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.

Focus on Suicidal Behaviours - The experience of the11th EPA Summer School

Every year, the European Psychiatric Association organizes the EPA Summer School, an intensive program that aims to support and promote the education of young psychiatry professionals through numerous activities. The program returned to being an in-person event this year, after changes imposed by the COVID-19 pandemic over the last two years. From September 29 to October 2, 2022, young psychiatrists selected by the EPA Committee on Education, 21 in total, gathered together in Strasbourg, France, to attend the activities organized around the topic "Focus on Suicidal Behaviours - One Step Beyond." This year's event adopted a blended learning format;the participants were required to attend and complete a 6-week online course entitled "Focus on Suicidal Behaviours", before coming to the in-person sessions held by a distinguished group of lecturers. The activities designed during the training days allowed the participants to not only expand their knowledge about suicide and related issues but also to exchange experiences from different European countries, and they encouraged critical thinking about what can be done more or better. In addition, they encouraged the participants to get to know each other, to socialize, and to building relationships with each other. This article presents step-by-step the activities organized during the Summer School and also attempts to describe the way the participants experienced them. © 2023 John Libbey Eurotext. All rights reserved.;Chaque année, l'Association Européenne de Psychiatrie organise une Université d'été, un programme intensif qui vise à soutenir et à promouvoir l'éducation des jeunes professionnels de la psychiatrie par le biais de nombreuses activités. Elle a pu se tenir de nouveau en présentiel en 2022, après 2 ans d'organisation en distanciel, imposée par la pandémie de covid-19. Du 29 septembre au 2 octobre 2022, les jeunes psychiatres sélectionnés par le Comité d'éducation de l'EPA, 21 au total, se sont retrouvés à Strasbourg, en France, pour assister à cette formation autour du thème « Focus sur les conduites suicidaires - One step beyond ». L'événement de cette année a été que le format était un enseignement mixte. Pour débuter, la 1re partie de la formation s'est déroulée en ligne, sous la forme d'un MOOC « Focus sur les comportements suicidaires », pour une durée de 6 semaines, la seconde partie était la formation en présentiel avec des experts internationaux, sur une durée de 2 jours 1/2. Ces journées de formation ont permis aux participants non seulement d'élargir leurs connaissances sur le suicide et les questions connexes, mais aussi d'échanger autour des expériences de différents pays européens et d'encourager la réflexion critique sur ce qui peut être fait de plus ou de mieux, en termes de prévention et de soins. De plus, la possibilité de rencontres et d'échanges entre les participants a permis la création d'un réseau social européen unique. Cet article présente étape par étape les activités de formation organisées pendant l'université d'été de l'EPA et témoigne du vécu des participants. © 2023 John Libbey Eurotext. All rights reserved.;Cada año, la Asociación Europea de Psiquiatría organiza una Escuela de Verano, un programa intensivo cuyo objetivo es apoyar y promover la formación de jóvenes profesionales de la psiquiatría a través de una gran variedad de actividades. Ha podido volver a celebrarse en persona en 2022, tras 2 años de organización a distancia, impuesta por la pandemia de la covid-19. Del 29 de septiembre al 2 de octubre de 2022, los jóvenes psiquiatras seleccionados por el Comité de Educación de la EPA, 21 en total, se reunieron en Estrasburgo (Francia) para asistir a esta formación sobre el tema "Enfoque en las conductas suicida - One step beyond (Un paso más allá"). Lo más destacado del acto de este año fue que el formato era una formación combinada. Para empezar, la 1a parte de la formación fue online, en forma de MOOC "Focus en conductas suicidas", con un duración de 6 semanas, la segunda parte fue la formación presencial con expertos internacionales, con una duración de 2 días y medio. Estas jornadas de formación les permitieron a los participantes no sólo ampliar sus conocimientos sobre el suicidio y cuestiones afines, sino también intercambiar en torno a experiencias de distintos países europeos y fomentar el pensamiento crítico sobre qué más o mejor se puede hacer, en términos de prevención y asistencia. Además, la posibilidad de encuentros e intercambios entre los participantes permitió crear una red social europea única. Este artículo presenta paso a paso las actividades de formación organizadas durante la escuela de verano de la EPA y da fe de la experiencia de los participantes. © 2023, John Libbey Eurotext. Tous droits réservés. © 2023 John Libbey Eurotext. All rights reserved.

