Exposure to domestic violence is associated with self-injurious thoughts and behaviors, including suicidal and nonsuicidal self-injury. However, an updated comprehensive review of the literature is unavailable. This systematic review aimed to describe the strength of the association between domestic violence exposure and self-injurious thoughts and behaviors among the adult population based on global literature. It also aimed to identify mediating and moderating factors and discuss whether the association varies according to the form of violence, sex, and between high-income countries (HICs) and low- and middle-income countries (LMICs). Systematic searches in EBSCO, PubMed, ProQuest, SCOPUS, and Google Scholar identified 36 eligible articles published between 2012 and 2024. We assessed the methodological quality and extracted relevant data for narrative synthesis. Studies showed a significant and moderate association between domestic violence exposure and self-injurious thoughts and behaviors in HICs and LMICs, as well as among males and females. Some studies reported a stronger association of self-injurious thoughts and behaviors with psychological and sexual violence. Mediators and moderators included posttraumatic stress disorder symptoms and loneliness. : Meta-analysis was not possible due to heterogeneity in definitions and measures of domestic violence and self-injurious thoughts and behaviors employed by the studies. There is strong evidence for the association between domestic violence and self-injurious thoughts and behaviors, indicating a critical need to integrate prevention and intervention efforts.

Certain forms of media reporting on suicide, particularly those involving celebrity suicides, have been associated with an increase in imitative suicidal behavior. This research employs data science methodologies, including association rule mining, to identify patterns of nonadherence to reporting guidelines in Irish national media articles about suicide. This study analyses a dataset of 2,939 articles identified as noncompliant with Samaritans' reporting guidelines, using association rule mining to explore relationships among key categories of nonadherence. Initial analysis was conducted on the full dataset, followed by comparative analysis of celebrity-related and noncelebrity-related subsets to examine potential differences in reporting practices. The most frequent recommendation not adhered to was the provision of helpline information, with higher nonadherence rates observed in celebrity-related articles and an increasing trend from 2019 to 2021. The second most common nonadherence involved the use of the term . Among those articles not adhering to two or more recommendations, association rule mining revealed co-occurrence patterns, which differed between celebrity-related media reports and noncelebrity-related reports. The top rules were linkage between nonadherences of the recommendations surrounding Graphic images and Methodology - Suicide Or Self-Harm within celebrity-related media, and linkage between nonadherences of the Methodology - Suicide Or Self-Harm and Location Details recommendations within noncelebrity-related media. : The dataset represents only 20% of guideline-breaking suicide articles, manually tagged with high inter-rater reliability, but excludes positive practices, full guideline coverage, and distinctions between ideation, attempt, or death. Results are discussed in terms of their implications for supporting journalists in adhering to principles of the responsible reporting of suicide within the media, and the need to address celebrity-related and noncelebrity-related reporting separately. Relevant challenges are also discussed.

US federal and state governments are investing in comprehensive behavioral health crisis system reforms. These reforms aim to prevent suicide, limit police involvement in crises, and reduce reliance on hospitals and emergency departments. Arizona's reform is considered a model for other states. We evaluated whether Arizona's crisis system reform was associated with reductions in behavioral health-related hospitalizations. We used a comparative interrupted time series design to assess Arizona's implementation of their crisis response system in 2015. We used 2011-2018 Healthcare Cost and Utilization Project (HCUP) State Inpatient Dataset (SID) data and selected Colorado, Kentucky, Michigan, New Jersey, New Mexico, and Washington as comparison states. Arizona's annual behavioral health-related hospital discharge rate per 100,000 population decreased from 686.3 in 2011 to 673.7 in 2014 and increased from 759.3 in 2016 to 955.7 in 2019. The comparative interrupted time series analyses revealed that implementation of Arizona's crisis system was not associated with a change in the rate of behavioral health hospitalizations. There may be some unmeasured, time-varying factors related to the rate of behavioral health-related hospitalizations between Arizona and our comparison states that we are not accounting for. Also, hospitals switched from using ICD-9 to ICD-10 codes in 2015, the same year as Arizona implemented their crisis system. More research is needed to confirm whether and how comprehensive crisis response systems impact behavioral health-related hospitalizations.

