Neurobiological Basis of Increased Risk for Suicidal Behaviour

According to the World Health Organization (WHO), more than 700,000 people die per year due to suicide. Suicide risk factors include a previous suicide attempt and psychiatric disorders. The highest mortality rate in suicide worldwide is due to depression. Current evidence suggests that suicide etiopathogenesis is associated with neuroinflammation that activates the kynurenine pathway and causes subsequent serotonin depletion and stimulation of glutamate neurotransmission. These changes are accompanied by decreased BDNF (brain-derived neurotrophic factor) levels in the brain, which is often linked to impaired neuroplasticity and cognitive deficits. Most suicidal patients have a hyperactive hypothalamus–pituitary–adrenal (HPA) axis. Epigenetic mechanisms control the above-mentioned neurobiological changes associated with suicidal behaviour. Suicide risk could be attenuated by appropriate psychological treatment, electroconvulsive treatment, and drugs: lithium, ketamine, esketamine, clozapine. In this review, we present the etiopathogenesis of suicide behaviour and explore the mechanisms of action of anti-suicidal treatments, pinpointing similarities among them.

Suicide Risk Factors among Polish Adults Aged 65 or Older in 2000–2018 Compared with Selected Countries Worldwide

The aim of this study was to determine the tendencies of change in suicide frequency among Polish adults aged 65 or older, recognize the importance of available socio-demographic data (age, sex, marital status, and education attainment level) and provide an in-depth psychological understanding of the obtained results. We analysed the influence of education and marital status on suicide risk in the Polish adult population aged 65 or older, which has not been previously presented in publications related to the Central Statistical Office or any other research. Our results indicated that male adults aged 65 or older that were single or divorced and with a lower education had a higher risk of death by suicide. In female adults aged 65 or older, those with higher education and who were divorced or married had a higher risk of fatal suicide behaviour meanwhile, single women and widows had a lower risk. The dominant method of suicide among Polish older adults was suicide by hanging, regardless of sex; female older adults were more likely to die by suicide by poisoning or jumping from a height, and male older adults were more likely to die by shooting with a firearm. Although data from recent years highlights a downward trend for suicide rates in Polish older adults, the problem cannot be considered solved.

A Survey of Computational Methods for Online Mental State Assessment on Social Media

Mental state assessment by analysing user-generated content is a field that has recently attracted considerable attention. Today, many people are increasingly utilising online social media platforms to share their feelings and moods. This provides a unique opportunity for researchers and health practitioners to proactively identify linguistic markers or patterns that correlate with mental disorders such as depression, schizophrenia or suicide behaviour. This survey describes and reviews the approaches that have been proposed for mental state assessment and identification of disorders using online digital records. The presented studies are organised according to the assessment technology and the feature extraction process conducted. We also present a series of studies which explore different aspects of the language and behaviour of individuals suffering from mental disorders, and discuss various aspects related to the development of experimental frameworks. Furthermore, ethical considerations regarding the treatment of individuals’ data are outlined. The main contributions of this survey are a comprehensive analysis of the proposed approaches for online mental state assessment on social media, a structured categorisation of the methods according to their design principles, lessons learnt over the years and a discussion on possible avenues for future research.

Suicide

Beyond the clinical difficulties in treating suicidal patients, suicide is a unique ethical challenge to psychiatrists. For unlike therapy in which patients and doctors share the desirability of the treatment’s goal, suicidal patients and doctors diverge in the way they consider the value of life as such. This makes the traditional standards of informed consent, beneficence, and the ‘do not harm’ principle hard to apply. After shortly outlining the history of the philosophical attitude towards suicide, including its ‘medicalization’ in modern times, the article tackles the problem of intervention in preventing suicidal behaviour, by examining four clinical cases that are distinguished by the intention of the patient, the effectiveness of treatment, and the rationality of the motive. The following section then addresses the heated debate on physician-assisted death, which is more controversial than suicide prevention. Two real-life cases, Bouvia and Chabot, are discussed in detail. Finally, the article focuses on the unique ethical features of research of suicide behaviour and treatment.

Psychiatric disorders in youth suicide and suicide attempters

This chapter reviews common psychiatric disorders and conditions which appear to be major risk factors for all types of suicidality, both non-fatal and fatal, among children and adolescents. Psychiatric illness remains the most well-defined risk factor for adolescent suicide and suicidality should be assessed in every young person suffering from a serious mental illness. These psychiatric conditions include personality disorders, conduct disorder, affective disorder, bipolar disorder, anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, schizophrenia, substance abuse, and eating disorders. Each psychiatric condition is described and discussed in terms of its unique features that are associated with suicidal behaviours and its risk for suicide behaviour.

Association between suicide behaviours in children and adolescents and the COVID-19 lockdown in Paris, France: a retrospective observational study

This retrospective observational study conducted in Necker Hospital for Sick Children, France (January 2018–June 2020) evaluated a potential temporal association between admissions for suicide behaviours in children and adolescents and the national COVID-19 lockdown (March–May 2020). During the study period, 234 patients were admitted for suicide behaviours (28% male; mean age 13.4 years). Using Poisson regression, we found a significant decrease in the incidence of admissions for suicide behaviour during the lockdown (adjusted incidence rate ratio: 0.46; 95% CI 0.24 to 0.86). This association might result from reduced help-seeking and decreased hospital admission rates during the lockdown, as well as cognitive and environmental factors. Further multicentre studies should be conducted to confirm these findings and investigate whether a compensatory rise in admissions for suicide behaviour occurred in the postlockdown period.

An examination of suicidal behaviour among veterans receiving mental-health appointments in person versus clinical video telehealth

Introduction The US Department of Veterans Affairs (VA) is a national leader in the implementation of clinical video telehealth (CVT) services. Despite the growth of mental-health services offered via CVT, it is unclear to what extent these services are offered and accessed by veterans with previous suicidal behaviour. Methods The current quality improvement project examined this question within a local VA health-care system using data from suicide behaviour reports (SBRs), the Veteran Health Administration’s official reporting and surveillance system. The frequency of SBRs was compared during two different time points among veterans who received individual mental-health appointments in person only or via CVT during the 2017 calendar year. Among veterans with a SBR, time in days elapsed from their first mental-health appointment to a SBR was examined as a function of treatment modality. Results Results indicated veterans who received in-person treatment only were more likely to present with a SBR six months prior to their first mental-health appointment compared to those who received CVT during the observation period. There were no differences in SBRs during the 12 months after the first appointment or the time from the first appointment to the SBR as a function of treatment modality used. Discussion Although veterans who received in-person mental-health services were more likely to have had a SBR six months prior to treatment, suicide risk throughout the observation period did not differ between groups. Clinical implications that arise from these findings are described in the discussion.