Development and external validation of a logistic and a penalized logistic model using machine-learning techniques to predict suicide attempts: A multicenter prospective cohort study in Korea.

Despite previous efforts to build statistical models for predicting the risk of suicidal behavior using machine-learning analysis, a high-accuracy model can lead to overfitting. Furthermore, internal validation cannot completely address this problem. In this study, we created models for predicting the occurrence of suicide attempts among Koreans at high risk of suicide, and we verified these models in an independent cohort. We performed logistic and penalized regression for suicide attempts within 6 months among suicidal ideators and attempters in The Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior (K-COMPASS). We then validated the models in a test cohort. Our findings indicated that several factors significantly predicted suicide attempts in the models, including young age, suicidal ideation, previous suicidal attempts, anxiety, alcohol abuse, stress, and impulsivity. The area under the curve and positive predictive values were 0.941 and 0.484 after variable selection and 0.751 and 0.084 in the test cohort. The corresponding values for the penalized regression model were 0.943 and 0.524 in the original training cohort and 0.794 and 0.115 in the test cohort. The prediction model constructed through a prospective cohort study of the suicide high-risk group showed satisfactory accuracy even in the test cohort. The accuracy with penalized regression was greater than that with the "classical" logistic model.

Risk factors for suicidal behavior in patients hospitalized for adjustment disorders.

INTRODUCTION: Adjustment disorder (AD) is a common psychiatric diagnosis, but it is often considered less severe than other diagnoses. However, it is strongly associated with suicidal behavior. AIM: To identify the factors linked to suicidal behavior in patients hospitalized for AD. METHODS: This is a retrospective, descriptive, and analytical study conducted in the psychiatric department of Mahdia's hospital over a period of nine years. The study included patients who were hospitalized for the first time due to adjustment disorder, according to DSM-5 diagnostic criteria. RESULTS: The study population included 129 patients. AD was prevalent among young (median age 29 years) and female patients (75.2%). Almost half of the cases were single (48.1%) and having a history of suicidal behavior (48.3%). Sixty patients (46.5%) were hospitalized following a suicidal attempt (SA) and drugs were used as a way in half of the cases (50%). Conflicts were the dominant factor precipitating the SA in 88.3% of cases. Factors linked to suicidal behavior in patients with AD were being in an intimate relationship and the presence of family conflicts. Indeed, the risk of suicidal behavior was found to be increased by 3.15 times in patients with AD who experienced family conflicts. Besides, being in an intimate relationship in patients with AD multiplies the risk of suicidal behavior by 5.863. CONCLUSIONS: Given the high risk of suicide associated with AD, it is essential to have a more in-depth understanding of the suicidal process and AD through new studies.

Lifetime use of multiple substances and youth suicide risk: assessing the role of depressive symptoms using structural equation modeling.

OBJECTIVES: This study assessed the direct and indirect effects (via depressive symptoms) of lifetime use of a broad range of substances on suicide risk among US adolescents. STUDY DESIGN: This was a cross-sectional study. METHODS: Data from the 2021 Youth Risk Behavior Survey were used (N = 12,303, 48.7% female). Associations between five types of substance use (cigarette, e-cigarette, alcohol, marijuana, and prescription pain medicine) and three dimensions of suicide risk (suicidal ideation, suicide plan, and suicide attempt) were measured by multivariate logistic regression models. The role of depressive symptoms was further examined by structural equation modeling. RESULTS: Almost three in five (57.5%) adolescents had used one or more substances in their lifetime (18.1% one type, 12.2% two types, 13.1% three types, 10.2% four types, and 3.8% five types). Adolescents using five substances were up to 16 times more likely to experience suicidal ideation and behaviors. Depressive symptoms significantly linked the pathway from substance use to suicide risk, resulting in much stronger indirect effects than the direct effects. Collectively, the five substance use behaviors and depressive symptoms explained about 60.4% of variance in suicidal ideation, 53.6% of variance in suicide plan, and 55.0% of variance in suicide attempt. CONCLUSIONS: Lifetime use of multiple substances is significantly correlated with suicidal ideation and behaviors among adolescents via the pathway of depressive symptoms. Routine screening for a broad range of substance use behaviors is needed to identify adolescents at risk for suicide and accessible mental health services could potentially attenuate the linkage between substance use and suicide risk.

