Search

Purpose: To analyze whether sociodemographic characteristics influence the substance choice and preclinical and clinical course of suicidal poisoning. Methods: This was a retrospective single-center study in patients hospitalized due to suicidal poisoning and who received at least one psychiatric exploration during their inpatient stay. Patients' sociodemographic, anamnestic, preclinical, and clinical parameters were analyzed with respect to sex and age. Results: 1090 patients were included, 727 (67%) were females, median age was 39 years (min–max: 13–91) with 603 (55%) aged 18–44 years. 595 patients (54.8%) ingested a single substance for self-poisoning, 609 (59.5%) used their own long-term medication. Comparing to males, females preferred antidepressants (n = 223, 30.7%, vs n = 85, 23.4%; p = 0.013) and benzodiazepines (n = 202, 27.8%, vs n = 65, 17.9%; p < 0.001); males more often used cardiovascular drugs (n = 33, 9.1%, vs n = 34, 4.7%; p = 0.005) and carbon monoxide (n = 18, 5.0%, vs n = 2, 0.3%; p < 0.001). Use of Z-drugs (n = 1, 1.7%, to n = 37, 33.3%; p < 0.001) and benzodiazepines (n = 4, 6.9%, to n = 33, 29.7%; p = 0.003) increased with age (< 18 to > 64 years), while use of non-opioid analgesics (n = 23, 39.7%, to n = 20, 18.0%; p < 0.001) decreased. Average dose of substance in patients > 64 years was 12.9 ± 18.4 times higher than recommended maximum daily dose (compared to 8.7 ± 15.2 higher in those aged < 18 years; p < 0.001). Males more often required intensive care (n = 150, 41.3%, vs n = 205 females, 28.2%; p < 0.001). Conclusion: These results underline the complexity of (para-)suicidal poisonings and identify potential measures for their prevention, such as restricting access and better oversight over the use of certain substances. [ABSTRACT FROM AUTHOR]

This cross-sectional study analyzed data from 12,541 employees aged 19–65 across 26 companies and public institutions who underwent workplace mental health screening. Workplace bullying was self-reported and categorized into 'Not bullied,' 'Occasional bullied,' and 'Frequently bullied.' Depression was assessed using the Center for Epidemiological Studies Depression scale, and suicidality was measured via a self-reported questionnaire from the Korea National Health and Nutrition Examination Survey. Overall, 18.7% of women and 10.6% of men reported experiencing workplace bullying. Multivariable logistic regression revealed that both the occasionally and frequently bullied were significantly associated with increased odds of suicidal ideation (OR = 1.47, 95% CI = 1.27–1.69; OR = 1.81, 95% CI = 1.36–2.40) and suicide attempts (OR = 2.27, 95% CI = 1.34–3.85; OR = 4.43, 95% CI = 2.13–9.21). The association between bullying and suicidal ideation was significant for participants with and without depression (OR = 1.47, 95% CI = 1.28–1.69; OR = 1.86, 95% CI = 1.31–2.62). Men exhibited a stronger association (p for interaction < 0.001). Whether an individual later had depressive symptoms or not, higher exposure to workplace bullying was associated with higher suicidality risk. The study highlights the need for companies to screen for bullying and provide mental health resources to prevent workplace-related suicides. [ABSTRACT FROM AUTHOR]

Purpose: Suicidal thoughts and behaviors (STB) have been increasing among US college students. Accurate measurement of STB is key to understanding trends and guiding suicide prevention efforts. We aimed to compare the prevalence estimates of STB among college students from two campus-based surveys (the National College Health Assessment [NCHA] and the Healthy Minds Study [HMS]) and one general population study (the National Survey on Drug Use and Health [NSDUH]). Methods: Estimates were generated from the three surveys for past year suicidal ideation (PYSI) and past year suicide attempts (PYSA) among 18- to 22-year-old full-time college students. Data were combined from each survey to develop bivariate and multivariate regression models for odds of PYSI and PYSA. Results: Estimates for PYSI varied between the three surveys: 34.3% for NCHA, 15.0% for HMS, and 10.7% for NSDUH. Estimates for PYSA were 2.6% for NCHA, 1.6% for HMS, and 1.7% for NSDUH. After adjusting for demographic and educational characteristics, odds of PYSI remained significantly lower for HMS participants (aOR 0.31, 95% CI 0.29–0.33) and NSDUH participants (aOR 0.19, 95% CI 0.19–0.30) compared to NCHA participants. The odds of PYSA for HMS participants were lower than those for NCHA participants (aOR 0.63, 95% CI 0.54–0.73). Conclusion: Estimates of PYSI and PYSA vary between leading sources of data on college student mental health. The differences are likely related to question wording, survey implementation, as well as institutional and individual representation. Accounting for these differences when interpreting estimates of STB can help guide suicide prevention efforts. [ABSTRACT FROM AUTHOR]

Suicide prevention in low- and middle-income countries (LMICs) faces unique challenges due to limited epidemiological data and contextual variations. This article highlights the urgency of addressing suicide, the second leading cause of death among individuals aged 15 to 29 globally, emphasizing the heightened vulnerability during college years. While high-income countries (HICs) have established surveillance systems, LMICs struggle due to inadequate resources, cultural stigma, and competing health priorities. The scarcity of reliable data hinders the formulation of evidence-based prevention programs and national policies. The article advocates for the implementation of surveillance systems on university campuses, utilizing cost-effective online mental health surveys like the WHO International College Student Initiative. Understanding the etiology of suicidal behavior is crucial, with psychosocial stressors affecting both HIC and LMIC college students, but the latter facing additional challenges like gender-based violence and financial stress. Cultural nuances further necessitate qualitative research to design context-sensitive prevention interventions. Access to mental healthcare is identified as a key preventive measure, especially on campuses, but challenges persist in encouraging help-seeking behavior. Digital interventions are proposed as promising solutions, considering their efficacy and potential to bridge treatment gaps in resource-constrained environments.

