Examining Resilience in Those With and Without Suicidal Ideation.

Objective: This study examined psychological resilience (PR) as a potential moderator and mediator of the association between borderline personality symptoms (BPS) and suicidal ideation (SI) among university students. Method: A cross-sectional design was used with (N = 257) university students. Moderation and mediation were tested in separate, theory-guided models using the PROCESS macro for SPSS, version 28. The moderation model (Model 1) and the mediation model (Model 4) were estimated with heteroskedasticity-consistent standard errors (HC3). In the adjusted analyses, sex, age, previous psychological consultation, previous psychotropic medication use, and family history of mental illness were entered as covariates. The indirect effect was evaluated using percentile bootstrap confidence intervals based on (5000) resamples. Results: BPS was positively correlated with SI, whereas PR was negatively correlated with both BPS and SI. In the adjusted moderation model, BPS was positively associated with SI (b = 0.118, p < 0.001) and PR was negatively associated with SI (b = -0.204, p = 0.048), but the interaction term was not significant (b = -0.001, p = 0.820) with negligible explained variance (ΔR2 = 0.0003). In the adjusted mediation model, BPS was significantly associated with lower PR (a: b = -0.135, p < 0.001), and PR was associated with lower SI while controlling for BPS and the covariates (b: b = -0.216, p = 0.028). The total effect of BPS on SI was significant (c: b = 0.146, p < 0.001), and the direct effect remained significant after including PR (c': b = 0.117, p < 0.001). The indirect effect was significant (ab = 0.029; 95% bootstrap CI [0.005, 0.061]). Conclusions: Psychological resilience did not moderate the association between BPS and suicidal ideation, but it showed a statistically significant indirect association consistent with the proposed mediation model. Higher BPS were associated with lower resilience, which in turn was associated with higher suicidal ideation. These findings suggest that resilience-related targets may complement interventions addressing core BPS-related risk processes, while the cross-sectional design precludes causal conclusions.

Psychological resilience and suicidality in the general population: A cross-sectional study based on data from the National Mental Health Survey of Korea 2021

Suicide deaths in people with non-affective psychosis represent a major health care concern. Previous research has shown that psychosis and the associated distress increase suicidal experiences, whereas psychological resilience weakens the impact of suicide precursors, such as defeat, entrapment, and hopelessness on suicidal experiences. The moderating roles of psychosis, distress, and psychological resilience in the relationships between defeat, entrapment, hopelessness, and suicidal thoughts and behaviors have not been tested longitudinally. This 3-month longitudinal study used moderated mediation analysis to investigate: (1) the impact of defeat/entrapment and hopelessness on suicidal thoughts and behaviors and (2) the moderating effects of psychosis, distress, and psychological resilience in the relationships between defeat/entrapment, hopelessness, and suicidal thoughts and behaviors. Individuals with non-affective psychosis-related diagnosis (including schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, or psychotic disorders not otherwise specified) and lifetime experiences of suicidal thoughts, plans, and/or acts were recruited from the North-West of England, UK. Of the 100 participants at baseline, 90 took part in the follow-up assessment. At baseline, most of the participants had experienced one or more lifetime suicide attempts. Suicidal thoughts and behaviors scores were significantly lower at follow-up, compared with baseline. Over time, defeat/entrapment predicted suicidal thoughts and behaviors when the severity of psychosis and the associated distress were moderate and high, and resilience was lowest. The impact of defeat/entrapment, psychosis, distress due to psychosis, and resilience needs to be incorporated into interventions aiming to reduce suicidal experiences. These findings impact psychosis and resilience-focused suicide prevention interventions for people with non-affective psychosis.

Depression and suicidal tendencies are notably prevalent among adolescents, yet few studies have revealed the impact of social status on them. This study aimed to explore the mediating and moderating effects of anxiety and psychological resilience on family status, school status, depression, and suicidal ideation. A total of 1,190 secondary school students aged 13 to 17 years (mean age: 13.57 ± 2.02 years) were evaluated depression, anxiety, and suicidal ideation using the PHQ-8 and GAD-7 questionnaires. Subjective family and school status were also assessed. Data analysis was conducted using Mplus, SPSS's Process, and the RSA 3.0 plugin. Subjective family/school status, anxiety, psychological resilience, depression, and suicidal ideation were significantly correlated. Anxiety played a partial mediating role in the influence of subjective family status and subjective school on depression and suicidal ideation, and psychological resilience moderated the impact of anxiety on adolescent depression and suicidal ideation (βdepression = -0.05, p < 0.01; βsuicidal ideation = -0.06, p < 0.05). Subjective family status and school status played important roles in depression and suicidal ideation in adolescents, and anxiety and psychological resilience played mediating and moderating roles.

