The roles of suicide-related rumination and COVID-19 in suicidal ideation and behaviours: Data from a large-scale youth epidemiological sample in Hong Kong

Suicide remains to be one of the leading causes of death amongst young people worldwide. Help-seeking, however, remains disproportionately suboptimal in the youth population. Identifying more effective and less stigmatizing markers of suicidal ideation and behaviours can be important for improving early engagement and intervention work. We therefore examined the prevalence of suicidal ideation, plan, and attempt in a large epidemiological youth sample in Hong Kong (n = 2540) during the period of 2019-2021, as well as the factors associated with each of these outcomes using separate multivariable logistic regression models. In this sample, the 12-month prevalence of suicidal ideation, plan, and attempt was 20.0%, 4.6%, and 1.3%, respectively. In particular, we found 'suicide-related rumination' to be amongst the only factor that was significant for all three outcomes (p < .010). Using a two-stage approach (i.e., selecting only those with suicidal ideation), we found that suicide-related rumination, poorer cognitive ability, and 12-month major depressive episode were specifically associated with 12-month suicide plan, while environmental factors, including COVID-19 stressors, personal life stressors, poorer family relationships, as well as non-suicidal selfharm, were specifically associated with 12-month suicide attempt. A two-stage approach should be considered in future interventions targeting youth suicide. Suicide-related rumination may be an important marker of overall suicidal risk. The role of environmental stressors in addition to intrinsic vulnerability also need to be emphasized to best support young people at risk.

ENgagENYOY: A digital transdiagnostic clinical - and peermoderated treatment platform for youth with mental health complaints in the Netherlands

The onset of mental disorders typically occurs between the ages of 12 and 25, and the burden of mental health problems is the most consequential for this group. Indicated prevention interventions to target individuals with subclinical symptoms to prevent the transition to clinical levels of disorders, even leading to suicide, have shown to be effective. However, the threshold to seek help appears to be high. Digital interventions could offer a solution, especially during the Covid-19 pandemic. In this talk, the presenters will take you on a journey through the background, effects and experience of the digital indicated prevention intervention ENgage YOung people Early (ENYOY). ENYOY specifically addresses young people with emerging mental health complaints, and offers a new approach for treatment in the Netherlands through a clinical- and peer- moderated treatment platform. Considering the waiting lists in (child and adolescent)- psychiatry and the increase in suicides amongst youth, early lowthreshold and non-stigmatizing help to support young people with emerging psychiatric symptoms is of crucial importance. Moreover, this project aims to bridge the gap between child and adolescent and adult psychiatry. We included 125 young people with subclinical mental health problems (stage 1b), age 16-25 years. Using a combined peer and clinical support approach participants followed their personalized digital therapeutic treatment journey for up to 12 months. The first results demonstrate that at 3 and 6 months follow-up complaints significantly decrease (K-10) and social functioning increase (SOFAS) (p < .05). This new approach may offer perspective for young people and the healthcare system.

Financial Crisis and its Effect on Psychological Well-Being, Health, Satisfaction, and Financial Incapability, A Systematic Review

Background and Objectives: The decline in GDP caused by the global economic recession of 2008 and that caused by the COVID-19 pandemic has resulted in the poor economy of countries around the globe with increased rates of unemployment and adverse job conditions. This systematic review aims to identify the impact of a Financial crisis on Psychological well-being, Life satisfaction, Health Satisfaction, and Financial Incapability. Methodology: The literature included in the review was searched from Feb 1, 2023, to March 26, 2023, by using the PUBMED database as the search engine. Studies discussing the impact of the financial or economic crisis on psychological well-being, Health, Life satisfaction, and Financial Incapabilities published in the English Language were included in this review whereas systematic reviews and metanalysis, case reports, articles published in languages other than English and articles with limited access were excluded. Result(s): Of the 26 articles found eligible for the study, there were 22 Quantitative studies, 2 qualitative studies, and 2 Mixed Method Studies. Most of the articles included in this study discussed the Global Economic crisis caused by COVID-19 and the Global Financial Crisis of 2008. Almost 80% of the studies included in this review discussed psychological well-being and the prevalence of psychological disorders including Depression, Anxiety, Stress, Fear, Loneliness, Burnout, and Suicide whereas the rest of the articles discussed mortality regarding mental disorders. Conclusion(s): Financial crisis or economic recession results in an increased prevalence of common mental disorders affecting psychological well-being by increasing rates of unemployment and adverse job conditions. Policymakers with competitive financial behavior and knowledge are essential elements for psychological well-being and life satisfaction.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