Individuals who have attempted suicide are at high risk of recurrence, necessitating targeted interventions. The Hospital Outreach Postsuicide attempt Engagement (HOPE) program provides psychosocial support postsuicide attempt, aiming to reduce re-presentations including those to the emergency department (ED). This study evaluated the longitudinal outcomes of HOPE participants compared to a matched treatment as usual (TAU) control group within a major health service in Victoria, Australia. This case-controlled study included 100 HOPE participants and 100 matched TAU participants. ED presentations were analyzed over 4 years (2 years pre- and post-HOPE) to assess frequency, type, and time to re-presentation. There were no significant differences in the overall number of ED presentations between the HOPE and TAU groups. However, HOPE participants exhibited significantly fewer mental health-related ED presentations postintervention. Time to first mental health-related re-presentation did not differ significantly between groups. Only participants who completed a minimum level of HOPE program engagement were included, precluding an intention-to-treat analysis. While the HOPE program reduced mental health-related ED presentations, it did not significantly extend the time to re-presentation for suicide attempts. These findings suggest that while beneficial for immediate care needs, HOPE may require integration with long-term community-based support to improve outcomes. Future research should explore broader measures of effectiveness, including patient-reported outcomes and quality of life metrics.

Accurate classification of intentional death as suicide is essential to target prevention measures appropriately. Unfortunately, manner of death (MOD) for many opioid-related fatalities are unclassified in the United States, and in Maryland, as many as 82% of overdose deaths are classified as . For opioid-related fatalities in Maryland, leverage death certificate data to develop a model for identifying suicide as MOD among those classified as by the medical examiner. Demographic and toxicology data were used to develop a classification model for opioid-related deaths where MOD was known, and then applied to a cohort where MOD was undetermined to estimate the likelihood that the intent was suicide. Antidepressants, neuroleptics, oxycodone, benzodiazepines, and acetaminophen were more common in deaths classified as suicide while fentanyl, cocaine, and morphine were more common among accidental deaths. Our classification model correctly identified suicide cases 82% of the time (PPV = 0.82; AUC = 0.90) and expanded the number of suicide cases by 43% when applied to undetermined deaths. The accuracy and completeness of death records. Data from standard autopsies can be used to detect additional suicide deaths with good statistical precision. Incorporating clinical information could enhance predictive accuracy and improve classification.

Exposure to media reporting on suicide leads to imitative suicide. This effect remains unexplored for frequently used sites, which this study will examine. : Data on 497 Australian newspaper articles on suicide that mentioned any of the top six most frequently used sites were retrieved between 2008 and 2017. The data were combined with national suicide data occurring during the same period, by determining the number of suicides occurring at the same sites that were reported in selected weeks pre- and post-article. Articles on suicide that mentioned frequently used sites were associated with a greater risk of suicide imitation at those same sites. A greater risk of imitation was associated with articles that reported the suicide method, suicide statistics and prevention initiatives, and published in the inside pages of a newspaper. A reduction in suicide was associated with articles that focused on a suicide death, reported the deceased being well-known, and reported on interviews with the bereaved. : Data were collected from text-based transcripts without imagery and excluded other traditional media (e.g., television). This study identified elements of media reporting on suicide at frequently used sites that were associated with increases and decreases in subsequent suicides at such sites.

Taiwan is among the few jurisdictions adopting a legislative approach to suicide prevention; a Suicide Prevention Act was implemented in June 2019. This study evaluates overall, age-, sex-, and method-specific suicide rates before and after the implementation of the Act. Monthly suicide mortality data from 2015 to 2023 were analyzed using interrupted time-series analysis using segmented regression with a quasi-Poisson distribution. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were reported. An immediate 10.1% reduction in overall suicide rates was observed after the enactment of the Suicide Prevention Act (IRR = 0.899, 95% CI = 0.837-0.966), although long-term trends remained unchanged. Hanging suicides declined steadily (IRR = 0.996, 95% CI = 0.993-0.999), while jumping suicides rose. Youth suicides (15-24 years) stabilized postintervention, and the 45-64-year age group experienced a significant decline (IRR = 0.849, 95% CI = 0.764, 0.942). In contrast, suicide rates among older adults (≥65 years) increased. Unmeasured factors may have affected the results. Some components of the plan began before the Act, limiting attribution of effects solely to the law. Taiwan's legislative approach may have helped stabilize suicide rates, especially among youth and middle-aged adults. Ongoing efforts should focus on older adults and shifts in suicide methods.

