Suicide risk and influencing factors among Austrian veterinary medicine students.

Suicidal and nonsuicidal self-injurious thoughts and behaviors (SITBs) among youth are major public health concerns. Although a growing body of research has focused on the complex association between nonsuicidal and suicidal self-injury, the temporal relationship between these two classes of behaviors is unclear. The current study addresses this empirical gap by examining the course of SITBs in adolescents receiving outpatient (N=106; 82.1% female) and inpatient (N=174; 75.9% female) treatment. SITBs (co-occurrence, age-of-onset, and time lag between SITBs) and major psychiatric disorders were assessed at a single time point with well-validated structured interviews. Adolescents in both clinical samples reported high co-occurrence of SITBs: most adolescents reported both lifetime nonsuicidal self-injury (NSSI) and suicidal thoughts. A similar temporal pattern of SITBs was reported in the two samples: thoughts of NSSI and suicide ideation had the earliest age-of-onset, followed by NSSI behaviors, suicide plans, and suicide attempts. However, the age-of-onset for each SITB was younger in the inpatient sample than in the outpatient sample. In terms of time lag between SITBs, suicide ideation occurred on average before initial engagement in NSSI, suggesting that pathways to NSSI and suicidal behavior may occur simultaneously rather than in succession from nonsuicidal to suicidal self-injury. Results also indicated that the time to transition between SITBs was relatively fast, and that a key period for intervention and prevention is within the first 6-12months after the onset of suicidal thinking. Taken together, these findings have important implications for understanding the time-lagged relationship between nonsuicidal and suicidal self-injury.

In Australia, adolescent suicidal and non-suicidal self-injury (NSSI) behaviours have been steadily increasing over that past two decades. However, existing research on the geographic distribution of these behaviours in Australia largely focuses on adults, suicides, or uses pre-COVID-19 data. This study aimed to map and describe the geographic regions where ambulance attendances for adolescent suicidal and NSSI behaviours are occurring. Data from the National Ambulance Surveillance System were used to analyse three-year averages and per capita rates of ambulance attendances for adolescents (12-17 years) across local government areas in New South Wales (NSW), Victoria, and Tasmania from 2021 to 2023. The three-year annual average of ambulance attendances for adolescent suicidal behaviour and NSSI were 6,504 in NSW (35.94 per 10,000), 4,017 in Victoria (25.61 per 10,000), and 444 in Tasmania (44.86 per 10,000). Nearly 90% of attendances required transport to hospital, and over 50% occurred outside traditional service hours. Results identified that Major Cities and high socioeconomic status (SES) local government areas (LGAs), were significantly less likely to have higher rates of ambulance attendances for adolescent suicidal and NSSI behaviours. This study highlights substantial variability across three eastern states of Australia where adolescent suicidal and NSSI behaviours are occurring, demonstrating the need for accessible after-hours mental health support, and that regional and lower SES LGA's are disproportionately impacted. Given the concerning state of adolescent mental health in Australia, this study highlights the need for targeted, data-informed responses to reduce the current reliance on emergency care.

Contrary to common clinical perceptions, individuals with personality disorders attempt and commit suicide at nearly the same rate as individuals with major depression. In particular, those with borderline personality disorder are at high risk for suicidal behavior and nonsuicidal self-injury. Yet there is significant controversy surrounding the diagnosis of borderline personality disorder in terms of its existence, its definition and symptom structure, its Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) axis location, and its importance as a contributing factor to suicidality and nonsuicidal self-injury. Furthermore, both suicidal and nonsuicidal self-harm is prominent in borderline personality disorder. There is often confusion between suicidal and nonsuicidal self-injury with one sometimes mistaken for the other. Nonsuicidal self-injury is sometimes met with hospitalization, because it is viewed as life threatening. Alternately, the potential lethality of suicidal behavior is underestimated, because it occurs in the context of multiple low lethality self-harm behaviors. It is possible to view these behaviors as distinct yet on a spectrum in borderline personality-disordered patients. With respect to treatment of self-injury in personality disorders, some recent pharmacotherapy trials have been conducted, though efficacy is often unclear. Findings with respect to psychotherapy, particularly dialectical behavior therapy, a form of cognitive behavioral treatment, are promising.

