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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]

Background: As global aging accelerates, depression among the elderly becomes more common. Research had revealed that patients with late-life depression (LLD) face a higher risk of suicide compared to their counterparts in other age groups, with the pathways to suicide being multifaceted. Thus, investigating the various factors linked to the elevated risk of suicide in patients with LLD is critical. Objective: To investigate the factors associated with a high level of suicide risk among patients with LLD. Methods: A total of 108 patients with LLD were recruited for this study. From October 2022 to November 2023, a cross-sectional study was conducted on patients with LLD from the Affiliated Brain Hospital of Guangzhou Medical University. Suicide risk was evaluated using the Chinese version of the Nurses' Global Assessment of Suicide Risk Scale (NGASR). Potential influencing factors were included and analyzed through multivariate linear regression to identify the factors associated with a high level of suicide risk among patients with LLD. Results: The mean NGASR score among patients with LLD was 7.30 ± 4.34 (range: 0 ~ 19). Multiple linear regression analyses revealed that depression-anxiety of the Brief Psychiatric Rating Scale (BPRS) (β = 0.31, 95% CI = 0.13, 0.45, p<0.001), activation of the BPRS (β=-0.29, 95% CI=-1.22, -0.35, p<0.001), normal cognitive function of the Mini-Mental State Examination (MMSE) (β = 0.21, 95% CI = 0.50, 3.48, p<0.05), involuntary admission (β = 0.20, 95% CI = 0.44, 3.43, p<0.05), and objective support of the Social Support Rating Scale (SSRS) (β = 0.21, 95% CI = 0.08, 0.66, p<0.05) were statistically associated with a high level of suicide risk in patients with LLD. Conclusion: This study found that LLD patients with severe depression-anxiety, low activation, normal cognitive function, involuntary admission, and strong objective support exhibited a high level of suicide risk. These patients should receive intensified monitoring and comprehensive measures should be implemented to prevent the occurrence of suicidal behaviors during hospitalization. [ABSTRACT FROM AUTHOR]

AbstractObjectivesMethodsResultsConclusions\nHIGHLIGHTSUniversal screening for suicide risk has not been shown to reduce suicide rates or reliably predict suicide, but there have been few studies assessing other potential benefits of this practice. We aimed to investigate the feasibility of implementing a universal inpatient suicide risk screening protocol and determine if a positive suicide screen was predictive of the need for psychiatric admission, and if it reduced the length of stay prior to psychiatric admission.We conducted a retrospective chart review of non-psychiatric admissions over 1 year at a tertiary care academic hospital. We calculated the proportion of patients screening positive for suicidal ideation (SI), and among those screening positive, the proportion receiving a psychiatric consult and being admitted to psychiatry. Length of stay among groups was determined. We performed chi square analysis and adjusted multivariate logistic regression comparing different demographics.97.2% of patients were screened, with 2.6% screening positive. Of these patients, 44.6% received a psychiatric consultation and 9.2% were admitted to psychiatry. Psychiatric admissions who screened positive for SI averaged 5.7 days until transfer to psychiatry, compared to 17.9 days for those who screened negative. Suicide risk screening had a sensitivity of 62.0%, specificity of 97.6%, positive predictive value of 9.2%, and a negative predictive value of 99.8% for psychiatric admission.Universal suicide risk screening is feasible and may help identify patients requiring psychiatric care sooner, reducing length of stay of those requiring psychiatric admission.Universal suicide risk screening may identify patients requiring psychiatric care earlierScreening may not predict suicide, but does predict need for psychiatric admissionPositive screens shorten transfer time to psychiatric care by 12 days on averageUniversal suicide risk screening may identify patients requiring psychiatric care earlierScreening may not predict suicide, but does predict need for psychiatric admissionPositive screens shorten transfer time to psychiatric care by 12 days on average [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Methods Results Conclusions Adolescents with psychosis‐spectrum symptoms are at particularly high risk for suicide, however, little is known about how suicidal cognitions manifest in this population. Suicidal cognitions can occur as verbal thoughts and/or mental images of suicide, and mental images may be indicative of a higher risk for suicidal behaviours. Suicidal mental imagery could be a salient and important suicide‐related risk factor for adolescents with hallucinations in particular, however, the co‐occurrence of these phenomena has yet to be studied. In a sample of psychiatrically hospitalised adolescents, we hypothesize that hallucinations will be associated with increased suicidal mental imagery and suicide attempts.This chart review study included data from 219 adolescents admitted to a psychiatric inpatient unit. Adolescents completed an assessment battery probing hallucinations, suicidal cognitions, and suicide attempts.Adolescents with past‐month hallucinations had higher rates of past‐week suicidal verbal thoughts and suicidal mental imagery, but not suicide attempts, compared to those without hallucinations. Adolescents with hallucinations reported a younger onset of suicidal mental imagery, and they endorsed more frequent imagery. Past‐month hallucinations were significantly and positively associated with suicidal mental imagery, beyond the effects of internalising symptoms. Suicidal mental imagery was positively associated with past‐week suicide attempts, but past‐month hallucinations were not.Our findings indicate that hallucinations are linked to suicidal mental imagery, an important yet under‐studied risk factor for suicidal behaviour. These data highlight the need for more research exploring suicidal mental imagery among high‐risk adolescents experiencing hallucinations to inform suicide risk assessment and intervention. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusions This study sought to better understand discussions of emergency dispatches (i.e., activation of local crisis services to conduct a welfare check) and the circumstances under which Veterans Crisis Line (VCL) callers and responders feel they are able contribute to (collaboration) and agree upon (consent) the decision to initiate an emergency dispatch.Semi‐structured interviews gathered data on veterans' (n = 40) experiences receiving an emergency dispatch and VCL responders' (n = 35) perspectives on initiating dispatches. Data were analyzed using a thematic analysis approach.Veterans calling the VCL were often seeking emotional support and were surprised to receive a suicide risk assessment and emergency dispatch. Responders reported they strive for collaboration and consent prior to sending a dispatch, but the crisis setting challenged this ideal. Overall, veterans and responders described similar features of the ideal, collaborative conversation about dispatches yet noted threats to achieving collaboration: complex standard operating procedures, responder training quality, and responder lack of comfort with de‐escalation.Increasing veteran awareness of VCL services, altering the timing and type of suicide risk assessment, enhancing de‐escalation skill, increasing consistency of VCL responder proficiencies, and revising guidelines for dispatch disclosure were identified as ways to improve collaboration and consent around emergency dispatches. [ABSTRACT FROM AUTHOR]