From 2004 to 2019, suicide rates among Black youth increased by 122 % for females and 65 % for males. Guided by the interpersonal theory of suicide, this study explored how perceptions of social support and parental involvement may contribute to suicidal behavior among Black youth aged 12–17 years. Data are from the 2004–2019 National Survey on Drug Use and Health (NSDUH). Multivariable logistic regression with backwards elimination was conducted to determine if characteristics associated with outcomes of interest (i.e., suicidal ideation, made a suicide plan, and made a suicide attempt) differed by sex. The characteristics examined included: age, poverty level, health insurance coverage, currently receiving mental health treatment, grades for last completed semester, parental involvement, frequency of arguments or fights with parents, frequency of fights at school or work, parental attitudes, and availability of emotional support. Over 400,000 Black youth with depression symptoms reported suicidal thoughts and behaviors (80 % female). Females had increased odds of suicidal ideation and making a plan if they had no one to talk to about serious problems. Males had increased odds of attempting suicide if they reported academic struggles. Limitations. This is a cross-sectional study and potential biases may affect generalizability of results. Risk and protective factors identified in this study aligned with the interpersonal theory of suicide. Evidence-based interventions that focus on increasing connectedness and self-esteem may be effective for Black youth struggling with suicidal ideation. Preventing suicide requires a comprehensive approach including prevention strategies for individuals, families, and communities. • This study explores factors associated with suicidal behavior among Black youth. • Lack of social support and parental involvement may increase suicide risk. • Improved parental relationships may protect against suicidal behavior. • Evidence-based interventions that focus on protective factors may be effective. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: The objective of this study was to analyze suicide attempts in adolescents treated in the emergency department before and during the coronavirus disease 2019 pandemic. Methods: This cross-sectional, documentary, and retrospective study assessed the medical records of adolescents treated for suicide attempts in two emergency rooms linked to a teaching hospital in São Paulo, Brazil. Data were collected from the pre-pandemic period (between January 1, 2015, and March 10, 2020) and the pandemic period (between March 11, 2020, and May 5, 2023), characterizing the adolescents, risk factors for suicide attempts during the pandemic, and treatment. Data were subjected to descriptive and inferential analyses, including association tests and trend analysis, with a p-value of 0.05). We observed an association between adolescents who had completed high school and cases during the pandemic, with a previous mental disorder diagnosis and pre-pandemic cases, and a higher number of suicide attempt notifications to the Brazilian epidemiological surveillance system during the pandemic period (p

BACKGROUND: Suicidal thoughts and attempts are commonly observed among patients with depression. The presence of concomitant psychotic symptoms in a patient with an existing depression increases the risk of drug-drug interactions, especially in cases when multiple drugs are used for treatment. CASE PRESENTATION: This case report describes a young adult female with a history of psychosis and depression, for which she had been taking risperidone and sertraline for the past six months. She was brought to the hospital by her family members after an alleged suicide attempt using her psychiatric medications. On examination, the patient exhibited disturbed consciousness and a moderately elevated body temperature, but notably, no muscle rigidity. These clinical features suggested a mild form of serotonin syndrome (SS). Despite a 1500 mg sertraline overdose, which would typically result in symptoms such as severe agitation, hallucinations, sweating, flushing, or tremors, the patient's SS was unexpectedly mild considering the amount of drugs ingested. CONCLUSION: It was concluded that the patient developed serotonin syndrome (SS) due to a toxic overdose of sertraline. However, the severity of SS was mitigated by the concurrent ingestion of an equivalent dose of risperidone, a serotonin receptor antagonist. As a result, the condition was classified as mild to moderate SS, which, despite the large dose of the selective serotonin reuptake inhibitor, did not necessitate the use of an antidote.

Abstract Background The World Health Organization has called for improved surveillance of self-harm and suicide attempts worldwide to benefit suicide prevention programs. International comparisons of registrations are lacking, however, and there is a need for systematically collected, high-quality data across countries. The current study investigated healthcare professionals’ perceptions of registration practices and their suggestions for ensuring high-quality registration of self-harm and suicide attempts. Methods Qualitative interviews (N = 20) were conducted among medical secretaries, medical doctors, nurses, and registration advisers from psychiatric and somatic emergency departments in all regions of Denmark between September 2022 and March 2023. Content analysis was performed using NVivo. Results Despite great efforts to standardize and assure the quality of registration in Denmark, almost all the healthcare professionals perceived registration practice as inconsistent and unreliable. Codes are often misclassified or unused due to insufficient time, non-standardized training, or insufficient information. The interview informants suggested that coding guidelines should be simplified and made more visible, alongside technical solutions in the electronic health record system. Conclusion The study findings resulted in eight overall recommendations for clinical practice that aim at improving the registration of patients presenting with self-harm or suicide attempts. This would be expected to help improve surveillance and prevention programs.

