Separated men are nearly 5 times more likely to take their lives than married men

Macdonald, J., Wilson, M., & Seidler, Z. (2025).

The Conversation.

Here is an excerpt:

What did we find?

We brought together findings from 75 studies across 30 countries worldwide, involving more than 106 million men.

We focused on understanding why relationship breakdown can lead to suicide in men, and which men are most at risk. We might not be able to prevent breakups from happening, but we can promote healthy adjustment to the stress of relationship breakdown to try and prevent suicide.

Overall, we found divorced men were 2.8 times more likely to take their lives than married men.

For separated men, the risk was much higher. We found that separated men were 4.8 times more likely to die by suicide than married men.

Most strikingly, we found separated men under 35 years of age had nearly nine times greater odds of suicide than married men of the same age.

The short-term period after relationship breakdown therefore appears particularly risky for men’s mental health.

What are these men feeling?

Some men’s difficulties regulating the intense emotional stress of relationship breakdown can play a role in their suicide risk. For some men, the emotional pain tied to separation – deep sadness, shame, guilt, anxiety and loss – can be so intense it feels never-ending.

Many men are raised in a culture of masculinity that often encourages them to suppress or withdraw from their emotions in times of intense stress.

Some men also experience difficulties understanding or interpreting their emotions, which can create challenges in knowing how to respond to them.

The information is here.

Here is a summary:

Separated men face a significantly higher risk of suicide compared to married men—nearly five times as likely—and twice as likely as divorced men. This suggests the immediate post-separation period is a critical window of vulnerability. Possible contributing factors include a lack of institutional support (unlike divorce, separation often lacks structured legal or counseling resources), social isolation, and heightened financial and parenting stressors. For psychologists, this highlights the need for proactive mental health screening, targeted interventions to bolster coping skills and social support, and gender-sensitive approaches to engage men who may be reluctant to seek help. The findings underscore separation as a high-risk life transition requiring focused suicide prevention efforts.

Addictive Screen Use Trajectories and Suicidal Behaviors, Suicidal Ideation, and Mental Health in US Youths

Xiao, Y., Meng, Y., Brown, T. T. et al. (2025).

JAMA.

https://doi.org/10.1001/jama.2025.7829

Key Points

Question  Are addictive screen use trajectories associated with suicidal behaviors, suicidal ideation, and mental health outcomes in US youth?

Findings  In this cohort study of 4285 US adolescents, 31.3% had increasing addictive use trajectories for social media and 24.6% for mobile phones over 4 years. High or increasing addictive use trajectories were associated with elevated risks of suicidal behaviors or ideation compared with low addictive use. Youths with high-peaking or increasing social media use or high video game use had more internalizing or externalizing symptoms.

Meaning  Both high and increasing addictive screen use trajectories were associated with suicidal behaviors, suicidal ideation, and worse mental health in youths.

Here are some thoughts:

The study identified distinct patterns of addictive use for social media, mobile phones, and video games. For social media and mobile phones, three trajectories were found: low, increasing, and high-peaking. For video games, two trajectories were identified: low and high addictive use. A significant finding was that nearly one-third of participants had an increasing addictive use trajectory for social media or mobile phones, beginning around age 11. Almost half of the youth had a high addictive use trajectory for mobile phones, and over 40% had a high addictive use trajectory for video games.

The findings indicate that high or increasing addictive screen use trajectories were associated with an elevated risk of suicidal behaviors and ideation compared to low addictive use. For example, an increasing addictive use of social media had a risk ratio of 2.14 for suicidal behaviors, and high-peaking addictive social media use had a risk ratio of 2.39 for suicidal behaviors. High addictive use of mobile phones was associated with increased risks of suicidal behaviors and ideation. Similarly, high addictive video game use was linked to a higher risk of suicidal behaviors and ideation.

This research underscores the importance of considering longitudinal trajectories of addictive screen use in clinical evaluations of risk and in the development of interventions to improve youth mental health.

Management of Suicidal Thoughts and Behaviors in Youth. Systematic Review

Sim L, Wang Z, et al (2025).

Prepared by the Mayo Clinic Evidence-based 

Practice Center under

The information is here.

Abstract

Background: Suicide is a leading cause of death in young people and an escalating public health crisis. We aimed to assess the effectiveness and harms of available treatments for suicidal thoughts and behaviors in youths at heightened risk for suicide. We also aimed to examine how social determinants of health, racism, disparities, care delivery methods, and patient demographics affect outcomes.

Methods: We conducted a systematic review and searched several databases including MEDLINE®, Embase®, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and others from January 2000 to September 2024. We included randomized clinical trials (RCTs), comparative observational studies, and before-after studies of psychosocial interventions, pharmacological interventions, neurotherapeutics, emerging therapies, and combinations therapies. Eligible patients were youths (aged 5 to 24 years) who had a heightened risk for suicide, including youths who have experienced suicidal ideation, prior attempts, hospital discharge for mental health treatment, or command hallucinations; were identified as high risk on validated questionnaires; or were from other at-risk groups. Pairs of independent reviewers selected and appraised studies. Findings were synthesized narratively.