The American Psychiatric Association Practice Guideline for the Treatment of Patients With Borderline Personality Disorder aims to improve care and treatment outcomes for individuals with BPD. The guideline provides evidence-based statements to enhance knowledge and optimize assessment and treatment. It addresses the high prevalence of BPD in clinical populations, the challenges of co-occurring disorders, and the importance of reducing stigma and discrimination. The document outlines assessment, treatment planning, psychosocial interventions, and pharmacotherapy recommendations based on available evidence and expert opinion. [Extracted from the article]

Suicide is a complex, multifaceted crisis affecting children and adolescents, and has become a major public health concern. While there is a plethora of research on this topic among neurotypically developing youth, much less is known about the nature of suicidality in autistic individuals. Autistic youth show an increased vulnerability for suicidal tendencies that are poorly understood among school mental health (SMH) professionals, who report a range of competency and self‐efficacy to address suicidality in school settings (Debski et al., 2007; O'Neill et al., 2020). Co‐occurring mental health difficulties pose significant challenges in the early detection of suicide risk in autistic youth. Given that suicide is the leading cause of death among autistic individuals, the incidence of suicidality among autistic youth is of particular concern. This article provides a practice‐friendly review of the research outlining innate vulnerabilities that present risk factors for suicide among autistic youth, along with assessment considerations that help inform the management of suicide risk in autistic youth. We conclude with recommendations for integrating a multi‐tiered neurodiverse‐affirming approach with sensitivity for student intersecting identities and system‐level influences on student mental health that enables SMH professionals to create supportive school environments for autistic youth that prevent further harm. Practitioner Points: Autistic youth show higher rates of suicidality compared to rates seen in nonautistic youth.Common approaches to suicide screening and prevention in schools do not adequately address issues of mental health, self‐harm, and suicidal intent in autism.A neurodiverse‐informed approach can help school mental health professionals understand suicide risk presentation and enhance safe and affirming school environments. [ABSTRACT FROM AUTHOR]

Firearm violence is a persistent public health crisis in the United States, with over 100,000 individuals being shot every year. This violence not only affects those directly injured but also thousands of youth who are exposed to indirect forms of firearm violence, such as witnessing gunfire or losing a family member to gun violence. Firearms are the leading cause of death among children and teens in the U.S., with youth of color disproportionately affected. Additionally, there has been an increase in adverse childhood experiences (ACEs) in the U.S., which further exacerbates the negative outcomes for children. This special issue of Youth & Society presents new research on the impacts of firearm violence on youth, including disparities, prevention efforts, and interventions. The findings highlight the need for preventive efforts that account for racial and ethnic groups, screening for suicide risk among younger adolescents, and addressing systemic factors that drive firearm violence outcomes. The research also explores the associations between firearm-related beliefs and perceived ease of firearm access with firearm exposure and police violence exposure. The studies provide insights into specific interventions and challenge presumptions about youth and their perceptions of safety. The research also identifies protective factors and pathways for mental health support and interventions for adolescents exposed to firearm violence. The implementation of firearm purchaser licensing laws has been found to be associated with lower rates of violence. Overall, this body of research contributes to the growing field of firearm violence prevention and offers opportunities for effective solutions to address this public health crisis. The impacts of firearm violence on youth are extensive and lifelong, [Extracted from the article]

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 global public health problem that takes hundreds of thousands of lives each year. The key to effective suicide prevention is early detection of suicidal ideations and timely intervention. However, several factors hinder traditional suicide risk screening methods. Primarily, the social stigma associated with suicide presents a challenge to suicidal ideation detection, as existing methods require patients to explicitly communicate their suicidal propensities. In contrast, progressively more at-risk people choose online platforms—such as Reddit—as their preferred avenues for sharing their suicidal experiences and seeking emotional support. As a result, these online platforms have become an unobtrusive source of user-generated textual data that can be used to detect suicidality with supervised machine learning and natural language processing techniques. In this paper, we proposed a suicidal ideation detection approach that combines textual and psycholinguistic features extracted from the Reddit forum. Subsequently, we selected the most informative features using the Boruta algorithm and employed four classifiers: logistic regression, naïve Bayes, support vector machines, and random forest. The naïve Bayes models trained with the combination of term frequency-inverse document frequency (TF-IDF) and National Research Council (NRC) features demonstrated the highest performance, obtaining a F1 score of 70.99%. Our experimental results illustrate that a combination of textual and psycholinguistic features yields better classification performance compared to using those features separately. [ABSTRACT FROM AUTHOR]

