Search Results (2,840)

Background/Objectives: Suicide attempts represent a major global health problem. Traumatic suicide methods, such as falls from great heights, stab wounds, and gunshot wounds, frequently result in severe or fatal injuries. The COVID-19 pandemic, as well as broader societal stressors including economic uncertainty and geopolitical conflicts, has substantially increased psychological stress in the population and has been discussed as a potential influencing factor for suicidal behavior. The aim of this study was to analyze severe traumatic suicide attempts and to evaluate the potential influence of the COVID-19 pandemic in a multicenter analysis of the TraumaRegister (TR) DGU^®. Methods: This retrospective multicenter analysis is based on the TraumaRegister DGU^®, a standardized database for seriously injured patients. Patients from Germany, Austria, and Switzerland from 2010 to 2023 with an Injury Severity Score (ISS) ≥ 9, an age ≥ 10 years, and a documented suicide attempt, who arrived at the hospital alive, were included. Results: Among severely injured trauma patients recorded in the registry, 12,247 (4.4%) cases were classified as suspected traumatic suicide attempts. Severe traumatic suicide attempts showed a clear age-dependent distribution, with a marked increase from adolescence and a plateau between 20 and 55 years of age. Both the mean age of the general population and the age of patients with suicide attempts increased over the study period. This trend was reflected in the rise in the ≥70-year age group from 13.6% in 2010 to 19.6% in 2023. The most common method was jumping from a height greater than 3 m (65.3%), followed by stab wounds (11.9%) and gunshot wounds (8.0%). While a significant decline in severe traumatic suicide attempts was observed between 2010 and 2019, a significant increase to 4.5% occurred in 2020, remaining at a comparable level in the following years. Sex-specific differences were observed, with penetrating injuries occurring more frequently in men, whereas jumps from heights > 3 m were more common among women. The highest hospital mortality was observed in gunshot injuries (67.9%). Conclusions: This study demonstrates an increase in severe traumatic suicide attempts in 2020 that persisted at a similar level until 2023. Sex-specific differences in suicide methods highlight the need for targeted prevention strategies. In addition, demographic aging is reflected in the increasing proportion of suicide attempts among older individuals, emphasizing the need for age-specific prevention measures. The relatively high survival rate after certain methods, particularly after falls from height (77%), underlines the importance of structured postoperative psychiatric care pathways. These findings specifically reflect traumatic suicide attempts resulting in severe injury and requiring trauma center treatment. Full article

Background/Objectives: The proportion of teenagers with access to a smartphone has reached 89 percent, marking a large increase in access to technology. Adolescence is a period of neuroplasticity where functional, structural, and systemic changes occur. Teenagers have experienced more persistent feelings of sadness and suicidality in recent years than ever before. Given the changes in this generation of adolescents and because adolescence is a period of neuroplasticity, this study seeks to understand the effects of smartphone use in adolescence. Methods: This scoping review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A total of 104 articles met the criteria for inclusion. Results: Analysis of results revealed five key themes: Psychological Disturbances (n = 52), Sleep (n = 43), Socioemotional Function (n = 23), Executive Function (n = 14), and Sensory Processing (n = 1). Conclusions: Results suggest that smartphones have a variety of effects on adolescent brain function that are primarily negative. The results of this study can inform the general population about the ways in which smartphone usage affects adolescent brain functioning. Further research is warranted to determine a causal relationship between smartphone use and adolescent brain functioning. Full article

Mental health disorders (MHDs) and acute coronary syndromes (ACSs) demonstrate reciprocal pathophysiological connections with substantial prognostic implications. Despite robust evidence linking MHDs to adverse cardiovascular outcomes, the bidirectional relationship remains inadequately characterized in clinical practice, with limited integration of mental health screening into routine cardiac care pathways. The present narrative review comprehensively presents contemporary data on epidemiology, shared biological mechanisms, clinical consequences, and integrated management strategies across the MHD–ACS continuum. A synthesis of peer-reviewed literature, meta-analyses, observational cohorts, randomized trials, and international guideline documents was performed, focusing on depression, anxiety, post-traumatic stress disorder, bipolar disorder, schizophrenia, and suicidality in relation to ACSs. MHDs are highly prevalent in ACS populations and independently predict increased mortality, major adverse cardiac events, and poorer functional recovery. Shared mechanisms include chronic low-grade inflammation, autonomic imbalance, hypothalamic–pituitary–adrenal axis hyperactivation, platelet hyperreactivity, and endothelial dysfunction. Selective serotonin reuptake inhibitors and cognitive behavioral therapy demonstrate the strongest evidence for treating depression in cardiac populations. Collaborative, stepped-care, and integrated cardiac rehabilitation models consistently improve psychological outcomes, with variable effects on cardiovascular endpoints. MHDs and ACSs form a self-reinforcing clinical continuum. Routine mental health screening and integrated cardio-psychiatric care represent essential components of secondary prevention and long-term outcome optimization. Full article

