Suicidal behaviors among Bangladeshi university students: Prevalence and risk factors

Background Bangladeshi university students are considered to be highly suicide-prone compared to other populations and cohorts. However, no prior epidemiological studies have assessed the suicidality (i.e., past-year suicidal ideation [SI], lifetime suicide plan [SP], and lifetime suicide attempt [SA]) among Bangladeshi students, including the variables such as past-year stressful life events and family mental health history. This is arguably a major knowledge gap in the country. Therefore, the present study investigated the prevalence and associated risk factors for suicidal behaviors among Bangladeshi university students. Methods A cross-sectional study was conducted utilizing a convenience sampling method among a total of 1844 university students between October and November 2019. Data were collected based on the information related to socio-demographics, perceived health-related questions, past-year stressful life events, family mental health history, and suicidal behaviors (i.e., SI, SP, and SA). Chi-square tests and binary logistic regressions were used to analyze the data utilizing SPSS statistical software. Results The prevalence of past-year suicidal ideation, lifetime suicide plans, and suicide attempts were 13.4%, 6.0%, and 4.4%, respectively. Females reported significantly higher suicidal behavior than males (i.e., 20.6% vs.10.2% SI; 9% vs. 4.6% SP; and 6.4% vs.3.6% SA). Risk factors for SI were being female, year of academic study, residing in an urban area, using psychoactive substances, experiencing both past year physical and mental illness, experiencing any type of stressful past-year life events, experiencing campus ragging (i.e., senior students abusing, humiliating and/or harassing freshers or more junior students), experiencing family mental illness history, and having family suicide attempt history. SP was associated with several factors including being female, year of academic study, using psychoactive substance, experiencing both past-year physical and mental illness, and experiencing any type of stressful past-year life events. Risk factors for SA were being female, year of academic study, using psychoactive substances, experiencing past-year mental illness, experiencing any type of stressful past-year life events, and having family suicide attempt history. Conclusions University students appear to be a vulnerable group for experiencing suicidal behaviors. The present findings warrant rigorous action and early intervention programs such as counseling and other mental health professional services by university authorities. Longitudinal studies are highly recommended involving countrywide representative samples.

Suicidal ideation, plans, and attempts and the use of psychoactive substances by adolescents

Introduction: Suicidal behavior and substance abuse constitute a serious public health problem. Aim: The study was to analyze the relationships between suicidal behaviors (ideation, plans, attempts) and substance abuse in adolescents. The authors also took into account the respondents’ motivation to attempt suicide and use psychoactive substances, as well as some demographic variables. Participants: The study involved 3493 secondary school students aged 16-17 years. The group included 69.41% girls and 30.59% boys. Methods: The participants were surveyed with a self-report questionnaire designed by one of the authors. Results: Statistically significant relationships were found between the respondents’ suicidal behaviors and the risky use of alcohol, cannabis, amphetamine, and designer drugs. Conclusions: 1. The use of psychoactive substances increases the risk of suicidal ideation and plans, as well as suicidal attempts in adolescents and young adults. 2. Significantly more respondents who report suicidal ideation, plans and attempts, in comparison to those who do not report such thoughts and behaviours, abuse alcohol and consumer cannabis, amphetamine and designer drugs to cope with problems and olster self-confidence. 3. In the group of respondents who report suicidal behaviour, psychoactive substances are consumed by significantly more men than women and by significantly more city inhabitants than people living in the country. 4. Young people, who report suicidal thoughts, plans, and attempts, are initiated into alcohol consumption at an earlier age than their non-suicidal peers.

An Epidemiologic, Longitudinal, and Discordant-Twin Study of the Association Between Gambling Disorder and Suicidal Behaviors

Gambling disorder is associated with suicidal behaviors, but it is not clear whether the association is due to common etiologic factors or to gambling disorder being causally related to suicidality. This question was examined from the perspective of epidemiologic, longitudinal, and discordant-twin studies. The results suggested that the causes of the association with disordered gambling differed for suicidal ideation, plan, and attempt and differed for men and women. The association of suicidal thoughts with disordered gambling was noncausally explained by common genetic influences among women but not men. Conversely, there was evidence consistent with a potentially causal influence of disordered gambling on suicide attempt among men but not women, which might have been related to gambling-related financial problems. The use of monetary data to identify individuals experiencing financial harms associated with their gambling may represent a more practicable target for screening, intervention, and prevention and may reduce gambling-related financial crises, thereby warding off a potential gambling-related suicide attempt.

