UNASSIGNED: South Korea has the highest suicide rate among Organisation for Economic Co-operation and Development countries; there is an increasing trend in suicide attempts among middle and high school students. Various factors contribute to the risk of suicide among adolescents, and the perception of suicide prevention has emerged as a significant factor. This study aimed to investigate the association between emotional and behavioral difficulties among middle and high school students and their perceptions of suicide prevention and to explore differences in suicide perception according to age.
UNASSIGNED: A survey was conducted among community middle and high school students, including 530 participants, between 2020 and 2021. Emotional and behavioral difficulties were assessed using the Strengths and Difficulties Questionnaire-Korean version, and participants were asked to complete a questionnaire on the importance and possibility of suicide prevention. A correlation test and analysis of variance were used to examine the relationships between the variables, and suicide awareness was compared according to age.
UNASSIGNED: The participants who displayed higher strength or lower difficulty were more likely to respond positively to suicide prevention measures. They also exhibited high strength and low difficulty levels, thus agreeing with the importance of suicide prevention. Regarding age-related perceptions of suicide, adults aged 20-29 years reported the lowest probability of suicide prevention.
UNASSIGNED: Suicide perceptions influence the incidence of suicide. Therefore, active societal engagement through suicide prevention campaigns and related education is essential to improve such perceptions. Continuous attention and support are required to address this issue.

BACKGROUND: Evidence suggests that having a chronic physical illness (CPI; eg, asthma, diabetes, and epilepsy) is an independent risk factor for suicidality (ie, suicidal ideation or attempts) among youth. Less is known about the mechanisms linking CPI and suicidality. Some evidence suggests that mental illness (eg, depression and anxiety) or neurodevelopmental disorder (eg, attention-deficit/hyperactivity disorder) mediates or moderates the CPI-suicidality association. Missing from the knowledge base is information on the association between having co-occurring CPI and mental illness or neurodevelopmental disorder (MIND) on youth suicidality.
OBJECTIVE: This study uses epidemiological data from the 2019 Canadian Health Survey of Children and Youth (CHSCY) to study the intersection of CPI, MIND, and suicidality in youth. We will estimate prevalence, identify predictors, and investigate psychosocial and service use outcomes for youth with CPI-MIND comorbidity versus other morbidity groups (ie, healthy, CPI only, and MIND only).
METHODS: Conducted by Statistics Canada, the CHSCY collected data from 47,850 children (aged 1-17 years) and their primary caregiving parent. Measures of youth CPI, MIND, family environment, and sociodemographics are available using youth and parent informants. Information on psychiatric services use is available via parent report and linkage to national administrative health data found in the National Ambulatory Care Reporting System and the Discharge Abstract Database, which allow the investigation of hospital-based mental health services (eg, emergency department visits, hospitalizations, and length of stay in hospital). Questions about suicidality were restricted to youths aged 15-17 years (n=6950), which form our analytic sample. Weighted regression-based analyses will account for the complex survey design.
RESULTS: Our study began in November 2023, funded by the American Foundation for Suicide Prevention (SRG-0-008-22). Access to the linked CHSCY microdata file was granted in May 2024. Initial examination of CHSCY data shows that approximately 20% (1390/6950) of youth have CPI, 7% (490/6950) have MIND, 7% (490/6950) seriously considered suicide in the past year, and 3% (210/6950) had attempted suicide anytime during their life.
CONCLUSIONS: Findings will provide estimates of suicidality among youth with CPI-MIND comorbidity, which will inform intervention planning to prevent loss of life in this vulnerable population. Modeling correlates of suicidality will advance understanding of the relative and joint effects of factors at multiple levels-information needed to target prevention efforts and services. Understanding patterns of psychiatric service use is vital to understanding access and barriers to services. This will inform whether use matches need, identifying opportunities to advise policy makers about upstream resources to prevent suicidality. Importantly, findings will provide robust baseline of information on the link between CPI-MIND comorbidity and suicidality in youth, which can be used by future studies to address questions related to the impact of the COVID-19 pandemic and associated countermeasures in this vulnerable population of youth.
UNASSIGNED: DERR1-10.2196/57103.

