Suicidality

自杀
  • 文章类型: Systematic Review
    目标:老年人的自杀率通常是所有年龄组中最高的,特别是在高收入国家。然而,对于可以防止老年人自杀的因素了解有限。本系统评价旨在确定和评估防止老年人自杀的心理因素。
    方法:在PROSPERO(CRD42022343694)上建立并注册了先验协议。EMBASE,MEDLINE,PsycINFO,搜索了WebofScience和Scopus。论文质量评估使用质量评估与多样化研究(QuADSs)工具。遵循系统审查和荟萃分析(PRISMA)指南的首选报告项目。包括17篇论文,并进行了叙述综合。
    结果:最初的搜索确定了10,673条记录,结果在删除重复项后筛选了5441条记录。确定的保护因素是(1)生活中的意义/目的,(2)生活的原因,(3)应对方式,(4)心理健康,(5)生活满意度,(6)人格因素,(7)认知功能,(8)归属感。最有经验支持的因素是生活中的意义,其次是心理健康和应对反应,例如主要控制策略,和人格特质,如积极的影响和代理。也有证据表明,一些保护因素的影响,例如生活中的意义,可能取决于老年生活的阶段和性别。
    结论:本综述确定了一些心理因素,这些因素已被发现可以防止老年人的自杀意念,代表减少老年人自杀的潜在治疗目标。未来研究的建议包括更多地使用纵向和病例对照设计,测量自杀连续体的结果,并使用允许比较年轻人和老年人以及老年范围内的样本。
    OBJECTIVE: Suicide rates in older adults are often the highest of any age group, particularly among high income countries. However, there is a limited understanding of the factors that could protect against suicidality in older age. This systematic review aimed to identify and evaluate the psychological factors that protect against suicidality in older age.
    METHODS: An a priori protocol was established and registered on PROSPERO (CRD42022343694). EMBASE, MEDLINE, PsycINFO, Web of Science and Scopus were searched. Papers were quality assessed using the Quality Assessment with Diverse Studies (QuADSs) tool. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Seventeen papers were included and narratively synthesised.
    RESULTS: The initial searches identified 10,673 records, resulting in the screening of 5441 records after the removal of duplicates. The protective factors identified were (1) meaning/purpose in life, (2) reasons for living, (3) coping styles, (4) psychological wellbeing, (5) life satisfaction, (6) personality factors, (7) cognitive functioning, and (8) sense of belonging. The factors with the most empirical support were meaning in life, followed by psychological wellbeing and coping responses, such as primary control strategies, and personality traits, such as positive affect and agency. There was also evidence to suggest that the influence of some protective factors, for example meaning in life, may depend upon stage in older life and gender.
    CONCLUSIONS: This review identified several psychological factors that have been found to protect against suicidal ideation in older adults, representing potential treatment targets for reducing suicide in older adults. Recommendations for future research includes greater use of longitudinal and case-control designs, measuring outcomes across the continuum of suicidality and using samples that allow comparison between younger and older adults and within the spectrum of old age.
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  • 文章类型: Journal Article
    自杀是25-44岁男性死亡的主要原因,通常与成为父亲相吻合的年龄。这篇综述旨在综合围产期父亲自杀和自残观念流行的证据,产后和早期育儿期。
    搜索了五个数据库(PsycINFO,Medline,WebofScience,PubMed和Cochrane系统评论数据库),以确定2000年1月1日至2023年3月9日之间发表的论文。在纳入的研究中,进行了荟萃分析以估计自杀和自残观念的患病率。进行亚组和敏感性分析以探索异质性的潜在来源。
    共确定了4215篇文章,14项研究纳入审查。自杀和自残观念的合并患病率为4.2%(95%CI[2.6%,6.2%])。自残观念的患病率估计值更高,为5.1%(95%CI[2.6%,6.2%])比3%的自杀率(95%CI[0.9%,6.1%])。
    这项审查发现,相当比例的父亲在养育子女的早期经历过自杀和自残的想法。然而,缺乏严格的患病率研究表明,迫切需要在这一领域进行进一步的研究。
    UNASSIGNED: Suicide is a leading cause of death in males aged 25-44 years, an age which often coincides with becoming a father. This review aims to synthesise the evidence of the prevalence of suicidal and self-harm ideation in fathers during the perinatal, postnatal and early parenting period.
