Abstract
Study Objectives
Insomnia is associated with elevated levels of suicidal thoughts and behaviors. Emerging evidence suggests that cognitive-behavioral therapy for insomnia (CBTI) may reduce ...suicidal ideation (SI). However, the role of digital therapeutics in both the alleviation and prevention of SI remains unclear, and treatment mechanisms facilitating SI reductions have not been clearly identified.
Methods
A total of 658 adults with Diagnostic and Statistical Manual of Mental Disorders, 5th Edition insomnia disorder enrolled in a single-site randomized controlled trial evaluating the efficacy of digital CBTI relative to attention control. Outcomes were measured at pretreatment, posttreatment, and 1-year follow-up.
Results
Before treatment, 126 patients endorsed SI (19.1% prevalence). Among those with baseline SI, CBTI patients reported lower SI rates at posttreatment (30.0% vs 54.5%, p = .005) and 1-year follow-up (29.6% vs 46.8%, p = .042) relative to control. PRODCLIN analysis estimated that half of suicidolytic effects of CBTI were mediated through insomnia remission. Among those without baseline SI, CBTI did not directly prevent new onset SI. However, insomnia remitters reported lower rates of new-onset SI at posttreatment relative to non-remitters (1.5% vs 6.5%, p = .009). Mediation analysis supported a significant indirect effect wherein CBTI increased the likelihood of insomnia remission, which was associated with SI prevention (αβ = −3.20, 95% CI = −5.74 to −0.87).
Conclusion
Digital CBTI reduces insomnia symptoms, which promotes SI alleviation and prevention. For nonsuicidal patients, digital CBTI may serve as a highly accessible monotherapy for improving sleep, thereby reducing the risk for SI. For suicidal patients, digital CBTI may be appropriately administered as an adjunct treatment to support mainline intervention more directly targeting suicidogenic thoughts.
Graphical Abstract
Graphical Abstract
Major affective disorder are common and disabling conditions linked to significant psychosocial impairment as well as negative outcome (e.g., suicidal behaviors) . According to a molecular ...perspective, major depressive disorder and suicidal behavior have been associated with structural and synaptic plasticity disturbances. Small non-coding RNAs, such as microRNAs (miRNAs), may play a significant role in the translational regulation of the synapse. This comprehensive overview is aimed to carefully review the preclinical and clinical literature results regarding the involvement of miRNAs in the pathophysiology and pharmacotherapy of major psychiatric conditions . MiRNAs may act as gene expression regulators critically affecting brain development. The alteration of some intracellular mechanisms together with impaired assembly, localization, and translational regulation of specific RNA binding proteins may affect important functions such as learning and memory contributing to the pathophysiology of major depressive disorder and suicidal behavior. Based on the main findings, most of the miRNAs which have been identified to date are expressed in human brain, where they regulate prominent neurobiological processes, such as neurogenesis and neuroplasticity. The main implications of the present findings are critically discussed.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
To examine whether lethal means counseling and provision of cable locks prompt safe firearm storage relative to control among firearm-owning members of the Mississippi National Guard.
This randomized ...controlled trial utilized a 2 × 2 factorial design (lethal means counseling vs control, provision of cable locks vs no cable locks). Follow-up assessments took place at 3 and 6 months after baseline. Data were collected (n = 232; 87.5% male; mean age = 35.01 years; 77.2% White) from February 2018 through July 2020.
Relative to control, lethal means counseling and provision of cable locks resulted in greater adoption of several safe storage methods over time. Lethal means counseling outperformed control (3 months: 55.0% vs 39.0%; odds ratio OR = 1.91). Cable locks outperformed control at 3 and 6 months on number of storage methods (1.41 vs 1.11; d = 0.29 and 1.34 vs 1.16; d = 0.15, respectively) and locking devices (59.8% vs 29.9%; OR = 3.49 and 58.4% vs 35.8%; OR = 2.52, respectively)
Lethal means counseling and cable locks can result in sustained changes in firearm storage.
The military may benefit from lethal means counseling, perhaps administering at point of entry.
Clinical Trials.gov identifier: NCT03375099.
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CEKLJ, DOBA, FSPLJ, IZUM, KILJ, NUK, ODKLJ, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
•Relations are proposed between theory of mind and suicide ideation and attempt.•Scarce research examines theory of mind and suicide-related experiences in teens.•Excessive theory of mind ...significantly relates to teen suicide ideation and attempt.•No and less theory of mind do not significantly relate to teen ideation and attempt.
Suicide ideation and attempt are alarmingly prevalent in adolescents, and even more so for youth in psychiatric settings. Interpersonal factors have been emphasized as important in the etiology and maintenance of suicide ideation and attempt in adolescents. Evaluating social cognitive deficits offers important insight into processes underlying interpersonal problems associated with suicide ideation and attempt; however little social-cognitive research has been conducted in this area. The aim of the current study was to explore the relation of theory of mind (ToM) impairments and suicide ideation and attempt among adolescent inpatients.