Metabolic and bariatric surgery (MBS) has evolved into a highly effective neurohormonal intervention for severe obesity; however, it introduces unique long-term vulnerabilities, particularly regarding alcohol (AUD) and substance use disorders (SUD). This review synthesizes the epidemiological, pharmacokinetic, and neurobiological drivers of postoperative substance misuse. Procedures like Roux-en-Y gastric bypass (RYGB) radically alter ethanol metabolism, eliminating first-pass metabolism and accelerating gastric emptying, while simultaneously recalibrating reward pathways, creating a “reward gap” that facilitates addiction transfer. These physiological shifts exacerbate critical micronutrient deficiencies (thiamine, B12, iron), increase the risk of post-bariatric hypoglycemia, and correlate with higher rates of liver cirrhosis and suicide. Furthermore, substance use is a primary driver of suboptimal weight loss trajectories and weight regain. Mitigation requires a lifelong, multidisciplinary framework involving preoperative risk stratification, validated screening (e.g., AUDIT-C), and targeted nutritional supplementation to safeguard the long-term metabolic and psychological benefits of MBS. Full article

Introduction: Major depressive disorder (MDD) is a leading cause of disability worldwide and contributes significantly to the global burden of disease. Recent data show an increasing prevalence of treatment-resistant depression (TRD). Patients with autism spectrum disorder (ASD) often exhibit MDD as a comorbidity and it is often resistant to conventional treatments. ASD determines emotional dysregulation and a reduced ability to understand mental states (mentalization). These features can lead to suicidal ideation and/or behavior. Intranasal esketamine may offer a novel therapeutic option for this population. Methods: This case series focuses on the clinical response to intranasal esketamine in patients with autism and TRD; esketamine is approved in Italy as an add-on therapy in TRD, so our case study is based on an in-label treatment. Three young patients (n = 3, F/M 2:1, age range 20–25 y) with light to moderate autism (Level 1 or 2) were treated. Esketamine was administered in augmentation with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) in accordance with EMA/AIFA guidelines. A structured follow-up protocol was set to monitor depressive symptoms, social cognition, and mentalization. Follow-up during treatment was maintained for six months, and psychometric evaluations were performed at six time points: baseline (T0), 1 week (T1), 1 month (T2), 2 months (T3), 3 months (T4), and 6 months (T5). Also, subjective quality of life was investigated before and after the observation period. Results: Despite differences in clinical profile, all patients showed good efficacy of esketamine in reducing depressive symptoms: two patients experienced clinical remission at T5 (MADRS < 10), one patient showed partial response (dMADRS = 43.24%). No major side effects were reported. Significant improvements were observed after the first week of treatment (P1: MADRS_T0 = 37, MADRS_T1 = 12; P2: MADRS_T0 = 32, MADRS_T1 = 21; P3: MADRS_T0 = 25, MADRS_T1 = 12). Depressive relapses occurred (e.g., P1, T3–T4), but they were not associated with hospitalizations and/or suicidal attempts. Suicidal ideation, when present, decreased by the end of the follow-up period. Lack of mentalization and in social cognition was noted, with just mild improvements during therapy. Subjective quality of life improved significantly for all patients (P1: 28% at T0, 73% at T5. P2: 25% at T0, 71% at T5. P3: 35% at T0, 80% at T5). Conclusions: Intranasal esketamine showed a favorable efficacy and safety in these three cases of TRD in comorbidity with ASD (at six months: total remission = 66.66%, partial remission = 33.33%, inefficacy = 0%, drop-out = 0, severe adverse events = 0). Besides improvements in depressive symptoms, esketamine was associated with a constant decrease in suicidal thoughts. A case series is unfit to form statistical conclusions; preliminary data warrant further investigation in randomized controlled studies to validate the therapeutic potential of esketamine in this population. Full article

