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Working conditions in psychiatry have worsened in many healthcare systems, allowing less time for person-centred care. There is a conflict between management and clinical values. Though IT carries great potential, many current systems fail to free up time for human-to-human contact. All these factors affect retention.
The ever-increasing expectation towards psychiatry to prevent suicides has taken to mean complete elimination in some places. This is problematic as suicide is not completely preventable; it is not a form of harm equivalent to other patient safety errors; and there is a plurality of relevant values. The impact on ‘second victims’ is also an important issue.
Owing to its relatively undeveloped conceptual foundations, psychiatry has often struggled to defend itself against various criticisms. A VBP-based analysis of the terminal and instrumental values of anti-psychiatry can highlight some of the weaknesses of its arguments. Critical psychiatry draws attention to problematic areas of psychiatric theory and practice to provide constructive criticism. Remarkably, much of that has now been adopted by mainstream psychiatry. A self-reflective stance and constructive criticism play an important role in keeping our profession on a sound ethical footing. A genuine dialogue about values among all stakeholders is needed for constant calibration.
Suicide prevention is an under-prioritised public health issue in Bangladesh. Recently, it has received academic attention substantiated by an increasing number of publications. Along with that, the Mental Health Act (2018), National Mental Health Policy (2022) and National Mental Health Strategic Plan (2020–2030) have come out. There are many challenges facing suicide prevention efforts in the country, such as suicide’s criminal legal status and associated stigma, lack of a national suicide prevention programme, inadequate clinical services, and most important, the absence of a national database on suicide. This paper analyses documents critically considering initiatives for suicide prevention, highlights the urgent necessity for suicide prevention strategies in the country and identifies prominent stakeholders. A national suicide database in which law enforcement agencies have a prominent stake is urgently needed. In the long term, suicide prevention should be considered in the lens of public health.
Interventions at frequently used suicide locations that restrict access to means, encourage help-seeking, and increase the likelihood of intervention by a third party are effective in preventing suicide at such sites. However, there have been concerns that such efforts may displace suicides to other sites. It is important to synthesize the evidence on suicide displacement effects.
Methods
We conducted a systematic search of Medline, PsycINFO, Scopus, and Google for eligible studies from their inception to February 20, 2025. Meta-analyses were conducted to assess the pooled effects of interventions on suicides at frequently used locations and other sites, and on overall suicides involving the same method.
Results
Our search identified 17 studies. Meta-analyses showed a reduction in suicides at the intervention sites (pooled incidence rate ratio [IRR] 0.09, 95% confidence interval [95% CI] 0.04–0.21) and no evidence of changes in suicides at other sites after restricting access to means was deployed alone. The pooled IRR for nearby sites (same type) was 0.99 (95% CI 0.72–1.38); for other sites (same type), it was 0.99 (95% CI 0.76–1.29); and for other sites (different/unspecified type), it was 1.19 (95% CI 0.90–1.58). There was an overall reduction in suicides involving the same method during the post-intervention period (IRR 0.77, 95% CI 0.65–0.92). Similar patterns were observed when restricting access to means was assessed alone or with other interventions.
Conclusions
Suicide numbers at other sites did not change after interventions such as restricting access to means were deployed at frequently used locations.
Individuals who die by suicide tend to share more characteristics with those who attempt suicide using violent methods than with those who employ nonviolent means. To date, limited research has been published on the demographic characteristics of individuals who engage in violent suicide attempts.
Objectives
This study aimed to examine trends in the characteristics of violent suicidal behavior in comparison to nonviolent suicidal behavior.
Methods
Patients included in the study were consecutively admitted between 2016 and 2021 to the Dr. Manninger Jenő National Trauma Center and the Psychiatric and Toxicology Wards of Péterfy Sándor Hospital in Budapest, Hungary, for medical treatment following violent or nonviolent suicide attempts. Differences in demographic characteristics, risk factors associated with violent suicidal behavior, and methods of attempt were analyzed using Chi-square tests and logistic regression models.