SUMMARYDespite the alarming suicide burden, South Asia lacks sufficient literature and research. The objective of this systematic review and meta-analysis was to appraise the current evidence and estimate the prevalence of suicidal behaviors (ideation, plan, attempts, completed suicide and non-suicidal self-injury (NSSI)) among countries in South Asia. We systematically searched PubMed, PsycINFO, Web of Science, Scopus, and CINAHL for observational and longitudinal studies involving statistical analysis of suicidal behaviors in south Asian countries as per the PRISMA guidelines, without any limitations concerning age, gender, language, or year of publication.A random-effects model was used to synthesize prevalence data, and mixed-effects regression models were employed for subgroup analyses. Main outcome was lifetime, period and point prevalence of completed suicide, suicidal ideation, plan, and Non suicidal behaviors. A total of 27 studies representing data pertaining to suicidality and related behaviors in South Asian countries were included. The point prevalence of suicidal ideation was 16.7% (95% CI: 11.5% to 23.5%), suicidal plan was 13.6% (13.0% to 14.2%) and attempted suicide was 5.6% (95% CI: 3.5% - 9.0%). The 12-month period prevalence for suicidal ideation was noted to be 11.8% (95% CI: 5.5% to 23.6%), plan 3.6% (95% CI: 2.1% to 6.0%). Suicidal attempts 3.0% (95% CI: 1.6% to 5.5%), completed suicides 0.1% (95% CI: 0% to 0.8%) and non-suicidal behaviors 6.5% (95% CI: 0.7% to 39.5%).Lifetime prevalence ranged from suicidal thoughts 15.9% (95% CI:15.0% to 16.8%), suicidal plan 7.9% (95% CI: 6.2% to 10.1%), attempts 3.1% (95% CI: 1.2% to 7.8%) and non-suicidal behaviors 44.8% (95% CI: 41.2% to 48.4%). We found evidence of significant heterogeneity for suicidal behaviors in the studies included. The epidemiological burden of suicidal behaviors among countries in South Asia appears to be very high. Knowledge about the epidemiology of such behaviors is important for policymaking and to inform context specific interventions to reduce loss of lives caused by suicidal behaviors.

Non-suicidal self-injury and suicidal behavior are prevalent in young adults, and often constitute a continuum of self-destructiveness. Not all those who self-injure, however, engage in suicidal behaviors with intent to die, perhaps due to protective intrapersonal characteristics. We examined the role of one such potential buffer, social problem-solving ability, as a moderator of the association between non-suicidal self-injury and suicidal thoughts and attempts, hypothesizing that individuals with greater social problem-solving ability would report fewer suicidal behaviors in relation to self-harm. An ethnically diverse sample was recruited from a large, Northeastern urban university, and completed self-report questionnaires assessing non-suicidal self-injury, suicidal behaviors, and social problem-solving ability. Multivariate hierarchical regression analyses were conducted. For the entire sample, individuals with higher social problem-solving abilities reported fewer suicidal behaviors associated with non-suicidal self-injury. In ethnically stratified analyses, social problem-solving significantly moderated the relationship between self-injury and suicidal behaviors for Whites and Hispanics only. Promotion of problem-solving skills may weaken the linkage between self-injury and potential for future suicidal behaviors for some individuals; however, culture-specific differences in this effect may exist.

