Search Results (748)

The Preliminary Exploration into Adoption Reunions (PEAR) survey examined the mental health issues faced by adoptees and first mothers. Data were collected from 1313 adoptees, first mothers, and first fathers. Study results indicate that adoption has lasting adverse effects on both adoptees and first mothers. Adoptees and first mothers are significantly more likely to attempt suicide (35 times and 37.7 times, respectively), abuse alcohol, display hypersexual behaviors, and restrict their eating compared to their peers: While first mothers have a lower life expectancy and are more likely to die by suicide than women who did not lose their children to adoption, adoptees frequently struggle with their identity and sense of belonging. They expressed experiencing trauma from their separation from their first mothers, regardless of the quality of their adoptive parents. The findings also highlight the negative impact of the secrecy surrounding adoption. Themes of secrecy and shame were prevalent in the responses from both adoptees and first mothers. The findings highlight the importance of listening to and validating the experiences of adoptees and first mothers and that there needs to be transparency in adoption practices, which may reduce the stigma associated with adoption, and facilitate healing. Full article

This narrative literature review explores the clinical use of Ketamine as part of an untested hypothetical model framework for bridge therapy for acute suicidality. Long-term suicide rates continue to increase in the United States and in many other countries, creating a pressing public health challenge with a variety of treatment considerations. Existing standard-of-care SSRI therapeutics have a delay between administration and symptom relief at 2–6 weeks, leaving a so-called danger zone of about 1–3 months of risk for suicidal follow-through behaviors. Ketamine, a potent NMDA (N-methyl-D-aspartate) receptor antagonist, has recently seen widespread interest in both regulatory and clinical settings for increasing neuroplasticity and alleviating depressive symptoms. Ketamine’s mechanism-of-action through mTORC1 is much faster than SSRI’s downstream transcriptional regulation, leading to quicker relief of suicidal symptoms and the removal of the danger zone lag period. The current literature suggests that a controlled, supervised subanesthetic dose of Ketamine in a clinical setting has low risks of addiction or abuse, distinguishing therapeutic uses of Ketamine from recreational uses. While the biological efficacy of Ketamine is established, this conceptual review focuses on a possible initial hypothetical framework of a “Bridge Protocol.” We searched PubMed, Google Scholar, The Cochrane Library, and PsycINFO (January 2000–December 2025) to synthesize evidence regarding SSRI latency, acute Ketamine protocols, and post-discharge safety. We conclude that while promising, the proposed Ketamine Bridge Therapy requires rigorous longitudinal validation and sustained clinical studies before it can be safely used and experience widespread adoption. Full article

Suicidal behavior in children and adolescents is a major global public health issue, and suicide is one of the leading causes of death in this age group. While psychosocial determinants of suicidality are well established, understanding its biological risk factors is crucial for targeted prevention and treatment. This review presents a narrative synthesis of recent literature examining current evidence on the biological mechanisms that contribute to youth suicidality. Genetic liability plays a substantial role, often interacting with environmental stressors. Key neurobiological factors include dysfunction of the serotonin system and impaired neuroplasticity, characterized by a glutamate–gamma-aminobutyric acid imbalance and reduced brain-derived neurotrophic factor. Psychosocial stress appears linked to these changes through several pathways, including dysregulation of the hypothalamic–pituitary–adrenal axis, chronic low-grade inflammation, oxidative stress, and activation of the kynurenine pathway. Neurodevelopmental conditions like autism spectrum disorders and attention deficit hyperactivity disorder, as well as sleep disturbances, may further increase risk. While therapeutic agents such as ketamine and lithium target these neurobiological systems, evidence for their anti-suicidal efficacy in youth remains limited, with only a small number of randomized controlled trials conducted in pediatric populations. Biological research offers valuable insights, but the use of varied study methods and a lack of longitudinal data complicate its translation into clinical practice. Future studies should employ integrative, developmentally informed models to elucidate causal mechanisms and inform more effective interventions. Full article