Results
A total of 298 inpatients (46.1% male, 53.9% female), aged between 18 and 65 – representing the economically active population – were included in the study. The sample comprised 145 individuals who attempted suicide using nonviolent methods (73% female, 27% male) and 153 who used violent methods (64.7% male, 35.3% female). Of the total sample, 22 individuals (12.1%) died during treatment due to severe medical complications. Among male attempters, the highest proportion fell within the economically active age range of 18–55 years, whereas among female attempters, the 18–35 age group represented the highest proportion. The most common violent methods, in descending order of frequency, were stabbing (49.7%), jumping from a height (29.8%), and jumping in front of a train (7.7%). The most frequently diagnosed psychiatric disorders among the sample were major depressive disorder (42.2%), anxiety disorders (44.9%), and bipolar disorder (12%). The leading reported motives for violent suicide attempts, in decreasing order of frequency, were marital conflict (32.4%), divorce/separation/break-up (30.2%), and severe or chronic somatic illnesses (12%). When comparing the two subgroups, the strongest risk factors associated with violent suicide methods included male gender, older age, and residence in the capital city.
Conclusions
Previous studies suggest that risk factors are largely indistinguishable between individuals who engage in violent versus nonviolent suicide attempts. However, individuals who attempted suicide using violent methods exhibited characteristics more closely aligned with those who died by suicide than with the remainder of the sample. The majority of data in this study were collected during the COVID-19 pandemic – a period marked by multiple overlapping crises – which may have played a disproportionately large role in the emergence of suicide risk.
Improving media adherence to World Health Organization (WHO) guidelines is crucial for preventing suicidal behaviors in the general population. However, there is currently no valid, rapid, and effective method to evaluate the adherence to these guidelines.
Methods
This comparative effectiveness study (January–August 2024) evaluated the ability of two artificial intelligence (AI) models (Claude Opus 3 and GPT-4O) to assess the adherence of media reports to WHO suicide-reporting guidelines. A total of 120 suicide-related articles (40 in English, 40 in Hebrew, and 40 in French) published within the past 5 years were sourced from prominent newspapers. Six trained human raters (two per language) independently evaluated articles based on a WHO guideline-based questionnaire addressing aspects, such as prominence, sensationalism, and prevention. The same articles were also processed using AI models. Intraclass correlation coefficients (ICCs) and Spearman correlations were calculated to assess agreement between human raters and AI models.
Results
Overall adherence to WHO guidelines was ~50% across all languages. Both AI models demonstrated strong agreement with human raters, with GPT-4O showing the highest agreement (ICC = 0.793 [0.702; 0.855]). The combined evaluations of GPT-4O and Claude Opus 3 yielded the highest reliability (ICC = 0.812 [0.731; 0.869]).
Conclusions
AI models can replicate human judgment in evaluating media adherence to WHO guidelines. However, they have limitations and should be used alongside human oversight. These findings may suggest that AI tools have the potential to enhance and promote responsible reporting practices among journalists and, thus, may support suicide prevention efforts globally.
Suicidal ideation and behaviours are common among adolescents, posing significant challenges. Parents have a protective role in mitigating this risk, yet they often feel ill-equipped to support their adolescents, and their specific support needs are not well understood.
Aims
To explore the lived experiences of parents with suicidal adolescents and identify their support needs in the context of a therapist-assisted online parenting programme.
Method
Semi-structured interviews were conducted with three stakeholder groups based in Australia: nine parents with lived experience caring for a suicidal adolescent, five young people who experienced suicidality during adolescence and five clinical/research experts in youth mental health/suicide prevention. Inductive thematic analysis was used to analyse and interpret findings.
Results
Three key themes highlight the experience of parenting a suicidal adolescent: the traumatising emotional experience, uncertainty and parent empowerment. Six themes described parents’ support needs: validation and support, practical and tailored strategies, rebuilding the parent–adolescent relationship, parental self-care, flexible and accessible modes of delivery, and understanding non-suicidal self-injury.
Conclusions
Findings highlight key themes of parenting a suicidal adolescent and parental support needs. An online parenting programme could offer parents flexible access to evidence-based parenting strategies. Yet, a purely digital approach may not address the complexities of the parent-adolescent dynamic and provide adequate tailoring. As such, a hybrid approach incorporating therapist support can provide parents with both the compassionate support and practical guidance they seek.
The commentary raises important points like patients' actual availability of out- or in-patient services in the wake of pandemics and nationwide lockdowns. The focus is also drawn to missed opportunities to include data from hotlines and online services, a possible increase in death by suicides or changes in the factors that could add up to or protect a person from suicide.