Objective: Counselor assessment of suicide risk is one key component of crisis counseling, and standards require risk assessment in every crisis counseling conversation. Efforts to increase risk assessment frequency are limited by quality improvement tools that rely on human evaluation of conversations, which is labor intensive, slow, and impossible to scale. Advances in machine learning (ML) have made possible the development of tools that can automatically and immediately detect the presence of risk assessment in crisis counseling conversations. Methods: To train models, a coding team labeled every statement in 476 crisis counseling calls (193,257 statements) for a core element of risk assessment. The authors then fine-tuned a transformer-based ML model with the labeled data, utilizing separate training, validation, and test data sets. Results: Generally, the evaluated ML model was highly consistent with human raters. For detecting any risk assessment, ML model agreement with human ratings was 98% of human interrater agreement. Across specific labels, average F1 (the harmonic mean of precision and recall) was 0.86 at the call level and 0.66 at the statement level and often varied as a result of a low base rate for some risk labels. Conclusions: ML models can reliably detect the presence of suicide risk assessment in crisis counseling conversations, presenting an opportunity to scale quality improvement efforts. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodResultsConclusionThis study explores the experience of an individual and family therapy youth suicide intervention from the perspectives of seven psychotherapy triads (young people aged 12–18, their parents/caregivers and therapists).Data were collected through semi-structured individual interviews and analyzed using consensual qualitative research methods.Four domains were identified: Focusing on the youth-parent relationship, individual therapy for young people and their parents, conjoint therapy, and public service structures and systemic practice that facilitated tailored treatment. All participant groups valued intervention that improved the youth-parent relationship; however, they held different views about its influence on suicidality and recovery. Separate youth and parent therapy was crucial for facilitating the tailoring of treatment and enhancing the reparative potential of conjoint therapy. Barriers to productive intervention included inaccessible, fragmented, and siloed treatment that excluded parents, stigmatizing clinician responses, and acute care that was not attuned to need or developmental context. Helpful intervention was systemically and attachment-informed, multi-disciplinary, individually tailored, and integrated freely available specialist therapy with crisis and inpatient care.A relational, nuanced, and flexible approach is needed to tailor youth suicide treatment in the context of the complexity of youth-parent relationships. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Background Design Data Sources Methods Results Conclusion Implications for the Profession and Patient Care Impact Reporting Method Patient or Public Contribution To examine the efficacy of the Single Suicide Question, a tactful single‐item tool, in assessing suicide risk among cancer patients.Suicide risk screening in cancer patients faces challenges such as cultural, the degree of attention given and the complexity and diversity of assessment methods. An efficient and simple suicide screening tool is needed within the nursing and treatment process.A retrospective cross‐sectional study.All data utilised in this study were obtained from assessments conducted by researchers at our institution between March 2018 and August 2023.Retrospectively analysed Single Suicide Question scores from 9703 patients (March 2018–August 2023), with 229 undergoing additional using other established tools (the Patient Health Questionnaire‐9, Generalised Anxiety Disorder‐7, Distress Thermometer) alongside the Mini International Neuropsychiatric Interview Suicidal Subscale (MINI Suicidal Subscale). These 229 patients were divided into the cut‐off determination dataset (174/229) and the validation dataset (55/229) to analyse, validate and compare the screening efficacy, consistency and optimal cut‐off points of the tools relative to the MINI Suicidal subscale (golden standard). K‐fold cross‐validation was employed to assess the stability of the Single Suicide Question and to revalidate its screening efficacy.In cut‐off determination dataset, the Single Suicide Question exhibited good screening efficacy and substantial agreement relative to the MINI Suicidal subscale, as validated in the validation dataset, outperforming other tools. The optimal cut‐off points of Single Suicide Question for screening moderate or higher and high suicide risk as 2 and 3 respectively. Its stability in K‐fold cross‐validation further supported its screening efficacy.The Single Suicide Question shows potential as a preliminary screening tool for suicide risk. Furthermore, it has also demonstrated the potential of a simple, tactful, culturally fitting question in assessing suicide risk, providing insight for the development of relevant tools in different cultural and linguistic backgrounds.Our study demonstrates the potential of the Single Suicide Question as a screening tool for identifying suicide risk among cancer patients, which may facilitate efficient suicide screening. Furthermore, it reveals that tactful, culturally fitting, yet simple tools can achieve good screening efficacy, providing insights for the development of similar tools in different cultural and linguistic contexts.This study investigated the effectiveness of using a culturally contextualised, specific single question to screen for suicide risk in Chinese cancer patients, demonstrating high screening efficacy and stability. With further research, this method may provide a tactful, culturally informed and efficient suicide screening approach to address the critical issue of suicide risk in cancer care, and it also serves as a reference for developing similar tools in diverse cultural and linguistic contexts.The study followed the STROBE checklist guidelines for cross‐sectional studies.The data provided by patients were the foundation of this study. Nurses played a central role in conducting the majority of assessments and contributing to the research design in this study. [ABSTRACT FROM AUTHOR]

Background: Recurrent depressive disorder (RDD) is mainly manifested as a low mood, negative and pessimistic mood, and often presents suicidal tendencies when severe. This study reports on a patient with RDD who experienced rat poison poisoning occurring tongue biting. The patient's psychiatric symptoms improved after receiving emergency management and subsequent combined medical care. Case presentation: The patient was a 51-year-old female with RDD complicated with rat poison poisoning. Tongue bite occurred on the third day of hospitalization. She received emergency treatment. Depression, anxiety and suicide risk assessment, safety management and caregiver-health education were conducted on the day of admission and before discharge. At the follow-up after discharge, the risk of suicide was reduced. Conclusions: Suicide in patients with RDD is characterized by repetition and complexity. The occurrence of clinical cases involving tongue bite after gastric lavage is rare. Suicide assessment and emergency management play an auxiliary role in the treatment of patients with recurrent depressive disorder. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Data from the general population of youth show increases in suicide ideation and attempt in recent years, with rates of increase differing across sex and racial/ethnic groups. This study assessed trends in suicide ideation and attempt from 2016 to 2021 in youth in juvenile detention, across sex, age, and racial/ethnic groups.We leveraged state‐wide suicide screening data of all detained youth (n = 53,769) from 2016 to 2021. We analyzed data for periods defined by statistically significant changes in trends of lifetime suicide attempt, past 6‐month suicide attempt, and current suicide ideation.The prevalence of lifetime, but not past six‐month, attempts increased, whereas the prevalence of current suicide ideation decreased annually from 2016 to 2021. Overall trends were qualified by distinct patterns among subgroups: rates of lifetime attempt increased among male, adolescent, and Black youth, while rates of current ideation decreased among male, adolescent, and White and Hispanic youth.These data document increasing rates of lifetime suicide attempts in detained youth from 2016 to 2021, especially among male and Black adolescents, concomitant with decreasing rates of current suicide ideation. Suicide prevention approaches for detained youth may need to prioritize variables besides or in addition to suicide ideation. [ABSTRACT FROM AUTHOR]

Suicidal ideation assessment can help reduce the suicide rate among people in prison. Studies for the assessment of suicidal ideation and risk factors for suicide among inmates have been done in Western countries, but in India, data is lacking regarding the assessment of suicidal ideation among the people in prison.1. To assess the prevalence of suicidal ideationin people in prison.2. To identify aggravating factors for suicidal behavior.It was a cross Sectional Observational Study at a district jail, Lajpore, Surat, Gujarat. After permission from the jail authority, people in prison with or without conviction, who were willing to give consent for participation, were enrolled in the study. Semi-structured questionnaires are used to assess socio-demographic profiles. Modified Suicide Ideation scale (MSSI) and General Health Questionnaire (GHQ) and PatientHealth Questionnaire (PHQ) scales were used as materials to assess suicidal ideation and psychiatric comorbidity. Frequency analysis and Pearson correlation among various factors with the use of appropriate statistical methods. Descriptive and qualitative analysis of data was done on 140 incarcerated persons in prison. Analysis showed that 10 (7.1%) people in prison had moderate suicidal ideation in the last 48 hours while 58 (41.4%) people in prison had suicidal ideation at any point in their life. The prevalence of depressive symptoms was high among people in prison. 57.9% had minimal depressive symptoms, while 9.3% had moderate to severe symptoms. Non-convicted inmates from urban areas were having significantly more psychological distress and depressive symptoms than other inmates. Advanced ageof the inmates, negative impact of imprisonment on life, depressive symptoms, and psychosocial distress emerged as risk factors correlated with suicidal ideation. During suicide risk assessment, inmate’s age, the impact of imprisonment, psychosocial distress, and depressive symptoms should be considered as risk factors among people in prison. [ABSTRACT FROM AUTHOR]