Mental health among elite athletes has received increasing attention, yet evidence from studies including matched control groups remains limited. This study investigated the prevalence and levels of anxiety, depression, and suicidal ideation among elite male soccer players compared with age- and education-matched controls from the general population. A total of 324 participants were included, comprising 214 elite male soccer players and 110 controls. Participants completed the Beck Depression Inventory–II (BDI-II) and the Beck Anxiety Inventory (BAI). Suicidal ideation was assessed using item 9 of the BDI-II. Data were analysed using descriptive statistics, reliability analysis, and non-parametric inferential statistics. In addition, a neural network classification analysis was conducted to examine whether combined anxiety and depressive symptoms could differentiate elite athletes from controls. No significant differences were found in the prevalence of depression (40.19% in athletes vs. 37.27% in controls) or anxiety (87.38% in athletes vs. 90.00% in controls). Levels of depressive symptoms were similar between groups, whereas anxiety levels were higher among controls. Suicidal ideation was significantly less prevalent in controls (22.73%) compared with elite soccer players (46.73%). Neural network classification achieved above-chance accuracy (68.8%) in differentiating athletes based on combined anxiety and depressive symptoms, but low sensitivity reinforces prior results that athletes and matched controls have similar levels of mental health outcomes. Elite soccer players and controls show similar prevalence of depression and anxiety, although anxiety severity appears lower among athletes. The joint configuration of anxiety and depressive symptoms modestly differentiates group affiliation, while suicidal ideation remains more prevalent among elite players. These findings highlight the complex and distinctive mental health profile of elite athletes and suggest the need for continued psychological support and monitoring in high-performance sport contexts. Full article

Background/Objectives: The increasing consumption of ultra-processed foods (UPFs) has been associated in recent years with negative effects on both physical and mental health. Ultra-processed products have been increasingly linked with poorer mental health outcomes, with research suggesting associations with higher rates of depression, anxiety, and cognitive difficulties. The aim of this systematic review was to determine whether and to what extent UPF intake is linked to metal health in children and adolescents. Methods: The methodological approach involved a systematic review of 20 recent epidemiological studies, identified through the PubMed and EBSCO databases using MeSH and TIAB search terms. The selected articles were evaluated in terms of sample characteristics, assessment tools, results and methodological quality. Results: Most findings revealed a positive association between high UPF consumption and mental health problems such as anxiety, depression, irritability or nervousness, sleep disturbances and suicidal ideation. However, variations were observed depending on the country, sex and the assessment tools used. Conclusions: In conclusion, the results of this review support the hypothesis that increased consumption of UPFs may be a risk factor for mental health in children and adolescents. Further longitudinal and interventional research is needed, alongside the promotion of healthy dietary policies targeting the pediatric and adolescent populations. Full article

Background/Objectives: One of the most relevant risk factors for suicide is the terminal stage of oncological disease. However, it remains unclear whether palliative care affects suicide rates in this population. This study aimed to compare suicide rates in oncological patients receiving palliative care to a general oncological cohort. Methods: The rate of suicide among all patients admitted to the palliative care ward at the Medical University of Vienna for oncological diagnoses from November 2012 to March 2022 was compared to that of a diagnosis-matched control group retrieved from the Austrian Cancer Registry. Competing risk models in SAS (SAS Institute Inc., Cary, NC, USA) were used to test for significant differences in cumulative incidences of death by suicide. Cumulative incidences were also compared for sex and the most common diagnostic groups separately. Results: 1524 patients with oncological diagnoses receiving palliative care and 794,986 patients in the control group were included in the analysis. No excess suicide mortality was revealed (p = 0.117) in the group of patients receiving palliative care. Importantly, this remained true, after also including any potential cases of suicide within the palliative care sample in the analysis (p = 0.467). Only for patients with pancreatic cancer, a higher cumulative suicide incidence in the palliative care sample was found (p = 0.008). Conclusions: Palliative care for oncological patients may be able to alleviate the excess suicide mortality that is otherwise expected in terminally ill patients. This study underscores the importance of comprehensive multidisciplinary end-of-life care that addresses not only physical but also psychosocial aspects. Full article

