Depression is the most common psychiatric disorder among patients with end-stage renal disease (ESRD), yet the risk factors for mortality in this population remain unclear.

To identify risk factors for mortality in ESRD patients with depression and assess the incidence of suicide attempts.

We used Taiwan’s National Health Insurance Research Database to identify adult patients who initiated maintenance dialysis between 1997 and 2012. Two ESRD cohorts were established at a depression-to-non-depression ratio of 1:8, matched by age and gender (n = 3289 with depression; n = 26 312 without depression). Outcomes included all-cause mortality and suicide attempts, with additional subgroup analyses by baseline depression severity.

ESRD patients with depression had a higher mortality risk (hazard ratio 1.15, 95% CI: 1.10–1.21) than those without. Risk factors for mortality included male gender, older age, diabetes and cardiovascular disease. Patients with depression also had a higher risk of suicide attempts (hazard ratio 3.02, 95% CI: 1.68–5.42). ESRD patients with severe depression had a significantly higher rate of hospital admissions for depression compared to those with non-severe depression (incidence rate ratio (IRR): 1.82, 95% CI: 1.14–2.93). Furthermore, patients with severe depression were associated with a significantly higher mortality rate compared to those without depression (IRR: 1.42, 95% CI: 1.15–1.76).

Depression is linked to poor survival in ESRD patients, with underlying comorbidities playing a key role in mortality. Given the increased risk of mortality, suicide attempts and hospital admissions, these high-risk patients require enhanced medical attention, particularly those with severe depression.

Schizophrenia is associated with premature mortality, but most evidence comes from high-income regions.

This study aimed to estimate the excess mortality associated with schizophrenia in southern China.

We linked register data from a nationwide information system for psychosis to death registers. Individuals diagnosed with schizophrenia and residing in Guangzhou between 2014 and 2021 were included. Standardised mortality ratios (SMRs) were calculated to compare the mortality of people with schizophrenia with that of the general population. Life expectancy, potential years of life lost (PYLL) and years of life lost (YLL) were estimated for all-cause mortality and specific causes of death. Gender difference in these metrics was examined.

There were 3684 deaths (11.3%) during the study period. The leading causes of death were circulatory, neoplastic and respiratory diseases. The mortality rate among people with schizophrenia was twofold greater than in the general population, with a greater risk associated with unnatural causes than natural causes. The risk of mortality due to suicide was 15-fold higher than that of the general population. The life expectancy in schizophrenia was around 60 years, which is 21 years shorter than that for the general population. Schizophrenia was associated with substantial premature mortality burden, showing greater impact in men than women.

Schizophrenia is associated with increased premature mortality, reduced life expectancy and substantial PYLL. The enduring disparity in mortality underscores an imminent call for targeted interventions aimed at suicide prevention and enhancement of the physical well-being of people with schizophrenia.

Research suggests that there may be an association between prescribed opioid use and suicide-related behaviours.

This 15-year retrospective population-based cohort study examines the relationship between opioid use, self-harm and suicide.

The study was based on the POPPY II study, a population-based cohort of 3 268 282 adults who initiated a prescription opioid between 1 July 2003 and 31 December 2018, in Australia. Prescription dispensing data were linked to hospitalisation, death and other data collections. Opioid use was defined as current opioid exposure, cumulative duration of exposure and estimated daily dose. Outcomes were self-harm hospitalisation and suicide mortality, categorised as overall and according to the method (opioid poisoning, non-opioid substance poisoning and other methods). Time-varying generalised estimating equations were used to assess the relationship with self-harm hospitalisation, and Cox proportional hazard models were used to assess the relationship with suicide mortality, controlling for known suicide-related risk factors.

There were 49 215 self-harm hospitalisations at a crude rate of 262 per 100 000 person-years and 3087 suicide deaths at a crude rate of 16.5 per 100 000 person-years. Intentional opioid poisoning was the least common method for both self-harm hospitalisation and suicide. Following multivariable adjustment, current opioid exposure, longer cumulative duration and higher doses were significantly associated with a greater risk of opioid-related self-harm or suicide. In adjusted models, associations for other methods of self-harm and suicide were not as strong or consistent.

Opioid poisoning was the least common method of self-harm and suicide. Despite this, for the minority of people prescribed high doses and/or a long duration of prescription opioids, there is an increased risk for opioid-related self-harm and suicide after controlling for known covariates. Suicide-related behaviours should be screened and monitored in people prescribed opioids, particularly among those on long-term and/or high-dose opioids.

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.

There is growing consensus on essential components of care for hospital-presenting self-harm and suicidal ideation, yet these are often inconsistently implemented. This qualitative study aimed to explore the implementation of components of care across hospitals. Interviews were conducted with health professionals providing care for self-harm and suicidal ideation in hospital emergency departments. Participants (N = 30) represented 15 hospitals and various professional roles. A framework analysis was used, where factors affecting each care component were mapped by hospital and hospital grouping.

A timely, compassionate response was facilitated by collaboration between liaison psychiatry and emergency-department staff and the availability of designated space. Other factors affecting the implementation of care components included patient preferences for, and staff encouragement of, family involvement, time taken to complete written care plans and handover and availability of next care impacting follow-up of patients.

The findings suggest a need for further integration of all clinical professionals on the liaison psychiatry team in implementing care for self-harm; improved systems of handover; further training and awareness on the benefits and optimal processes of family involvement; as well as enhanced access to aftercare.

Gambling-related harm is a global public health concern. Suicide mortality is increased among people who experience gambling harm, and people who die by suicide often have contact with mental health treatment services in the months preceding their death.

To assess via a case–control study how gambling diagnosis predicts suicidal death and mental healthcare utilisation using linked routinely collected healthcare data.

We linked the Welsh Longitudinal General Practice Dataset, Annual District Death Extract, Patient Episode Database for Wales, and Outpatient Appointments Dataset Wales using the Secure Anonymised Information Linkage (SAIL) Databank. A sample of individuals with gambling diagnosis who died by suicide and an age- and sex-matched comparator group of all-cause decedents between 1993 and 2023 were extracted. Predictors of suicidal death, including mental health diagnosis and treatment contacts, were analysed using binary logistic regression models and chi-squared tests.

A matched cohort of 92 individuals diagnosed with a gambling diagnosis (mean age 61.5 years, s.d. 13.1; 71% male) who died by suicide and 2990 comparators were identified. Gambling diagnosis status was a significant predictor of suicide (odds ratio 30.94; 95% CI 3.57–268.28; P = 0.002). Individuals with gambling disorder had significantly more mental health treatment contacts (P < 0.001), particularly in-patient contacts (P < 0.001). No difference in out-patient contacts was found.

Historical diagnosis of gambling harm is a significant predictor of suicidal death and mental health treatment utilisation. Improved screening and coding practices would facilitate greater data linkage research on gambling-related suicide and suicide prevention.

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.