Objective: To describe the professional approach to people with suicidal behavior in Primary Health Care and its associations with the sociodemographic, educational and occupational variables of health workers. Methods: Cross-sectional study of 192 health professionals from 20 Basic Health Units in a municipality in greater São Paulo. A questionnaire for sociodemographic, educational and occupational characterization was applied, as well as the instrument for Evaluating Professional's Assistance to People with Suicidal Behavior. The results were presented using measures of central tendency and dispersion, and parametric and non-parametric tests were used in the analysis, considering the nature of the variables. A significance level of 5% was adopted. Results: There was a predominance of females, average age of 43.27 years, higher education, and average working time of 10.71 years. The higher scores were reached in the Professional Sensibility and Knowledge/Abilities domains. Lower scores were obtained for Professional Experience and Organization of the Care Network, demonstrating frailty in the professional performance and in network coordination needed in the approach to suicidal behavior. Age, working time in the unit and the frequency of treatment of populations at risk for suicidal behavior were associated with scores in Professional Sensibility, Experience and Knowledge/Abilities. Conclusion: Sensibility, knowledge and abilities of Primary Care health professionals contribute to the approach to suicidal behavior, associated with occupational and educational characteristics. Professional experience and Organization of the care network reveal the weaknesses in the coordination necessary to approach suicidal behavior, indicating paths for training and work in health. [ABSTRACT FROM AUTHOR]

Copyright of Lijecnicki Vjesnik is the property of Croatian Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose This study investigated the association of the index method, defined as the method used in the first suicide attempt (SA), with the outcome of SAs among adolescents. Methods The study analyzed medical records of 227 adolescents aged 10-18 years with clear SAs who visited the emergency department of Severance Hospital in Seoul, Korea from January 2007 through February 2021, focusing on the index methods and meaningful SAs defined as hospitalization, death or transfer to another hospital for psychiatric hospitalization. The association of the index method with the meaningful SAs was quantified using logistic regression. Results Among the 227 adolescents, 80 underwent the meaningful SAs (35.2%). The adolescents with the meaningful SA chose drug intoxication, fall, and hanging as the index methods more frequently than those without the outcome, whereas they showed a reverse pattern in cutting (P < 0.001). The association of fall or cutting with the meaningful SAs remained significant after adjustment (fall: adjusted odds ratio, 6.93 [95% confidence interval, 1.70-28.26]; cutting: 0.39 [0.17-0.91]; compared with those undergoing drug intoxication). Multiple SAs were also associated with the meaningful SA (1.76 [1.04-3.13]). Conclusion This study identifies the index method and multiple SAs as factors associated with the meaningful SA among adolescents in the emergency department. This finding may be helpful in interviewing adolescents with SAs.

Spontaneous esophageal perforation (also known as Boerhaave syndrome) is associated with sudden increase in intra-esophageal pressure by vomiting, coughing or straining at stool. This case describes a 13-year-old girl who developed the perforation after consuming 270 mg/kg of caffeine tablets for a suicide attempt. Presumably, the perforation was caused primarily by caffeine-induced severe vomiting, and secondarily by caffeine-induced gastric acid secretion with smooth muscle relaxation and by the large amount of caffeine-induced sudden increase in intra-esophageal pressure.

Previous studies have reported an association between concussion and suicidality in high school students in the United States. When controlling for multiple life stressors in adolescence (e.g., bullying, substance use, poor grades), however, the relationship between concussion and suicidality was either attenuated or became non-significant in one study. Rather than assessing concussion as a possible risk factor for suicidality, this study examined predictors of ideation, planning, and attempts among youth who experienced concussion in the past year. The sample included 13,677 participants from the 2019 Youth Behavior Risk Survey, of whom 1754 (13%) reported experiencing a concussion in the past year. Binary logistic regressions were conducted to predict ideation, planning, and attempts with modifiable stress factors, including physical activity, bullying, poor grades, insufficient sleep, binge drinking, marijuana use, illicit drug use, and depression. Among adolescents who experienced a concussion in the past year, 25% reported suicidal ideation (31% girls/19% boys), 20% reported suicide planning (25% girls/17% boys), and 15% reported a suicide attempt (17% girls/13% boys). In a multi-variable model among girls with prior year concussion, being bullied (odds ratio [OR] = 2.37), illicit drug use (OR = 2.80), current marijuana use (OR = 2.47), and depression (OR = 9.22) predicted suicidal ideation. Among boys with prior year concussion, being bullied (OR = 2.29) and depression (OR = 9.50) predicted suicidal ideation. Additional models were used to examine the association between having one or more modifiable stressors and suicidality, revealing that having three or more modifiable stressors was associated with a substantial increase in proportions of youth reporting suicidality. Among adolescents experiencing a concussion, treating depression and substance use, stopping bullying, and increasing physical activity may be associated with reduced risk for suicidality. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives: to identify and characterize the care provided to adolescents admitted to an emergency department due to a suicide attempt. Methods: an observational, cross-sectional, descriptive study with a retrospective approach, carried out with medical records of adolescents aged 10 to 19 admitted for suicide attempts, between January 2015 and July 2020, in an emergency department. Data were subjected to descriptive and inferential analysis. Results: eighty-eight service occurrences were identified, mainly to females, exposed to multiple risk factors. Exogenous intoxication was the main method used, occurring at home and on weekdays. There were systemic repercussions, requiring multiple interventions and hospitalizations. Only 26% of cases were notified. Conclusions: adolescents treated for suicide attempts were exposed to multiple risk factors, with intoxication as the main means used. There is concern about the underreporting of cases and the logic of clinical care and medicalization.

N/a.