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.

Effects of Covid-19 Vaccines on Mental Health of an Individual A Cross-Sectional Clinical Study

Objective: The mains and objectives of the study was to evaluate the impact of Covid'19 vaccination on mental health status. Study Design: A Cross-Sectional Clinical Study. Place and Duration: It is a cross-sectional study which was conducted by the house officers and the faculty of Dow International Dental College from june2022 to January 2023. Methodology: This study was conducted by distributing the questionnaire among the patients coming to the Outpatient Department at Dow International Dental College. A total of 280 Questionnaires were filled among the Vaccinated Patients coming to the OPD. Questions were inquired related to demographics, dosage, history, last dose, and benefit of vaccine, depression, sleep deprivation, feeling low, trouble concentrating and suicidal thoughts. The consent to fill this questionnaire by the patient was taken by 'Implied Consent'. It was in English language but was translated in Urdu by the house officers whenever it was needed to ensure the comprehension of the questions to the patients. The filled questionnaire was collected by the house officers of the dental department. A total of more than 280 questionnaires were distributed among the participants out of which 250 questionnaires were filled correctly giving us a response rate of 89.2% and dropouts of 10.8%. Practical Implications: The results of this cross-sectional clinical study have practical implications for the wider community. Encouraging Covid-19 vaccination can have a positive impact on both physical and mental health, and promoting vaccine uptake may lead to improved mental health outcomes for individuals. Such benefits can reduce the overall burden of mental health issues during the pandemic, which is beneficial to the community. Thus, public health campaigns should focus on the potential positive effects of Covid-19 vaccines on mental health to improve community well-being and promote vaccine acceptance. Result(s): Approximately 48% women and 52% male have anxiety, depression or either disorder, respectively. Adults with anxiety and depression were more likely to have low educational attainment, low household income, lack of health insurance and either lack or delay medical care. The filled questionnaire was collected by the house officers of the dental department. A total of more than 280 questionnaires were distributed among the participants out of whom 250 questionnaires were filled correctly giving us a response rate of 89.2% and dropouts of 10.8%. There was a common mental impact that was noticed and brought about people's mental health at stake. Conclusion(s): Forceful vaccination has a potential to affect mental health of an individual. Further studies are required to extrapolate the findings of the present study.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

The effect of intervention using an emotional recognition coaching companion robot on the elderly people with depression

Aims: During the COVID-19 pandemic, care for the elderly in the community was greatly limited. Accordingly, the demand for alternative community care have increased to cope with changing situations. In this study, we tried to find out whether the companion robot improved mood state and related problem in depressive or isolated community dwelling elderly. Method(s): For 186 community dwelling elderly who have received social welfare service due to depression or social isolation, we provided companion robot that could support their daily living. The robot was equipped with special program that could recognize and respond to the participant's own emotion. It was part of behavioural activation techniques which is one of powerful treatment for depression. The self-report questionnaires were used to measure changes in cognitive function, depression, suicidality, loneliness, resilience and satisfaction of life. Outcomes were measured before using companion robot and after 3 months, and we compared them. Result(s): The elderly using companion robot for 3 months showed improved cognitive function, depression (p < .001), suicidality (p < .001), and loneliness (p = .033) in the self-report questionnaire. Resilience (p = .749) and satisfaction of life (p = .246) were also improved but not reached significance. Conclusion(s): These findings showed that the use of companion robot with emotional recognition coaching program could help improve depression, cognitive function, loneliness and suicidal ideation. In particular, this effect was also useful for those who were diagnosed with depression. Also if we can put more techniques of behavioural activation programs into robot, it could be useful in community care for depressive and isolated elderly.