Results: We included 65 studies reporting on 14,534 patients (33 RCTs, 13 comparative observational studies, and 19 before-after studies). Psychosocial interventions identified from the studies comprised psychotherapy interventions (33 studies, Cognitive Behavior Therapy, Dialectical Behavior Therapy, Collaborative Assessment and Management of Suicidality, Dynamic Deconstructive Psychotherapy, Attachment-Based Family Therapy, and Family-Focused Therapy), acute (i.e., 1 to 4 sessions/contacts) psychosocial interventions (19 studies, acute safety planning, family-based crisis management, motivational interviewing crisis interventions, continuity of care following crisis, and brief adjunctive treatments), and school/community-based psychosocial interventions (13 studies, social network interventions, school-based skills interventions, suicide awareness/gatekeeper programs, and community-based, culturally tailored adjunct programs). For most categories of psychotherapies (except DBT), acute interventions, or school/community-based interventions, there was insufficient strength of evidence and uncertainty about suicidal thoughts or attempts. None of the studies evaluated adverse events associated with the interventions. The evidence base on pharmacological treatment for suicidal youths was largely nonexistent at the present time. No eligible study evaluated neurotherapeutics or emerging therapies.

Conclusion: The current evidence on available interventions intended for youths at heightened risk of suicide is uncertain. Medication, neurotherapeutics, and emerging therapies remain unstudied in this population. Given that most treatments were adapted from adult protocols that may not fit the developmental and contextual experience of adolescents or younger children, this limited evidence base calls for the development of novel, developmentally and trauma-informed treatments, as well as multilevel interventions to address the rising suicide risk in youths.

The Role of Emotion Dysregulation in Understanding Suicide Risk: A Systematic Review of the Literature

Rogante, E.,  et al. (2024).

Healthcare, 12(2), 169.

https://doi.org/10.3390/healthcare12020169

Abstract

Suicide prevention represents a global imperative, and efforts to identify potential risk factors are intensifying. Among these, emotional regulation abilities represent a transdiagnostic component that may have an impactful influence on suicidal ideation and behavior. Therefore, the present systematic review aimed to investigate the association between emotion dysregulation and suicidal ideation and/or behavior in adult participants. The review followed PRISMA guidelines, and the research was performed through four major electronic databases (PubMed/MEDLINE, Scopus, PsycInfo, and Web of Science) for relevant titles/abstracts published from January 2013 to September 2023. The review included original studies published in peer-reviewed journals and in English that assessed the relationship between emotional regulation, as measured by the Difficulties in Emotional Regulation Scale (DERS), and suicidal ideation and/or behavior. In total, 44 studies were considered eligible, and the results mostly revealed significant positive associations between emotion dysregulation and suicidal ideation, while the findings on suicide attempts were more inconsistent. Furthermore, the findings also confirmed the role of emotion dysregulation as a mediator between suicide and other variables. Given these results, it is important to continue investigating these constructs and conduct accurate assessments to implement effective person-centered interventions.

Here are some thoughts. I used this research in a recent article.

This systematic review explores the role of emotion dysregulation in understanding suicide risk among adults, analyzing 44 studies that assess the association between emotional regulation difficulties—measured primarily by the Difficulties in Emotion Regulation Scale (DERS)—and suicidal ideation and behavior. The findings largely support a significant positive correlation between emotion dysregulation and suicidal ideation across both clinical and nonclinical populations. Specific dimensions of emotion dysregulation, such as impulsivity, lack of emotional clarity, and ineffective use of regulatory strategies, were particularly linked to increased suicidal thoughts. However, results regarding suicide attempts were more inconsistent, with some studies showing a strong link while others found no significant associations.

The review also highlights the mediating role of emotion dysregulation between various risk factors (e.g., childhood trauma, psychopathy, depression) and suicidal outcomes. Emotion dysregulation appears to amplify suicide risk by influencing how individuals cope with psychological pain and stress. Despite methodological limitations—including reliance on self-report measures, sample heterogeneity, and limited longitudinal data—the evidence suggests that improving emotional regulation could be a valuable target for suicide prevention strategies. The authors recommend further research using robust statistical methods and comprehensive assessments to better understand causal pathways and enhance intervention effectiveness.

Preventing Veteran Suicide: a landscape analysis of existing programs, their evidence, and what the next generation of programs may look like.

Ramchand, R. et al. (2025, April 16).

RAND.

https://www.rand.org/pubs/research_reports/RRA3635-1.html

Preventing veteran suicide is a national priority for government, veteran advocacy groups, and the private sector. This attention has led many individuals and organizations to leverage their expertise to create, expand, or promote activities that they hope will prevent future deaths. While the number and array of diverse approaches reflect a nation committed to a common goal, they also can create confusion. Advances in technology also generate questions about the future of veteran suicide prevention.

In this report, the authors analyze current and emerging activities to prevent veteran suicide. They introduce the RAND Suicide Prevention Activity Matrix, a framework that organizes current approaches, how they complement each other, how they might change, their evidence for preventing veteran suicide, and why they might (or might not) work. This framework places 26 categories of activities in a matrix based on whom the activity targets (the veteran directly, those who regularly interact with the veteran, or social influences) and what the activity is intended to accomplish (address social conditions, promote general well-being, address mental health symptoms, provide mental health supports, and prevent suicide crises). Entities committed to preventing veteran suicide and seeking to design evidence-informed, comprehensive suicide prevention strategies will benefit from the framework and evidence reviewed in this report, in addition to the recommendations the authors developed from these data.

