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Child abuse (CA) is a well-established risk factor for suicidal ideation (SI) and suicidal behaviour (SB). However, only few studies have investigated the impact of CA on the persistence of SI over time. Those existing studies have used varying operationalizations to measure the persistence of SI, leading to inconsistent findings. The aim of this study is to examine the persistence of SI by integrating prospective ecological momentary assessments (EMAs) with retrospective structured interviews within one clinical sample. Patients admitted to psychiatric hospitals following an acute suicidal crisis (  = 75) or recent suicide attempt (  = 107) were assessed shortly after admission and then, after discharge, engaged in a 3-week EMA (EMA phase 1), followed by a 6-month EMA period (EMA phase 2). SI was measured using the Self-Injurious Thoughts and Behaviors Interview at baseline and via EMA prompts during both phases. Persistence was indicated by the number of episodes and repeated reports of SI. Multiple regression analyses were conducted to examine the influence of CA on the persistence of SI. Retrospective interview data showed that CA predicted the persistence of SI over the year before a suicidal crisis or suicide attempt (  = .22,  = 2.67,  = .008). Prospective EMA data indicated that CA was associated with greater persistence of passive SI during EMA phase 1 (  = .20,  = 2.19,  = .030) and with higher persistence of active SI in EMA phase 2 (  = .21,  = 1,99,  = .050). This study shows that CA is linked to greater persistence of SI across different methods and time points. It also highlights the importance of distinguishing between passive and active SI when examining persistence.

Bullying is a risk factor for the physical and mental health of adolescents. The advent of new technologies has resulted in a brand-new type of bullying, cyberbullying (CB). The co-occurring effects of cyberbullying and traditional bullying(TB) forms of bullying on adolescent mental health are unclear. We performed a meta-analysis to explore the unique and combined effects of CB and TB on adverse psychological outcomes in victims by conducting a joint study of both types of bullying. By doing so, we provide the basis for a comprehensive community bullying prevention program. The database PubMed, PsyclNFO, and Web of Science were searched for studies from 2010 to 2021. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed for data abstraction, and the NIH tool was used to evaluate study-level risk of bias. 42 studies with 266,888 participants were identified. Random-Effect models were used for our study. The moderator analysis was used to explore the moderator of prevalence. Studies with three groups of victims (TB only, CB only, and Both) and two groups of victims (TB and CB) were compared in subgroup analysis. The mean victimization rate was 24.32% (95% CI 20.32–28.83%) for TB and 11.10% (95% CI 9.12–13.44%) for CB. Roughly one-third of TB victims were also victimized by CB. Conversely, only about one-third of CB victims were free from TB. The estimated ORs for depression, suicidal ideation, suicide attempts, and self-harm in the three-group (TB only, CB only and Both) analysis were: depression [TB only: 3.33 (2.22–5.00); CB only: 3.38 (2.57–4.46); Both: 5.30 (2.43–11.56)]; suicidal ideations [TB only: 3.08 (2.12–4.46); CB only: 3.52 (2.38–5.20); Both: 6.64 (4.14–10.64)]; self-harm [TB only: 2.70 (1.86–3.91); CB only: 3.57 (3.20–3.98); Both: 5.57 (2.11–16.00)]; and suicide attempts: [TB only: 2.61 (1.50–4.55); CB only: 3.52 (2.50–4.98); Both: 7.82 (3.83–15.93)]. TB and CB victimization among youth are a matter of public health concern. Victimization appears to be a marker of greater psychopathological severity, particularly suicide-related issues.

Child maltreatment is a robust risk factor for suicidal ideation and behaviors during adolescence. Elevations in internalizing and externalizing symptomology have been identified as two distinct developmental pathways linking child maltreatment and adolescent risk for suicide. However, recent research suggests that the co-occurrence of internalizing and externalizing symptomology may form a distinct etiological pathway for adolescent risk behaviors. Using the Longitudinal Studies on Child Abuse and Neglect (LONGSCAN) sample (N = 1,314), the present study employed a person-centered approach to identify patterns of concurrent change in internalizing and externalizing psychopathology over five time points from early childhood to adolescence in relation to previous experiences of child maltreatment and subsequent suicidal ideation and behaviors. Results indicated four distinct bivariate externalizing and internalizing growth trajectories. Group membership in a heightened comorbid internalizing and externalizing symptom trajectory mediated the association between childhood abuse and adolescent suicidal ideation and suicidal behaviors. These findings suggest that the concurrent development of externalizing and internalizing symptoms in childhood and adolescence may constitute a unique developmental trajectory that confers risk for suicide-related outcomes.

