Suicidal ideation and suicide attempt following ketamine prescription in patients with treatment-resistant depression: a nation-wide cohort study.

Ketamine, including esketamine, is an effective treatment for patients with treatment-resistant depression (TRD); however, its long-term efficacy in real-world populations remains poorly characterized. This is a retrospective cohort study using TriNetX US Collaborative Network, a platform aggregating electronic health records (EHRs) data from 93 million patients from 56 health care organizations in the US, and the study population includes 321,367 patients with a diagnosis of TRD who were prescribed relevant treatment in their EHRs. The prescription of ketamine (including esketamine) was associated with significant decreased risk of suicidal ideation compared to prescription of other common antidepressants: HR = 0.65 (95% CI: 0.53 - 0.81) at 1 day - 7 days, 0.78 (95% CI: 0.66 - 0.92) at 1 day - 30 days, 0.81 (95% CI: 0.70 - 0.92) at 1 day - 90 days, 0.82 (95% CI: 0.72 - 0.92) at 1 day - 180 days, and 0.83 (95% CI: 0.74 - 0.93) at 1 day - 270 days. This trend was especially robust among adults over 24 years of age, males, and White patients with TRD. No significant difference was observed for suicide attempts, except significantly increased risk for adolescents (aged 10-24) at 1 day - 30 days with HR = 2.22 (95% CI: 1.01-4.87). This study provides real-world evidence that ketamine has long-term benefits in mitigating suicidal ideation in patients with treatment-resistant depression. Future work should focus on optimizing dosage regimens for ketamine, understanding the mechanism, and the difference in various demographic subpopulations.

Differences in Beliefs About Suicide by Occupation in a Representative Sample of Adults in the United States, General Social Survey 2002-2021.

OBJECTIVE: Beliefs about suicide are important aspects of suicide prevention gatekeeper trainings. This study sought to determine if workers in finance- and legal/judicial-related industries have significantly different levels of suicide acceptability compared to the general US population. METHOD: Cross-sectional data are from the 2002 to 2021 General Social Survey (GSS). Suicide acceptability was measured with four dichotomous items to which respondents indicated yes/no if they thought someone has the right to end their life in four negative life scenarios. Occupational categories were coded based on U.S. Census Bureau occupation and industry codes. Covariates for multiple logistic regression analyses included age, educational attainment, sex, race, ethnicity, survey year, and religiosity. RESULTS: Among the 15,166 respondents, 651 people worked in finance-related occupations and 319 people worked in legal/judicial-related occupations. In adjusted models, people in finance-related occupations had greater odds of endorsing suicide as acceptable if one has an incurable disease (aOR = 1.25, 95%CI = 1.03-1.52) and marginally greater odds of endorsing suicide as acceptable if one dishonors their family (aOR = 1.31, 95%CI = 0.99-1.74) than the general adult population. People in legal/judicial-related occupations were more likely to endorse 3 of the 4 suicide acceptability items compared to the general adult population, however these differences were not statistically significant after accounting for demographic factors. CONCLUSION: Workers in non-clinical industries that frequently see clients during negative life events are prime audiences for gatekeeper trainings but may have entrenched beliefs about suicide acceptability. Research is needed to determine how these beliefs may impact gatekeeper training.HIGHLIGHTSNegative life events (e.g., divorce) are common correlates of suicidal crisisSuicide acceptability differed by occupation type compared to the general US adult populationFinancial- and legal/judicial workers may need more tailored suicide gatekeeper training.

Is anybody there? A longitudinal examination of help-seeking and suicidal risk among Latino, Black, and non-Hispanic white adolescents.

INTRODUCTION: Understanding adolescents' and emerging adults' help-seeking behaviors is important to curb suicidal thoughts and behaviors (STB), especially among racial/ethnic minorities who have some of the highest chronic rates of STB in the United States. Learning how diverse groups of adolescents seek help during emotional crises can help us understand the stark health disparities related to suicide risk and respond to them in culturally informed ways. METHODS: The study observed adolescents via a nationally representative sample (n = 20,745) over 14 years (National Longitudinal Study of Adolescents to Adult Health [Add Health]) to examine the association between help-seeking behaviors and STB. Longitudinal multinomial logistic regressions were run to assess for racial/ethnic and gender disparities. RESULTS: Help-seeking was not protective for Black female STB but alternatively was protective for each male group (non-Hispanic white, Black, and Latino). Latinas in their early-to-late 20s with no self-reported STB were at an extremely high risk of suicide attempts just 6 years later. CONCLUSIONS: This is the first study to examine race/ethnicity*gender in six independent groups to assess suicidality longitudinally among a nationally representative sample. Tailoring existing interventions to meet the needs of growing and diverse communities is critical for suicide prevention programs and policies.

