Search Results (54)

Background: Free fatal falls (FFF) represent a distinct form of blunt force trauma (BFT) that is frequently encountered in forensic practice. Distinguishing FFF injuries from other forms of BFT, such as motor vehicle accidents (MVAs), can pose challenges. Despite its growing usage, the role of postmortem computed tomography (PMCT) in diagnosing FFF and its comparison with autopsy remains underexplored. Purpose: This review synthesizes fracture patterns in FFF, examining both extrinsic and intrinsic variables that influence skeletal injuries. It also compares PMCT and autopsy findings to establish a replicable database for forensic analysis. Methods: PubMed and Google Scholar were systematically searched by three independent reviewers. The inclusion criteria required studies to be published in English, report at least 10 cases, focus on fatal falls, and provide precise data on skeletal injuries. Studies lacking detailed descriptions, focusing on survivors, or involving non-free falls were excluded. Data extraction tables facilitated synthesis and analysis. Key Findings: FFF are characterized mainly by axial skeletal fractures, particularly of the chest, skull, and pelvis. A history of intoxication and psychiatric disorders often correlates with the manner of death. Fracture patterns vary by fall height, impact surface, and cause: accidental falls show greater chest and skull involvement, whereas suicidal falls present more pelvic and skull fractures. PMCT detects fractures more frequently than traditional autopsy. Conclusions: Distinct fracture patterns aid in differentiating suicidal from accidental FFF, shaped by extrinsic and intrinsic factors. Given its superior fracture detection capabilities, PMCT should be integrated into forensic protocols for FFF investigations. Full article

Background/Objectives: Research has shown that those who experience childhood sexual abuse (CSA) are at increased risk of subsequent sexual revictimization. Multiple sexual victimizations can lead to higher rates of depression, anxiety, trauma, and suicidality. Prior research has yielded varying definitions of revictimization, including only accounting for revictimization that occurred in adulthood or multiple CSA episodes by the same perpetrator, or it has broadly assessed maltreatment without a specific focus on CSA. This study examined mental health outcomes in survivors of CSA who experienced sexual revictimization in childhood from a different perpetrator, comparing their mental health outcomes (i.e., depression, suicidal ideation, post-traumatic stress disorder (PSTD), hopelessness, guilt, and shame) to those who reported CSA by one perpetrator. Methods: Adult survivors of CSA (n = 627) completed an online survey describing their CSA experience, whether they experienced CSA by one or multiple perpetrators in childhood, and a series of mental health questionnaires. Results: Almost half of the sample reported CSA by more than one perpetrator in childhood (n = 267; 42.58%). Survivors who reported multiple CSA perpetrators reported significantly higher levels of depression, suicidal thoughts, PTSD, hopelessness, shame, and some facets of guilt in adulthood compared to those who reported CSA by a single perpetrator. Conclusions: Experiencing CSA by multiple perpetrators in childhood may lead to more negative mental health outcomes in adulthood. The findings emphasize the importance of early identification and intervention for individuals who experienced CSA. Full article

Background: Cancer is one of the leading causes of morbidity and mortality worldwide and in Spain. Individuals with cancer are at a higher risk of suicide compared to the general population due to both general and disease-specific risk factors. Objective: To update knowledge on nursing care measures to address the risk of suicide in cancer patients. Methods: A narrative review was conducted by searching PubMed, WOS, Scopus, and CINAHL during February and March 2025. The inclusion criteria comprised original qualitative, quantitative, and/or mixed-methods studies related to the topic of the review. Results: Of the 289 identified studies, 23 were selected. Twelve studies of cancer patients, ten studies of healthcare professionals, and one study of caregivers and survivors were included. Regarding suicide risk factors, eight studies addressed demographic aspects, fifteen socio-economic factors, twenty-one psycho-emotional factors, and seventeen physical factors. Key risk factors included male sex, advanced age, social isolation, lack of social support, hopelessness, and physical deterioration. Seventeen studies highlighted the need for continuous and comprehensive nursing care using validated tools for systematic assessment of suicide risk. Eight emphasised the importance of ongoing training in suicide prevention, which is essential for developing communication skills and improving therapeutic relationships. Five studies underscored the relevance of a holistic approach that addresses the physical, emotional, social, and spiritual dimensions of patient care. Six extended this approach to include family members and caregivers. Conclusions: Suicide risk in cancer patients is associated with multiple risk factors. Emotional support and a comprehensive, continuous nursing approach—based on systematic assessments, specialised training, and a holistic focus—are key to effective suicide prevention. Full article