ABSTRACTBackground and AimsPsychological disorders like anxiety and depression are prevalent among dental professionals, being responsible for negatively affecting their mental health. Such factors are detrimental and may lead to suicidal thoughts and ideation. This study aimed to evaluate the impact of anxiety and depression on suicidal thoughts and ideation among dental professionals in Pakistan.MethodsThis descriptive, cross‐sectional study formulated a self‐reporting online questionnaire of dental professionals of Karachi, Pakistan between September and December 2023. The online questionnaire consisted of demographics and validated tools to measure anxiety using GAD‐7, depression using PHQ‐9, and Suicide thoughts and ideation using SIDAS.ResultsA total of 636 dental professionals were recruited in the study. Overall, 76.1% of the participants reported moderate to severe anxiety, 64.1% experienced moderate to severe depression, and 11.9% of participants reported high levels of suicidal thoughts and ideation. Anxiety and depression had a statistically significant association with suicide among dental professionals (p‐value < 0.001).ConclusionThis study highlights the positive association of anxiety and depression with suicidal ideation and thoughts among dental professionals. Hence, it is important to monitor the mental health of dental professionals and provide essential health and support to overcome such psychological distress.

Emotional distress can lead to suicidal ideation and potentially suicide completion, yet there is very little literature on suicidal ideation in individuals with a diagnosis of neurofibromatosis (NF; NF1, NF2, and schwannomatosis). To examine the baseline occurrence, severity, and clinical correlates of suicidal ideation in adults with NF. Individuals with NF (N = 220) completed assessments measuring depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), perceived stress (Perceived Stress Scale-10), pain (Graded Chronic Pain Scale and PROMIS Pain Interference Short Form 8a), and general quality of life (World Health Organization Quality of Life-Brief version) before beginning a two-arm, single-blind randomized control trial of a live-video mind-body program for stress management and resiliency. Nineteen percent (n = 42) of the individuals experienced suicidal ideation (ie, >0; ideation present several days or greater). More individuals with NF2 experienced suicidal ideation compared with those with NF1 or schwannomatosis. All of the clinical variables except pain intensity were significantly correlated ( P < 0.01) with greater suicidal ideation. Suicidal ideation in individuals with NF was comparable to or higher than that in other medical populations (eg, cancer, dermatological, neurologic). Depression and poor psychological quality of life significantly increased the risk for suicidal ideation. Suicidal ideation was relatively prevalent in individuals with NF seeking participation in a mind-body randomized controlled trial. NF clinicians should be prepared to discuss these concerns and provide resources when suicidal ideation is present. ClinicalTrials.gov (Identifier NCT03406208).