The effect of COVID-19 pandemic on depression and suicidal ideation in Korean community dwelling elderly

Aims: The impacts of the coronavirus disease of 2019 (COVID-19) pandemic on mental health have been relatively severe. This study examined the influence of the COVID-19 especially on depression and suicidal ideation in community-dwelling elderly in Korea. Method(s): Data were employed from a survey on elderly mental health in Jeollanam-do (southwest province in Korea). A total of 2423 elderlies were recruited from 22 counties in Jeollanam-do between April and October 2021. We used self-reported questionnaires, including sociodemographic factors, COVID-19 related stress, suicidal ideation, Geriatric Depression Scale-Short Form Korean Version (GDS-SF). Logistic regression was performed to examine the factors on depression and suicidal ideation. Result(s): Of the 2423 subjects, 622 (25.7%) reported depressive symptoms and 518 (21.4%) reported suicidal ideation. The multivariate logistic regression analysis revealed that living alone, poor perceived health status, the worry of COVID-19 infection and restriction of daily activity due to COVID-19 pandemic were significantly associated with depression. Male sex, poor perceived health status, disability in house chores and depressive symptom are risk factors for suicidal ideation. Conclusion(s): These findings showed that increased risk factor for depression and suicidal ideation in community dwelling elderly during COVID-19 pandemic. We confirmed that feelings of isolation and negative perception of health were risk factors on depression in community dwelling elderly in the context of the COVID -19 pandemic. Also male, poor self-perceived health status, difficulty of independent living and worry and depression are increased the risk of suicidal ideation among the elderly.

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.

Research progress on the addictive characteristics of non-suicidal self-injury.

In recent years, especially after the outbreak of COVID-19, a large number of non-suicidal self-injury (NSSI) behaviors in adolescents have emerged, which has attracted wide attention from the society and become a serious public mental health problem. Repeated NSSI is also considered as an addictive behavior, which shares many similar neurobiological mechanisms with substance addiction, such as the dopamine reward system and the endogenous opioid system. This paper aims to review the domestic and international research progress on the characteristics of addiction in NSSI, including the general background, mechanism, assessment, and intervention.Copyright © 2022 Chinese Journal of Psychiatry. All rights reserved

The impact of transgender minority stress and emotion regulation on suicidality and self-harm

Transgender and gender diverse (TGD) individuals experience high levels of minority stress, as well as a high prevalence of suicidality and self-harm. The current study investigates if emotion regulation mediates the relationships of minority stressors with self-harm and suicidality. TGD adult primary care patients (N = 115) completed a survey including measures of minority stressors, emotion dysregulation, self-harm, and suicidality. Emotion regulation mediated the relationship between victimisation and suicidality. Emotion regulation did not mediate the relationship between victimisation and self-harm. TGD individuals' suicide risk may be increased when they experience victimisation through increased emotion dysregulation.

Long-Term Neurologic Sequelae Among Patients with Varying COVID-19 Severity: An Administrative Claims Database Analysis

Objectives: Examine the long-term incident neurologic sequelae post COVID recovery and assess relationship with COVID severity using real-world data. Method(s): This retrospective cohort study was conducted using Optum Research Database between 01July2019 to 30Sep2022. Patients included were >=18 years with COVID diagnosis (index date) between 01Jan2020 and 31Oct2020, with continuous enrollment 6 months before and >=12 months after index date, known demographics, not pregnant, and with no baseline neurologic conditions. Patients were stratified into COVID severity cohorts as mild (index diagnosis), moderate (inpatient visit within 15 days of index), or severe (evidence of acute respiratory distress) and followed for a minimum of 12-months post-index. Neurologic sequelae examined were persistent headache, migraine, anosmia, sleep disturbance, cognitive dysfunction, post-traumatic stress disorder, suicidality, anxiety, depression, attention deficit hyperactivity disorder, cerebrovascular disease (CVD), fatigue/myalgia and tremors. Descriptive statistics and incidence rate ratios (IRR) were calculated to assess outcomes. Result(s): Of 534,843 patients, 107,656 (Mild 96,637;Moderate 3,371;Severe 7,648) met the study inclusion criteria. Median follow up time was 750, 774 and 768 days in the mild, moderate and severe cohorts, respectively. About 20% of patients in the mild, 32% in moderate and 35% in the severe cohort experienced >=3 neurologic sequelae during the follow-up period. A significantly higher incidence of any neurologic sequelae was observed in moderate and severe cohorts compared with the mild cohort (IRR 3.1 and 3.0, respectively;p<0.001). Cognitive dysfunction (moderate IRR 5.4, severe IRR 5.7;p<0.001), and CVD (moderate IRR 4.8, severe IRR 4.0;p<0.001) were the most commonly occurring manifestations in moderate and severe cohorts compared with the mild cohort. Conclusion(s): These results highlight the need for long-term monitoring and preventative strategies for neurologic conditions post COVID recovery that might impair quality of life and increase overall healthcare burden in the U.S.Copyright © 2023

