Caffeine, in the form of coffee, tea and energy drinks, is recognised as the world's most utilised psychoactive substance and consumed by approximately 80% of the global population daily. Emerging studies have suggested a more complex relationship in terms of the mental health outcomes that can arise after consumption. This is the first systematic review and meta-analysis that aims to explore the effects of caffeine consumption on the risk of suicide attempts, ideation and self-harm.

This PRISMA-adherent systematic review involved a systematic search of PubMed, Embase, Cochrane and PsycINFO for all studies that evaluated the effects of caffeine consumption on the risk of suicide attempts, ideation and self-harm. Random effects meta-analyses and meta-regression were used for primary analysis.

Seventeen studies were included. The results demonstrated that coffee consumption of more than 60 cups per month significantly decreases the risk of suicide attempts. In contrast, energy drink consumption from as low as one cup per month was significantly associated with an increased risk of both suicide attempts and ideation. Meta-regression demonstrated a strong association between the dosage consumed and suicidality outcomes. Systematic review highlighted that male gender and substance usage significantly increased caffeine consumption.

The results studied the associations between coffee and energy drink intake with suicide risk and suicidal ideation. Coffee intake was associated with reduced odds of suicide ideation and attempts, while consuming energy drinks was associated with an increased risk of both adverse outcomes. Further studies would be essential to elucidate the psychosocial factors and causative links underlying this association. Understanding the relationship between caffeine consumption and mental health outcomes is crucial to develop public health strategies to boost the mental health of consumers.

The phenomenon of suicide has become a significant global concern, claiming over 800,000 lives annually and resulting in millions of suicide attempts worldwide. In the aftermath of the COVID-19 pandemic, these troubling statistics have worsened, with notable increases in suicidal behavior, especially among vulnerable populations such as the youth, the elderly, and those in socioeconomically disadvantaged groups. This paper aims to explore the impact of the COVID-19 pandemic on suicide rates in Spain, using a theoretical ex post facto analysis. Spain has witnessed an alarming rise in suicide rates, particularly among young people, and a disturbing trend of increased suicidal ideation and self-harm behaviors. While some studies report no significant change in suicide rates during the pandemic, others point to the exacerbating effects of social isolation, economic instability, and public health measures. This study provides an in-depth examination of the psychosocial consequences of the pandemic on mental health in Spain, emphasizing the urgency of the need to address pre-existing inequalities and implement effective suicide prevention measures. Furthermore, it highlights the importance of gender-sensitive strategies and the need for systemic reforms to ensure better mental healthcare access for all segments of society. To achieve this goal, this paper uses a narrative literature review combined with a theoretical ex post facto analysis to assess the influence of the COVID-19 pandemic on suicide patterns in Spain.

Internationally, there are observable sex differentials in mortality in many countries, most notably in affluent countries, with women living longer than men. To understand if this is also the case in Aotearoa New Zealand (NZ), we visualise the precise nature and evolution of sex differentials in mortality by age over time, within a wider context of increasing life expectancy and falling mortality. This allows us to determine if NZ mirrors other affluent countries in having a male/female inequality in mortality, and how the inequality has evolved over several generations in NZ. We use newly available single-year mortality data by sex in NZ to visualise and analyse the sex differentials in mortality using an observational study design. Sex and age-specific mortality data were obtained from the human mortality database from 1948 to 2021 for NZ. The data were then processed to create a smoothed data series using a geometric mean of those two years older and younger as well as aggregating the single-year age groups over 90 into a single category due to small numbers. The processed data was then visualised using a lexis diagram. There are clear patterns of elevated mortality ratios at younger ages (18-30) for males compared to females. The relative difference in mortality inequality between the sexes grew between 1950 and 1980 in NZ, before converging between 2000 and 2020. There is a consistent gap of at least 3 years in life expectancy across the study period by sex. Particularly striking is the longstanding nature of this inequality in mortality by sex in NZ and the relative lack of focus from policymakers. This focus on one country, NZ, allows examination of this specific context to understand how policy changes may have exacerbated or ameliorated trends in male/female mortality inequality.

Suicide attempts may involve various parts of the body with different severity grades and therefore represent a multidisciplinary challenge. The head and neck region is highly vulnerable to severe self-inflicted injuries, yet literature on this topic remains limited.

A retrospective analysis was performed of patients with suicide attempts in an Otorhinolaryngology (ORL) department of a tertiary referral hospital over a 15-year period. The aim of the study was to analyse their clinical course and injury patterns.

70 patients were included (m: 42/70; f: 28/70). The mean age at suicide attempt was 43.7 years. Women were significantly younger than men (p = 0.046). Seven injury types were differentiated: strangulation (44.3%), stabbing (17.1%), jumping from a height and firearm use (10.0% each), jumping in front of a moving vehicle and ingestion of acids/bases (7.1% each) as well as ingestion of pills (4.3%). Men were dominantly involved in strangulation (14/42; 33.3%) and stabbing (11/42; 26.2%), whereas women appeared with strangulation (17/28; 60.7%) and tablet ingestion (3/28; 10.7%). Men required ORL-specific surgical care significantly more often than women (43.9% vs. 7.1%; p < 0.001). Men chose "violent" methods more frequently than women (90.5% vs. 46.4%; p < 0.001). Women were more likely to receive psychiatric treatment (p = 0.0011).

Violent suicide attempts were more common in males and therefore required more often surgical intervention. Soft attempts and psychiatric diagnoses were more often associated with female gender. Routine laryngoscopy is recommended within 24h after the initial trauma. All individuals were successfully treated in an interdisciplinary setting and survived with moderate morbidity.

Our study investigated the association between confidant networks and mortality among older Chinese adults, focusing on the impact of the absence, types, and size of the networks.

A prospective cohort study included 11,930 participants aged over 65 from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018. Cox proportional hazards models were employed for analysis, supplemented by subgroup and interaction analyses.

Participants without confidant networks had higher mortality (HR=1.194, 95% CI 1.097-1.300) after adjusting for confounders. A dose-response relationship was observed between the size of confidant networks and mortality. Notably, having a spouse as a confidant was strongly associated with decreased mortality (HR=0.765, 95% CI 0.677-0.865), whereas having formal helpers as confidants did not significantly affect mortality (HR=0.813, 95% CI 0.636-1.040).

Identifying and supporting older adults without confidant networks is crucial for enabling them to benefit from these networks and potentially enhance their longevity.