Suicide Following a Near-Death Experience.

Background: Sometimes during real or presumed life-threatening and/or near-death circumstances, an individual undergoes an altered state of consciousness referred to as a near-death experience (NDE). The prevalent position in the field of NDE research for the last several decades has been that such experiences result in positive antisuicidal attitudes and that it is highly unlikely that experients will try to kill themselves afterward. In addition, the important consideration of passive suicidal ideation is neglected in NDE research. Aims: To question the premature assumption that people are highly unlikely to die by suicide after an NDE. Method: Four case studies of suicide after an NDE are provided and examined. Results: Although important quantitative data are still needed, it can no longer be argued that people do not die by suicide after an NDE. Limitations: Only four cases were available for examination, and the degree of impact that the NDE had on their suicide is uncertain. Conclusion: Much more research is needed on suicide risk post NDE. In the meantime, the NDE should not be ignored in suicide assessments, but therapists and other relevant professionals need to be attentive to any possible indications of either active or passive suicidal ideation post NDE.

Heightened vigilance and its associations with suicidal ideation and suicide attempt among 285 Korean transgender and nonbinary adults: Effect modification by connectedness to the LGBTQ+ community.

INTRODUCTION: Anti-transgender stigma presents threats of discrimination to transgender and nonbinary (TGNB) individuals, prompting them to stay vigilant. Using a longitudinal data of 285 South Korean TGNB adults, we examined vigilance and its associations with suicidal ideation and suicide attempt and explored the protective role of connectedness to the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community. METHODS: Data were collected in October 2021 (baseline) and October 2022 (follow-up). Vigilance was measured using the 4-item Heightened Vigilance Scale at baseline. At follow-up, 12-month suicidal ideation and suicide attempt, and connectedness to the LGBTQ+ community were measured. RESULTS: Having heightened levels of vigilance was associated with increased prevalence of suicidal ideation (Prevalence Ratio [PR]: 1.33, 95% Confidence Interval [CI]: 1.09-1.62) and suicide attempt (PR: 2.18, 95% CI: 1.23-3.86), after adjusting for covariates including anti-transgender discrimination experiences and lifetime suicidality at baseline. When stratified by connectedness to the LGBTQ+ community, the associations between vigilance and suicidality remained statistically significant among those with low connectedness whereas no statistically significant association was observed among those with high connectedness. CONCLUSION: The study provides empirical evidence for policies and interventions that ensure safety of TGNB individuals from discrimination and promote connectedness to the LGBTQ+ community to reduce the suicide risk among TGNB individuals.

Can profiles of behaviors occurring within 48 h of a suicide attempt predict future severity of suicidal thoughts and reattempt?: An examination of hospitalized patients 12 Months post-discharge.

Behavioral warning signs (WS) are near-term changes within individuals, which aid in determining imminent risk for suicide attempts. However, those who attempt suicide differ in their engagement of WS, and it is unclear if these differences relate to future risk of suicidal behavior. Using a sample of 132 adults presenting to a hospital following a suicide attempt, the current study sought to determine if differences in engagement in WS for the index attempt prospectively predicted suicide attempt, frequency of ideation, and intensity of suicide ideation 12 months post discharge. Latent class analyses (LCAs) conducted on 6 behaviors (i.e., alcohol use, nightmares, interpersonal negative life events, suicide communication, risky behavior, low sleep, and high sleep) found a 5-class solution optimally fit the data. One identified class, characterized by engagement in risky behaviors the hours before an attempt differed from other identified classes in terms of risk for future suicidal ideation and behaviors. More specifically, participants in "High Risky Behavior" class had higher rates of 12-month suicide reattempt, significantly more frequent suicide ideation, and significantly worse intensity of suicide ideation during the 12 months following their index attempt compared to participants endorsing typical patterns of WS. These results held when adjusting for various traditional baseline covariates (e.g., depressive symptoms). The current study demonstrates that patterns of behavioral WS may be utilized as their own prognostic indicator of future suicidal ideation and behaviors among high-risk individuals reporting a recent suicide attempt, which can inform post-discharge clinical intervention and prevention efforts.