Meta-analytic evidence indicates that there tends to be an increase in suicides in the period after news reporting on celebrity suicides. Importantly, this evidence relies on original research, including present-day celebrities who died by suicide. The present paper supplements this perspective by providing historical evidence, testing whether celebrity suicide news was related to increases in suicides in fin-de-siècle Vienna (1890-1913). Significant figures ( = 58) were identified using the Austrian Biographical Dictionary. Civil death registers for the city of Vienna were used to identify suicides occurring in periods immediately after a given celebrity's death (and in the control periods). A content analysis assessed media attention. Media attention was positively related to increases in suicides, a finding consistent with the Werther effect hypothesis. However, the analysis indicated that only one suicide with massive media attention drove this association - Colonel Redl's suicide in 1913. Causal interpretations are limited. Colonel Redl's suicide seems to hold a special historical position. This historical evidence supplements the available meta-analytic evidence on celebrity suicide news effects occurring today.

Given the known bidirectional relationship between trauma and suicide, there is a critical need for suicide prevention efforts to be grounded in a trauma-informed approach. The purpose of this scoping review is to identify and map the current literature base for trauma-informed approaches to suicide prevention across all levels of prevention, settings, and population groups. A systematic search was conducted in seven academic databases, with results screened in duplicate. 27 papers ( = 1 systematic review, = 2 mixed methods, = 8 qualitative, = 5 quantitative, = 11 discussion papers) were eligible for inclusion, primarily published in the past five years, mostly from the United States. The majority focus on children/young people, at the selective or indicated level. Lived experience leadership is lacking, and most do not explore suicide-specific outcomes. The results may not represent global trauma-informed suicide prevention strategies, and the paper does not evaluate the effectiveness of these approaches. The explicit application of trauma-informed care to suicide prevention strategies has been a much-needed addition to the recent academic literature. More work is needed to ensure this approach is embedded across all levels of suicide prevention, with lived experience involvement, to better support individuals, communities, and the workforce.

The Veteran Crisis Line (VCL) Lethal Means Safety (LMS) Pilot offered cable gun locks or medication take-back envelopes to veteran callers at risk of suicide. We aimed to assess the acceptability of offering LMS interventions to these veterans and examined call outcomes, health care use, and mortality of veterans associated with acceptance of the intervention. We assessed the acceptability of offering LMS interventions to eligible veterans who contacted the VCL between June 13, 2022, and March 31, 2023. To examine outcomes associated with acceptance of the intervention, we used inverse probability of treatment weights to balance veteran characteristics. We found that 41.6% of veterans who were identified VHA enrollees accepted the intervention after being offered one, three times the rate of nonidentifiable veterans. Additionally, veterans who were offered any intervention, whether they accepted it or not, had a lower risk of having an emergency dispatch than those not offered one. Veterans were not randomized to the intervention, so no causal inferences can be made. Our evaluation suggests that LMS interventions are acceptable to at-risk veterans. Further evaluation is needed to determine whether acceptance of an intervention has any long-term impacts on veteran outcomes.

Parents of adolescents with suicide attempts experience psychological distress and often request support. This may be provided through web-based psychoeducation. : To examine the feasibility, acceptability, and use of a psychoeducation website for parents. : In a Danish feasibility trial, parents accessed a website during 2023-2024 and completed self-report measures on usage and satisfaction. : Among 29 enrolled parents, most visited the website once or twice, usually for less than one hour. Text-based information and video clips were rated as most useful. While around half of the participants indicated that the website did not fully meet their needs, most would recommend it to others. : Small sample size. : The website was accessed and used, although many parents may need additional professional support.