Interpersonal needs and depression are two recognized significant risk factors for suicidal ideation. Previous studies have preliminarily revealed the gender-dependent effects of interpersonal needs and depression on suicidal ideation. However, there are very few studies that place these variables within a single framework and apply symptom-level analysis to investigate the gender-dependent relationships among them. This study applied symptom-level network analysis to construct female and male networks using data from 781 female and 628 male young adults. The networks included interpersonal needs, depressive symptoms, and suicidal ideation. Key characteristics of networks, including edge connections, bridge expected influence (BEI), and global expected influence (GEI), were compared. The results suggested that gender significantly impacts edge connections, node BEI, and GEI of the final networks. Several significantly gender-dependent connections were disclosed, such as perceived burdensomeness (PB)-suicidal ideation, hopelessness-suicidal ideation, PB-sense of failure, and PB-sadness. PB (marginally) and thwarted belongingness show significant gender differences in their impact on depressive symptoms. The GEI of the female network is significantly greater than that of the male network. These findings offer valuable insights for modern theoretical frameworks examining gender differences in the connections between suicidal ideation, interpersonal needs, and depressive symptoms. Additionally, results provide empirical support for selecting screening, prevention, and intervention strategies for suicidal ideation and depression across genders.

Although increased mortality in patients with Parkinson disease (PD) is well documented, studies on suicide-related mortality have yielded conflicting results. Moreover, the impact of comorbidities, socioeconomic factors and health behaviours as potential risk factors for suicide remains underinvestigated. This study aimed to investigate suicide mortality risk in patients with PD and comprehensively elucidate the association between comorbidities, socioeconomic factors, health behaviours and suicide in PD.

This nationwide population-based cohort study used Korean National Health Insurance Service data from 2009, with a longitudinal follow-up until 31 December 2021. This study included 2,732,294 (PD, n = 4132; without PD, n = 2,728,162) individuals. PD was defined by ICD-10 code (G20) and registration code (V124). Comorbidities were identified using medical history, ICD-10 codes, laboratory data and prescribed medications. Health behaviours were obtained from a self-reported National Health Screening Program questionnaire. The primary outcome was suicide mortality, determined by ICD-10 codes for intentional self-harm (X60-X84).

Suicide mortality in patients with PD increased by 2.71-fold. Males with PD had more than a sevenfold higher risk (HR = 7.34, 95% CI, 5.25-10.26). Low-income patients with PD had an approximately fivefold higher risk compared to high-income non-PD individuals (HR = 5.10, 95% CI, 3.07-8.46). Patients with PD concomitant with depression (HR = 5.00, 95% CI, 3.06-8.16) and alcohol consumption (HR = 3.54, 95% CI, 2.14-5.89) also showed increased suicide risk.

This study suggests that patients with PD have a higher risk of suicide, particularly males, those with lower income, depression or alcohol consumption.

Prison correctional personnel often experience increased workplace violence (WPV) and higher risk of suicide, but the link between the two is not yet clear. This study aims to explore the specific mediating variables and mediating paths between WPV and suicide.

This is a cross-sectional study of 472 Chinese correctional personnel conducted through an online survey. We used the Workplace Violence Scale (WVS), the Athens Insomnia Scale (AIS), the Chinese version of the Depression Anxiety Stress Scale (DASS), and the revised Beck Suicidal Ideation scale (BSI) to quantify the WPV experienced by subjects and their mental health status. Data analysis, including mediation and network analysis, was performed using SPSS and R software.

Presence of insomnia and/or depression mediated the relationship between WPV and suicide risk, which accounted for 36.62% of the total effect. Insomnia alone accounted for 9.87%, depression alone accounted for 12.73%, whereas both put together accounted for 14.03%. Male personnel experienced more WPV than their female counterparts, and WPV in men had a stronger association with suicide risk. Network analysis indicated that daytime dysfunction and downheartedness were important nodes in mediating pathways.

Experiencing WPV may lead to an increased risk of suicide among correctional personnel, particularly men, with insomnia and depression mediating the experienced risk. Correctional institutions should take measures to reduce the occurrence of WPV experienced by correctional personnel mitigate the impact of this occupational hazard, and prioritise the mental health of correctional personnel, particularly those already experiencing worrying symptoms.

The differential influence of sex on premature mortality in schizophrenia is unclear. This study assessed the differences in all-cause and specific cause mortality risks in people with schizophrenia compared to several control groups stratified by sex. We conducted a PRISMA 2020-compliant systematic review and random-effects meta-analysis of cohort studies assessing mortality relative risk (RR) for people with schizophrenia, comparing by sex. We measured publication bias and conducted a quality assessment through the Newcastle-Ottawa scale. We meta-analyzed 43 studies reporting on 2,700,825 people with schizophrenia. Both males and females with schizophrenia had increased all-cause mortality vs. comparison groups (males, RR=2.62, 95%CI 2.35-2.92; females, RR=2.56, 95%CI 2.27-2.87), suicide (males, RR=9.02, 95%CI 5.96-13.67; females, RR=12.09, 95%CI 9.00-16.25), and natural cause mortality (males, RR=2.11, 95%CI 1.88-2.38; females, RR=2.14, 95%CI 1.93-2.38). No statistically significant differences in sex-dependent mortality risk emerged. There was an age-group-dependent increased mortality risk in females < 40 years vs. >/=40 years old (RR=4.23/2.17), and significantly higher risk of death due to neurological disorders (dementia) in males vs. females (RR=5.19/2.40). Increased mortality risks were often associated with specific modifiable risk factors. The increased mortality risk did not improve over time, calling for more studies to identify modifiable factors, and for better physical healthcare for males and females with schizophrenia.

This study sought to explore the relationship between sociodemographic-, mental health-, knowledge-, attitudinal-, and conformity to masculine norms variables with suicide literacy, suicide stigma, and help-seeking attitudes among men in a university setting (n = 471) in Ireland. Multiple linear regression with backward elimination was used to determine the independent variables associated with suicide literacy, suicide stigma, and help-seeking attitudes. Lower suicide literacy was associated with an ethnic minority background, living in a rural community, postgraduate students compared to undergraduate students, no depression symptoms in the past year, decreasing loneliness, greater suicide stigma, more negative help-seeking attitudes, lower resilience, greater conformity to the masculine norm power over women and lower conformity to the masculine norm emotional control. Greater suicide stigma was associated with a non-ethnic minority background, all departments of study compared to health and sports science, lower suicide literacy, more negative help-seeking attitudes, and greater conformity to the masculine norms of power over women, dominance, and heterosexual self-presentation. More negative help-seeking attitudes were associated with no generalized anxiety disorder symptoms in the past year, depression symptoms in the past year, greater suicide risk, lower suicide literacy, greater suicide stigma, greater resilience, and greater conformity to the masculine norms emotional control, self-reliance, violence, and heterosexual self-presentation. Findings highlight a need for gender-responsive psychoeducational programmes to target suicide literacy, suicide stigma, and/or help-seeking attitudes among men in university settings. They also highlight that such initiatives need to be co-produced alongside ethnic minority and rural-dwelling men to ensure they are culturally sensitive and acceptable.

This study aimed to explore the relationship between the masculine norm of self-reliance and suicidal thoughts among Australian men, hypothesising that lack of help-seeking might mediate the relationship between high self-reliance and the emergence of suicidal thoughts.

