suicide risk

自杀风险
  • 文章类型: Journal Article
    目的:青少年自杀是一个重要的全球公共卫生问题。尽管许多研究调查了影响世界各地青少年自杀风险的因素,在马来西亚的背景下,可用的数据有限,特别是在砂拉越的不同种族社区中。这项研究旨在确定与沙捞越青少年自杀风险相关的因素,马来西亚。
    方法:使用面对面访谈对砂拉越的1,344名青少年进行了基于社区的横断面研究。进行了分层二元逻辑回归分析,以确定确定青少年自杀风险的因素。
    结果:构建了两个预测模型。两种模型都显示女性(OR=1.578,95%CI:1.191,2.092,p=0.001),患有马来人种族(OR=1.733,95%CI:1.236,2.429,p=0.001)和患有疾病的自杀风险显著增加(OR=1.895,95%CI:1.221,2.942,p=0.004)。特别是,模型2,显示出更好的拟合,发现偶尔的宗教活动(OR=1.610,95%CI:1.126,2.303,p=0.009),不良的父母关系(OR=1.739,95%CI:1.035,2.922,p=0.037)和更高的成瘾(OR=1.015,95%CI:1.008,1.022,p=0.001),抑郁(OR=1.919,95%CI:1.241,2.968,p=0.003),和压力(OR=2.707,95%CI:1.689,4.340,p=0.001)评分与自杀风险增加显着相关。
    结论:这项研究揭示了导致砂拉越青少年自杀风险的多种因素。这些发现强调了整体预防策略的重要性,包括心理和社会层面,以降低这一人群的自杀风险。有必要进行进一步的研究,以了解这些因素之间的复杂相互作用,并指导制定有针对性的干预措施。
    OBJECTIVE: Adolescent suicide is a significant global public health concern. Although numerous studies have investigated factors that influence the risk of suicide among adolescents around the world, limited data are available in the Malaysian context, especially among the diverse ethnic communities of Sarawak. This study aimed to determine the factors associated with the risk of suicide among adolescents in Sarawak, Malaysia.
    METHODS: A community-based cross-sectional study was conducted among 1,344 adolescents in Sarawak using face-to-face interviews. Hierarchical binary logistic regression analysis was performed to identify factors that determine the risk of suicide among adolescents.
    RESULTS: Two predictive models were constructed. Both models revealed that being female (OR=1.578, 95 % CI: 1.191, 2.092, p=0.001), having Malay ethnicity (OR=1.733, 95 % CI: 1.236, 2.429, p=0.001) and having a disease significantly increased the risk of suicide (OR=1.895, 95 % CI: 1.221, 2.942, p=0.004). In particular, Model 2, which showed a better fit, found that occasional religious practice (OR=1.610, 95 % CI: 1.126, 2.303, p=0.009), poor parental relationships (OR=1.739, 95 % CI: 1.035, 2.922, p=0.037) and higher addiction (OR=1.015, 95 % CI: 1.008, 1.022, p=0.001), depression (OR=1.919, 95 % CI: 1.241, 2.968, p=0.003), and stress (OR=2.707, 95 % CI: 1.689, 4.340, p=0.001) scores were significantly associated with an increased risk of suicide.
    CONCLUSIONS: This study sheds light on multiple factors that contribute to the risk of suicide among adolescents in Sarawak. These findings underscore the importance of holistic prevention strategies, including psychological and social dimensions, to mitigate the risk of suicide in this population. Further research is warranted to understand the complex interplay of these factors and guide the development of targeted interventions.
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  • 文章类型: Journal Article
    研究表明,炎症细胞因子的增加与自杀风险有关,但自杀风险与炎症因子之间的关系尚不清楚。本研究旨在探讨MDD患者特异性炎症标志物与自杀风险的关系。
    这是一项横断面研究。首先,我们测量并比较了130例MDD患者和130例健康对照(HC)的心理特征和10种外周炎性细胞因子.其次,MDD患者根据自杀风险的严重程度分为4组进行组间比较。最后,采用多元线性回归分析探讨自杀风险的预测因子.
