The months following psychiatric hospitalization are associated with heightened suicide risk among adolescents. Better characterizing predictors of trajectories of suicidal ideation (SI) post-discharge is critical.

We examined trajectories of SI over 18 months post-discharge and emotional processing variables (recognition, reactivity, and regulation) as predictors using a multi-method approach. Participants were 180 adolescents recruited from a pediatric psychiatric inpatient unit, assessed during hospitalization and 3, 6, 12, and 18-months post-discharge. At each time-point, participants reported on SI; at baseline, they completed measures of emotion dysregulation, reactivity, and a behavioral task measuring facial emotion recognition.

A three-group model best fits the data (Chronic SI, Declining SI, and Subthreshold SI groups). The Chronic SI group, compared to the Declining SI group, had greater difficulty identifying children’s sad facial expressions. The Declining SI group compared to the Subthreshold SI group reported greater overall emotion dysregulation and difficulties engaging in goal-directed behavior. No other emotional processing variable was significantly associated with specific SI trajectories.

The findings suggest that difficulties in properly identifying peer emotions may be predictive of resolution of severe SI post-discharge. Furthermore, the results suggest that emotion regulation may be an important target for discharge planning.

The Columbia Suicide Severity Rating Scale (C-SSRS) is a predominant tool for screening and scoring suicidal ideation and behaviour to identify individuals at risk. No meta-analysis has examined its predictive significance.

To evaluate the C-SSRS assessment of suicidal ideation and suicidal behaviour as predictors of future fatal and non-fatal suicide attempts.

A systematic search of Medline, PsycInfo, Embase, and Health and Psychosocial Instruments databases was conducted from January 2008 to February 2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the study was registered in PROSPERO (CRD42022361944). Two independent reviewers screened and extracted data, and assessed the risk of bias. Pooled odds ratios were calculated using random-effects models, and heterogeneity was assessed with the I2 statistic. Publication bias was evaluated with Egger’s test and funnel plots.

The search identified 1071 unique records, of which 28 studies met inclusion criteria. The meta-analysis included 27 studies with independent samples. Suicidal behaviour (pooled odds ratio 3.14, 95% CI 1.86–5.31) and suicide attempts (pooled odds ratio 2.78, 95% CI 1.82–4.24) were predictors of future non-fatal suicide attempts. Suicidal ideation severity (odds ratio 1.46/point, 95% CI 1.28–1.77) was a stronger predictor of future non-fatal suicide attempts than suicideal ideation intensity (odds ratio 1.11/point, 95% CI 1.04–1.18). Two studies linked higher suicidal ideation severity and a history of suicidal behaviour with an increased risk of fatal suicide attempts, though meta-analysis was not feasible for only two studies.

Suicidal behaviour, suicide attempts and to a lesser extent suicidal ideation, identified using the C-SSRS, predicted future non-fatal suicide attempts. These findings support the use of the C-SSRS to detect individuals at higher-risk requiring enhanced preventive interventions.

The association between cannabis use and suicidality has been established, but details on impacts of legalisation, as well as long-term service use, have had limited attention.

To examine if changes are present in suicide presentations with access to legal cannabis.

This study employed administrative database and medical record reviews to identify two cohorts of patients presenting with suicidal ideation/attempts and cannabis use to emergency departments, for two periods: 17 October 2018 to 30 April 2019, and 17 October 2020 to 30 April 2021. Demographic and clinical outcome data were obtained, and emergency department healthcare usage for 2 years before and 2 years after index encounter were compared, to further understand emergency department presentations for the same complaint.

Number of emergency department encounters following the index visit and number of emergency department encounters specifically relating to suicidality following the index visit were significantly different between cohorts (t = 2.05, P = 0.042; t = 2.23, P = 0.027, respectively), with the immediate post-cannabis legalisation period demonstrating greater numbers of subsequent emergency department visits for suicidality. Additional associations were found between personality disorders and repeat emergency department visits related to cannabis use.

There appears to be stability in the patient profile of those presenting to the emergency department with a complaint relating to suicide while reporting cannabis use from the period directly following legalisation in Canada, to a similar time frame 2 years later despite reported increased use of cannabis in the general population over this period. Despite the rising potency and access to legal cannabis, suicide risk remains stable, although concerning.

Understanding what psychosocial interventions can reduce self-harm and suicide within in-patient mental health settings can be challenging, due to clinical demands and the large volume of published reviews.

To summarise evidence from systematic reviews on psychosocial and ward-level interventions (excluding environmental modifications) for self-harm and suicide that may enhance patient safety in in-patient mental health settings.

We systematically searched Medline, Embase, CINAHL, PsycINFO and CDSR (2013–2023) for systematic reviews on self-harm and suicide prevention interventions that included in-patient data. Review quality was assessed using AMSTAR-2, primary study overlap via an evidence matrix, and evidence strength evaluated (GRADE algorithm). Findings were narratively synthesised, with input from experts-by-experience throughout (PROSPERO ID: CRD42023442639).