This study used data from on the Australian Longitudinal Study on Male Health 'Ten to Men', a prospective longitudinal cohort study that began in 2013/2014 with boys and men aged 10-55 years (N = 16,021) at wave 1. The focus was on men who participated in waves 1 and 2 (2013/2014, 2015/2016) and had linked administrative data. A causal mediation analysis was conducted to quantify the total effect of self-reliance at wave 1 on suicidal thoughts at wave 2, and to investigate the extent of mediation by help-seeking between waves 1 and 2.

High self-reliance was associated with an increased odds of suicidal thoughts (OR = 1.46, 95% CI 1.24-1.72). However, there was no significant mediating effect of a lack of help-seeking on the relationship between self-reliance and suicidal thoughts (OR = 1.00, 95% CI 0.99-1.01).

Findings suggest that highly self-reliant men are at an increased risk of experiencing suicidal thoughts; however, this relationship is not explained by lack of help-seeking. Future studies could explore other potential mechanisms to better understand why highly self-reliant men are more likely to experience suicidal thoughts.

Men are up to four times more likely to die by suicide than women. At the same time, men are less likely to disclose suicidal ideation and transition more rapidly from ideation to attempt. Recently, socialized gender norms and particularly conformity to masculine norms (CMN) have been discussed as driving factors for men's increased risk for suicidal thoughts and behaviors (STBs). This study aims to examine the individual interplay between CMN dimensions and their association with depression symptoms, help-seeking, and STBs.

Using data from an anonymous online survey of 488 cisgender men, latent profile analysis was performed to identify CMN subgroups. Multigroup comparisons and hierarchical regression analyses were used to estimate differences in sociodemographic characteristics, depression symptoms, psychotherapy use, and STBs.

Three latent CMN subgroups were identified: Egalitarians (58.6 %; characterized by overall low CMN), Players (16.0 %; characterized by patriarchal beliefs, endorsement of sexual promiscuity, and heterosexual self-presentation), and Stoics (25.4 %; characterized by restrictive emotionality, self-reliance, and engagement in risky behavior). Stoics showed a 2.32 times higher risk for a lifetime suicide attempt, younger age, stronger somatization of depression symptoms, and stronger unbearability beliefs.

The interplay between the CMN dimensions restrictive emotionality, self-reliance, and willingness to engage in risky behavior, paired with suicidal beliefs about the unbearability of emotional pain, may create a suicidogenic psychosocial system. Acknowledging this high-risk subgroup of men conforming to restrictive masculine norms may aid the development of tailored intervention programs, ultimately mitigating the risk for a suicide attempt.

Depression is a growing public health concern that affects approximately 5% of adults in their lifetime (WHO in Depression, 2021). Understanding the biological correlates of depression is imperative for advancing treatment. Of particular interest is allostatic load, a multisystem indicator of chronic physiological dysregulation (McEwen and Seeman in, Ann N Y Acad Sci, 1999). The current longitudinal study examined the association between allostatic load, depressive symptoms, and the moderating roles of sex and race. Participants consisted of 150 young adults (Mage = 18.81) who reported their demographics and depressive symptoms at T1 and T2, a year and a half later. Allostatic load was computed using indicators of metabolic, cardiovascular, and neuroendocrine functioning. Allostatic load was found to predict changes in depressive symptoms. Moreover, interaction effects models revealed that the associations between allostatic load and depressive symptoms at follow-up were further influenced by sex, such that the relationship was significant for males, with pronounced effects for Black males in particular. Black males may be particularly vulnerable to the mental health consequences of biological dysregulation.

Suicide mortality remains a global health concern, and community characteristics affect regional variations in suicide. This study investigated spatially clustered patterns of suicide mortality rates in South Korea and evaluated the impact of community factors on suicide.

Suicide mortality rates were estimated by sex, age group, and district, using the 2021 Cause of Death Statistics in South Korea from the MicroData Integrated Service. Community-determinant data for 2021 or the nearest year were collected from the Korean Statistical Information Service. The spatial autocorrelation of suicide by sex and age was examined based on Global Moran's I index. Geographically weighted regression (GWR) was used to discern the influence of community determinants on suicide.

Suicide mortality rates were significantly higher among men (40.64 per 100,000) and adults over the age of 65 years (43.18 per 100,000). The male suicide mortality rates exhibited strong spatial dependence, as indicated by a high global Moran's I with p < 0.001, highlighting the importance of conducting spatial analysis. In the GWR model calibration, a subset of the community's age structure, single-person household composition, access to mental healthcare centers, and unmet medical needs were selected to explain male suicide mortality. These determinants disproportionately increased the risk of male suicide, varying by region. The GWR coefficients of each variable vary widely across 249 districts: aging index (Q1:0.06-Q3:0.46), single-person households (Q1:0.22-Q3:0.35), psychiatric clinics (Q1:-0.20-Q3:-0.01), and unmet medical needs (Q1:0.09-Q3:0.14).

Community cultural and structural factors exacerbate regional disparities in suicide among men. The influencing factors exhibit differential effects and significance depending on the community, highlighting the need for efficient resource allocation for suicide. A regionally tailored approach is crucial for the effective control of the community's mental health management system.

Suicide rates are known to be increased in patients after discharge from in-patient psychiatric treatment. However, evidence on risk factors for suicide within this patient group are contradictory. Thus, this study aims to investigate suicide after discharge from a sizeable psychiatric care facility to determine associated risk factors.

Data on individual patient level from a 15-year single-centre cohort were linked to data from the national death registry and cumulative incidence rates were calculated applying competing risk models. Independent variables included the patients' sex, age at admission, diagnosis, and length of admission. For each of these factors, subdistribution hazards ratios were calculated using a Fine-Gray model.

In our sample of 18,425 discharges, when using patients with the diagnosis of substance-use-disorders as a comparator, a significant increase in hazard of post-discharge suicide for male sex (SHR = 1.67;p = 0.037) as well as the discharge diagnoses of affective disorders (SHR = 3.56;p = 0.017) and neurotic stress and somatoform disorders (SHR = 3.73;p = 0.024) were found. Interestingly, the hazard of suicide significantly decreased in more recent discharges (SHR = 0.93;p = 0.006). No statistically significant association of the length of admission with the suicide risk was found (SHR = 0.98;p = 0.834).

Suicides may have been mis-identified as natural death in the national death register.

Male sex and distinct diagnoses were associated with an increased risk for suicide after discharge from a psychiatric care institution. The markedly increased suicide risk within this patient collective highlights the need for the development of tools to assess suicidal behaviour in this group of patients reliably.

This study investigated the characteristics and survival rates of patients with intentional severe trauma (self-harm or suicide) who were transported to either a regional trauma center (TC) or a non-TC facility.