    UNASSIGNED: Five databases were searched (PsycINFO, Medline, Web of Science, PubMed and the Cochrane Database of Systematic Reviews) to identify papers published between 1 January 2000 and 9 March 2023. A meta-analysis was conducted to estimate the prevalence of suicidality and self-harm ideation across the included studies. Subgroup and sensitivity analyses were conducted to explore potential sources of heterogeneity.
    UNASSIGNED: A total of 4215 articles were identified, with 14 studies included in the review. The combined pooled prevalence of suicidal and self-harm ideation was 4.2% (95% CI [2.6%, 6.2%]). Prevalence estimates were higher for self-harm ideation at 5.1% (95% CI [2.6%, 6.2%]) than for suicidality at 3% (95% CI [0.9%, 6.1%]).
    UNASSIGNED: This review found that a considerable proportion of fathers experience suicidal and self-harm ideation during the early years of parenting. However, the paucity of rigorous prevalence studies indicates that further research in this area is needed urgently.
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  • 文章类型: Systematic Review
    难治性抑郁症(TRD)定义为被诊断患有抑郁症的患者,有使用不同剂量和治疗持续时间的抗抑郁药的失败史。NMDA受体拮抗剂氯胺酮迅速减轻TRD中的抑郁症状。我们通过对脑磁共振成像(MRI)研究的系统回顾,检查了TRD中氯胺酮治疗反应的神经相关性。使用“氯胺酮和抑郁症和磁共振”在PubMed中进行了全面搜索。\"数据库查询的时间跨度为\"开始日期:2018/01/01;结束日期:2024/05/31。“总共包括41篇原创文章,包括1396篇TRD和587例健康对照(HC)。抑郁症的诊断是使用DSM疾病的结构化临床访谈(SCID),迷你国际神经精神病学访谈(MINI),和/或精神科医生的临床评估。情感性精神障碍患者被排除在外。大多数研究应用氯胺酮[0.5mg/kg外消旋氯胺酮和/或0.25mg/kgS-氯胺酮]稀释在60cc生理盐水中,一次静脉输注40分钟,四次,或在2周内间隔2-3天六次。临床结果定义为缓解,回应,和/或抑郁症状的百分比变化。T2*加权成像的脑MRI(静息状态或任务表现),动脉自旋标记,弥散加权成像,和T1加权成像在基线和主要在氯胺酮给药后1-3天获得。只有≥2项研究复制的研究结果被纳入默认模式,显著性,额顶叶,皮质下,边缘网络被认为是有意义的。在边缘的结构/功能特征中发现了TRD中对氯胺酮的治疗反应的基于大脑的标志物(亚遗传ACC,海马体,扣带束-海马部分;快感缺失/自杀意念),显著性(背侧ACC,脑岛,扣带束回部分;思考/自杀意念),额顶叶(背外侧前额叶皮质,上纵束;快感缺失/自杀意念),默认模式(后扣带回皮质;思维沉思),和皮层下(纹状体;快感缺失/思考)网络。大脑边缘的特征,显著性,和额顶叶网络可用于预测TRD,对氯胺酮有更好的反应,以缓解快感缺乏症,沉思,和自杀意念。
    Treatment-resistant depression (TRD) is defined as patients diagnosed with depression having a history of failure with different antidepressants with an adequate dosage and treatment duration. The NMDA receptor antagonist ketamine rapidly reduces depressive symptoms in TRD. We examined neural correlates of treatment response to ketamine in TRD through a systematic review of brain magnetic resonance imaging (MRI) studies. A comprehensive search in PubMed was performed using \"ketamine AND depression AND magnetic resonance.\" The time span for the database queries was \"Start date: 2018/01/01; End date: 2024/05/31.\" Total 41 original articles comprising 1,396 TRD and 587 healthy controls (HC) were included. Diagnosis of depression was made using the Structured Clinical Interview for DSM Disorders (SCID), the Mini-International Neuropsychiatric Interview (MINI), and/or the clinical assessment by psychiatrists. Patients with affective psychotic disorders were excluded. Most studies applied ketamine [0.5mg/kg racemic ketamine and/or 0.25mg/kg S-ketamine] diluted in 60cc of normal saline via intravenous infusion over 40 min one time, four times, or six times spaced 2-3 days apart over 2 weeks. Clinical outcome was defined as either remission, response, and/or percentage changes of depressive symptoms. Brain MRI of the T2*-weighted imaging (resting-state or task performance), arterial spin labeling, diffusion weighted imaging, and T1-weighted imaging were acquired at baseline and mainly 1-3days after the ketamine administration. Only the study results replicated by ≥ 2 studies and were included in the default-mode, salience, fronto-parietal, subcortical, and