Thirteen systematic reviews (seven meta-analyses, six narrative), comprising over 160 000 participants, were identified. Based on quantitative reviews, cognitive–behavioural therapy reduces repeat self-harm by follow-up, and dialectical behaviour therapy decreases the frequency of self-harm. Narrative review evidence suggested that post-discharge follow-up, as well as system and ward-based interventions (e.g. staff training) may reduce suicide and/or self-harm. However, review quality varied, patient involvement was lacking and methodological quality of trials informing reviews was predominately low. Overlap was slight (covered area 12.4%).

The effectiveness of interventions to prevent self-harm and suicide in in-patient settings remains uncertain due to variable quality reviews, evidence gaps, poor methodological quality of primary studies and a lack of pragmatic trials and co-production. There is an urgent need for better, co-designed research within in-patient mental health settings.

Suicide rates in the United States have been increasing, necessitating an understanding of demographic variations by ethnicity, age, sex and method to inform effective prevention strategies.

To dissect suicide rates in the US population from 2001 to 2023 by age, sex, ethnicity, and method.

This retrospective observational study utilized suicide data and population statistics from the CDC’s WISQARS database for the years 2001 (n = 30,418), 2018 (n = 48,132), 2020 (n = 45,721) and 2023 (n = 49,014). Cases were stratified by age, sex, ethnicity, and suicide method to assess trends and demographic differences.

From 2001 to 2023, the overall US suicide rate rose from 10.7 to 14.6 per 100,000, with a temporary decrease in 2019 and 2020 (14.4 and 13.8, respectively). The primary driver of the increase was firearm-related suicides among White males, contributing 25.8% of the rise from 2001 to 2018 and 51.6% from 2020 to 2023. Decline between 2018 and 2020 was mainly due to reductions in firearm and drug-related suicides among White males, but firearm suicides surged again from 2020 to 2023. Additionally, firearm suicides among ethnic minorities, especially Black/African-American males, accounted for 14.0% of the increase during 2020–2023. Drug-related suicides also increased by 8.6% among White females aged 45 and older in the same period.

Firearm suicides are the leading factor in the changing suicide rates in the United States from 2001 to 2023, alongside rising drug-related suicides among White females. These trends highlight the necessity for targeted prevention efforts that consider demographic-specific factors and method accessibility.

Despite increasing awareness and understanding of children’s victimisation through experiences of domestic violence (EDV), little attention has been given to the associated health outcomes.

Examine associations between four different forms of childhood EDV (physical violence, threats of harm, property damage and intimidation or control) and four mental disorders and six health risk behaviours.

Data were drawn from the Australian Child Maltreatment Study. Associations were examined using survey-weighted logistic regression models. Estimates were calculated adjusting for each other form of EDV, as well as other types of child maltreatment and socio-economic factors. Each model was stratified for men and women.

All mental disorders and health risk behaviours were more common among those with any childhood EDV compared to those without. Intimidation or control and damage to property or pets independently predicted most mental disorders and health risk behaviours. The strongest association was found between intimidation or control and post-traumatic stress disorder (adjusted odds ratio (aOR) 2.30, 95% CI 1.77–2.98) and generalised anxiety disorder (aOR 1.65, 95% CI 1.36–1.99), and damage to property or pets and severe alcohol use disorder (aOR 1.76, 95% CI 1.36–2.27).

Childhood EDV characterised by intimidation or control and property damage or harm to pets significantly increases the risk of mental disorders and health risk behaviours in adulthood. Urgent investment is needed in child-centred and trauma- and family-violence-informed interventions that support children’s recovery and stronger legal protections to prevent children from being weaponised in post-separation coercive control.

Being diagnosed with cancer can be stressful and has been linked to suicide. However, an updated analyses where a wide range of cancers are compared is lacking.

To examine whether individuals first-time diagnosed with cancer within the past 5 years had higher suicide rates than those with no such diagnosis. Associations with time since diagnosis, and stage and site of cancer, were analysed.

A population-based cohort study design applied to nationwide, longitudinal data on all persons aged 15 years or above (N = 6 987 998) and living in Denmark between 2000 and 2021. Specific sites of cancer first-time diagnosed were considered as exposure for the subsequent 5 years, and death by suicide was examined as outcome. Adjusted incidence rate ratios (aIRRRs) were calculated using Poisson regression models and adjusted for sociodemographics, psychiatric disorders and suicide attempts prior to cancer diagnosis.