    我们发现,自杀风险较高的组的IL-6、CRP水平较高,TNF-α,CXCL-2和IFN-γ,和较低水平的IL-2和IL-8(均p<0.01)。然而,我们发现MIS组和LS组之间的CRP没有差异(p=0.337).回归模型拟合良好。IL-2,IL-8负预测自杀风险(所有p<0.05),IL-6,CRP,TNF-α,CXCL-2和IFN-γ可以积极预测自杀风险(均p<0.05)。
    本研究采用了自我评估量表。
    IL-6、CRP水平越高,TNF-α,CXCL-2和IFN-γ水平降低MDD患者的IL-2和IL-8,自杀的风险越高。
    UNASSIGNED: Studies have shown that increased inflammatory cytokines are associated with suicide risk, but the relationship between suicide risk and inflammatory cytokines is not clear. This study aimed to investigate the relationship between specific inflammatory markers and suicide risk in patients with MDD.
    UNASSIGNED: This is a cross-sectional study. Firstly, we measured and compared psychological characteristics and 10 peripheral inflammatory cytokines in 130 MDD patients and 130 healthy controls(HC). Secondly, MDD patients were divided into 4 groups according to the severity of suicide risk for comparison between groups. Finally, multiple linear regression analysis was used to explore the predictors of suicide risk.
    UNASSIGNED: We found that the group with higher suicide risk had higher levels of IL-6, CRP, TNF-α, CXCL-2, and IFN-γ, and lower levels of IL-2 and IL-8 (all p<0.01). However, we found no difference in CRP between MIS and LS groups (p=0.337). Regression models were well-fitted. IL-2,IL-8 negatively predicted suicide risk (all p<0.05),IL-6,CRP,TNF-α,CXCL-2, and IFN-γ can positively predict the risk of suicide (all p<0.05).
    UNASSIGNED: This study employed a self-assessment scale.
    UNASSIGNED: The higher the levels of IL-6, CRP, TNF-α, CXCL-2, and IFN-γ and the lower the levels of IL-2 and IL-8 of MDD patients, the higher the risk of suicide.
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  • 文章类型: Journal Article
    酒精使用障碍(AUD)是一种主要的公共卫生问题,心理,和社会后果。尽管监管存在差异,禁欲仍然是主要的治疗目标。解决酒精使用障碍的多面性需要一个全面的方法。
    招募了150名AUD患者(66%为男性),平均年龄为54.10±11.3岁。抑郁症,冲动,述情障碍,和绝望进行了评估,以确定在这些方面是否存在显着差异禁欲(N=72)和活跃饮酒者(N=78)。
    研究发现心理维度得分存在显著差异,活跃的饮酒者表现出更高的抑郁水平,冲动,述情障碍,与禁欲患者相比,绝望。
    AUD患者的治疗结果因监管机构而异,但禁欲仍然是管理AUD最安全和最优选的目标。优先考虑以禁欲为导向的干预措施对于实现长期康复和最小化复发风险至关重要。这些结果强调了AUD和心理健康问题之间的复杂关系,强调需要全面的干预措施来解决饮酒和相关的心理困扰。提倡禁欲(或至少减少饮酒)不仅可以保持心理健康,还可以防止自杀等危及生命的后果。
    UNASSIGNED: Alcohol use disorder (AUD) is a major public health concern due to its various physical, psychological, and social consequences. Despite regulatory differences, abstinence remains the primary treatment objective. Addressing the multifaceted nature of alcohol use disorder requires a comprehensive approach.
    UNASSIGNED: 150 AUD patients (66%male) with a mean age of 54.10 ± 11.3 years were recruited for the study. Depression, impulsivity, alexithymia, and hopelessness were assessed to determine if there were significant differences in these dimensions between abstinent (N=72) and active drinkers (N=78).
    UNASSIGNED: The study found significant differences in the psychological dimensions scores, active drinkers exhibited higher levels of depression, impulsivity, alexithymia, and hopelessness compared to abstinent patients.
    UNASSIGNED: Treatment outcomes for patients with AUD vary between regulatory agencies, but abstinence remains the safest and most preferred objective in managing AUD. Prioritizing abstinence-oriented interventions is crucial for achieving long term recovery and minimizing relapse risk. These results emphasize the intricate relationship between AUD and mental health issues, highlighting the need for comprehensive interventions addressing both alcohol consumption and associated psychological distress. Promoting abstinence (or at least reducing alcohol consumption) not only preserves mental health but also prevents life-threatening consequences such as suicide.
