Risk factors for suicide reattempt: a systematic review and meta-analysis.

BACKGROUND: Suicide is one of the main external causes of death worldwide. People who have already attempted suicide are at high risk of new suicidal behavior. However, there is a lack of information on the risk factors that facilitate the appearance of reattempts. The aim of this study was to calculate the risk of suicide reattempt in the presence of suicidal history and psychosocial risk factors and to estimate the effect of each individual risk factor. METHODS: This systematic review and meta-analysis were conducted following the PRISMA-2020 guidelines. Studies on suicide reattempt that measured risk factors were searched from inception to 2022. The risk factors studied were those directly related to suicide history: history of suicide prior to the index attempt, and those that mediate the transition from suicidal ideation to attempt (alcohol or drug misuse, impulsivity, trauma, and non-suicidal self-injury). RESULTS: The initial search resulted in 11 905 articles. Of these, 34 articles were selected for this meta-analysis, jointly presenting 52 different effect sizes. The pooled effect size across the risk factors was significant (OR 2.16). Reattempt risk may be increased in presence of any of the following risk factors: previous history, active suicidal ideation, trauma, alcohol misuse, and drug misuse. However, impulsivity, and non-suicidal self-injury did not show a significant effect on reattempt. CONCLUSION: Most of the risk factors traditionally associated with suicide are also relevant when talking about suicide reattempts. Knowing the traits that define reattempters can help develop better preventive and intervention plans.

Anxious and depressive symptoms and health-related quality of life in a cohort of people who recently attempted suicide: A network analysis.

BACKGROUND: Suicide is an international health concern with immeasurable impact from the perspective of human and social suffering. Prior suicide attempts, anxious and depressive symptoms, and relatively lower health-related quality of life (HRQoL) are among the most replicated risk factors for suicide. Our goal was to visualize the distribution of these features and their interconnections with use of a network analysis approach in individuals who recently attempted suicide. METHODS: Individuals with a recent suicide attempt were recruited from nine University Hospitals across Spain as part of the SURVIVE cohort study. Anxious and depressive symptoms, and perceived HRQoL were included in the network analysis. Network structures were estimated with the EBICglasso model. Centrality measures and bridge symptoms connecting communities were explored. Subnetworks comparing younger and older individuals, and women and men were analyzed. RESULTS: A total of 1106 individuals with a recent suicide attempt were included. Depressed mood was the symptom with the greatest influence in the overall network, followed by anxiety symptoms such as feeling nervous, worrying, restless, and having difficulties to relax. Perceived general health was associated with increased suicidal ideation in the whole sample. Older people showed a specific connection between perceived general health and depressed mood. LIMITATIONS: The cross-sectional design does not allow determination of established causality. CONCLUSIONS: Depressed mood was the core network's symptom and, therefore, an important target in the management and prevention of suicide. HRQoL had more influence on the network of older populations, in which it should be a primary focus.

Risk of suicide attempt repetition after an index attempt: A systematic review and meta-analysis.

OBJECTIVES: To estimate the risk of suicide attempt repetition among individuals with an index attempt. It also aims to study the role of risk factors and prevention programme in repetition. METHODS: This systematic review and meta-analysis was conducted in keeping with the PRISMA 2020 guidelines. Studies on attempt repetition (both cohort studies and intervention studies) were searched from inception to 2022. RESULTS: A total of 110 studies comprising 248,829 attempters was reviewed. The overall repetition rate was 0.20 (0.17, 0.22). Repetition risk linearly increased over time. A higher risk of attempt repetition was associated with female sex and index attempts in which self-cutting methods were used. Moreover, a mental disorder diagnosis was associated with an increasing repetition risk (OR = 2.02, p < .01). The delivery of a preventive programme reduced the repetition risk, OR = 0.76, p < .05; however, this effect was significant for psychotherapy interventions, OR = 0.38, p < .01. CONCLUSION: One in five suicide attempters will engage in a new suicide attempt. An elevated repetition risk is associated with being female, more severe index methods and psychiatric disorder diagnosis. Preventive programmes, particularly psychotherapy, may contribute to reducing repetition risk and eventually save lives.

Clinical predictors and psychosocial risk factors of suicide attempt severity.

BACKGROUND: Suicide attempts are an important predictor of completed suicide and may differ in terms of severity of medical consequences or medical lethality. There is little evidence on serious suicide attempt (SSA) and very few studies have compared SSA with non-SSA. OBJECTIVE: The aim of this multisite, coordinated, cohort study was to analyze the role of clinical variables and the sociodemographic and psychological risk factors of SSA. METHOD: In this multisite, coordinated, cohort study, 684 participants (222 for the mild suicide attempt group, 371 for the moderate suicide attempt group and 91 for the SSA group) were included in the study. Ordinal regression models were performed to analyze the predictor variables of SSA. RESULTS: Early physical abuse (OR=1.231) and impulsivity (OR=1.036) were predictors of SSA, while depressive symptoms were associated with a lower risk of SSA. CONCLUSION: Environmental and psychological factors as physical abuse and impulsivity are related with severe suicide severity. These findings will help to develop strategies to prevent suicide and may be considered for the treatment and management of suicide.

Impact of the coronavirus outbreak on mental health in the different Spanish regions.

COVID-19 is an infectious disease that has affected millions of people worldwide, Spain being one of the countries most affected by the pandemic. It is key to study its impact on the mental health of the Spanish population during the lockdown situation.