Background: Suicide and self-harm are global disease burden that contributes significantly to years of lost life and mortality. Despite the increasing rates of suicide and self-harm in Nigeria, this topic is understudied. Methods: A mixed-methods design was adopted. Study 1 interviewed n = 18 participants (n = 11 clinicians; n = 5 patients with a history of self-harm and suicide ideation; and n = 2 caregivers). All interviews were audio-recorded, transcribed verbatim, and analyzed using IPA. Study 2 surveyed n = 562 non-clinical sample about their tolerance toward self-harm and the data was analyzed using One-way ANOVA in SPSS. Results: Study 1 qualitative findings showed substance use, perceived rejection and social isolation were considered predisposing factors for suicide and self-harm. Cultural and religious beliefs shaped help-seeking behaviours. Although Study 2 found no significant differences in demographic characteristics concerning public tolerance toward persons with a history of self-harm, 64% believed that individuals who died by suicide would face punishment after death; 51% believed that victims of attempted suicide are a source of shame to their families; and 33.8% agreed that dying by suicide is the correct behaviour. Conclusions: Patients with a history of self-harm and suicidal ideation consider family members and close friends as valuable sources of support. Due to the potential clinical implication of cultural and religious beliefs, as shown in the present study's findings, the authors recommend a co-development of culturally appropriate psychological intervention for persons with a history of self-harm and suicidal ideation to be tested in randomized control trials. [ABSTRACT FROM AUTHOR]

Background: Stressful life events are associated with higher odds of suicidal thoughts and behaviors. Furthermore, stressful life events can trigger specific symptoms, including the suicidal narrative and suicide crisis syndrome, resulting in an increased risk of suicidal thoughts and behaviors. This study examined the moderating role of suicide risk in the relationship between stressful life events, the suicidal narrative, and the suicide crisis syndrome. Methods: 2,260 adults completed an online survey recruited through advertisements on social media. The level of emotional distress was assessed through the Suicide Narrative Inventory, Suicide Crisis Inventory-2, Stressful Life Events Questionnaire, and Mini International Neuropsychiatric Interview. The PROCESS macro (Hayes) was used to analyze the moderation models. Results: Stressful life events were positively correlated with the suicidal narrative and suicide crisis syndrome. The effects of stressful life events on suicidal narrative and suicide crisis syndrome were strongest when suicide risk was low and weakest when suicide risk was high. Conclusions: These findings suggest that including stressful life events as part of suicide risk assessment in general and clinical settings is critical to managing treatment for suicidal thoughts and developing adaptive coping. [ABSTRACT FROM AUTHOR]

College counseling centers are seeing increasing rates of suicidal thoughts and behaviors, and nonsuicidal self-injury (NSSI) among students. The high degree of need and limited resources underscores the need for novel approaches to identify at-risk students. We used latent profile analysis (LPA) to identify subgroups of students (n = 371) with different patterns of interpersonal factors and examine whether these subgroups differed by risk for self-injurious thoughts and behaviors. The best-fitting LPA had three profiles, which differed in urges to die by suicide and engage in NSSI. The profile with low average social support and higher instability (greater day-to-day fluctuations of self-reported social support and rejection) was associated with greatest risk, suggesting that this combination leaves individuals more vulnerable to suicide and NSSI. [ABSTRACT FROM AUTHOR]

Objective: To evaluate universal suicide risk screening and evaluation processes among newly homeless Veterans. Study Setting: Not applicable. Study Design: Examination of Veterans Health Administration (VHA) using newly homeless patients' health record data in Calendar Year 2021. Data Collection: Not applicable. Data Source: Health record data. Principal Findings: Most patients received suicide risk screening and/or evaluation in the year prior to and/or following homeless identification (n = 49,505; 87.4%). Smaller percentages of patients were screened and/or evaluated in close proximity to identification (n = 7358; 16.0%), 1–30 days prior to identification (n = 12,840; 39.6%), or 1–30 days following identification (n = 14,263; 34.3%). Common settings for screening included primary care, emergency and urgent care, and mental health services. Of positive screens (i.e., potentially elevated risk for suicide), 72.6% had a Comprehensive Suicide Risk Evaluation (CSRE) completed in a timely manner (i.e., same day or within 24 h). Age, race, and sex were largely unrelated to screening and/or evaluation. Conclusions: Although many newly identified homeless patients were screened and/or evaluated for suicide risk, approximately 13% were not screened; and 27% of positive screens did not receive a timely CSRE. Continued efforts are warranted to facilitate suicide risk identification to ensure homeless patients have access to evidence‐based interventions. [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]

Background: Emergency departments (EDs) are often the front door for urgent mental health care, especially when demand exceeds capacity. Long waits in EDs exert strain on hospital resources and worsen distress for individuals experiencing a mental health crisis. We used as a test case the Australian Capital Territory (ACT), with a population surge of over 27% across 2011–2021 and a lagging increase in mental health care capacity, to evaluate population-based approaches to reduce mental health-related ED presentations. Methods: We developed a system dynamics model for the ACT region using a participatory approach involving local stakeholders, including health planners, health providers and young people with lived experience of mental health disorders. Outcomes were projected over 2023–2032 for youth (aged 15–24) and for the general population. Results: Improving the overall mental health care system through strategies such as doubling the annual capacity growth rate of mental health services or leveraging digital technologies for triage and care coordination is projected to decrease youth mental health-related ED visits by 4.3% and 4.8% respectively. Implementation of mobile crisis response teams (consisting of a mental health nurse accompanying police or ambulance officers) is projected to reduce youth mental health-related ED visits by 10.2% by de-escalating some emergency situations and directly transferring selected individuals to community mental health centres. Other effective interventions include limiting re-presentations to ED by screening for suicide risk and following up with calls post-discharge (6.4% reduction), and limiting presentations of frequent users of ED by providing psychosocial education to families of people with schizophrenia (5.1% reduction). Finally, combining these five approaches is projected to reduce youth mental health-related ED presentations by 26.6% by the end of 2032. Conclusions: Policies to decrease youth mental health-related ED presentations should not be limited to increasing mental health care capacity, but also include structural reforms. [ABSTRACT FROM AUTHOR]

Background: Supporting individuals in managing their suicidality can prevent suicidal behavior. This study evaluated the suicide prevention project SERO, which was launched in Central Switzerland in 2021. SERO comprises four components: the suicide risk assessment technique PRISM-S, a personal safety plan, mental health first aid courses for relatives, and a self-management app. We assessed the mental health of individuals at increased suicide risk after hospital discharge and evaluated the usage and usefulness of SERO components. Methods: A cross-sectional study targeted former patients of Lucerne Psychiatry with an increased suicide risk. Between March 2023 and March 2024, we collected data from 24 individuals through a questionnaire administered six months post-discharge. Descriptive statistics characterized sociodemographics, assessed self-efficacy, self-management, and health literacy, and analyzed the usage and usefulness of SERO components. Associations between the usage of SERO components and mental health outcomes were investigated using Wilcoxon rank sum tests. Results: Mental health assessments indicated, on average, low to moderate levels of self-efficacy, self-management, and health literacy, with substantial variations across individuals. Participants' exposure to SERO components varied: 83% used PRISM-S for suicide risk assessment, 67% developed a personal safety plan, 38% used the SERO app, and 8% reported that their relatives participated in a mental health first aid course. 50% of safety plan users and 44% of SERO app users found the tools helpful before or during a suicidal crisis. 78% of SERO app users would recommend the app to others. Conclusion: Low to moderate levels of self-efficacy, self-management, and health literacy underscore the need for targeted interventions to support individuals at suicide risk. Positive feedback on the personal safety plan and the SERO app suggests their potential effectiveness in helping individuals manage their suicidality. Therefore, integrating structured measures for promoting self-management into standard care protocols in psychiatric hospitals and into patients' lives may contribute to preventing suicides. The main limitation of our study is its small sample size. Future larger-scale studies should investigate user experiences in detail, assess the causal effects of SERO components on specific mental health and suicideoutcomes, and evaluate the cost-effectiveness of each component separately and in combination. [ABSTRACT FROM AUTHOR]