limbic networks were regarded as meaningful. Putative brain-based markers of treatment response to ketamine in TRD were found in the structural/functional features of limbic (subgenual ACC, hippocampus, cingulum bundle-hippocampal portion; anhedonia/suicidal ideation), salience (dorsal ACC, insula, cingulum bundle-cingulate gyrus portion; thought rumination/suicidal ideation), fronto-parietal (dorsolateral prefrontal cortex, superior longitudinal fasciculus; anhedonia/suicidal ideation), default-mode (posterior cingulate cortex; thought rumination), and subcortical (striatum; anhedonia/thought rumination) networks. Brain features of limbic, salience, and fronto-parietal networks could be useful in predicting the TRD with better response to ketamine in relief of anhedonia, thought rumination, and suicidal ideation.
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  • 文章类型: Journal Article
    抑郁和焦虑是多发性硬化症(MS)最常见的神经精神症状,自身免疫介导的脱髓鞘神经退行性疾病。他们的患病率为25-65%和20-54%,分别,常伴有慢性疲劳和认知障碍,但通常与运动和其他缺陷无关,提示不同的病理生理机制。这两种疾病通常在MS诊断之前出现,导致更快的残疾和损害生活质量。危险因素是(年轻)年龄,遗传和家族史负担。虽然没有关于MS患者抑郁(和焦虑)的具体神经病理学数据,现代神经影像学研究显示双侧额颞叶,皮质下和边缘萎缩,显微结构白质病变和额顶破坏,边缘和神经内分泌网络。MS中抑郁和焦虑的发病机制与共同机制有关,包括氧化应激,线粒体功能障碍,神经炎症和神经内分泌机制诱导复杂的功能性和结构性脑损伤,但它们也受到社会和其他因素的影响。不幸的是,MS患者焦虑,严重的抑郁症或自杀想法往往被低估和治疗不足。目前的治疗,除了抗抑郁治疗包括经颅磁刺激,认知,放松,必须个性化的饮食和其他医疗保健措施。当前的最新评论是基于对PubMed的系统分析,谷歌学者和科克伦图书馆,直到2024年5月,重点是患病率,临床表现,神经影像数据,免疫机制和治疗方案。MS中的抑郁和焦虑,像许多其他神经免疫疾病一样,是相关的,其中,大脑紊乱的多区域模式和复杂的致病机制值得进一步阐明,作为早期诊断和适当管理的基础,以提高这种致残疾病的生活质量。
    Depression and anxiety are the most frequent neuropsychiatric symptoms of multiple sclerosis (MS), an autoimmune-mediated demyelinating neurodegenerative disease. Their prevalence is 25-65% and 20-54%, respectively, often associated with chronic fatigue and cognitive impairment, but usually not correlated with motor and other deficits, suggesting different pathophysiological mechanisms. Both disorders often arise before MS diagnosis, lead to faster disability and impair the quality of life. Risk factors are (young) age, genetic and family history burden. While no specific neuropathological data for depression (and anxiety) in MS are available, modern neuroimaging studies showed bilateral fronto-temporal, subcortical and limbic atrophies, microstructural white matter lesions and disruption of frontoparietal, limbic and neuroendocrine networks. The pathogenesis of both depression and anxiety in MS is related to shared mechanisms including oxidative stress, mitochondrial dysfunction, neuroinflammation and neuroendocrine mechanisms inducing complex functional and structural brain lesions, but they are also influenced by social and other factors. Unfortunately, MS patients with anxiety, major depression or suicidal thoughts are often underassessed and undertreated. Current treatment, in addition to antidepressant therapy include transcranial magnetic stimulation, cognitive, relaxation, dietary and other healthcare measures that must be individualized. The present state-of- the-art review is based on systematic analysis of PubMed, Google Scholar and Cochrane Library until May 2024, with focus on the prevalence, clinical manifestation, neuroimaging data, immune mechanisms and treatment options. Depression and anxiety in MS, like in many other neuroimmune disorders, are related, among others, to multi-regional patterns of cerebral disturbances and complex pathogenic mechanisms that deserve further elucidation as a basis for early diagnosis and adequate management to improve the quality of life in this disabling disease.