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  • 文章类型: Journal Article
    面临被迫离开祖国的移民青年有紧急的心理健康负担,使他们面临更高的自杀风险。因此,儿科服务提供者在对该人群的护理中纳入自杀筛查和评估至关重要.移民家庭寻求安全,但是,在许多情况下,在移民旅程和东道国社区中遇到不良事件和社会心理不平等。创伤等因素,适应应激,和交叉性影响移民的自杀风险。总结性创伤事件导致移民青年的心理健康负担和自杀结局恶化。文化适应压力会导致东道国的社会边缘化,进一步增加了现有的心理健康负担。最后,交叉性包含复杂的社会文化影响,塑造了流动青年文化认同的发展,影响了自杀风险。通过研究这些因素,作者通过儿科临床实践中的循证工具,提出了在移民青年自杀风险筛查和评估中的文化考虑因素.获得精神卫生服务的障碍,污名,还解决了东道国社区对医疗保健系统的不信任。作者提出了通过创伤知情护理在该人群中进行早期自杀筛查和预防的建议,积极倡导,文化敏感性。
    Migrant youth who face forced displacement from their home countries have an emergent mental health burden, placing them at increased suicide risk. As such, it is crucial for pediatric providers to include suicide screening and assessment in their care for this population. Migrant families seek safety but, in many cases, encounter adverse events and psychosocial inequities in the migration journey and in the host community. Factors such as trauma, acculturative stress, and intersectionality influence suicide risk in migrants. Summative traumatic events contribute to the mental health load and worsen suicidal outcomes in migrant youth. Acculturative stress can lead to social marginalization in the host country, further adding to the existing mental health burden. Finally, intersectionality encompasses complex sociocultural influences, which shape the development of cultural identity in migrant youth and influence suicide risk. By examining these factors, the author advances cultural considerations in screening and assessment for suicide risk in migrant youth through evidence-based tools in pediatric clinical practice. Barriers to access to mental health services, stigma, and distrust of the health care system within the host community are also addressed. The author establishes recommendations for early suicide screening and prevention within this population through trauma-informed care, active advocacy, and cultural sensitivity.
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  • 文章类型: Journal Article
    背景:有时在真实或假定危及生命和/或濒临死亡的情况下,一个人经历了一种被称为濒死体验(NDE)的意识状态的改变。在过去的几十年中,NDE研究领域的普遍地位是,这种经历会导致积极的反自杀态度,并且经验者随后不太可能试图自杀。此外,在NDE研究中忽略了被动自杀意念的重要考虑。目的:质疑人们在NDE后极不可能死于自杀的过早假设。方法:提供并检查了四个NDE后自杀的案例研究。结果:尽管仍需要重要的定量数据,不能再争辩说人们在NDE后不会死于自杀。局限性:只有四例可供检查,NDE对他们自杀的影响程度是不确定的。结论:NDE后的自杀风险需要更多的研究。同时,NDE在自杀评估中不应该被忽视,但是治疗师和其他相关专业人员需要注意NDE后主动或被动自杀意念的任何可能迹象。
    Background: Sometimes during real or presumed life-threatening and/or near-death circumstances, an individual undergoes an altered state of consciousness referred to as a near-death experience (NDE). The prevalent position in the field of NDE research for the last several decades has been that such experiences result in positive antisuicidal attitudes and that it is highly unlikely that experients will try to kill themselves afterward. In addition, the important consideration of passive suicidal ideation is neglected in NDE research. Aims: To question the premature assumption that people are highly unlikely to die by suicide after an NDE. Method: Four case studies of suicide after an NDE are provided and examined. Results: Although important quantitative data are still needed, it can no longer be argued that people do not die by suicide after an NDE. Limitations: Only four cases were available for examination, and the degree of impact that the NDE had on their suicide is uncertain. Conclusion: Much more research is needed on suicide risk post NDE. In the meantime, the NDE should not be ignored in suicide assessments, but therapists and other relevant professionals need to be attentive to any possible indications of either active or passive suicidal ideation post NDE.
