Approximately one-fifth of adolescents in the US experience a major depressive episode each year. Universal depression screening for adolescents is recommended as part of routine pediatric primary care, but its cost-effectiveness is unclear.

To evaluate the cost-effectiveness of universal routine depression screening in adolescent primary care compared with usual care.

This economic evaluation used a decision-analytic model with an embedded state-transition submodel and annual transitions. A hypothetical population of 1000 adolescents and young adults from ages 12 to 22 years, including 12 demographic groups of disaggregated combinations of sex (female and male) and race or ethnicity (American Indian or Alaska Native; Asian, Native Hawaiian, or Pacific Islander; Black or African American; Hispanic, Latino, or Spanish; White; and multiracial or other race or ethnicity) was simulated in pediatric primary care settings.

Universal depression screening of varying frequencies, including annual, biennial, and single-time screening at age 12 years, compared with usual care, defined as 20% annual screening rate.

Costs, health effects as measured by quality-adjusted life-years (QALYs) and depression-free days, and incremental cost-effectiveness ratios (ICERs) from the health care sector and limited societal perspectives.

A universal annual screening policy had an ICER of $66 822 per QALY or $84 per depression-free day gained compared with single-time screening from the limited societal perspective, including caregiver time costs. Universal single-time screening had an ICER of $44 483 per QALY and $62 per depression-free day gained compared with usual care. Targeted universal depression screening was more cost-effective for female individuals and those who identified as Hispanic, Latina, or Spanish, multiracial, or other race or ethnicity. Results were sensitive to treatment recovery rates, depression health state utility scores, treatment costs involving psychotherapy, suicide-related hospitalization costs, and initial depression prevalence at age 12 years. In approximately 99.8% of probabilistic simulations, universal annual screening had an ICER less than $150 000 per QALY threshold.

The study results suggest that universal annual depression screening for adolescents in primary care is cost-effective compared with a $100 000 per QALY willingness-to-pay threshold. Universal annual screening may be more cost-effective if health systems invest in efforts to enhance family access to telemedicine behavioral health, decrease treatment costs, or improve treatment effectiveness. Future analyses could examine whether additional potentially associated demographic factors, such as gender orientation, sexual identity, rurality, or comorbidities, affect cost-effectiveness outcomes.

Suicide attempts are prevalent among patients with bipolar disorder (BD). Impaired serotonin (5-HT) system in the pathogenesis of suicide attempt is partially heritable. To quantify the combined effects of multiple genetic variants, we developed a dynamic model of the 5-HT presynapse with functionally integrated individual genetic variants. The model includes five genetic variants in 5-HT system genes (TPH2, SLC6A4, MAOA) and quantitatively assesses their influence on 5-HT synthesis, reuptake, and degradation. The model was validated on 140 unaffected individuals and tested on 101 BD patients. Predicted mean concentrations of 5-HT, 5-HT precursor, and degradation product were compared between BD patients with and without a history of attempted suicide, and unaffected individuals. The model consists of eight differential equations that describe the temporal concentration change of model outputs. Calculated concentrations in unaffected control individuals aligned with published experimentally measured values, validating our model. BD patients with a history of suicide attempt showed lower calculated concentrations of 5-HT degradation product 5-hydroxy-3-indolacetic acid (5-HIAA) compared to unaffected individuals (p = 0.044). Additionally, higher calculated concentrations of free cellular 5-HT (p = 0.048) and stored 5-HT (p = 0.047), with the effect size d = 0.35, were observed when comparing suicide attempters to non-attempters.. Our approach illuminated a complex interplay of genetic variants in 5-HT system genes that contributes to the risk of suicide attempt, with quantitative and personalized outputs unattainable through genetic association studies.

Borderline personality disorder (BPD) is associated with a high risk of suicidality, including suicide ideation, suicide attempts, and suicide. This meta-analysis aims to determine the lifetime prevalence of these dimensions in patients with BPD and to identify associated factors to inform clinical practice and intervention strategies.

We searched PubMed, Scopus, Web of Science, and Embase for observational articles (cross-sectional, cohort, longitudinal and case-control) reporting suicide ideation, suicide attempts, and suicide in patients with BPD. Data including age, sex, diagnostic criteria, inpatient/outpatient care, comorbidity, and rates of suicide ideation, suicide attempts, and suicide were extracted. A pooled analysis with a random effects model was performed using STATA.

