Methylphenidate is sometimes used to address residual symptoms of major depressive disorder (MDD), but concerns about psychiatric destabilization and limited long-term evidence have constrained its use. We examined the psychiatric safety of methylphenidate in adults with MDD in a large, real-world cohort.

Using the TriNetX Global Collaborative Network, we identified adults with MDD who initiated methylphenidate and matched them 1:1 with controls who did not receive methylphenidate. Patients with attention-deficit/hyperactivity disorder, bipolar disorder, mania, or recent psychiatric destabilization were excluded. The primary outcome was a composite of all-cause hospitalization or emergency room visits; secondary outcomes included hospitalization, emergency visits, suicidal behavior, manic episodes, and recurrence of MDD. Hazard ratios (HRs) were estimated with Cox proportional hazards models after propensity score matching.

Of 425,190 eligible patients, 3,211 matched pairs were included (mean age, 55.8 years; 58% female). Over 1 year, the composite outcome occurred less frequently in the methylphenidate group than in controls (574 vs. 694; HR, 0.85; 95% CI, 0.76–0.95). No significant differences were observed for hospitalization, emergency visits, suicidal behavior, manic episodes, or MDD recurrence. Results were consistent across subgroups defined by sex, age, and antidepressant class.

In adults with MDD, methylphenidate use was associated with a lower risk of hospitalization or emergency visits and was not linked to increased risk of suicidality, mania, or recurrence. These findings support the psychiatric safety of methylphenidate as an adjunctive treatment for selected patients, though longer follow-up is needed.

Emotion regulation, while closely linked to depressive symptoms, has seldom been examined together with them in studies of the relationship between chronotype and suicidality. We therefore examined whether chronotype predicts suicidality through the sequential mediation of poor emotion regulation and depressive symptoms. In addition, we examined whether these mediation pathways differ between morning-type and evening-type groups.

This study included 3109 Korean adults from the general population. Chronotype, depressive symptoms, emotion regulation, and suicidality were assessed using the Composite Scale of Morningness, Self-Rating Depression Scale, Emotion Regulation Skills Questionnaire, and the Suicidality module of the Mini International Neuropsychiatric Interview, respectively.

Chronotype did not have a direct effect on suicidality. Instead, eveningness was indirectly linked to higher suicidality. Specifically, individuals with stronger eveningness tendencies reported poorer emotion regulation, which increased depressive symptoms; depressive symptoms, in turn, predicted suicidal ideation, which emerged as a significant predictor of suicide attempts. Subgroup analyses revealed that the same sequential pathway was significant only among evening-types, but not among morning-types.

Chronotype appears to play a role in suicide risk in the general population. Screening for chronotype and focusing on emotion regulation and depressive symptoms may enhance prevention efforts tailored to chronotype, especially for evening-type individuals.

Suicidal ideation, plans and attempts, is a leading public health issues among adolescents worldwide, including in Pakistan. This study examines the effectiveness of a culturally adapted didactic strategy (CADS) in targeting suicidal ideation and associated symptomatology (ClinicalTrials.gov: NCT05324670).

Adolescents (n = 70, male) expressing suicidal ideation who recently engaged in self-harm (previous 6 months), were assigned to 6 sessions (weekly) of CADS or a control intervention (psycho-education material) and assessed pre- and post-intervention utilising the Beck Scale for Suicidal Ideation (BSS), the Depression, Anxiety and Stress Scale-21 (DASS-21) and Barratt Impulsiveness Schedule-II (BIS-II).

Participants in the CADS cohort demonstrated a significant reduction in suicidal ideation compared to controls at treatment end (F = 266.7, p < 0.001, ηp2 = 0.80), and six-weeks post intervention. Individuals receiving CADS demonstrated a modest reduction in attentional (F = 32.5, p < 0.001, ηp2 = 0.33), motoric (F = 45.9, p < 0.001, ηp2 = 0.41) and non-planning impulsivity (F = 21.9, p < 0.001, ηp2 = 0.25), in depressive (F = 142.2, p < 0.001, ηp2 = 0.68), and anxiety symptoms (F = 43.9, p < 0.001, ηp2 = 0.40) and stress levels (F = 96.4, p < 0.001, ηp2 = 0.59). These findings were maintained at six-week follow-up.

CADS was an effective short-term intervention in reducing suicidal ideation, impulsivity, depressive and anxiety symptoms in a high school adolescent male population. Future studies including an active comparator and greater participant diversity would further elucidate the potential efficacy of this intervention.

To audit data on clinical outcomes and suicidal ideation, as part of a service evaluation, in individuals presenting with low mood at an Irish frontline, community-based, rural psychology service, to determine whether the intervention provided was effective in reducing suicidal ideation and low mood.

Clinical outcome data from 428 service users who scored in the clinical range for depression and who completed an intervention with the service were audited to determine if scores on suicidal and self-harm ideation – as measured by PHQ9 Q9 – changed between assessment and discharge.

91% of service users who scored in the clinical range for depression and expressed suicidal or self-harm ideation at assessment reported an improvement post-intervention. At discharge, 85% of these individuals no longer reported any suicidal or self-harm ideation. A majority (68.5%) of those who reported ideation at assessment, and a majority of those who did not report ideation (78%), achieved reliable change (i.e. an improvement of ≥5pts) in their final PHQ-9 scores. Clinical recovery was achieved by discharge in 69% of those without and 47% of those with ideation at assessment. Not reporting suicidal or self-harm ideation at assessment was statistically more likely to result in reliable change at discharge than reporting such ideation.