A sample of 391 adolescent inpatients completed measures on ToM, suicidal ideation and attempt, clinical symptoms and sociodemographics.
Binary logistic regression analyses revealed significant relations between excessive ToM (hypermentalizing) and two suicide outcome variables (suicide ideation in the past four weeks, suicide attempt in the past year), while covarying for sociodemographics and multiple clinical symptom scales.
Excessive ToM, or over-attributing the mental/emotional states of others, appears to share a salient relation to recent suicidal thoughts and behavior in adolescent inpatients. Current findings may indicate that interventions incorporating social cognitive components (e.g., Mentalization Based Therapy and Cognitive Behavioral Therapy) may be of promise to treating youth with suicidal thoughts and behaviors and excessive ToM.
The current study uses cross-sectional data and discrepancies exist in time periods assessed by primary measures.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Objective
Non‐suicidal self‐injury (NSSI) comprising thoughts and behaviors is common and often co‐occurring with suicidal behavior like ideation, plan, and attempt. As limited data are available for ...adolescents and young adults, this study aims to present prevalence estimates for lifetime NSSI, its co‐occurrence with suicidal behavior, conditional probabilities and their association with socio‐demographic characteristics, severity characteristics of suicidal behavior, and health service utilization.
Method
The epidemiological Behavior and Mind Health (BeMIND) study assessed in 2015/16 a random‐community sample of N = 1180 aged 14–21 years from Dresden, Germany, regarding lifetime NSSI via self‐administered questionnaire and suicidal behaviors via standardized interview.
Results
Any lifetime NSSI was reported by 19.3% (thoughts: 18.0%, behaviors: 13.6%) of the sample with higher prevalence in females (OR = 2.7, 95% CI 1.9–3.8, P < 0.001). Lifetime prevalence of co‐occurring NSSI and suicidal behavior was 7.7%. Females had a 3.3‐ to 8.8‐fold odds of co‐occurrence than males. Among those with any NSSI, 39.6% endorsed suicidal behavior, and 66.3% of those with any suicidal behavior reported NSSI. 42.3% of those with any NSSI reported to have used mental healthcare services at any time during their life with higher rates in those with co‐occurring suicidal behavior (62.3%).
Conclusion
Non‐suicidal self‐injury and co‐occurring suicidal behavior is common in adolescents and young adults—especially females. The limited utilization of mental healthcare services underpins the need for improving recognition of NSSI and suicidal behavior as well as the accessibility of mental healthcare services during adolescence and emerging adulthood.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Background: The lack of knowledge about Nonsuicidal Self-Injury (NSSI) in Spanish adolescents, especially NSSI thoughts may be due to the paucity of NSSI assessment instruments with validity evidence ...in this sample. The aim of this study was to assess NSSI thoughts and behavior. In addition, the study examined the association between various NSSI features and suicidal behavior and included a preliminary validation of the new Self-Injurious Thoughts and Behaviors Interview - Non-Suicidal Self-Injury (SITBI-NSSI). Method: 685 Spanish adolescents between 13 and 18 years old (M = 15.58, SD = 1.08; 60.9% girls) completed measures of NSSI features and suicidal behavior. Results: Among adolescents, 19% thought about self-injury, and 16.8% presented NSSI behaviors. The girls had higher levels of NSSI, as well as greater frequency, number of functions, methods, and suicidal thoughts and desire. Some of the functions, methods, and precipitants differed by sex. Those with ANS had a higher risk of suicidal behavior than the comparison group. The association of SITBI-NSSI with other measures supports the validity of the data. Conclusions: Most features of NSSI are similar to those found in Spanish and internationally. The SITBI-NSSI could facilitate the evaluation of NSSI in Spanish adolescents. Keywords: Nonsuicidal Self-Injury SITBI-NSSI Thought Validation Adolescents Pensamientos y Conductas de Autolesión no Suicida en Adolescentes: Validación de la SITBI-NSSI Antecedentes: La falta de conocimiento sobre la autolesión no suicida (ANS) en adolescentes comunitarios españoles, especialmente los pensamientos ANS, puede deberse a la escasez de instrumentos de evaluación ANS con evidencias de validez. El objetivo del estudio fue evaluar los pensamientos y el comportamiento de ANS. Además, se examinó la asociación entre varias características de ANS y conducta suicida, y se llevó a cabo la validación preliminar de la nueva Entrevista de pensamientos y comportamientos autolesivos - Autolesión no suicida (SITBI-ANS). Método: 685 adolescentes españoles entre 13 y 18 años (M = 15.58, DT = 1.08; 60.9% chicas) completaron medidas de características ANS y conducta suicida. Resultados: El 16.8% presentó conductas ANS y el 19% lo pensó. Las chicas tuvieron mayor presencia de ANS, frecuencia, número de funciones, métodos, pensamientos y deseo suicida. Algunas de las funciones, métodos y precipitantes diferieron según el sexo. Aquellos con ANS tuvieron más riesgo de conducta suicida respecto al grupo de comparación. La asociación de SITBI-ANS con otras medidas apoya la validez de los datos obtenidos. Conclusiones: La mayoría de las características de ANS son similares a las encontradas en español e internacionalmente. SITBI-ANS facilitaría la evaluación de ANS en adolescentes españoles. Palabras clave: Autolesión no Suicida SITBI-NSSI Pensamiento Validación Adolescentes