This retrospective, national, population-based, observational, case-control study included patients who sustained intentional severe trauma and had an abnormal Revised Trauma Score at the injury site between January 2018 and December 2019. The data were a community-based severe trauma survey based on data collected from severe injury and multiple casualty patients transported by 119 emergency medical services (EMS), distributed by the Korea Disease Control and Prevention Agency. The treatment hospitals were divided into two types, TC and non-TCs, and several variables, including in-hospital mortality, were compared. Propensity score matching (PSM) was used to mitigate the influence of confounding variables on the survival outcomes.

Among the 3864 patients, 872 and 2992 visited TC and non-TC facilities, respectively. The injury severity did not differ significantly between patients treated at TCs and non-TCs (TC, 9; non-TC, 9; p=0.104). However, compared with those treated at non-TCs, patients treated at TCs had a higher rate of surgery or transcatheter arterial embolization (14.2% vs 38.4%; p<0.001) and a higher admission rate to the emergency department (34.4% vs 60.6%; p<0.001). After PSM, 872 patients from both groups were analyzed. Patients treated at TCs exhibited a higher overall survival rate than those treated at non-TCs (76.1% vs 66.9%; p<0.001), and multiple variable logistic regression analysis demonstrated that the causes of injury and transport to the TC were significantly associated.

Using Korean EMS data, the results of this study revealed that initial transport to TCs was associated with reduced mortality rates. However, considering the limitations of using data from only 2 years and the retrospective design, further research is warranted.

Retrospective national, population-based observational case-control study.

Level III.

Suicide represents a major public health concern, affecting a significant portion of individuals. However, there remains a gap in understanding the age and sex disparities in the occurrence of suicide. Therefore, this study aimed to investigate the sex-related inequalities in suicide rates in Ghana from 2000 to 2019.

We utilized data from the WHO Health Equity Assessment Toolkit (HEAT) online software. We analysed sex differences in both crude and age-standardized suicide rates in Ghana spanning from 2000 to 2019. Crude and age-adjusted suicide rates were calculated based on the International Classification of Diseases (ICD) definition and coding of suicide mortality. We measured inequality in terms of sex. Two inequality indicators were used to examine the suicide rates: the difference (D) and the ratio (R).

Age-standardized and crude suicide rates in Ghana were higher among men from 2000 to 2019. Between 2000 and 2007, the age-standardized suicide rate for women rose steadily and declined slightly between 2008 and 2019. Age-standardized suicide rates for men increased consistently from 2000 to 2010, then declined steadily from 2011 to 2019. The crude suicide rates among men and women followed similar patterns. The widest absolute inequality in crude suicide rates (D) was recorded in 2013 (D=-11.91), while the smallest difference was observed in 2000 (D=-7.16). We also found the greatest disparity in age-standardized rates in 2011 (D=-21.46) and the least in 2000 (D=-14.32). The crude suicide rates increased with age for both men and women aged 15-54 years and 55-85+ years respectively. However, the increased rate was higher in men than in women across all age groups surveyed. A similar pattern was observed for relative inequality in both crude and age-standardized rates of suicide.

The suicide rate in Ghana has declined over time. Suicide is more common among older men. Inequalities in suicide rates, in both absolute and relative terms, are similar. There is a need to monitor suicide trends in Ghana, especially among older men. Moreover, the findings could serve as a basis for future studies on suicide in Ghana.

Mental ill-health and suicide represent a significant proportion of the burden of global disease among men. Connell's relational theory of masculinities provides a useful framework to explore how mental health literacy, mental health stigma, and delayed help-seeking and help-offering behaviors are associated with mental ill-health among men, particularly within male-dominated industries. To address the high incidences of mental ill-health in male-dominated industries, several workplace interventions targeting these outcomes have been implemented. No review to date has examined the current state of evidence for these interventions or identified the behavior change techniques used. This review was restricted to empirical, quantitative research reporting on psychosocial interventions targeting mental health literacy, stigma, and help-seeking and help-offering behaviors in male-dominated industries. Quality appraisal was completed using the Effective Public Health Practice Project and a narrative synthesis was conducted. Twelve articles were included for review which reported on four distinct interventions. The methodological quality of two articles was strong, three moderate and seven weak. The strongest evidence of intervention effects related to mental health literacy and help-seeking intentions. There was less evidence relating to help-offering and help-seeking behaviors and mental health stigma. Sixteen behavior change techniques were identified across interventions that are discussed in relation to the wider men's health literature. The evidence on psychosocial interventions in male-dominated industries is limited due to methodological and conceptual issues. Recommendations for future research include standardized reporting of intervention descriptions, the use of theory to guide intervention development, and utilizing validated and reliable outcome measures.

Men are more likely to have unmet need for mental healthcare than women. However, an under-investigated aspect of the gender difference is the role of mental health literacy. This study investigated how combinations of gender and mental health literacy were related to two indicators of unmet need: not perceiving a need for mental healthcare despite poor mental health, and refraining from seeking mental healthcare.

This cross-sectional study was based on a questionnaire sent to a general population sample, aged 16-84 years, in Stockholm County, Sweden, in 2019. Of the 1863 respondents (38%), 1563 were included (≥18 years). The sample was stratified into four groups, men and women with low or high mental health literacy, using the third quartile of the Mental Health Knowledge Schedule. The likelihood of not perceiving a need for mental healthcare and refraining from seeking mental healthcare, at any time in life, were investigated by calculating odds ratios with 95% confidence intervals.

Men with low mental health literacy were most likely to not perceive a need for mental healthcare, also when adjusting for age, education, and poor mental health (OR 5.3, 95% CI 3.6-7.7), and to refrain from seeking mental healthcare, also when adjusting for age and education (OR 3.3, 95% CI 1.7-6.4), followed by men with high mental health literacy (OR 1.9, 95% CI 1.5-2.4, and OR 1.5, 95% CI 1.0-2.2) and women with low mental health literacy (OR 1.9, 95% CI 1.2-2.9, and OR 2.1, 95% CI 1.1-3.9). Women with high mental health literacy were least likely (reference group).

The results show differences in the likelihood of unmet need for mental healthcare based on combinations of gender and mental health literacy level, with men having low mental health literacy being most at risk, and women with high mental health literacy being least at risk. This challenges generalisations of a gender difference in unmet need by showing heterogeneity among men and women based on mental health literacy. Men with low mental health literacy may be particularly in need of targeted interventions to reduce potential individual and societal consequences of their unmet need.

In most countries, men are at higher risk than women for suicide death. Research focused on masculinity and men's mental health increasingly demonstrates that relationships between gender and various health outcomes, including suicidality, is complex as these relationships can be further explained by certain psychological processes or health behaviors. The objective of this study was to extend this area of research in a national sample of US men (n = 785) by investigating if their adherence to certain hegemonic masculine gender role norms (toughness and self-reliance through mechanical skills) is associated with the suppression of distressing thoughts and if thought suppression then increases their risk for suicidal thoughts and behaviors.

Men in the US who have recently experienced a stressful life event completed an anonymous online survey. Structural Equational Modeling (SEM) was used to test for direct and indirect effects (i.e., mediation) between variables.

