Suicidality, perceived chronic stress, and stress-induced cortisol changes of individuals with schizophrenia.

The associations of suicidality with stress are poorly studied in schizophrenia. The study aimed to determine whether suicidality was correlated with perceived chronic stress and the cortisol fluctuations under stress tasks in schizophrenia. High suicidality was defined as a lifetime history of suicide attempts or suicidal ideation in the past 2 weeks. Individuals with schizophrenia and high suicidality (SZ-HS, n = 59), with low suicidality (SZ-LS, n = 207), and healthy controls (HC, n = 196) finished the Perceived Stress Scale. Then, they participated in an experiment that induced stress using the Paced Auditory Serial Addition Task and the Mirror Tracing Persistence Task. Negative affect was measured at baseline and after finishing each task. The salivary cortisol was collected before-, after 20 min, and after 40 min of the tasks. SZ-HS had elevated perceived stress than SZ-LS and HC. Mixed effect models showed that stress tasks induced cortisol changes in all groups; cortisol of SZ-LS was reduced more than HC, but SZ-HS and SZ-LS did not differ in cortisol fluctuations. SZ-HS and SZ-LS experienced similar negative affect changes during tasks and the difference in withdrawal rates was nonsignificant. SZ-HS had an increased error rate than SZ-LS. In conclusion, suicidality was correlated with high-level perceived stress but did not result in differences in cortisol reactivities under stress tasks. It suggests the inconsistency between appraisal of stress and biological stress system disturbance among SZ-HS compared to SZ-LS.

History of suicidal behavior and clozapine prescribing among people with schizophrenia in China: a cohort study.

BACKGROUND: Clozapine is an off-label drug used in most countries to prevent suicide in individuals with schizophrenia. However, few studies have reported real-world prescription practices. This study aimed to explore the association between a history of suicidal behavior and clozapine prescribing during eight weeks of hospitalization for individuals with early-stage schizophrenia. METHODS: This observational cohort study used routine health data collected from a mental health hospital in Beijing, China. The study included 1057 inpatients who had schizophrenia onset within 3 years. History of suicidal behavior was coded from reviewing medical notes according to the Columbia Suicide Severity Rating Scale. Information on antipsychotic use during hospitalization was extracted from the prescription records. Time to clozapine use was analyzed using Cox regression models adjusted for sociodemographic and clinical covariates. RESULTS: The prevalence rates of self-harm, suicidal behavior, and suicide attempt were 12.3%, 7.5%, and 5.4%, respectively. A history of self-harm history was positively associated with clozapine uses upon admission (4.1% vs. 0.8%, exact p = 0.009). Among those who had not used clozapine and had no clozapine contraindication, A history of suicidal behavior increased the possibility of switch to clozapine within 56 days after admission (Hazard Ratio[95% CI], 6.09[2.08-17.83]) or during hospitalization (4.18[1.62-10.78]). CONCLUSION: The use of clozapine for early-stage schizophrenia was more frequent among those with suicidal behavior than among those without suicidal behavior in China, although the drug instructions do not label its use for suicide risk.

Risk factors for subsequent suicidal acts among 12-25-year-old high-risk callers to a suicide prevention hotline in China: a longitudinal study.