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  • 文章类型: Journal Article
    兽医和兽医护士的心理健康问题和自杀风险在文献中有很好的记载。兽医助理的数据被忽视了,however.此外,缺乏有关葡萄牙兽医专业人员的信息。833名葡萄牙兽医专业人员的在线样本(443名兽医,287名护士,和103名助手)在2022年12月至2023年3月之间完成了有关自杀风险和心理健康的自我报告问卷。描述性分析显示,3.5%的受访者在其一生中曾尝试过自杀;17.2%的受访者曾经历过极其严重的抑郁和自杀意念;17.8%和27.0%的受访者曾经历过极其严重的压力和焦虑,分别为27.4%和27.7%的人报告倦怠和同情疲劳,分别。多元线性回归分析显示,有精神病史的专业人士;有抑郁症的当前临床症状,焦虑,和压力;每周工作超过40小时经历更高水平的倦怠,同情疲劳,和自杀的想法。其他变量,比如作为一个女人,作为一名兽医助理,不同意安乐死的动机也预示着一些心理健康问题。葡萄牙兽医专业人员的心理健康问题是一个主要的健康问题。这些专业人士自杀的风险更高,并讨论了临床意义和指南。
    Mental health problems and suicide risk among veterinarians and veterinary nurses are well documented in the literature. Data on veterinary assistants have been overlooked, however. In addition, information on Portuguese veterinary professionals is lacking. An online sample of 833 Portuguese veterinary professionals (443 veterinarians, 287 nurses, and 103 assistants) completed self-report questionnaires about suicide risk and mental health between December 2022 and March 2023. Descriptive analysis revealed that 3.5% of respondents attempted suicide during their lifetime; 17.2% experienced extremely severe depression and suicidal ideation; 17.8% and 27.0% experienced extremely severe stress and anxiety, respectively; and 27.4% and 27.7% reported burnout and compassion fatigue, respectively. Multiple linear regression analysis revealed that professionals with a history of mental illness history; with current clinical symptoms of depression, anxiety, and stress; and working more than 40 hours per week experienced greater levels of burnout, compassion fatigue, and suicide ideation. Other variables such as being a woman, being a veterinary assistant, and disagreeing with motives for euthanasia also predicted some mental health problems. Mental health problems in the Portuguese veterinary professionals are a major health concern. These professionals are at higher risk for suicide, and clinical implications and guidelines are discussed.
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  • 文章类型: Letter
    全科医生(GP)在抑郁症的早期发现和管理以及预防自杀风险中起着关键作用。他们通常是危机中人们接触的第一批医疗保健专业人员。然而,它们的有效性可能受到几个障碍的限制,包括缺乏具体的培训和适当的工具。EAAD-Best项目旨在通过其iFightDepression工具填补这些空白,一个旨在支持患者的在线工具,心理学家,精神病医生,和全科医生在管理抑郁症和预防自杀方面。本文探讨了iFightDepression平台在意大利的实施,评估其对全科医生在对抗抑郁症中赋权的影响。通过对项目收集的数据进行定性和定量分析,强调了意大利全科医生关于他们在心理健康方面的具体培训的“未满足的需求”。在iFD项目开始后的短短7个月内,2,068名意大利全科医生的反应表明全科医生致力于对抗抑郁症和预防自杀风险。
    General Practitioners (GPs) play a key role in the early detection and management of depression and in preventing suicide risk. They are often the first healthcare professionals that people in crisis contact. However, their effectiveness can be limited by several barriers, including the lack of specific training and appropriate tools.The EAAD-Best project aims to fill these gaps through its iFightDepression tool, an online tool designed to support patients, psychologists, psychiatrists, and GPs in managing depression and preventing suicide. This article examines the implementation of the iFightDepression platform in Italy, assessing its impact on the empowerment of GPs in the fight against depression. Through a qualitative and quantitative analysis of the data collected by the project, the \'unmet need\' of GPs\' in Italy regarding their specific training in mental health is highlighted.The response of 2,068 Italian GPs in just 7 months after the start of the iFD project is an expression of GPs\' engagement to work against depression and for suicide risk prevention.
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  • 文章类型: Journal Article
    背景:先前的工作表明,有问题的短视频使用与不良心理有关,生理,和教育成果。随着短视频平台的盛行,这种有问题的行为与自杀意念和自我伤害行为之间的潜在关系尚未得到彻底检查。此外,考虑到有问题的短视频使用的潜在双重性质,特别是它的积极方面,可能存在将这种有问题的行为与SI和SIB联系起来的潜在机制,最终驱使个人走向极端的结果。然而,这种调解途径没有得到严格审查。因此,本研究旨在调查他们之间的关系,并深入研究其潜在机制,特别识别睡眠障碍和抑郁之间的潜在介质。
    方法:采用定量横断面研究设计对来自中国大陆大学一年级和二年级学生的大样本数据进行建模(N=1,099;Mage=19.80岁;男性占51.7%)。
    结果:结果表明,有问题的短视频使用对SI和SIB具有双重影响。一方面,有问题的短视频使用与自杀意念的风险降低直接相关,尝试,和NSSI。另一方面,这种有问题的行为与通过睡眠障碍增加的NSSI风险间接相关,它与自杀意念的风险升高间接相关,尝试,和NSSI通过抑郁症。此外,总的来说,有问题的短视频使用与NSSI呈正相关,但与自杀意念和尝试无关.