The American Anti-Vaxxer COVID Dead: A Dynamic Chronicle of Failed Sacrifices

Unlike earlier pandemics, where a "politics of blame" was directed against those who spread infection, the COVID pandemic in the United States has created occasions for the deployment of a "politics of commendation" for performing acts of sacrifice. Frontline healthcare workers have been celebrated for sacrificing themselves in service to their patients, even as critics have charged their being hapless victims of "social murder" at the hands of irresponsible medical administrators. Governmental officials, notably in Texas, have also recommended the elderly to refuse COVID care, die and thus sacrifice themselves selflessly for the benefit of the younger generation. Lately, COVID vaccine-refusal has been seen as an act of noble political sacrifice-typically to further individual liberty against the coercive power of the Federal government's promotion or mandating of vaccination. Anti-vaxxers embracing the role of such political sacrifices, however, generally fail to realize this aspiration, insofar they are often just culpable of their own demise by neglecting public health advisories. Furthermore, the partisan politicization of their deaths militates against the normal recognition of their being sacrifices. Party political calculations have frequently demanded denial of the COVID origins of the anti-vaxxer deaths, and also effectively eliminated any normal attendant rites of reciprocation, memorialization or sacralization of the victims, typical of sacrifices, proper.

The Impact of Covid-19 on Online Discussions: the Case Study of the Sanctioned Suicide Forum

The COVID-19 pandemic has been at the center of the lives of many of us for at least a couple of years, during which periods of isolation and lockdowns were common. How all that affected our mental well-being, especially the ones' who were already in distress? To investigate the matter we analyse the online discussions on Sanctioned Suicide, a forum where users discuss suicide-related topics freely. We collected discussions starting from March 2018 (before pandemic) up to July 2022, for a total of 53K threads with 700K comments and 16K users. We investigate the impact of COVID-19 on the discussions in the forum. The data show that covid, while being present in the discussions, especially during the first lockdown, has not been the main reason why new users registered to the forum. However, covid appears to be indirectly connected to other causes of distress for the users, i.e. anxiety for the economy. © 2023 ACM.

Seduction and scissiparity: The American crisis of adolescent identity

The COVID-19 era unleashed a separate medical crisis in the United States: adolescent mental health struggles led to a spike in teen suicides. Adolescence, the period of development long associated with the search for one's identity—a struggle that requires engagement with one's peers for a healthy resolution—was complicated by the lockdowns and extended periods of isolation. The social convulsions associated with this past year exposed an unfortunate vulnerability of this generation: deep down, they long for what their predecessors had—embodied, meaningful connections with their peers. Using the existential theories of French Jesuit Pierre Teilhard de Chardin, this paper examines how the contextual elements of this pandemic have contributed to an evolutionary process vis-à-vis the current crisis of adolescent identity, and then explores how we might consider deliberate learning opportunities for to help students understand themselves and the impact of what has just happened to the global community.