The CDC reports that the United States has the highest suicide rates in over 80 years. Numerous public policies aimed at reducing the rising suicide rates, such as Aetna’s partnership with the American Foundation for Suicide Prevention (AFSP) and the zero-suicide initiative, continue to challenge these attempts. It, therefore, remains imperative to explore the shortcomings of these efforts that hamper their efficiency in reducing suicide rates. Advancements in research over time have sparked scientific skepticism, encouraging re-evaluation of established concepts. The current paper tests prevalent assumptions and arguments to uncover a scientifically informed approach to addressing rising suicide rates in clinical settings.
In this chapter, we discuss how the design and evolution of the Massachusetts Commission on LGBTQ Youth elevated respect for the lived experience of queer youth in setting policies that impact their lives. Originally founded in 1992, the Commission on Gay and Lesbian Youth was formed to respond to high suicide risk among gay and lesbian youth in the Commonwealth. That original Commission transformed in 2006 into an independent state agency established by law. Today, the Commission on Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning (LGBTQ) Youth advises others in state government on effective policies, programs, and resources for LGBTQ youth and produces the Safe Schools Program with the Department of Elementary and Secondary Education. This chapter details the experience of artist and legal designer Alexander (Alex) Nally, who led agency and government relations on the Commission for five years, and focuses on how human-centered design approaches can improve policy interventions.
This article describes an innovative program to provide safe, evidence-based psychiatric care at the Baltimore Convention Center Field Hospital (BCCFH), set up for COVID-19 patients, to alleviate overextended hospitals.
Methods
This article describes the staffing and workflows utilized at the BCCFH including universal suicide risk assessment and co-management of high acuity patients by an NP-led psychiatry service.
Results
The Columbia-Suicide Screening Rating Scale (C-SSRS) proved feasible as a suicide screening tool. Using the SAFE-T protocol, interdisciplinary teams cared for moderate and low risk patients. The NP psychiatry service evaluated over 70 patients, effecting medication changes in more than half and identified and transferred several decompensating patients for higher-level psychiatric care. Group therapy attendees demonstrated high participation. There were no assaults, self-harm incidents, or suicides.
Conclusions
The BCCFH psychiatry/mental health program, a potential model for other field hospitals, promotes evidence-based, integrated care. Emphasizing safety, including suicide risk, is crucial within alternate care sites during disasters. The engagement of dually-certified (psychiatric and medical) nurse practitioners boosts safety and provides expertise with advanced medication management and psychotherapeutic interventions. Similar future sites should be ready to handle chronically ill psychiatric patients, detect high-risk or deteriorating ones, and develop therapeutic programs for patient stabilization and support.
College students disproportionately live with increased risk and burden of mental illness and suicide, yet most students do not access formal campus mental health services. One part of the solution to this problem has been the Bandana Project (BP), a peer-led mental health awareness and suicide prevention program. The program leverages the members’ vested interest in peer support, mental health promotion, and suicide prevention efforts to foster connectedness and offer alternative support to those who may be struggling. Education offered through the program orients members to relevant, evidence-based suicide prevention strategies and to various mental health resources. The program may contribute to reducing the burden of suicide and mental illness on campuses and help make college communities more supportive of students’ mental health. Further development, applications, and limitations of this program on the college campus setting – and beyond – are discussed.
The Suicide Cognitions Scale (SCS) has demonstrated considerable promise as a risk screening tool, although it has yet to be validated for use with adolescents or in Spanish-speaking populations. The aim of this study was to develop a Spanish version of the 16-item SCS-Revised (SCS-R) and to examine its psychometric properties in a sample of adolescents. Participants were 172 adolescents aged between 12 and 18 years (M = 15.32, SD = 1.57) and currently in residential care. They completed the Spanish SCS-R and a series of other psychological measures. The psychometric properties of the SCS-R were examined through factor analyses and testing of convergent/discriminant validity and construct validity. Factor analyses supported a bifactor structure, indicating that SCS-R items were primarily measuring a common underlying latent variable. SCS-R scores were positively correlated with multiple indicators of psychopathology and other suicide risk factors (e.g., depression, hopelessness) but negatively correlated with protective factors (e.g., believing that one’s mental pain will eventually end). Importantly, SCS-R scores differentiated adolescents in residential care who had previously attempted suicide from those who had only thought about suicide. Scores also differentiated adolescents who had previously attempted suicide from those who had previously only engaged in non-suicidal self-injury. This constitutes further evidence that the SCS-R measures a construct that distinguishes suicidal thought from action and is specific to suicidal forms of self-harm. Overall, the results suggest that the Spanish SCS-R is a potentially useful tool for identifying adolescents at risk of attempting suicide in residential care.