Despite initial concerns about the severe negative impact of COVID-19 on individuals with a history of mental health problems and suicide attempts, its effects remain unclear. This study examined the pandemic’s impact on individuals with and without lived experience of suicide attempts. An online nationwide sample of 1351 adults from the United States completed questionnaires from 26 May to 25 June 2021. A history of suicide attempt(s) (n = 159; 12%) was associated with significantly higher odds of utilizing mental health services, hospitalization for psychiatric reasons, and contacting hotlines. This history predicted worse outcomes in functioning, optimism, despair, and impairment. Notably, 57.6% of these individuals believed surviving a suicide attempt made them more resilient, while 21.9% expressed uncertainty about its impact on their resilience. In sum, participants with a history of suicide attempt(s) reported more depressive symptoms, worse daily functioning, more despair, less optimism, and greater service utilization during the pandemic, yet many also cited increased resilience due to their suicide history. Full article

This paper explores suicidality and suicide research from an autoethnographic analysis framed through grief concepts. Self-identifying as a Muslim in the United States, the author explains how lived experiences being racialized through Islamophobia, identifying as a genderfluid non-binary woman, being socially biracial, holding a postpartum bipolar diagnosis, and being connected to a diaspora, are critical elements to develop a deeper sociocultural understanding of suicide. Grief concepts that are used to analyze these themes include disenfranchised grief, ambiguous loss, anticipatory grief, and secondary loss. While these grief concepts are understood as part of the author’s embodied lived experience as an individual, there is also a collective grief that is explored through the author’s bilingual experience with Arabic as it relates to the topics of suicide and genocide occurring in the Arabic-speaking diaspora located in Gaza, Palestine. A conceptual framework is offered to make sense of the author’s lived experience by both incorporating and challenging existing academic perspectives on suicide and research. The emic, or insider, perspective is contextualized such that it may hold implications beyond the individual author, such as for U.S. Muslims and other hard-to-reach populations. A positionality statement demonstrates the author’s reflexivity of being an insider ‘participant’–researcher in conducting transformative research approaches with the U.S. Muslim community. Further directions are shared for scholars with lived experience who may seek to utilize comparable individual or collaborative autoethnographic approaches with such majority-world communities. Full article

Background/Objective: South Korea continues to have the highest suicide rate among the Organization for Economic Co-operation and Development (OECD) countries, with a growing number of emergency department (ED) admissions related to self-harm and suicide attempts. However, trauma-focused analyses that integrate psychiatric profiles and suicide mechanisms remain limited, hindering effective clinical care and preventive strategies. Methods: This retrospective study analyzed trauma patients who presented to the ED of Wonju Severance Christian Hospital following suicide attempts between October 2015 and December 2023. Of 305 self-harm cases, 208 survivors who underwent psychiatric evaluation were included. The variables analyzed included the mechanism, site, and severity of injury (ISS and AIS); psychiatric diagnosis and prior psychiatric history; repeated suicide attempts; alcohol use; physical pain; interpersonal conflict; and economic vulnerability. Chi-square, Fisher’s exact, and Kruskal–Wallis’ tests were used for statistical comparisons. Results: Stabbing/cutting (56.7%) and falling (35.6%) were the most common attempts. Mood disorders were the predominant psychiatric diagnosis (63.9%), followed by adjustment disorders (26.0%), alcohol use (25.5%), and psychotic disorders (22.1%). Among the fall-related cases, patients were typically younger and predominantly women. The median ISS was highest in fall-related cases (17) compared with stabbing/cutting (4), with 25.96% of patients with an ISS ≥16, indicating severe trauma. A psychiatric history was associated with a higher incidence of falls (44.3%), and previous suicide attempts correlated with the use of high-lethality attempts. Severe physical pain was linked to stabbing/cutting in 10 of 11 cases. Interpersonal conflict was more frequently associated with stabbing/cutting (59.6%) than with falls (31.9%). No significant association was found between alcohol use and the method of suicide attempt. Conclusions: The suicide mechanisms in patients with trauma are closely associated with psychiatric and psychosocial factors. Stabbing/cutting is often impulsive and driven by interpersonal conflict or alcohol use, while falling is more frequent in patients with psychiatric histories of repeated attempts. These findings emphasize the importance of mechanism-informed psychiatric evaluations and trauma protocols. Regionally adapted, interdisciplinary approaches and early psychiatric intervention are crucial for effective post-attempt management and suicide prevention. Full article