Adverse Childhood Experiences and Associations with Mental Health, Substance Use, and Violence Perpetration among Young Adults in sub-Saharan Africa.

Background: Adverse childhood experiences (ACEs) can have debilitating effects on child well-being, with consequences persisting into adulthood. Most ACE studies have been conducted in high-income countries and show a graded relationship between multiple ACE exposures and adverse health outcomes. Less is known about the types and burden of ACEs in sub-Saharan Africa (SSA). Objective: To estimate the pooled prevalence of six individual and cumulative ACE exposures (physical, sexual, and emotional violence; orphanhood; witnessing interparental and community violence) and assess their association with mental health outcomes, substance use, and violence perpetration among young adults in SSA. Participants and setting: Aggregate data from the Violence Against Children and Youth Survey (VACS) in Cote d'Ivoire 2018, Kenya 2019, Lesotho 2018, Mozambique 2019, and Namibia 2019 included a sample of 11,498 young adults aged 18-24 years. Methods: Cumulative ACEs were defined by an integer count of the total number of individual ACEs (0 to 6). Weighted prevalence and adjusted odds ratios were estimated. Result: ACEs prevalence ranged from 7.8% (emotional violence) to 55.0% (witnessing community violence). Strong graded relationships between cumulative ACE exposure and all study outcomes for both males and females were observed. Among females, witnessing interparental violence was the only individual ACE risk factor significantly associated with increased odds of substance use; among males, emotional violence was significantly associated with all outcomes. Conclusion: ACEs are associated with adverse mental health, substance use, and violence perpetration in SSA. Gender-specific and culturally sensitive intervention strategies are needed to effectively mitigate ACEs in this population.

Childhood maltreatment and suicide attempts in major depression and bipolar disorders in South Korea: A prospective nationwide cohort study.

BACKGROUND: Childhood maltreatment (CM) is prevalent among patients with mood disorders and considered an important risk factor for suicide in the general population. Despite mood disorders being implicated in up to 60 % of completed suicides, the predictive role of CM on suicide attempt (SA) among early mood disorder patients remains poorly understood. METHODS: We enrolled 480 participants diagnosed with early-onset major depressive disorder (MDD), bipolar I disorder (BD I), and bipolar II disorder (BD II). Over an average of 60 weeks, participants underwent follow-up assessments at 12-week intervals. Using multivariate logistic regression, we examined the association between CM and SA history at baseline. Further, the Cox proportional hazard model assessed the predictive role of childhood maltreatment in SA during follow-up. RESULTS: At baseline, 38 % of the total participants reported SA history, with a follow-up prevalence of 10 %. Childhood maltreatment was significantly associated with past SAs and was a robust predictor of future SA, adjusting for relevant clinical risk factors. Emotional abuse and sexual abuse related to SA history, and physical abuse increased future SA risk. LIMITATIONS: Potential biases in reporting SA and childhood maltreatment, along with unexplored factors such as additional environmental and familial risks, may affect the study's findings. CONCLUSIONS: Childhood maltreatment emerged as a robust predictor of SA among early-onset mood disorder patients. Systematic evaluation of CM early in the clinical process may be crucial for effective risk management. Additionally, our findings highlight the importance of implementing proactive interventions for CM to prevent the onset of adverse psychological trajectories.

Experience of pre-suicidal suffering: insights from suicide attempt survivors.