Key Findings

• The authors identified 307 suicide prevention programs, 156 of which were currently operating and 226 that were proposed to expand existing services or initiate new programs.
• These organizations' suicide prevention activities were categorized across 26 suicide prevention activity categories and organized into the RAND Suicide Prevention Activity Matrix.
• Among the 156 current programs, there is a strong focus on those that aim to build social connections and those that offer case management or noncrisis psychological counseling.
• Veterans are the primary focus of most current programs, but many programs are also offered to family members and friends — often in addition to serving veterans directly.
• Nonprofit organizations operate most current programs, and just under half of the programs are accessed virtually or via a combination of in-person and virtual access.
• Among the 226 proposed programs, the most common types are multifunctional digital health platforms (mobile health applications), suicide risk assessment tools, and real-time monitoring.
• The following activity types have a robust evidence base for preventing suicide: community-based suicide prevention initiatives, suicide risk assessment, noncrisis psychological treatment, crisis psychological clinical services, and pharmacotherapy (for those with mental health conditions).

Recommendations

• Organizations charged with developing, investing in, implementing, or evaluating comprehensive suicide prevention strategies should prioritize implementation of evidence-based prevention activities.
• When implementing a suicide prevention activity, organizations should consider the context in which the activity is intended to be delivered.
• Organizations should conduct a needs assessment to identify gaps in suicide prevention activities.
• Organizations should apply different thresholds of evidence when considering different suicide prevention activities.
• Organizations should invest strategically in research that can fill notable gaps in knowledge.

The Interpersonal Theory of Suicide: State of the Science

Robison, M., et al. (2024).

Behavior Therapy, 55(6), 1158–1171.

https://doi.org/10.1016/j.beth.2024.04.008

Abstract

In this state-of-the-science review, we summarize the key constructs and concepts within the interpersonal theory of suicide. The state of the scientific evidence regarding the theory is equivocal, and we explore the reasons for and some consequences of that equivocal state. Our particular philosophy of science includes criteria such as explanatory reach and pragmatic utility, among others, in addition to the important criterion of predictive validity. Across criteria, the interpersonal theory fares reasonably well, but it is also true that it struggles somewhat—as does every other theory of suicidality—with stringent versions of predictive validity. We explore in some depth the implications of the theory and its status regarding people who are minoritized. Some implications and future directions for research are also presented.

Highlights

• The full Interpersonal Theory of Suicide (ITPS) has yet to be empirically tested.

• However, the ITPS provides explanation, clinical utility, and predictive validity.

• The IPTS may be intensified by non-humanness, lack of agency, and discrimination.

• Minoritized people may benefit by integrating the IPTS and Minority Stress Theory.

Here are some thoughts:

The article reviews the empirical and theoretical foundations of the Interpersonal Theory of Suicide (ITS), which seeks to explain suicidal ideation and behavior. The theory identifies four central constructs: thwarted belongingness (a perceived lack of meaningful social connections), perceived burdensomeness (the belief that one’s existence is a burden on others), hopelessness about these states improving, and the capability for suicide (fearlessness about death and high pain tolerance). While thwarted belongingness and perceived burdensomeness contribute to suicidal ideation, the capability for suicide differentiates those who act on these thoughts.

The article highlights that perceived burdensomeness has the strongest link to suicidality, driven by a tragic misperception that others would be better off without the individual. Thwarted belongingness emphasizes subjective feelings of isolation rather than objective social circumstances. Hopelessness compounds these states by fostering a belief that they are permanent. The capability for suicide, often acquired through exposure to painful experiences or self-harm, explains why only some individuals transition from ideation to action.

Despite its clinical utility, testing ITS comprehensively remains challenging due to measurement limitations and the complexity of suicide. For example, constructs like perceived burdensomeness overlap with suicidal ideation in measurement tools, complicating empirical validation. Additionally, the theory’s applicability across diverse populations, including minoritized groups, requires further exploration.

Clinicians can use ITS to identify risk factors and tailor interventions—such as fostering social connections or addressing distorted beliefs about burdensomeness. However, its predictive validity is limited, underscoring the need for ongoing refinement and research into its constructs and applications.

Zero Suicide Model Implementation and Suicide Attempt Rates in Outpatient Mental Health Care

Ahmedani, B. K., et al. (2025).

JAMA Network Open, 8(4), e253721.

https://doi.org/10.1001/jamanetworkopen.2025.3721

Key Points

Question  Is implementation of the Zero Suicide model in outpatient mental health care associated with reductions in suicide attempts?

Findings  This quality improvement study of 55 354 to 451 837 individuals per month aged 13 years or older found that implementation of the Zero Suicide model was associated with a reduction in suicide attempt rates in 3 of 4 health systems, while the fourth system experienced a lower sustained rate. Two systems that implemented the model before the observation period maintained low or declining rates.

Meaning  Findings from this study support implementation of the Zero Suicide model in outpatient mental health care.

Abstract (partial) 

Importance  Suicide is a major public health concern, and as most individuals have contact with health care practitioners before suicide, health systems are essential for suicide prevention. The Zero Suicide (ZS) model is the recommended approach for suicide prevention in health systems, but more evidence is needed to support its widespread adoption.

Objective  To examine suicide attempt rates associated with implementation of the ZS model in outpatient mental health care within 6 US health systems.

