Archives of Suicide Research最新文献

Objective: This study explored demographic characteristics of people who disclosed self-harm ideation (SHI) or behaviors (SH) and their accessing of mental health services (MHS) during three government-declared waves of the COVID-19 pandemic in Ontario, Canada.

Methods: We analyze the results of a cross-sectional survey of adults in Ontario aged 18 years or older, representative of the provincial population based on age, gender, and location. The survey was conducted using Delvinia's AskingCanadians panel at three timepoints: August 2020 (n = 2500), March 2021 (n = 2500), and March 2022 (n = 5000). Accessing of MHS was identified in a subsample of survey respondents who reported SHI (wave 1, August 2020, N = 421) and SH (wave 2, March 2021, N = 105; wave 3, March 2022, N = 259). Chi-square tests, Fisher's exact test, and binary logistic regression were employed to identify associations between service access and demographics across waves.

Results: The survey in wave 1 identified 421 respondents with SHI (16.8%). Surveys in wave 2 and 3 identified 105 (4.1%) and 259 respondents (5.2%), respectively with SH. The majority of respondents who disclosed SHI (wave 1) and SH in wave 2 did not access MHS [wave 1 (36.3%); wave 2 (46.7%)], whereas more accessed MHS in wave 3 (60.6%). Older adults, men, people living with others, and in rural areas were less likely to access MHS overall.

Conclusions: MHS access is a key component of comprehensive suicide prevention and intervention. Future prevention efforts should aim to increase MHS access, particularly in specific demographic groups, ensuring timely service access.

Objective: Interpersonal dysfunction robustly predicts suicide attempts (SA) and non-suicidal self-injury (NSSI) in adolescents. We sought to better elucidate how two interpersonal constructions (interpersonal sensitivity and social problem-solving strategies) may lead to NSSI vs. SA in adolescents.

Method: We compared non-overlapping groups of adolescents engaged in either SA (n = 49, M_age = 15.80, SD = 1.23, 63% female) or NSSI (n = 50, M_age = 15.35, SD = 1.34, 82% female), and healthy controls (HC; n = 43, M_age = 15.46, SD = 1.30, 61% female). We hypothesized: (1) greater interpersonal sensitivity and deficits in social problem-solving strategies would differentiate the three groups and indicate higher risk for being in the NSSI and SA groups, relative to the HC groups, and (2) amongst clinical groups, there would be greater deficits in social problem-solving in the SA group, and greater interpersonal sensitivity in the NSSI group.

Results: NSSI and SA groups demonstrated more interpersonal sensitivity and lower (i.e., worse) social problem-solving skills vs. HCs. Participants were more likely to be in both the SA and NSSI groups based on interpersonal sensitivity (OR_SA = 2.61; OR_NSSI = 2.75) and social problem-solving (OR_SA = 19.11; OR_NSSI = 10.89). Significant differences were observed between the NSSI and SA groups on interpersonal sensitivity [t(97) = 4.28, p < .001, d = 0.86; higher levels in the NSSI group], but not on social problem-solving [t(97) = 1.97, p = .052, d = 0.40].

Conclusions: Both greater interpersonal sensitivity and challenges in social problem-solving predict NSSI and suicidal behavior in adolescents, and interpersonal sensitivity may be a particularly salient risk factor for NSSI. Implications for treatment and future research are discussed.

Objective: The suicide crisis syndrome (SCS) is a suicide-specific acute cognitive-affective state that seeks to identify individuals at increased near-term risk of suicide. However, little is known about its correlates in psychiatric populations. We aimed to assess symptom severity and sociodemographic correlates of SCS in patients with major depressive disorder (MDD), compared to healthy controls.

Methods: Between November 2021 and August 2022, we cross-sectionally administered the revised Suicide Crisis Inventory (SCI-2) to patients with MDD and matched healthy controls across 24 centers in India. We compared SCS total and domain scores between groups using independent samples t-tests. Linear regressions were used to determine the sociodemographic characteristics uniquely associated with SCS, over and above clinical diagnosis.

Results: We obtained responses from 1196 patients with MDD (Mean age = 38.1 ± 12.2 years, 54.8% female) and 1067 controls (Mean age = 36.7 ± 11.4 years, 50.5% female). The MDD group had significantly greater severity of total SCS symptoms (t[2063]= -58.57, p < 0.001, Cohen's d = 2.42) and each of its five domains. In multivariate analyses, age (B= -.37, SE=.11, p < 0.001), female sex (B = 3.61, SE = 1.62, p = 0.026), and living in a nuclear family (B= -3.97, SE = 1.73, p = 0.022) were significantly associated with SCS symptoms. The relationship between age and SCS symptoms was significantly stronger among MDD patients (B= -0.48, SE = 0.14, p < 0.001).

Conclusion: Our findings are consistent with prior cross-national investigations of SCS correlates in community samples and overlap with correlates of suicidal behavior. These results point to the potential utility of the SCS construct in early identification of at-risk individuals and prevention of subsequent suicidal behavior.