A burgeoning body of evidence suggests a higher prevalence of nonsuicidal self-injury (NSSI) behaviors among adolescents. This study aimed to examine the comorbid internalizing symptoms and suicidal behaviors, along with associations between dissociative experiences and suicide risk in adolescents attending a psychiatric outpatient unit in Ankara, Türkiye. The study included 81 adolescents aged 12–18 years, who engaged in NSSI and sought treatment at a psychiatric outpatient clinic. Psychiatric evaluations were conducted through semi-structured clinical interviews. NSSI behaviors were assessed using the Inventory of Statements About Self-Injury, and suicide risk was measured using the Suicide Probability Scale. Additionally, internalizing symptoms and dissociative experiences were evaluated using the Revised Children’s Anxiety and Depression Scale-Child Version and the Adolescent Dissociative Experiences Scale, respectively. Moderate to high correlations were found among suicide risk, dissociation, NSSI severity, anxiety and internalizing scores. Mediation analysis revealed that NSSI significantly mediated the relationship between dissociation and suicide risk. These findings indicate that assessing both dissociation and NSSI could provide valuable insights into comprehending and addressing adolescent suicide, thereby facilitating the development of targeted interventions to mitigate the effects of dissociative experiences.

ABSTRACTThis study used structural equation modeling to examine the relationships between emotion dysregulation, internalizing symptoms, nonsuicidal self-injury (NSSI), and suicide. One hundred forty-eight undergraduates completed a brief structured interview and self-report measures of emotion dysregulation, internalizing symptoms, and NSSI and suicidal behaviors. Results indicated a significant indirect effect of emotion dysregulation on NSSI via internalizing symptoms and on suicide attempts via NSSI. Findings provide a more nuanced understanding of the indirect association between emotion dysregulation and NSSI and suicidal behaviors. Implications for the potential utility of targeting internalizing symptoms as well as emotion dysregulation in interventions addressing NSSI and suicidal behaviors are discussed.

IntroductionSleep is a fundamental human requirement, considered one of the major contributing factors to physical and mental health, especially among adolescents. Poor quality sleep has many potential consequences including non-suicidal self-injury (NSSI), suicidal thoughts or behaviour and complete suicide. The NSSI and suicidal behaviour are increasing in Nepal. Thus, this study aimed to assess the role of sleep problem on suicidal behaviour and non-suicidal self-injury among adolescents in Pokhara metropolitan, Nepal.MethodsA cross-sectional analytical study was conducted among 673 adolescents using a multistage cluster sampling technique from private and public schools in Pokhara Metropolitan. Self-administered questionnaire was used for data collection. Collected data was entered and managed in EpiData (version 3.1) and analysed in IBM SPSS (version 23). Binary logistic regression was used to identify the association of sleep problem with NSSI and suicidal behaviour.ResultsThe study found that sleep problem (65.2%, 439), suicidal behaviour (18.6%, 125) and NSSI (57.9%, 390) were prevalent among adolescents in study setting. The presence of sleep problem significantly influenced the suicidal behavior (AOR = 3.88, 95% CI = 2.27–6.63) alongside the sex of student (AOR = 1.96, 95% CI = 1.28–3.00), adolescents from family having monthly income less than NPR 40,000 (AOR = 1.97 95% CI = 1.16–3.35) and private schools students (AOR = 2.99, 95% CI = 1.84–4.86). Likewise, sleep problem was also associated with non-suicidal self-injury (AOR = 3.24, 95% CI = 2.26–4.65), in addition to attending private school (AOR = 2.52, 95% CI = 1.71–3.72).ConclusionThis study concludes that sleep problem is prevalent among the adolescents and increase the risk of NSSI and suicidal behaviour. Therefore, parents and teachers need to assess their conditions and help them maintain sound sleep. Additionally, suicide prevention strategies need to be adopted to mitigate further risk.