Youth suicide risk and mental health post-COVID: An Australian perspective

Aims: Suicide is a leading cause of death for young people, and rates in Australia are increasing. The Australian city of Melbourne faced the toughest COVID-19 pandemic lockdown restrictions worldwide, which had a major impact on youth mental health. This study aimed to provide a snapshot into the mental health and suicide-related thoughts and behaviours of Australian Adolescents from Melbourne post the lockdowns. Method(s): Participants were 932 young people (Age M = 15.5, 53% female) recruited from high schools in Melbourne, Australia as part of a larger RCT. Participants completed measures of suicidal ideation (SIDAS) and behaviour (recent attempts and current plans), and depressive symptoms (PHQ-9). Result(s): Preliminary results indicate that 28% of participants experienced some level of suicidal ideation with 7% reporting severe suicidal ideation. Suicide attempts in the sample in the last 12 months (13%) and current plans (3%) were less common but still prevalent. In terms of depressive symptoms, the breakdown in the sample was 5% severe, 8% moderately severe, 18% moderate, 25% mild and 43% none to minimal with 1% not reporting. Data related to particular risk factors (e.g., years since the pandemic, gender, school etc.) along with implications for practice and policy will be presented at the conference. Conclusion(s): This study sheds light on the mental health and suiciderelated thoughts and behaviours of school-attending young people following COVID-19-related lockdowns in Australia. The high levels of suicidality and poor mental health in the cohort point to a need for targeted interventions and support for this group.

TwIdw—A Novel Method for Feature Extraction from Unstructured Texts

Featured ApplicationThe research has a potential application in the field of fake news detection. By using the feature extraction technique, TwIdw, proposed in this paper, more relevant and informative features can be extracted from the text data, which can lead to an enhancement in the accuracy of the classification models employed in these tasks.This research proposes a novel technique for fake news classification using natural language processing (NLP) methods. The proposed technique, TwIdw (Term weight–inverse document weight), is used for feature extraction and is based on TfIdf, with the term frequencies replaced by the depth of the words in documents. The effectiveness of the TwIdw technique is compared to another feature extraction method—basic TfIdf. Classification models were created using the random forest and feedforward neural networks, and within those, three different datasets were used. The feedforward neural network method with the KaiDMML dataset showed an increase in accuracy of up to 3.9%. The random forest method with TwIdw was not as successful as the neural network method and only showed an increase in accuracy with the KaiDMML dataset (1%). The feedforward neural network, on the other hand, showed an increase in accuracy with the TwIdw technique for all datasets. Precision and recall measures also confirmed good results, particularly for the neural network method. The TwIdw technique has the potential to be used in various NLP applications, including fake news classification and other NLP classification problems.

Screening adolescents for psychosocial concerns

Psychosocial issues are cen-'tral to the care of adolescent patients. Pediatricians routinely discuss substance use, sexual health, and accident prevention with adolescents and are likely to see specific mental health concerns in about 20% of their patients. In light of rising suicide rates and the likely consequences of COVID-19, depression is an increasingly common concern. With limited access to mental health clinicians, individual pediatricians must manage patients' mental health needs by enhancing their own skills, collocating mental health personnel in their practices, and building trusted referral networks. Because psychosocial screening is now an expected part of pediatric primary care,1 this article focuses on screening adolescent patients, including choice of tools and follow-up of positive results.

The Earthquake Disaster in Turkiye: A Review from Child and Adolescent Psychiatry Perspective

The earthquake has long-lasting various mental and behavioral effects on children and adolescents. The aim of this review was to discuss the nature and extent of psychiatric problems, management options, and the process of organizing psychological interventions for affected children. Individuals show a range of physically, emotionally, and cognitively healthy responses that can help them cope with the aftermath of a disaster. Psychiatric symptoms such as acute stress reactions, post-traumatic stress disorder, depression, anxiety disorder, increased risk of suicide, sleep disorders, substance use disorders, and psychotic disorders may develop in some children. Comorbidities and sub-clinical syndromes are also common. There are many risk factors and protective factors in the development of mental disorders. Close follow-up of children at high risk and interventions for psychosocial support may prevent the development of mental disorders. It is very important to start the intervention at the earliest period. The psychological impacts of young disaster victims can be addressed by skilled local volunteers, medical professionals, and educators in primary health care programs. With the nation's overall social and economic recovery, children can recover more quickly from traumatic experiences.Copyright © 2023, Duzce University Medical School. All rights reserved.