BackgroundDecedents without known mental disorders constitute 5%-40% of suicides and epidemiologic studies show that 20% of those with a history of suicidal behavior (SB) may be free of psychiatric disorders. This implies that suicide ideation (SI) may occur in the psychiatrically healthy volunteers (HVs), providing an opportunity for preventing suicide and SB. Yet, studies of HVs have not focused on the occurrence of SI, nor has SI in HVs been characterized, especially in relation to the occurrence of stress. If SI is not rare in HVs, current approaches to managing suicide risk in medical settings may be too limited to identify psychiatrically healthy individuals at risk for suicide.Aims & ObjectivesWe recruited HVs and major depressive disorder (MDD) patients to test two hypotheses: (1) some HVs, screened to exclude those meeting lifetime criteria for Axis I or II disorders and with no personal or family history of SB, would endorse SI on Ecological Momentary Assessment (EMA); and (2) HVs’ SI scores would be lower than those of MDD patients. In addition, we investigated whether HV and MDD groups had different responses to stressors in terms of SI.MethodHVs and MDD patients were recruited through advertisements: some patients were recruited in the emergency department. Participants provided 7 days of ecological momentary assessment (EMA) data about SI and stressors. EMA data was collected in six 2-hour epochs during a 12-hour period selected to match participant wake hours. Longitudinal mixed effects logistic regression models compared HV and patient SI scores and frequency of stressors. Mixed effects linear regression models compared HVs’ and patients’ SI score change from the previous epoch’s SI score when each stressor occurred.ResultsHVs (n=42) reported less frequent (p<0.001) and less intense SI (p<0.003) than patients (n=80). HVs did endorse SI and/or SI-related items in 44% of EMA epochs, endorsing actual SI items, as opposed to SI related items (lack of wish to live) in 25% of epochs with non-zero SI scores. For 7 of 8 stressors, patients reported stressors more often than HVs (all p<0.001) and responded to them with greater SI (0.0001<p<0.0472). HVs reported statistically significant SI increases only in response to neglect (p<0.0147), indicating HVs were relatively resilient to other stressors.Discussion & ConclusionThe occurrence of SI and SB among psychiatrically healthy individuals has been relatively neglected. However, SI does occur in this population. Although HVs demonstrated more modest SI increases than patients in response to stressors, the reports of SI in 44% of epochs by HVs suggest that focusing solely on individuals with mental disorders when screening for suicide risk may be too narrow an approach.Disclosure of InterestM. Oquendo, MD, PhD earned royalties from: Research Foundation for Mental Hygiene, Inc. - Columbia Suicide Scale, Conflict with: Honoraria - Alkermes - Grant Reviews, Honorarium.

BackgroundSports specialty students in China face unique “dual stress” from academic demands and athletic training, intensified by cultural values and societal expectations. This stress contributes to elevated suicidal ideation, with limited understanding of how online social support (OSS) and psychological resilience mediate these relationships, particularly across genders.ObjectiveTo investigate the tripartite relationship among academic-training dual stress, OSS, and suicidal ideation, with psychological resilience as a mediator, and to analyze gender-specific differences.MethodsA sample of 1,460 sports specialty students (60% male, 40% female) completed surveys assessing stress, resilience, OSS, and suicidal ideation. Structural equation modeling (SEM) and gender-stratified regression analyses tested mediation and moderation effects.ResultsDual stress positively predicted suicidal ideation, partially mediated by reduced psychological resilience (β = −0.220*** for males, β = −0.180*** for females). OSS buffered this relationship, with stronger moderating effects for females via emotional support (β = −0.330***) and males via instrumental support (β = −0.370***). Gender differences emerged in stress exposure, resilience levels, and OSS preferences.ConclusionPsychological resilience and OSS play critical roles in mitigating the impact of dual stress on suicidal ideation, with gender-specific patterns. Tailored digital interventions leveraging OSS could enhance resilience and reduce suicide risk in this vulnerable group.

To explore inherent associations between psychological distress and resilience, and its effect on quality of life among medical and non-medical students. The cross-sectional study was conducted from December 2018 to January 2020 after approval from the Department of Psychology Ethics Committee of the International Islamic University, Islamabad, and comprised medical and non-medical students of either gender enrolled with different institutions of higher learning in Rawalpindi and Islamabad. Data were obtained using Brief Resilience Scale, Kessler Psychological Distress Scale and Quality of Life Scale. Data was analysed using SPSS. Of the 300 subjects, 150(50%) each were medical and non medical students. Within both groups, 75(50%) each were males and females. Psychological resilience was a positive predictor of quality of life ( =0.30) whereas psychological distress served as a negative predictor of quality of life ( =-0.54). Medical students were significantly higher on psychological distress (p=0.001), whereas non-medical students were higher on quality of life (p=0.001) and resilience (p=0.001). Female students were higher on quality of life and male students were higher on psychological distress (p=0.002). Resilience needs to be promoted among students, particularly medical students, as it may help in reduction and adequate management of academic distress levels.