BACKGROUND: A few previous cross-sectional studies investigated correlated factors of suicidal ideation or suicide attempts among suicide prevention hotline callers; however, scarcely any evidence was from a longitudinal study. In addition, it is still unclear whether improvements in some suicide risk factors could reduce the occurrence of subsequent suicidal acts. This longitudinal study focusing on the risk factors for subsequent suicidal acts among adolescent and young adult callers with high suicide risk aims to fill this gap. METHODS: This study recruited 12-25-year-old high-risk callers to a China nationwide suicide prevention hotline. Potential risk factors, including hopefulness, psychological distress, depression, history of suicide attempts, alcohol or substance misuse, and acute life events, were examined during the index calls, and improvements in hopefulness, psychological distress, and suicide intent were assessed before ending the index calls. The recruited callers were followed up 12 months after their index calls. The primary outcome was the occurrence of suicidal acts (suicide attempts or suicide death) during follow-up. Kaplan-Meier survival curves, log-rank tests, and Cox proportional hazards model were used. RESULTS: During the follow-up period, 271 of 1656 high-risk adolescent and young adult callers attempted suicide, and seven callers died by suicide. After adjusting for demographic variables, low hopefulness (Hazard Ratio [HR] = 2.03, 95% Confidence Interval [CI]=[1.47, 2.80]) at the beginning of the index call was associated with a higher risk for subsequent suicidal acts, whereas improvements in psychological distress (HR = 0.61, 95%CI [0.41, 0.89]) and suicidal intent (HR = 0.56, 95%CI [0.38, 0.84]) during the index call reduced the risk of subsequent suicidal acts. In addition, alcohol or substance misuse (Model 2, HR = 1.65, 95%CI [1.11, 2.46]) and suicide attempt history(Model 1: one episode, HR = 1.96, 95%CI=[1.05, 3.66]; two or more episodes, HR = 2.81, 95%CI [1.59, 4.96]. Model 2: one episode, HR = 2.26, 95%CI [1.06, 4.82]; two or more episodes: HR = 3.28, 95%CI [1.63, 6.60]) were risk factors for subsequent suicidal acts. CONCLUSIONS: While suicide prevention hotline operators deliver brief psychological interventions to high-risk adolescent and young adult callers, priority should be given to callers with low hopefulness and to the alleviation of callers' high psychological distress and suicide intent.

Case fatality of repeated suicidal acts among suicide attempters in rural China: a retrospective cohort study.

Background: Individuals presenting to hospital due to suicide attempt are at high risk for repeated suicidal act, yet there are meager data on the extent to which repeated suicidal acts result in death. Methods: This retrospective cohort study was based on a general hospital self-harm register system in a rural county in China. Identified individuals who attempted suicide were contacted and followed up for up to 8 years. Main outcomes over follow-up were: 1) suicide death, 2) nonlethal suicide attempt, and 3) suicidal acts including suicide death and nonlethal attempt. Incidence densities, correlates, and case fatality of repeated suicidal acts were estimated. Findings: A total of 1086 individuals (two-thirds females, mean age 40.6 years) with a suicide attempt presenting to hospital (index attempt) were identified and followed up, with most of the index attempts by pesticide ingestion (79%). Over follow-up, there were 116 suicidal acts carried out by 108 individuals (69 females, 39 males), including 34 suicide deaths (21 females, 13 males), yielding a high case-fatality of 29.3%. During follow-up, suicide death rates were also high overall and in the first year of follow-up (846.7 and 1787.2 per 100,000 person years). Over follow-up, pesticide was the most common method (47/116) of repeated suicidal act and yielded a higher case-fatality than other methods (46.8% vs 17.4%, χ2 = 11.68, P < 0.001). The incidence densities of repeated suicidal acts and nonlethal attempts were low compared to rates reported in previous literature. Interpretation: Incidence densities of repeated suicidal acts in a rural China cohort were low compared to previous studies. However, rates of suicide deaths over follow-up were high, a result driven by the high case-fatality of suicidal acts and attributable to the common use of pesticides. Reducing suicidal acts with pesticides is a key target for suicide prevention in rural China. Funding: Beijing Municipal High Rank Public Health Researcher Training Program, Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support, and Beijing Hospitals Authority's Ascent Plan.

Prevalence of and optimal screening tool for postpartum depression in a community-based population in China.