BackgroundAdverse childhood experiences (ACEs) are well-established risk factors for both non-suicidal self-injury (NSSI) and suicidal behaviors (SBs). Actually, NSSI and SBs often co-occur among adolescents. This study aims to examine the specific effects of ACE types on the co-occurrence of NSSI and three stages of SBs in Chinese adolescents, as well as potential gender differences.MethodsA cross-sectional study was conducted in Chongqing, China. From April to May 2024. A total of 5,143 junior high school students were recruited through stratified cluster sampling. Information was collected through a self-reported questionnaire. Latent class analysis (LCA) was used to identify the co-occurrence patterns of NSSI and SBs. Multinomial logistic regression was employed to examine the independent associations between ACE types and these co-occurrence patterns. Gender differences were assessed using relative odds ratios (ROR).ResultsThe prevalence of different ACE types ranged from 2.5% to 23.0%, with 46.4% of participants reporting one or more ACEs. Three co-occurrence patterns of NSSI and SBs were identified: low risk class, suicidal ideation class, and suicide attempts class. Physical abuse (odds ratios [OR] = 1.50, 95% confidence intervals [CI] 1.05 to 2.15) was associated with suicidal ideation class, while emotional abuse (OR = 1.88, 95% CI 1.18 to 3.02) and neglect (OR = 1.45, 95% CI 1.01 to 2.09) were associated with suicide attempts class. A gender difference was found in the association between neglect and suicide attempts class (ROR = 2.34, 95% CI 1.14 to 4.83).ConclusionsSuicide attempts (SA) and suicidal ideation (SI) tend to co-occur with NSSI among adolescents. Distinct ACE types have unique effects on this co-occurrence, with gender differences. These findings emphasize the importance of considering NSSI and SBs together, and it is more promising to develop tailored anti-ACEs interventions.

Exposure to suicide and suicidal behaviors among Hong Kong adolescents

Psychopathological profiles of adolescent presenting to emergency departments following a suicide attempt: A comprehensive analysis.

The prevalence of self-directed violence (SDV) is increasing in adolescents. SDV, defined as behavior that is self-directed and deliberately results in actual injury or the potential for injury to self, includes both nonsuicidal self-injury (NSSI) and suicidal behavior. In this study, an intact group of students in grades 8–12 at their school were surveyed about their history of SDV, the size of their peer groups and the strength of relationships with peers, and the function that SDV served for those who reported a history of SDV. Approximately one-third of the youth surveyed reported engaging in one or more SDV behaviors. Functions of both NSSI and suicidal ideation and behavior were primarily for emotion regulation, with youth who engaged in both NSSI and suicidal behaviors reporting a greater need for emotion regulation. While the size of peer groups reported did not differ for youth who engaged in SDV versus those who did not, the more friends an adolescent identified, the less likely the youth was to engage in SDV for emotion regulation.

Recent studies have found a higher incidence of suicidal ideation/plan/attempt and non-suicidal self-injurious behavior among smokers (Poorolajal et al., 2016; Marin et al., 2020). People with mental health problems have been shown to be one of the most smoking populations (Szatkowski et al, 2015). At the same time, the presence of a mental disorder is an independent predictor of the occurrence of suicidal ideation (Klonsky et al, 2017). An important question about the impact of nicotine consumption on the course of self-Injurious thoughts and behaviors in persons with non-psychotic mental disorders remains unclear. The aim of the study is to evaluate the influence of tobacco smoking (TS) on the risk of lifetime suicidal plan (SP), attempt (SA) and nonsuicidal self-injury (NSSI) in patients with nonpsychotic mental disorders (NPMD) and suicidal ideation (SI). Four hundred and 78 consecutive patients with NPMD and SI were included. All patients were evaluated by a psychiatrist, underwent Self-Injurious Thoughts and Behaviors Interview (SITBI) as well as semi-structured interview designed to gather information on demographic and biographical features. Mann-Whitney, chi-square test and stepwise logistic regression were used as statistical methods. The mean age of the sample was 28 (11.46) and most of the patients were female 417 (97.2%). Lifetime TS was reported by 324 (67.8%) patients. We found no differences between smokers and non-smokers in age, gender, educational and occupational statuses, as well as the diagnoses of mental disorders and their number (Tab.1). SP, SA and NSSI were significantly more common in patients with lifetime tobacco smoking history. No significant differences were found in age of onset of self-injurious thoughts and behavior, and total number of SP, SA and NSSI between lifetime smokers and non-smokers (Tab. 2) Stepwise logistic regression analysis revealed an association of lifetime TS with lifetime SA and NSSI, but not with SP (Tab: 3). In consistence with previous studies (Sankaranarayanan et al., 2015; Marin et al., 2020), our results suggested that lifetime tobacco smoking is strongly associated with an increased risk of suicidal and non-suicidal self-injurious behavior. Moreover, we showed suggested that tobacco smoking involved in transition from ideation to action. It is proposed that smoking may increase the risk of suicide through a biological pathway - decreasing the activity of the serotonergic system of hippocampus, reduce brain serotonin function and activate of the hypothalamo-pituitary-adrenal axis (HPA). Thus, nicotine may be able to activate the attenuated responsiveness of the HPA axis to psychological stress (Poorolajal et al, 2016). History of lifetime TS in patients with NPMD and SI is associated with an increased risk of suicidal and nonsuicidal self-injurious behavior.

