National trends and correlates of treatment resistance in major depressive episode and associated suicidal ideation and behaviors among adults in the United States.

To examine recent 12-year trends in prevalence of suicidal ideation and behaviors (SIBs) among US adults experiencing a past-year treatment-resistant depression (TRD). Using data from the National Survey of Drug Use and Health, we estimated the annual percentage of individuals aged ≥18 with TRD who reported past-year SIBs, and estimated linear trends adjusting for potentially confounding factors from 2009 to 2020. Of estimated 237.5 million US adults, 7.1 % met diagnostic criteria for a past-year major depressive episode (MDE) between 2009 and 2020. Of these, 9.7 % met criteria for TRD. The proportion reporting past-year suicidal ideation in TRD ranged from 39.5 % (95 % confidence interval [CI], 32.1-47.3 %) in 2009-2010 to 43.4 % (95 % CI, 36.7-503 %) in 2019-2020, with an average annual percent change (AAPC) of 1.3 % (95 % CI, -0.7 % to 3.3 %). The prevalence of past-year suicide attempts in TRD was 7.3 % across the study period (AAPC, 0.1 %; 95 % CI, -4.3 % to 4.7 %). Past-year SIBs were significantly associated with an increased likelihood of meeting criteria for TRD among adults with MDE (adjusted odds ratio [AOR], 1.53; 95 % CI, 1.35-1.75 for suicidal ideation; AOR, 2.17; 95 % CI, 1.79-2.62 for suicide attempts). No significant differences were observed between 2019 and 2020, reflecting the COVID-19 pandemic. Among individuals with TRD, proportions of SIBs are high. These findings underscore an urgent need for suicide prevention efforts in this high-risk population, including preventive services across diverse settings and accessibility to evidence-based pharmacological and non-pharmacological interventions.

Rhee TG ，Bommersbach TJ ，Rosenheck RA ，Nierenberg AA ，McIntyre RS ... -  《-》

National Trends and Disparities in Suicidal Ideation, Attempts, and Health Care Utilization Among U.S. Adults.

Samples H ，Cruz N ，Corr A ，Akkas F ... -  《-》

Prevention of self-harm and suicide in young people up to the age of 25 in education settings.