BACKGROUND: Postpartum depression (PPD) is an important public health problem worldwide. China is planning to launch PPD screening in community settings, but there are questions on the community prevalence of PPD and validated screening tools. METHODS: We sought to recruit all eligible new mothers during postnatal home visits in two districts of Changsha, China, and after informed consent, screened them for PPD using three self-administered questionnaires-the Edinburgh Postpartum Depression Scale (EPDS), the Patient Health Questionnaire (PHQ-9), and Whooley Questions for Depression Screening. Video structured diagnostic interviews were performed online according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) by qualified specialists who were blinded to screening results. Optimal screening was determined based on the acceptability of scales and diagnostic accuracy metrics including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS: Out of 3004 eligible women, 2730 (90.9 %) completed the screening questionnaires. Among those screened, the video structured diagnostic interview was administered to 1862 (68.2 %) and 62 (3.3 %) were diagnosed with a current depressive condition. The optimal screening approach involved combining Whooley Questions (at least one "yes") with EPDS (cutoff >10) in series, with sensitivity of 0.76 (95 % CI 0.63 to 0.85), specificity of 0.93 (0.92 to 0.94), PPV of 0.28 (0.21 to 0.36) and NPV of 0.99 (0.98 to 1.00). LIMITATIONS: Due to the regional sample and exclusion of mothers with telephone contact rather than home visits, our findings may not be fully generalizable to the entire population. CONCLUSIONS: The prevalence of PPD among women in this sample was substantially lower than those reported in previous studies in China, the majority of which used screen positivity in measuring prevalence. Combining Whooley Questions with EPDS in series is the most optimal screening approach in this population, though this would still result in a high number of false positives at current prevalence.

Development of the Life Gatekeeper suicide prevention training programme in China: a Delphi study.

Background: Youth suicide has been a pressing public mental health concern in China, yet there is a lack of gatekeeper intervention programmes developed locally to prevent suicide among Chinese adolescents. Aims: The current Delphi study was the first step in the systematic development of the Life Gatekeeper programme, the first gatekeeper programme to be developed locally in China that aims to equip teachers and parents with the knowledge, skills and ability to identify and intervene with students at high risk of suicide. Methods: The Delphi method was used to elicit a consensus of experts who were invited to evaluate the importance of training content, the feasibility of the training delivery method, the possibility of achieving the training goals and, finally, the appropriateness of the training materials. Two Delphi rounds were conducted among local experts with diversified professional backgrounds in suicide research and practice. Statements were accepted for inclusion in the adjusted training programme if they were endorsed by at least 80% of the panel. Results: Consensus was achieved on 201 out of 207 statements for inclusion into the adapted guidelines for the gatekeeper programme, with 151 from the original questionnaire and 50 generated from comments of the panel members. These endorsed statements were synthesised to develop the content of the Life Gatekeeper training programme. Conclusions: This Delphi study provided an evidence base for developing the first gatekeeper training programme systematically and locally in China. We hope that the current study can pave the way for more evidence-based suicide prevention programmes in China. Further study is warranted to evaluate the effectiveness of the Life Gatekeeper training programme.

Effectiveness of a localised and systematically developed gatekeeper training program in preventing suicide among Chinese adolescents.

To combat the pressing issue of contemporary suicide rates, an effective Life Gatekeeper training program was developed to educate school teachers in identifying and intervening with at-risk students. Two single-arm sequential studies evaluated the program's effectiveness, spanning implementation science stages from design to refinement. The initial study employed face-to-face training (FTF), followed by a standardized video-based 'Train-the-trainer' (TTT) approach. In Study 1, post-intervention and one-month follow-up results showed improved suicide literacy, reduced stigma, and increased willingness to intervene among gatekeepers. The revised TTT program (study 2) also yielded reduced stigmatization and improved intervention competence. In addition, six out of twenty teachers exhibited gatekeeper behaviors. In conclusion, both delivery methods proved effective, particularly the practical application of the TTT version, although further research is warranted to examine long-term effectiveness of the program.

Short-term antipsychotic treatment response in early-onset, typical-onset, and late-onset first episode schizophrenia.