BACKGROUND: Insomnia has been identified as a potential risk factor for suicidality. However, to date, few studies using the longitudinal-design have examined the underlying mechanism of this relationship. Based on a resilience perspective, this study aimed to investigate the dynamic longitudinal relationships between insomnia, resilience, and suicidality.
METHODS: A total of 5785 freshmen were sampled from a large-scale health-related cohort among Chinese college students. This study spanned six waves, covering the period from 2020 to 2022. Data from T1 to T4 were used because resilience was not measured at baseline (T0) and T5. The cross-lagged panel models and the latent growth curve mediation model were used to examine the longitudinal dynamic relationships between insomnia, resilience, and suicidality.
RESULTS: The results showed that insomnia symptoms and suicidality mutually predicted each other, and resilience played a longitudinal mediating role in linking insomnia symptoms and suicidality.
CONCLUSIONS: Given that resilience served as a mediator in the relation between insomnia symptoms and suicidality, some resilience-oriented prevention and intervention programs will be helpful in reducing the risk of suicide among university students.

Stressful life events (SLEs) and suicidal ideation (SI) are prevalent in persons with major depression disorder (MDD). Less is known about the underlying role of insomnia symptoms in the association between SLEs and SI. This three-wave prospective cohort study sought to investigate the longitudinal association among SLEs, insomnia symptoms, and SI in persons with MDD. The study population included 511 persons with MDD (mean [SD] age, 28.7 [6.7] years; 67.1% were females). Generalized estimated equations (GEEs) were utilized to explore prospective association among exposure of SLEs, insomnia symptoms, and SI. Additionally, a structural equation model (SEM) was employed to estimate the longitudinal mediating effect of insomnia symptoms in the relationship between SLEs and SI. Our study demonstrated that cumulative SLEs were determined to be longitudinally associated with SI in persons with MDD. We further observed that the association between SLEs and SI was significantly mediated by insomnia symptoms. Clinicians assessing persons with MDD, especially those with the history of SLE, could carefully evaluate and promptly treat insomnia symptoms as part of personalized assessment of their depressive illness, thereby achieving early prevention and intervention for suicidal behaviors in persons with MDD.

BACKGROUND: Transgender and non-binary (TNB) individuals are at greater risk of mental health concerns relative to their cisgender peers due to experiences of minority stress. Thus, it is critically important to identify factors that may be protective and buffer the effects of minority stress. This study examined whether romantic relationship involvement and quality buffered effects of TNB minority stress on depressive symptoms and suicidal ideation.
METHODS: A large international sample (n = 1156) of TNB adults (n = 654 partnered; n = 502 single) reported on minority stress experiences, relationship status and quality, and mental health outcomes (i.e., depressive symptoms and suicidal ideation).
RESULTS: The effects of victimization and rejection on depressive symptoms and suicidal ideation were attenuated among partnered individuals. However, once relationship quality was considered, the buffering effects of relationship involvement applied only to those in more satisfying relationships; the stress-buffering effects were not observed among those in distressed relationships. Of particular importance, general interpersonal satisfaction did not act as a minority stress buffer, suggesting there may be unique stress-buffering effects of being in a satisfying romantic relationship on depressive symptoms and suicidal ideation.
CONCLUSIONS: The cross-sectional nature of the current study precludes definitive conclusions regarding causation.
CONCLUSIONS: These findings suggest that romantic involvement may serve a stress-buffering role for TNB adults, but only when these relationships are satisfying. Our results have important theoretical and clinical implications, and further research is needed to investigate the utility of relationship interventions to buffer the effects of TNB minority stress on depressive symptoms and suicidality.

UNASSIGNED: Replicated evidence indicates that ketamine and esketamine reduce measures of suicidality in persons with treatment-resistant depression (TRD). It remains uncertain whether individuals experience worsening of preexisting suicidality with either agent.
UNASSIGNED: The Food and Drug Administration Adverse Event Reporting System (FAERS) database was searched from 1970 and 2019 to 30 September 2023 for reports of suicidal ideation, depression suicidal, suicidal behavior, suicidal attempt, and completed suicide in association with ketamine and esketamine exposure, respectively. We present reporting odds ratios (ROR) significance was determined when the lower limit of the 95% confidence interval (CI) exceeded 1.0. Lithium was used as the control agent.
UNASSIGNED: Observed a higher ROR for suicidal ideation (ROR 7.58, 95% CI 6.34-9.07) and depression suicidal (ROR 14.19, 95% CI 1.80-112.07) with esketamine. Significantly lower RORs were observed for suicide attempt with ketamine (ROR 0.15, 95% CI 0.11-0.21) and esketamine (ROR 0.57, 95% CI 0.48-0.67).
UNASSIGNED: Mixed RORs across aspects of suicidality were observed with ketamine and esketamine. Limitations of the FAERS database prevent any determination of causal effects new onset suicidality to either agent. The lower RORs for suicide attempt with ketamine and esketamine is noted but cannot be interpreted as a direct therapeutic effect.