Managing individuals at suicide risk poses significant challenges for mental health professionals (MHPs), particularly when these clients are also coping with the sudden loss of a loved one. Existing research suggests that stigma and perceived lack of competence often affect MHPs' willingness to treat such cases. However, the extent to which symptom severity and the cause of loss (suicide vs. accident) influence MPHs' decisions remains unclear. In this study, we examined these factors and whether suicide prevention training moderates MHPs' willingness to treat and their perceived competence. Using a vignette-based design, we presented 413 MHPs (e.g., clinical psychologists, clinical social workers, and psychiatrics) from Israel with hypothetical cases manipulated by suicidal risk (no risk, depression, or high risk) and cause of loss (suicide or accident). Participants rated their willingness to treat, likelihood of referral, and perceived competence. : As suicide risk increased, MHPs showed a decreased willingness to treat and increased referral inclinations, regardless of the cause of loss. Suicide prevention training significantly increased willingness to treat and enhanced perceived competence. The cause of loss (suicide vs. accident) had no significant effect on willingness to treat or perceived competence. : The study relied on hypothetical vignettes and self-report measures, which may not fully capture the complexities of real-world clinical decision-making. These findings highlight the significance of targeted training programs during MHPs' academic studies and among experienced professionals to boost their competence and reduce stigma when treating individuals at suicide risk.

Identifying gaps in skill levels and increasing access to training focused on patient-centered skill delivery among integrated primary care providers (i.e., primary care providers, such as physicians and embedded behavioral health providers in primary care, such as psychologists) are needed to improve suicide prevention care. : This pilot study examined an adapted suicide prevention measurement tool's acceptability and feasibility among established (nontrainee) integrated primary care providers and examined preliminary validity of total scores with patient experience. Thirty-three providers completed a virtual simulation, which was rated using the suicide prevention measurement tool. Twenty-four primary care patients also listened to four pre-recorded simulations with previously agreed upon scores using the measurement tool to preliminarily examine construct validity with the patient's experience. Descriptive statistics for primary study variables (e.g., acceptability) were calculated. Findings suggest that this suicide prevention tool is feasible and acceptable among established integrated primary care providers. There was also preliminary support for its validity. : The sample is small. Utilizing an evidence-based suicide prevention measurement tool, with good feasibility and acceptability, may be an important next step to address the gaps in suicide training to achieve high-quality suicide prevention care.

Inert gases are an emerging means of suicide in Toronto, Canada. Trends in suicide by these methods change over time, yet long-term patterns remain uncharacterized in cities like Toronto. To update trends in suicide using inhalational gas and explore the profiles of individuals using different methods in Toronto. Suicide deaths were identified from coroner's records and classified by suicide methods. Time trends were explored, and bivariate analyses were performed to characterize differences in profiles between groups. There were 229 suicide deaths by inert gas between 1998 and 2020. For 2016-2020, suicide by nitrogen increased by 100%, whereas there was a decrease in suicide by helium (-38%) and charcoal burning (-57%) compared to 2011-2015. Males comprised a higher proportion of inhalational gas deaths compared to other methods. Individuals who died by compressed gas and charcoal burning were more likely to have left suicide notes compared to people who died by other methods. The number of suicide deaths by gas inhalation may be underestimated due to potential misclassification. Suicide prevention strategies including restricting access to suicidal means, providing helpline information on the products, and responsible media reporting should each be advocated for.

Suicide is a leading cause of death among individuals with a schizophrenia spectrum disorder (SSD). Individuals who identify with a sexual and/or gender minority (SGM) identity are also at increased risk for suicidal thinking and behavior. To explore the association between SGM status and suicidality among university students with an SSD. We used the 2019-2020 Healthy Minds survey data to explore the relationship between SGM status and past-year suicidal ideation, plan, and attempt among individuals with SSDs using bivariate and multivariable analyses. Of 134 students with SSDs, 47.5% endorsed a sexual minority identity and 18.7% endorsed a gender minority identity. Gender minority individuals had 3.98 the odds of suicidal ideation compared to cisgender individuals (95% CI 1.16-13.60, = .0277). There was no association between sexual minority identity and suicidal ideation. This work was limited to a cross-sectional assessment using self-report survey data from a predominantly non-Latino White college student cohort, resulting in a small sample size and limited generalizability. The intersectionality of having a gender minority identity and an SSD may confer a heightened risk of suicidal ideation among young adults. University campuses and first-episode psychosis programs should consider targeted suicide prevention efforts in this population.