In schizophrenia, the age at illness onset may reflect genetic loading and predict prognosis. We aimed to compare the pre-treatment symptom profiles and clinical symptom responses to antipsychotic treatment of individuals with late-onset schizophrenia (LOS; onset age: 40-59 years) with individuals with early-onset schizophrenia (EOS; onset age < 18 years) or typical-onset schizophrenia (TOS; onset age: 18-39 years). We conducted an 8-week cohort study in inpatient departments of five mental health hospitals in five cities in China. We included 106 individuals with LOS, 80 with EOS, and 214 with TOS. Their onset of schizophrenia was within three years and the disorders were minimally treated. The Positive and Negative Syndrome Scale (PANSS) was used to evaluate clinical symptoms at baseline and after 8 weeks of antipsychotic treatment. Mixed effect models were used to compare symptom improvement within eight weeks. Antipsychotic therapy reduced all PANSS factor scores in all three groups. LOS had significantly better improvement in PANSS positive factor scores than EOS at week 8 after adjusting for sex, duration of illness, dose equivalents of antipsychotics at baseline, sites as fixed effects, and individuals as random effects. LOS was associated with reduced positive factor scores at week 8 when receiving 1 mg olanzapine dose equivalent per 1 kg body weight compared with EOS or TOS. In conclusion, LOS had better early improvement of positive symptoms than EOS and TOS. Thus, personalized treatment for schizophrenia should consider the age of onset.

Neutrophil/lymphocyte, platelet/lymphocyte, monocyte/lymphocyte ratios and systemic immune-inflammation index in patients with depression.

BACKGROUND: Evidence suggest immunity abnormalities and inflammation might play an important role in the pathophysiology of depression. This study explored the relationship between inflammation and depression using neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) as inflammatory markers. METHODS: We collected the full blood count results of 239 patients with depression and 241 healthy controls. Patients were divided into three diagnostic subtype groups: severe depressive disorder with psychotic symptoms, severe depressive disorder without psychotic symptoms, and moderate depressive disorder. We analyzed the Participants' neutrophil (NEU), lymphocyte (LYM), monocyte (MON), and platelet (PLT) counts, compared the differences in NLR, MLR, PLR and SII, and explored the relationships between depression and these indicators. RESULTS: There were significant differences in PLT, MON, NEU, MLR, and SII among the four groups. MON and MLR were significantly higher in three groups of depressive disorders. SII was significantly increased in two severe depressive disorder groups, while the SII in the moderate depressive disorder group showed an increasing trend. CONCLUSION: Increased MON, MLR and SII, as signs of inflammatory response, were not different among three subtypes of depressive disorders, and may be biological indictors of depressive disorders (Tab. 1, Ref. 17). Text in PDF www.elis.sk Keywords: depression, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII).

History of suicide attempt associated with amygdala and hippocampus changes among individuals with schizophrenia.

Abnormalities in subcortical brain structures may reflect higher suicide risk in mood disorders, but less is known about its associations for schizophrenia. This cross-sectional imaging study aimed to explore whether the history of suicide attempts was associated with subcortical changes among individuals with schizophrenia. We recruited 44 individuals with schizophrenia and a history of suicide attempts (SZ-SA) and 44 individuals with schizophrenia but without a history of suicide attempts (SZ-NSA) and 44 healthy controls. Linear regression showed that SZ-SA had smaller volumes of the hippocampus (Cohen's d = -0.72), the amygdala (Cohen's d = -0.69), and some nuclei of the amygdala (Cohen's d, -0.57 to -0.72) than SZ-NSA after adjusting for age, sex, illness phase, and intracranial volume. There was no difference in the volume of the subfields of the hippocampus. It suggests the history of suicide attempts is associated with subcortical volume alterations in schizophrenia.

Predictive value of suicidal risk assessment using data from China's largest suicide prevention hotline.