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Gender identity represents a topic of growing interest in mental health research. People with non-conforming gender identity are prone to suffer from stigmatization and bullying and often present ...psychiatric issues, which may in turn lead to a high prevalence of suicidal ideation and behaviors. The present meta-analysis aimed to estimate the prevalence of suicidal ideation and suicidal behaviors in gender non-conforming children, adolescents and young adults. A systematic search was performed in Web of Science and PsycINFO from inception to December 2018. We selected cross-sectional and cohort studies including youths (up to 25 years) with a diagnosis confirmed by a clinician according to international classifications, or after a direct interview with a peer. A random-effects meta-analysis was computed for the following outcomes: non-suicidal self-injury (NSSI), suicidal ideation and suicide attempts. Overall, we found a mean prevalence of NSSI of 28.2% (9 studies, 3057 participants, 95% CI 14.8–47.1). A similar prevalence (28%) was found for suicidal ideation (6 studies, 2249 participants, 95% CI 15–46.3), while the prevalence of suicide attempts was 14.8% (5 studies, 1039 participants, 95% CI 7.8–26.3). Subgroup analyses revealed no significant differences according to biological sex. Given the prevalence of suicidal behaviors in gender non-conforming youths, it appears desirable to implement therapeutic and support strategies for this population. Moreover, educational interventions directed to parents, teachers, mental health professionals and general community should be promoted to struggle against stigma and social isolation, factors that may contribute to increasing the risk of suicidal behaviors.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, ODKLJ, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, SIK, UILJ, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
This Systematic Review is thought to deepen the relation between sociodemographic variables most associated with suicidal behaviour and suicide methods in Europe and America. A research was made from ...articles and reviews published between 2005-2015 in PsycINFO, Medline, Web of Science Core Collection, Scopus, and SciELO. Thanks to it, we retrieved 5,222 records which were analysed against the inclusion (e.g., any design of the study, published in English or Spanish) and quality criteria, including 53 studies in the review. In these results it is noticeable how men (36% of the studies) and elderly (28% of the studies) commit suicide more frequently. Women (30% of the studies) and young people (17% of the studies) have more attempts and suicidal behaviour. The most commonly used methods among them include hanging (24% of the studies), firearm (17% of the studies), and precipitation (6% of the studies); unemployment (17% of the studies), rural life (9% of the studies), a marital status other than marriage (15% of the studies), and low education (23% of the studies) are also closely associated with both suicide and suicidal behaviour. Consequently, important connections can be concluded when carrying out psychological autopsies, which should be taken into account due to their clear implications in personal and material damage that must be elucidated judicially, clarifying the specific occurrence as suicide, homicide, or accident.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Grief, guilt, abandonment, anger, shame, and rejection are the most common feelings experienced by suicide survivors, who differ from other bereaved individuals for the intensity of these feelings. ...Moreover, suicide risk and psychiatric disorders associated with suicidality are more frequent in people who have lost a loved person by suicide. Given the complexity and the consequences linked to the suicide of a loved person, it is necessary to act promptly. Among the various strategies, psychoeducation has proved effective for several mental disorders and for suicide bereavement. It is a therapeutic intervention aimed at identifying and understanding the psychological features associated with the mental pain of suicide survivors, to facilitate the management of the illness and the recognition of relationships in the social environment. We developed a psychoeducational group that took place at the Suicide Prevention Center of the Sant'Andrea Hospital in Rome. It was a homogeneous, finite-group composed of 8-12 suicide survivors and conducted by two trained psychologists supervised weekly by the Director of the Suicide Prevention Center. The intervention comprised 21 weekly sessions of 90 min. Each session concerned a determined topic and began with the presentation of the issue, continued with specific exercises, and finished with a group discussion. The main goals of the group were to provide support, normalize the reactions of the survivors, and assist them in reducing their emotional suffering and their thoughts about suicide, investigate the potential presence of suicide risk, implement prevention strategies, and integrate the loss of the loved person. The psychoeducational approach we delivered for suicide survivors allows individuals to interact with other individuals in the same situation in order to help them resume the normal course of life, placing the suicide of a loved person in a broader perspective.
Patients with a substance use disorder were more likely (adjusted odds ratio, 8.7) to have been diagnosed with COVID-19. About 60.1% of people aged 12 years or older in 2019 reported having used a ...substance during the past month. The rate of emergency department visits related to suicidal ideation or suicide attempt increased among all age groups 5 years or older from 2008 to 2017.
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