Impacto de la pandemia COVID-19sobre la salud mental en las diferentescomunidades autónomas españolas / Impact of the COVID-19 pandemic on mental health in different countries on mental health in the different Spanish Spanish autonomous communities

Introducción: La COVID-19 es una enfermedad infecciosa que está afectando a millones de personas alrededor delmundo, siendo España uno de los países más afectados porla pandemia. Es fundamental evaluar el impacto en la saludmental de la población española durante el periodo de confinamiento. El objetivo es analizar las respuestas desadaptativas en cada comunidad autónoma durante las dos primerassemanas tras la declaración del estado de alarma en España.Metodología. A través de un cuestionario “online”, serecogieron variables clínicas y sociodemográficas de los participantes del 19 al 26 de marzo. Para estudiar las respuestasdesadaptativas, se utilizaron los cuestionarios DASS-21 y EIE.Resultados. 21.152 personas completaron el cuestionario.La edad media fue 39,75 (DE 14,039) y el 69,6 % eran mujeres.La mayoría de los participantes vivía en Asturias (36,2 %) yCantabria (11,9 %). La respuesta desadaptativa más frecuentede la muestra fueron los síntomas depresivos (46,7 %), seguidadel estrés (33,2 %) y la ansiedad (10,7 %). Los resultados dela DASS-21 desvelaron que en Andalucía [n = 1979 (9,3 %)]se observó un mayor porcentaje en los tres dominios: síntomas depresivos (59,7 %), estrés (41,7 %) y ansiedad (16,2 %).Castilla-La Mancha tuvo el porcentaje más alto de respuestaintrusiva (31,2 %) y Andalucía de respuesta evitativa (55,7 %).Conclusiones. Casi la mitad de la muestra presentórespuestas desadaptativas, siendo los síntomas depresivos yla conducta evitativa las más frecuentes. El impacto sobrela salud mental durante y tras eventos traumáticos de granescala debería de abordarse minuciosamente para minimizarlas respuestas desadaptativas en la población general. (AU)

Introduction: COVID-19 is an infectious disease that hasaffected millions of people worldwide, Spain being one ofthe countries most affected by the pandemic. It is key tostudy its impact on the mental health of the Spanish population during the lockdown situation.The aim is to analyse maladaptive responses in eachautonomous community during the first two weeks afterthe state of emergency was declared in Spain.Material and Methods. Through an online questionnaire, clinical and sociodemographic information was collected from participants between 19 and 26 March 2020. TheDASS-21 and the IES questionnaires were used to evaluatethe maladaptive psychological responses.Results. A total of 21,152 people completed the questionnaire. Mean age was 39.75 (SD 14.039), and 69.6% werewomen. Most of the participants lived in Asturias (36.2%)and Cantabria (11.9%). In the sample as a whole, among themaladaptive responses, depressive symptoms represented thehighest percentage (46.7%), followed by stress (33.2%) andanxiety (10.7%) symptoms. The results of the DASS-21 revealed that a higher proportion of the people from Andalusia[n = 1979 (9.3%))]were affected in all three domains: depressive (59.7%), stress (41.7 %), and anxiety (16.2%) symptoms,Castilla La Mancha had the highest percentage of intrusiveresponse (31.2%), while Andalusia had the highest percentage of avoidance behaviour (55.7%). Conclusions. Almost half of the sample showed maladaptive reactions, depressive symptoms and avoidance behaviour being the most common responses. Repercussionson mental health during and after large-scale traumaticevents should be addressed carefully to minimize maladaptive responses in the general population. (AU)

Deep Brain Stimulation in Patients with Parkinson's Disease: Effect on Psychiatric Symptoms and Quality of Life.

BACKGROUND AND STUDY AIMS: To determine the effect on psychiatric symptoms and quality of life in 30 patients with Parkinson's disease (PD) treated with deep brain stimulation (DBS) of both subthalamic nuclei (STN) after 1 year of follow-up. MATERIAL AND METHOD: We conducted a prospective 1-year follow-up study with a baseline assessment before and 6 and 12 months after surgery. The following were used as assessment instruments: the Bech-Rafaelsen Melancholia Scale (MES), the Bech-Rafaelsen Mania Scale (MAS), the Beck Scale for Suicidal Ideation (SSI), the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Oviedo Sleep Questionnaire (OSQ), the 36-Item Short Form Health Survey (SF-36), the Unified Parkinson's Disease Rating Scale (UPDRS), the dose of levodopa, and the active contact stereotactic coordinates. RESULTS: We recorded a clinical improvement between baseline with medication use (ON medication) and the results obtained at 6 and 12 months with medication use and stimulation (ON stimulation, ON medication) in MES and OSQ (p < 0.0001) and in SF-36 (p < 0.005). No changes were observed in MAS and SSI. There was a clinical improvement between baseline with ON medication and the results obtained at 12 months with ON stimulation, ON medication in Y-BOCS (p < 0.04). Also, there was a 53.3% reduction in levodopa at 6 months and a 54.7% reduction at 12 months after surgery (p < 0.0001). There was an improvement between baseline with OFF medication and the results obtained at 6 and 12 months OFF medication, ON stimulation (p < 0.0001) in UPDRS-III. There were no statistically significant differences between the initial and final active contact coordinates, or between stimulation parameters. CONCLUSIONS: DBS of the STN in patients with PD is associated with an improvement in psychiatric (affective and sleep-wake cycle) symptoms, clinical motor symptoms, and quality of life at 1 year after surgery.