Suicidal behavior is a multifactorial and highly heritable phenotype; however, data concerning its genetic determinants in disparate ethnic groups remain limited. Genes implicated in serotonergic neurotransmission and stress response regulation are regarded as primary candidates for elucidating biological vulnerability to suicide. The objective of this study is to investigate the relationship between suicide attempts and candidate gene polymorphisms in an ethnically homogeneous Kazakh population from Astana, Kazakhstan. The study’s sample population comprised 126 patients with a documented history of suicide attempts and 120 age- and gender-matched controls without a history of suicidal behavior. A comprehensive genotyping analysis was conducted, encompassing polymorphisms in genes associated with serotonergic signaling, stress response, and neuroplasticity (TPH1, TPH2, HTR2A, MAOA, SLC6A4, ANKK1, BDNF, COMT, CXCL8, SKA2, and FKBP5). The associations were assessed across several genetic models, using odds ratios with 95% confidence intervals. A substantial correlation was identified between the HTR2A rs6311 polymorphism and suicide attempts. The CC genotype exhibited a protective effect (p = 1.36 × 10⁻⁵), while the TT genotype was associated with an elevated risk (OR = 3.16; 95% CI: 1.72–5.81). The association remained robust after stratification by sex, with an even stronger effect observed in women (OR = 4.70; 95% CI: 2.08–10.64). A nominal sex-specific association was observed for the SKA2 rs7208505 variant, suggesting a potential role in stress-response mechanisms in women; however, this association was no longer statistically significant after adjustment for multiple comparisons. These results identify HTR2A rs6311 as a potential genetic marker of suicide risk in the Kazakh population and support the involvement of serotonergic receptor regulation in the biological mechanisms underlying suicidal behavior. The results underscore the significance of sex-specific genetic influences, thereby enhancing our understanding of the polygenic underpinnings of suicidality. Full article

Background: Adolescents with neurodevelopmental disorders (NDDs), particularly autism spectrum disorder (ASD) and borderline intellectual functioning/intellectual disability (BIF/ID), represent a clinically complex population in psychiatric emergency settings, with unclear contributions to acute psychopathology and suicide risk. Aims: This study examined whether ASD and BIF/ID differentially influence clinical severity, psychopathological profiles, and suicidality in adolescents admitted for psychiatric emergencies, comparing high-functioning ASD, ASD with cognitive impairment, and adolescents without NDDs. Methods: We conducted a retrospective, single-center cohort study including 206 consecutive patients aged 11–17 years admitted to a psychiatric emergency unit between January 2022 and December 2023. Patients were stratified into four groups: ASD (ASD-HF; ASD-BIF/ID), BIF/ID and N-ASD/N-BIF/IDClinical severity, global functioning, psychiatric diagnoses, adverse childhood experiences, emotional dysregulation, and suicidality were assessed using standardized diagnostic and behavioral measures. Group comparisons were performed to identify predictors of suicidality. Results: ASD-BIF/ID patients exhibited the lowest global functioning, whereas ASD-HF adolescents showed functioning comparable to controls. Suicidal ideation and behaviors were significantly more frequent in ASD-HF. BIF/ID was associated with greater behavioral impairment and lower suicidality. Conclusions: ASD and BIF/ID may differentially shape psychiatric emergency presentations. Adolescents with high-functioning ASD showed a higher prevalence of suicidality in this specific clinical context. Limits: This study is limited by its cross-sectional, single-center, and retrospective design, small and uneven subgroup sizes, and assessment tools not specifically validated for autistic or intellectually disabled populations. The high prevalence of bipolar spectrum disorders may reflect referral bias. Despite these limitations, adolescents with high-functioning ASD exhibited elevated suicidality, underscoring the importance of risk assessment adapted to cognitive and diagnostic profiles. Full article

Background/Objectives: Suicidal ideation and non-suicidal self-injury (NSSI) among elementary school students represent critical public health concerns that require develop-mentally appropriate, evidence-informed school-based interventions. This study con-ducted a retrospective comparative analysis of two school-based approaches—Sandplay Therapy with Suicidal Ideation and Self-Injury-Focused Engagement (SPT-SAFE) and a School-based Dialectical Behavior Therapy-informed Brief Intervention (DBT-BI)—for elementary school students presenting with suicidal ideation and NSSI. The objective was to describe pre–post-changes in key outcomes within each intervention and to explore whether outcome trajectories differed between the two approaches in a non-randomized, real-world school-based setting. Methods: This retrospective study analyzed archival clinical records from 109 elementary school students (SPT-SAFE: N = 59; DBT-BI: N = 50) who received services at a school-based suicide prevention center in South Korea between 2022 and 2024. Seven validated outcome measures assessed suicidal ideation, NSSI frequency, depression, anxiety, aggression, impulsiveness, and self-concept at pre- and post-intervention. Pre–post-changes and exploratory between-group differences were examined using 2 × 2 mixed-design ANOVAs (Group × Time interaction), with baseline-adjusted ANCOVAs conducted as complementary analyses. Suicidal ideation was operationalized using the SIQ-JR total score, and NSSI was operationalized using the FASM summed frequency index. Results: Both interventions were associated with significant reductions in suicidal ideation (F = 29.98, p < 0.001, partial η² = 0.219) and NSSI frequency (F = 15.95, p < 0.001, partial η² = 0.130), with large within-group effect sizes and no significant Group × Time interactions. Accordingly, between-group differences were limited and should be interpreted as exploratory rather than comparative–effectiveness evidence. Modest between-group differences favoring DBT-BI were observed for self-concept outcomes (F = 4.14, p = 0.044, partial η² = 0.037; d = −0.39). Conclusions: These findings suggest that both interventions were associated with pre–post-improvements in suicidal ideation and NSSI frequency within a school-based clinical context. Full article