The aim of this study was to identify independent risk and protective factors associated with self-reported suicidal thoughts and behaviors (STB) among young adolescents by examining self-report data on mental health, substance abuse, violence involvement, social and economic challenges and supports, physical health and demographics in relation to STB. Data from nearly 27,000 students who completed the 2018-19 Maryland Middle School Youth Risk Behavior Survey/Youth Tobacco Survey (YRBS/YTS) were used to identify independent risk and protective factors associated with STB among middle school students (grades 6–8; ages 11-14). Twenty-three percent of students reported lifetime suicidal ideation and nine percent reported lifetime attempt(s). Independent risk factors associated with STB include depression, substance abuse or misuse, violence involvement, bullying victimization at school or electronically, sexual activity, and sleep deprivation. Protective factors include having an adult outside of school to confide in and feeling that teachers care and provide encouragement. Interactive effects by gender and/or race/ethnicity were observed for some factors in relation to STB. These results suggest that evidence-based programs and policies at the universal and selective/indicated levels in school settings are needed and should be introduced earlier on to address the widespread prevalence of STB in young adolescents. Program planners should take into consideration social, cultural and language needs when implementing and developing intervention strategies. [ABSTRACT FROM AUTHOR]

Abstract Background Suicide is a leading cause of death in children and youth, with suicidal thoughts and suicide attempts (referred to as non-fatal suicidal behaviors (NFSB)) being among its strongest predictors. Positive parenting (e.g., warmth, responsiveness), negative parenting (e.g., control, hostility), and parent-child relationship quality (e.g., trust, communication) have been reported to be associated with differences in NFSB in this population. To date, no comprehensive systematic review has considered together the wide range of parenting factors studied in relation to NFSB, and no meta-analysis of existing findings has been conducted. The present study will critically appraise and synthesize the existing evidence from observational studies that examine the relationships between parenting factors and (i) suicidal ideation and (ii) suicide attempt in children and youth. Methods Studies will be retrieved from APA PsycInfo, MEDLINE, CINAHL, Embase, Scopus, and the Cochrane Library databases. Retrospective, cross-sectional, and longitudinal studies, conducted in clinical and population settings, among youth aged less than 25 years and published as articles and dissertations in English or French will be eligible. Two reviewers will select articles using the Covidence Software after title and abstract screening and full-text assessment, will extract information using double data entry, and will appraise studies’ quality using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Any disagreements will be discussed with a third reviewer. Publication bias will be evaluated using funnel plots and Egger’s test. In addition to a narrative summary of results, meta-analyses will be conducted using results from at least three studies. Three-level random effect models will allow to derive pooled estimates from dependent effect sizes (from the same sample or study). In case of significant heterogeneity, moderation analyses will be performed considering participants’ characteristics and methodological aspects of studies. The results will be reported according to the PRISMA guidelines, and the certainty of evidence will be assessed using the GRADE approach. Discussion In highlighting parenting factors associated with NFSB and in estimating the overall strength of these associations in children and youth, our results will inform further intervention and prevention strategies designed for young people experiencing NFSB and their families. Systematic review registration PROSPERO CRD42020165345

Abstract Background Non-medical use of prescription opioids (NMUPO), defined as taking an opioid in a manner or dose other than prescribed, taking someone else’s, or for the feelings that it produces, has been reported by 5 to 20% of adolescents, and is associated with a two fold increase in suicidal behaviors among adolescents. Adolescents with long-term health problems (LTHP) have poorer mental health and may seek NMUPO for pain relief that is not obtained through standard care. For this study, we measured the association between NMUPO and suicidal behaviors, and further assessed effect modification by LTHP hypothesizing the association between NMUPO and suicidal behaviors was stronger for adolescents with LTHP. Findings For students with LTHP, 13.5% reported suicide ideation, while 8.0% of students without LTHP reported suicide ideation. For suicide attempt, 4.4% of students with LTHP reported a suicide attempt, while 2.1% of students without LTHP reported a suicide attempt. The proportion of students who reported suicide ideation and attempts increased with higher occasions of NMUPO. Adjusted logistic regression models found increased odds of suicide ideation (OR (95% CI): 1–5 occasions: 2.3 (2.0–2.6); > 6 occasions: 2.7 (2.2–3.8)) and suicide attempts (OR (95% CI): 1–5 occasions: 3.2 (2.7–3.7); > 6 occasions: 4.1 (3.1–5.3)) for students who reported NMUPO. An interaction term for NMUPO and LTHP was then added to the models. Effect modification was not present on the multiplicative scale. On the additive scale, evidence of effect modification was observed: higher risk was indicated for students with LTHP versus no LTHP for both suicide ideation (Predicted risk (95%CI): > 6 occasions NMUPO, LTHP: 0.24 (0.18–0.29); No LTHP: 0.16 (0.13–0.18)) and attempt (Predicted risk (95%CI): 1–5 occasions NMUPO, LTHP: 0.08 (0.07–0.10); No LTHP: 0.05 (0.05–0.06); > 6 occasions NMUPO, LTHP: 0.11 (0.07–0.15); No LTHP: 0.06 (0.05–0.08)). Conclusions The results affirmed that NMUPO is associated with suicidal behaviors among adolescents. A pattern also emerged of higher risk of suicidal behaviors for those with LTHP who reported NMUPO. Areas of further inquiry should explore chronic medical or pain conditions as possible modifying pathways that could exacerbate the effects of NMUPO on suicidal behaviors specific to an adolescent population.

Predicting suicidal behavior is one of the most challenging tasks in mental health-related disciplines. We addressed this noteworthy issue in young Argentinean people, since suicidal behavior is an increasing albeit meagerly studied phenomenon throughout this country. We aimed to compare mental health-related variables, impulsivity-related traits, and main demographic variables between groups with and without suicide attempt history and to assess potentially affecting factors related to increasing suicidal risk in each group. A cross-sectional sample of 451 young college students (Mage = 21.74) answered online self-reported questionnaires. Differences and multiple linear regression analyses were performed. The group with suicide attempt history had worst scores in all mental health-related variables (suicidal risk, psychological discomfort, social functioning and coping, depression, anxiety, and alcohol-related consequences), higher positive urgency and (lack of) premeditation, and higher frequency of mental disorder history, than their counterparts without suicide attempt history. The best-fitted model to predict suicidal risk for this group included the following: psychological discomfort, social functioning and coping, depression, anxiety, negative alcohol-related consequences, positive urgency, and (lack of) premeditation. In the group without suicide attempt history, the best-fitted model included the following: sex, age, psychological discomfort, social functioning and coping, depression, anxiety, negative urgency, and (lack of) premeditation. Both depression and anxiety demonstrated to be the most relevant predictors of suicidal risk irrespective of suicide attempts. In addition to depression and anxiety, other predictors seem to act upon producing or restraining such outcomes. Our findings suggest that such predictors may be negative alcohol-related consequences and the positive and negative urgency impulsivity-related traits. [ABSTRACT FROM AUTHOR]