Men's engagement in thought suppression mediated the relationship between self-reliance and suicidality. The norm of toughness was both directly related to suicidality and mediated by thought suppression.

Thought suppression appears to be a process that provides some explanation for the relationships between hegemonic masculine norms and suicidality in men, though this study indicated it may play only a small role. Research continues to build that certain masculine norms, such as self-reliance and toughness, are particularly concerning for men's health.HIGHLIGHTSMen's thought suppression mediates the relationship between self-reliance and suicidalityMen's toughness impacts suicidality both directly and via engagement in thought suppressionThese findings have implications for interventions that help men manage distressing thoughts.

Various studies have indicated that the prevalence of depression is almost twice as high among women as among men. A major factor associated with the development of depression and other affective disorders are adverse and psychologically traumatic life events that contribute to changes in the neuroendocrine system, altering the capacity to adapt to stress. These changes are involved in the pathogenesis of mental disorders, along with genetic and other factors, and are to a significant degree regulated by gender dependent mechanisms. While women have a high prevalence of depressive disorders, men show a higher rate of alcohol and substance abuse. These differences in the epidemiology are most likely explained by different predisposition to mental disorders in men and women and a diversity of biological consequences to adverse life events. Taking this into account, there is a need for a critical review of currently used approaches to modeling depressive disorders in preclinical studies, including the use of animals of both sexes. Adaptation of experimental models and protocols taking into account gender characteristics of neuroendocrine changes in response to stress, as well as structural-morphological, electrophysiological, molecular, genetic and epigenetic features, will significantly increase the translational validity of experimental work.

Suicidality in mood disorder patients is common, especially in emergency department (ED), but the patterns and associated factors of suicidality are not clear. This study compared biomarkers and mental health symptoms (i.e., depression, anxiety, and psychiatric symptoms) between mood disorder patients with and without the whole range of suicidality comprising suicidal ideation (SI), suicide plan (SP), and suicide attempt (SA). This cross-sectional, comparative, convenient-sampling study was conducted between January 2021 and March 2022, in emergency department of Beijing Anding Hospital, China. Patients with mood disorders at a psychiatric emergency department were assessed, with measurements of suicidality, biomarkers, depressive, anxiety, and psychiatric symptoms were assessed using the 24 items-Hamilton Depression Rating Scale (HAMD-24), Hamilton Anxiety Rating Scale (HAMA), Young Manic Rating Scale (YMRS) and Brief Psychiatric Rating Scale (BPRS), respectively. The propensity score matching (PSM) method was used to identify patients in mood disorder with and without SI, SP, and SA. A generalized linear model (GLM) was used to assess the differences in biomarkers, depressive, anxiety, and psychiatric symptoms between patients in mood disorder with and without SI, SP, and SA. In total, 898 participated in this survey and completed the assessment. Illness duration was significantly negatively associated with SA (OR = 0.969, 95%CI = 0.939-0.999, P = 0.046). HAMD-24 total score was significantly positively associated with the SI (OR = 1.167, 95%CI = 1.134-1.201, p < 0.001), SP (OR = 1.159, 95%CI = 1.126-1.192, p < 0.001) and SA (OR = 1.189, 95%CI = 1.144-1.235, p < 0.001) of the matched samptched sample. However, YMRS total score was significantly negatively associated with the SI (OR = 0.928, 95%CI = 0.905-0.951, p < 0.001), SP (OR = 0.920, 95%CI = 0.897-0.944, p < 0.001) and SA (OR = 0.914, 95%CI = 0.890-0.938, p < 0.001) of the matched sample after adjusting for age, gender, marital status, and occupation. The duration of illness, severity of depressive symptoms and severity of manic symptoms appeared to be more likely to influence suicidality. Considering the significant risk of suicide in mood disorders on psychiatric emergency care, timely treatment and effective management of suicidality in this population group need to be developed.

We explored the epidemiological characteristics of suicide attempts and identified suicide trends and associated factors.

This retrospective, cross-sectional, observational, and single-center study included consecutive 412 patients who were admitted to Emergency Department for follow-up and treatment after a suicide attempt between June 2019 and June 2022. We assessed patient demographics, suicidal behavior, previous suicide attempts, psychiatric disorders, drug use, visits to the psychiatry clinic within the past 6 months, the persistence of suicidal ideation, and clinical outcomes.

The study population consisted of 259 females (62.86%) and 153 males (37.14%), with a mean age of 29.50±11.51 (range: 13-72) years. Females attempted suicide more often than males, but suicide completion was more common in males. Overall, 79.37% (n=327) of the suicide attempters were aged <40 years and most were 20-29 years old (n=147, 35.68%). Non-fatal suicide attempts were more common in single, unemployed, and poorly educated individuals, but this was not the case for suicide completers. However, there was no significant difference in marital status, education, and occupation among suicide completers. Drug poisoning was the major form of suicide attempt (n=345, 83.74%). Mental disorders, family or relationship conflicts, and separation from a partner were common causes of suicidal ideation. Patient numbers were particularly high in the autumn (i.e., September), and at night.

Females, young adults, singletons, the unemployed, and individuals with psychiatric disorders and low education levels are more likely to attempt suicide, particularly during hours when they are likely to be alone.

This study utilizes data from the World Values Survey (WVS) and the country-level Economic Policy Uncertainty (EPU) index to explore the relationship between the EPU and subjective health status. Unlike studies that use suicide as the investigated variable, we find that the adverse association between subjective health and the EPU for women is no less than that for men. The adverse impact is robust for men of prime working age (25-54). It is also robust for women younger than 25, the age range (15-25) among women that suffer from depression at the highest rate. In addition, an asymmetric effect occurs for males of prime working age (25-54) and women older than 55. Specifically, the asymmetric effect indicates that the association between subjective health status and the EPU differs when the EPU is declining and increasing for both sexes, with the effect of the former greater than the latter. This might reflect that the EPU affects both sexes through different mechanisms, with men of prime working age being breadwinners and older women's long life expectancy and poverty caused by shorter careers.

In most countries, men are more likely to die by suicide than women. Adherence to dominant masculine norms, such as being self-reliant, is linked to suicide in men in Western cultures. We created a suicide prevention media campaign, "Boys Do Cry," designed to challenge the "self-reliance" norm and encourage help-seeking in men. A music video was at the core of the campaign, which was an adapted version of the "Boys Don't Cry" song from "The Cure." There is evidence that suicide prevention media campaigns can encourage help-seeking for mental health difficulties.

We aimed to explore the reach, engagement, and themes of discussion prompted by the Boys Do Cry campaign on Twitter.

We used Twitter analytics data to investigate the reach and engagement of the Boys Do Cry campaign, including analyzing the characteristics of tweets posted by the campaign's hosts. Throughout the campaign and immediately after, we also used Twitter data derived from the Twitter Application Programming Interface to analyze the tweeting patterns of users related to the campaign. In addition, we qualitatively analyzed the content of Boys Do Cry-related tweets during the campaign period.