Depression is a risk factor for suicide attempt, but its ability to differentiate individuals at heightened risk as a total score falls short. Prospective investigations of individual depressive symptoms in relation to adolescent suicide attempt are limited and seldom control for established risk factors such as attempt history and other depressive symptoms. Participants (n = 854) were suicidal adolescents enrolled in intensive outpatient treatment targeting suicidality. Depressive symptoms (composite measures of mood, sleep, appetite/weight, and psychomotor disturbance, as well as single-item measures of disturbed concentration, negative self-appraisal, suicidal ideation (SI), anhedonia, and low energy) were measured at entry. Suicide attempts between treatment entry and six months after discharge were recorded (n = 156; 'future attempters'). Bivariate comparisons found significant differences between future attempters and non-attempters on all depressive symptoms besides appetite/weight and psychomotor disturbances. Logistic regression showed that only sleep disturbance and SI contributed to future attempt while controlling for age, sex, attempt history, and other depressive symptoms. A subsequent model revealed that middle and late insomnia largely accounted for sleep's relationship with future attempt. Age, attempt history, and SI were significant predictors in both models. Difficulty with maintaining sleep, early morning awakenings, and severe SI might signal an additional warning for proximate suicide attempt, particularly in youth with attempt history. These results support the measurement of deconstructed depressive symptoms as a practical addition to risk assessment for clinicians managing suicidal adolescents. Such specific risk indicators might signal the need for more intensive care and closer post-discharge monitoring. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodResultsConclusions\nHIGHLIGHTSPsychiatric multimorbidity is a well-documented risk factor for suicide. However, diagnostic heterogeneity and patterns of comorbidity likely exists within the population of those who attempt suicide. Person-centered statistical approaches, such as latent class analysis (LCA), extract distinguishable groups differentiated by prevalence and comorbidity of psychiatric disorders.The present study used LCA to identify typologies of psychiatric heterogeneity in a sample of 213 inpatients (M age = 33.04 [SD = 12.67]; 57.3% female; 62.4% White; 23.9% Hispanic/Latino) with a history of suicide attempt who were recruited for a suicide prevention clinical trial. Class differences in suicide history characteristics; demographic characteristics; and cognitive-affective and behavioral risk factors, obtained from an initial evaluation involving the administration of a semi-structured diagnostic interview, suicide risk assessment, and battery of self-report measures, were explored.LCA identified three classes in the best-fitting solution: Depressive-High Comorbidity (n = 68), Depressive-Low Comorbidity (n = 86), and Bipolar (n = 59). The Depressive-Low Comorbidity class reported less severe suicidal ideation (p < .001), anxiety (p < .001), stress (p < .001), unlovability beliefs (p = .006), and impulsivity (p < .001). The Depressive-Low Comorbidity class also reported fewer actual attempts than the Bipolar class (p = .001) and fewer interrupted attempts than the Depressive-High Comorbidity class (p = .004).The Depressive-High Comorbidity and Bipolar classes consistently endorsed higher levels of suicide risk factors. These findings may help to illuminate typologies of suicide attempters with unique clinical needs, which is an essential step toward personalized medicine.LCA identified three classes of heterogeneity in inpatients with suicide attemptsThose with more complex diagnostic profiles reported higher levels of suicide riskFindings have important implications for individualized risk interventions [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Empirically supported suicide risk assessment and conceptualization is a central aim of the Zero Suicide model. The Suicide Status Form (SSF) is the essential document and scaffolding of the Collaborative Assessment and Management of Suicidality—Brief Intervention (CAMS‐BI) and is hypothesized as an example of a psychological assessment as therapeutic intervention (PATI). However, this hypothesis has never been directly tested.N = 57 patients deemed at risk for outpatient suicidal behavior and treated as part of an inpatient psychiatric consultation and liaison service were recruited to participate in CAMS‐BI at a Level 1 trauma center in the southeastern United States. During the CAMS‐BI process, patients were asked to rate their subjective units of distress (SUDS) at five time points throughout the intervention (k = 285).The omnibus random intercept multilevel model revealed a significant difference in pre‐ to post‐session ratings of SUDS across patients. Post hoc pairwise comparisons revealed no significant differences between SSF sections (e.g., Section A, Section B, and Section C) and relative reductions in SUDS; however, there was an observable trend toward a favorable effect of Section A of the SSF.The SSF may represent an example of PATI pending replication and extension of the current results. [ABSTRACT FROM AUTHOR]

Introduction and Objective: Suicide is a major public health concern. Recently, suicide rates have increased among traditionally low-risk groups (e.g., white, middle-aged males). Suicide risk assessments and prevention strategies should be tailored to specific at-risk populations. This systematic review examines suicide risk detection and management in primary care, focusing on treatments to reduce suicide rates and improve prevention efforts. Methodology: A systematic review was conducted following PRISMA guidelines. Literature was collected and analyzed using Boolean operators with relevant keywords in databases (e.g., PubMed, Google Scholar, PsycINFO) to identify randomized and non-randomized studies focusing on suicide risk factors and management strategies in primary care, published in the past 10 years. The risk of bias 2.0 and Newcastle Ottawa scale was used to assess risk of bias, and data from moderate-quality studies were synthesized. Results: Thirteen moderate-quality studies were reviewed. Key findings include the need for assessingmodifiable risk factors like substance use and mental health. General practitioner (GP) engagement post-suicide attempt (SA) improves outcomes and reduces repeat SAs. Effective strategies include comprehensive risk assessments, collaborative treatment, and enhanced GP support. Barriers to effective suicide prevention include insufficient information, judgmental communication, lack of positive therapeutic relationships, and inadequate holistic assessments. These findings highlight the need for tailored suicide prevention strategies in primary care. However, the evidence sample size is small with reduced statistical power that limits generalizability. The included studies were also regional examinations, which restrict their broader relevance. Discussion: Significant risk factors, barriers, and effective strategies for suicide prevention were identified. For children aged 12 or younger, preexisting psychiatric, developmental, or behavioral disorders, impulsive behaviors, aggressiveness, and significant stressful life events within the family were critical. For adults, loneliness, gaps in depression treatment, and social factors are significant. Barriers to suicide prevention included insufficient information, judgmental communication, lack of positive therapeutic relationships, inadequate holistic risk assessments, lack of individualized care, insufficient tangible support and resources, inconsistent follow-up procedures, variability in risk assessment, poor communication, stigma, and negative attitudes. Effective methods include the Postvention Assisting Bereaved by Suicide training program, continued education, comprehensive clinical assessments, individualized care, and community-based interventions like the SUPRANET program. [ABSTRACT FROM AUTHOR]