A longitudinal study examining the associations of bullying victimization and suicidal ideation among sexual minority adolescents.

INTRODUCTION: Roughly one-third of sexual minority adolescents (SMA) report at least one lifetime suicide attempt. Supportive connections are protective for ideation, yet little is known about this association with SMA-especially longitudinally. METHODS: Five-step logistic regressions examined the associations of bullying, SMA, and ideation, and also how connectedness mediates this from age 9 and 15 (Fragile Families and Child Wellbeing Study; N = 3,023 adolescents). RESULTS: At age 9, SMA reported higher levels of daily bullying compared with heterosexual peers (26% versus 14%), and at age 15, SMA reported daily (7%) and weekly (20%) bullying. SMA (32%) reported ideation compared with their heterosexual peers (13%) at age 15. Parental and school connectedness protected adolescents regardless of sexual orientation for SI, but parental attachment buffered the effect of SMA ideation more than school connectedness. CONCLUSION: Impressing upon schools to be mindful of bullying on their campuses, especially of SMA, is crucial for suicide prevention as we found heterosexual students connected to their school were protected from ideation, yet this was not found for SMA. Strong parent-child bonds can mediate the effects of bullying while at school, speaking to the importance of having at least one trusted adult in an adolescent's life.

Questions of faith: Religious affiliations and suicidal ideation among sexual minority young adults.

OBJECTIVE: To examine how the associations of specific religious affiliations with recent suicidal ideation vary by sexual orientation among young adults. METHOD: This project was a cross-sectional secondary analysis of data from the 2006 and 2011 surveys of the National Research Consortium of Counseling Centers in Higher Education. The analytic sample was restricted to persons between the ages of 18-29 (n = 40,150). Multiple logistic regression analyses were used to examine associations of religious affiliations with recent suicidal ideation between heterosexual and sexual minority (e.g., gay, lesbian, bisexual, questioning) young adults. RESULTS: Approximately 6.7% of the sample self-identified as sexual minority. Compared to heterosexuals, sexual minorities were more likely to report recent suicidal ideation (aOR = 4.52, 95% CI = 3.97-5.16). Among heterosexuals, Unspecified Christian and Catholic denominations were associated with 24% and 37% reduced odds of recent suicidal ideation compared to agnostic/atheist heterosexuals. However, among sexual minorities, Unspecified Christian and Catholic denominations were associated with 68% and 77% increased odds of recent suicidal ideation compared to agnostic/atheist sexual minorities. Unspecified Christian and Catholic sexual minorities had 184% and 198% increased odds of recent suicidal ideation compared to Unitarian/Universalist sexual minorities. CONCLUSIONS: Although protective for heterosexuals, religious affiliation may not be globally protective against suicidal ideation among sexual minorities.

"Can we talk?": A longitudinal analysis of Latino & non-Hispanic parent-child connectedness & adolescent ideation.

BACKGROUND: Over 16 million U.S. adults report a major depressive episode each year. Hispanic females comprise the highest number of U.S. births compared to other race/ethnicities and are expected to remain as the Hispanic population grows. Research postulates that depression often co-occurs within families and is passed down to future generations but has yet to determine racial/ethnic disparities for depression and more acute forms including ideation. METHODS: Using data from the Fragile Families and Child Wellbeing Study, latent class analyses examined the association of primary caregiver's (PCG) depressive symptoms and how their child's perceived level of parent-child closeness is related to their now-adolescent's (age 15) likelihood of ideation (N = 4,898 families). RESULTS: Hispanic PCG's reported a lower rate of depressive symptoms (37%) than non-Hispanic PCG's (45%). Hispanic PCG's depressive symptoms were more likely to be chronic throughout their adolescent's lifetime (15%). Regardless of race/ethnicity, PCG's chronic depressive symptoms negatively affected parental closeness and increased suicidal risk for adolescents. These associations were found at ages 9 and 15 for non-Hispanic families, and at age 15 for Hispanic families. LIMITATIONS: While this is an important first step, parental closeness and ideation can wax and wane. Asking teens about ideation before adolescence could have strengthened our study. CONCLUSIONS: Suicide prevention must be family system focused, and not solely adolescent focused. Impressing upon individuals who serve children (i.e. teachers) and adults (i.e. physicians) to include yearly depression and suicide screens/assessments is crucial given PCG's different wave presentations and how ideation can present as early as middle school.