Background/Objectives: Antisocial personality disorder (ASPD) is strongly associated with violence, substance use, criminal behavior, and elevated suicide risk. Although inflammatory and metabolic dysregulation have been implicated in severe psychiatric disorders, the biological correlates of impulsivity, aggression, and suicide risk in forensic ASPD populations remain unclear. This study aimed to investigate whether routine hematological, inflammatory, and metabolic parameters are associated with these clinical features. Methods: This cross-sectional study included 57 male individuals diagnosed with antisocial personality disorder (ASPD) who had committed crimes and were referred to the Forensic Psychiatry Department of Elazığ Fethi Sekin City Hospital in Turkey by the court, and 56 age-matched healthy controls. Participants completed standardized assessments of impulsivity (BIS-11), aggression (BPAQ), and suicide probability (SPS). Hematological indices, inflammatory markers, and routine biochemical parameters were analyzed. Group comparisons, correlation analyses, and multivariable logistic regression were performed. Results: Compared with age-matched controls, individuals with ASPD showed markedly higher impulsivity, aggression, and suicide probability, alongside substantially higher rates of substance use, imprisonment history, and suicide attempts (all p < 0.001). Hematological and inflammatory analyses revealed lower red blood cell (RBC) counts and elevated mean corpuscular volume (MCV), red cell distribution width (RDW), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and CRP–albumin ratio (CAR) in the ASPD group (all p < 0.05). Biochemical profiling showed reduced glucose, total protein, albumin, HDL, ALT, and vitamin B12 levels, with increased uric acid levels in ASPD (p < 0.05). Multivariable analysis indicated that being married and having higher education were protective against ASPD, whereas higher uric acid and CAR levels were associated with increased risk. Conclusions: The findings indicate that criminal offenders with ASPD show increased inflammatory markers and altered hematological and biochemical profiles. Routine blood parameters, combined with psychometric assessments, may help identify individuals at higher behavioral risk and support early risk stratification in forensic psychiatric settings, although causal relationships cannot be inferred from this cross-sectional study. Full article

Teachers play a key role as gatekeepers in adolescent suicide prevention, and knowledge about suicidality is a well-established predictor of teachers’ gatekeeper self-efficacy. However, little attention has been paid to other potential predictors, particularly teachers’ empathy and self-efficacy in collaborating with colleagues to support adolescents experiencing mental distress. This cross-sectional study examined the associations between suicide-related knowledge, teacher empathy (perspective taking, empathic concern, and personal distress), collaborative self-efficacy, and gatekeeper self-efficacy. A convenience sample of 455 Italian secondary school teachers (84% female; mean age = 46.7 years, SD = 10.5) completed an anonymous self-report questionnaire. Data was analyzed using descriptive statistics and multiple regression analyses. Overall, teachers demonstrated adequate knowledge of adolescent suicidality. However, several myths persisted, including the belief that openly talking about suicide may increase risk. Higher gatekeeper self-efficacy was associated with greater knowledge, higher levels of perspective taking and empathic concern, lower levels of empathic distress, greater collaborative self-efficacy, and prior exposure to adolescent suicidality. These findings underscore the joint contribution of personal and relational factors to teachers’ gatekeeper self-efficacy and offer important implications for the development of teacher-focused gatekeeper training programs. Full article

Suicidal behaviors constitute a major global public health problem, with sexual minority groups showing a higher risk of engaging in such behaviors. This study aimed to analyze the influence of hopelessness, life satisfaction, and spirituality on suicide risk according to self-reported sexual orientation. A total of 532 individuals participated (M = 31.15 years, SD = 12.002). Of these, 39.8% identified as heterosexual, 34.2% as gay or lesbian individuals, and 25.9% as bisexual. Participants were assessed using the Plutchik Suicide Risk Scale, Beck’s Hopelessness Scale, the Beliefs and Values Scale, and Diener’s Satisfaction with Life Scale. The results indicate that 52.9% of bisexual participants and 41.2% of gay and lesbian participants presented a high suicide risk, compared with 15.6% of heterosexual participants. Individuals with a high suicide risk reported higher levels of hopelessness (p < 0.001), lower levels of life satisfaction (p < 0.001), and similar levels of spirituality. The proportion of variance explained in suicide risk was 42.8% among bisexual participants, 34.2% among gay and lesbian participants, and 29.9% among heterosexual participants. Hopelessness predicted a similar proportion of across groups (β = 0.446 in heterosexuals, β = 0.447 in gays and lesbians, and β = 0.457 in bisexuals). Life satisfaction showed a protective predictive effect, with β = −0.241 in bisexual participants, followed by gay and lesbian participants (β = −0.186) and heterosexual participants (β = −0.137). Spirituality was significant only among gay and lesbian participants (β = 0.133) and bisexual participants (β = 0.214). Sexual minority groups exhibited a higher risk of suicide, with life satisfaction—but not spirituality—acting as a protective factor. Full article