UNASSIGNED: Identify factors associated with formal and informal mental health help-seeking intentions among college students reporting suicidal thoughts and behaviors (STBs).
UNASSIGNED: College students with STBs in the 2018-2020 Healthy Minds Study.
UNASSIGNED: Cross-sectional secondary analysis using logistic regressions to determine whether demographic (age, sex, race, religion, and finances) and psychosocial factors (mental health, perceptions about mental health help, and barriers) are associated with (in)formal help-seeking intentions.
UNASSIGNED: Positive significant factors for all help-seeking intentions included being in a romantic relationship, Christian, symptoms of anxiety, or positive beliefs and knowledge about therapy efficacy. Depressive symptoms, Black/African American, psychological inflexibility, low perceived need, and barriers were negatively associated. Informal help-seeking was negatively associated with Hispanic/Latinx and personal stigma toward mental health. Formal help-seeking was positively associated with Asian/Asian American and negatively associated with financial stress.
UNASSIGNED: Unique factors were associated with formal or informal help-seeking intentions in college students with STBs.

Non-suicidal self-injury (NSSI) can both precede and co-occur with suicidal attempts (SA). Underlying mechanisms/factors leading to the transition to SA in NSSI youths have been proposed (including the role of social cognition), despite they should be yet confirmed. Therefore, the study aims at exploring the role of the Theory of Mind in the differentiation of a sample of NSSI youngsters (aged 15-24) according to the presence of SA. We divided the sample into 4 groups using the Deliberate Self Harm Inventory (DSHI) and Columbia Suicide Severity Rating Scale (C-SSRS): control group (notNSSInotSA), NSSI without SA (NSSInotSA), NSSI with SA (NSSIplusSA), and SA without NSSI (SAonly). NSSIplusSA patients displayed higher Reading the Mind in the Eyes Test (RMET) scores (indicative of ToM abilities) than both the NSSInotSA (p=0.0016) and SAonly groups (p=0.0198), while SAonly patients showed lower RMET scores compared to the control group (p=0.0214). Multiple regression models used to differentiate NSSInotSA and NSSIplusSA found a significant association between RMET and LOSCS-CSC (Level Of Self-Criticism Scale-Comparative Self-Criticism) (pC=0.0802, pD=0.0016, pG=0.0053). Our findings supported the hypothesis that a hypertrophic affective ToM may possibly be associated with the occurrence of SA in youth NSSI. Further larger and longitudinal studies should confirm these preliminary findings, by exploring all social cognition dimensions.

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.

BACKGROUND: To enable greater use of NIMH Research Domain Criteria (RDoC) in real-world settings, we applied large language models to estimate dimensional psychopathology from narrative clinical notes.
METHODS: We conducted a cohort study using health records from individuals age 18 years or younger evaluated in the psychiatric emergency department of a large academic medical center between November 2008 and March 2015. Outcomes were hospital admission and length of emergency department stay. RDoC domains were estimated using a HIPAA-compliant large language model (gpt-4-1106-preview), and compared to a previously-validated token-based approach.
RESULTS: The cohort included 3,059 individuals (median age 16 (25%-75% 13-18); 1580 (52%) female, 1479 (48%) male; 105 (3.4%) identified as Asian, 329 (11%) as Black, 288 (9.4%) Hispanic, 474 (15%) as another race, and 1863 (61%) as white), of whom 1695 (55%) were admitted. Correlation between LLM-extracted RDoC scores and the token-based scores ranged from small to medium by Kendall\'s Tau (0.14-0.22). In logistic regression models adjusted for sociodemographic and clinical features, admission likelihood was associated with greater scores on all domains, with the exception of sensorimotor, which was inversely associated (p<.001 for all adjusted associations). Tests for bias suggested modest but statistically significant differences in positive valence scores by race (p<.05 for Asian, Hispanic, and Black individuals).
CONCLUSIONS: A large language model extracted estimates of 6 RDoC domains in an explainable manner, which were associated with clinical outcomes. This approach can contribute to a new generation of prediction models or biological investigations based on dimensional psychopathology.