During the campaign, Twitter users saw the tweets posted by the hosts of the campaign a total of 140,650 times and engaged with its content a total of 4477 times. The 10 highest-performing tweets by the campaign hosts involved either a video or an image. Among the 10 highest-performing tweets, the first was one that included the campaign's core video; the second was a screenshot of the tweet posted by Robert Smith, the lead singer of The Cure, sharing the Boys Do Cry campaign's video and tagging the campaign's hosts. In addition, the pattern of Twitter activity for the campaign-related tweets was considerably higher during the campaign than in the immediate postcampaign period, with half of the activity occurring during the first week of the campaign when Robert Smith promoted the campaign. Some of the key topics of discussions prompted by the Boys Do Cry campaign on Twitter involved users supporting the campaign; referencing the original song, band, or lead singer; reiterating the campaign's messages; and having emotional responses to the campaign.

This study demonstrates that a brief media campaign such as Boys Do Cry can achieve good reach and engagement and can prompt discussions on Twitter about masculinity and suicide. Such discussions may lead to greater awareness about the importance of seeking help and providing support to those with mental health difficulties. However, this study suggests that longer, more intensive campaigns may be needed in order to amplify and sustain these results.

Workplace offensive behaviours, such as violence and bullying, have been linked to psychological symptoms, but their potential impact on suicide risk remains unclear. We aimed to assess the association of workplace violence and bullying with the risk of death by suicide and suicide attempt in multiple cohort studies.

In this multicohort study, we used individual-participant data from three prospective studies: the Finnish Public Sector study, the Swedish Work Environment Survey, and the Work Environment and Health in Denmark study. Workplace violence and bullying were self-reported at baseline. Participants were followed up for suicide attempt and death using linkage to national health records. We additionally searched the literature for published prospective studies and pooled our effect estimates with those from published studies.

During 1 803 496 person-years at risk, we recorded 1103 suicide attempts or deaths in participants with data on workplace violence (n=205 048); the corresponding numbers for participants with data on workplace bullying (n=191 783) were 1144 suicide attempts or deaths in 1 960 796 person-years, which included data from one identified published study. Workplace violence was associated with an increased risk of suicide after basic adjustment for age, sex, educational level, and family situation (hazard ratio 1·34 [95% CI 1·15-1·56]) and full adjustment (additional adjustment for job demands, job control, and baseline health problems, 1·25 [1·08-1·47]). Where data on frequency were available, a stronger association was observed among people with frequent exposure to violence (1·75 [1·27-2·42]) than occasional violence (1·27 [1·04-1·56]). Workplace bullying was also associated with an increased suicide risk (1·32 [1·09-1·59]), but the association was attenuated after adjustment for baseline mental health problems (1·16 [0·96-1·41]).

Observational data from three Nordic countries suggest that workplace violence is associated with an increased suicide risk, highlighting the importance of effective prevention of violent behaviours at workplaces.

Swedish Research Council for Health, Working Life and Welfare, Academy of Finland, Finnish Work Environment Fund, and Danish Working Environment Research Fund.

Public and academic medical ethics debates surrounding justice and age discrimination often proceed from a problematic understanding of old age that ignores the diversity of older people. This article introduces the feminist perspective of intersectionality to medical ethical debates on aging and old age in order to analyze the structural discrimination of older people in medicine and health care. While current intersectional approaches in this field focus on race, gender, and sexuality, we thus set out to introduce aging and old age as an additional category that is becoming more relevant in the context of longer life expectancies and increasing population aging. We analyze three exemplary cases on the individual, institutional, and public health level, and argue that considering the intersections of old age with other social categories helps to accommodate the diverse identities of older people and detect inequality and structural discrimination.

Objectives: The aim of the study was to assess mortality trends due to suicide in Poland in the years 2000-2019 with the use of joinpoint regression. Methods: The study analysed all suicide deaths in Poland in the years 2000-2019 (N = 113,355). Age-standardised death rates (SDRs), the annual percentage change (APC) and the average annual percentage change (AAPC) were determined. Results: In the male group, SDR was 29.3 in 2000 and 21.6 in 2019, in the female group, SDR decreased from 5.2 to 3.0. In 2019, the highest SDR values were noted in the group aged between 45 and 64 years. The most common method of suicide was hanging. In 2019, odds ratios (OR) of death due to suicide for age groups 15-24 years vs. 65 years or above were 51.47 among men and 181.89 among women. With regards to primary vs. tertiary education, OR values were 1.08 and 0.25, respectively; for single vs. widowed individuals 8.22 and 12.35; while for rural vs. urban residents 1.60 and 1.15. Conclusion: There is a need to implement educational programmes, primarily designed for young people.

This article provides an overview of suicide and how society deals with it. Starting from early societal imprints through historical, religious and political influences, the origins of stigmatization are addressed. Even today, suicidal people experience stigmatization not only from society but also from the health system that treats suicidal people. This has far-reaching consequences for the people affected and runs counter to optimal treatment. Different approaches to a possibly improved handling of suicidality will be discussed.

Rates of help-seeking for common mental health problems are lower for men, but less is known about patterns of engagement once they are in contact with services. Previous research has been limited in its ability to understand the intersection between service user characteristics and engagement. This study compared analytic approaches to investigate intersectional associations between sociodemographic and socioeconomic indicators and use of psychological treatment services by men.

Data from 9,904 male service users attending two psychological treatment services in London were analysed. The association between ethnicity, sexual orientation, religious affiliation and employment status of service users and service use outcomes was explored using multinomial logistic regression and latent class analysis (LCA).

Being from a minoritised ethnic background, of Muslim faith, being unemployed, and living in the most deprived neighbourhoods were associated with greater risk of not commencing or completing treatment. Seven classes were identified in LCA, with men predominately differentiated by self-reported ethnicity and religion. Compared with the 'White British, non-religious' class, the 'Asian Muslim' class and the 'minoritised ethnic, non-religious' class were at higher risk of disengagement, whilst the 'Asian, other religion' class were at higher risk of being referred elsewhere rather than completing initiated treatment.

There were significant inequalities in engagement by men associated with ethnicity, religion and socioeconomic status. Compared with the regression models, further nuance was apparent in LCA regarding the intersection of gender, religion and ethnicity. Identifying groups at greater risk of discontinuation of treatment could inform more personalised pathways through care.

Sexuality is an integral aspect of the human experience that defines an individual. Robust research, substantiated by the World Health Organization, demonstrates that healthy sexuality improves mental health and quality of life. Despite this level of global advocacy and clinical evidence, sexuality and sexual health as determinants of health have been largely overlooked in the mental healthcare of patients being treated under the requirements of a forensic order (forensic patients). In this review, the authors have evaluated the literature related to the sexual development, sexual health, sexual knowledge and risks, sexual experiences, sexual behavior and sexual desires of forensic patients to inform policy and clinical practice. Furthermore, the review explored how forensic patients' sexual healthcare needs are managed within a forensic mental healthcare framework. The paper concludes with recommendations for service providers to ensure that sexual health and sexuality are components of mental health policy frameworks and clinical care.