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  • 文章类型: Journal Article
    工人补偿制度旨在为受伤的工人提供经济支持。然而,寻求补偿通常会导致较差的身心健康结果。这篇综述考察了以前的研究,以调查工人的补偿与心理健康和自我伤害结果之间的关系。跨五个数据库的三层搜索策略确定了将工人薪酬索赔视为暴露或风险因素的研究,与心理健康相关的结果,自我伤害和自杀。其中包括9项全文研究;然而,异质性限制了泛化性。大多数研究支持追求补偿与较差的心理健康和自我伤害结果之间的关联。一些研究将其归因于该系统的特定方面,例如正义感知和索赔系统的导航。研究结果表明,工人的补偿与心理健康或自我伤害结果之间存在关联。不确定的发现强调了进一步研究的必要性。了解追求赔偿的精神影响对于帮助制定更容易获得的赔偿制度至关重要。
    Workers\' compensation systems aim to financially support injured workers. However, seeking compensation often leads to poorer physical and mental health outcomes. This review examines previous studies to investigate the relationship between workers\' compensation and mental health and self-harm outcomes. A three-tiered search strategy across five databases identified studies that examined workers\' compensation claims as an exposure or risk factor, with outcomes related to mental health, self-harm and suicidality. Nine full-text studies were included; however, heterogeneity limited generalizability. Most studies supported an association between pursuing compensation and poorer mental health and self-harm outcomes. Some studies attributed this to specific aspects of the system such as justice perception and navigation of the claims system. Findings suggest an association between workers\' compensation and mental health or self-harm outcomes. Inconclusive findings highlight the need for further research. Understanding the psychiatric impacts of pursuing compensation is crucial to help formulate a more accessible compensation system.
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  • 文章类型: Journal Article
    目的:自杀是青少年死亡的主要原因。越来越多的医疗专业人员被要求在很少的培训下筛查抑郁症状和自杀意念。本文的目的是回顾与自杀念头和行为有关的因素,症状评估,以及为医疗服务提供者提供治疗的初步建议。
    方法:风险和韧性因素的文献综述,评估措施,并对青春期女性的抑郁和自杀意念和行为进行了治疗选择。
    结果:鉴于青春期女性自杀念头和抑郁症状的风险较高,建议对症状进行准确彻底的评估。
    结论:医疗提供者应了解与抑郁和自杀意念相关的症状,以便提供更有效的评估。提供了可用于临床和可能的一线治疗的简短评估措施的建议。
    OBJECTIVE: Suicide is a leading cause of death for adolescents. Medical professionals are increasingly being asked to screen for depressive symptoms and suicidal ideation with little training. The purpose of this paper is to review factors related to suicidal thoughts and actions, assessment of symptoms, and initial suggestions for treatment for medical providers.
    METHODS: A literature review of risk and resilience factors, assessment measures, and treatment options for depression and suicidal ideation and behavior in adolescent females was conducted.
    RESULTS: Given the higher risk of suicidal thoughts and depressive symptoms in adolescent females, accurate and thorough assessment of symptoms is recommended.
    CONCLUSIONS: Medical providers should be aware of symptoms related to depression and suicidal ideation in order to provide more effective assessments. Recommendations for brief assessment measures that can be used in the clinic and possible first line treatments are provided.