Help-seeking behaviors and attitudes of emerging adults: How college students reporting recent suicidal ideation utilize the internet compared to traditional resources.

Objective: Suicide is the second leading cause of death among emerging adults, yet little is known regarding their online help-seeking. Participants: The National Research Consortium of Counseling Centers in Higher Education's dataset (N=26,292). Methods: Students across the United States were recruited from 73 four-year institutions to participate during the 2010-2011 school year. Results: Observed the effectiveness of online and traditional help-seeking stratified by recent suicidal ideation related to their most distressful period in the past year. Females and younger students endorsed both types of help-seeking, yet those with recent ideation were less likely to disclose any help-seeking. Among those reporting recent ideation, only females reported that traditional supports were more than moderately helpful. Regardless of whether students endorsed ideation, students who were younger, engaged in risky behaviors and identified as females reported that online resources were more than moderately helpful. Conclusions: Online resources could potentially bridge barriers to traditional help-seeking for those reluctant to seek out care, yet traditional resources were reported to be the most effective among this sample.

Oh, SNAP! Poverty Simulations in Social Justice Classrooms: Active and Experiential Learning.

The Supplementary Nutrition Assistance Program (SNAP) Challenge encourages critical self-reflection and analysis of biases over seven consecutive days. Active learning methodologies are discussed compared to pre-formed lectures. Adaptive flexibility and empathy are salient skills for social workers that are emphasized in simulations. Students are challenged to only eat the average daily allowance for approved food options ($4.50/day) and chronical their observations. The Challenge improves students' awareness of power and privilege with their future clients. This novel approach not only addresses the Council of Social Work's Core Competencies but also trains new social workers to effectively deliver social services empathically.

Young Adolescents' Help Seeking Behaviors and Attitudes: An Examination of an Underserved Community.

Young adolescents' endorsement of help-seeking and reported levels of connectedness are vital for culturally-tailored prevention initiatives. There is a dearth of information on how younger adolescents attending middle schools (ages 11-15) obtain help from trusted adults, especially among Hispanics. This is problematic as Hispanics, especially female high school students, have consistently reported higher rates of depression and suicidal behaviors for over 30 years. This pilot study included 72 young adolescents (86% Hispanic) in Central Texas. Surprisingly, although there were significant gender and age differences, no group strongly endorsed seeking help during times of distress. Yet, females were more likely to report that they would talk to a counselor or other adult at school when distressed compared to males. While no gender differences were found endorsing trusted adults as helpful, younger female adolescents held higher beliefs these individuals could help during times of distress. What is most pivotal is that this study suggests that changes in help seeking attitudes can occur from one grade to another. Therefore, early adolescence, instead of the more common period of high school, might be a critical time to offer upstream mental health prevention approaches.

Use of Mental Health Services Among College Students by Sexual Orientation.

PURPOSE: The current study examines differences between lesbian, gay, bisexual, and questioning (LGBQ) students and heterosexual students in terms of counseling and mental health services received (healthcare utilization), from whom students would seek help, and who contributed positively to students' ability to cope during a stressful period. METHODS: An online survey was administered among 25,844 college students, enrolled in 76 schools (mean age = 25.52). The majority of participants was graduate students (42.81%) and reported their race/ethnicity as non-Hispanic White (70.49%). RESULTS: Compared with their heterosexual counterparts, gay males and lesbian/gay and bisexual females reported receiving more counseling or mental health services, most notably from counselors, therapists, psychologists, and/or social workers. Bisexual males and LGBQ females were less likely to seek help from a parent or family member compared with heterosexual males and females, respectively. Racial/ethnic minority bisexual females were less likely to seek help from a friend or roommate than non-Hispanic White bisexual females. Compared with their heterosexual counterparts, gay and questioning males and LGBQ females were more likely to report that religion reduced their ability to cope. CONCLUSION: The current findings illuminate important differences by sexual orientation in terms of seeking and receiving mental health services. Although we found that lesbian/gay and bisexual college students were more likely to receive counseling and mental healthcare, we cannot ascertain whether they were satisfied with the services they received. The findings also suggest that certain groups of LGBQ students do not find support with their clergy and family, which may indicate a lack of understanding or acceptance of LGBQ issues.