35 studies including 34,832 patients with BPD were included in the final analysis. The pooled rate of suicidal ideation, suicide attempts, and suicides in patients with BPD was 80 % (95 % CI: 61 %-94 %), 52 % (95 % CI: 47 %-58 %), and 6 % (95 % CI: 4 %-8 %), respectively. The younger age group of BPD patients had a significantly higher lifetime prevalence of suicide ideation, and suicide attempt (p < 0.001). The inpatient group of BPD patients had a significantly higher lifetime prevalence of suicidal attempt (p < 0.001), while the outpatient group had a significantly higher lifetime prevalence of suicide (p = 0.003).

BPD carries a high suicide risk, influenced by factors like age and clinical setting, while the impact of comorbid depression remains unclear. Future research should standardize diagnostics and use longitudinal studies to better understand and mitigate suicide risk in BPD.

Treatment-resistant depression (TRD) affects approximately 30% of patients with major depressive disorder (MDD), for whom effective treatment options are limited. Repetitive transcranial magnetic stimulation (rTMS) has shown efficacy in alleviating depressive symptoms in TRD. However, it remains unclear if these improvements are driven or mediated by changes in cognitive function or biological markers, such as brain-derived neurotrophic factor (BDNF).

This study examines the effects of rTMS on depressive symptoms, cognition, and BDNF levels, as well as the potential moderating role of lifetime suicidal attempts (LSA) on cognition and the predictive value of baseline BDNF for clinical outcomes. Twenty-five TRD patients were included, with 13 in the rTMS treatment group (receiving 20 sessions of rTMS over four weeks) and 12 as control group. Depression severity, cognitive function (Mini-Mental State Examination, Verbal Fluency, Digit Span), and serum BDNF levels were measured pre- and post-treatment. Mixed-effects linear regression models assessed clinical and biological associations.

rTMS significantly reduced HAM-D (p < 0.001) and CGI (p < 0.001) scores compared to controls. Cognitive performance improved significantly in MMSE (p = 0.049) and Digit Span (p = 0.04), with no significant changes in BDNF levels (p = 0.39). LSA did not moderate cognitive outcomes, and baseline BDNF did not predict clinical improvement (p = 0.68).

rTMS reduced depressive symptoms in TRD patients, with modest cognitive benefits. Baseline BDNF did not predict outcomes, though the lack of significant change suggests complex neuroplastic responses. Future studies should include larger samples and refined biomarker assessments.

Given the many adverse health outcomes associated with depression, it is imperative to promote help-seeking behaviors. However, in Lesotho, there are no published studies that have investigated the help-seeking dynamics for depression. As such, the following questions remain unanswered: (a) What proportion of people living with depression in Lesotho seek help? (b) Are there significant sex differences in the factors associated with help-seeking for depression? To address these questions, we examined the prevalence and sex differences in the factors associated with help-seeking for depression in Lesotho.

Secondary data from the 2023-2024 Lesotho demographic and health survey was used. We sampled 2172 men and 1484 women. Binary logistic regression models were fitted in STATA 18. Statistical significance was set at p < 0.05.

Overall, the proportion of women who sought help for depression was slightly higher (17.1% [14.4-20.3]) compared to men (16.4% [14.3-18.8]). More women (43.6%) sought help for depression from formal help providers than men. Likewise, more than half of male participants (60%) sought help from informal sources. Among men, those with moderate depression had significantly higher odds of seeking help (AOR = 2.02, 95%CI: 1.56-2.61). Help-seeking was also more likely among men with secondary education (AOR = 1.98, 95%CI: 1.13-3.47), those currently in a union (AOR = 1.85, 95%CI: 1.41-2.42) or previously in a union (AOR = 2.30, 95%CI: 1.54-3.45), and those in the richest wealth index (AOR = 1.64, 95%CI: 1.06-2.53). Among women, moderate (AOR = 2.41, 95%CI: 1.76-3.32) and severe depression (AOR = 3.42, 95%CI: 2.26-5.18) significantly increased help-seeking likelihood. Women aged 45-59 years (AOR = 2.46, 95%CI: 1.36-4.45), exposed to media (AOR = 1.63, 95%CI: 1.21-2.19), or consuming alcohol (AOR = 1.36, 95%CI: 1.01-1.84) also had higher odds of seeking help.