Conclusions and Relevance  In this quality improvement study, ZS model implementation was associated with a reduction in suicide attempt rates among patients accessing outpatient mental health care at most study sites, which supports widespread efforts to implement the ZS model in these settings within US health systems.

The study is linked above.

Here are some thoughts:

This study examined the impact of the Zero Suicide (ZS) model on suicide attempt rates within outpatient mental health care settings across six U.S. health systems.  The ZS model, a recommended approach for suicide prevention in health systems, was implemented in four of the health systems during the study period, while the other two had already adopted the model prior to the study.    

The study found that the implementation of the ZS model was associated with a reduction in suicide attempt rates in three of the four health systems that implemented the model during the study period.  The fourth system showed a sustained lower rate of suicide attempts following implementation.  The two health systems that had implemented the ZS model before the study period maintained low or declining rates of suicide attempts.    

This research is important for psychologists because it provides evidence supporting the effectiveness of the ZS model in reducing suicide attempts in outpatient mental health care settings.  Given that suicide is a major public health concern and that a large proportion of individuals who attempt suicide have had contact with the health system prior to their attempt, the study's findings highlight the critical role of health systems in suicide prevention.  The results of this study support the implementation of the ZS model in outpatient mental health care.

Applying ideation-to-action theories to predict suicidal behavior among adolescents

Okado, I., Floyd, F. J. et al. (2021).

Journal of Affective Disorders, 295, 1292–1300.

https://doi.org/10.1016/j.jad.2021.08.137

Abstract

Background

Although many risk factors for adolescent suicidal behavior have been identified, less is known about distinct risk factors associated with the progression from suicide ideation to attempts. Based on theories grounded in the ideation-to-action framework, we used structural equation modeling to examine risk and protective factors associated with the escalation from suicide ideation to attempts in adolescents.

Methods

In this cross-sectional study, data from the 2013 and 2015 Hawaii High School Youth Risk Behavior Surveys (N = 8,113) were analyzed. The sample was 54.0% female and racially/ethnically diverse. Risk factors included depression, victimization, self-harm, violent behavior, disinhibition, and hard substance use, and protective factors included adult support, sports participation, academic achievement and school safety.

Results

One in 6 adolescents (16.4%) reported suicide ideation, and nearly 1 in 10 (9.8%) adolescents had made a suicide attempt. Overall, disinhibition predicted the escalation to attempts among adolescents with suicide ideation, and higher academic performance was associated with lower suicide attempt risk. Depression and victimization were associated with suicide ideation.

Limitations

This study examined data from the Youth Risk Behavior Survey, and other known risk factors such as anxiety and family history of suicide were not available in these data.

Conclusions

Findings provide guidance for targets for clinical interventions focused on suicide prevention. Programs that incorporate behavioral disinhibition may have the greatest potential for reducing suicide attempt risk in adolescents with suicidal thoughts.

Highlights

• Depression and victimization are associated with suicide ideation in adolescents.

• Disinhibition potentiates suicide attempt risk in adolescents with suicide ideation.

• Higher academic performance protects against adolescent suicide attempt.

Risk of Attempted and Completed Suicide in Persons Diagnosed With Headache

Elser, H., Farkas, D. K., et al. (2025).

JAMA Neurology.

https://doi.org/10.1001/jamaneurol.2024.4974

Abstract

Importance  Although past research suggests an association between migraine and attempted suicide, there is limited research regarding risk of attempted and completed suicide across headache disorders.

Objective  To examine the risk of attempted and completed suicide associated with diagnosis of migraine, tension-type headache, posttraumatic headache, and trigeminal autonomic cephalalgia (TAC).

Design, Setting, and Participants  This was a population-based cohort study of Danish citizens from 1995 to 2020. The setting was in Denmark, with a population of 5.6 million people. Persons 15 years and older who were diagnosed with headache were matched by sex and birth year to persons without headache diagnosis with a ratio of 5:1. Data analysis was conducted from May 2023 to May 2024.

Conclusions and Relevance  Results of this cohort study revealing the robust and persistent association of headache diagnoses with attempted and completed suicide suggest that behavioral health evaluation and treatment may be important for these patients.

Here are some thoughts:

This study identified a significant association between headache diagnoses and elevated risks of both attempted and completed suicide. The analysis revealed a robust and persistent link, with individuals diagnosed with headaches facing a disproportionately higher likelihood of suicidal behavior compared to the general population. While the study did not specify headache subtypes, the findings underscore the need for heightened mental health screening and intervention in patients with headache disorders. Researchers emphasized integrating suicide risk assessments into routine clinical care for this vulnerable population.

Implications for Practice

The results align with broader calls to address mental health comorbidities in chronic pain conditions. Primary care providers, in particular, are urged to adopt proactive strategies, such as safety planning and risk screening, to mitigate suicide risk in patients with headaches. Psychologists also need to identify headaches as a risk for suicide.

Federal Agency Dedicated to Mental Illness and Addiction Faces Huge Cuts

Trump is Burning Down SAMSHA

SAMSHA Braces for 50% Staff Reduction

The New York Times

Originally posted March 13, 2025

Federal Agency Dedicated to Mental Illness and Addiction Faces Huge Cuts The Substance Abuse and Mental Health Services Administration has already closed offices and could see staff numbers reduced by 50 percent.