Background: For patients with suicide attempts or self-harm, acute-care hospitals often function as the primary or sole point of contact with the healthcare system. However, little is known about patient characteristics or clinical trajectories of suicide attempts and self-harm episodes among those admitted to acute-care hospitals. This study aimed to describe the characteristics of suicide attempts and self-harm among patients admitted to acute-care hospitals, and the clinical practices provided in these hospitals, using a nationwide inpatient database in Japan. Methods: Using data from the Japanese Diagnosis Procedure Combination inpatient database from June 2015 to March 2017, we identified patients with emergency admission for suicide attempts or self-harm. We did not include patients with elective admission to psychiatric hospitals or outpatients. We described patient characteristics, treatments for physical injuries, psychiatric interventions, and discharge status. Results: We identified 17,881 eligible patients during the 22-month study period. Overall, 38% of the patients did not have any psychiatric or behavioral comorbidities at admission. The most common suicide method was drug overdose (50%), followed by hanging (18%), jumping from a height (13%), cutting or piercing without wrist cutting (7.1%), poisoning (6.6%), and wrist cutting (5.4%). Suicide was completed by 2,639 (15%) patients. Among patients discharged to home, 51% did not receive any psychiatric intervention. In 468 acute-care hospitals (54%), no psychiatric intervention was provided during the study period. Conclusion: We found that half of acute-care hospitals did not provide any hospital-based psychiatric care for patients with suicide attempts or self-harm.

Purpose Methods for suicide attempt are largely divided into poisoning and non-poisoning, which differ in clinical features and severity. We aimed to investigate the clinical features of adolescents with suicide attempt and factors associated with poor outcomes from the 2 methods. Methods A retrospective study was conducted on adolescents (10-18 years) who visited the emergency department after suicide attempt from 2011 through 2018. The adolescents were divided into the poisoning and non-poisoning groups. We analyzed the differences of clinical features and outcomes between the 2 groups. Poor outcomes were defined as hospitalization to the intensive care unit or death. Factors associated with poor outcomes were investigated using multivariable logistic regression. Results Of 4,335 adolescents in total, 2,134 (49.2%) were categorized as the poisoning group. In this group, the adolescents with poor outcomes used acetaminophen most frequently (26.5%), followed by sedative or antipsychotics (22.3%). In the non-poisoning group, those with the outcomes used fall from height (73.2%) most commonly, followed by hanging (21.0%). The factors associated with the outcomes were age (for increment of 1 year; odds ratio, 1.11; 95% confidence interval, 1.02-1.22) in the poisoning group, and being boys (1.34; 1.03-1.73) and non-use of alcohols (2.87; 1.73-4.74) in the non-poisoning group. Conclusion In adolescents who used poisoning for suicide attempt, increasing age is associated with poor outcomes. The outcomes are associated with being boys and non-use of alcohols in those who used non-poisoning methods.

This article reviews the designated health care institution for child abuse in Korea and the compatible systems in other countries. The Korean system is ready to be commenced by a relevant law, which came into effect in July 2019. To find lessons for the designated hospital or professional system, we examined the designated institutions for rape victims, tuberculosis patients, and aftercare for emergency department-based suicide attempters. We also looked at safeguarding system of the United Kingdom, which comprises designated and named professionals, and the National Association of Children’s Hospitals and Related Institutions guidelines and specialist system in the United States. The systems in the United States and the United Kingdom may offer insight to improving the planned designated health care institution for child abuse in Korea. This includes policy issues such as qualification control of professionals, role differentiation in accordance with the hospital classification, and assigning the title of the professional and health care institutions.

Introduction: The word “trauma” is commonly used to refer to a stressful event, however, each person’s individual adaptability and coping capacity is what defines whether an event is traumatic for them. The psychological trauma resulting from a traumatic event compromise both the mental and physical health of the traumatized individual. Several studies report the incidence of traumatic experiences in community and clinical samples and in specific populations. Suicide is still a major global public health concern and globally more than 700,000 people die from suicide every year. There is substantial research regarding the impact that exposure to a traumatic event has on mental health and suicidal behavior in various study populations, but this area remains unexplored in the Community of Portuguese Language Countries (CPLC). Objective: This study aims to 1) describe the traumatic experiences, mental health levels and suicidal behavior, comparing differences between country of residence; 2) assess correlations between traumatic experiences and mental health and suicidal behavior; and 3) assess the impact of exposure to a traumatic event on mental health and suicidal behavior. Methods: The participants of this study are 1006 individuals from Portugal, Brazil, and African Countries with Portuguese as an Official Language (ACPOP). The measurement instruments included a sociodemographic questionnaire, Brief Symptoms Inventory-18 (BSI-18), Brief Trauma Questionnaire (BTQ), and the Portuguese version of Suicidal Behaviors Questionnaire-Revised (SBQ-R). Results: The results indicate that the rates of anxious, depressive, and somatic symptomatology are within the average range for a community population in Portugal. The ACPOP participants reported greater impact of war, while Portuguese participants reported greater impact of disasters and Brazilian participants reported greater impact of psychological and sexual abuse, assault, and death of a family member. Brazilian participants showed the worst levels of mental health and greater suicidal thoughts, but Portuguese participants showed greater probability of committing suicide. Although strong correlations were found between traumatic experiences and mental health levels and suicidal behavior, only physical and sexual abuse were positively correlated with all BSI-18 and SBQ-R subscales. A linear regression analysis revealed that traumatic experiences explain 23.4% of the variance in mental health levels and 11.6% of the variance in suicide probability. Conclusion: Mental health is of paramount importance for quality of life. Therefore, it is important to understand the risk factors for poor mental health outcomes including suicide risk, in this case exposure to traumatic events, for a direct and effective intervention and prevention. Our results elucidate and reinforce the impact of traumatic experiences on mental health and its role as a predictor of suicide attempts, contributing to a better understanding about these themes to assist future preventive or remedial intervention. Governments of Portuguese Language Countries should include strategies aimed at minimizing the impact of traumatic experiences when implementing mental health policies and prevention campaigns.