PURPOSE: Psychache significantly contributes to the suicidal process. However, the transition from pre-suicidal suffering to a suicide crisis remains one of the least explored stages in suicidology. METHODS: We retrospectively explored experience of pre-suicidal suffering through semi-structured, in-depth interviews with 12 individuals recruited from the Vilnius City Mental Health Center, Lithuania. Interpretative phenomenological analysis was employed to identify recurring patterns. RESULTS: Nine primary group experiential themes emerged: Certain adverse life events occurring during the suicidal process were not immediately perceived as connected; Complex traumatic events laid the groundwork for a profound sense of lack; A compensatory mechanism balanced the experience of profound lack; Exhaustion ensued from efforts to sustain the compensatory mechanism; The main trigger directly challenged the compensatory mechanism; The affective state followed the experience of the main triggering event; Dissociation served to isolate psychache; Thoughts of suicide experienced as automatic; Suicide was perceived as a means to end suffering. CONCLUSION: The findings suggest that the suicidal process unfolds over an extended period of suffering, culminating in a crisis to alleviate unbearable psychological pain. In clinical practice, identifying the main triggering event discussed in this study can be pivotal in understanding the essence of suffering characterized by profound lacking and developed compensatory mechanisms.

Increasing prevalence of self-harm, suicidal behavior and suicidal ideation throughout a three-year period in the context of COVID-19 pandemic in Spain.

The COVID-19 pandemic had a great impact on mental health both in the general population and in individuals with preexisting mental disorders. Lockdown, social restrictions, changes in daily habits and limited access to health services led to changes in consultations in mental health services. This study aimed to determine changing trends in psychiatric admissions by the inclusion of adult patients admitted to the Emergency Department (ED) of Hospital Clínic of Barcelona between 2019 and 2021. Acute admissions, social issues and psychiatric diagnoses were compared between years, seasons and considering the interaction between both years and seasons. A total of 13,677 individuals were included in the analysis. An overall reduction in consultations to the ED and a higher proportion of acute admissions was observed in 2020 in context of the COVID-19 outbreak. Increased prevalence of sleeping disorders and substance use disorders was found in 2020. Self-harming behavior, suicidal thoughts and suicidal behavior showed an increasing tendency over time, with their highest rates in 2021. Prevention and management strategies should be considered in order to address increasing needs in mental health care.

Dynamic association between suicidal ambivalence and suicide risk among individuals with a history of suicide attempts.

OBJECTIVE: Suicide risk is highly fluctuating. There is a need for predictors of short-term change in suicide risk to optimize risk assessment and treatment, especially among individuals who already attempted suicide. METHODS: Based on 1776 daily assessments of 16 former psychiatric inpatients with a history of suicide attempts, we examined how suicidal ambivalence and, respectively, wish to die (WTD) and wish to live (WTL) predicted same-day and change in perceived suicide risk (i.e., next-day perceived suicide risk, controlled for same-day perceived suicide risk) in multilevel regression models. Additionally, based on the assumptions of nonlinear dynamics, we examined the associations between levels of fluctuations in the WTD/WTL and perceived suicide risk within the same time period. RESULTS: Suicidal ambivalence, WTD, and a WTL significantly correlated with same-day suicide risk. Suicidal ambivalence and WTD significantly predicted change in suicide risk. Fluctuations in WTD were significantly associated with concurrent suicide risk. CONCLUSION: The results suggest that suicidal ambivalence and WTD are drivers of suicide risk among individuals who already attempted suicide. The association between fluctuations in WTD and suicide risk was small and warrants further investigation on the practical utility as a warning sign.

Does personality dysfunction add incremental utility over general psychopathology when modeling previous suicide attempts in adolescent patients?

