While depressive symptoms are common during menopausal transition, the relationship between the two remains unclear. Therefore, this study aimed to examine the longitudinal changes in depressive symptoms among middle-aged Korean women and identify those with elevated and worsening symptoms during this period.

A total of 1,178 participants who underwent comprehensive health examinations at Kangbuk Samsung Hospital in Korea were followed for a median of 10.8 years (IQR, 9.2–11.6; maximum, 12.7), including all women who reached natural menopause during follow-up, with only data prior to HRT initiation included. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D), and menopausal stages were classified according to the STRAW + 10 criteria and final menstrual period (FMP). Linear mixed-effects models and group-based trajectory modelling (GBTM) were applied to evaluate longitudinal changes in depressive symptoms and to identify distinct trajectories in the severity and stability of depressive symptoms.

The age-adjusted prevalence of CES-D ≥ 16 was 11.0%, 11.5%, 11.2% and 12.4%, with corresponding mean scores of 6.7, 6.6, 6.9 and 7.1 across stages. After adjusting for time-varying age and covariates, menopausal stage transitions were not significantly associated with higher levels of depressive symptoms, whether analysed as continuous or binary variables. For binary CES-D (≥16), the estimated coefficients (95% CI) were 0.10 (–0.20 to 0.41) for early transition, 0.09 (–0.21 to 0.39) for late transition and 0.26 (–0.09 to 0.61) for post-menopause. Similarly, time relative to the FMP (–11 to +9 years) showed no significant association with depressive symptoms. GBTM identified three distinct trajectories: most participants (75.5%) maintained consistently low depressive symptoms throughout the transition, whereas 5.8% showed worsening symptoms. Poor sleep quality (OR 5.83, 95% CI 3.25 to 10.45) and moderate-to-severe vasomotor symptoms (OR 2.95, 95% CI 1.30 to 6.70) were significantly associated with the worsening trajectory. Suicidal ideation was higher in this group (45.4% at baseline, increasing to 70.5% at follow-up).

Most women maintained low depressive symptoms during the menopausal transition; however, a subset experienced worsening symptoms linked to menopause-related physical symptoms. Medical visits for menopause-related symptoms may provide opportunities for screening depressive symptoms in higher-risk women, though the screening effectiveness requires further evaluation.

The distinction between passive and active suicidal ideation (SI) and their underlying etiologies remains poorly understood. The Interpersonal Theory of Suicide implicates guilt, loneliness, and hopelessness in these SI subtypes, but there is minimal work testing these relationships in real time, capturing clinically meaningful fluctuations in SI. We conducted the first ecological momentary assessment (EMA) study to distinguish between passive and active SI in adolescents, and the first study to evaluate moment-to-moment etiological factors and mediators of passive and active SI in this age group.

Participants (N = 104) were adolescent psychiatric inpatients (Mage = 15.1; 72.12% female). They completed an EMA protocol including measures of guilt, loneliness, hopelessness, and passive and active SI for four weeks post-discharge. Multilevel modeling was used to evaluate guilt and loneliness, respectively, as predictors of prospective passive and active SI, respectively. We also evaluated whether hopelessness mediated the interaction between guilt and loneliness in predicting future SI. Hopelessness was also evaluated as a mediator between passive and active SI.

Guilt predicted prospective passive and active SI, respectively, whereas loneliness only predicted prospective passive SI. The interaction between guilt and loneliness did not predict active SI, and hopelessness did not mediate the association between guilt and active SI. Passive SI prospectively predicted active SI, but hopelessness did not mediate this association.

Findings suggest that passive and active SI may share overlap but also differences in their etiologies. Their relationship with etiological factors and mediators may differ as a function of temporal scale.

As populations age rapidly, understanding the psychological benefits of sustained employment has become increasingly important. In South Korea, where the suicide rate among older adults is one of the highest among Organisation for Economic Co-operation and Development (OECD) countries, identifying modifiable social determinants, such as employment, may inform effective prevention strategies.

This retrospective cohort study used data from the Korean Welfare Panel Study (2009–2024), a nationally representative longitudinal survey. Individuals with depressive symptoms or suicidal ideation at baseline were excluded. The main exposure was participation in a government-led senior employment program. We employed discrete-time survival analysis using a generalized linear model with a complementary log–log link function, which appropriately handled the interval-censored structure of the panel data.