BACKGROUND: Suicide hotlines are widely used, with potential for identification of callers at especially high risk. METHODS: This prospective study was conducted at the largest psychological support hotline in China. From 2015 to 2017, all distressed callers were consecutively included and assessed, using a standardized scale consisting of 12 elements, yielding scores of high risk (8-16), moderate risk (4-7), and low risk (0-3) for suicidal act. All high-risk and half of moderate- and low-risk callers were scheduled for a 12-month follow-up. Main outcomes were suicidal acts (nonlethal attempt, death) over follow-up. RESULTS: Of 21,346 fully assessed callers, 5822, 11,791, and 3733 were classified as high-, moderate-, or low-risk for suicidal acts, with 8869 callers (4076 high-, 3258 moderate-, and 1535 low-risk) followed up over 12 months. Over follow-up, 802 (9.0 %) callers attempted suicide or died by suicide. The high-risk callers (15.1 %) had 3-fold higher risk for subsequent suicidal acts than moderate- (5.1 %) and 12-fold higher risk than low-risk callers (1.3 %). The weighted sensitivity, specificity, and positive predictive value of high risk scores were 56.4 %, 74.9 %, and 14.4 %. LIMITATIONS: Assessed callers with different risk levels were followed disproportionally. CONCLUSIONS: Suicidal risk assessment during a hotline call is both feasible and predictive of risk, guiding resource allocation to higher risk callers.

The age of onset and cognitive impairment at the early stage of schizophrenia.

In schizophrenia, the age of first episode onset can reflect genetic loading and predict prognosis. Little is known about the association between the age of onset and cognition among individuals with early-stage schizophrenia. We aimed to compare the pre-treatment neurocognition profile between individuals with early-onset schizophrenia (EOS, the age of onset < 18 years), typical-onset schizophrenia (TOS, the age of onset between 18 and 39 years), and late-onset schizophrenia (LOS, the age of onset between 40 and 59 years). We included individuals with a current diagnosis of schizophrenia within 3 years and medication naive or less than 2 weeks of cumulative antipsychotic exposure and current daily antipsychotic dosage equivalent to ≤ 15 mg of olanzapine. Assessments included the MATRICS Consensus Cognitive Battery (MCCB) and the Positive and Negative Syndrome Scale (PANSS). We used linear regression to compare the difference between age-of-onset groups. We included 356 participants (67 EOS, 195 TOS, and 94 LOS). Compared with LOS, TOS was associated with lower scores in the verbal learning scores of the MCCB after adjusting for education years and the subscale scores of the PANSS (45.5 ± 12.9 vs. 40.5 ± 14.1, adjusted B = - 5.79, p = 0.001). The three groups had no difference in other cognitive domain scores. The association between the age of onset and MCCB verbal memory was U-shape (square of the age of onset, adjusted B = 0.02, p = 0.003). Patients with LOS had a better verbal learning function compared with individuals with TOS. These findings suggest that involvement of cognition assessment and rehabilitation training is necessary for patients with TOS.

Auditory Hallucinations, Depressive Symptoms, and Current Suicidal Ideation or Behavior Among Patients with Acute-episode Schizophrenia.

Suicide risk and auditory hallucinations are common in schizophrenia, but less is known about its associations. This cross-sectional study aimed to determine whether the presence and severity of auditory hallucinations were associated with current suicidal ideation or behavior (CSIB) among patients with schizophrenia. We interviewed 299 individuals with schizophrenia and acute symptoms and reviewed their medical records. Measurement included the Psychotic Symptom Rating Scale (PSYRATS-AH), the Calgary Depression Scale for Schizophrenia (CDSS), and the Positive and Negative Syndrome Scale. Logistic regression and path analysis were used. The CSIB prevalence was higher among patients with current auditory hallucination than those without (19.5% vs. 8.6%, crude odds ratio = 2.58, p = .009). Lifetime auditory hallucination experience (adjusted odds ratio [AOR] = 3.81; 95% CI: 1.45-10.05) or current auditory hallucination experience (AOR = 3.22; 95% CI: 1.25-8.28) can elevate the likelihood of CSIB while controlling for depressive symptoms and lifetime suicide-attempt history. Among those with auditory hallucinations, the emotional score of the PSYRATS-AH was positively associated with the CDSS score and there was a small indirect effect of the CDSS score on the association between the emotional domain score and CSIB (bias-corrected 95% CI, 0.02-0.20). In conclusion, the presence of auditory hallucinations was strongly associated with CSIB, independent of depressive symptoms and lifetime suicide attempts. Suicide risk assessment should consider auditory hallucination experience and patients' appraisal of its emotional characteristics. Future cohort studies are necessary to provide more conclusive evidence for the mediating pathways between auditory hallucinations and CSIB.HIGHLIGHTSThe presence of auditory hallucinations was associated with current suicidality.Auditory hallucinations' emotional severity was related to depressive symptoms.The severity of auditory hallucination was not directly associated with suicidality.