Impact of the COVID-19 pandemic on the well-being of the stranded seafarers

PurposeThis study examines the impact of the COVID-19 pandemic on the well-being and mental health of the seafarers who had to overstay on ships after their contracts expired, identifies topics that affect their mental distress and recommends measures to overcome these.Design/methodology/approachFour research questions about the impacts on the seafarers before and during the COVID-19 pandemic were raised. A literature review and a questionnaire survey were conducted to find answers. Ship officers were asked to assess and fill in the questionnaires for the stranded seafarers onboard in order to collect sufficient samples rapidly for this study.FindingsDespite the guidelines provided by the shipping companies being adequate to protect the seafarers from COVID-19, their mental distress levels have been worsened under the pandemic. The crew change crisis causes anxiety and negatively impacts on their working performance;however, the repatriation expectation of the stranded seafarers is of the highest concern. Three topics were identified as having impacts on the mental health of the stranded seafarers: crew change crisis, low vaccination rate and the lack of key worker recognition. While international stakeholders are advocating for support in these issues, the shipping companies and the seafarers need to do their parts to exacerbate the mental distress, and to survive and thrive beyond the pandemic.Originality/valueThe findings of this study will help the shipping companies to navigate the challenges and the seafarers to overcome issues caused by the COVID-19 pandemic.

Adaptation of the Suicide Crisis Inventory (Sci-2) in a Russian Internet Sample during the Covid-19 Epidemic

The article presents a new diagnostic category, Suicide Crisis Syndrome (SCS), which was proposed to the next revision of Diagnostic and Statistical Manual of Mental Disorders (DSM). Study objective: Adaptation of the Suicide Crisis Inventory (SCI-2) on a Russian sample. Participants: 618 responses to an internet-survey were used, the study lasted from June 16, 2020 to April 26, 2021. Age of the participants: 18-99 (.=26.9;SD=12.8). Gender: 451 females (74.2%), 135 males (22.2%), 32 participants preferred not to answer or chose other gender identity. Instruments: Suicide Crisis Inventory (SCI-2), Suicidal Narrative Inventory (SNI), Stressful Life Events Questionnaire, Columbia Suicide Severity Rating Scale (C-SSRS), questions about recent and lifetime suicidal behavior. Results: Confirmatory factor analyses confirmed the five-factor (chi(2)[1420]=5003.56, p<.001, CFI=.99, TLI=.99, RMSEA=.07, SRMR=.06) and one-factor (chi(2)[1430] = 9847.34, p<.001, CFI=.98, TLI=.98, RMSEA=.10, SRMR=.07) solutions of the inventory, with five-factor as a better solution (Delta chi(2)[10] = 4843.78, p <.001). Based on retrospective data (self-reports on suicidal attempts during the last month), SCI-2 showed good diagnostic qualities (AUC=.85, 95% CI [.72;.97]). The cut-off score was established (80), which indicates the presence of acute suicidal risk. Conclusions: Adaptation of the Suicide Crisis Inventory (SCI-2) went well, the instrument is ready for use for clinical and research purposes.

The First Wave of COVID-19 in Forensic Psychiatry: A Rapid Review Series

At the beginning of the pandemic, experts expected an increasing number of hospitalizations in forensic settings, uncontrollable outbreaks of COVID-19, and deterioration of mental health of residents within institutions. Certain publications corroborated these concerns;however, no synthesis of the results of empirical publications at the initial stage of the pandemic has yet been conducted. Three rapid reviews were conducted on these topics. Besides almost a two-fold decrease in the total number of urgent consultations/hospitalizations, there were no changes in the number of involuntary hospitalizations, suicide attempts, and psychoses. The COVID-19 morbidity and mortality rates in secure institutions were compatible with the general population. However, the lockdown period was associated with a significant increase in self-harm in secure settings.