Older adults who participated in the employment program had a significantly lower risk of developing depressive symptoms (adjusted hazard ratio [HR] = 0.76, 95% confidence interval [CI]: 0.67–0.86) and suicidal ideation (adjusted HR = 0.60, 95% CI: 0.45–0.81) compared to those who did not participate. Subgroup analyses revealed that the strength of the association was particularly strong among individuals aged ≥80 years, those with chronic illness, poor self-rated health, and those who were previously or never married.

Structured government-supported employment may mitigate the risk of depressive symptoms and suicidal ideation in later life. These findings support the potential of senior employment programs as effective mental health promotion and suicide prevention strategies for aging populations.

Suicide is a significant global public health problem, with a disproportionately large burden among youth in low- and middle-income countries (LMICs). Despite growing awareness of the problem, evidence-based interventions in these settings are scarce.

This systematic review aims to identify and synthesise the evidence-based literature on the effectiveness of psychosocial-interventions to prevent suicide among young people aged 10–24 years in LMICs to reduce the risk of suicide and improve their mental-wellbeing.

After registering protocol with the PROSPERO database of systematic reviews (CRD 420251016364), we searched electronic databases (e.g., PubMed, Medline, Cochrane Library, APA PsycINFO, Scopus, EMBASE, Web of Science and Google Scholar) for potential studies. We considered relevant literature in the English language and published from January 2000 to March 2025. Studies eligible for inclusion were psychosocial interventions compared with a control group, conducted on adolescents in LMICs, and with suicidal-ideation and suicide attempt as primary outcome. Reducing symptoms of anxiety and depression as well as improvements in quality of life were considered as secondary outcomes.

Among 1,223 identified studies, only four met the inclusion criteria. Despite the limited evidence base, all included trials reported reductions in suicidal ideation and improvements in emotional well-being, suggesting the potential effectiveness of culturally adapted psychosocial approaches. Estimated intervention effect sizes ranged from large to extremely large (Cohen’s d = 1.46, 2.08, 1.30 and 3.02, respectively), compared with small-to-moderate effect sizes from high-income countries (d ≈ 0.24 to 0.54). Secondary benefits were noted for hopelessness, depressive symptoms and quality of life. However, interpretation is limited by small samples and inconsistent methods, reducing comparability with high-income data.

The review highlights major gaps in youth suicide prevention within LMICs, emphasising the urgent need for contextually relevant, evidence-based psychosocial interventions and policy frameworks. Findings suggest moderate effectiveness of current interventions, underscoring the importance of culturally tailored implementation to enhance impact.

Among the clinical features of bipolar disorder (BD), sleep disturbances are highly prevalent and persist across all phases of the illness, from onset to acute and inter-episodic periods. Substantial evidence suggests that sleep disturbances may function as proximal triggers for suicidal behavior, independent of other underlying psychiatric conditions. Although suicide is a major clinical concern in BD, the interplay between sleep disturbances and suicidality remains incompletely understood.

We conducted a systematic review and meta-analysis (SRMA) following the PRISMA guidelines. We performed a comprehensive search across PubMed, PsycINFO, and SCOPUS, including all studies reporting an association between sleep disturbances and suicidal behavior in BD. A total of 16 reports, comprising 14 cross-sectional studies and two longitudinal studies, were included in this SRMA.

Among individuals with BD, sleep disturbances were associated with increased odds of lifetime suicidal behaviors (OR = 1.51, 95% CI = 1.23, 1.86), and a history of suicide attempts was associated with significantly elevated odds of experiencing sleep disturbances (OR = 1.37, 95% CI = 1.21, 1.55). In addition, poor sleep quality as measured by the Pittsburgh Sleep Quality Index positively correlated with suicidality (r = 0.24, 95% CI = 0.10, 0.36).

These results highlight the link between sleep disturbances and suicidal tendencies in individuals with BD. Prompt recognition and treatment of sleep disturbances could be crucial for averting or reducing suicidal behaviors in this population.