Background: Although the risks associated with non-suicidal self-harm (NSSH) have been widely described in the literature, evidence remains fragmented regarding how these risks are understood and managed by individuals with lived experience.

Objective: Our systematic review aimed to identify the risks perceived by those who engage in NSSH and the risk management strategies they utilized.

Methods: We searched five databases and performed a quality assessment and meta-synthesis of qualitative findings. We summarized the quantitative findings from one study because a narrative synthesis was not feasible.

Results: We included 37 eligible studies (n = 34 qualitative only; n = 3 mixed methods), with only one presenting quantitative findings. Our meta-synthesis of qualitative findings highlighted three overarching themes: (1) Physical risks: understanding and managing injuries; (2) Interpersonal risks: impacts of and responses to self-harm; (3) Intrapersonal risks: a personal assessment. Individuals who self-harm showed a nuanced understanding of all overarching risks. Management strategies included damage limitation and concealment of scars. The perceived utility of risk management strategies varied from useful to counterproductive. Quantitative findings from one study showed that users of online self-harm communities perceive similar physical and interpersonal risks, including fears of judgment and stigma.

Conclusion: Views on self-harm risk management strategies were mixed. Incorporating lived experience perspectives can promote person-centered care for NSSH, enhancing peer support interventions and collaborative clinician-patient risk management plans.

This prospective longitudinal study examined associations between Dark Triad traits and suicidal ideation through interpersonal pathways among Chinese university students (N = 2,018 across three waves), guided by the Interpersonal Theory of Suicide (ITS). Analyses revealed distinct patterns: Machiavellianism showed positive associations with suicidal ideation through thwarted belongingness, while psychopathy was positively linked to suicidal ideation via both thwarted belongingness and perceived burdensomeness. Narcissism demonstrated negative associations with suicidal ideation through reduced thwarted belongingness. Gender differences emerged prominently, with perceived burdensomeness serving as a more salient pathway between psychopathy and suicidal ideation for women, whereas thwarted belongingness was more strongly associated with Machiavellianism and narcissism for men. These findings, observed in a collectivistic cultural context, extend the ITS by demonstrating how personality traits may differentially relate to suicide risk through gender-specific interpersonal mechanisms. The results suggest the potential value of tailored prevention approaches with particular attention to burden-related concerns for women and belongingness-focused strategies for men-while highlighting the need for further research to examine these associations across diverse populations.

Objective: The Looming Vulnerability Model suggests that rapidly approaching or increasing threats, like visual looming stimuli, can potentially contribute suicidal thoughts and behaviors. This study investigates the neurobiological basis of this theory in suicide attempters, focusing on the EEG power spectrum.

Methods: In a case-control design, participants completed a visual Looming task involving threatening and neutral stimuli during EEG neuroimaging. The final sample included 15 participants with recent suicide attempts and major depressive disorder (SA+MDD), 19 participants with major depressive disorder (MDD), and 18 Healthy Controls (HC). EEG absolute power was calculated and group differences were analyzed using ANOVA with post-hoc tests.

Results: Participants in the SA+MDD group showed significantly greater delta band power in frontopolar regions (AF3, Fp2, Fpz) compared to HC under both task conditions. Theta band power over the right frontal cortex during both conditions differentiated SA+MDD from MDD participants, while increased beta synchronization in the right premotor area distinguished SA+MDD from both MDD and HC, particularly during trials with neutral stimuli. Additionally, gamma band desynchronization to threatening stimuli was observed in SA+MDD compared to MDD.

Conclusions: The findings support a link between electrophysiological responses to looming stimuli and recent suicide attempts. Increased delta and theta power may reflect heightened emotional processing and sensitivity to threat or pain, while elevated beta activity may indicate increased demands on motor inhibition. Gamma desynchronization may reflect a residual vulnerability to suicidal behavior in the aftermath of a recent attempt.

Objective: To Quantify the risk of suicide following self-harm within the various healthcare settings to which patients present to help understand the risk factors involved.

Method: A matched case-control study using electronic records for primary care, secondary care (hospitals) and national mortality registries in England between 2001-2019 (N = 594674). Cases with a death attributed to suicide were compared with a randomly selected control population.

Results: The one-year suicide risk, adjusted for age and sex, was higher after recorded self-harm in primary care (odds ratio OR: 83, 95% confidence intervals CI: 76-91) and secondary care data (OR 124; 95% CI: 111-138) compared to those with no self-harm records. Suicide risk was highest in the first month after self-harm in primary care (OR 310; 95% CI: 244-393) and secondary care data (OR 458; 95% CI: 331-633). Suicide risk increased with the number of self-harm admissions in the final year (OR for patients with ≥3 self-harm attempts 505; 95% CI: 227-1123: p < 0.0001 for trend). While suicide risk following self-harm was increased across all age-groups and sexes, it was higher in females and older individuals compared to their counterparts with no self-harm records (p < 0.05).