Zero Suicide Quality Improvement: Developmental and Pandemic-Related Patterns in Youth at Risk for Suicide Attempts

The Zero Suicide (ZS) approach to health system quality improvement (QI) aspires to reduce/eliminate suicides through enhancing risk detection and suicide prevention services. This first report from our randomized trial evaluating a stepped care for suicide prevention intervention within a health system conducting ZS-QI describes (1) our screening and case identification process, (2) variation among adolescents versus young adults, and (3) pandemic-related patterns during the first COVID-19 pandemic year. Between April 2017 and January 2021, youths aged 12-24 years with elevated suicide risk were identified through an electronic health record (EHR) case-finding algorithm followed by direct assessment screening to confirm risk. Eligible/enrolled youth were evaluated for suicidality, self-harm, and risk/protective factors. Case finding, screening, and enrollment yielded 301 participants showing suicide risk indicators: 97% past-year suicidal ideation, 83% past suicidal behavior;and 90% past non-suicidal self-injury (NSSI). Compared to young adults, adolescents reported more past-year suicide attempts (47% vs. 21%, p <.001) and NSSI (past 6 months, 64% vs. 39%, p <.001);less depression, anxiety, posttraumatic stress, and substance use;and greater social connectedness. Pandemic onset was associated with lower participation of racial-ethnic minority youths (18% vs. 33%, p <.015) and lower past-month suicidal ideation and behavior. Results support the value of EHR case-finding algorithms for identifying youths with potentially elevated risk who could benefit from suicide prevention services, which merit adaptation for adolescents versus young adults. Lower racial-ethnic minority participation after the COVID-19 pandemic onset underscores challenges for services to enhance health equity during a period with restricted in-person health care, social distancing, school closures, and diverse stresses.Copyright © 2023 Society of Clinical Child and Adolescent Psychology.

Prevalence a prediktory sebevražednosti mezi studenty ošetřovatelství v Indonésii

Úvod: Studenti ošetřovatelství jsou během pandemie covidu-19 zranitelnou populací, protože zažívají vyšší úroveň stresu a problémů s duševním zdravím než studenti mimo zdravotní péči, což je vystavuje vyššímu riziku sebevražedného chování. Cíl: Prozkoumat sebevražednost mezi studenty ošetřovatelství a posoudit souvislost mezi nezávislými proměnnými a sebevražedností. Metody: Tato průřezová studie zahrnovala 670 studentů ošetřovatelství z 5 indonéských univerzit, kteří byli vybráni metodou postupného vzorkování. Vlastní validované nástroje se skládaly z 8 sekcí: sociodemografický dotazník, RSES k posouzení sebe- úcty, BHS k posouzení beznaděje, UCLA-3 k posouzení osamělosti, GSES k posouzení sebeúčinnosti, PHQ-9 k posouzení deprese, CD-RISC-10 k posouzení odolnosti a SBQ-R k posouzení sebevražednosti. K identifikaci významných prediktorů sebevražednosti byla použita binární logistická regrese. Výsledky: Prevalence sebevražednosti mezi studenty ošetřovatelství byla 22,8 %. Se sebevražedností byly významně spojeny následující faktory (p < 0,05): nízká odolnost (AOR = 2,044;95 %CI: 1,309-3,192), osamělost (AOR = 1,609;95 %CI: 1,040-2,492), beznaděj (AOR = 48,48 95 %CI: 2,356-8,398) a deprese (AOR = 9,413;95 %CI: 5,795-15,288). Závěr: Tato zjištění poskytují důkaz, že odolnost, osamělost, beznaděj a deprese jsou rizikovými faktory sebevražednosti mezi studenty ošetřovatelství. Tento výsledek lze použít jako základ pro rozvoj vhodných strategií prevence sebevražd.Alternate :Introduction: Nursing students are a vulnerable population during the COVID-19 pandemic because they experience a higher level of stress and mental health problems than the non-healthcare student population, putting them at a higher risk for suicidal behaviour. Aim: To explore suicidality among nursing students and assess the association between independent variables and suicidality. Methods: This cross-sectional study involved 670 nursing students from 5 Indonesian universities who were recruited using consecutive sampling. Self-administered validated instruments consisted of 8 sections: sociodemographic questionnaire, RSES to assess self-esteem, BHS to assess hopelessness, UCLA-3 to assess loneliness, GSES to assess self-efficacy, PHQ-9 to assess depression, CD-RISC-10 to assess resilience, and SBQ-R to assess suicidality. Binary logistic regression was employed to identify significant predictors of suicidality. Results: Suicidality prevalence among nursing students was 22.8%. The following factors were significantly associated with suicidality (p < 0.05): low resilience (AOR = 2.044;95%CI: 1.309-3.192), loneliness (AOR = 1.609;95%CI: 1.040-2.492), hopelessness (AOR = 4.448;95%CI: 2.356-8.398), and depression (AOR = 9.413;95%CI: 5.795-15.288). Conclusions: These findings provide evidence that resilience, loneliness, hopelessness, and depression are risk factors for suicidality among nursing students. This outcome can be used as a basis to develop appropriate suicide prevention strategies.