While psychiatric disorders (e.g., depression, anxiety) are well-established predictors of suicidal ideation (SI) in individuals with traumatic brain injury (TBI), the roles of other psychological and cognitive factors remain underexplored. This study examined associations between SI and emotion-processing difficulties, coping strategies, psychological resilience, and cognitive functioning after moderate–severe TBI.

This was a secondary analysis of data from 106 individuals with moderate–severe TBI. SI and emotional distress were assessed using the Inventory of Depression and Anxiety Symptoms and Hospital Anxiety and Depression Scale, respectively. Participants also completed measures of emotional lability and detachment (Comprehensive Assessment of Traits Relevant to Personality Disorders [CAT-PD]), coping (Coping Scale for Adults), psychological resilience (Connor–Davidson Resilience Scale), and cognitive functioning, including subjective (CAT-PD, Brief Rating of Executive Function) and objective measures (Brief Test of Adult Cognition by Telephone). Spearman’s correlations and path models were used to examine psychological and cognitive correlates of SI.

SI was positively associated with emotional lability, emotional detachment, non-productive coping, and self-reported cognitive problems, and negatively associated with resilience. Path models indicated that emotional distress accounted for 76–100% of these associations. Conversely, SI was not significantly associated with adaptive coping or objective cognitive performance.

Emotion-processing difficulties, non-productive coping strategies, low resilience, and self-reported cognitive problems are linked to SI in individuals with moderate–severe TBI, primarily through their associations with emotional distress. Findings underscore the importance of addressing emotional distress, including depression and anxiety, and its underlying contributors in suicide prevention for this population.

Suicide represents a significant public health concern. Suicide prevention strategies are shifting toward transdiagnostic perspectives examining interrelated risk factors, but their interrelationships remain unclear. This study investigated relationships between psychopathological dimensions, impulsivity, and childhood maltreatment in individuals with suicidal ideation (SI), comparing those with versus without intention to act using network analysis.

Data were obtained from the Suicide Prevention and Intervention Study project. Participants were categorized into two groups based on their intention to act according to the Columbia Suicide Severity Rating Scale. Psychological symptoms, impulsivity traits, and childhood maltreatment were assessed. Network analysis was performed, and centrality measures were computed.

A total of 1,265 individuals were categorized into the SI without intention to act (n = 345) and SI with intention to act (n = 920) groups. The former showed lower depression and hostility scores, and lower prevalence of major depressive and anxiety disorders. Network analyses revealed that in the SI without intention to act group, obsessive-compulsive symptoms were central, connecting to depression and anxiety, while negatively correlating with non-planning impulsivity. In contrast, the SI with intention to act group showed a more densely interconnected network where emotional abuse served as a bridge between childhood maltreatment and other psychopathological dimensions.

This study identifies symptom interaction patterns between individuals with SI without and with intention to act. Understanding these relationships may improve suicide risk assessment and inform personalized interventions, potentially reducing the transition from ideation to action. Trauma-focused approaches addressing emotional abuse may be especially relevant for individuals at high risk.

Although life stressors are known risk factors for suicide, the specific stressor types that most strongly precipitate suicidal outcomes, and on what timescale, remain poorly understood. Based on existing theory, we investigated whether objectively rated interpersonal stressors, especially social and targeted rejection stressors, are proximally associated with increased likelihood of suicidal ideation and behavior.

Using an objectively rated contextual threat interview to assess stressful life events, and a timeline followback procedure for assessing suicide-related outcomes, we examined how the severity of four types of acute life events (i.e. non-interpersonal, interpersonal without social rejection, social rejection without targeted rejection, and targeted rejection) were temporally associated with the likelihood of same-day and next-day suicidal ideation and behavior over 16 months in 143 young adults (Mage = 25.27, SD = 4.65) with recent suicidal ideation or behavior.

After controlling for prior-day suicidal ideation and non-interpersonal stressors, daily within-person increases in interpersonal stressor severity were related to higher odds of same-day (but not next-day) suicidal ideation. Additionally, greater increases in targeted rejection severity were uniquely related to increased likelihood of both same-day and next-day suicidal behavior after controlling for prior-day suicidal behavior and other types of stressors.