COVID-19 Special Collection

Time perception and suicidal ideation during COVID-19 pandemic: A longitudinal study

Reliable estimates of the prevalence and risk of suicide and suicidal ideation (SI) among childhood cancer survivors (CCSs) are crucial in informing efforts to address this issue. To systematically evaluate the prevalence and risk of suicide and SI among CCSs. A literature search was conducted of PubMed, Embase, Cochrane Library, and PsycINFO from January 1, 2000, to November 17, 2024. All noncontrolled and controlled studies that evaluated the prevalence and risk of suicide and SI and drew comparisons between CCSs and their counterparts. Studies including participants older than 25 years, no reported outcomes, case studies, case reviews, and review articles were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was followed with prospective PROSPERO registration. Prevalence was pooled for single-arm studies. Relative risk ratio (RR) was pooled for double-arm studies. Metaprop was used to meta-analyze the prevalence of suicide and SI under a generalized linear mixed model. For dichotomous outcomes, meta-analyses were performed to compute the RR of the psychological outcome compared with controls. Prevalence of suicide and SI, the RR of suicide and SI among CCSs compared with controls, and risk factors associated with suicidality outcomes. From 531 records, 16 studies were included. Studies on suicide included 148 869 participants and studies on SI included 20 140 participants. The prevalence of suicide among CCSs was 0.30% (0.13%-0.69%) and of SI was 9% (95% CI, 7%-11%). There was a significantly increased risk of SI among CCSs compared with controls (RR, 1.67 [95% Cl, 1.39-2.01]), but not of suicide (RR, 1.50 [95% CI, 0.63-3.62]). Subgroup analyses suggested that prevalence of SI is much higher during the active cancer period than years after (proportion, 0.14 [95% CI, 0.10-0.19] vs 0.08 [95% CI, 0.06-0.09]). The systematic review identified preexisting mental illness, poor physical health, older age, male sex, and being single as risk factors associated with suicidality outcomes. In this meta-analysis of suicide and SI among CCSs, the risk of suicide was no different among CCSs compared with controls, but CCSs had a higher risk of SI. Future studies are needed to explore suicidality outcomes among CCSs to guide targeted support policies.

This thesis had two major aims: the first was aimed to test the efficacy of an Individual Cognitive Behavior Therapy for treatment of unipolar mood disorders with suicidal behavior and the second was to evaluate the risk and protective factors for suicidal behavior among patients with unipolar mood disorders in Malaysia. A review of literature on suicidal behavior in Malaysia suggested that lack of suicidal behavior-related measurements has been hindrance in identification of the risk and protective factors for suicidal behaviors. In addition, the investigation of variables that predicts treatment outcomes for patients with unipolar mood disorders with suicidal behavior has also beenhampered. This review chapter (Chapter 2; parts of them have been published in Comprehensive Psychiatry, 2014 and The Scientific World Journal, 2014) sets the scene for the following empirical chapters.Since most of the instruments used are not validated in Malaysia, thus the next 4 chapters validated two measuring instruments of risk factors and two measuring instruments for protective factors for suicidal behavior (other fours measures were not included as chapters due to limitation in words allowed in this thesis). The validated instruments and other measures were used to identify the risk and protective factors for suicidal behavior as well as to test the efficacy of Individual Cognitive Behavior Therapy (ICBT) for patients with unipolar mood disorders with suicidal behavior.Chapter 3, on Positive and Negative Suicide Ideation (PANSI) Inventory (submitted for publication), Chapter 4, on Beck Hopelessness Scale (BHS), Chapter 5, on Satisfaction With Life Scale (SWLS; published in Comprehensive Psychiatry, 2014), and Chapter 6, is on Reasons For Living Inventory (RFL; published in Comprehensive Psychiatry, 2014). The Exploratory and Confirmatory Factor Analyses were used to examine the psychometric properties and to establish the reliability and validity of these instruments. These measures were validated using the sample size of 483 from both medical and psychiatry patients. All the measures were found to have good reliability and validity using the exploratory and confirmatory factor analyses.Chapter 7 compared the two groups and the results showed that psychiatry patients had significantly higher mean scores on risk factors (hopelessness, psychological distress, depressive, anxiety and stress symptoms) and lower mean scores on protective factors (reasons for living, self esteem, hopefulness, satisfaction with life and social support) for suicidal behavior as compared to medical patients. In addition, patients with suicidal ideation had significantly higher mean scores on risk factors and lower mean scores on protective factors for suicidal behavior as compared to patients without suicidal ideation. And finally, there was a significant interaction between diagnosis (psychiatry patients with suicidal ideation, psychiatry patients without suicidal ideation, medical patients with suicidal ideation and medical patients without suicidal ideation) and suicidal behavior (suicidal ideation).Chapter 8 is a controlled trial comparing the Treatment As Usual (TAU) (N=36) with TAU + Individual Cognitive Behavior Therapy (ICBT) (TAU+ICBT) (N=36) groups. All the outpatients were diagnosed as suffering from unipolar mood disorders with suicidal ideation according to DSM IV-TR criteria. Eight sessions of manualised ICBT were given and each session lasted for 90 minutes. The measures of depressive symptoms (BDI-T and DASS-D), measures of suicidal ideation symptoms (PANSI-T and BSS-T), measures of risk factors for suicidal behavior (DASS-T, DASS-D, BHS-T, DASS-A, DASS-S) and measures of protective factors for suicidal behavior (RFL-T, RSE-T, AHTS-T, PRS-T, SWLS-T, PSR-FR, PSR-FM, SCB, MO, RF, FS, FSD, and CC) were administered at pre, mid, post, 3 months follow-up and 6 months follow-up for both groups. The TAU groups received outpatient treatment as usual by the psychiatrists of the hospital. The results showed that the TAU+ICBT groups consistently and significantly scored better on most of measures when compared to the TAU group. In addition, the TAU+ICBT group improved at earlier stage and the rate of improvement was significantly faster than the TAU group. The TAU group had significant improvement on seven dependent measures only. Thus the addition of the ICBT to TAU produced a more generalized and significant improvement on all the measures of depressive symptoms, measures of suicide ideation symptoms, measures of risk and protective factors of unipolar mood disordered with suicidal ideation patients.The general discussion of the whole thesis was presented in chapter 9, which ties together all the major significant findings from the previous chapters in the general context. The first empirical chapters on assessments were discussed and provided the base for discussions of chapter seven on psychopathology of mood disordered patients with suicidal behavior. Following that the findings of controlled trial on Individual Cognitive Behavioral Therapy of unipolar mood disorders with suicidal ideation in Malaysia was discussed and put in the general context of literature. The discussions were concluded with several strengths of this thesis, limitations of the studies and directions for future research.