Suicidal behavior during the COVID-19 pandemic: clinical aspects and associated factors / Comportamento suicida durante a pandemia da COVID-19: aspectos clínicos e fatores associados / Comportamiento suicida durante la pandemia de COVID-19: aspectos clínicos y factores asociados

Resumo Objetivo Analisar os aspectos clínicos e os fatores associados ao comportamento suicida durante a pandemia da COVID-19. Métodos Estudo transversal e analítico, realizado com registros assistenciais de 130 pacientes que buscaram atendimento em emergência psiquiátrica após ideação, planejamento ou tentativa de suicídio. Utilizou-se um formulário para caracterização sociodemográfica, clínica e terapêutica, assim como para identificação das necessidades de cuidados e dos fatores associados. A análise dos dados foi constituída pelos testes Exato de Fischer, Qui-quadrado de Pearson e pela Regressão de Poisson, considerando nível de significância de 5%. Resultados O comportamento suicida foi expresso pela tentativa de suicídio, ideação e planejamento, predominando no sexo feminino, em adultos jovens, desempregados e de baixa renda familiar, assim como em pacientes com histórico de transtorno mental, de internação psiquiátrica, de tentativas prévias e de abandono terapêutico. As principais alterações psíquicas envolveram ansiedade, depressão, sentimentos de desesperança, alucinações audiovisuais e delírios persecutórios. O consumo de substâncias psicoativas elevou em até 13,8 vezes o risco para tentativa de suicídio e as crises situacionais em 10,6 vezes a ideação. Ainda, a perda de renda e a internação anterior foram associados à manifestação do comportamento. As evidências de cuidados envolveram intervenções medicamentosas, medidas de vigilância e admissão hospitalar. Conclusão Durante a pandemia da COVID-19, o comportamento suicida foi associado à maior predisposição para o consumo de substâncias psicoativas, crises situacionais e perda de renda. Destaca-se a necessidade de políticas públicas voltadas para identificação, prevenção e gerenciamento adequado dos estados de risco.

Resumen Objetivo Analizar los aspectos clínicos y los factores asociados al comportamiento suicida durante la pandemia de COVID-19. Métodos Estudio transversal y analítico, realizado con registros asistenciales de 130 pacientes que buscaron atención en emergencia psiquiátrica después de ideación, planificación o intento de suicidio. Se utilizó un formulario para la caracterización sociodemográfica, clínica y terapéutica, como también para la identificación de las necesidades de cuidados y de los factores asociados. El análisis de los datos estuvo constituido por la prueba Exacta de Fisher, Ji cuadrado de Pearson y por la Regresión de Poisson, considerando un nivel de significancia del 5 %. Resultados El comportamiento suicida se expresó a través del intento de suicidio, ideación y planificación, con predominio del sexo femenino, adultos jóvenes, desempleados y con bajos ingresos familiares, así como pacientes con historial de trastorno mental, de internación psiquiátrica, de intentos previos y de abandono terapéutico. Las principales alteraciones psíquicas incluyeron ansiedad, depresión, sentimientos de desesperanza, alucinaciones audiovisuales y delirios de persecución. El consumo de substancias psicoactivas aumentó 13,8 veces el riesgo de intento de suicidio, y las crisis situacionales aumentaron 10,6 veces la ideación. Además, la pérdida de ingresos e internaciones anteriores se asociaron a la manifestación del comportamiento. Las evidencias de cuidados incluyeron intervenciones medicamentosas, medidas de vigilancia y admisión hospitalaria. Conclusión Durante la pandemia de COVID-19, el comportamiento suicida se asoció a un aumento de la predisposición al consumo de sustancias psicoactivas, crisis situacionales y pérdida de ingresos. Se destaca la necesidad de políticas públicas orientadas hacia la identificación, prevención y una gestión adecuada de los estados de riesgo.