On average, one person dies by suicide every 40 s. However, extant studies have largely focused on the risk factors for suicidal behaviors, not so much on the formation of suicidal thoughts. Therefore, we attempt to explain how suicidal thoughts arise and persist inside one’s mind using a multifiltering information mechanism called Mindsponge. Bayesian analysis with Hamiltonian Markov Chain Monte Carlo (MCMC) technique was run on a dataset of multinational students (N = 268) of an international university in Japan. Item 9 in the PHQ-9 was used to survey suicidal ideation. The associations among four main variables, namely, (i) suicidal ideation, (ii) help-seeking willingness (informal and formal sources), (iii) sense of connectedness, and (iv) information inaccessibility (represented by being international students), were tested in four models. Sense of connectedness is negatively associated with suicidal ideation, but its effect becomes less impactful when interacting with international students. The impact of a sense of connectedness on informal help-seeking willingness (toward family members) among international students is also lessened. Informal help-seeking is negatively associated with suicidal ideation, whereas formal help is positive. The findings support our assumption on three fundamental conditions for preventing suicidal thoughts: (i) a high degree of belongingness, (ii) accessibility to help-related information, and (iii) healthy perceived cultural responses towards mental health. Therefore, systematically coordinated programs are necessary to effectively tackle suicidal ideation.

Abstract Background Concerns about ethical conflicts, moral distress, and burnout in veterinary practice are steadily increasing. Root causes of these problems have not been rigorously identified. Little research has been done to evaluate the existence of moral distress in North American veterinarians or to explore its impact on career sustainability and poor well-being. Hypothesis/Objectives Ethical conflict and resultant moral distress are common occurrences in contemporary veterinary practice and negatively impact daily practice life, but may not be identified or labeled by veterinarians as such. Animals No animals were used in this study. Methods Mixed methods sequential explanatory design; confidential and anonymous on-line sampling of 889 veterinarians in North America. Results A majority of respondents reported feeling conflict over what care is appropriate to provide. Over 70% of respondents felt that the obstacles they faced that prevented them from providing appropriate care caused them or their staff moderate to severe distress. Seventy-nine percent of participants report being asked to provide care that they consider futile. More than 70% of participants reported no training in conflict resolution or self-care. Conclusions and Clinical Importance Veterinarians report widespread ethical conflict and moral distress across many practice types and demographics. Most veterinarians have little to no training on how to decrease the impact of these problems. Ethical conflict and resulting moral distress may be an important source of stress and poor well-being that is not widely recognized or well defined. Well-researched and effective tools used to decrease moral distress in human healthcare could be adapted to ameliorate this problem.

IntroductionTimely detection of suicidal thoughts is one of the ways to prevent suicide. Use the psychiatric interview only for this purpose in adolescents is often insufficient due to poor compliance. Thus, the search for objective neurophysiological markers of suicidal ideation in adolescents seems to be actual.ObjectivesThe aim of the study was to reveal the relationships between pre-treatment EEG parameters and intensity of suicidal ideation in depressive female adolescents.Methods72 female depressive patients (all right-handed, age 16–25, mean 18,2±2.6 years old) were enrolled in the study. Pre-treatment total HDRS-17 scores varied from 13 to 43 (mean 26,9±7.5). Multichannel eyes closed EEG was recorded, and absolute spectral power was calculated in 8 narrow frequency sub-bands. All patients answered the inventory on intensity of suicidal thoughts. Spearman’s correlations between pre-treatment EEG parameters and suicidal ideation scores were analyzed.ResultsScores of intensity of suicidal ideation correlated positively (p<0.05÷0.01) with values of EEG alpha2 (9-11 Hz) spectral power in F7, F8, F4, C3, C4, T4, P4 and O2 EEG leads, as well as with values of EEG delta (2-4 Hz) spectral power in F7, F3 and C3 EEG leads (p<0.05).ConclusionsThe intensity of suicidal ideation in depressive female adolescents associates with wide propagation of EEG alpha2, especially over the right hemisphere, and with EEG signs of decreased functional state of anterior regions of the left hemisphere. The study supported by RBRF grant No.20-013-00129a.DisclosureNo significant relationships.

Background Inflammatory factors are associated with depression. We seek to investigate the correlation between inflammatory cytokines and prognosis of depression or suicidal ideation and behavior at 3 months in depression patients. Methods Eighty-two depressed outpatients were recruited and treated as usual. Plasma cytokines were measured at baseline. Patients were followed up with Patient Health Questionnaire-9 and suicidal ideation and behavior according to the item 3 of Hamilton depression scale for 3 months. Results Compared to the depression patients with low level of interleukin-1β, the high one had severe depressive symptoms at month 2 and 3 (B 0.92, P  < 0.01; B 0.86, P  = 0.02; respectively). The incidence of suicidal ideation or behavior was 18.3% at 3 months. Depression patients with high levels of tumor necrosis factor-α showed high risk of suicidal ideation and behavior than the low one (OR 2.16, 95% CI 1.00-4.65, P  = 0.04). Conclusions High levels of interleukin-1β and tumor necrosis factor-α were predictive of middle-term severe depressive symptoms and suicidal ideation and behavior respectively.