Every day, Dora Dantzler-Wright and her colleagues distribute overdose reversal drugs on the streets of Chicago. They hold training sessions on using them and help people in recovery from drug and alcohol addiction return to their jobs and families.

They work closely with the federal government through an agency that monitors their productivity, connects them with other like-minded groups and dispenses critical funds that keep their work going.

But over the last few weeks, Ms. Wright’s phone calls and emails to Washington have gone unanswered. Federal advisers from the agency’s local office — who supervise her group, the Chicago Recovering Communities Coalition, as well as addiction programs throughout six Midwestern states and 34 tribes — are gone. “We just continue to do the work without any updates from the feds at all,” Ms. Wright said. “But we’re lost.”

The article is paywalled here.

Here is a summary:

The Substance Abuse and Mental Health Services Administration (SAMHSA), a federal agency addressing mental illness and addiction, is facing significant staff cuts, potentially up to 50%. This is causing concern among those who rely on the agency for support and funding, such as community organizations providing addiction recovery services.   

SAMHSA plays a critical role in overseeing the 988 suicide hotline, regulating opioid treatment clinics, funding drug courts, and providing resources for addiction prevention and treatment. While overdose fatalities have been declining, they remain significantly higher than in 2019, and experts fear that these cuts will hinder the agency's ability to address the ongoing behavioral health crises.   

The cuts are happening through layoffs and "voluntary separations," and there is speculation that SAMHSA could be folded into another agency or have its funding and staff reduced to 2019 levels. This has raised concerns about reduced oversight, accountability, and the potential for negative impacts on relapse rates and overall health outcomes.

Making progress in reducing veteran suicide rates

Wes Martin

Stars and Stripes

Originally posted 23 Jan 25

According to the Department of Veterans Affairs and Centers for Disease Control and Prevention, the suicide rate among veterans is nearly 60% higher than the general population. It is one of the leading causes of deaths among veterans under the age of 45. Post-traumatic stress disorder being left untreated or mistreated adds to the problem. PTSD leads to overwhelming feelings of hopelessness, emotional numbness and isolation. These are directly linked to suicidal ideation. Flashbacks, nightmares, hypervigilance, anger and avoidance behaviors severely disrupt daily functioning, further exacerbating depression and making recovery feel impossible. Self-medicating with substances like alcohol or drugs — common for those suffering — can further compound the issue.

A broad stroke of traditional medication and talk therapy is not enough to combat the complexities involved in this crisis. Often when addressing PTSD and other mental health related treatments, heavy pharmaceuticals will be applied. This method is rife with dangerous drug side-effects coinciding with the risk of reliance and addiction to a drug not specifically adept at correcting the misfiring brain chemistry. It can be a “wet-blanket” effect, leaving patients feeling empty or zombie-like while simply going through the motions of life.

Emerging treatments such as psychedelics are being explored with comprehensive medical evaluation as long-term recovery options. Ibogaine is one example. Derived from the African plant Tabernanthe iboga, ibogaine has been studied for its potential to alleviate symptoms of PTSD, depression and anxiety. Recent research indicates that ibogaine can effectively reduce those symptoms in veterans with traumatic brain injuries.

The information is here.

Here are some thoughts:

The suicide rate among veterans is nearly 60% higher than the general population, with PTSD being a major contributor. Untreated PTSD leads to hopelessness, emotional numbness, and isolation, often exacerbated by self-medication with substances. Traditional treatments like pharmaceuticals and talk therapy are often insufficient, risking side effects and addiction without addressing root causes. Emerging treatments, such as ibogaine—a psychedelic derived from the African plant Tabernanthe iboga—show promise. Ibogaine promotes neuroplasticity and may "reset" brain pathways damaged by trauma, potentially reversing PTSD-related changes. Companies like mPath Therapeutics Corp. are developing safe, regulated ibogaine treatments. Prioritizing innovative, evidence-based therapies like ibogaine could significantly reduce PTSD, depression, and suicide rates among veterans, offering hope for long-term recovery.

Is suicide a mental health, public health or societal problem?

Goel, D., Dennis, B., & McKenzie, S. K. (2023).

Current Opinion in Psychiatry, 36(5), 352–359.

https://doi.org/10.1097/yco.0000000000000888

Abstract

Purpose of review 

Suicide is a complex phenomenon wherein multiple parameters intersect: psychological, medical, moral, religious, social, economic and political. Over the decades, however, it has been increasingly and almost exclusively come to be viewed through a biomedical prism. Colonized thus by health and more specifically mental health professionals, alternative and complimentary approaches have been excluded from the discourse. The review questions many basic premises, which have been taken as given in this context, particularly the ‘90 percent statistic’ derived from methodologically flawed psychological autopsy studies.

Recent findings

An alternative perspective posits that suicide is a societal problem which has been expropriated by health professionals, with little to show for the efficacy of public health interventions such as national suicide prevention plans, which continue to be ritually rolled out despite a consistent record of repeated failures. This view is supported by macro-level data from studies across national borders.

Summary

The current framing of suicide as a public health and mental health problem, amenable to biomedical interventions has stifled seminal discourse on the subject. We need to jettison this tunnel vision and move on to a more inclusive approach.

A pdf can be found here.

Here are some thoughts.