Establishment and psychometric characteristics of emotional words list for suicidal risk assessment in speech emotion recognition.

Background: Emotional disturbance is an important risk factor of suicidal behaviors. To ensure speech emotion recognition (SER), a novel technique to evaluate emotional characteristics of speech, precision in labeling emotional words is a prerequisite. Currently, a list of suicide-related emotional word is absent. The aims of this study were to establish an Emotional Words List for Suicidal Risk Assessment (EWLSRA) and test the reliability and validity of the list in a suicide-related SER task. Methods: Suicide-related emotion words were nominated and discussed by 10 suicide prevention professionals. Sixty-five tape-recordings of calls to a large psychological support hotline in China were selected to test psychometric characteristics of the EWLSRA. Results: The results shows that the EWLSRA consists of 11 emotion words which were highly associated with suicide risk scores and suicide attempts. Results of exploratory factor analysis support one-factor model of this list. The Fleiss' Kappa value of 0.42 indicated good inter-rater reliability of the list. In terms of criteria validities, indices of despair (Spearman ρ = 0.54, P < 0.001), sadness (ρ = 0.37, P = 0.006), helplessness (ρ = 0.45, P = 0.001), and numbness (ρ = 0.35, P = 0.009) were significantly associated with suicidal risk scores. The index of the emotional word of numbness in callers with suicide attempt during the 12-month follow-up was significantly higher than that in callers without suicide attempt during the follow-up (P = 0.049). Conclusion: This study demonstrated that the EWLSRA has adequate psychometric performance in identifying suicide-related emotional words of recording of hotline callers to a national wide suicide prevention line. This list can be useful for SER in future studies on suicide prevention.

Mental health problems among hotline callers during the early stage of COVID-19 pandemic.

Background: The study aims to explore the mental health of the hotline callers during the COVID-19 pandemic in China. Methods: Callers (N = 10,490) from the Beijing Psychological Support Hotline from January 21st to June 30th in 2019 and 2020 were enrolled and divided into two groups (during (2020) and before (2019) COVID-19 pandemic). The severity of depressive symptoms, psychological distress, hopefulness, and suicidal ideation (SI) was assessed. Demographic characteristics and major concerns were also collected. Mann-Whitney U and chi-square test were used to compare the differences in mental health conditions and major concerns between two years and between different age groups. The multivariable logistic regression was used to explore whether mental health conditions were associated with pandemic and demographic factors. Results: Results from multivariable logistic regression analysis indicated that the change in suicidal ideation (OR = 1.52, 95% CI: 1.21-1.92) was significantly different across age groups. Callers during the pandemic reported a higher level of hopefulness (OR = 1.13, 95% CI [1.03-1.24]), a lower level of depressive symptoms (OR = 0.81, 95% CI [0.74-0.89]) and psychological distress (OR = 0.89, 95% CI [0.81-0.98]), and were less likely to report SI (OR = 0.69, 95% CI [0.61-0.77]) compared with callers before the pandemic. Conclusions: Compared with callers before the pandemic, hotline callers during the early stage of COVID-19 pandemic did not present significant mental health problems. Younger callers during the pandemic were more vulnerable for the presence of suicidal ideation. Hotline-based crisis interventions might provide specific psychological support to cope with troubles during the pandemic.