Gerontology, the study of aging and older adulthood, is a vast field consisting of many intersecting disciplines, such as medicine, nutrition, public policy, psychology, social work, and professional counseling. As the older adult population rapidly increases, so too will the prevalence of mental health concerns among this population, including risk for suicide. Older adults presently comprise 16.5% of the U.S. population, yet account for 19.3% of all deaths by suicide (Drapeau & McIntosh, 2020). Professional counselors are newly eligible Medicare providers and can close gaps in healthcare access for older adults who rely on Medicare to receive mental health services, which might include suicide risk assessment and intervention. The Gerontological Imagination is an integrative paradigm to understand the process of aging across multiple disciplines. In this manuscript, we use The Gerontological Imagination as a guiding framework to discuss a professional counselor’s role in identifying and responding to suicide among older adults. [ABSTRACT FROM AUTHOR]

Introduction: People who inject drugs are 13 times more likely to die by suicide than the general population. Guidelines for responding to risk in this population are limited. Harm reduction services attended by people who inject drugs require targeted strategies to address the complexities of suicide risk among this population. Methods: Co‐design, engaging health professionals and people with lived experience informed the study. Mixed methods were used to understand the experience of managing suicide risk among clients attending the Medically Supervised Injecting Centre (MSIC) in Sydney. A survey was administered to assess staff confidence in managing risk. Focus groups were conducted with health professionals and MSIC clients to explore experiences of suicide management, response and opportunities for improvement. Results: Half (N = 17) the MSIC staff surveyed reported over 10 years' experience working with this population. Confidence in managing suicide risk was low. Three key themes emerged from focus groups (N = 17): (i) Autonomy and the need to involve clients in the assessment process; (ii) Trust between clients and health professionals, and transparency in decision‐making; and (iii) System barriers, described by health professionals as inadequate referral pathways for clients in distress, and by clients as negative experiences of care, including involuntary admission and not receiving medication (e.g. methadone). Discussion and Conclusions: Revised assessment guidelines and a tailored safety plan were developed. These resources are also suitable for other alcohol and other drug services. The challenge in managing suicide risk in harm reduction services is balancing duty of care with staff–client relationships and client engagement. [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]

Objective: The experience of frontline clinicians is an underutilized source of knowledge about improving youth suicide intervention. This qualitative study explored the perspectives of highly experienced, specialized mental health clinicians on the practical application of risk assessment, stabilization, and treatment and their experience of working in this practice area. Method: Data were collected from seven focus groups with 28 clinicians and analyzed using consensual qualitative research methods. Results: Four domains emerged, describing 1) youth suicide intervention as relationally focused and attachment-informed, 2) the need for flexible and tailored care balancing individual and family intervention in the context of family complexity and fractured relationships, 3) a nuanced, therapeutic approach to managing the complexity and uncertainty of adolescent suicide risk, and 4) working in youth suicide intervention as emotionally demanding and facilitated or hampered by the organizational and systems context. Conclusion: The importance of harnessing family systems and attachment-informed approaches to alliance, risk assessment, and treatment was emphasized, along with the parallel need for systemic clinician support and consideration of the potential negative consequences of administrative and risk management protocols. [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]

Background: In India, the leading cause of mortality for those aged 15-39 in 2016 was reported to be suicide. Despite these alarming statistics, efforts to prevent suicide are nevertheless thwarted by a number of obstacles to getting help. Timely identification is essential to ensuring that people at risk of suicide receive the right care and assistance. The World Health Organization's mental health action plan advocates employing self-help treatments through electronic and mobile technologies in addition to other steps to promote accessibility to and availability of evidence-based mental health services with encouraging results. With encouraging results, technology has been utilized to give self-help and guided psychological therapies, and it may be employed as a low-intensity and low-cost tactic to reach a bigger population in need of care. Aims and Objectives: The objectives of this study were to study the comparison of mobile application versus conventional teaching techniques for implementation of suicide risk assessment among medical students. Materials and Methods: Study comprises MBBS students. Sample size was calculated to be 138, with 67 in Group A (conventional teaching) and 67 in Group B (mobile teaching). Week 1 and 2 - students were randomly allocated into Group A and B. Both the groups were taught about suicide risk assessment. Results: We found that 87.61% found the mobile application easier to comprehend than the conventional teaching methods. Conclusion: Mobile application learning for implementation of suicide risk assessment in MBBS students is non-inferior to conventional teaching methods. [ABSTRACT FROM AUTHOR]

Aim: To describe nurses' experiences of working with suicide prevention and suicide risk assessment in the care of older people. Background: Suicide is a problem among older people, worldwide. Risk factors for suicide are, among others, depression, illness and pain and a feeling of isolation. Nurses have valuable experience in suicide prevention and risk assessments. This study can shed light on what is needed to promote the mental health of older people, which has been partly overlooked in previous research. Methods/Design: A descriptive qualitative study was conducted. Ten nurses working in care of older people across four different municipalities were interviewed. Conventional content analysis was used to analyse the data. Results: Despite shortcomings in guidelines, nurses describe performing suicide risk assessments and suicide prevention in a similar manner. The importance of giving the patients time is emphasised, although time is exactly what appears to be lacking. Conclusion: By engaging with the experiences of nurses, important aspects that require further attention are highlighted. Nurses should inquire about suicidal ideation, even if older persons do not explicitly express such thoughts. Normal ageing needs to be comprehended and considered in assessments. In this work, time is important. Patient or Public Contribution: The results were coproduced by means of interviews with nurses working in care of older people. Reporting Method: The study was conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Implications for Practice: Encountering older people who may have experienced the loss of loved ones and addressing one's personal capabilities in the context of the ageing body imposes substantial challenges on nursing care, necessitating a capacity to adeptly navigate and address these complex issues. [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]