    结论:这些研究结果表明,有问题的短视频使用对SI和SIB有双重影响。因此,理解这种有问题的行为对这些复杂的心理状况的真正影响是至关重要的。
    BACKGROUND: Prior work suggests that problematic short video use was associated with adverse psychological, physiological, and educational outcomes. With the prevailing of short video platforms, the potential relationships between this problematic behavior and suicidal ideation and self-injurious behaviors have yet to be thoroughly examined. Besides, considering the potential dual nature of problematic short video use, particularly its positive aspects, a potential mechanism may exist linking such problematic behavior to SI and SIBs, ultimately driving individuals towards extreme outcomes. Nevertheless, such mediation paths have not been rigorously examined. Thus, the current study aimed to investigate their relationships and delve into the underlying mechanism, specifically identifying potential mediators between sleep disturbance and depression.
    METHODS: A quantitative cross-sectional study design was employed to model data derived from a large sample of first- and second-year university students residing in mainland China (N = 1,099; Mage = 19.80 years; 51.7% male).
    RESULTS: Results showed that problematic short video use has a dual impact on SI and SIBs. On the one hand, problematic short video use was directly related to the decreased risk of suicidal ideation, attempts, and NSSI. On the other hand, such problematic behavior was indirectly associated with the increased risk of NSSI through sleep disturbance, and it indirectly related to the elevated risk of suicidal ideation, attempts, and NSSI through depression. Besides, on the whole, problematic short video use was positively associated with NSSI but not suicidal ideation and attempts.
    CONCLUSIONS: These findings indicated that problematic short video use had a dual impact on SI and SIBs. Consequently, it is paramount to comprehend the genuine magnitude of the influence that such problematic behavior holds over these intricate psychological conditions.
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  • 文章类型: Journal Article
    行为警告信号(WS)是个体内部的近期变化,这有助于确定自杀企图的迫在眉睫的风险。然而,那些试图自杀的人对WS的参与不同,目前尚不清楚这些差异是否与未来的自杀行为风险有关。使用132名自杀未遂后到医院就诊的成年人的样本,当前的研究试图确定在WS中参与指数尝试的差异是否可以前瞻性地预测自杀企图,频率的想法,以及出院后12个月自杀意念的强度。对6种行为进行的潜在类别分析(LCA)(即,酒精使用,噩梦,人际负面生活事件,自杀通讯,危险行为,低睡眠,和高睡眠)找到了5级解决方案,最佳地适合数据。一个确定的班级,其特征是在尝试前几个小时参与危险行为,在未来自杀意念和行为的风险方面与其他确定的类别不同。更具体地说,“高风险行为”类的参与者有更高的12个月自杀再尝试率,自杀意念明显更频繁,与支持典型WS模式的参与者相比,在他们的索引尝试后的12个月内,自杀意念的强度明显更差。这些结果在调整各种传统基线协变量时保持不变(例如,抑郁症状)。当前的研究表明,行为WS的模式可以用作他们自己的预后指标,以预测报告最近自杀未遂的高危个体的未来自杀意念和行为。这可以为出院后的临床干预和预防工作提供信息。
    Behavioral warning signs (WS) are near-term changes within individuals, which aid in determining imminent risk for suicide attempts. However, those who attempt suicide differ in their engagement of WS, and it is unclear if these differences relate to future risk of suicidal behavior. Using a sample of 132 adults presenting to a hospital following a suicide attempt, the current study sought to determine if differences in engagement in WS for the index attempt prospectively predicted suicide attempt, frequency of ideation, and intensity of suicide ideation 12 months post discharge. Latent class analyses (LCAs) conducted on 6 behaviors (i.e., alcohol use, nightmares, interpersonal negative life events, suicide communication, risky behavior, low sleep, and high sleep) found a 5-class solution optimally fit the data. One identified class, characterized by engagement in risky behaviors the hours before an attempt differed from other identified classes in terms of risk for future suicidal ideation and behaviors. More specifically, participants in \"High Risky Behavior\" class had higher rates of 12-month suicide reattempt, significantly more frequent suicide ideation, and significantly worse intensity of suicide ideation during the 12 months following their index attempt compared to participants endorsing typical patterns of WS. These results held when adjusting for various traditional baseline covariates (e.g., depressive symptoms). The current study demonstrates that patterns of behavioral WS may be utilized as their own prognostic indicator of future suicidal ideation and behaviors among high-risk individuals reporting a recent suicide attempt, which can inform post-discharge clinical intervention and prevention efforts.