BACKGROUND: Identifying patients at risk for a suicide attempt (SA) is critical in adolescents with mental disorders. The current study aimed to 1) examine whether personality dysfunction (PD) is associated with previous SA, 2) explore the incremental utility of PD over psychiatric disorders in modeling previous SA. METHODS: The sample comprised of n = 498 adolescent patients (mean age = 15.41 years, 79.12 % females, inpatient 48.8 %, outpatient 51.2 %). SA in the past year, PD according to the alternative DSM-5 model for personality disorders, and psychiatric diagnoses were assessed using semi-structured interviews. Logistic regression and principal component analysis examining the associations and specific patterns of PD and SA in the past year were conducted. Hierarchical (stepwise) logistic regression was applied to investigate the incremental utility of PD over that of psychiatric diagnoses to identify individuals with SA in the past year. RESULTS: Including all facets of PD revealed a significant model with SA in the past year as outcome (χ2(12) = 106.65, McFaddens Pseudo-R2 = 0.17, p < 0.01). Adding PD to the model explained a significant amount of variance in past SA over that of psychiatric diagnoses (Pseudo-R2 = 0.18, Wald χ2 = 43.05, p < 0.01). LIMITATIONS: As we only studied past SA and due to the cross-sectional design, no conclusion regarding the prediction of future SA can be drawn. DISCUSSION: PD should routinely be assessed in adolescent patients since individuals with PD are more likely to have attempted suicide even when controlling for comorbid psychiatric disorders. PD may represent an important target for intervention in those with suicidal thoughts and behaviors.

The impact of antidepressant treatment on the network structure of neurocognition and core emotional depressive symptoms among depressed individuals with a history of suicide attempt: An 8-week clinical study.

BACKGROUND: A more in-depth understanding of the relationship between depressive symptoms, neurocognition and suicidal behavior could provide insights into the prognosis and treatment of major depressive disorder (MDD) and suicide. We conducted a network analysis among depressed patients examining associations between history of suicide attempt (HSA), core emotional major depression disorder, and key neurocognitive domains. METHOD: Depressed patients (n = 120) aged 18-65 years were recruited from a larger randomized clinical trial conducted at the Douglas Institute in Montreal, Canada. They were randomly assigned to receive one of two antidepressant treatments (i.e., escitalopram or desvenlafaxine) for 8 weeks. Core emotional MDD and key neurocognitive domains were assessed pre-post treatment. RESULTS: At baseline, an association between history of suicide attempt (HSA) and phonemic verbal fluency (PVF) suggested that HSA patients reported lower levels of the latter. After 8 weeks of antidepressant treatment, HSA became conditionally independent from PVF. Similar results were found for both the HAM-D and the QIDS-SR core emotional MDD/neurocognitive networks. CONCLUSION: Network analysis revealed a pre-treatment relationship between a HSA and decreased phonemic VF among depressed patients, which was no longer present after 8 weeks of antidepressant treatment.

Suicide attempt during ramelteon addition to flunitrazepam: A case report.

Background: Benzodiazepines, such as flunitrazepam, may be at risk of disinhibition, leading to aggressiveness, impulsivity, self-harm, and possibly suicide attempts, whereas ramelteon may be far from disinhibition. Case Presentation: In a 43-year-old female with primary insomnia, flunitrazepam alone did not induce any type of disinhibition, but the addition of ramelteon to flunitrazepam brought about disinhibition, leading to aggressiveness and finally to her suicide attempt. Her disinhibition rapidly subsided as soon as ramelteon alone was discontinued. Conclusion: These findings suggest that a suicide attempt may occur during ramelteon and flunitrazepam combination in a susceptible patient.

Association between the Big Five personality traits and suicide-related behaviors in Japanese institutionalized youths.