Suicide is one of the leading causes of death in the United States, and safety planning is a best practice to reduce the risk of suicide. It is currently unknown if electronic safety planning with a phone app results in effective safety planning compared to paper versions. To evaluate electronic safety planning vs. a paper safety plan in the ED setting. A pilot randomized controlled trial was conducted in which 30 participants were randomized 1:1 into traditional paper safety planning versus safety planning on a phone app (My3). Outcomes of interest included safety plan completeness, safety plan quality, and return ED visits within 3 months. Despite taking less time to complete, paper safety planning was more complete than electronic safety planning. There were no significant differences in quality or return ED visits within 3 months. This study was limited to a small sample size by our local IRB. Given that plan completeness has previously shown mixed associations with clinical outcomes, further research is needed to refine and evaluate electronic formats.

Media plays a crucial role in shaping perceptions of suicide; however, little is known about the extent to which Saudi newspapers adhere to the World Health Organization (WHO) guidelines for responsible suicide reporting. This study aims to assess the adherence of Saudi newspapers to WHO recommendations and identify harmful and helpful reporting practices. A content analysis was conducted on 471 suicide-related news articles from five major Saudi newspapers (2010-2024). Each report was evaluated for harmful elements, such as graphic details of methods used, and helpful elements, such as mental health information or hotline details. The findings showed significant variability in adherence to WHO guidelines. Harmful practices included mentioning the method of suicide in 85.4% of reports, describing the method in 21.4%, and specifying the location in 81.3%. The age of those who died by suicide was disclosed in 63.5% of cases, and nationality in 70.1%. In contrast, helpful reporting practices were rare, with only 3.2% of reports mentioning warning signs and 0.8% including expert opinions. The study only analyzed online newspaper content and did not assess audience impact. These findings highlight the urgent need to promote and implement media coverage guidelines, whether locally developed or based on existing WHO recommendations, in Saudi Arabia. However, this study is limited to online newspaper content and does not assess audience impact.

Although emotion dysregulation and adverse childhood experiences (ACEs) are key psychosocial risk factors for suicidal ideation and suicide attempts, it remains unclear which specific dimensions of these factors can distinguish the transition from ideation to attempts. To determine whether specific dimensions of emotion dysregulation and adverse childhood experiences differentiate young adults with histories of suicidal ideation from those with histories of suicide attempts. A sample of 418 young adults (63% non-Latinx White; 71% female; = 23.56, = 2.85) completed measures of ACEs, emotion dysregulation, and suicidal ideation and attempts. Multinomial logistic regression assessed how specific dimensions of emotion dysregulation and ACEs predicted membership in three groups: no history of ideation or attempts, ideation only, and attempt history, controlling for depressive symptoms, age, and gender. The suicidal ideation group reported greater cumulative ACEs and depressive symptoms than those without ideation/attempt history. The suicide attempts group reported greater ACEs and difficulties with goal-directed behavior than the other two groups. Difficulties engaging in goal-directed behavior and emotional awareness were more predictive of membership in the suicide attempts than the suicidal ideation group. The cross-sectional, retrospective design, and predominantly White female sample limit causal inferences and generalizability. Focusing on specific emotion regulation strategies may improve outcomes for young adults at risk for suicidal ideation and attempts and with a history of ACEs. Goal-directed behavior and emotional awareness offer promising targets for intervention to reduce suicide risk in this population.

Suicide is a growing public health concern in India, with Kerala being one of the states with the highest suicide rates. Responsible media reporting is a crucial population-level suicide prevention strategy. However, the quality of suicide reporting in newspapers remains a concern. : To assess the quality of newspaper reports of suicide in Kerala, India, against the World Health Organization (WHO) media guidelines for reporting suicide. : Content analysis of suicide reports published by the 11 most widely circulated Malayalam daily newspapers in Kerala, between June and November 2023. : A total of 1,068 suicide news reports were analyzed. Harmful reporting practices, such as reporting the method used (90.9%), mentioning negative life events (36.8%), stating the method in headlines (46.7%), and using photographs of the deceased (69.9%), were common, while helpful practices, such as providing contact details of helplines (0.7%), were rare. : The study is limited to print newspaper reports and does not examine suicide reporting in other media formats. Additionally, it focuses only on Malayalam newspapers in Kerala. : The study highlights a low level of adherence to WHO guidelines indicating the need for effective dissemination of the guidelines and training of media professionals.