Background: Artificial intelligence (AI) is increasingly integrated into healthcare systems worldwide, including mental health services. While AI holds promise for improving efficiency and addressing workforce shortages, its role in psychiatry remains complex due to the central importance of empathy, clinical judgment, and ethical responsibility. Understanding clinicians’ perceptions is essential for guiding responsible AI implementation, particularly in culturally specific settings such as Saudi Arabia. Material and Methods: A cross-sectional survey was conducted among psychiatrists and family medicine physicians in Saudi Arabia between October and December 2025. The survey questionnaire was adapted from previously published instruments to assess perceptions of AI’s impact on mental health professions, the likelihood that AI could fully replace clinicians in ten core psychiatric tasks, expected timelines for replacement, and views on the balance between AI’s benefits and risks. Descriptive statistics, subgroup comparisons, and multivariable linear regression were used to analyze factors associated with higher perceived AI replacement likelihood. Results: A total of 100 physicians participated (mean age, 43.3 ± 8.9 years; 47% female). Most respondents anticipated that AI would lead to slight (45.0%) or substantial (43.0%) changes in professional roles. Perceptions varied by task: administrative tasks were most replaceable (clinical documentation, 4.03 ± 0.95; 79% likely), diagnostic/assessment tasks showed mixed perceptions (40–58%), high-risk diagnostics (suicidal/homicidal thoughts) were largely resistant (2.73–2.82; 8–30%), and relational tasks including empathetic care were least replaceable (24% likely). Physicians currently using AI tools reported significantly higher AI replacement likelihood scores, a finding that remained significant after adjustment. Overall, 64.0% of participants believed that the benefits of AI in mental health care outweighed its potential risks. Conclusions: Mental health professionals in Saudi Arabia largely view AI as a supportive tool rather than a replacement for clinicians. Clear boundaries remain around tasks requiring empathy and ethical judgment. These findings underscore the need for culturally sensitive, clinician-led, and ethically grounded AI integration strategies that strengthen, rather than undermine, the human foundations of mental health care. Full article

Background/Objectives: An extensive body of data suggests that inflammation may contribute to the pathophysiological mechanisms of psychiatric illness. Circumstantial evidence implied that low-dose aspirin (LDA) may enhance the therapeutic efficacy of psychotropic drugs. We examined whether LDA administration with psychotropic medications is associated with medication regimen stability and other therapeutic effects in patients with bipolar disorder (BD), schizophrenia, and schizoaffective disorder (SAD). Methods: This retrospective study analyzed data from Clalit Health Services’ Southern District database in Israel, including 1924 patients treated between 2017 and 2019. The Study Group consisted of patients treated with LDA plus psychotropic medications, whereas the Control Group included patients treated only with psychotropic medications. Study outcomes included suicide attempts and pharmacotherapy-related negative events, defined as psychotropic dose escalation, augmentation, or switching. Results: The study group included 137 patients (55% males, age 63.3 ± 12.3 years), and the control group included 1787 patients (60% males, age 47 ± 16.9 years). Significant differences were observed across nearly all outcomes, favoring the LDA co-treatment group. Patients in the study group exhibited lower rates of medication dosage increase (40 [29%] vs. 726 [40.5%], p = 0.01); fewer changes and/or additions of psychotropic medications (37 [26.9%] vs. 778 [43.5%], p < 0.001); and a non-significantly lower rate of suicide attempts (0 [0%] vs. 16 [0.9%], p = 0.53). Conclusions: Overall, LDA co-treatment was associated with better clinical outcomes among patients with BD, schizophrenia, and SAD. Follow-up large-scale epidemiological studies and prospective randomized clinical trials are needed to examine the therapeutic potential of add-on LDA to psychotropic medications. Full article

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

Suicide is a serious and global health problem, with important consequences for individuals and for society. Understanding health workers’ perspectives is important for understanding how clinicians think about this topic and their attitudes toward and adherence to current guidelines. These findings can also have implications for future directions in guideline development and suicide-prevention policy. The purpose of this study was to investigate health workers’ experiences with and perceptions of suicide risk assessments. We conducted an electronic survey in which we asked health workers (N = 183) 18 questions about their experiences with and opinions about suicide risk assessments, suicide prevention, risk factors for suicide, and questions relating to the Norwegian guidelines for suicide risk assessment. The health workers in this study consisted of psychologists, doctors, nurses, and social workers from three different Norwegian hospitals. We found that the professional groups differed significantly in their responses. We also found significant differences between staff at the different hospitals in how they perceived the risk factors and standardized questions. In general, the respondents were skeptical regarding the emphasis on standardized suicide risk assessments. Furthermore, respondents perceived suicide as at least partly preventable. There were some differences between professions and hospitals. This may be due to cultural and educational aspects. Suicide risk prevention is complex, involving a variety of factors. Methodological limitations should be taken into consideration. Future research should further explore health workers’ concerns about standardized suicide risk assessments. Full article