Aim: Inmates in correctional institutions experience higher rates of suicide attempt (SA), suicidal ideation (SI), and nonsuicidal self-injury (NSSI) than the general population. This study aimed to examine the association between the Big Five personality traits and suicide-related behavior, and to estimate the prevalence rate of such behaviors among Japanese institutionalized youth. Methods: The participants were 436 youths who had been admitted to four juvenile classification homes (JCHs) between September 2021 and March 2023; they were asked to respond to a self-report questionnaire after obtaining informed consent. Results: A total of 8.1% and 19.3%, 29.4% and 44.7%, and 46.3% and 75.3% of males and females had experienced SA, SI, and NSSI in their lifetime, respectively. Females reported significantly higher instances of suicide-related behaviors than males considering all suicide-related behaviors. Logistic regression analyses revealed that neuroticism significantly increased the odds ratios for SA, SI, and NSSI on controlling for sex, age, and number of admissions to JCHs. For NSSI, the odds ratio for agreeableness was significantly lower than 1, indicating a lower probability of NSSI. Conclusion: The findings of our study demonstrate that neuroticism, one of the Big Five traits, was consistently and significantly associated with all suicide-related behaviors, including SA, SI, and NSSI, among youth offenders, while agreeableness was found as a protective factor only against NSSI. The results of this study might help correctional officers identify justice-involved youth at higher risk for suicide and allow the development of early interventions to prevent suicide.

Prevalence of childhood trauma in patients with psychiatric disorders and its association with perceived social support and suicide attempts: A cross-sectional observational study in a tertiary hospital in South India.

Background: Adverse childhood experiences include exposure of children to physical abuse, physical neglect, emotional neglect, emotional abuse, and sexual abuse. Children exposed to severe maltreatment and trauma during their early childhood are at a higher risk of early onset of psychiatric disorders. Aim: To find the prevalence of childhood adverse experiences in psychiatric patients and its association with perceived social support and suicidal attempts. Materials and Methods: A cross-sectional observational study was conducted in the psychiatry outpatient department at a tertiary care hospital in Kerala. Patients with a diagnosis of substance use disorders, psychotic disorders, mood disorders, and neurotic disorders according to ICD-10 (F10-F45) and in remission were included in the study. Institutional Ethical Committee approval and informed consent from the participants were obtained. Socio-demographic and clinical details were obtained. Childhood Trauma Questionnaire-Short Form and Multidimensional scale of Perceived Social Support were administered. Descriptive statistics and Chi-square test were employed for data analysis. Results: Eighty-five per cent of the subjects had a history of at least one type of childhood trauma. Emotional abuse was the most commonly reported type of trauma. Among patients with childhood trauma, 47.2% reported high levels of perceived social support, whereas 18.5% individuals reported a history of at least one suicide attempt. Conclusions: A significant proportion of patients with psychiatric disorders in an Indian setting have experienced childhood trauma. Childhood trauma in psychiatric disorders is associated with a higher risk of attempting suicide.

Predictive model of suicide risk in Colombian university students: quantitative analysis of associated factors.

Introduction: The risk of suicide and completed suicides among young university students presents critical challenges to mental and public health in Colombia and worldwide. Employing a quantifiable approach to comprehend the factors associated with these challenges can aid in visualizing the path towards anticipating and controlling this phenomenon. Objective: Develop a predictive model for suicidal behavior in university students, utilizing predictive analytics. Method: We conducted an observational, retrospective, cross-sectional, and analytical research study at the University of Manizales, with a focus on predictive applicability. Data from 2,436 undergraduate students were obtained from the research initiative "Building the Future: World Mental Health Surveys International College Students." Results: The top ten predictor variables that generated the highest scores (ranking coefficients) for the sum of factors were as follows: history of sexual abuse (13.21), family history of suicide (11.68), medication (8.39), type of student (7.4), origin other than Manizales (5.86), exposure to cannabis (4.27), exposure to alcohol (4.42), history of physical abuse (3.53), religiosity (2.9), and having someone in the family who makes you feel important (3.09). Discussion: Suicide involves complex factors within psychiatric, medical, and societal contexts. Integrated detection and intervention systems involving individuals, families, and governments are crucial for addressing these factors. Universities also play a role in promoting coping strategies and raising awareness of risks. The predictive accuracy of over 80% in identifying suicide risk underscores its significance. Conclusion: The risk factors related to suicidal behavior align with the findings in specialized literature and research in the field. Identifying variables with higher predictive value enables us to take appropriate actions for detecting cases and designing and implementing prevention strategies.

Effectiveness of physical barriers to prevent suicide by jumping from high-risk bridges: From an integrative review to a northern Italian province's paradigm.