Conclusion: In both the primary care and secondary care datasets, the one-year relative suicide risk following self-harm was high, which is consistent with previous studies. The increased risk of suicide mortality following self-harm in older individuals and females may inform risk-stratification after a self-harm event.

Objective: Men are more likely than women to die by suicide, while women are more likely to report suicidal ideation and make suicide attempts. To understand this, it is necessary to consider the ways in which men and women are exposed to divergent pressures in gendered social roles. We reviewed the literature to identify a set of seven pathways by which masculinity may impact upon suicidality (moderation of the relationship between masculinity and suicidality by adverse life events, mediation of the relationship between masculinity and suicidality by help-seeking, social support, maladaptive coping, impulsivity, and mental health, and a protective function of positive masculine psychological characteristics on suicidality), and tested these in two samples.

Method: In Study 1 we tested pathways in a sample of 195 participants in an online survey. In Study 2 we tested pathways in a sample of 48 participants admitted to hospital for a suicide attempt. In both studies we included both men and women, and tested moderation of relationships by sex.

Results: Both studies demonstrated a protective role of "positive" masculine psychological characteristics in the development of suicidality. There was also support from both for an indirect effect of "negative" masculine psychological characteristics on suicidal ideation through impulsivity (those high in negative masculinity had higher suicidal ideation due to increased levels of impulsivity). In Study 1 only, the relationship between negative masculine psychological characteristics and suicidal ideation was mediated by help seeking and by maladaptive coping (amongst men only). In all other cases, results were consistent across men and women.

Conclusions: Our results suggest both protective and risk functions of masculinity in the development of suicidality, and provide evidence for pathways from negative masculinity to suicidality through impulsivity and help-seeking, as well as protective functions of positive masculine psychological characteristics, providing potential targets for clinical intervention.

Objective: Insomnia and nightmares have been identified as significant predictors of suicidal ideation (SI), but the specific psychological processes underlying this relationship remain unclear. The current study aimed to examine the insomnia/nightmares-SI relationship, concerning the mediating role of defeat and entrapment according to the integrated motivational-volitional (IMV) model in the Iranian population.

Methods: Participants (N = 459) completed a self-report survey assessing insomnia/nightmare symptoms, feelings of entrapment and defeat, and SI. Path analysis was conducted to evaluate the mediating effect of defeat and entrapment on the association between insomnia/nightmares and SI.

Results: Findings indicated that insomnia/nightmare symptoms were correlated with SI. Moreover, findings demonstrated that entrapment mediated the relationship between insomnia $(\beta \text{\hspace{0.17em}=\hspace{0.17em}0.03,}p\text{\hspace{0.17em}=\hspace{0.17em}0.001})$/nightmares $(\beta \text{\hspace{0.17em}=\hspace{0.17em}0.24,}p<\text{0.072})$ and SI. Additionally, insomnia $(\beta \text{=} \text{0.07,}p\text{\hspace{0.17em}=\hspace{0.17em}0.001})$ and nightmares $(\beta \text{\hspace{0.17em}=\hspace{0.17em}0.04,}p\text{\hspace{0.17em}=\hspace{0.17em}0.022})$ had indirect effect on SI through defeat.

Conclusion: The findings offer new insights into the psychological mechanisms linking insomnia/nightmare symptoms and SI by highlighting the role of defeat and entrapment. However, the complicated relationship between sleep disturbances and SI warrants further examination through longitudinal studies. Such studies are crucial for developing targeted interventions to prevent the emergence of SI in individuals who suffer from sleep disturbances.

Objective: Suicide is the leading cause of death on the railway networks, yet little is known about the geography and socio-environmental determinants of such deaths in England.

Method: We analyzed official records of all suspected suicides recorded on England's mainline railway from April 2019 to March 2021 (N = 436), alongside area-level data (e.g., deprivation and urbanicity) and railway characteristics (e.g., station size). We used SaTScan's Poisson discrete scan statistic to detect spatial-temporal clusters and compared suicides at station and non-station locations, including stations with no recorded suicides over the study period.

Results: Most railway suicides-particularly those occurring at stations-took place in urban areas, typically at locations with a very low incidence of previous suicides. A large majority (84.5%) lived within 2 miles of a station and died close to home (median 2.1 miles) or their last known location (1.5 miles). Suicides occurred most often at stations (43.3%), followed by trackside locations (37.6%), foot/level crossing (15.1%) or other rail areas (3.9%). These were often not the nearest station to the deceased (59.6%), but were generally smaller and more likely to be served by fast/non-stopping trains. Across the network, stations without suicides were far less likely to be served by such trains (66% vs. 94.3%; OR = 6.62, 95% CI 3.33-13.18).

Conclusions: Urbanicity and the availability of non-stopping train services are key predictors of railway suicide. Restricting access to high-speed trains-especially at smaller urban stations and at non-station locations-could be an effective element of broader strategies and local partnership approaches to prevent suicide.