Rising rates of suicide fatality, attempts, and ideations among adolescents aged 10–19 over the past two decades represent a national public health priority. Theories that seek to understand suicidal ideation overwhelmingly focus on the transition from ideation to attempt and on a sole cognition: active suicidal ideation – the serious consideration of killing one’s self, with less attention to non-suicidal cognitions that emerge during adolescence that may have implications for suicidal behavior. A large body of research exists that characterizes adolescence not only as a period of heightened onset and prevalence of active suicidal ideation and the desire to no longer be alive (i.e., passive suicidal ideation), but also for non-suicidal cognitions about life and death. Our review synthesizes extant literature in the content, timing and mental imagery of thoughts adolescents have about their (1) life; and (2) mortality that may co-occur with active and passive suicidal ideation that have received limited attention in adolescent suicidology. Our “cognition-to-action framework for adolescent suicide prevention” builds on existing ideation-to-action theories to identify life and non-suicidal mortality cognitions during adolescence that represent potential leverage points for the prevention of attempted suicide and premature death during this period and across the life span.
Although the Department of Veterans Affairs (VA) has made important suicide prevention advances, efforts primarily target high-risk patients with documented suicide risk, such as suicidal ideation, prior suicide attempts, and recent psychiatric hospitalization. Approximately 90% of VA patients that go on to die by suicide do not meet these high-risk criteria and therefore do not receive targeted suicide prevention services. In this study, we used national VA data to focus on patients that were not classified as high-risk, but died by suicide.
Methods
Our sample included all VA patients who died by suicide in 2017 or 2018. We determined whether patients were classified as high-risk using the VA's machine learning risk prediction algorithm. After excluding these patients, we used principal component analysis to identify moderate-risk and low-risk patients and investigated demographics, service-usage, diagnoses, and social determinants of health differences across high-, moderate-, and low-risk subgroups.
Results
High-risk (n = 452) patients tended to be younger, White, unmarried, homeless, and have more mental health diagnoses compared to moderate- (n = 2149) and low-risk (n = 2209) patients. Moderate- and low-risk patients tended to be older, married, Black, and Native American or Pacific Islander, and have more physical health diagnoses compared to high-risk patients. Low-risk patients had more missing data than higher-risk patients.
Conclusions
Study expands epidemiological understanding about non-high-risk suicide decedents, historically understudied and underserved populations. Findings raise concerns about reliance on machine learning risk prediction models that may be biased by relative underrepresentation of racial/ethnic minorities within health system.
Suicide is a leading cause of death in the United States, particularly among adolescents. In recent years, suicidal ideation, attempts, and fatalities have increased. Systems maps can effectively represent complex issues such as suicide, thus providing decision-support tools for policymakers to identify and evaluate interventions. While network science has served to examine systems maps in fields such as obesity, there is limited research at the intersection of suicidology and network science. In this paper, we apply network science to a large causal map of adverse childhood experiences (ACEs) and suicide to address this gap. The National Center for Injury Prevention and Control (NCIPC) within the Centers for Disease Control and Prevention recently created a causal map that encapsulates ACEs and adolescent suicide in 361 concept nodes and 946 directed relationships. In this study, we examine this map and three similar models through three related questions: (Q1) how do existing network-based models of suicide differ in terms of node- and network-level characteristics? (Q2) Using the NCIPC model as a unifying framework, how do current suicide intervention strategies align with prevailing theories of suicide? (Q3) How can the use of network science on the NCIPC model guide suicide interventions?
While past research suggested that living arrangements are associated with suicide death, no study has examined the impact of sustained living arrangements and the change in living arrangements. Also, previous survival analysis studies only reported a single hazard ratio (HR), whereas the actual HR may change over time. We aimed to address these limitations using causal inference approaches.