In 2016, globally, suicide was the second leading cause of death amongst those aged 15 to 29 years. Self-harm is increasingly common among young people in many countries, particularly among women and girls. The risk of suicide is elevated 30-fold in the year following hospital presentation for self-harm, and those with suicidal ideation have double the risk of suicide compared with the general population. Self-harm and suicide in young people are significant public health issues that cause distress for young people, their peers, and family, and lead to substantial healthcare costs. Educational settings are widely acknowledged as a logical and appropriate place to provide prevention and treatment. A comprehensive, high-quality systematic review of self-harm and suicide prevention programmes in all education settings is thus urgently required. This will support evidence-informed decision making to facilitate rational investment in prevention efforts in educational settings. Suicide and self-harm are distressing, and we acknowledge that the content of this review is sensitive as the data outlined below represents the lived and living experience of suicidal distress for individuals and their caregivers. To assess the effects of interventions delivered in educational settings to prevent or address self-harm and suicidal ideation in young people (up to the age of 25) and examine whether the relative effects on self-harm and suicide are modified by education setting. We searched the Cochrane Common Mental Disorders Specialised Register, CENTRAL, The Cochrane Database of Systematic Reviews, Ovid MEDLINE, PsycINFO, ERIC, Web of Science Social Science Citation Index, EBSCO host Australian Education Index, British Education Index, Educational Research Abstracts to 28 April 2023. We included trials where the primary aim was to evaluate an intervention specifically designed to reduce self-harm or prevent suicide in an education setting. Randomised controlled trials (RCTs), cluster-RCTs, cross-over trials and quasi-randomised trials were eligible for inclusion. Primary outcomes were self-harm postintervention and acceptability; secondary outcomes included suicidal ideation, hopelessness, and two outcomes co-designed with young people: better or more coping skills, and a safe environment, with more acceptance and understanding. We used standard methodological procedures as expected by Cochrane. Two review authors independently selected studies, extracted data, and assessed risk of bias. We analysed dichotomous data as odds ratios (ORs) and continuous data as standardised mean differences (SMDs) with 95% confidence intervals (CIs). We conducted random-effects meta-analyses and assessed certainty of evidence using the GRADE approach. For co-designed outcomes, we used vote counting based on the direction of effect, as there is a huge variation in the data and the effect measure used in the included studies. We included 51 trials involving 36,414 participants (minimum 23; maximum 11,100). Twenty-seven studies were conducted in secondary schools, one in middle school, one in primary school, 19 in universities, one in medical school, and one across education and community settings. Eighteen trials investigated universal interventions, 11 of which provided data for at least one meta-analysis, but no trials provided data for self-harm postintervention. Evidence on the acceptability of universal interventions is of very low certainty, and indicates little or no difference between groups (OR 0.77, 95% CI 0.36 to 1.67; 9 studies, 8528 participants). Low-certainty evidence showed little to no effect on suicidal ideation (SMD -0.02, 95% CI -0.23 to 0.20; 4 studies, 379 participants) nor on hopelessness (MD -0.01, 95% CI -1.98 to 1.96; 1 trial, 121 participants). Fifteen trials investigated selective interventions, eight of which provided data for at least one meta-analysis, but only one trial provided data for self-harm postintervention. Low-certainty evidence indicates that selective interventions may reduce self-harm postintervention slightly (OR 0.39, 95% CI 0.06 to 2.43; 1 trial, 148 participants). While no trial provided data for hopelessness, little to no effect was found on acceptability (OR 1.00, 95% CI 0.5 to 2.0; 6 studies, 10,208 participants; very low-certainty evidence) or suicidal ideation (SMD 0.04, 95% CI -0.36 to 0.43; 2 studies, 102 participants; low-certainty evidence). Seventeen trials investigated indicated interventions, 14 of which provided data for at least one meta-analysis, but only four trials provided data for self-harm postintervention and two reported no events in both groups. Low-certainty evidence suggests that indicated interventions may slightly reduce self-harm postintervention (OR 0.19, 95% CI 0.02 to 1.76; 2 studies, 76 participants). There is also low-certainty evidence indicating that these interventions may decrease the odds of non-suicidal self-injury (OR 0.65, 95% CI 0.24 to 1.79; 2 studies, 89 participants). Evidence of a slight decrease in acceptability in the intervention group is of low certainty (OR 1.44, 95% CI 0.86 to 2.42; 10 studies, 641 participants). Low-certainty evidence shows that indicated interventions may slightly reduce suicidal ideation (SMD -0.33, 95% CI -0.55 to -0.10; 10 studies, 685 participants) and may result in little to no difference in hopelessness postintervention (SMD -0.27, 95% CI -0.55 to 0.01; 6 studies, 455 participants). There were mixed findings regarding the effect of suicide prevention interventions on a range of constructs relevant to coping skills and safe environment. None of the trials, however, measured the impact of improvements in these constructs on self-harm or suicidal ideation. While this review provides an update on the evidence about interventions targeting self-harm and suicide prevention in education settings, there remains significant uncertainty about the impact of these interventions. There are some promising findings but large replication studies are needed, as are studies that examine the combination of different intervention approaches, and can be delivered in a safe environment and implemented over a long period of time. Further research is required to understand and measure outcomes that are meaningful to young people with lived experience, as they want coping skills and safety of the environment in which they conduct their everyday lives to be measured as key outcomes in future trials.

Sharma V ，Marshall D ，Fortune S ，Prescott AE ，Boggiss A ，Macleod E ，Mitchell C ，Clarke A ，Robinson J ，Witt KG ，Hawton K ，Hetrick SE ... -  《Cochrane Database of Systematic Reviews》

Suicidality Trajectory, Hopelessness, Resilience, and Self-Efficacy Among Patients With Treatment-Resistant Depression in Vietnam.