Background: Although uncommon, suicide by jumping is almost always lethal and can be significantly elevated locally due to the availability of tall structures including bridges and other high-risk locations. Empirical evidence suggests that restricting access to certain suicide methods is highly effective at preventing suicide, prompting the construction of physical barriers in many high-risk jumping locations. However, some have argued that these measures are too costly and only lead to method or location substitution. Objectives: To examine whether physical barriers are effective at preventing suicide by jumping or whether method or location substitution occur. Methods: An integrative review of the most representative literature. Results: Results clearly show that physical barriers are highly effective at preventing suicide by jumping with little to no method or location substitution occurring. Furthermore, their cost is far outweighed by the monetary benefits of averted suicides. Conclusions: Using the Italian pre-alpine/alpine areas as a paradigm, we argue that local topography and socioeconomic particularities led to significantly elevated rates of suicide in general, and of suicide by jumping from bridges in particular, especially among young adults who are more vulnerable to economic crises and show elevated susceptibility to impulsive acts, a known characteristic associated with suicide by jumping, which makes the issue even more topical and clinically relevant. As these finding are easily generalized to other territories with similar topographical and/or economic characteristics, we end with a call to action, urging local authorities to heed the scientific evidence and take the necessary steps to improve suicide prevention.

'I live it all together sadness, desperation': A qualitative exploration of psychosocial challenges and needs of young people after suicide attempt.

This study aimed to explore the psychosocial challenges and support needs of young people after suicide attempt. In the research, the phenomenological approach was used. Semi-structured interviews were held with 16 young people shortly after suicide attempt. Data were analysed via content analysis. The data were categorized into five themes: effort to return to the old normal, living with remains, need for support, barriers to seeking help, and awareness. Understanding the psychological challenges and support needs of young people who have attempted suicide will facilitate future research and practice. To support young people in the acute period following the intervention, supportive interventions at the individual, social and political levels need to be established. These findings shed light into the structuring of supportive interventions to be applied to young people following a suicide attempt.

Prevalence and associated risk factors for suicidal ideation, non-suicidal self-injury and suicide attempt among male construction workers in Ireland.

BACKGROUND: Suicide among male construction workers are reported to be disproportionally high compared to the working age population. However, there is minimal understanding of the prevalence and associated factors for suicidal ideation, non-suicidal self-injury, and suicide attempt among this occupational group globally. METHODS: A cross-sectional study was conducted on a large sample of male construction workers in Ireland (n = 1,585). We investigated the prevalence of suicidal ideation, non-suicidal self-injury and suicide attempts and sociodemographic, occupational, and mental health factors associated with these three outcomes. Multivariable Poisson regression was performed to estimate the prevalence rate ratio of suicidal ideation (model 1 primary outcome), while multivariable logistic regression was used to estimate the odds ratio of non-suicidal self-injury (model 2 primary outcome), and suicide attempt (model 3 primary outcome). RESULTS: The lifetime prevalence rate for suicidal ideation was 22%, 6% for non-suicidal self-injury, and 6% for suicide attempt. In univariate modelling, socio-demographic and occupation-specific factors associated with the three outcomes included younger age (suicidal ideation and non-suicidal self-injury), not being in a relationship (suicide attempt) and working 35-44 h per week (suicidal ideation and suicide attempt). The mental health factors generalized anxiety disorder, depression, and suicide bereavement were significantly associated with increased risk of the three outcomes. In fully adjusted multivariable models, increasing severity of generalized anxiety disorder and depression were associated with an increased prevalence rate ratio of suicidal ideation, and a higher odds ratio of non-suicidal self-injury and suicide attempt. CONCLUSION: Suicidal ideation, non-suicidal self-injury and suicide attempt are significant issues for male construction workers that require specific attention. Findings highlight a need to support younger male construction workers and those bereaved by suicide. They also highlight the need for the early detection and treatment of generalized anxiety disorder and depression in order to intervene in, and potentially prevent, suicidality among male construction workers.