Methods
Multi-point data from a general Japanese population sample were used. Participants reported their living arrangements twice within a 5-year time interval. After that, suicide death, non-suicide death and all-cause mortality were evaluated over 14 years. We used inverse probability weighted pooled logistic regression and cumulative incidence curve, evaluating the association of time-varying living arrangements with suicide death. We also studied non-suicide death and all-cause mortality to contextualize the association. Missing data for covariates were handled using random forest imputation.
Results
A total of 86,749 participants were analysed, with a mean age (standard deviation) of 51.7 (7.90) at baseline. Of these, 306 died by suicide during the 14-year follow-up. Persistently living alone was associated with an increased risk of suicide death (risk difference [RD]: 1.1%, 95% confidence interval [CI]: 0.3–2.5%; risk ratio [RR]: 4.00, 95% CI: 1.83–7.41), non-suicide death (RD: 7.8%, 95% CI: 5.2–10.5%; RR: 1.56, 95% CI: 1.38–1.74) and all-cause mortality (RD: 8.7%, 95% CI: 6.2–11.3%; RR: 1.60, 95% CI: 1.42–1.79) at the end of the follow-up. The cumulative incidence curve showed that these associations were consistent throughout the follow-up. Across all types of mortality, the increased risk was smaller for those who started to live with someone and those who transitioned to living alone. The results remained robust in sensitivity analyses.
Conclusions
Individuals who persistently live alone have an increased risk of suicide death as well as non-suicide death and all-cause mortality, whereas this impact is weaker for those who change their living arrangements.
Edited by
David Kingdon, University of Southampton,Paul Rowlands, Derbyshire Healthcare NHS foundation Trust,George Stein, Emeritus of the Princess Royal University Hospital
The psychiatry of primary care, and the work that GPs do, has expanded as a field of interest for psychiatrists beyond its early roots in epidemiological research and studies into the detection of mental disorders by general practitioners. An understanding of the key role of the primary care team in managing often-complex mental health problems in the wider community as well as how to work effectively at the interface in partnership and joint work with GPs is essential not only for general adult psychiatrists but other specialists too – as policy makers, both local to the UK and internationally, continue to recognise its importance. The Pathways to Care model provides a useful framework for understanding how the prevalence of mental illness in the community (particularly for common mental disorders such as anxiety and depression) is distributed and how this changes according to the way that health care systems are organised. Ways of working include collaborative care, social prescribing, brief psychological therapy – including CBT-guided self-help – and antidepressants (although controversies surround their usage), with suicide prevention, shared care with CMHTs and training and education of both groups being prominent issues.
Edited by
David Kingdon, University of Southampton,Paul Rowlands, Derbyshire Healthcare NHS foundation Trust,George Stein, Emeritus of the Princess Royal University Hospital
The suicides of important kings are recorded in the Bible, and the chapter starts with an overview of the history of suicide. It then covers suicide verdicts, international suicide rates and methods, then the epidemiology of suicide is reviewed. This includes the effect of marital status, the elderly and the young, mental illness, the emotions of hopelessness and shame, as well as suicide in major mental disorders such as depression, schizophrenia, bipolar disorder and alcoholism. Economic influences such as poverty, occupation and unemployment, as well as worldwide financial crashes are covered. Can anything reduce the rates? Does religion help prevent suicide? Does suicide prevention and risk assessment help, or is this still just ’a work in progress’? Self harm has reached almost epidemic numbers in most parts of the world. The aetiology and why this should be is covered as well as what the later risk of completed suicides is.
Suicide is a leading causes of student death, especially in young men, and appears to be increasing in prevalence. The most effective preventative measures so far involve limiting access to the means of self-destruction. Institutions can monitor the built environment for ‘suicide hotspots’ such as towers, bridges and car parks, and reduce access to chemicals and drugs on campus. Social media and other online activity appear to increase the likelihood of suicide. Alcohol and recreational drugs are strong risk factors. Individuals with autism are at high risk, as are those with a diagnosis of bipolar disorder. Students who have to take time out of academic studies – or to leave – are especially vulnerable. Warning signs include social withdrawal, academic failure and low mood. Asking about suicidal thoughts appears not to increase the likelihood of suicide, but may be protective. Support pathways for distressed students and staff should be regularly reviewed. Websites should be kept updated with helpful links, including simple instructions for crisis management. Information-sharing agreements should be reviewed to consider permissions to contact next of kin. All institutions need a suicide ‘postvention’ plan and team in readiness to compassionately manage the rare but devastating occurrence of suicide.