In total, 707 513 (10%) individuals were included. While 12 800 individuals died by suicide in the non-cancer group, 601 died of suicide in the cancer group, resulting in an aIRR of 2.0 (95% CI: 1.9–2.1). The highest rate was found in the period immediately following diagnosis (<6 months: 3.9, 95% CI: 3.6–4.2 versus 4–5 years: 1.8, 95% CI: 1.5–2.0). Also, higher rates were found for high-stage tumours (3.1, 95% CI: 2.8–3.4). The highest aIRRs were found for pancreatic cancer (7.5, 95% CI: 5.8–9.7) and oesophageal cancer (7.1, 95% CI: 5.4–9.3). Almost all sites of cancer analysed showed elevated rates of suicide compared with individuals without cancer.

Several recently diagnosed cancers were linked to elevated rates of suicide, especially during the first period following diagnosis. High tumour stage was associated with the highest rates, as were cancer sites with poor prognosis, suggesting prioritisation of these patient groups for suicide prevention efforts.

The significant heterogeneity among individuals who die by suicide complicates prevention, suggesting that a “one-size-fits-all” approach is insufficient. It is crucial to identify distinct subgroups for targeted strategies. This study aims to characterize suicide profiles based on trait impulsivity and related factors.

Data from the FRieNDS project (Factores de Riesgo en Defunciones por Suicidio – Risk Factors in Suicide Deaths), a psychological autopsy study of 408 suicide deaths, were used. After determining the optimal number of clusters via stability analysis through agglomerative nesting, a final cluster analysis was performed on 391 valid suicide deaths (defined as cases with no missing data on the variables used for clustering) using k-means on a lower-dimensional representation of the data encoded by an autoencoder. Key clustering variables included sex, impulsivity (Barratt Impulsivity Scale-11), aggression, intent to die, previous history of suicide attempts, history of substance abuse, psychotic and affective disorders, and the presence of a depressive episode at the time of death.

We identified three clusters: (1) Impulsive-aggressive (29.8%), characterized by high rates of Cluster B disorders, substance abuse, more stressful events, and low lethal intent; (2) depressive prior attempters (24.5%), which comprised mostly women and showed greater behavioural changes before death; and (3) non-impulsive/aggressive (45.7%), a group with no clear psychopathological profile, less healthcare contact, and minimal communicated intent to die, despite having few prior attempts.

Our study identified three suicide clusters with varying impulsivity levels, highlighting the need for tailored interventions and community-level research for better suicide prevention strategies.

Impulsivity and aggression are known risk factors for suicide, with observed age and sex differences in their impact.

To explore variations in impulsivity and aggression based on sex and age and examine their roles in predicting suicide.

We examined 582 participants (406 individuals who died by suicide, 176 non-suicidal sudden-death controls) using the psychological autopsy method. Measures of impulsivity and aggression included the Barratt Impulsiveness Scale (BIS) and the Brown–Goodwin History of Aggression (BGHA). Participants were categorised into four groups: suicide male, control male, suicide female and control female. For group comparisons, we used analyses of variance and Spearman’s rank correlation to assess the relationship between age and BIS and/or BGHA ratings. Stepwise logistic regression was used to identify predictors of suicide for each sex.

Higher levels of BIS and BGHA ratings were found in the suicide group compared with controls (BIS: 51.3 v. 42.2, P = 0.002, η2 = 0.017; BGHA: 7.1 v. 4.1, P < 0.001, η2 = 0.028), with no significant sex differences. BIS and BGHA ratings decreased with age in the suicide groups (suicide male: impulsivity ρ = −0.327, P < 0.001; suicide female: aggression ρ = −0.175, P = 0.038) but not among controls. Logistic regression analysis revealed that for men, aggression (odds ratio 1.072, 95% CI: 1.032–1.112) was a key predictor. For women, younger age (odds ratio 0.970, 95% CI: 0.948–0.993), low BIS impulsivity ratings (odds ratio 1.018, 95% CI: 1.001–1.036) and living with children (odds ratio 0.448, 95% CI: 0.208–0.966) were protective factors.

Impulsive and aggressive behaviours are critical factors in suicide risk among younger individuals, indicating an age effect but no sex dimorphism, with aggressive behaviours being a better predictor for men and impulsive and aggressive behaviours for women.

Literature has shown that a significant minority of bereaved people are at risk of prolonged grief disorder (PGD). However, studies on its prevalence and correlates within Italian samples remain scarce.

This study aimed to explore the prevalence and correlates of PGD symptom severity among 1603 bereaved Italian adults.

Self-reported data on PGD, suicidal ideation, depression, anxiety and stress were gathered. Descriptive characteristics and bereavement-related information were also collected.