Help-seeking for depression is low among men and women in Lesotho. However, the factors associated with help-seeking differ by sex. Among women, leveraging the media could yield more effective outcomes; among men, addressing poverty and improving education could prove effective in improving help-seeking for depression. The study also underscores a need to focus on harnessing the potential of informal support networks.

Suicidal behavior in the Mexican population is understudied, and there is a paucity of research exploring the role of psychological factors and of the interpersonal theory of suicide in this population. The objectives of this work were: to explore the associations between interpersonal and psychopathological variables and suicide attempts. We also explored psychopathological differences in suicidal behavior between patients with a history of child sexual abuse and those without and examined the most accurate predictors of suicide attempts in the study sample. Finally, we tested the mediation between related variables. Results showed that the most accurate predictors of suicide attempts were perceived burdensomeness, suicidal ideation, and suicide plans. Patients with a history of child sexual abuse differed in levels of depressive symptoms, hopelessness, perceived burdensomeness, and NSSI frequency. Suicide plans mediated the associated between perceived burdensomeness and suicide attempts. Clinical and intervention implications are discussed.

Suicide and suicidality are a serious public health concern for military populations globally. Systematic surveillance is a key component to creating an evidence base for prevention strategies. The aim of this scoping review is to map how suicide and suicidality is surveilled in military populations, and to summarize key inclusions, limitations and gaps.

A scoping review of four databases (PubMed, PsychInfo, ProQuest and CINAHL) and a targeted grey literature search of official military websites using Google was conducted using variations of the search terms 'Suicidality,' 'Military' and 'Surveillance'. Sources that referenced systematic, population-level data collection on suicide and/or suicidality in active duty military personnel, written in English with any publication date, were considered. Sources that used veteran and part-time personnel data were excluded, as were sources that focused exclusively on subsets of the population such as one job role or one overseas deployment rotation. Descriptive analysis was conducted, comparing sources across surveillance type, data collection and usages, and limitations and author recommendations.

Twenty-six articles were identified by the search criteria. Most sources were from the USA (n = 14), and publication dates ranged from 1968 to 2023. The most common surveillance systems were military mortality databases focused on death by suicide. Ideation, non-suicidal self-injury and suicide attempts were under-surveilled, as were event and outcome characteristics. Best-practice guidelines were unable to be determined due to the heterogeneity of systems and paucity of published details.

This study was the first scoping review to map the application of surveillance systems specifically in military populations. We identified an over-reliance on mortality databases, a paucity of surveillance of non-fatal suicidality and opportunities for improvement including enhanced data collection and the integration of lived experience perspectives. The findings of this review contribute new knowledge to the field and have important research and practical implications.

Accumulating evidence supports the efficacy of (es)ketamine in the treatment of major depressive disorder (MDD), particularly treatment-resistant depression (TRD). Yet around 50% of the individuals with TRD do not respond to (es)ketamine. Elucidating predictors of response and remission could improve treatment outcomes at the individual level by defining subpopulations that are most likely to benefit from (es)ketamine. This systematic review outlines the predictive value of demographic and clinical characteristics for treatment outcomes of (es)ketamine in MDD. A systematic literature search was performed to retrieve studies investigating the association between baseline characteristics and the likelihood of achieving response and remission following (es)ketamine treatment in MDD. Forty-four studies investigating the association between response and remission and demographic variables, characteristics of the depressive episode, treatment resistance, psychiatric comorbidities, symptomatology, suicidal risk/attempts, family/personal history, medication use, somatic variables, personality traits, and neurocognitive performance were included. The predictive value of demographic and clinical variables for treatment outcomes of (es)ketamine was limited with either no significant relationship or inconsistent results. Findings provide preliminary support for a positive association of response with anhedonia, sleep disturbances, childhood physical abuse, obesity, openness, better episodic memory, and visual learning, poorer neurocognitive performance, slower processing speed, and lower attention, as well as a negative association with melancholic depression, benzodiazepine use, and metabolic syndrome. However, these characteristics have been investigated in a limited number of studies and warrant replication. These findings suggest that (es)ketamine represents a promising treatment prospect for individuals who present clinical characteristics that are often considered difficult to treat.