An integrative review was utilized to summarize empirical and theoretical literature to provide a greater comprehensive understanding of the sexuality and sexual experiences of forensic patients. This included identifying original qualitative, quantitative, or mixed-method research, case reports, case series and published doctoral thesis pertaining to the research topic.

Twenty-one articles were selected for review. We grouped the review findings into three main themes: 1) Forensic patient themes, 2) Forensic mental health staff themes and 3) Forensic mental health organization themes. The review demonstrated scant information on the sexual healthcare needs of forensic patients or how health services manage these needs while the patient is in a hospital or reintegrating into the community.

There is a dearth of evidence-based, individualized or group approaches which clinicians can utilize to assist forensic patients to achieve a healthy sexual life and it is recommended that such services be developed. Before that however, it is essential to have a clear understanding of the sexual healthcare needs of forensic patients to identify areas where this vulnerable population can be supported in achieving optimal sexual health. Urgent changes to clinical assessment are required to incorporate sexual healthcare as a component of routine mental healthcare.

It is important to understand the role of social determinants, such as gender, in suicidal ideation. This study examined whether conformity to specific masculine norms, particularly high self-reliance and emotional self-control, moderated the relationship between psychological distress and suicidal ideation for men. The other norms explored were those pertaining to behavioral-emotional or social hierarchy status aspects of masculinity, and whether they moderated the psychological distress-suicidal ideation relationship for men and women. The Conformity to Masculine Norms Inventory, the Kessler Psychological Distress Scale, and the Suicidal Ideation Attributes Scale were administered to an Australian community sample in an online survey (n = 486). As predicted, higher psychological distress was associated with higher suicidal ideation. Self-reliance enhanced the relationship and was the only moderator among men. High self-reliance levels might be an important indicator of risk, which can be used when assessing and working with men who are hesitant to openly discuss suicidal ideation with clinicians. For female participants, higher endorsement of behavioral-emotional norms and lower conformity to social hierarchy status norms appear to increase suicide risk in the presence of psychological distress. Our findings suggest that high self-reliance is of particular concern for men experiencing psychological distress. It is also important to consider the roles of masculine norm endorsement in the psychological distress-suicidal ideation relationship among women.

This study focused on the well-being of the survivors of suicide attempts and the well-being of their interpersonal relationships after the attempt. The data came from a sample of 392 college students from 10 Muslim majority countries who reported having attempted suicide in the last 4 years. Suicide was conceptualized as a goal-directed behavior embedded in a sociocultural context and motivated by personal or interpersonal goals. We tested a process that linked culturally shaped self-construal to the postsuicidal personal and interpersonal well-being. We posited that this process would operate through the attitudes towards suicide, motives for suicide, the strength of the intention to die. Our model indicated that the acceptability of suicide was positively associated with escape motives, and this association was even stronger for the individuals with interdependent self-construals. Escape motives were negatively associated with postsuicidal personal and interpersonal well-being, but communication motives were not associated with these outcomes. We also found evidence that having an interdependent self-construal might be beneficial for postsuicidal personal and interpersonal well-being. Our results further suggested that the postsuicidal personal and interpersonal well-being of highly interdependent individuals may depend on the interpretation of their act of suicide by their close others.

Global rates of depression have increased significantly since the beginning of the COVID-19 pandemic. It is unclear how the recent shift of many mental health services to virtual platforms has impacted service users, especially for the male population which are significantly more likely to complete suicide than women. This paper presents the findings of a rapid meta-analytic research synthesis of 17 randomized controlled trials on the relative efficacy of virtual versus traditional face-to-face cognitive behavioral therapy (CBT) in mitigating symptoms of depression. Participants' aggregated depression scores were compared upon completion of the therapy (posttest) and longest follow-up measurement. The results supported the noninferiority hypothesis indicating that the two modes of CBT delivery are equally efficacious, but the results proved to be significantly heterogeneous indicating the presence of moderating effects. Indirect suggestive evidence was found to support moderation by gender; that is, depressed males may benefit more from virtual CBT. Perhaps, this field's most telling descriptive finding was that boys/men have been grossly underrepresented in its trials. Future trials ought to oversample those who have been at this field's margins to advance the next generation of knowledge, allowing us to best serve people of all genders, those who live in poverty, Indigenous, Black, and other Peoples of Colour, as well as any others at risk of being marginalized or oppressed in contemporary mental health care systems.

Globally, suicide affects more men than women. Emotional pain underpins many theoretical accounts of suicidality, yet little is known about the role of disgust in suicide. Self-directed disgust, whereby aspects of the self-serve as an object of disgust, has been hypothesised to factor in suicide. This research aimed to explore the processes which link self-disgust to attempted suicide in males.

Nine men who had attempted suicide completed semi-structured interviews. The interview data were analysed using a constructivist grounded theory methodology.

Three concepts emerged out of the analysis: (1) self-disgust; (2) worthlessness; and (3) the endured emotional distress of 'the abyss'" - these concepts interweaved, leading the men to experience hopelessness, disconnection and an inability to cope, leading ultimately to their suicide attempt. Throughout this journey, various disgust-related processes worsened men's distress and increased their suicidal risk. Historic adversities prevailed across the data, as did the men's difficulties in understanding their emotions.

Self-disgust was an important emotion in the men's experiences of suicide and shaped their views of themselves and their lives. The distancing and repellent properties of self-disgust, in addition to the fear of having their 'disgustingness' exposed, increased suicidal risk. Self-disgust appeared more pervasive in the suicidality of men with a history of multiple childhood adversities. The limitations of this research are discussed as implications for clinical practice and directions for future research.

Suicide is a leading cause of death among children and young people (CYP) worldwide, and rates have been increasing in recent years. However, while evidence exists regarding factors associated with suicide and self-harm, there is limited information publicly available on the CYP who present in suicidal crisis. This is a case series study of CYP (aged 8-16) experiencing suicidal crisis who presented in an Emergency Department at a pediatric hospital in North-West England between March 2019 and March 2021 (n = 240). Clinical records were extracted and audited to explore demographic data, methods of recording patient attendance, the clinical pathways available and the patterns of pathway usage, and differences in CYP presentations before and after the COVID-19 pandemic. Attendees were mostly White females, with a mean age of 13.5 years, and 24% had a diagnosed special educational need. "Social/social problems" was the most commonly used code for recording attendance (38%), and pathways varied depending on code used. A range of parental and familial factors were also identified. There were more CYP presenting with self-harm in addition to suicide ideation after the pandemic began (43 vs 27% pre-pandemic). This study provides the first clear insight into CYP who seek help at a North-West Emergency Department for suicidal crisis, and work is now needed to develop effective prevention strategies tailored toward the groups most at-risk.