Objectives: Patients with cancer often experience severe mental distress, and suicide is an important issue, particularly prevalent in individuals with lung cancer. The present study aimed to investigate the longitudinal incidence of suicide among patients with lung cancer using national registry data. Methods: A population-based retrospective review of patients diagnosed with lung cancer in 2008 was conducted. Longitudinal medical records, including clinical outcomes and medical insurance data, were investigated. The primary outcome was the incidence of suicide, compared between patients undergoing the first curative treatment option (surgery or non-surgery). Cox proportional hazard regression models were used to adjust for medical history, sociodemographic variables, and lifestyle factors. Results: Among the 4495 patients included, 1306 (29.1%) underwent surgery as the first treatment. Compared to the non-surgery group, the surgery group was younger and had a lower Charlon comorbidity score (p < 0.001), higher physical activity (p < 0.001), and higher income level (p < 0.001). The total number of suicides was 28 (0.62%). The surgery group demonstrated similar trends in the development of suicide and early 5-year follow-up to those of the non-surgery group. Conclusions: The longitudinal risk of suicide among patients with lung cancer increased. Both surgical and non-surgical treatment groups demonstrated similar suicide trends, although patients in the surgery group had multiple protective factors. Full article

Suicide is a major public health problem that has grown at alarming rates in the last two decades. Colorectal cancer (CRC) is one of the most common causes of cancer deaths in the United States in both males and females. However, the influence of suicidal ideation (SI) on the association between CRC and risk of mortality has not been well examined. Methods: For this study, the 2005–2018 National Health and Nutrition Examination Survey (NHANES), a nationally representative survey of United States adults aged 20 years or older, was utilized. CRC survivorship was determined from self-reported data on CRC, and mortality was ascertained by linking the NHANES data with death files from the National Death Index up to December 2019. Suicidal ideation (SI) confirmation was based on a response to a survey question. Results: People with SI had a significantly higher rate (12.3% vs. 7.5%, p < 0.01) of mortality than those without SI. Also, individuals with CRC (2.4%) had a statistically significant higher rate of frequent SI (almost daily) than individuals without CRC (0.6%). Upon a mean follow-up of 7.5 years, more CRC survivors (34.6%) died than non-CRC survivors (7.6%). The adjusted HR was elevated HR = 5.4 among individuals who had CRC and SI but close to 1.0 among individuals who had a history of CRC alone after adjusting for demographic and health variables. Conclusions: In this first national study in the U.S., we found that SI and CRC combined had worse mortality outcomes than CRC alone. Additionally, people with CRC were more likely to experience frequent SI. Our findings underscore the importance of mental healthcare and psychological well-being promotion among individuals with chronic diseases and the high need for integrated care approaches that address both physical and mental health needs. Full article

Background: Suicide and self-injury are serious public health concerns, especially in young populations, owing to multiple social, cultural, and gender determinants. Qualitative evidence exploring narratives regarding the factors behind suicide among young women is rare in Pakistan. Objective: The present study aims to explore the complex dimensions of suicide or self-injury among young women of Southern Punjab. Methods: Semi-structured interviews were conducted in a marginalized district in South Punjab, with participants consenting to in-person meetings at their homes or phone interviews. We collected detailed accounts of fifteen deceased girls or self-harm survivors, with insights provided by close relatives of the victims. Results: Our findings identified several conducive factors to suicidality, including receiving insults in front of others, low self-esteem, household pressures, work burdens, unfulfilled romantic desires, feelings of worthlessness, cheating in love, marriage without choice, and engagement in risky behaviors. These causes could be categorized into personal (such as an inferiority complex), social (a lack of family support and frequent conflicts), and cultural factors (forced marriages). Conclusions: Our study advocates for empowering women through education and restricting access to suicide means, such as pesticides or Paraphenylenediamine (PPD). Moreover, the government should take strict measures to discourage the forced marriage of young females in rural contexts. This study highlights the importance of integrating suicide prevention initiatives with research efforts within Pakistan’s healthcare system. Full article

Adults bereaved by the suicide or overdose death of someone close to them are vulnerable to adverse mental health outcomes, but little is known about how these individuals utilize avoidance- and approach-based coping strategies, how these strategies relate to outcomes, and what accounts for these associations. Informed by contemporary theories of bereavement, we utilize prospective data from suicide- and overdose-bereaved adults (N = 212) who completed two waves of online data collection approximately two years following the death (T1 and T2; six months apart) to examine the mediating role of meaning making in the relationship between coping strategies and grief-related mental health outcomes, such as prolonged grief (PG), posttraumatic stress (PTS), and depression. Path analysis with mediation was used to investigate the relations between coping strategies at T1, meaning making at T2, and mental health outcomes at T2. The results indicated direct effects of avoidant coping at T1 in predicting higher PG and PTS symptoms at T2, while approach-based coping at T1 indirectly predicted an improvement in all three T2 outcomes due to increased meaning making. These results suggest that avoidance-based strategies directly and indirectly contribute to poorer outcomes and impaired meaning making processes, while approach-based strategies lead to increased meaning making and adaptation to loss among suicide and overdose loss survivors. The clinical implications and future directions for research are discussed. Full article