Although diagnostically distinct from suicidal behaviour and, by definition, not intended to cause death, nonsuicidal self-injury (NSSI) remains one of the strongest predictors of suicide. NSSI and suicidal behaviour appear to share a suicidal state of mind, marked by detachment from life and ambivalence toward death. This study investigates suicidal risk in adolescents with NSSI by examining suicidal motivations and regulatory needs linked to psychache and by exploring their contribution to suicidal behaviour. A sample of 134 adolescents with active suicidal ideation, self-harm or recent suicide attempts was assessed using self-report measures and structured interviews. Associations between suicidal ideation, motivations and NSSI features were explored using linear regressions. Logistic regressions tested links between suicidal motivations and suicidal attempts in a filtered NSSI subsample. A hierarchical logistic regression compared the associative value of suicidal motivations and personality disorder criteria on suicidal behaviour. Suicidal ideation and motivations were significantly associated with NSSI variables. In the NSSI subsample, interpersonal influence and low fear were linked to suicide attempts. Suicidal motivations showed greater predictive power for suicidal behaviour than personality disorder traits, improving model accuracy. These findings suggest that assessing suicidal motivations in adolescents with NSSI may enhance clinical risk evaluation and support more targeted interventions.

The lifetime prevalence of major depressive disorder (MDD) in adolescents is reported to be as high as 20%; thus, MDD constitutes a significant social and public health burden. MDD is often associated with nonsuicidal self-injury (NSSI) behavior, but the contributing factors including cognitive function have not been investigated in detail. To this end, the present study evaluated cognitive impairment and psychosocial factors in associated with MDD with NSSI behavior. Eighteen and 21 drug-naïve patients with first-episode MDD with or without NSSI (NSSI+/– group) and 24 healthy control subjects (HC) were enrolled in the study. The Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Adolescent Self-injury Questionnaire, Beck Scale for Suicide Ideation–Chinese Version (BSI-CV), Shame Scale for Middle School Students, Sensation Seeking Scale (SSS) and Childhood Trauma Questionnaire (CTQ) were used to assess depression-related behaviors, and event-related potentials (ERPs) were recorded as a measure of cognitive function. The latency of the N1, N2, P3a, P3b, and P50 components of ERPs at the Cz electrode point; P50 amplitude and P50 inhibition (S1/S2) showed significant differences between the 3 groups. CTQ scores also differed across three groups, and the NSSI– and NSSI+ groups showed significant differences in scores on the Shame Scale for Middle School Students. Thus, cognitive function was impaired in adolescents with MDD with NSSI behavior, which was mainly manifested as memory decline, attention and executive function deficits, and low anti-interference ability. We also found that childhood abuse, lack of social support, and a sense of shame contributed to NSSI behavior. These findings provide insight into the risk factors for MDD with NSSI behavior, which can help mental health workers more effectively diagnose and treat these patients.