Detecting suicidal ideation in social media text is a critical public health objective, demanding high-accuracy, deployable models. This study addresses the challenge of achieving clinical reliability within severe hardware constraints. We conduct a comparative fine-tuning benchmark of two Transformer models, DistilBERT and RoBERTa, for binary classification of suicidal risk. The models were optimized on a balanced, 10,000-sample subset of the Reddit Suicide Detection Dataset under CPU-only, low-resource constraints. Prediction robustness is achieved through a simple selection process that chooses the output with the highest confidence score from the two models. RoBERTa achieved a peak F1-Score of 97.4% and 97.40% accuracy, substantially outperforming DistilBERT (94.1% F1-Score). Crucially for safety-critical applications, error analysis confirmed RoBERTa’s ethical superiority by achieving a 40% reduction in False Negatives compared to DistilBERT. The validated framework establishes that high-performance, ethically robust risk detection is feasible under resource limitations, enabling the safe integration of the final classification system with a constrained LLaMA 3 conversational module for proactive support.

Background Understanding relationships between substance use and suicidal ideation and behaviour (SIB) has important public health implications for suicide prevention in low- and middle-income countries (LMICs), where 75% of suicides occur. This systematic review explored the associations between substance use and SIB in LMICs. Methods We searched five databases using a combination of keywords for substance use, SIB and LMICs to identify English-written quantitative studies published between January 2006 and February 2016. Data were extracted to provide an overview of what is known about the topic, highlight gaps in the literature, and explore the implications of current knowledge for suicide prevention. Studies included in the review were assessed for methodological quality using the Scottish Intercollegiate Guidelines Network checklist. Results Analysis of included studies ( N  = 108) demonstrated a consistent positive association between substance use and SIB across all substances (i.e. alcohol, tobacco, cannabis, illicit drugs, non-medical use of prescription drugs), all substance use dimensions (i.e. intoxication, use, and pathological use) and all SIB dimensions (i.e. suicidal ideation, non-fatal suicidal behaviour, and suicide). Most of the available research evidence comes from upper-middle-income countries, only 22% comes from lower-middle-income and low-income countries. Most studies focused on alcohol and tobacco, while neglecting substances such as cannabis, opioids, sedatives, stimulants, misuse of prescription medication, inhalants, and hallucinogens. Most of the studies employed a cross-sectional design, were conducted within a risk-factor paradigm, and provided little information about the potential interaction between variables. Conclusions Public health suicide prevention policy and research in LMICs should take account of the fact that: substance use is a potentially modifiable risk factor; assessment and management of substance use is integral to the care of at-risk patients; reducing consumption and hazardous use of substances in LMICs is important for suicide prevention; and research needs to be expanded to include more theory driven research that focuses on all substance use dimensions and SIB dimensions, while employing more sophisticated statistical methods.

With suicide rates in the United States at an all-time high, individuals experiencing suicidal ideation are increasingly turning to large language models (LLMs) for guidance and support. The objective of this study was to assess the competency of 3 widely used LLMs to distinguish appropriate versus inappropriate responses when engaging individuals who exhibit suicidal ideation. This observational, cross-sectional study evaluated responses to the revised Suicidal Ideation Response Inventory (SIRI-2) generated by ChatGPT-4o, Claude 3.5 Sonnet, and Gemini 1.5 Pro. Data collection and analyses were conducted in July 2024. A common training module for mental health professionals, SIRI-2 provides 24 hypothetical scenarios in which a patient exhibits depressive symptoms and suicidal ideation, followed by two clinician responses. Clinician responses were scored from -3 (highly inappropriate) to +3 (highly appropriate). All 3 LLMs were provided with a standardized set of instructions to rate clinician responses. We compared LLM responses to those of expert suicidologists, conducting linear regression analyses and converting LLM responses to z scores to identify outliers (z score>1.96 or <-1.96; P<0.05). Furthermore, we compared final SIRI-2 scores to those produced by health professionals in prior studies. All 3 LLMs rated responses as more appropriate than ratings provided by expert suicidologists. The item-level mean difference was 0.86 for ChatGPT (95% CI 0.61-1.12; P<.001), 0.61 for Claude (95% CI 0.41-0.81; P<.001), and 0.73 for Gemini (95% CI 0.35-1.11; P<.001). In terms of z scores, 19% (9 of 48) of ChatGPT responses were outliers when compared to expert suicidologists. Similarly, 11% (5 of 48) of Claude responses were outliers compared to expert suicidologists. Additionally, 36% (17 of 48) of Gemini responses were outliers compared to expert suicidologists. ChatGPT produced a final SIRI-2 score of 45.7, roughly equivalent to master's level counselors in prior studies. Claude produced an SIRI-2 score of 36.7, exceeding prior performance of mental health professionals after suicide intervention skills training. Gemini produced a final SIRI-2 score of 54.5, equivalent to untrained K-12 school staff. Current versions of 3 major LLMs demonstrated an upward bias in their evaluations of appropriate responses to suicidal ideation; however, 2 of the 3 models performed equivalent to or exceeded the performance of mental health professionals.