Interpersonal stressors are strong, proximal risk factors for suicidal ideation and behavior, and these effects are particularly strong for targeted rejection life events. Clinicians should thus assess recent interpersonal and, especially, targeted rejection stressors when evaluating acute suicide risk, and may reduce such risk by helping patients stabilize and strengthen their social relationships.

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.

We aimed to present the hospital presented age-specific rate ratio of Traveller women with self-harm or suicide-related ideation and further explore their experiences when attending hospitals in Ireland with thoughts of suicide.

A sequential mixed method analysis was adopted. National presentation data from 24 Irish Emergency Departments (EDs) for suicidal thoughts or self-harm, between 2018–2022 and qualitative interviews were conducted. Descriptive statistics, Poisson regression and rate ratios (95% confidence intervals), were used. Interpretative Phenomenological Analysis (IPA) was conducted on interviews with Traveller women presenting to EDs with suicidal thoughts in 2023. We involved lived experience women in the research.

693 Traveller women presentations were assessed in the 5-year period. Traveller women between 40–49 years of age had 7·81 (95% CI 6·39– 9·55) times higher risk of ideation presentation and those 50+ had 6·41 (95% CI 5·04–8·15) times higher risk of self-harm, when compared to White Irish females. One in four Traveller female presentations, requested no next of kin involvement when discharged. The ‘Power of human connection’ theme emerged from two Traveller women interviewed, reflecting the powerfulness of support in the participants experiences of suicidal ideation.

Results highlight the potential suicide risk of Traveller women over the age of 40 and the significant issue of social isolation when all forms of interpersonal support – family, Traveller organisations, and public health services – are lacking, but crucial for a collaborative safety plan upon ED discharge.

Work stress levels rose among health and educational workforces during the COVID-19 pandemic, and can affect employee well-being and organisational efficiency.

To explore the association of work stress with mental health, including suicidal ideation and physical health, as well as presenteeism, as aspects of organisational efficiency in UK healthcare and university workers.

A total of 328 UK participants completed self-report questionnaires between April 2022 and September 2023 in the context of the European Platform to Promote Wellbeing and Health in the Workplace (EMPOWER) study. Cross-sectional analyses were conducted.

Two hundred and ninety-two (90%) employees reported work-related stress (Mini-Psychosocial Stressors at Work Scale). Depressive, anxiety and somatic symptoms were reported (61, 55 and 75%, respectively); 11% of the participants reported suicidal ideation (Patient Health Questionnaire 9) and 56% reported presenteeism (iMTA Productivity Cost Questionnaire). Psychological and somatic symptoms were worse when suicidal ideation or presenteeism was reported. Stressful work factors included having too much work to do (63%), a bad working atmosphere (28%), poor work–home balance (32%) and working hours hindering private life (35%). Spearman correlations showed significant associations between work stress and suicidal ideation (0.225), depressive (0.290), anxiety (0.299) and somatic symptoms (0.245) and presenteeism (0.311), but not with having a chronic medical condition.

Given the association between work stress, suicidal ideation and presenteeism, research should explore how psychosocial risk factors linked to work stress could be reduced for healthcare and higher education employees. The findings warrant the development of policies to address work stress, and to provide employee support for suicidal ideation and presenteeism in the work setting.

Previous studies have shown that repetitive transcranial magnetic stimulation (rTMS) can treat suicidal symptoms; however, the effects of rTMS on suicidal ideation (SI) in late-life depression (LLD) have not been well-characterized, particularly with theta burst stimulation (TBS).

Data were analyzed from 84 older adults with depression from the FOUR-D trial (ClinicalTrials.gov identifier: NCT02998580), who received either bilateral standard rTMS or bilateral TBS targeting the dorsolateral prefrontal cortex. The primary outcome was change in the Beck Scale for Suicide Ideation (SSI). The secondary outcome was remission of SI. Demographic, cognitive, and clinical characteristics that may moderate the effects of rTMS or TBS on SI were explored.