Association of Religiosity With Sexual Minority Suicide Ideation and Attempt.

INTRODUCTION: The purpose of this study is to explore how the associations between importance of religion and recent suicide ideation, recent suicide attempt, and lifetime suicide attempt vary by sexual orientation. METHODS: Survey data were collected from the 2011 University of Texas at Austin's Research Consortium data from 21,247 college-enrolled young adults aged 18-30 years. Respondents reported sexual identity as heterosexual, gay/lesbian, bisexual, or questioning. Two sets of multivariable models were conducted to explore the relations of religious importance and sexual orientation with the prevalence of suicidal behavior. The first model was stratified by sexual orientation and the second model was stratified by importance of religion. To explore potential gender differences in self-directed violence, the models were also stratified by gender identity. The main outcome measures were recent suicidal ideation, recent suicide attempt, and lifetime suicide attempt. RESULTS: Overall, increased importance of religion was associated with higher odds of recent suicide ideation for both gay/lesbian and questioning students. The association between sexual orientation and self-directed violence were mixed and varied by strata. Lesbian/gay students who viewed religion as very important had greater odds for recent suicidal ideation and lifetime suicide attempt compared with heterosexual individuals. Bisexual and questioning sexual orientations were significantly associated with recent suicide ideation, recent attempt, and lifetime attempt across all strata of religious importance, but the strongest effects were among those who reported that religion was very important. CONCLUSIONS: Religion-based services for mental health and suicide prevention may not benefit gay/lesbian, bisexual, or questioning individuals. Religion-based service providers should actively assure their services are open and supportive of gay/lesbian, bisexual, or questioning individuals.

A longitudinal study of Latino and non-Hispanic mothers' and fathers' depressive symptoms and its association with parent-child communication.

BACKGROUND: Roughly 8% of the U.S. population report moderate or severe depression for two or more weeks and Latinos (3.7%) report higher rates of severe depression compared to non-Hispanic whites (2.6%) (Pratt and Brody, 2014). As the Latino population continues to grow in the U.S., there is little research on the manifestations for depression, and how this affects the family system longitudinally. METHODS: Based on data from the Fragile Families and Child Wellbeing Study, a 3-step latent class analysis examined the association of self-reported parental depressive symptoms and their children's perceived levels of closeness and openness to communicate with their parents over 9 years (N=3956 families). RESULTS: Latino parents reported four different depressive patterns, while non-Hispanic parents were more diversified and had six patterns in terms of latent class analysis. Latinos reported episodic symptoms, while NH parents were more likely to report chronic depressive symptoms over time. Regardless of race/ethnicity, parental depressive symptoms negatively affected their children's reported level of parental closeness and openness to communicate with mothers and fathers. LIMITATIONS: As with any self-report data, the risk of social desirability bias is likely still present. Additionally, these results cannot be generalized to the broader U.S. CONCLUSIONS: Due to the different mental health presentations over 9 years, and following the federal initiatives (National Institute of Mental Health, 2015) of early and consistent surveillance, we advise that clinicians and primary care physicians screen for depressive symptoms at least yearly.

A longitudinal examination of how mothers' and fathers' mental health and thoughts of death are related to their child's self-reported levels of parental connectedness.