Objective:This study aimed to measure the quality of life (QOL) of lung cancer patients and evaluate the relationship between QOL and suicidal ideation (SI) in a tertiary hospital in Vietnam. Methods:A cross-sectional study was conducted at Bach Mai Hospital in Hanoi, Vietnam. A total of 256 patients with lung cancer were recruited. The QOL of cancer patients was evaluated using the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) version 3. Multivariate Tobit regression was employed to identify associations between SI and QOL. Result:Overall, the mean global health status score was 58.3 ± 15.8, and those with SI had significantly higher scores than those without SI. Regarding functional scales, patients with SI had significantly lower physical functioning (82.22 ± 11.42) compared to those without SI (90.58 ± 11.90) (p<0.05). Meanwhile, regarding symptom scales, scores for fatigue, nausea and vomiting, pain, insomnia, appetite loss, constipation, diarrhea, and financial difficulties among patients with SI were significantly higher than those without SI (p<0.05). In the multivariate analysis, having SI increased the role functioning score (Coef. = 9.41, 95% CI = 0.38-18.45) and diarrhea score (Coef. = 22.33, 95% CI = 2.05-42.60).Conclusion: This study indicated moderate QOL and perceived the lowest social functioning in lung cancer patients. SI was associated with role functioning scores and diarrhea scores. SI should be monitored and controlled regularly in this population during treatment to improve their QOL.

Attitudes toward suicide are complex and multifaceted. Their predictive roles and how they interact with mental health in suicidal ideation and suicide attempts are not well understood. Elaborating on attitudes toward suicide can help contribute to suicide prevention. The current study examined whether and how attitudes toward suicide and depression levels are involved in suicidal ideation and suicide attempts among college students. A cross-sectional survey was administered to 1,427 Chinese college students (61.32% females; mean age, 22.42 years), of whom 570 reported suicidal ideation. Participants completed questionnaires to assess their endorsed attitude toward suicide, stigmatized attitude toward suicide, self-stigma toward suicide, depression, suicidal ideation, and suicide attempts. Structural equation modeling revealed that the associations between the three types of attitudes, i.e., endorsed attitude, stigmatized attitude, and self-stigma, and suicidal ideation and suicide attempts were fully or partially mediated by depression. The results suggested that attitudes toward suicide significantly influence suicidal behaviors through depression levels and future suicide prevention efforts should consider these influences.