Patients with treatment-resistant depression (TRD) have higher rates of suicidal ideation and a higher suicide attempt prevalence than patients with other types of depression. This study was designed to study the suicidality trajectory and relationships between hopelessness, resilient coping, and self-efficacy, respectively, and suicidal ideation and suicide attempts in patients with TRD during hospitalization and at 3 months after discharge. A longitudinal survey of 53 psychiatric inpatients with TRD was conducted. Suicidality, hopelessness, resilient coping, self-reported medication adherence, and self-efficacy were assessed at Weeks 1 and 2 (T0 and T1) after hospitalization and Week 1 and Months 1 and 3 after discharge. Data were analyzed using a Cox regression model. Suicidality varied across the five time points, with a downward trend observed between T0 and T1 (reflecting the initial effects of inpatient treatment) and an upward trend observed across the 3-month follow-up. Antidepressant overdose was the most common method used for suicide. The risk of high suicidal ideation during follow-up was 1.63, 2.63, and 1.14 times higher, respectively, in participants with a high level of hopelessness, low level of resilient coping, and low self-efficacy. Also, having a higher level of hopelessness and being younger in age increased the risk of attempting suicide by 3.07 times and over 6 times, respectively, compared to older participants. Suicidality was shown to fluctuate between the in-hospital treatment phase and the first 3 months following discharge in this sample of patients with TRD. Younger age, feelings of hopelessness, low resilience, and low self-efficacy were the top four factors contributing to postdischarge suicide risk. These findings highlight the need for regular patient monitoring and assessment to identify those with TRD who are at high risk of suicide as well as the importance of focusing on hopelessness, resilience, and self-efficacy as predictors of suicide ideation and attempts. Nurses should help patients with TRD, especially those who are younger, and improve and maintain their hope, resilience, and self-efficacy both during hospitalization and shortly after discharge.

Pham TTH ，Wu CY ，Lee MB ，Nguyen VT ，Pham TTH ，Dang TT ，Vu ST ，Nguyen TS ... -  《-》

Nationwide trends in sadness, suicidal ideation, and suicide attempts among multicultural and monocultural adolescents in South Korea during the COVID-19 pandemic, 2011-2022.

Researches on the mental health of Korean adolescents during COVID-19 have largely focused on those from monocultural families, but there is limited data on sadness, suicidal ideation, and suicide attempts in multicultural adolescents. This nationwide serial cross-sectional study included 688,708 adolescents aged 12-18 years who participated in the Korean Youth Risk Behavior Web-based Survey from 2011 to 2022. We compared and analyzed the prevalence of sadness, suicidal ideation, and suicide attempts among multicultural and monocultural adolescents. Multicultural adolescents were defined as those with at least one non-Korean parent. In 2021, the prevalence of sadness among multicultural adolescents was 31.86% [95% confidence interval (CI) 30.00-33.71], suicidal ideation 17.17% (15.74-18.61), and suicide attempts 4.25% (3.51-4.99). Among monocultural adolescents, the prevalence rates were 26.09% (25.50-26.69) for sadness, 12.41% (11.97-12.85) for suicidal ideation, and 1.92% (1.76-2.67) for suicide attempts. Adolescents from multicultural backgrounds were found to have higher rates of sadness, suicidal ideation, and suicide attempts. In the general population, these rates had decreased during the pre-pandemic period but increased after the onset of the pandemic then stabilized from 2020 to 2021. Female gender, smoking, alcohol use, and low school performance emerged as significant risk factors. However, no distinct risk factors specifically linked to suicide attempts were identified. Joinpoint regression analysis results aligned with the beta slope values in the main findings, reflecting a consistent pattern across both analyses. This study revealed that sadness, suicidal ideation, and suicide attempts increased during the pandemic, reversing a pre-pandemic decline. Multicultural adolescents faced these issues more than monocultural ones, underlining the need for targeted public health measures to support at-risk adolescents during pandemics.

Jo H ，Park J ，Lee H ，Lee K ，Lee H ，Son Y ，Kang J ，Lee S ，Choi Y ，Lee JH ，Fond G ，Boyer L ，Smith L ，Lee J ，López Sánchez GF ，Dragioti E ，Tully MA ，Rahmati M ，Woo HG ，Woo S ，Yon DK ... -  《-》