The current study aimed to assess whether online suicide risk assessment affects state mood and is the first to examine if suicide‐related self‐stigma or coping related to suicidal ideation are predictors of mood change. The Australian participants (N = 661, Mage = 34.9, SD = 12.3, 57.1% female), recruited through a crowd‐sourcing platform, completed a visual analogue mood measure before and after the Suicidal Ideation Attributes Scale (SIDAS), an assessment tool. Followed by a modified version of the Internalised Stigma Scale, the Brief COPE and DASS‐21. State mood did not change from pre‐ to post‐suicide risk assessment in the overall sample, t(662) = −.16, p =.868, d = −.01. Contrary to hypotheses, neither self‐stigma nor coping were related to mood change following exposure to the SIDAS. The multiple regression model was not significant, F(9,643) = 1.16, p =.31., nor was any single predictor including gender, current Suicide risk β = −.04, t = −.80 or psychological distress β = −.09, t = −1.76, p =.08. These findings suggest that online exposure to a suicide risk tool is unlikely to be iatrogenic in relation to state mood, even in the context of elevated self‐stigma, suicidal ideation and psychological distress. [ABSTRACT FROM AUTHOR]

Suicide screening is critical in pediatric emergency departments (EDs). Behavioral measures of suicide risk may complement self-report measures. The current study examines suicide-specific behavioral measures and tests their potential short-term within-person effects among respondents, ability to discriminate future suicide attempt from suicidal ideation, and translation into interpretable categorical composite scores. The sample included 167 youth (10–17 years), presenting for suicide-related reasons to a pediatric psychiatric ED. During their ED visit, participants completed the Death/Life Implicit Association Test (IAT) and the Suicide Stroop Task. Recurrent suicidal thoughts and attempts were assessed within 6 months of the ED visit via medical records and email surveys. Youth displayed a decrease in the levels of distress and self-injurious desires (negative mood, desire to hurt themselves, and desire to die) after completing the behavioral tasks. The Death/Life IAT prospectively differentiated with 68% accuracy between youth who attempted suicide after their ED visit and those who had suicidal ideation but no attempt, p = 0.04, OR = 5.65, although this effect became marginally significant after controlling for self-report and demographic covariates. Neither the Suicide Stroop Task, nor the categorical composite scores predicted suicide attempts, ps = 0.08–0.87, ORs = 0.96–3.95. Behavioral measures of suicide risk administered in the ED do not appear to increase distress or self-injurious desires. They may be able to distinguish those who go on to attempt suicide (vs. consider suicide) within six months after discharge. [ABSTRACT FROM AUTHOR]

The study explores in depth the relationship between missing persons' psychosocial and criminological characteristics/circumstances and violent-fatal outcomes (suicide and homicide). A relational analytical explicative study of 929 cases and controls was designed using a retrospective and stratified design. Data gathering was conducted through the content analysis of judicial and police information, as well as the development of psychological autopsy techniques and semi-structured interviews with the persons involved in the missing person cases including offenders in prison. Bivariate and multivariate statistical techniques were utilised for analyses. The findings showed that there are different risk and protective factors which can distinguish between good state of health, suicide, and homicide outcomes. This research entails implications for prevention and police risk assessment system. [ABSTRACT FROM AUTHOR]

Objective: The aim of our study was to explore the relationship between changes in neural oscillatory power in the EEG, the severity of depressiveanxiety symptoms, and the risk of suicide in MDD. Methods: 350 MDD patients' demographic and clinical data were collected, and their depressive and anxious symptoms were evaluated using HDRS-17 and HAMA-14, along with a suicide risk assessment using the Nurses' Global Assessment of Suicide Risk (NGASR). EEG data were captured, processed, and analyzed to study brain activity patterns related to MDD. The participants were divided based on suicide risk levels, and statistical analyses, including chi-square, t-tests, Pearson's correlations were used to explore the associations between brain activity, symptom severity, and suicide risk. Closely related variables were identified and ultimately the optimal model was screened using stepwise regression analysis with a forward strategy, and mediation effects were further used to determine the possible interactions between the variables in the regression model. Results: The regression model showed a significant effect of HDRS-17 and alpha power of Medial Occipital Cortex (MOC) on suicide risk, with elevated HDRS-17 increasing suicide risk and elevated alpha power decreasing suicide risk. Mediation effect analyses showed that MOC alpha power partially mediated the effect of depression level on suicide risk, and that an increase in depression severity may lead to a decrease in MOC alpha power, while a decrease in MOC alpha power may lead to an increase in suicide risk. Conclusion: The severity of depression directly increases suicide risk, whereas higher alpha power in the MOC serves as a protective factor, reducing this risk. Notably, MOC alpha power not only directly impacts suicide risk but also mediates the effects of both depression severity and anxiety levels on this risk. Limitations: The relatively small sample size of this study may limit the representativeness of the overall MDD patient population and the detailed analysis of different subgroups. This study did not delve into the relationship between the severity of cognitive symptoms in MDD patients and suicide risk. [ABSTRACT FROM AUTHOR]

Introduction: Suicide risk assessment based on self-report questionnaires is considered as problematic because risk states are dynamic and at-risk individuals may conceal suicidal intentions for several reasons. Therefore, recent research efforts increasingly focus on implicit risk markers such as the suicide attentional bias (SAB) measured with the Suicide Stroop Task (SST). However, most SST studies failed to demonstrate a SAB in individuals with suicide risk and repeatedly demonstrated insufficient psychometrics of the SST. This study aimed to investigate a SAB using a modified SST (M-SST) and to test its psychometric properties. Method: We compared n = 61 healthy controls and a high-risk inpatient sample of n = 40 suicide ideators and n = 40 suicide attempters regarding interference scores of positive, negative and suicide-related words. Interference scores were calculated by subtracting the mean reaction time (mean RT) of the neutral words from the mean RT of the suicide-related words (mean RT Suicide-mean RT Neutral), resulting in a suicide-specific interference score. Similarly, interference scores were calculated for the positive and negative words by subtracting the mean RT of neutral words from the mean RT of positive and negative words. Results: A Group x Interference ANOVA showed a significant interaction effect (p <.001, ηp2 = .09), indicating that group effects significantly vary across interference type. Post hoc comparisons revealed that both ideators and attempters demonstrated greater interferences only for suicide-related words compared to healthy controls, indicating a SAB in patients, while a difference between ideators and attempters was lacking. The suicide interference score classified with an AUC = 0.73, 95% CI [0.65 - 0.82], p <.001, between controls and patients with STBs. The M-SST demonstrated good internal consistency and convergent validity. Discussion: The study adds evidence to the assumptions of the Cognitive Model of Suicide, viewing a SAB as a cognitive marker of suicide vulnerability independently of the engagement in suicidal behavior. The results' clinical implications are discussed in the context of recommended intervention strategies during an acute suicidal state. Future studies with the M-SST should include non-suicidal patient controls to investigate whether a SAB is uniquely related to suicidality. [ABSTRACT FROM AUTHOR]