Abstract Objective To analyze the clinical aspects and factors associated with suicidal behavior during the COVID-19 pandemic. Methods Cross-sectional analytical study performed with care records of 130 patients who sought care in the psychiatric emergency department after suicidal ideation, planning or attempt. A form was used for sociodemographic, clinical and therapeutic characterization, and for identification of care needs and associated factors. Data analysis consisted of Fischer's exact test, Pearson's chi-square test and Poisson's regression, considering a significance level of 5%. Results Suicidal behavior was expressed by suicide attempt, ideation and planning. It was predominant in the female sex, young adults, unemployed, with low family income, and in patients with a history of mental disorder, psychiatric hospitalization, previous attempts and of therapeutic abandonment. The main psychic alterations involved anxiety, depression, feelings of hopelessness, audiovisual hallucinations and persecutory delusions. The consumption of psychoactive substances increased by up to 13.8 times the risk for suicide attempt, while situational crises increased suicidal ideation by up to 10.6 times. The loss of income and previous hospitalization were associated with manifestation of the behavior. Evidence of care involved drug interventions, surveillance measures, and hospital admission. Conclusion During the COVID-19 pandemic, suicidal behavior was associated with a greater predisposition to consume psychoactive substances, situational crises and loss of income. The need for public policies aimed at the identification, prevention and adequate management of risk states stands out.

Challenges and Potential Solutions for Physician's Suicide risk factors in the COVID-19 Era: Psychiatric Comorbidities, Medicine Judicialization, and Burnout.

INTRODUCTION: Suicide in physicians outlines a public health problem that deserves more consideration. A recently performed meta-analysis and systematic review evaluated suicide mortality in physicians by gender and investigated several related risk factors. It showed a post-1980 suicide mortality ratio 46% higher in female physicians than women in the general population and a 33% lower risk in male physicians than men in general, despite an overall contraction in physicians' mortality rates in both genders. METHODS: This narrative review was conducted through a search and analysis of relevant articles/databases to address questions raised by the meta-analysis, and how they may be affected by COVID-19. The process included unstructured searches on physician suicide, burnout, medicine judicialization, healthcare organization and COVID-19 on Pubmed, and Google searches for relevant databases, medical society, expert and media commentaries on these topics. We focus on three factors critical to address physician suicides: epidemiological data limitations, psychiatric comorbidities, and professional overload. RESULTS: We found relevant articles on suicide reporting, physician mental health, effects of healthcare judicialization and organization on physician and patient health, and how COVID-19 may impact such factors. This review addresses information sources, underreporting/misreporting of physicians' suicide rates, inadequate diagnosis and management of psychiatric comorbidities and chronic effects on physicians' work capacity, and finally, medicine judicialization and organization failure increasing physician "burnout". We discuss these factors in general and in relation to the COVID-19 pandemic. CONCLUSIONS: We describe an overview of the above factors, discuss possible solutions, and specifically address how COVID-19 may impact such factors.

Canadian news media coverage of suicide during the COVID-19 pandemic.