This article challenges the prevailing view of suicide as primarily a mental health issue, arguing instead that it's a complex societal problem. The authors criticize the methodological flaws in psychological autopsy studies, which underpin the widely cited "90 percent statistic" linking suicide to mental illness. They contend that focusing solely on biomedical interventions and risk assessment has been ineffective and that a more inclusive approach, considering socioeconomic factors and alternative perspectives like critical suicidology, is necessary. The paper supports its argument with data from various countries, highlighting the disconnect between suicide rates and access to mental healthcare. Ultimately, the authors call for a shift in perspective to address the societal roots of suicide.

Suicide-related emergencies underdetected among minority, male youth, and preteens, study finds

Will Houston

UCLA Health

Originally poste 29 OCT 24

A new study by UCLA Health reveals that hospital emergency departments may be missing signs of suicidal thoughts and behaviors in children, boys and Black and Hispanic youth. 

The research(Link is external) (Link opens in new window), published in the journal JAMA Open Network, analyzed electronic health records of nearly 3,000 children and teenagers presenting to two emergency departments in southern California for mental health reasons. Using machine learning algorithms, the researchers determined standard medical record surveillance methods miss youth with suicide-related emergencies. These methods disproportionately missed suicide-related visits among Black, Hispanic, male, and preteen youths, compared with other races and ethnicities, female youths, and adolescents. 

“Existing methods are missing kids, and not missing them at random,” said Dr. Juliet Edgcomb(Link opens in new window), study corresponding author, associate director of the UCLA Health Semel Institute for Mental Health Informatics and Data Science Hub(Link is external) (Link opens in new window) and assistant professor-in-residence in the UCLA Health Department of Psychiatry. “Without accurate and equitable detection of suicide-related emergencies, it is difficult for suicide prevention strategies to help the populations they aim to serve.” 

Here is the article.

Here is the research article.

Here are some thoughts:

A recent study by UCLA Health researchers found that emergency departments are not effectively identifying children and teenagers who are experiencing suicidal thoughts and behaviors. The study, which analyzed electronic health records of nearly 3,000 young patients, revealed that current methods for detecting suicidality are inadequate and disproportionately miss suicidal emergencies among minority youth, preteen youth, and boys. The study highlights the need for improved detection methods, particularly those incorporating artificial intelligence, to better address this growing mental health crisis and ensure that all youth at risk receive appropriate care.

Share of Adult Suicides After Recent Jail Release

Miller TR, Weinstock LM, Ahmedani BK, et al.

JAMA Network Open. 2024;7(5):e249965.

doi:10.1001/jamanetworkopen.2024.9965

Key Points

Question  What proportion of US adults who died by suicide spent at least 1 night in jail shortly before their death?

Findings  In this cohort modeling study involving nearly 7.1 million US adults released from incarceration in 2019, nearly 20% of suicides occurred among those who were released from jail in the past year and 7% were by those in their second year of jail release.

Meaning  Findings of this study suggest that focused suicide prevention efforts could reach a substantial number of adults who were formerly incarcerated within 2 years, when death by suicide is likely to occur.

----------------

Abstract

Importance  Although people released from jail have an elevated suicide risk, the potentially large proportion of this population in all adult suicides is unknown.

Objective  To estimate what percentage of adults who died by suicide within 1 year or 2 years after jail release could be reached if the jail release triggered community suicide risk screening and prevention efforts.

Design, Setting, and Participants  This cohort modeling study used estimates from meta-analyses and jail census counts instead of unit record data. The cohort included all adults who were released from US jails in 2019. Data analysis and calculations were performed between June 2021 and February 2024.

Main Outcomes and Measures  The outcomes were percentage of total adult suicides within years 1 and 2 after jail release and associated crude mortality rates (CMRs), standardized mortality ratios (SMRs), and relative risks (RRs) of suicide in incarcerated vs not recently incarcerated adults. Taylor expansion formulas were used to calculate the variances of CMRs, SMRs, and other ratios. Random-effects restricted maximum likelihood meta-analyses were used to estimate suicide SMRs in postrelease years 1 and 2 from 10 jurisdictions. Alternate estimate was computed using the ratio of suicides after release to suicides while incarcerated.

Conclusions and Relevance  This cohort modeling study found that adults who were released from incarceration at least once make up a large, concentrated population at greatly elevated risk for death by suicide; therefore, suicide prevention efforts focused on return to the community after jail release could reach many adults within 1 to 2 years of jail release, when suicide is likely to occur. Health systems could develop infrastructure to identify these high-risk adults and provide community-based suicide screening and prevention.

Abortion Access Tied to Suicide Rates Among Young Women

Michael DePeau-Wilson

MedPage Today

Originally posted 28 DEC 22

Restrictions on access to reproductive care were associated with suicide rates among women of reproductive age, researchers found.

In a longitudinal ecologic study using state-based data from 1974 to 2016, enforcement of Targeted Regulation of Abortion Providers (TRAP) laws was associated with higher suicide rates among reproductive-age women (β=0.17, 95% CI 0.03-0.32, P=0.02) but not among women of post-reproductive age, according to Ran Barzilay, MD, PhD, of the University of Pennsylvania in Philadelphia, and colleagues.

Nor was enforcement of TRAP laws associated with deaths due to motor vehicle crashes, they reported in JAMA Psychiatry in a new tab or window.

