessaire que cette acquisition soit complète pour qu'un risque suicidaire soit présent, ce qui fait en sorte qu'il faut toujours le considérer sérieusement. Il s'avère donc important pour les personnes travaillant auprès de ces enfants de dépister ce risque, de soulager la détresse sous-jacente et ainsi prévenir les tentatives de suicide, dont l'incidence tend à augmenter avec l'âge. To understand the different dimensions of suicidal risk for children 12 and under, a scoping review inspired by the Arskey and O'Malley (2005) model was conducted. Research engines used were PubMed, Web of Science, CINAHL, EMBASE and Google Scholar. A total of 13 articles and one report, published between 2005 and 2017 in French or English, were included in this study. Findings show that overall, for both girls and boys under 12 years old suicidal ideation and verbalizations are more prevalent than attempts. The means frequently used to attempt suicide are medication intoxication, hanging and strangulation. It is very difficult to assess the suicidal intent (wish to die) behind the attempt. It often appears to be an impulsive act. Methodological bias are often present in the studies found. Furthermore, even if children do not fully understand the concept of death, they still can attempt suicide. They need to be considered seriously by people working in the health care system. It is important that their emotional pain be heard to prevent further attempts in the future. [ABSTRACT FROM AUTHOR]

• Complex interplays among suicidal ideation and correlates in adolescents. • The most central nodes were hopeless, loneliness and verbal bullying victimization. • The strongest bridging symptoms were sexual bullying, sex, and relational bullying. Suicide has aroused global concern, and a better understanding of the complex interactions between suicide ideation and various psychopathological features is critical. We aimed to explore the complex interplays among adolescents. This study adopted a multistage stratified cluster sampling method and recruited adolescents aged 12 to 20 year-old from 8 middle and high schools between December 2020 and September 2021 in Guangzhou, China. We assessed loneliness, social support, bullying victimization, depressive symptoms, and suicidal ideation. We used network analysis to examine the network structure of the correlates of suicidal ideation and identify central symptoms and bridge symptoms. We used case-drop bootstrapping and correlation stability coefficients to examine the stability of the network. Among 8686 adolescents, 347 (4 %) adolescents reported suicidal ideation in the past two weeks. Network analyses identified 'hopeless', 'psychomotor', and 'failure' were the three strongest edges linked to suicidal ideation. The most central nodes were identified as 'hopeless' being the most central node, followed by loneliness and verbal bullying victimization, while sexual bullying victimization, sex, and relational bullying were the strongest bridging symptoms. The findings shed light on the complexity of associations of suicidal ideation and could provide insight into school-based suicide risk assessment and prevention for adolescents. [ABSTRACT FROM AUTHOR]