Introduction: Stigma was first described as an attribute that discredits an individual from society, diminishing the person. People who have self-stigma endorse negative stereotypes about themselves, which leads to negative reactions and feelings of shame. Self-stigma affects the overall health, mainly mental health, quality of life and can lead to poor self-esteem and poor self-efficacy, and has been found to be a major barrier when it comes to seeking help from mental health professionals. There are several studies addressing the effects of self-stigma on people with mental illness and studies addressing how self-stigma affects treatment seeking in people with mental illness. That being said, there is a large gap in demonstrating the relationship between experiences of stigmatization and the impact on mental health. Moreover, self-stigma can be seen as a risk factor for suicide, whose consequences (shame, hopelessness, social isolation and low self-esteem) are also risk factors for suicide. Objectives: The majority of the studies conducted about self-stigma and stigmatizing experiences in Portugal, Brazil and African Countries are focused on the mental health stigma and HIV/AIDS related stigma. Thus, this study aims to address the lack of studies of the impact of stigmatizing experiences in the normative populations in this countries and to explore the impact of self-stigma and stigmatizing experiences on the mental health and suicidal behavior by 1) evaluating the stigmatizing experiences, self-stigma, mental health and suicidal behavior, comparing differences between countries of residence; 2) evaluating the correlations between self-stigma, stigmatizing experiences, mental health variables and suicidal behavior; 3) determining the effect of self-stigma, number of stigmatizing experiences and sociodemographic variables in predicting mental health and suicidal behavior. Methods: 1006 participants from Portugal, Brazil and African Countries with Portuguese as an Official Language (ACPOL), 424 men and 576 women, between the ages of 18 and 80 years old (mean=41.76; SD=14.19) responded to the survey. 53.7% reported having had stigmatizing experiences, in which 15.9% reported experiences about skin colour, 10.7% regarding cultural or ethnic origin, 13.5% regarding gender identity, 9.5% regarding sexual orientation, 17.6% regarding physical attributes, 8.3% regarding age, 15.4% regarding weight, 1.5% regarding physical illness, 3.3% regarding mental illness, 1.3% regarding physical disabilities, 9.5% regarding poverty and 8.1% regarding place of residence. Measurement instruments included a sociodemographic questionnaire, the Brief Symptom Inventory-18, the Portuguese version of the Suicidal Behaviours Questionnaire- Revised (SBQ-R) and the Paradox of Self‑Stigma scale (PaSS‑24). Results: The results showed participants with higher levels of self-stigma and stigmatizing experiences presented significantly higher mental health issues and suicidal behavior. Correlational analyses showed significant correlations among mental health and suicidal variables and self-stigma variables. Regression analyses showed that sociodemographic variables, number of stigmatizing experiences and self-stigma explained 25.3% of mental health issues and sociodemographic variables, number of stigmatizing experiences and self-stigma explained 13.5% of suicidal behavior. Conclusions: Self-stigmatization has a negative impact on mental health and suicidal behavior, and countries should initiate mental health promotion campaigns and suicide prevention campaigns whose central goal should be to optimize people's quality of life

Aim: This study aimed to examine longitudinal changes on suicidal risk levels, adjusting for impulsivity‐related traits, quarantine duration, main demographic factors, mental disorder history, and loneliness, in young Argentinean college students with (ideation; attempt) and without suicidal behavior history, during a quarantine of up to 103‐day duration of the COVID‐19 pandemic. Methods: A longitudinal design with two‐repeated measures was used (N = 1202). Follow‐up was a month later from the first measurement. Three groups were analyzed: with suicidal ideation history, with suicide attempt history, and without suicidal behavior history. Results: Percentages of college students with high or moderate suicidal risk were alarming (accumulated: 62.23% first measurement, 57.65% second measurement). Multilevel analysis on the three groups showed that suicidal risk diminished from the first measurement to the follow‐up, having mental disorder history predicted higher suicidal risk, and negative urgency had the largest increasing effects on suicidal risk which persisted over time. Conclusions: Suicidal risk widely affects college students during lengthy quarantines of the COVID‐19 pandemic and it should be tracked in those having pre‐existing vulnerabilities, but also in those without. Education on managing negative emotions may help decrease suicide risk in college students during the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Abstract: In this study, we defined obsessive thoughts (OT) as bothersome, unpleasant thoughts about oneself that keep entering the mind against one's will, and compulsive behavior (CB) as behavior that a person repeats against his or her wishes. The study included 12,532 adults selected randomly through a one-person-per-household method. Each subject selected underwent a face-to-face interview using the Korean version of the Composite International Diagnostic Interview with a questionnaire that examines lifetime suicide attempts (LSAs). Among the participants, 341 (2.74%) had OT and 639 (5.14%) had CB. The highest LSA rate was in subjects with both OT and CB, followed by those with either OT or CB; subjects with neither OT nor CB had the lowest LSA rate. In a multivariate logistic regression analysis of OT and CB, OT, ordering, and rituals of repeating words were significantly associated with LSAs. In subjects with OT and CB, those with MDD had a significantly higher risk of LSAs compared with those without, and MDD with both OT and CB showed odds of approximately 27-fold (adjusted odds ratio, 27.24; 13.29-55.82; p < 0.0001) compared with those without MDD, OT, or CB. OT and CB were associated with increased risk of LSAs, and comorbid MDD further increased LSAs. [ABSTRACT FROM AUTHOR]