Additionally, enforcement of a TRAP law was associated with a 5.81% higher annual rate of suicide than in pre-enforcement years, the researchers found.

"Taken together, the results suggest that the association between restricting access to abortion and suicide rates is specific to the women who are most affected by this restriction, which are young women," Barzilay told MedPage Today.

Barzilay said their study "can inform, number one, clinicians working with young women to be aware that this is a macro-level suicide risk factor in this population. And number two, that it informs policymakers as they allocate resources for suicide prevention. And number three, that it informs the ethical, divisive debate regarding access to abortion."

In an accompanying editorial, Tyler VanderWeele, PhD, of Harvard T.H. Chan School of Public Health in Boston, wrote that while analyses of this type are always subject to the possibility of changes in trends being attributable to some third factor, Barzilay and colleagues did "control for a number of reasonable candidates and conducted sensitivity analyses indicating that these associations were observed for reproductive-aged women but not for a control group of older women of post-reproductive age."

VanderWeele wrote the findings do suggest that a "not inconsiderable" number of women might be dying by suicide in part because of a lack of access to abortion services, and that "the increase is cause for clinical concern."

But while more research "might contribute more to our understanding," VanderWeele wrote, its role in the legal debates around abortion "seems less clear. Regardless of whether one is looking at potential adverse effects of access restrictions or of abortion, the abortion and mental health research literature will not resolve the more fundamental and disputed moral questions."

"Debates over abortion access are likely to remain contentious in this country and others," he wrote. "However, further steps can nevertheless be taken in finding common ground to promote women's mental health and healthcare."

For their "difference-in-differences" analysis, Barzilay and co-authors relied on data from the TRAP laws index to measure abortion access, and assessed suicide data from CDC's WONDER database in a new tab or window database.

The info is here.

Risk of Suicide After Dementia Diagnosis

Alothman D, Card T, et al.

JAMA Neurology

Published online October 03, 2022.

Abstract

Importance  Patients with dementia may be at an increased suicide risk. Identifying groups at greatest risk of suicide would support targeted risk reduction efforts by clinical dementia services.

Objectives  To examine the association between a dementia diagnosis and suicide risk in the general population and to identify high-risk subgroups.

Design, Setting, and Participants  This was a population-based case-control study in England conducted from January 1, 2001, through December 31, 2019. Data were obtained from multiple linked electronic records from primary care, secondary care, and the Office for National Statistics. Included participants were all patients 15 years or older and registered in the Office for National Statistics in England with a death coded as suicide or open verdict from 2001 to 2019. Up to 40 live control participants per suicide case were randomly matched on primary care practice and suicide date.

Exposures  Patients with codes referring to a dementia diagnosis were identified in primary care and secondary care databases.

Main Outcomes and Measures  Odds ratios (ORs) were estimated using conditional logistic regression and adjusted for sex and age at suicide/index date.

Conclusions and Relevance  Diagnostic and management services for dementia, in both primary and secondary care settings, should target suicide risk assessment to the identified high-risk groups.

Key Points

Question  Is there an association between dementia diagnosis and a higher risk of suicide?

Findings  In this nationally representative case-control study including 594, 674 persons in England from 2001 through 2019, dementia was found to be associated with increased risk of suicide in specific patient subgroups: those diagnosed before age 65 years (particularly in the 3-month postdiagnostic period), those in the first 3 months after diagnosis, and those with known psychiatric comorbidities.

Meaning  Given the current efforts to improve rates of dementia diagnosis, these findings emphasize the importance of concurrent implementation of suicide risk assessment for the identified high-risk groups.

The research is here.

‘What if Yale finds out?’

William Wan

The Washington Post

Originally posted November 11, 2022

Suicidal students are pressured to withdraw from Yale, then have to apply to get back into the university

Here are two excerpt:

‘Getting rid of me’

Five years before the pandemic derailed so many college students’ lives, a 20-year-old math major named Luchang Wang posted this message on Facebook:

“Dear Yale, I loved being here. I only wish I could’ve had some time. I needed time to work things out and to wait for new medication to kick in, but I couldn’t do it in school, and I couldn’t bear the thought of having to leave for a full year, or of leaving and never being readmitted. Love, Luchang.”

Wang had withdrawn from Yale once before and feared that under Yale’s policies, a second readmission could be denied.

Instead, she flew to San Francisco, and, according to authorities, climbed over the railing at the Golden Gate Bridge and jumped to her death.

Her 2015 suicide sparked demands for change at Yale. Administrators convened a committee to evaluate readmission policies, but critics said the reforms they adopted were minor.

They renamed the process “reinstatement” instead of “readmission,” eliminated a $50 reapplication fee and gave students a few more days at the beginning of each semester to take a leave of absence without having to reapply.

Students who withdrew still needed to write an essay, secure letters of recommendation, interview with Yale officials and prove their academic worth by taking two courses at another four-year university. Those who left for mental health reasons also had to demonstrate to Yale that they’d addressed their problems.

In April — nearly 10 months after S. had been pressured to withdraw — Yale officials announced another round of changes to the reinstatement process. 

They eliminated the requirement that students pass two courses at another university and got rid of a mandatory interview with the reinstatement committee.

The reforms have not satisfied student activists at Yale, where the mental health problems playing out on many American campuses has been especially prominent.