This study aims to analyze the association between care-specific psychosocial factors in terms of familism, care stigma, caregiver burden, and gains with suicidal ideation of informal caregivers of older adults in Germany.

Data from the Attitudes Towards Informal Caregivers Project (ATTIC) of 433 informal caregivers of adults aged ≥ 60 years was used to analyze the research question. The Internalized Caregiver Stigma Scale was used to measure the internalized attitudes and behavior of informal caregivers regarding care provision for older adults, suicidal ideation was measuring passive suicide thoughts, care gains were measured with positive aspects of care scale and familism was measured with the short attitudinal familism scale. Linear regression analysis with robust standard errors were calculated and adjusted for contextual and personal factors (e.g., co-residence, personality, social support).

Stronger beliefs in negative internalized care stigma were associated with higher frequency of suicide thoughts, while stronger positive internalized care stigma, familism, and care gains were not significantly associated with suicidal ideation. The associations were also found in additional analysis with a log-transformed outcome of suicidal ideation and in analyses excluding mental health as covariate (except for burden, which was significantly associated with suicidal ideation).

Care-specific psychosocial factors in terms of negative care stigma are important to the risk for suicidal ideation. Thus, changing negative thoughts, evaluations and expectations about informal care and its performance could be helpful to prevent informal caregivers experiencing (high levels of) suicidal ideation.

Suicide is one of the top ten leading causes of death for the general population and for members of the United States military. Despite substantial resources invested in preventing suicide in both civilian and governmental agencies, identifying effective approaches remains a challenge.

Consistent with the continued need to identify effective strategies, a military stakeholder requested a rapid review of suicide prevention programs which incorporated trained, non-provider personnel (e.g., case managers, care navigators). We found a lack of comprehensive reviews on this topic and developed an evidence map to characterize the current state of the research on case management programs for suicide prevention. The elements for this evidence map included characteristics and components of the relevant programs, role of the case manager, outcomes measured, and any indications of effectiveness.

We included four systematic reviews and 30 articles representing 27 studies in this review. Case management as a service was applied differently across settings and populations and the results on suicide-related outcomes were mixed. Models or approaches with multiple studies showing some evidence of effectiveness included intensive case management (ICM) and multilevel, population-based programs. Other programs showed some evidence of effectiveness but were represented by just one study.

To help advance our understanding of the effectiveness of suicide prevention programs that incorporate case management, future studies should provide comprehensive descriptions of case management, including clear definitions of the service and descriptions of the role (e.g., educational background, specific tasks performed, duration, and type of patient involvement).

Intro: Perpetrators of mass violence and individuals who commit suicide have been discussed in terms of the experiencing similar ideations and tendencies. This has led to the promotion of utilising suicide prevention strategies to aid the reduction of mass violence probability. However, there is minimal research in terms of the identifying differentiation behaviours between potential mass violence and individuals who potentially will commit suicide without mass violence. Method: The present study involves a comparative systematic review of both suicide research and mass violence research, to explore and identify behavioural similarities and differences in pre-event behaviour between the two phenomena. Results: The results showcase key similarities but more notably, six key behavioural differences, especially in terms of externalisation and internalisation. Conclusion: There are potentially six key behavioural pre-event differences between mass violence and individuals who commit suicide without mass violence. Implications and future research are discussed.

Background and Objectives. Suicide represents a primary global health concern, particularly among young individuals aged 15 to 29. Clinicians are actively engaged in efforts to prevent suicide and implement timely interventions. This study aimed to evaluate the effectiveness of self-reported measures in differentiating between adolescents exhibiting suicidal ideation (SI) only and those at risk or with a previous history of suicide attempts (SA). Methods. Seventy-eight adolescent patients (mean age: 15.53 ± 1.49) were classified into two groups using the Columbia Suicide Severity Rating Scale (C-SSRS). Forty-five patients presented with SI but lacked a prior history of SA, while 33 adolescents had a documented history of either concrete or interrupted SA. Notably, all participants in the SA group also reported SI. Participants completed the Multi-Attitude Suicide Tendency Scale (MAST) and the Beck Depression Inventory-Short Form (BDI-SF) to assess protective and risk factors associated with suicidality, as well as perceived depression. Results. Attraction toward life (AL) exhibited a negative correlation with perceived depression in both groups, whereas attraction toward death (AD) was positively correlated with depression in the SA group. In the SI group, scores for repulsion by life (RL) demonstrated a positive correlation with depression. Furthermore, RL scores were significantly higher in the SA group. ROC analysis revealed good accuracy for both assessment tools in differentiating the two groups. Conclusions. The BDI-SF and MAST are effective instruments for identifying adolescents at risk for suicide and implementing tailored preventive and therapeutic interventions. The user-friendly nature and adaptability make those self-report measures useful in various settings, allowing administration without clinician involvement.