Background: Suicide is a leading cause of death in children and youth, with suicidal thoughts and suicide attempts (referred to as non-fatal suicidal behaviors (NFSB)) being among its strongest predictors. Positive parenting (e.g., warmth, responsiveness), negative parenting (e.g., control, hostility), and parent-child relationship quality (e.g., trust, communication) have been reported to be associated with differences in NFSB in this population. To date, no comprehensive systematic review has considered together the wide range of parenting factors studied in relation to NFSB, and no meta-analysis of existing findings has been conducted. The present study will critically appraise and synthesize the existing evidence from observational studies that examine the relationships between parenting factors and (i) suicidal ideation and (ii) suicide attempt in children and youth. Methods: Studies will be retrieved from APA PsycInfo, MEDLINE, CINAHL, Embase, Scopus, and the Cochrane Library databases. Retrospective, cross-sectional, and longitudinal studies, conducted in clinical and population settings, among youth aged less than 25 years and published as articles and dissertations in English or French will be eligible. Two reviewers will select articles using the Covidence Software after title and abstract screening and full-text assessment, will extract information using double data entry, and will appraise studies' quality using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Any disagreements will be discussed with a third reviewer. Publication bias will be evaluated using funnel plots and Egger's test. In addition to a narrative summary of results, meta-analyses will be conducted using results from at least three studies. Three-level random effect models will allow to derive pooled estimates from dependent effect sizes (from the same sample or study). In case of significant heterogeneity, moderation analyses will be performed considering participants' characteristics and methodological aspects of studies. The results will be reported according to the PRISMA guidelines, and the certainty of evidence will be assessed using the GRADE approach. Discussion: In highlighting parenting factors associated with NFSB and in estimating the overall strength of these associations in children and youth, our results will inform further intervention and prevention strategies designed for young people experiencing NFSB and their families. Systematic review registration: PROSPERO CRD42020165345 [ABSTRACT FROM AUTHOR]

Background: Non-medical use of prescription opioids (NMUPO), defined as taking an opioid in a manner or dose other than prescribed, taking someone else's, or for the feelings that it produces, has been reported by 5 to 20% of adolescents, and is associated with a two fold increase in suicidal behaviors among adolescents. Adolescents with long-term health problems (LTHP) have poorer mental health and may seek NMUPO for pain relief that is not obtained through standard care. For this study, we measured the association between NMUPO and suicidal behaviors, and further assessed effect modification by LTHP hypothesizing the association between NMUPO and suicidal behaviors was stronger for adolescents with LTHP. Findings: For students with LTHP, 13.5% reported suicide ideation, while 8.0% of students without LTHP reported suicide ideation. For suicide attempt, 4.4% of students with LTHP reported a suicide attempt, while 2.1% of students without LTHP reported a suicide attempt. The proportion of students who reported suicide ideation and attempts increased with higher occasions of NMUPO. Adjusted logistic regression models found increased odds of suicide ideation (OR (95% CI): 1–5 occasions: 2.3 (2.0–2.6); > 6 occasions: 2.7 (2.2–3.8)) and suicide attempts (OR (95% CI): 1–5 occasions: 3.2 (2.7–3.7); > 6 occasions: 4.1 (3.1–5.3)) for students who reported NMUPO. An interaction term for NMUPO and LTHP was then added to the models. Effect modification was not present on the multiplicative scale. On the additive scale, evidence of effect modification was observed: higher risk was indicated for students with LTHP versus no LTHP for both suicide ideation (Predicted risk (95%CI): > 6 occasions NMUPO, LTHP: 0.24 (0.18–0.29); No LTHP: 0.16 (0.13–0.18)) and attempt (Predicted risk (95%CI): 1–5 occasions NMUPO, LTHP: 0.08 (0.07–0.10); No LTHP: 0.05 (0.05–0.06); > 6 occasions NMUPO, LTHP: 0.11 (0.07–0.15); No LTHP: 0.06 (0.05–0.08)). Conclusions: The results affirmed that NMUPO is associated with suicidal behaviors among adolescents. A pattern also emerged of higher risk of suicidal behaviors for those with LTHP who reported NMUPO. Areas of further inquiry should explore chronic medical or pain conditions as possible modifying pathways that could exacerbate the effects of NMUPO on suicidal behaviors specific to an adolescent population. [ABSTRACT FROM AUTHOR]