Among participants who lost a close other person at least 12 months prior, the prevalence of probable PGD and severe suicidal ideation was 7.7% (n = 104) and 0.7% (n = 9), respectively. The overall prevalence of severe suicidal ideation in the sample was 4.5%, rising to 18.2% among those with probable PGD. The probable PGD diagnosis showed minimal agreement with reported depression (phi = 0.25), anxiety (phi = 0.19), and stress (phi = 0.26), suggesting potentially limited overlap and supporting their distinctiveness. The severity of PGD symptoms was significantly positively associated with older age and suicidal ideation, and negatively associated with lower educational background and time since loss. PGD severity also varied by kinship, cause of death and place of residence. Specifically, bereaved individuals who lost a grandparent due to natural causes associated with ageing and lived in small- to medium-sized cities reported lower PGD symptom severity relative to others.

These findings contribute to the understanding of PGD symptomatology in bereaved individuals in Italy, although the results may not generalise to the entire Italian population.

Adolescence is a pivotal stage for brain development and a critical window for the emergence and transition of self-injury thoughts and behaviours (SITBs). However, the genetic and neurobiological mechanisms underlying SITBs transition during this developmental period are poorly understood.

This study investigates associations among genetic predispositions, brain abnormalities and SITBs transition during adolescence, and identifies potential neurobiological and clinical mediators of genetic effects.

This national retrospective cohort study analysed 5-year longitudinal data from the Adolescent Brain and Cognitive DevelopmentSM Study® (N = 11 868 children aged 9–10 years at baseline). Logistic regression models identified genetic susceptibility and neurobiological abnormalities associated with SITBs transition over a 4-year period. Generalised additive models characterised genetic risk trajectories and critical developmental periods. Mediation analyses examined neurobiological and clinical pathways linking genetic susceptibility to SITBs.

Our findings highlight a notable correlation between SITBs transition and genetic susceptibility, including polygenic risk scores for suicide attempt, ever contemplated self-harm and ever self-harm. The analysis indicates that ages 10–15 years may be a critical period during which genetic risk exerts its most pronounced influence. Structural and functional brain imaging detected some alterations, particularly in grey matter volume (GMV) of the left ventral posterior cingulate cortex, alongside disrupted resting-state functional connectivity in the dorsal attention and default mode networks. Mediation analysis suggests that the association between genetic susceptibility and SITBs transition over 4 years may be partially mediated by GMV changes in the left inferior frontal sulcus, altered resting-state connectivity between the auditory and sensorimotor hand networks and the p-factor.

These results may offer insights into integrating genetic, neurobiological and clinical data to enhance the accuracy of suicide risk stratification in adolescents, and inform the development of more nuanced and targeted early intervention strategies.

Voluntary self-prohibition (VSP) is a suicide prevention policy that allows individuals who recognize their risk for suicide to voluntarily prevent themselves from purchasing firearms through systems requiring background checks. It is unclear whether psychiatrists are aware of this suicide prevention tool or when to recommend it appropriately.

To evaluate Virginia psychiatrists’ awareness and use of VSP alongside Substantial Risk Orders (SROs) to inform policy and practice.

A convenience sample of Virginia psychiatrists was surveyed on knowledge and use of VSP and SRO, including vignettes of patients at varying risk levels.

Sixty-three psychiatrists completed the survey. Most (66.7%) were unaware of VSP or SRO. After brief education, 74.1% of respondents chose VSP in the vignette where it was most strongly indicated and 72.2% chose SRO in the vignette where it was most strongly indicated. After learning about VSP, 83% agreed or strongly agreed that VSP could be a useful tool.

The sample was small and did not collect certain information which may have provided additional insight into respondents’ choices.

After brief education, most respondents found VSP potentially useful. Ensuring knowledge of VSP and SRO may improve the uptake of both policies and suicide prevention efforts.

Suicidal behaviors (SB) in bipolar disorder (BD) are major adverse outcomes that may influence disease progression. While staging models exist for psychiatric disorders, none include suicide. This study aims to stratify suicidal risk in BD, propose a staging model for SB, and assess its clinical utility.

Participants from the FondaMental Advanced Centers of Expertise for Bipolar Disorder (FACE-BD) cohort were categorized into five stages (St) based on SB: St0 (no suicidal ideation [SI]), St1 (SI but no suicide attempt [SA]), St2a (non-severe/violent SA), St2b (severe /violent SA), and St3 (multiple SAs). Stages were analyzed based on demographic, clinical, cognitive, and biological characteristics using logistic regression.

Key differences emerged between stages. St1 showed longer untreated illness and higher lability and lower functioning than St0. St2a was linked to anxiety, substance use disorders, and longer disorder duration, while male gender and lithium bitherapy were protective. St2b exhibited shorter untreated illness and higher childhood trauma (CTQ) scores, with male gender and alcohol use as risk factors. St3 was associated with BD-II, alcohol use, longer disorder duration, and more depressive episodes, but less anxiety. No biochemical or cognitive differences were found across stages. The model was significantly associated with SA occurrence (LRT = 28.74, p < 0.0001).

This staging model for suicidality in BD provides a multifaceted approach to risk stratification and predictive insights, although further refinement is needed.