We examined sexual orientation and sex differences in seven methods of suicide among adult suicides reported in the United States National Violent Death Reporting System (2012-2015; N = 59,075). Overall, most sexual minorities (i.e., lesbians, gay men, bisexuals) identified in the dataset used hanging (38%) followed by firearm (30%) and drug or poison ingestion (20%). Sexual minorities were more likely than heterosexuals to be younger, female, and Black/African American. Multivariate sex-stratified analyses in the overall sample showed that strong sexual orientation differences in lethal methods existed among men but not among women. However, when we compared sex differences in lethal methods among sexual minorities only, we found that lesbian/bisexual women, as compared to gay/bisexual men, were more likely to use a firearm or drug or poison ingestion than hanging. Findings suggest that the higher rate of suicide mortality among sexual minorities is likely driven by hanging, a method of suicide that is not particularly amenable to lethal method restricted-access prevention approaches. Future research directions, clinical training recommendations, and intervention opportunities are discussed.

Objective: To assess the cases of paracetamol poisoning in Brazil.

Analysis of official records of deaths between 1996 and 2019 from the Brazil Mortality Information System (SIM), admissions between 2008 and 2020 from the Hospital Information System (SIH), and cases of poisoning between 2017 and 2020 in health services, reported to the Brazilian Notifiable Diseases Surveillance System (SINAN). In SIM and SIH, records with ICD-10 were included: F55, T39, X40, X60, and Y10. In SINAN, commercial products containing paracetamol were identified. Records were stratified by age, sex, and intentionality. Mean and standard error were calculated for each stratum based on the annual data, by federation unit. Poisoning reports by 1,000,000 inhabitants were calculated from each state and compared to the national average.

In total, 492 deaths, 5,666 hospital admissions, and 17,031 cases of paracetamol poisoning were recorded in the period. Deaths occurred mostly among adults (71.3% ± 3.0) and in suicide attempts (37.3% ± 2.7). Hospital admissions were more frequent in adults (69.7% ± 1.4), women (57.1% ± 2.5), and unintentional poisoning (80.2% ± 4.2). Poisoning reports was more also frequent among adults (71.4% ± 1.2), women (74.2% ± 0.6), and due to accidents (79.6% ± 1.8). The South and Southeast regions of the country presented the highest frequencies in all outcomes, above the national average.

Paracetamol exposure is a concern for preventable poisonings, hospital admissions and deaths. More accurate data about paracetamol poisoning are required to support surveillance actions and the development of mechanisms to reduce poisoning, particularly related to adults, women and suicide attempts.

Despite being a collection of holistic assessment tools, the comprehensive geriatric assessment primarily focuses on the social category of age during the assessment and disregards for example gender. This article critically reviews the standardized testing process of the comprehensive geriatric assessment in regard to diversity-sensitivity. I show that the focus on age as social category during the assessment process might potentially hinder positive outcomes for people with diverse backgrounds of older patients in relation to other social categories, such as race, gender or socio-economic background and their influence on the health of the patient as well as the assessment and its outcomes. I suggest that the feminist perspective of intersectionality with its multicategorical approach can enhance the diversity-sensitivity of the comprehensive geriatric assessment, and thus improve the treatment of older patients and their quality of life. By suggesting an intersectional-based approach, this article contributes to debates about justice and diversity in medical philosophy and advocates for the normative value of diversity in geriatric medicine.

Unemployment can involve financial strain and major psychosocial challenges. Integration of the existing evidence is needed to better characterize the association between unemployment and mental health, independently of macroeconomic contexts.

Main objectives of this study: (a) review, integrate, and summarize evidence about the association between unemployment and anxiety disorders, mood disorders, and suicidal behaviour, and (b) identify variables affecting this association.

Systematic review of literature following PRISMA guidelines. PubMed, Web of Science, SciELO, RCAAP, and Cochrane Library databases were searched. Quantitative empirical studies on the association between unemployment and mental illness of community-based samples were included. The quality of the evidence provided in the studies was assessed following pre-defined methodological criteria.

Overall, 294 articles were considered eligible. In total, 55.7% of the studies were conducted in Europe; 91.4% supported a positive association between increased unemployment rates and anxiety, mood disorders, or suicidal behavior. Men and young adults were most severely affected by unemployment. Education and social support were found to buffer the negative outcomes of job loss.

Unemployment was inversely associated with mental health irrespectively of the economic context; unemployed individuals were more vulnerable to commit suicide and suffer from anxiety and mood disorders.

Gender discrimination (GD) has been frequently linked to mental health. The heterogeneity of how GD is defined has led to variation around the analysis of GD. This might affect the study of the association between GD and health outcomes. The main goal of this systematic scoping review is to operationalize the definition of the GD construct.

Three search strategies were set in Pubmed, CINAHL and PsycINFO. The first strategy obtained results mainly about women, while the second focused on men. The third strategy focused on the identification of GD questionnaires. The prevalence of GD, factors and consequences associated with GD perception, and forms of discrimination were the principal variables collected. Risk of bias was assessed (PROSPERO:CRD42019120719).

Of the 925 studies obtained, 84 were finally included. 60 GD questionnaires were identified. GD prevalence varied between 3.4 and 67 %. Female gender and a younger age were the factors most frequently related to GD. Poorer mental health was the most frequent consequence. Two components of the GD construct were identified: undervaluation (different recognition, opportunities in access, evaluation standards and expectations) and different treatment (verbal abuse and behaviour).

Two-component GD definition can add order and precision to the measurement, increase response rates and reported GD.

Suicides Among Adolescents in a Major German City Abstract. Objective: Adolescent suicide is a major contributor to the overall mortality in this age group. This study examined sex and age differences in suicide methods. Method: The investigation is based on death certificates from the years 1996 to 2019 of the city of Leipzig and includes all suicides in the age group under 25 years. The impact of sex and age on the method and location of suicide was examined using chi square statistics. Moreover, we verified the association between suicides and death by drug overdose through statistical regression. Results: 140 suicides were included in the study. The suicide methods differed between the age groups (χ^² = 17,878; p = .022). Individuals under 21 years of age committed suicide almost exclusively by strangulation, jumping from heights, railway suicide, or deliberate intoxication. With the onset of early adulthood, the spectrum of methods expanded. Suicide methods were also different between the sexes (χ^² = 35,166; p < .001): Male adolescents preferred highly lethal methods such as strangulation, whereas in female adolescents intoxication was the leading method of suicide, with a predominance of antidepressants. The annual rates of suicide and death by drug overdose were found to correlate (Pearson correlation = 0,571, p = .004). Minors (χ² = 3.125, p = .077) tended to avoid their own residential environment as a place of suicides compared to adults. Conclusion: When assessing the individual suicide risk and weighing safeguarding measures in clinical practice, the differences shown in the choice of methods should be taken into account.