PURPOSE: The COVID-19 pandemic led to concerns about increases in suicidal behaviour. Research indicates that certain types of media coverage of suicide may help reduce suicidality (the Papageno effect), while other types may increase suicidality (the Werther effect). This study aimed to examine the tone and content of Canadian news articles about suicide during the first year of the pandemic. METHODS: Articles about suicide from Canadian news sources were collected and coded for adherence to responsible reporting of suicide guidelines. Articles which directly discussed suicidal behaviour in the COVID-19 context were identified and compared to other suicide articles in the same period. Lastly, a thematic analysis was conducted on the sub-sample of articles discussing suicide in the COVID-19 context. RESULTS: The sub-set of articles about suicide in the COVID-19 context (n = 103) contained significantly more putatively helpful content compared to non-COVID-19 articles (n = 457), such as including help information (56.3% Vs 23.6%), quoting an expert (68.0% Vs 16.8%) and educating about suicide (73.8% Vs 24.9%). This lower adherence among non-COVID-19 articles is concerning as they comprised over 80% of the sample. On the plus side, fewer than 10% of all articles provided monocausal, glamourized or sensational accounts of suicide. Qualitative analysis revealed the following three themes: (i) describing the epidemiology of suicidal behaviour; (ii) discussing self and communal care; and (iii) bringing attention to gaps in mental health care. CONCLUSION: Media articles about suicide during the first year of the pandemic showed partial adherence to responsible reporting of suicide guidelines, with room for improvement.

Suicidal Risk and Depression in Pregnant Women in Times of Pandemic.

PURPOSE: Pregnancy is a risk period for the development of mental disorders. About 10% of pregnant women worldwide experience a mental disorder, mainly depression, and this percentage has been aggravated by the COVID-19 pandemic. This study aims to understand the impact of COVID-19 on the mental health of pregnant women. METHODS: Three hundred and one pregnant women in the week 21.85 ± 9.9 were recruited through social media and pregnant women forums from September 2020 to December 2020. A multiple-choice questionnaire was administered to evaluate the sociodemographic characteristics of the women, the care provided, and different aspects related to COVID-19. A Beck Depression Inventory was also delivered. RESULTS: Of the pregnant women 23.5% had seen or had considered seeing a mental health professional during pregnancy. Predictive models using multivariate logistic regression found that this fact was associated with an increased risk of depression (OR = 4.22; CI 95% 2.39-7.52; P < 0.001). Among women with moderate-severe depression, it was associated with an increased risk of having suicidal thoughts (OR = 4.99; CI 95% 1.11-27.9; P = 0.044) and age was found to be a protective variable (OR = 0.86; CI 95% 0.72-0.98; P = 0.053). CONCLUSIONS: The COVID-19 pandemic represents a major mental health challenge for pregnant women. Despite the decrease in face-to-face visits, there are opportunities for health professionals to identify the existence of psycho-pathological alterations and suicidal ideation by asking the patient if she is seeing or considering seeing a mental health professional. Therefore, it is necessary to develop tools for early identification to ensure correct detection and care.

Psychosocial and financial well-being mediated the effects of COVID-19 distress on suicidality: a serial mediation model among Hong Kong young adults.

PURPOSE: The COVID-19 pandemic has brought significant distress on not only the physical health but also mental health of individuals. The present study investigated the direct and indirect effects from COVID-19 distress to suicidality via psychosocial and financial well-being among young people. METHODS: This cross-sectional survey recruited 1472 Hong Kong young people via random sampling in 2021. The respondents completed a phone survey on COVID-19 distress, the four-item Patient Health Questionnaire and items on social well-being, financial well-being, and suicidality. Structural equation modeling (SEM) was conducted to examine the direct and indirect effects of COVID-19 distress on suicidality via psychosocial and financial well-being. RESULTS: The direct effect of COVID-19 distress on suicidality was not significant (ß = 0.022, 95% CI - 0.097-0.156). The total indirect effect from COVID-19 distress to suicidality was significant and positive (αßγ = 0.150, 95% CI = 0.085-0.245) and accounted for 87% of the total effect (B = 0.172, 95% CI = 0.043-0.341). There were significant specific indirect effects via social well-being and psychological distress, and financial well-being and psychological distress. CONCLUSION: The present findings support different pathways from COVID-19 distress to suicidality via functioning in different domains among young people in Hong Kong. Measures are needed to ameliorate the impact on their social and financial well-being to reduce their psychological distress and suicidality.