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  • 文章类型: Journal Article
    背景:先前的一些横断面研究调查了自杀预防热线来电者自杀意念或自杀企图的相关因素;然而,几乎没有任何证据来自纵向研究。此外,目前尚不清楚某些自杀风险因素的改善是否可以减少随后的自杀行为的发生。这项纵向研究的重点是自杀风险高的青少年和年轻成年呼叫者中随后自杀行为的危险因素,旨在填补这一空白。
    方法:这项研究招募了12-25岁的高危人群到中国全国性的自杀预防热线。潜在风险因素,包括希望,心理困扰,抑郁症,自杀未遂史,酒精或物质滥用,和急性生活事件,在索引调用期间进行了检查,和希望的改善,心理困扰,在结束索引调用之前,对自杀意图进行了评估。招募的呼叫者在索引呼叫后12个月进行了随访。主要结果是在随访期间发生自杀行为(自杀未遂或自杀死亡)。Kaplan-Meier存活曲线,对数秩测试,采用Cox比例风险模型。
    结果:在随访期间,1656名高危青少年和年轻成年来电者中的271人企图自杀,七个打电话的人自杀了.在调整人口统计学变量后,低希望(危险比[HR]=2.03,95%置信区间[CI]=[1.47,2.80])在指标调用开始时与随后的自杀行为的高风险相关,而在指数呼叫期间,心理困扰(HR=0.61,95CI[0.41,0.89])和自杀意图(HR=0.56,95CI[0.38,0.84])的改善降低了后续自杀行为的风险.此外,酒精或物质滥用(模型2,HR=1.65,95CI[1.11,2.46])和自杀未遂史(模型1:一次发作,HR=1.96,95CI=[1.05,3.66];两次或更多次发作,HR=2.81,95CI[1.59,4.96]。模型2:一集,HR=2.26,95CI[1.06,4.82];两次或两次以上发作:HR=3.28,95CI[1.63,6.60])是随后自杀行为的危险因素。
    结论:虽然自杀预防热线操作员对高危青少年和年轻成年来电者进行简短的心理干预,应优先考虑希望较低的来电者,并减轻来电者的高度心理困扰和自杀意图。
    BACKGROUND: A few previous cross-sectional studies investigated correlated factors of suicidal ideation or suicide attempts among suicide prevention hotline callers; however, scarcely any evidence was from a longitudinal study. In addition, it is still unclear whether improvements in some suicide risk factors could reduce the occurrence of subsequent suicidal acts. This longitudinal study focusing on the risk factors for subsequent suicidal acts among adolescent and young adult callers with high suicide risk aims to fill this gap.
    METHODS: This study recruited 12-25-year-old high-risk callers to a China nationwide suicide prevention hotline. Potential risk factors, including hopefulness, psychological distress, depression, history of suicide attempts, alcohol or substance misuse, and acute life events, were examined during the index calls, and improvements in hopefulness, psychological distress, and suicide intent were assessed before ending the index calls. The recruited callers were followed up 12 months after their index calls. The primary outcome was the occurrence of suicidal acts (suicide attempts or suicide death) during follow-up. Kaplan-Meier survival curves, log-rank tests, and Cox proportional hazards model were used.
    RESULTS: During the follow-up period, 271 of 1656 high-risk adolescent and young adult callers attempted suicide, and seven callers died by suicide. After adjusting for demographic variables, low hopefulness (Hazard Ratio [HR] = 2.03, 95% Confidence Interval [CI]=[1.47, 2.80]) at the beginning of the index call was associated with a higher risk for subsequent suicidal acts, whereas improvements in psychological distress (HR = 0.61, 95%CI [0.41, 0.89]) and suicidal intent (HR = 0.56, 95%CI [0.38, 0.84]) during the index call reduced the risk of subsequent suicidal acts. In addition, alcohol or substance misuse (Model 2, HR = 1.65, 95%CI [1.11, 2.46]) and suicide attempt history(Model 1: one episode, HR = 1.96, 95%CI=[1.05, 3.66]; two or more episodes, HR = 2.81, 95%CI [1.59, 4.96]. Model 2: one episode, HR = 2.26, 95%CI [1.06, 4.82]; two or more episodes: HR = 3.28, 95%CI [1.63, 6.60]) were risk factors for subsequent suicidal acts.
    CONCLUSIONS: While suicide prevention hotline operators deliver brief psychological interventions to high-risk adolescent and young adult callers, priority should be given to callers with low hopefulness and to the alleviation of callers\' high psychological distress and suicide intent.
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