The kynurenine pathway (KP) is the primary route of tryptophan metabolism and a key interface linking immune activation, metabolic state, and neurochemical signaling. Although KP biomarkers are widely studied in psychiatric disorders, their interpretation remains inconsistent, in part due to biological context and compartmentalization. In this narrative review, we integrate evidence across peripheral and central systems to clarify how age, sex hormones, metabolic health, inflammation, and behavioral factors systematically bias KP flux and shape biomarker readouts. We re-examine the interpretation of the kynurenine/tryptophan ratio in light of differential IDO1 and TDO2 regulation, blood–brain barrier constraints, and cell-specific downstream metabolism that governs neuroprotective and neurotoxic outputs. We further synthesize clinical evidence linking KP alterations to symptom severity, cognitive dysfunction, treatment resistance, and suicidality, highlighting quinolinic acid as a mechanistic node connecting immune activation to glutamatergic dysregulation. Together, this framework reframes the kynurenine pathway not as a static biomarker of disease, but as a context-sensitive metabolic system with direct implications for study design, risk stratification, and personalized approaches in psychiatry. Full article

Fibromyalgia (FM) is associated with increased suicidal behavior (SB). This critical review integrates the ideation-to-action models—Interpersonal Theory of Suicide (IPTS), Three-Step Theory (3ST), and Integrated Motivational–Volitional (IMV) Model—with clinical and neuropsychological correlates to discriminate between suicidal ideation (the motivational component) and suicidal action (the volitional component) in FM. Ideation is related to hopelessness, perceived burden, thwarted belongingness, and entrapment, as well as to pain/interference, sleep disturbances, fatigue, mood, pain catastrophizing, and attentional pain vigilance. The transition to action is associated with impulsivity, executive dysfunction (including inhibitory control, flexibility, and decision-making under ambiguity/risk), acquired capability due to repeated exposure to pain and medical procedures, and access to lethal means. Suicidal planning is conceptualized as high-severity ideation, while action includes preparatory behaviors and suicide attempts. Evidence from Spanish instruments is synthesized—Columbia Suicide Severity Rating Scale (C-SSRS), Plutchik Suicide Risk Scale (PSRS), Beck Depression Inventory-II (Item 9 of the BDI-II), and Suicide Behaviors Questionnaire—Revised (SBQ-R)—pointing out overlaps with pain/depression and the lack of specific validation in FM. Prospective cohorts, standardization of definitions/windows, comparable neuropsychological batteries, and mechanistic trials on motivational and volitional targets and interventions focused on pain reduction are proposed. Full article

This review focuses on suicidal ideation and attempts in the context of major depressive disorder. Despite clinical advances, suicide risk assessment still relies mainly on subjective evaluation. Emerging evidence highlights immune-inflammatory dysregulation as a biological link between depression and suicidality. This review summarizes current findings on inflammatory biomarkers as potential predictors of suicidal behavior. The discussed markers include acute phase proteins (C-reactive protein, homocysteine), hematological indices from routine blood tests (NLR, PLR, MLR, SII, NAR), and cytokines (IL-6, TNF-α, IL-1β, IL-4, IL-10). Many studies report increased levels of CRP, IL-6, TNF-α, and IL-1β and decreased IL-4 and IL-10 in suicidal individuals, reflecting an imbalance between the immune-inflammatory response system (IRS) and the compensatory immune-regulatory reflex system (CIRS). Such dysregulation may promote neuroinflammation and neurotoxicity via the kynurenine pathway. Hematological ratios offer inexpensive, accessible indicators that could complement psychiatric evaluation. However, heterogeneity across studies, lack of standardized cut-off values, and the influence of confounders such as age, sex, and medication limit their clinical utility. Inflammatory biomarkers currently hold potential as objective adjuncts—but not substitutes—to clinical judgment in assessing suicide risk. Full article