Results from this clinical service evaluation suggest swift access to psychological intervention, by this rural, frontline primary care psychology service, was associated with reductions in levels of suicidal and self-harm ideation in those suffering from depressive symptoms in the clinical range.

Suicide is a major public health challenge requiring early detection of suicidal ideation (SI). Traditional direct questioning methods suffer from stigma and disclosure bias, failing to identify many at-risk individuals. While machine learning (ML) models show promise, most lack external validation. Indirect screening, using psychosocial data rather than direct SI questions, offers a scalable alternative. This study aimed to externally validate an indirect, ML-based SI screening tool. We tested if a model trained on a Slovenian general population sample retained predictive accuracy when applied to an independent Croatian sample during a period of societal stress (pandemic and earthquakes), assessing performance across age and gender subgroups.

A logistic regression model was trained on a Slovenian sample (N = 2,989) and validated on a Croatian sample (N = 2,364). The model used only indirect predictors, including sociodemographics, life satisfaction, behavioral changes, and Brief COPE subscales. The target outcome was the presence of SI (SIDAS score > 0). Performance was measured by the area under the receiver operating characteristic curve (AUROC).

The model demonstrated strong external validity on the entire Croatian sample, achieving an AUROC of 0.80. Performance remained robust across subgroups: males (AUROC = 0.83), females (AUROC = 0.79), younger adults (AUROC = 0.77), and older adults (AUROC = 0.81). Self-blame, behavioral disengagement, and relationship dissatisfaction were key predictors.

An indirect, ML-based screening tool can reliably identify SI risk in the general population. The model demonstrated strong cross-national transferability and resilience during a societal crisis, proving it is a feasible and valid strategy for population-level prevention.

Suicidal ideation following trauma exposure is frequently associated with depressive and post-traumatic stress disorder (PTSD) symptoms; however, the interactive effects of depression and distinct PTSD symptom clusters on suicidal ideation remain poorly understood.

To examine whether specific PTSD symptom clusters – namely intrusion, avoidance and hyperarousal – moderate the association between depressive symptoms and suicidal ideation, and whether these effects vary across different trauma types.

Medical records of 127 psychiatric out-patients with a history of at least one traumatic event were analysed. All participants had completed the Hamilton Rating Scale for Depression, the Impact of Event Scale-Revised, and the suicidal ideation item of the Beck Depression Inventory II. Trauma types were categorised into early versus late, single versus multiple, and interpersonal versus non-interpersonal.

Hierarchical regression analyses identified a significant moderating effect of avoidance symptoms on the relationship between depression and suicidal ideation (β = 0.19, P = 0.012), whereas intrusion and hyperarousal symptoms did not show such effects. Specifically, higher levels of avoidance were associated with a stronger positive relationship between depression and suicidal ideation. This moderating effect was observed only among individuals with late (β = 0.28, P = 0.002), single (β = 0.29, P = 0.002) or non-interpersonal trauma (β = 0.34, P = 0.018); it was not evident among those with early, multiple or interpersonal trauma.

These findings underscore the relevance of targeting avoidance symptoms to mitigate suicidal ideation, particularly in individuals with late-onset, single-incident or non-interpersonal trauma exposure. Exposure-based therapeutic interventions may offer particular benefit for reducing suicidal ideation among trauma-exposed individuals with depressive symptoms.

Depression in adolescents involves complex interactions among depression, anxiety, sleep disturbances, and suicidal symptoms. Network theory offers insights into dynamic symptom relationships during recovery.

Of 797 adolescents initially enrolled, 649 with complete baseline data were included in the network analyses; 458 and 277 participants were retained at the 1-month and 3-month follow-ups, respectively. Cross-sectional Gaussian Graphical Models and Cross-Lagged Panel Network (CLPN) analyses examined relationships among nine symptom domains: depression, somatic/subjective anxiety, sleep quantity/quality, daytime insomnia, passive/active sleepiness, and suicidal ideation/tendency. Network centrality and bootstrap validation assessed parameter stability.

Cross-sectional networks showed structural invariance across timepoints (p>0.05). Subjective anxiety demonstrated highest centrality at T0-T1, while somatic symptoms dominated at T2. Depression maintained high closeness centrality throughout. Although betweenness centrality also suggested a central role for depression, its lower stability (CS < 0.5) necessitates a more cautious interpretation of this specific metric. CLPN revealed more predictive relationships during T0→T1 (76.5% significant edges) than T1→T2 (24.7%). Active sleepiness strongly predicted subsequent somatic anxiety (B=0.683) and depression (B=0.647). Suicide ideation-tendency showed stable bidirectional connections. Network stability was excellent (CS>0.5) except betweenness centrality.

Central symptoms evolved during recovery, with subjective anxiety initially dominant but somatic symptoms becoming central over time. The early post-treatment period showed heightened symptom network activity, with sleep disturbances identified as robust predictors of subsequent affective deterioration. Findings support dynamic, network-informed interventions targeting evolving symptom centrality and predictive pathways, particularly addressing sleep-related symptoms and suicide risk during critical recovery phases.

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.