Background: Mental health outcomes are often passed-down in families, which underscores the importance of understanding mechanisms related to positive health outcomes. We focus on parent-child connectedness, which has been shown to not only decrease children's distress but strengthens their social coping resources. Methods: Utilizing four waves of the Fragile Families and Child Wellbeing Study, a national study of nearly 5000 mostly unmarried parents, we observed the influence of parents' depressive symptoms and thoughts of death (TOD) on their 9-year-old child's self-reported levels of connectedness to their parents. Results: Mothers and fathers reported similar rates of depression over time, with peak symptomology when their child turned 3 years old and declining levels as their children grew older. Compared to children whose mothers reported no symptoms, children whose mothers reported chronic depression and TOD were > 7 times as likely (OR = 8.13, p < 0.001) to report feeling distant from their mother, even if depression and TOD were only periodic (OR = 5.94, p < 0.001) or if their mother only reported depression (OR = 4.00, p = 0.002). Fathers reporting chronic depression earlier in their child's life had the highest odds of low child-reported connectedness (OR = 4.42, p < 0.001), but onset later in their child's lives (ages 5 and 9) also resulted in low reported connectedness from their children (OR = 2.73, p = 0.048). Conclusions: Given the ramifications of parental mental health for parent-child connectedness, upstream prevention approaches, such as screening in pediatricians' offices may be a key objective for mental health promotion. As trusted adults play critical roles in children's lives, universal prevention highlighting family bonds for new parents may be a salient intervention focus.

The Relationship Between Suicide Ideation, Behavioral Health, and College Academic Performance.

The impact of suicidal ideation on college students' academic performance has yet to be examined, yet mental health is often linked with academic performance. Underclassmen and upperclassmen were compared on behavioral health outcomes related to academic success (N = 26,457). Ideation (b = -0.05, p < .05), increased mental health (b = -0.03, p < .01) or substance use severity (b = -0.02, p < .01) was associated with lower GPAs. Underclassmen's behavioral health severity was related to lower GPA. Students reported higher GPAs when participating in extracurricular activities during the past year. Ideation, beyond mental health, is an important when assessing academic performance. Increasing students' connections benefits students experiencing behavioral concerns but also aids in suicide prevention initiatives and improves academic outcomes. Creating integrated health care systems on campus where physical, mental health and academic support services is crucial to offer solutions for students with severe or co-morbid mental health histories.

Mental Health Care Utilization: How Race, Ethnicity and Veteran Status are Associated with Seeking Help.

As veterans disproportionately experience higher rates of mental illness than civilians, conflicting results surround the impact of race/ethnicity on treatment utilization. This study utilized the CDC's Texas Behavioral Risk Factor Surveillance System data, a random-digit dialed telephone survey of non-institutionalized adults. A subset of Texas respondents (n = 8563) were asked questions related to mental health treatment, stigma, help-seeking attitudes and emotional support. While no differences were found in health care utilization between non-Hispanic white veterans and non-veterans, there were distinct patterns among racial/ethnic minority veterans and non-veterans. Black and Latino non-veterans reported significantly lower health care utilization compared to non-Hispanic white non-veterans. Among veterans, there were no differences in reported utilization rates comparing non-Hispanic whites and Latinos and also non-Hispanic whites and Blacks. Our study adds to the literature by examining health care utilization among a diverse group of veterans by focusing on Veterans Administration (VA) and non-VA services to veterans.

An exploratory study of nonsuicidal self-injury and suicidal behaviors in adolescent Latinas.

To date, there is little research to validate empirically differences between nonsuicidal self-injurious behavior (NSSI) and attempted suicide among Latina adolescents. Understanding the characteristics and contextual features of self-harmful behaviors among Latina teens is a critical public health and social justice matter given the disproportionate rates of attempted suicide and anticipated population growth of this vulnerable group. In this article, we draw on an ecodevelopmental model to focus attention on factors in the sociocultural environment that shape suicidal behaviors and NSSIs. Through analysis of qualitative interviews conducted with girls who used NSSI (n = 18), attempted suicide (n = 29), used NSSI and attempted suicide (n = 8,) and had no reported lifetime history of self-harm (n = 28), we describe the sociocultural factors that shaped psychosocial vulnerabilities and gave rise to decisions to use NSSI or attempt suicide. Our analysis revealed that adolescents who engaged in NSSI perceived their negative feelings as something that could be controlled through self-injurious acts, whereas powerlessness was a theme underlying the emotional states of girls who attempted suicide. When NSSI ceased to function as a mechanism for control, girls came to sudden decisions to attempt suicide. Most teens identified specific, and often multiple, situations that induced intense affective states and shaped decisions to inflict self-harm. Two situational experiences emerged as particularly salient and promising for subsequent studies on self-harmful behaviors among Latina adolescents: transnational stress and bullying. We describe each of these and offer suggestions for future research and practice.