Despite decades of research, suicide risk factors predict outcomes at chance levels, and there is a dearth of protective factor and resilience research, which limits the utility of risk-based approaches. Further, suicide prevention interventions primarily consist of individual psychotherapies and treating individuals after suicide-related outcomes occur. Unfortunately, there is a lack of upstream suicide prevention interventions targeting known suicide risk factors and aiming to increase well-being and resilience in the U.S. Thus, we discuss these problems in the field and the U.S. health care system and provide a possible solution. We propose using low-intensity, universal, and upstream prevention interventions, such as Stress Control. Stress Control is a classroom-style, Cognitive Behavior Therapy-based program shown to reduce “risk,” stress, anxiety, and depression and boost well-being and resilience as part of a stepped-care model. Although Stress Control’s suicide prevention effectiveness has not yet been directly assessed, we discuss how it could be a promising suicide prevention strategy with additional testing. A proposed mechanism for this reduction is building resilience to common risk factors and suicide ideation via evidence-based coping skills, thereby decreasing future suicide risk. We review current limitations and discuss how upstream, scalable, universal prevention interventions can help improve psychological resilience and reduce suicidal thoughts and behaviors, lowering the U.S. suicide rate. Implications and recommendations are discussed. Full article

Background/Objectives: This study examined gender-specific psychological and interpersonal correlates of suicidal behaviour using the framework of the Interpersonal Theory of Suicide (IPTS). Methods: The study included a total of 181 respondents from a clinical group (N = 93) and a control group (N = 88). Logistic regression analyses were conducted separately for women (N = 86) and men (N = 80) for cases that met leverage values (LEV) ≤ 0.2. Variables included personality traits, coping style, hopelessness, self-esteem, hope, perceived burdensomeness, thwarted belongingness, and acquired capacity for suicide. Interaction terms were also tested. Results: Among women, hopelessness (Exp(B) = 1.37; p = 0.038) and perceived burdensomeness (Exp(B) = 1.12; p = 0.033) were identified as significant correlates of suicidal behaviour. Among men, an avoidance-focused style (Exp(B) = 1.18; p = 0.009) and the interaction of general capacity for suicide x perceived burdensomeness x thwarted belongingness (Exp(B) = 5.29; p = 0.043) emerged as significant correlates. Further analysis indicated that thwarted belongingness became a significant factor in men only when perceived burdensomeness and capacity for suicide were high (Nagelkerke R² = 0.33; Exp(B) = 1.17; p = 0.042). Conclusions: Gendered expressions of suicidality appear to follow distinct pathways. Within the IPTS framework, women’s suicidality is more closely shaped by internalized cognitive and affective processes, including hopelessness and perceived burdensomeness, whereas men’s behaviour is influenced by maladaptive coping, social disconnection, and acquired capacity for suicide. These findings highlight the importance of gender-specific prevention and intervention strategies across clinical and community contexts. Early identification of these correlates may reduce suicidal intent, prevent rehospitalization, and improve mental health outcomes. Full article

Background/Objectives: The COVID-19 pandemic disrupted social structures, healthcare access, and psychological well-being, potentially intensifying substance use and suicidal behavior. Although both phenomena have been independently studied, their co-occurrence during the pandemic has not been systematically synthesized. To evaluate the prevalence and patterns of suicidal behavior among individuals with substance use during the COVID-19 pandemic through a systematic review and random-effects proportions meta-analysis. Methods: A systematic search of PubMed, Scopus, Web of Science, and EBSCO Host was conducted from 11 March 2020 to 15 October 2022 for studies published between March 2020 and October 2022. Eligible studies included observational designs reporting substance use and suicidal behavior in adults during the pandemic. Risk of bias was assessed using National Institutes of Health tools. Proportional meta-analyses were performed using a random-effects model with Freeman–Tukey double arcsine transformation. Heterogeneity was quantified using the I² statistic. Results: Twenty studies comprising 70,684 individuals were included. Substance use during the pandemic was reported in 24.6 percent of participants, while 30.7 percent exhibited suicidal behavior. A total of 16.1 percent presented with both substance use and suicidal behavior. The pooled prevalence of any suicidal behavior among individuals with substance use was 33.8 percent (95 percent CI, 22.8 to 45.7), with substantial heterogeneity. Alcohol showed a pooled prevalence of 36.2 percent, cannabis 48.1 percent, and tobacco 11.5 percent. Suicidal ideation was the most frequent outcome, with a pooled prevalence of 36.8 percent among substance users. Most studies reported an increased association between substance use and suicidal behavior compared with pre-pandemic periods. Conclusions: Substance use and suicidal behavior frequently co-occurred during the COVID-19 pandemic, particularly suicidal ideation and alcohol use. These findings highlight the need for integrated mental health and substance use interventions during public health crises. Full article