The incidence of suicide is high among adolescents and young adults, especially those suffering from psychiatric diseases. Because of the reported association between depression and suicidality, exploring suicide risk factors in depressed patients is crucial for the identification of those at high risk and preventing suicide. In recent decades, electroencephalography parameters have been considered for identifying biomarkers of suicide ideation and attempts in depressed patients. This study aimed to review the available literature on resting-state EEG for suicidality in depressed patients.

A systematic search was performed in five electronic databases, including APA PsycINFO, Embase, Medline (via PubMed), Scopus, and Web of Science. Papers with full text available in English in which resting-state EEG was evaluated in depressed patients with suicide ideation or suicide attempts compared to a control group of healthy subjects or non-suicidal depressed patients were included. The risk of bias was assessed by using the Newcastle-Ottawa scale.

A total of 4665 references were retrieved from five electronic databases from which eleven studies were included in this systematic review. A meta-analysis was not performed due to the substantial heterogeneity of the studies. Five of the eleven reviewed papers were classified as high-quality, and six had moderate quality.

According to the included studies in this review, the EEG signals of depressed patients with suicide ideation or suicide attempts may be different from patients with low risk of suicidality or healthy subjects. Connectivity measures sound more promising parameters than the power spectral analysis and EEG asymmetry.

The protocol of this review was registered in PROSPERO (No. CRD42024502056).

The aim was to ascertain whether serum carotenoid levels are linked to suicidal ideation, along with how depressive disorder influences the association.

This research was conducted using a cross-sectional design and encompassed 7,335 adults from the United States. The levels of serum carotenoids, encompassing α-carotene, β-carotene, β-cryptoxanthin, lycopene, and lutein/zeaxanthin, were ascertained by employing high-performance liquid chromatography. Item nine of the nine-item Patient Health Questionnaire was used to evaluate suicidal ideation. The study used multivariable-adjusted logistic regression and restricted cubic spline models to ascertain the link between serum carotenoid levels and suicidal ideation. Mediation and stratified analyses were used to ascertain the impact of depressed symptoms on the association between serum carotenoid levels and suicidal ideation.

Out of the total participants, 245 individuals (3.3%) reported having suicidal ideation. Participants who had suicidal ideation showed lower levels of serum α-carotene, β-carotene, β-cryptoxanthin, and lutein/zeaxanthin compared to those who did not have suicidal ideation. After controlling potential confounding factors, serum β-carotene level was still associated with risk of suicidal ideation (per 1-standard deviation (SD) increment, odds ratio [OR]: 0.73, 95% confidence interval [CI]: 0.55-0.98). The mediation analysis revealed that 36.3% of this association was mediated by the severity of depressive symptoms. Stratified analysis manifested that the association remained in depressed people but was attenuated in people without depressive disorder.

Increased serum β-carotene level may decrease the susceptibility to suicidal ideation, especially in depressed people. Further intervention studies are needed to validate whether β-carotene consumption contributes to preventing suicidal ideation.

Employment quality stands as a crucial social determinant impacting workers' health. In this study, we investigate the association between low-quality employment and the emergence of suicidal thoughts and planning.

We analyzed data from 7,797 Korean workers, amounting to 30,945 observations. Low-quality employment was characterized by three primary dimensions: employment insecurity, income inadequacy, and a lack of rights and protection. We employed a generalized estimating equation to probe the link between experiencing low-quality employment and the occurrence of suicidal thought and planning within the subsequent year. Odds ratios (OR) and 95% confidence intervals (CI) were estimated.