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.

Innovative angles from a youth epidemiological study: Data from the HK-YES in Hong Kong

There are few specific epidemiological studies focusing on youth mental health in a non-western population. In particular, studies which are designed to include a broad range of youth-relevant potential risk and protective factors during the COVID-19 period are scarce. Such data are important for formulating programs to enhance healthy coping, as well as to facilitate the screening of risk factors. We present data from a comprehensive youth epidemiological study in Hong Kong from innovative angles which extend beyond conventional prevalence reporting. For example we investigated the change in major depressive episode states in a cohort with longitudinal data, which provide us with insight into what determines the persistence of depression. We also look into suicidal ideation and the role of rumination in this population. We also report the use of a recently identified marker for brain inhibition/excitation balance (visual stress) as a predictor associated with mental health outcomes. Finally, we studied the role of personality in mediating mental health outcomes.

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.

NEI 2022 Abstracts

The proceedings contain 96 papers. The topics discussed include: practical pharmacotherapy for opioid use disorder in the age of fentanyl;can COVID-19 cause acute psychosis in pediatric patients? a case report;a survey of bullying experiences in a child and adolescent psychiatric clinic population;acute emergence of suicidal thoughts following Lemborexant initiation: an adverse reaction case report;assessing the unmet clinical need and opportunity for digital therapeutic intervention in schizophrenia: perspective from people with schizophrenia;rapid antidepressant effects and MADRS item improvements with AXS-05 (DEXTROMETHORPHAN-BUPROPION), an oral NMDA receptor antagonist in major depressive disorder: results from two randomized double-blind, controlled trials;targeting lncRNA NEAT1 impedes Alzheimers disease progression via MicroRNA-193a mediated CREB/BDNF and NRF2/NQO1 pathways;and impact of AXS-05 (DEXTROMETHORPHAN-BUPROPION), an Oral NMDA receptor antagonist, on Anhedonic symptoms in major depressive disorder.

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.

Identifying the Bridge Between Anxiety Response to COVID-19 and Depression Symptoms in General Population: A Network Analysis.

BACKGROUND: Previous studies have suggested links between anxiety response to the novel coronavirus (COVID-19) and depression symptoms in general population. However, a symptom-level investigation has not been reported. OBJECTIVE: This study aimed to use network analysis to identify central symptoms and bridge symptoms that link COVID-19 anxiety and depression. METHODS: Data from 1788 participants were analyzed. Coronavirus anxiety and depression symptoms were measured using the Stress and Anxiety to Viral Epidemics-6 Items Scale and the Patient Health Questionnaire-9, respectively. Network analysis was performed using R. RESULTS: The results revealed 'thoughts of suicide or self-harm' from Patient Health Questionnaire-9 and 'worry about others avoiding me' from Stress and Anxiety to Viral Epidemics-6 Items Scale as bridge symptoms. Findings suggest direct relationship between fear of social isolation and thoughts of suicide or self-harm. 'Feeling tired with little energy' and 'trouble concentrating' are strongly linked to 'thoughts of suicide or self-harm', suggesting these symptoms as risk factors for suicidal or self-injurious thoughts during the pandemic. CONCLUSIONS: The findings suggest fear of social isolation as a risk factor for developing thoughts of suicide or self-harm. These results should be taken into account during evaluation of risk of suicide or mental health interventions for the pandemic.