Previously published analyses of suicide case investigations suggest that work or working conditions contribute to 10%–13% of suicide deaths. Yet, the way in which work may increase suicide risk is an underdeveloped area of epidemiologic research. In this Commentary, we propose a definition of work‐related suicide from an occupational health and safety perspective, and review the case investigation‐based and epidemiologic evidence on work‐related causes of suicide. We identified six broad categories of potential work‐related causes of suicide, which are: (1) workplace chemical, physical, and psychosocial exposures; (2) exposure to trauma on the job; (3) access to means of suicide through work; (4) exposure to high‐stigma work environments; (5) exposure to normative environments promoting extreme orientation to work; and (6) adverse experiences arising from work‐related injury or illness. We summarise current evidence in a schema of potential work‐related causes that can also be applied in workplace risk assessment and suicide case investigations. There are numerous implications of these findings for policy and practice. Various principle‐ and evidence‐based workplace intervention strategies for suicide prevention exist, some of which have been shown to improve suicide‐prevention literacy, reduce stigma, enhance helping behaviours, and in some instances maybe even reduce suicide rates. Prevailing practice in workplace suicide prevention, however, overly emphasises individual‐ and illness‐directed interventions, with little attention directed to addressing the working conditions that may increase suicide risk. We conclude that a stronger emphasis on improving working conditions will be required for workplace suicide prevention to reach its full preventive potential. [ABSTRACT FROM AUTHOR]

Background: Suicide is the leading cause of death of children and young people under 35 in the UK, and suicide rates are rising in this age group. Schools are considered an appropriate and logical setting for youth suicide prevention activities, with universal, selective, and indicated approaches all demonstrating efficacy. Given that international best practice recommends suicide prevention programmes combine these approaches, and that to date this has not been done in school settings in the UK, this study aims to evaluate the feasibility of delivering a suicide prevention programme incorporating universal, selective, and indicated components in UK schools. Methods: This study is a feasibility cluster-randomised controlled trial (RCT) of an adapted version of the Multimodal Approach to Preventing Suicide in Schools (MAPSS) programme. The programme, initially developed in Australia, involves delivering universal psychoeducation to all pupils, screening them for suicide risk, and delivering Internet-based Cognitive Behavioural Therapy (Reframe IT-UK) to those students identified as being at high-risk for suicide. The programme will be trialled in six secondary schools in Northwest England and will target Year 10 students (14- and 15-year-olds). The primary aims are to assess: 1) the acceptability and safety of delivering MAPSS in a school setting in the UK; 2) the social validity of the MAPSS programme; and 3) the feasibility of delivering a large-scale, appropriately powered, cluster-RCT and economic evaluation of this intervention in the future. Secondary aims are to assess changes over time in mental health and wellbeing outcomes. Discussion: This study is the first to evaluate a suicide prevention programme comprising universal, selective, and indicated components in UK schools. If the programme is found to be feasible, it could be more widely tested in schools and may ultimately lead to reduced rates of suicide and suicidal behaviour in young people. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodResultsConclusions\nHIGHLIGHTSSuicide risk assessments are obligatory when patients express a death wish in clinical practice. Yet, suicide risk estimates based on unguided risk assessments have been shown to be of low reliability. Since generalizability of previous studies is limited, the current study aimed to assess inter-rater and intra-rater reliability of risk estimates conducted by psychotherapists and psychology students using written case vignettes.In total, N = 256 participants (psychology students, psychotherapists) were presented with 24 case vignettes describing patients at either low, moderate, severe or extreme risk of suicide. Participants were asked to assign a level of risk to each single vignette at a baseline assessment and again at a follow-up assessment two weeks later.Risk estimates showed a low inter-rater reliability, both for students (AC1 = .35) and for psychotherapists (AC1 = .44). Intra-rater reliability was moderate for psychotherapists (AC1 = .59) and rather low for psychology students (AC1 = .47). In general, intra- and intra-rater reliability were highest for vignettes displaying “low” and “extreme” risk.The results highlight that the reliability of unguided suicide risk assessments is questionable. Standardized risk assessment protocols are therefore recommended. Nonetheless, even reliable risk estimation does not imply predictive validity of risk estimates for future suicidal behavior.Suicide risk estimates have been shown to be of low reliabilitySuicide risk estimates by psychotherapists and students also showed low inter-rater and intra-rater reliability in the current studyReliable risk estimation does not imply predictive validity of risk estimates for future suicidal behavior [ABSTRACT FROM AUTHOR]

Increased suicide rates in prison are a serious concern. Early identification of inmates at risk is a component of effective suicide prevention. The present study examined two suicide screening instruments in a sample of men in the Berlin, Germany, prison system (n = 289). The Screening for Initial Risk Assessment (SIRAS) identified significantly more high-risk inmates than the Vienna Instrument for Suicidality in Correctional Institutions (VISCI) (66 vs. 24). The results further show that the agreement in the classification was evident only in inmates with suicidal ideation, but was otherwise quite low. This can be explained by the fact that the instruments differ in terms of the risk factors taken into account. Finally, it was found that inmates classified as high risk received more monitoring and psychiatric or psychological support, which supports the construct validity of the instruments. As there were no deaths by suicide in the sample, no statistical information on the predictive validity of the instruments could be provided. Although research in this area is challenging, methodologically sound studies are needed to inform practice. [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]

Assessment of suicidal risk is one of the most challenging tasks faced by health professionals, notably in emergency care. We compared telephone suicide risk assessment at prehospital Emergency Medical Services Dispatch Center (EMS-DC), with subsequent face-to-face evaluation at Psychiatric Emergency Service (PES), using French national Risk-Urgency-Danger standards (RUD). Data were collected for all suicidal adult patients (N = 80) who were addressed by EMS-DC to PES between December 2018 and August 2019 and benefited from RUD assessment at both services. Suicidal risk was given a score of 1, 2, 3 or 4, in order of severity. Mean of the differences between the RUD score at EMS-DC and PES was −0.825 (SD = 1.19), and was found to be significant (p < 0.01). The average time between RUD assessments was 420 min (SD = 448) and was negatively correlated with the difference in the RUD score (r = −0.295, p = 0.008). Associated suicide attempt increased the odds of a decrease in the RUD score (OR = 2.989; 95% CI = 1.141–8.069; p < 0.05). Telephone evaluation of suicidal risk using RUD at EMS-DC yielded moderately higher scores than those obtained by a subsequent face-to face evaluation at PES, with this difference partially explained by the time between assessments, and by clinical and contextual factors. [ABSTRACT FROM AUTHOR]