Emotional (mental) pain can precipitate a suicidal intention in humans. In contemporary society characterized by an increase in international migrations, the potential impact of immigration remains among the controversial and even quite complex topics in the sociology of suicidal behavior. In other respects, our understanding of the potential impact of immigration status on emotional pain in adults with a dual diagnosis of schizophrenic and comorbid substance use disorders remains unclear. This cross-sectional survey aimed to examine the potential impact of immigration status on the experience of emotional pain. All study participants (N = 93) gave written and signed consent before beginning to complete this individual survey. The analysis revealed significant main effects of both immigration and gender on emotional pain intensity, with the native-born and females reporting a higher intensity of emotional pain. However, no significant effects were found for immigration or gender concerning general self-efficacy. Additionally, significant interactions were found between immigration and gender for both emotional pain intensity and general self-efficacy, with native-born females exhibiting higher emotional pain intensity and general self-efficacy compared to non-native-born females. Regarding the unique contribution of general self-efficacy, the analysis showed that it (but not the lifetime patterns of psychoactive substance use) solely and significantly explained participants’ emotional pain intensity, with higher general self-efficacy associated with lower emotional pain. A mediation analysis revealed that general self-efficacy significantly mediated the relationship between immigration and emotional pain among females, but not males, suggesting that general self-efficacy played a key role in explaining how immigration influenced emotional pain for females with a dual diagnosis of schizophrenic and comorbid substance use disorders. This is the first evidence of the potential impact of immigration status on the experience emotional pain among adults with a dual diagnosis. The general self-efficacy played a key role in explaining how immigration status influenced current emotional pain for females, and not for males, with a dual diagnosis of schizophrenic and comorbid substance use disorders. Full article

Introduction: University students often describe their academic years as a period of continuous personal change, which may increase vulnerability to unhealthy lifestyle habits. These habits can influence body composition and are associated with both physical conditions (e.g., overweight, sedentary behavior) and psychological well-being, including suicide risk. Method: A quantitative, non-experimental, cross-sectional, descriptive–comparative–correlational design was employed, using a non-probabilistic intentional sample of 174 university students. Data were collected using the OMRON 514C body composition monitor, the Difficulties in Emotional Regulation Scale (DERS-E), and Plutchik’s Suicide Risk Scale. Statistical analyses included descriptive statistics, independent samples t-tests for gender comparisons, Pearson’s correlation analyses, and multiple linear regression analyses to examine whether the observed bivariate associations remained significant after controlling for gender. Results: Descriptive analyses showed variability in body composition, emotional dysregulation, and suicide risk. Gender comparisons indicated that men presented higher weight, height, skeletal muscle mass, visceral fat level, and basal metabolic rate, whereas women reported higher body fat percentage, greater emotional dysregulation, and higher suicide risk. Correlation analyses revealed that suicide risk was negatively associated with skeletal muscle mass (r = −0.24, p = 0.002), basal metabolic rate (r = −0.21, p = 0.006), height (r = −0.27, p < 0.001), emotional rejection (r = −0.24, p = 0.001), and emotional confusion (r = −0.22, p = 0.004). Multiple regression analyses, controlling for gender, indicated that the associations between body composition indicators (skeletal muscle and basal metabolism) and suicide risk did not remain statistically significant (p > 0.05). In contrast, emotional dysregulation dimensions, particularly emotional rejection, maintained significant associations with suicide risk after adjustment for gender. Additionally, negative associations were found between BMI and emotional dysregulation, and between height and emotional clarity, even after controlling for gender. Discussion: The findings highlight emotional dysregulation as a central and robust factor associated with suicide risk in university students, whereas body composition indicators appear to play a more limited and gender-dependent role. The fact that associations between physical markers (skeletal muscle, basal metabolism) and suicide risk were mediated by gender underscores the importance of considering sociodemographic factors when interpreting body–mental health relationships. These results support the need for integrated biopsychosocial prevention strategies that address emotional regulation within the university context, while considering the differential impact of gender on both physical and psychological risk factors. Full article