Individual Factors Underlying Suicidal Behaviors in Patients with Borderline Personality Disorder: A Qualitative Study

Background: Borderline personality disorder (BPD) is associated with a high risk of suicide. Limited information is available on the individual factors underlying suicidal behaviors, especially suicide attempts (SAs), in Iranian patients with BPD. Objectives: This study aimed to analyze the individual factors underlying suicidal behaviors in patients with BPD. Methods: This was a qualitative descriptive study that was conducted from May 2020 to February 2021 in Tehran and Karaj, Iran, on 23 participants, including 14 patients with BPD and seven mental health professionals, as well as two members of their families. The research environment included psychiatric inpatient wards, psychiatric emergencies, and psychiatric clinics. Participants were selected through purposive sampling. Data were collected using semi-structured interviews and were analyzed using conventional content analysis. Results: Data analysis revealed five main themes and 15 sub-themes related to the individual factors underlying the identification and prediction of the risk for suicidal behaviors and SAs. The extracted themes included “psychological pain and loneliness”, “defects in the distinction and integration of emotions”, “unconventional behavior and emotion”, “pervasive incompatibility”, and “breakdown of the self-integrity”. Conclusions: The BPD is a complex and challenging disorder in which patients with BPD usually tend to engage in suicidal behaviors, and with the emergence of individual factors underlying the occurrence of such behaviors, appropriate preventive measures and interventions can be taken to reduce suicide-related behaviors such as suicidal thoughts and planning, as well as SAs.

Item Response Theory and Differential Item Functioning Analyses With the Suicidal Behaviors Questionnaire–Revised in US and Chinese Samples

Background: Despite the widespread use of the Suicidal Behaviors Questionnaire–Revised (SBQ-R) and advances in item response theory (IRT) modeling, item-level analysis with the SBQ-R has been minimal. Aims: This study extended IRT modeling strategies to examine the response parameters and potential differential item functioning (DIF) of the individual SBQ-R items in samples of US ( N = 320) and Chinese ( N = 298) undergraduate students. Method: Responses to the items were calibrated using the unidimensional graded response IRT model. Goodness-of-fit, item parameters, and DIF were evaluated. Results: The unidimensional graded response IRT model provided a good fit to the sample data. Results showed that the SBQ-R items had various item discrimination parameters and item severity parameters. Also, each SBQ-R item functioned similarly between the US and Chinese respondents. In particular, Item 1 (history of attempts) demonstrated high discrimination and severity of suicide-related thoughts and behaviors (STBs). Limitations: The use of cross-sectional data from convenience samples of undergraduate students could be considered a major limitation. Conclusion: The findings from the IRT analysis provided empirical support that each SBQ-R item taps into STBs and that scores for Item 1 can be used for screening purposes.

Maternal suicide attempts and deaths in the first year after cesarean delivery

Background Cesarean delivery (CD) has been associated with postpartum psychiatric disorders, but less is known about the risk of suicidal behaviors. We estimated the incidence and risk of suicide attempts and deaths during the first postpartum year in mothers who delivered via CD v. vaginally. Method All deliveries in Sweden between 1973 and 2012 were identified. The mothers were followed since delivery for 12 months or until the date of one of the outcomes (i.e. suicide attempt or death by suicide), death by other causes or emigration. Associations were estimated using Cox proportional hazards regression models. Results Of 4 016 789 identified deliveries, 514 113 (12.8%) were CDs and 3 502 676 (87.2%) were vaginal deliveries. During the 12-month follow-up, 504 (0.098%) suicide attempts were observed in the CD group and 2240 (0.064%) in the vaginal delivery group (risk difference: 0.034%), while 11 (0.0037%) deaths by suicide were registered in the CD group and 109 (0.0029%) in the vaginal delivery group (risk difference: 0.008%). Compared to vaginal delivery, CD was associated with an increased risk of suicide attempts [hazard ratio (HR) 1.46; 95% CI 1.32–1.60], but not of deaths by suicide (HR 1.44; 95% CI 0.88–2.36). Conclusions Maternal suicidal behaviors during the first postpartum year were uncommon in Sweden. Compared to vaginal delivery, CD was associated with a small increased risk of suicide attempts, but not death by suicide. Improved understanding of the association between CD and maternal suicidal behaviors may promote more appropriate measures to improve maternal mental well-being and further reduce suicidal risks.

Prediction of Suicidality According to Serum Folate Levels in Depressive Patients Receiving Stepwise Pharmacotherapy

Background: The effects of serum folate levels on suicidal behavior, strongly associated with depression, have not been investigated. Therefore, this study investigated the associations between serum folate levels and suicidal behavior in patients with depressive disorders.Methods: Serum folate levels were measured at baseline in 1,094 patients with depressive disorder, 884 of whom were followed during a 12-month period of stepwise pharmacotherapy. Suicidal behaviors evaluated at baseline were (i) previous suicide attempt and (ii) baseline suicidal severity; behaviors evaluated at follow-up were (iii) increased suicidal severity and iv) fatal/non-fatal suicide attempt. Associations of serum folate levels with four types of suicidal behaviors were analyzed using logistic regression models after adjustment for relevant covariates; they were also examined using area under receiver operating characteristic (AUROC) curve analyses.Results: Reduced serum folate levels (<6.0 ng/mL) were independently associated with all four types of suicidal behaviors. AUROC curve analyses indicated that discriminant or prognostic values of reduced serum folate levels were fair for fatal/non-fatal suicide attempt during follow-up, whereas they were modest for previous suicide attempt, baseline suicidal severity, and increased suicidal severity.Conclusions: Serum folate levels could serve as a biomarker of suicidal behavior in depressive patients. However, it should be used as an adjunct rather than a substitute for prediction of suicidal behavior considering its low prognostic values. Further replication studies are needed for its clinical utilization.