Background: Suicide is a global public health issue, particularly in low- and middle-income countries and among vulnerable groups such as adolescents. Despite increasing research efforts, understanding the psychosocial factors associated with suicidal behavior remains a challenge. This study examines family and personal histories of suicidal behavior, exposure to violence, empathy, and perceived social support in adolescents who have received healthcare services in Ecuador. Methods: A cross-sectional study was conducted with 438 adolescents aged 12 to 18 years. Participants were classified into suicide attempt survivors (AS, n = 58) and non-attempters (NAS, n = 380). A characterization questionnaire was applied (prior hospitalization for suicide attempt, family history, and survivor condition), the Alexian Brother Urge to Self-Injure scale, the Plutchik Suicide Risk Scale, the Multidimensional Scale of Perceived Social Support, and the Cognitive and Affective Empathy Test. Results: Adolescents with a history of suicide attempts exhibited higher levels of self-injurious behavior impulse (OR = 8.90, CI 95% [4.28–18.52], p < 0.001), Gravity attempt (OR = 8.162, CI 95% [4.34–15.37], p < 0.001), and suicide risk (OR = 2.90, CI 95% [1.42–5.94], p = 0.006). A significant association was found between suicide attempts and exposure to domestic (p = 0.000), school (p = 0.000), and sexual violence (p = 0.000). A family history of suicide attempts increased the likelihood of suicidal behavior in adolescents (OR = 2.40, CI 95% [1.12–5.16], p = 0.022). In contrast, perceived family support acted as a potential protective factor (OR = 0.36, CI 95% [0.15–0.91], p = 0.055). Conclusions: These findings highlight the need for prevention strategies that address social and developmental factors. Full article

Suicide is one of the leading causes of death worldwide, affecting numerous individuals close to the person who died by suicide, including family members, friends, and colleagues. Those affected by the suicide of someone are referred to as “suicide survivors”, and the psychological consequences they face are particularly severe. One of these consequences is grief, which is more complicated in survivors of suicide compared with those grieving deaths from other causes, mainly because of the stigma that continues to surround them. Therefore, psychotherapeutic intervention for suicide loss survivors is crucial. This study examines the efficacy of cognitive-behavioral programs for addressing grief and other related variables in suicide loss survivors. The search was conducted in databases including Psycinfo, Academic Search Premier, Medline, APA PsycArticles, E-Journals, Scopus, and PubMed. Five randomized controlled trials were selected, one of which focused exclusively on minors. The results reveal that cognitive-behavioral therapy is effective, although the methodological quality of these studies is not adequate, and the representativeness of the samples is very low. More RCTs are needed on the application of cognitive-behavioral programs to treat grief in suicide loss survivors. Full article

Background: How individuals are informed of the traumatic loss of a loved one can influence their grieving process and quality of life. Objective: This qualitative study aimed to explore, through thematic analysis, how life stages might influence the experience and feelings of those who have received communication of a traumatic death from police officers or healthcare professionals. Method: Recruited through social networks and word of mouth, 30 people participated in the study. Subjects were divided into three groups according to age (Group 1: ten participants aged between 20 and 35 years; Group 2: ten participants aged between 45 and 55 years; and Group 3: ten participants aged 60 and over). Participants completed an ad hoc questionnaire online. Atlas.ti software 8 was used to perform thematic analysis. Results: The three age groups had the following four key themes in common: (a) emotional reactions; (b) subjective valuation of the notification; (c) support; and (d) needs. Subtle differences emerged between age groups; yet the quality of the reactions and main themes did not vary greatly between the groups considered. Conclusions: The communication of an unexpected and violent death seems to provoke rather similar effects in survivors of different life stages. A few differences were noted in sub-themes (increased need for professional training in younger recipients; absence of suicidal ideation in older adults); perhaps quantitative designs could provide further details in future investigations. Full article

Suicide is an increasingly important public healthcare concern worldwide. Studies examining the effect of attempted suicide on clinical outcomes among patients with trauma are scarce. We conducted a retrospective cohort study at a community emergency department in Japan. We included all severely injured patients with an Injury Severity Score > 15 from January 2002 to December 2021. The primary outcome measure was in-hospital mortality. The other outcome of interest was hospital length of stay. One-to-one propensity score matching was performed to compare these outcomes between suicide attempt and no suicide attempt groups. Of the 2714 eligible patients, 183 (6.7%) had trauma caused by a suicide attempt. In the propensity score-matched analysis with 139 pairs, the suicide attempt group showed a significant increase in-hospital mortality (20.9% vs. 37.4%; odds ratio 2.27; 95% confidence intervals 1.33–3.87) compared with the no suicide attempt group. Among survivors, the median hospital length of stay was significantly longer in the suicide attempt group than that in the no suicide attempt group (9 days vs. 12 days, p = 0.0076). Because of the unfavorable consequences and potential need for additional healthcare, increased attention should be paid to patients with trauma caused by a suicide attempt. Full article