Associations of racial/ethnic identities and religious affiliation with suicidal ideation among lesbian, gay, bisexual, and questioning individuals.

BACKGROUND: Our aim was to examine the associations of racial/ethnic identity and religious affiliation with suicidal ideation among lesbian, gay, bisexual, and questioning (LGBQ) and heterosexual college students. An additional aim was to determine the prevalence of passive suicidal ideation (i.e., death ideation) and active suicidal ideation among culturally diverse LGBQ individuals. METHODS: Data from the National Research Consortium probability-based sample of college students from 70 postsecondary institutions (n=24,626) were used to examine active and passive suicidal ideation in the past 12-months and lifetime active suicidal ideation among students by sexual orientation, racial/ethnic identity, and religious affiliation. RESULTS: Across most racial/ethnic groups and religious affiliations, LGBQ students were more likely to report active suicidal ideation than non-LGBQ individuals. Among LGBQ students, Latino individuals had lower odds of reporting both past 12-month passive and active suicidal ideation than their non-Hispanic white LGBQ counterparts. Compared to Christian LGBQ students, Agnostic/Atheist LGBQ individuals had greater odds of reporting past 12-month passive suicidal ideation, and Jewish LGBQ students were less likely to endorse past 12-month passive and active suicidal ideation. LIMITATIONS: Cross-sectional design and self-reported data. CONCLUSIONS: Results corroborate previous research showing elevated prevalence of suicidal ideation among LGBQ individuals in comparison to their heterosexual counterparts. These findings are among the first to document prevalence differences within the LGBQ population based on intersectional identities (race/ethnicity and religious affiliation). Providers should recognize that LGBQ individuals might need support in negotiating the complex relationship between multiple identities, especially due to their elevated prevalence of suicidal ideation.

Latino and Latina Adolescents' Help-seeking Behaviors and Attitudes Regarding Suicide Compared to Peers with Recent Suicidal Ideation.

Although Latinas have consistently reported higher rates of suicidal behavior for the past 20 years (CDC, 1996), there is a dearth of information regarding their help-seeking attitudes and behaviors when dealing with distress and suicide. Associations between adolescents' ideation and help-seeking from adults were different for non-Hispanic Whites and Latinos from 14 high schools (N = 4,983). Among females, ideators and Latinas reported lower levels of help-seeking attitudes than nonideators and non-Hispanic Whites. Males showed interaction effects of ideation by race/ethnicity on help-seeking. Within sex by race/ethnicity, differences showed that while non-Hispanic White students reported consistent differences between suicidal ideation and no reported suicidal ideation, Latinos were more similar between these groups, particularly with having support from friends and family to seek help from adults. Research should clarify how culture contributes to decreased help-seeking norms among those with suicidal ideation.

The influence of intersecting identities on self-harm, suicidal behaviors, and depression among lesbian, gay, and bisexual individuals.

Individuals with lesbian, gay, and bisexual (LGB) identities have higher prevalence of self-directed violence, but very little is known about racial/ethnic differences between LGB populations. This study aimed to examine racial/ethnic differences in self-harm, suicidal ideation, suicide attempt, and depression among LGB and heterosexual emerging adults. Data are compiled from the Fall 2008 and Spring 2009 National College Health Assessment and limited to respondents within emerging adulthood (ages 18­24) who indicated their sexual orientation and racial/ethnic identities (n = 89,199). Within each racial/ethnic group, LGB individuals were significantly more likely to report self-harm, suicidal ideation, suicide attempt, and depression than non-LGB individuals.

The associations of race/ethnicity and suicidal ideation among college students: a latent class analysis examining precipitating events and disclosure patterns.

The aim of this paper was to examine precipitating events for suicidal ideation and how these experiences relate to disclosure in a diverse sample of college students were examined. Among non-Hispanic White students, relationship/academic problems were most associated with ideation. A romantic break-up increased the odds of getting help. Among racial/ethnic minority students, family/academic problems were most associated with ideation and students who reported multiple events were less likely to get help compared with those not reporting events. Future research should examine the reasons for interpersonal conflict among this high-risk group and their attitudes about help-seeking, and identify cultural norms associated with disclosure.