(cut)

In recent years, Yale has also faced an “explosion” in demand for mental health counseling, university officials said. Last year, roughly 5,000 Yale students sought treatment — a 90 percent increase compared with 2015.

“It’s like nothing we’ve ever seen before,” said Hoffman, the director of Yale Mental Health and Counseling. Roughly 34 percent of the 14,500 students at 

Yale seek mental health help from college counselors, compared with a national average of 11 percent at other universities.

Meeting that need has been challenging, even at a school with a $41.4 billion endowment.

Bluebelle Carroll, 20, a Yale sophomore who sought help in September 2021, said she waited six months to be assigned a therapist. She secured her first appointment only after emailing the counseling staff repeatedly.

“The appointment was 20 minutes long,” she said, “and we spent the last five minutes figuring out when he could see me again.”

Because of staffing constraints, students are often asked to choose between weekly therapy that lasts 30 minutes or 45-minute sessions every two weeks.

The info is here.

Interventions to reduce suicidal thoughts and behaviours among people in contact with the criminal justice system

A. Carter, A. Butler, et al. (2022)

The Lancet, Vol 44, 101266

Summary

Background

People who experience incarceration die by suicide at a higher rate than those who have no prior criminal justice system contact, but little is known about the effectiveness of interventions in other criminal justice settings. We aimed to synthesise evidence regarding the effectiveness of interventions to reduce suicide and suicide-related behaviours among people in contact with the criminal justice system.

Findings

Thirty-eight studies (36 primary research articles, two grey literature reports) met our inclusion criteria, 23 of which were conducted in adult custodial settings in high-income, Western countries. Four studies were randomised controlled trials. Two-thirds of studies (n=26, 68%) were assessed as medium quality, 11 (29%) were assessed as high quality, and one (3%) was assessed as low quality. Most had considerable methodological limitations and very few interventions had been rigorously evaluated; as such, drawing robust conclusions about the efficacy of interventions was difficult.

Research in context

Evidence before this study

One previous review had synthesised the literature regarding the effectiveness of interventions during incarceration, but no studies had investigated the effectiveness of interventions to prevent suicidal thoughts and/or behaviours among people in contact with the multiple other settings in the criminal justice system. We searched Embase, PsycINFO, and MEDLINE on 1 June 2021 using variants and combinations of search terms relating to suicide, self-harm, prevention, and criminal justice system involvement (suicide, self-injury, ideation, intervention, trial, prison, probation, criminal justice).

 Added value of this study

Our review identified gaps in the evidence base, including a dearth of robust evidence regarding the effectiveness of interventions across non-custodial criminal justice settings and from low- and middle-income countries. We identified the need for studies examining suicide prevention initiatives for people who were detained in police custody, on bail, or on parole/license, those serving non-custodial sentences, and those after release from incarceration. Furthermore, our findings suggested an absence of interventions which considered specific population groups with diverse needs, such as women, First Nations people, and young people.

The research is here.

On loving thyself: Exploring the association between self-compassion, self-reported suicidal behaviors, and implicit suicidality among college students

Zeifman, R. J., Ip, J., Antony, M. M., & Kuo, J. R. 

(2021). Journal of American college health

J of ACH, 69(4), 396–403.

Abstract

Suicide is a major public health concern. It is unknown whether self-compassion is associated with suicide risk above and beyond suicide risk factors such as self-criticism, hopelessness, and depression severity. 

Participants: Participants were 130 ethnically diverse undergraduate college students. 

Methods: Participants completed self-report measures of self-compassion, self-criticism, hopelessness, depression severity, and suicidal behaviors, as well as an implicit measure of suicidality. 

Results: Self-compassion was significantly associated with self-reported suicidal behaviors, even when controlling for self-criticism, hopelessness, and depression severity. Self-compassion was not significantly associated with implicit suicidality. 

Conclusions: The findings suggest that self-compassion is uniquely associated with self-reported suicidal behaviors, but not implicit suicidality, and that self-compassion is a potentially important target in suicide risk interventions. Limitations and future research directions are discussed.

Discussion

Clinical implications

Our findings suggest that self-criticism and self-compassion are uniquely predictive of self-reported suicidal behaviors.  Therefore, in addition to the importance of targeting self-criticism, self-compassion may also be an important, and independent, target within suicide risk interventions. Indeed, qualitative analysis of interviews conducted with individuals with borderline personality disorder (a psychiatric disorder characterized by high levels of suicide risk) and their service providers, identified self-compassion as an important theme in the process of recovery.  Interventions that specifically focus on fostering self-compassion, by generating feelings of self-reassurance, warmth, and self-soothing, include compassion-focused therapy and mindful self-compassion. Compassion based interventions have shown promise for a wide range of populations, including eating disorders, psychotic disorders, personality disorders, and healthy individuals.

A pdf of the research is here.

FCC Approves 988 as Suicide Hotline Number

Jennifer Weaver
KUTV.com
Originally posted 16 July 20

A three-digit number to connect to suicide prevention and mental health crisis counselors has been approved.

The Federal Communications Commission voted unanimously Thursday to make 988 the number people can call to be connected directly to the National Suicide Prevention Hotline.

Phone service providers have until July 2022 to implement the new number. The 10-digit number is currently 1-800-273-8255 (TALK).