Impact of COVID-19 pandemic on major depressive disorder in acute psychiatric inpatients.

Introduction: The spread of the coronavirus disease 2019 (COVID-19) pandemic and the subsequent restrictions significantly affected mental health, especially major depressive disorder (MDD) whose incidence increased by 27.6% in 2020, after the COVID-19 outbreak. Few studies focused on the impact of the pandemic on the clinical characteristics of outpatients with MDD and even fewer on inpatients admitted for a major depressive episode (MDE). We aimed to compare the characteristics of MDD of two groups of patients admitted for an MDE before and after the pandemic outbreak and to investigate which variables are significantly related to post-lockdown hospitalizations. Methods: This retrospective study included 314 patients with MDD hospitalized from January 2018 to December 2021 for an MDE (DSM-5) before (n = 154) and after (n = 160) the Italian lockdown (9th of March 2020). We compared patients' sociodemographic and clinical characteristics. The characteristics significantly different between the two groups were included in a logistic regression to identify the factors more strictly associated with post-lockdown hospitalizations. Results: During post-lockdown hospitalization, we found a higher rate of severe MDE (33 patients, 21.4%, in the pre-lockdown and 55 patients, 34.4%, in the post), MDE with psychotic features (3 patients, 2.0%, in the pre-lockdown and 11 patients, 6.9%, in the post-lockdown), and suicidal ideation (42, 27.3%, in the pre-lockdown and 67, 41.9%, in the post-lockdown), with a lower proportion of patients followed by psychiatric services before admission (106 patients, 68.8%, in the pre-lockdown and 90 patients, 56.3%, in the post-lockdown) and a higher percentage of them in treatment with psychotherapy (18 patients, 11.7% in the pre-lockdown and 32, 20.0%, in the post-lockdown) and more frequent increase of the antidepressant dosage (16 patients, 10.4% in the pre-lockdown and 32 patients, 20.0% in the post-lockdown) and adoption of augmentation strategies (13 patients, 8.4%, in the pre-lockdown and 26 patients, 16.3%, in the post-lockdown) to treat the MDE. In the regression model, post-lockdown hospitalizations were significantly associated with suicidal ideation (OR = 1.86; p = 0.016) and psychotic features (OR = 4.41; p = 0.029) at admission, the increase in the antidepressant daily dose (OR = 2.45; p = 0.009), and the employment of an augmentation therapy (OR = 2.25; p = 0.029). Discussion: These results showed an association between the COVID-19 pandemic and the occurrence of MDE with more severe clinical features. This might be true also for future calamities, suggesting that in these emergency contexts, patients with MDD would require more attention, resources, and intense treatments with a specific focus on suicide prevention.

Suicidal Behavior in the Trans-Baikal Region: Epidemiological Characteristics, the Impact of the Covid-19 Pandemic and the Implementation of the Who Tool for Improvement of Monitoring Systems

The article provides an analysis of the current epidemiological characteristics of suicidal behavior in the TransBaikal Region, an assessment of the impact of the COVID -19 pandemic on the indicators of suicidal activity of the population, and also presents the first results of self-harm monitoring implemented in the subject based on the WHO tool. It has been established that in Transbaikalia a positive trend continues in a significant decrease in the number of suicides, although the rate of completed suicides in the Territory is 2.5 times higher than the national average and 1.5 times higher than in the Far Eastern Federal District. The spread of a new coronavirus infection COVID -19 and its associated adverse socioeconomic impacts have resulted in a slowdown in the decline in suicide rates and a 1.5-fold increase in the number of suicide attempts among the population of the region in 2020. The monitoring of self-injurious behavior standardized by WHO has allowed a more detailed analysis of the epidemiological features of suicide attempts in the region.