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  • 文章类型: Journal Article
    美国青年的自杀和非自杀自我伤害(NSSI)仍然是一个日益严重的严重公共卫生问题。令人震惊的自杀率朝着错误的方向发展,研究人员致力于到2025年弯曲自杀曲线并降低自杀率。了解前提和条件,现有措施,和不同的流行率在少数群体是必要的制定有效的战略,以实现这一目标。本研究对可操作性进行了叙述性回顾,测量,风险因素(例如,枪支和社交媒体),和种族差异,种族,年龄,性别认同,能力,性取向,移民状态,和系统参与(例如,寄养和少年司法)在美国年轻人中自杀和非自杀自我伤害。对研究的影响,实践,以及纳入积极青年发展的政策方法,文化,讨论了青年参与干预的问题。
    Suicidality and non-suicidal self-injury (NSSI) among youth in the United States continue to be a growing and serious public health concern. With alarming rates of suicide trending in the wrong direction, researchers are committed to bending the curve of suicide and reducing rates by 2025. Understanding the antecedents and conditions, existing measures, and disparate prevalence rates across minoritized groups is imperative for developing effective strategies for meeting this goal. This study presents a narrative review of the operationalization, measurement, risk factors (e.g., firearms and social media), and disparities across race, ethnicity, age, gender identity, ability, sexual orientation, immigration statuses, and system involvement (e.g., foster care and juvenile justice) of suicidality and non-suicidal self-harm across youth in the United States. Implications for research, practice, and policy approaches that incorporate positive youth development, cultural, and youth participation in interventions are discussed.
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  • 文章类型: Systematic Review
    有问题的大麻使用在有情绪障碍的人群中非常普遍。这强调了需要了解大麻和大麻素在这一人群中的影响,特别是考虑到娱乐性大麻使用的合法化。
    我们旨在(1)系统地评估横截面和纵向研究,调查大麻使用之间的相互作用,大麻使用障碍(CUD),以及情绪障碍和症状的发生,重点关注重度抑郁症(MDD)和双相情感障碍(BD);(2)检查大麻对MDD和BD的预后和治疗结果的影响。
    遵循PRISMA准则,我们进行了广泛的英语研究,调查大麻对情绪障碍的发展和预后的潜在影响,从开始到2023年11月发表,使用EMBASE,PsycINFO,PubMed,和MEDLINE数据库。
    我们的文献检索确定了3,262项研究,78符合纳入标准。我们发现,在普通人群中,使用大麻与抑郁和躁狂症状的增加有关,此外还增加了发生MDD和BD的可能性。此外,我们观察到大麻的使用与MDD或BD的不良预后有关.
    我们的研究结果表明,使用大麻可能会对发展产生负面影响,当然,MDD和BD的预后。未来精心设计的研究,考虑到类型,金额,以及大麻使用频率,同时解决混杂因素,对于全面了解这种关系至关重要。
    https://www.crd.约克。AC.uk/prospro/display_record.php?ID=CRD42023481634。
    Problematic cannabis use is highly prevalent among people with mood disorders. This underscores the need to understand the effects of cannabis and cannabinoids in this population, especially considering legalization of recreational cannabis use.
    We aimed to (1) systematically evaluate cross-sectional and longitudinal studies investigating the interplay between cannabis use, cannabis use disorder (CUD), and the occurrence of mood disorders and symptoms, with a focus on major depressive disorder (MDD) and bipolar disorder (BD) and; (2) examine the effects of cannabis on the prognosis and treatment outcomes of MDD and BD.
    Following PRISMA guidelines, we conducted an extensive search for English-language studies investigating the potential impact of cannabis on the development and prognosis of mood disorders published from inception through November 2023, using EMBASE, PsycINFO, PubMed, and MEDLINE databases.
    Our literature search identified 3,262 studies, with 78 meeting inclusion criteria. We found that cannabis use is associated with increased depressive and manic symptoms in the general population in addition to an elevated likelihood of developing MDD and BD. Furthermore, we observed that cannabis use is linked to an unfavorable prognosis in both MDD or BD.
    Our findings suggest that cannabis use may negatively influence the development, course, and prognosis of MDD and BD. Future well-designed studies, considering type, amount, and frequency of cannabis use while addressing confounding factors, are imperative for a comprehensive understanding of this relationship.
    https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023481634.