History of suicide attempts associated with the thinning right superior temporal gyrus among individuals with schizophrenia.

Individuals with schizophrenia have higher rates of suicide attempts than the general population. Specific cortical abnormalities (e.g., the cortical surface area and thickness) may be associated with a history of suicide attempts. We recruited 74 individuals with schizophrenia (37 suicide attempters were individually matched with 37 non-attempters on age, sex, phase of illness, and study center) and 37 healthy volunteers. The cortical surface area and thickness data were extracted from structural MRI and compared between the groups. Suicide attempters showed significantly smaller surface areas in the whole brain (p = .028, Cohen's d = -0.54) than non-attempters. No association was found between the cortical surface area of individual brain regions and a history of suicide attempts. The mean cortical thickness did not differ significantly between the groups; however, suicide attempters demonstrated a thinner cortex in the right superior temporal gyrus (p < .001, q = 0.037, Cohen's d = -0.88). These findings indicate that a history of suicide attempts among individuals with schizophrenia is associated with a reduction in the global cortical surface area and specific cortical thinning of the right superior temporal gyrus. The morphometric alteration of the right superior temporal gyrus may represent a biomarker of suicidal behavior in individuals with schizophrenia.

Comparison of Psycho-Social Factors Associated With Suicidal Ideation and Suicide Attempts Among People Living With HIV in Central West China.

Background: Previous studies have described the correlation of suicidal ideation (SI) or suicide attempts (SA) in people living with HIV (PLWH), whereas few studies compare the correlation between SI and SA in PLWH. Understanding specific risk factors for SI and SA among PLWH will help with developing tailored and effective suicide prevention strategies among this high-risk group. Methods: A cross-sectional study was conducted from December 2020 to April 2021 in Baoji municipality, Shaanxi Province. The PLWH registered with the Baoji Municipal Center for Disease Control and Prevention (CDC) were recruited and interviewed. Questionnaires and interviews for this study consisted of socio-demographic variables, mental health history, and psychosocial characteristics. The HIV-related clinical features were obtained from CDC medical records. The PLWH included were divided into three groups, i.e., those with a history of suicide attempts (SA group), those with suicidal ideation only (SI group), and those without any suicidal behavior (NSB group). Multinomial logistic regression was used for three-way comparisons among these three groups of PLWH. Results: In total, 995 PLWH were interviewed. The prevalence of probable depression, probable anxiety, SI, and SA in PLWH after being diagnosed as HIV+ was 18.6%, 13.5%, 26.7%, and 3.2%, respectively. Compared with the NSB group, the SI or SA groups were more likely to report probable depression [adjusted odds ratio (AOR) = 2.43, 4.44, respectively], probable anxiety (AOR = 2.80, 5.62, respectively), and high HIV-related stigma (AOR = 2.05, 2.65, respectively). The SI group was more likely to experience high HIV-related stress (AOR = 1.91) and lower quality of life (AOR = 0.56) than the NSB group. Social support and HIV-related clinical features were not associated with SI or SA in this sample. The SA group did not differ from the SI group on any of the psychosocial or HIV-related clinical features. Conclusions: Mental health problems are serious in community residents identified with having an HIV infection in a Central West China municipality. It is important to deliver low-cost and effective psychological services tailored for PLWH that are focused on reducing mental health problems. Future studies should utilize sensitive screening measures and further clarify factors potentially associated with the transition from SI to SA in PLWH.

Symptomatology in 1,112 women screened positive and negative using the Edinburgh postnatal depression scale (EPDS): longitudinal observations from the first trimester to 6 weeks postpartum of a Chinese cohort.