There was a statistically significant change in the total SSI score over time [χ2(7) = 136.018, p < 0.001], with no difference between the two treatment groups. Remission of SI was 55.8% in the standard rTMS group and 53.7% in the TBS group. In the standard rTMS group, there was no difference in remission of SI between males and females, whereas remission was higher in females in the TBS group (χ2(1) =6.87, p = 0.009). There was a significant correlation between time to remission of SI and RCI z-score for D-KEFS inhibition/switching [rs = −0.389, p = 0.012].

Both bilateral rTMS and bilateral TBS were effective in reducing SI in LLD. There may be sex differences in response to TBS, with females having more favorable response in reducing SI. There may be an association between improvement in cognitive flexibility and inhibition and reduction of SI.

Studies conducted during the COVID-19 pandemic found high occurrence of suicidal thoughts and behaviours (STBs) among healthcare workers (HCWs). The current study aimed to (1) develop a machine learning-based prediction model for future STBs using data from a large prospective cohort of Spanish HCWs and (2) identify the most important variables in terms of contribution to the model’s predictive accuracy.

This is a prospective, multicentre cohort study of Spanish HCWs active during the COVID-19 pandemic. A total of 8,996 HCWs participated in the web-based baseline survey (May–July 2020) and 4,809 in the 4-month follow-up survey. A total of 219 predictor variables were derived from the baseline survey. The outcome variable was any STB at the 4-month follow-up. Variable selection was done using an L1 regularized linear Support Vector Classifier (SVC). A random forest model with 5-fold cross-validation was developed, in which the Synthetic Minority Oversampling Technique (SMOTE) and undersampling of the majority class balancing techniques were tested. The model was evaluated by the area under the Receiver Operating Characteristic (AUROC) curve and the area under the precision–recall curve. Shapley’s additive explanatory values (SHAP values) were used to evaluate the overall contribution of each variable to the prediction of future STBs. Results were obtained separately by gender.

The prevalence of STBs in HCWs at the 4-month follow-up was 7.9% (women = 7.8%, men = 8.2%). Thirty-four variables were selected by the L1 regularized linear SVC. The best results were obtained without data balancing techniques: AUROC = 0.87 (0.86 for women and 0.87 for men) and area under the precision–recall curve = 0.50 (0.55 for women and 0.45 for men). Based on SHAP values, the most important baseline predictors for any STB at the 4-month follow-up were the presence of passive suicidal ideation, the number of days in the past 30 days with passive or active suicidal ideation, the number of days in the past 30 days with binge eating episodes, the number of panic attacks (women only) and the frequency of intrusive thoughts (men only).

Machine learning-based prediction models for STBs in HCWs during the COVID-19 pandemic trained on web-based survey data present high discrimination and classification capacity. Future clinical implementations of this model could enable the early detection of HCWs at the highest risk for developing adverse mental health outcomes.

NCT04556565

This study examines the prospective associations of alcohol and drug misuse with suicidal behaviors among service members who have left active duty. We also evaluate potential moderating effects of other risk factors and whether substance misuse signals increased risk of transitioning from thinking about to attempting suicide.

US Army veterans and deactivated reservists (N = 6,811) completed surveys in 2016–2018 (T1) and 2018–2019 (T2). Weights-adjusted logistic regression was used to estimate the associations of binge drinking, smoking/vaping, cannabis use, prescription drug abuse, illicit drug use, alcohol use disorder (AUD), and drug use disorder (DUD) at T1 with suicide ideation, plan, and attempt at T2. Interaction models tested for moderation of these associations by sex, depression, and recency of separation/deactivation. Suicide attempt models were also fit in the subgroup with ideation at T1 (n = 1,527).

In models controlling for socio-demographic characteristics and prior suicidality, binge drinking, cannabis use, prescription drug abuse, illicit drug use, and AUD were associated with subsequent suicidal ideation (AORs = 1.42–2.60, ps < .01). Binge drinking, AUD, and DUD were associated with subsequent suicide plan (AORs = 1.23–1.95, ps < .05). None of the substance use variables had a main effect on suicide attempt; however, interaction models suggested certain types of drug use predicted attempts among those without depression. Additionally, the effects of smoking/vaping and AUD differed by sex. Substance misuse did not predict the transition from ideation to attempt.

Alcohol and drug misuse are associated with subsequent suicidal behaviors in this population. Awareness of differences across sex and depression status may inform suicide risk assessment.