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  • 文章类型: Journal Article
    澳大利亚国防军退伍军人的自杀和自杀死亡人数增加,最近引起了人们的关注。进行了系统的范围审查,以确定,总结和综合有关澳大利亚退伍军人自杀和自杀的现有文献,目的是确定未来的研究重点。
    我们在PubMed/MEDLINE上进行了符合PRISMA标准的系统搜索,Embase和CINAHL数据库,用于报告澳大利亚退伍军人自杀和自杀的主要数据的所有手稿。搜索得到灰色文献和参考列表搜索的补充。任何研究类型的手稿,自越南时代以来,以英语出版,有资格列入。
    共26篇文章和报告,利用各种主要是定量的方法,包括在审查中。调查结果,尤其是在更大和更近的研究中,表明退伍军人的自杀倾向增加。自杀死亡似乎随着军队的过渡而增加。精神疾病被认为是自杀和自杀的重要危险因素。目前的服务被认为是防止自杀的保护因素。关于行动部署对自杀和自杀的影响,有不同的证据。
    确定了与过渡对风险的相对贡献有关的差距,各种社会心理关联(例如,关系,金融,employment),服务前因素以及这些因素在多大程度上是因果关系或中介性的。更好地了解卫生服务的利用也将有助于针对预防工作。这些领域的未来研究是有必要的。
    UNASSIGNED: Increased suicidality and suicide deaths among veterans of the Australian Defence Force have gained recent prominence. A systematic scoping review was conducted to identify, summarise and synthesise the existing literature relating to Australian veteran suicide and suicidality, with the objective of identifying future research priorities.
    UNASSIGNED: We conducted a PRISMA-compliant systematic search on PubMed/MEDLINE, Embase and CINAHL databases for all manuscripts reporting primary data on suicide and suicidality in Australian veterans. The search was supplemented by grey literature and a search of reference lists. Manuscripts of any study type, published in the English language since the Vietnam era, were eligible for inclusion.
    UNASSIGNED: A total of 26 articles and reports, utilising a variety of mostly quantitative approaches, were included in the review. Findings, especially in larger and more recent studies, indicate increased suicidality in the veteran population. Suicide deaths appeared to increase with transition out of the military. Mental illness was identified as an important risk factor for suicide and suicidality. Current service was identified as a protective factor against suicide. There was mixed evidence regarding the impact of operational deployment on suicide and suicidality.
    UNASSIGNED: Gaps were identified in relation to the relative contributions to risk from transition, the various psychosocial correlates (for example, relationships, finances, employment), pre-service factors and the extent to which these are causal or mediating in nature. A better understanding of health service utilisation would also aid in targeting preventive efforts. Future research in these areas is warranted.
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  • 文章类型: Journal Article
    警察谈判人员应对危机和高风险情况,包括精神健康危机,但是对大自然知之甚少,这些事件的频率和特征。本系统综述研究了过去20年中发表的同行评审文章中有关谈判事件中精神障碍和自杀率的文献。在确定的1455篇文章中,11符合研究纳入标准。大多数人只提供间接证据,使用致命的警察遭遇数据,案例回顾和沟通技术分析。没有找到可靠的患病率估计,尽管研究结果表明,自杀是超过一半事件的诱发因素,并且在大多数事件中都存在。精神障碍(主要是物质使用,情绪和精神障碍)也被确定为事件发生之前和期间的重要因素。很少有文章描述这些关键事件的频率或特征。需要进一步的研究来告知前线的反应,为提供这项关键服务的警察提供资源和支持途径。
    Police negotiators respond to crisis and high-risk situations including mental health crises, but little is known about the nature, frequency and characteristics of these events. This systematic review examined literature about mental disorder and suicidality prevalence in negotiation events from peer-reviewed articles published within the last 20 years. Of 1455 articles identified, 11 met study inclusion criteria. Most contributed only indirect evidence using data on fatal police encounters, case reviews and analysis of communication techniques. Reliable prevalence estimates were not found, though findings suggest suicidality was a precipitating factor in more than half of events and was present during most events. Mental disorder (primarily substance use, mood and psychotic disorders) was also identified as a significant factor prior to and during events. Few articles described frequency or characteristics of these critical events. Further research is needed to inform frontline responses, resourcing and support pathways for police providing this crucial service.
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