PURPOSE: To compare the characteristics of depression-related symptoms identified by individual EPDS items in women who screened positive and negative, and to describe the occurrence of thoughts of self-harm in these women. METHODS: Based on a Chinese cohort of 1,112 women, scores on each EPDS item were analyzed at 7 time points from the first trimester to 6 weeks postpartum. Scores greater than 0 indicated the presence of symptoms, and higher scores indicated more severe symptoms. We defined the most frequent, serious and important symptoms for screening-positive and screening-negative groups as the item with the highest proportion of respondents scoring 1 or higher, highest proportion scoring 3, and highest average score, respectively. RESULTS: In screened positive women the most frequent symptom was feeling sad or miserable, and the most serious and important symptoms were both sleeping problems. Among those screened negative, self-blame was the most frequent, serious and important item. For women who screened positive in the first trimester, only self-blame and feeling overwhelmed showed stability over time. Symptoms in women screened negative were relatively stable. Four in ten women who had self-harm thoughts were screened negative. CONCLUSION: Women who screened positive in EPDS differed from those screened negative in the characteristics in depressive symptoms. Intervention strategies focusing on the most frequent, serious and important symptoms (such as sadness and insomnia) may be worthwhile. Health practitioners should be trained to respond to a positive response to thoughts of self-harm, regardless of whether the women are screened positive or negative.

Objectives of screening for depression in adolescents / 中国学校卫生

Abstract@#Depression is a major public health issue among adolescents. The Ministry of Education of China recently proposed to integrate depression screening into students school health check among adolescents. However, there are inconsistencies regarding the strength of recommendation and implementation details of routine screening for adolescent depression across professional organizations and countries. This paper outlines the epidemiology and risk factors of adolescent depression and summarizes relevant international guidelines and recommendations. We suggest that before the national implementation of school based depression screening, key issues including scientific evidence, execution details, resource allocation and ethical considerations need to be examined in close collaboration with all stakeholders. Systematic piloting followed by rigorous evaluation will also be needed.

CART Peptides Differently Regulate Firing Rates and GABAergic Synaptic Inputs of DMV Neurons Innervating the Stomach Antrum and Cecum of Adult Male Rats.

BACKGROUND/AIM: Central administration of cocaine- and amphetamine-regulated transcript peptides (CARTp) alters gastrointestinal motility and reduces food intake in rats. Since neurons in the dorsal motor nucleus of the vagus (DMV) receive GABAergic and glutamatergic inputs and innervate the smooth muscle of gastrointestinal organs, we hypothesized that CARTp acts on the DMV or presynaptic neurons. METHODS: We used 3,3'-dioctadecyloxa-carbocyanine perchlorate (DiO) retrograde tracing with electrophysiological methods to record DMV neurons innervating the stomach antrum or cecum in brainstem slices from adult rats. RESULTS: DiO application did not change the electrophysiological properties of DMV neurons. CART55-102 had no effect on the basal firing rates of neurons in either the stomach antrum-labeled group (SLG) or cecum-labeled group (CLG). When presynaptic inputs were blocked, CART55-102 further increased the firing rates of the SLG, suggesting a direct excitatory effect. Spontaneous inhibitory postsynaptic currents (sIPSCs) occurred at a higher frequency in SLG neurons than in CLG neurons. CART55-102 reduced the amplitude and the frequency of sIPSCs in SLG neurons dose-dependently, with higher doses also reducing spontaneous excitatory postsynaptic currents (sEPSCs). Higher doses of CART55-102 reduced sIPSC and sEPSC amplitudes in CLG neurons, suggesting a postsynaptic effect. In response to incremental current injections, the SLG neurons exhibited less increases in firing activity. Simultaneous applications of current injections and CART55-102 decreased the firing activity of the CLG. Therefore, stomach antrum-projecting DMV neurons possess a higher gating ability to stabilize firing activity. CONCLUSION: The mechanism by which CARTp mediates anorectic actions may be through a direct reduction in cecum-projecting DMV neuron excitability and, to a lesser extent, that of antrum-projecting DMV neurons, by acting on receptors of these neurons.