The purpose of this study was to identify factors that influence suicidal ideation and attempts among Korean women, using longitudinal data. Data from wave 4 (n = 7227), wave 5 (n = 6892), and wave 6 (n = 6632) of the Korean Longitudinal Survey of Women and Families collected on 2012, 2014, and 2016 were subjected to Kaplan–Meier and Cox regression analysis. Number of cases for suicidal ideation was 4.7% of the total cases (n = 20,751) between wave 4 through 6; number of cases for suicidal attempts was 5.7% of the cases from suicide ideation (n = 979). Depressive feelings, bad or worst health, and increased stress had significant impacts on suicidal ideation (χ2 = 1867.84, p <.001; χ2 = 983.61, p <.001; χ2 = 884.01, p <.001) and suicidal attempts (χ2 = 5.36, p <.05; χ2 = 11.19, p <.01; χ2 = 7.46, p <.05; χ2 = 6.21, p <.05) over time, respectively. From the Cox regression analysis, non-marital status (OR = 2.50, CI = 1.40–4.48) and having more than two children (OR = 2.55, CI = 1.18–5.51) compared to not having children were identified as predictors for suicidal attempt. Although the negative effect of number of children on suicidal attempts conflicts with previous evidence, socially determined mother roles and the significance of children should be considered in culturally sensitive terms when interpreting our findings. [ABSTRACT FROM AUTHOR]

Objective: To assess suicide attempts in children seeking care at a Poison Control Center. Methods: Cross-sectional study with children (<12 years old) that attempted suicide and were cared at the Poison Control Center in Londrina, Paraná, Southern Brazil, from April 1985 to December 2018. Results: We identified 59 children, most of them females (74.6%), who used only one product (77.9%). Among the products involved, medications were the most important ones (88.1%). Neurological/ psychiatric/muscular manifestations (61.0%) were the main symptoms presented. The main reason identified for the suicide attempt was conflicts with family and/or friends (27.1%). Suicide attempts were more frequent in 2001-2003 and 2016-2018. Conclusions: Suicide attempts occurred mainly in female children with a single agent (mainly medications), and the main reason was family conflicts. [ABSTRACT FROM AUTHOR]

Abstract Background Our objective was to explore intentional injury disparity between Indigenous populations and the total population in the province of British Columbia (BC), Canada. We focus on hospitalizations, including both self-inflicted injuries and injuries inflicted by others. Methods We used data from BC’s universal health care insurance plan, 1991 to 2010, linked to Vital Statistics databases. Indigenous people were identified through the insurance premium group, and birth and death records. Place of residence was identified through postal code. We calculated crude hospitalization incidence rates and the Standardized Relative Risk (SRR) of hospitalization, standardized by gender, 5-year age group, and Health Service Delivery Area (HSDA). With HSDA populations as the units of observation, linear regression was used to test hypothesized associations of Indigenous ethnicity, geographic, and socio-economic characteristics with SRR of injury. Results During the period 1991–2010, the crude rate of hospitalization for intentional injuries was 8.4 per 10,000 person-years (95% confidence interval (CI): 8.3 to 8.5) for the total BC population, compared to 45.3 per 10,000 (95% CI: 44.5 to 46.1) for the Indigenous population. For both populations, risk declined over the period for injuries self-inflicted and inflicted by others. The linear regression model predicts that the off-reserve Indigenous population will have SRR of intentional injury 3.98 greater, and the on-reserve Indigenous population 4.17, greater than the total population. The final model was an excellent fit (R2 = 0.912, F = 177.632, p

Self-harm is a common finding during adolescence and skin-cutting a frequent method of non-suicidal self-injury. However, suicide attempts with severe neck cutting injuries are infrequently reported. Here, we report in detail the case of an adolescent with no prior psychiatry history or self-harm behaviours who had a first suicide attempt with complete external jugular vein laceration. Careful psychiatric evaluation and history reveal exposure to significant adverse childhood experiences. Our aim with this case report is to illustrate and discuss the influence of trauma during early childhood and dissociative symptomatology in suicidal behaviour during adolescence.

Background: the incidence of suicide attempt in the country has been increasing in recent years. In the 10 to 19 age group it has become the third cause of death in the last five years.Objective: to characterize the cases of suicide attempt in adolescents, with a diagnosis made at the "Raymundo Castro" Pediatric Teaching Hospital of the municipality of Puerto Padre, Las Tunas, from December 2017 to May 2018.Methods: a descriptive cross-sectional study was carried out in a population of 30 adolescents who were admitted to the aforementioned pediatric hospital with a diagnosis of suicide attempt, during the period herein declared. The following variables were assessed: personal and family history of suicide attempt, suicide method, causes of the attempt, family functionality and psychiatric diagnosis. Descriptive statistics was used for data analysis and processing.Results: the 15 to 19 age group (86,6 %), the female sex (80 %) and the attempt to ingest tablets (83,3 %) prevailed, with a predominance of psychoactive drugs. Most of the attempts occurred at home. 56,7 % had no personal or family history of suicide attempts. Dysfunctional families and family conflicts were the main causes of attempt. The adjustment disorder was the most frequent psychiatric diagnosis.Conclusions: variables of suicide attempt were characterized in these adolescents, with a predominance of women of intermediate adolescence, with adjustment disorders, who came from a dysfunctional and conflictive family environment.

Background: a suicide attempt is a multifactorial phenomenon. In Las Tunas, deaths by suicide last year were slightly higher than the national average.Objective: to characterize the cases of suicide attempt of patients belonging to the “Aquiles Espinosa Salgado” Polyclinic of Las Tunas, from January 2018 to May 2019.Methods: a retrospective descriptive study was carried out with all the cases of suicide attempt belonging to the aforementioned health district and period of time. The following variables were studied: sex, age, schooling, occupation, marital status, personal pathological history, type of conflict, suicidal motivation and method. The results were analyzed according to descriptive statistics.Results: 68 cases were reported with female predominance (75,71 %). The characterization by ages presented a non-uniform distribution (asymmetry = 1,38), more frequent in the 11 to 14 age group (mode 13). 29,41 % of the subjects relapsed in this type of suicidal behavior. The most frequent conflicts were with some relative (64,71 %) or among couples (23,53 %). At the same time these were the causes of the suicidal act.Conclusions: the variables related to the cases of suicide attempt included in this research were characterized.