The overall incidence rates for suicidal thought and planning were 1.5% and 0.2%, respectively, across the observations. Workers with the lowest employment quality demonstrated higher propensities to develop both suicidal thought (OR: 2.05, 95% CI: 1.37-3.06) and planning (OR: 3.39, 95% CI: 1.08-10.64) at the following year, compared with workers with the highest overall employment quality. Specifically, daily employment exhibited associations with the onset of suicidal thought (OR: 1.64, 95% CI: 1.17-2.31) and suicide planning (OR: 3.49, 95% CI: 1.54-7.92) when compared to permanent employment. Additionally, individuals in the lowest monthly wage quartile displayed a heightened likelihood of developing suicidal thought (OR: 2.09, CI: 1.36-3.23) compared with those in the highest quartile.

Our findings suggest that low-quality employment is associated with the onset of suicidal thought and suicide planning at follow-up. Therefore, employment quality is a critical social determinant of workers' mental health.

In the aftermath of bereavement, our research explores the subtleties of Prolonged Grief Disorder (PGD), focusing particularly on its correlation with suicidal behaviors and their variation across genders. This study seeks to elucidate the impact of gender on these behaviors among individuals suffering from PGD, thereby enhancing our understanding and facilitating the development of tailored therapeutic interventions.

By November 24th, 2023, we had rigorously reviewed key databases such as PubMed, Web of Science, Cochrane Library, PsycINFO, and Embase. Independently, two researchers conducted detailed interviews and filled out questionnaires with participants to gather demographic information and record instances of prolonged grief disorder. The study also meticulously tracked occurrences of suicidal ideation, suicide attempts, suicide deaths, and self-injury among the participants.

The findings indicate that 22.34% of males reported suicidal ideation (95% CI: 21.33-23.35), a figure that rises to 26.84% among females (95% CI: 25.99-27.69). Notably, 12.11% of males attempted suicide (95% CI: 11.49-12.72), marginally surpassing the 9.60% observed in females (95% CI: 9.17-10.04). More striking disparities were observed in suicide deaths, with rates for males at 3.66% (95% CI: 3.32-4.00) compared to a notably higher 7.12% for females (95% CI: 6.44-7.81). Furthermore, the incidence of self-injury was lower among males, at 2.48% (95% CI: 2.03-2.94), than in females, who reported a rate of 5.09% (95% CI: 4.69-5.49). These patterns underscore the critical need for gender-specific interventions aimed at reducing these significant disparities.

This study distinctly underscores the profound impact of gender on the manifestation of suicidal behaviors in individuals afflicted with prolonged grief disorder. It reveals that females are more prone to suicidal ideation, self-injury, and suicide deaths, while males predominantly exhibit a higher incidence of suicide attempts and risk-taking behaviors. These unmediated trends highlight the necessity for gender-specific clinical interventions tailored to address particular behaviors and modify prevalent patterns that typically resist conventional approaches.

PROSPERO (york.ac.uk), identifier CRD42023480035.

Suicidal thoughts and behaviors are elevated among active-duty service members (ADSM) and veterans compared to the general population. Hence, it is a priority to examine maintenance factors underlying suicidal ideation among ADSM and veterans to develop effective, targeted interventions. In particular, interpersonal risk factors, hopelessness, and overarousal have been robustly connected to suicidal ideation and intent.

To identify the suicidal ideation risk factors that are most relevant, we employed network analysis to examine between-subjects (cross-sectional), contemporaneous (within seconds), and temporal (across four hours) group-level networks of suicidal ideation and related risk factors in a sample of ADSM and veterans (participant n = 92, observations n = 10 650). Participants completed ecological momentary assessment (EMA) surveys four times a day for 30 days, where they answered questions related to suicidal ideation, interpersonal risk factors, hopelessness, and overarousal.

The between-subjects and contemporaneous networks identified agitation, not feeling close to others, and ineffectiveness as the most central symptoms. The temporal network revealed that feeling ineffective was most likely to influence other symptoms in the network over time.

Our findings suggest that ineffectiveness, low belongingness, and agitation are important drivers of moment-to-moment and longitudinal relations between risk factors for suicidal ideation in ADSM and veterans. Targeting these symptoms may disrupt suicidal ideation.